Percutaneous Laser Disc Decompression In The Treatment Of Lumbar Disc Herniation Experimental And Clinical Study

Objective:Via observing the histological and cytological changes of the dogs’discs in different age groups, with the immunohistochemical method,to investigate the differences between each group, and to evaluate the feasibility and rationality of the Spontaneously Dog-Cataplastic Model; On the basis of the above-mentioned study, prepared by Central saw canine model of lumbar disc herniation,Using PLDD to intervene between the dogs’discs of different age groups, to observe the postoperatively histological and cytological changes of the discs in one month, and to investigate the PLDD’s effect on milieu interieur of the lumbar discs.Methods:Experiment One:Executing 2 youth dogs(8 months old) and 2 aged dogs(6 years old), geting 4 discs from each, with fixing, embedding and slicing, then using macropathological observation to know the disc-changes in organization of the two groups; Using HE staining to observe the morphocytological changes of the dogs’discs in different age groups; Using immunohistochemical method to observe the apoptosis and the content changes of collagen IV of each dog, then analyzing the positive expression of Bax and Bcl-2. Experiment Two:16 dogs into blank control group, the model group, laser therapy groupⅠ, groupⅡlaser treatment, the three groups of young dogs (8 months), and laser treatment of the elderly dogs in groupⅡ(age 6), After three groups in the spontaneous disc degeneration model on the basis of the legal system adopted by the Central Saw canine model of lumbar disc herniation, after 10 weeks, using PLDD to treat NO.1 group and NO.2 group, executing these four groups separately at once,7 days after operation and 1 month after operation, record the changes in and after PLDD, then observing the discs macropathologically, getting the discs fixed, embedded, sliced and stained, to observe the morphocytological changes of nucleus pulposus at different time period(HE staining method); The apoptosis of nucleus pulposus (TUNEL method); Using immunohistochemical method (SABC method), with the standard of the changes in quantity, area and grey level of the cells, to observe the changes of Bax, Bcl-2, and collencyte IV in tissues.Results:Experiment One:1. "With macropathological observation and HE staining, there were significant differences between old and young dogs in the morphocytological changes; 2. The Apoptosis-Index of aged dogs were apparently higher than youth ones; 3. The aged dogs’positive rate of Bax were higher than youth ones, while their positive rate of Bcl-2 were lower than youth ones; 4. The content of collagen IV in the discs of aged dogs were apparently lower than youth ones. Experiment Twol, the three groups of modeling and laser treatment for the two groups generally pathological observation and control group more clear distinction: Experiment Two:With HE staining, was observed under light microscope that lumbar disc herniation and modeling after PLDD disc after cell morphology and histological changes in the model there are defects annulus fibrosus and nucleus pulposus prominent degeneration, the nucleus pulposus cells in chordoma cells, cartilage cells interactive presence.there was no histocyte exist at the laser-antrum of the two laser-treatment groups after PLDD immediately, the laser-antrum was clear, and there was little damage with the persistent nucleus pulposus, annuli fibrosi and lamina terminalis; 7 days after operation, there were edema and inflammatory infiltration with nucleus pulposus tissues in the two PLDD treatment groups; One month later, there were chondrocytes and fibrous tissue prolificated and replaced in the discs, the cytological changes of the aged group is slower than the youth; 3. After PLDD, the cell’s quantity, area and grey level of Bax and Bcl-2 in the treatment group, which expressed positive, were higher than the blanked-control group, and would be on top at 7th day after operation, while one month later, such index would be normal; 4. After PLDD, the treatment groups’ quantity, area and grey level of collencyte IV in nucleus pulposus, were lower than the blanked-control group, and one month later, those would be normal; The recovery of aged dogs were significantly worse than the youth ones.Conclusion:Experiment One:1. There are significant differences from aged and youth dogs, which are in the macropathological and morphocytological changes, the Apoptosis-Index of nucleus pulposus, the content of collagen IV in discs and the positive rate of Bax and Bcl-2,etc; 2. The Spontaneously Dog-Cataplastic Model is scientically reasonable, and it can simulate normal and cataplastic discs via dogs with different age. Experiment Two:1. Spontaneous degeneration in the canine model on the basis of the legal system adopted by the Central Saw animal model of lumbar disc herniation is a scientific and effective animal model of lumbar disc herniation preparation methods.2.After PLDD, there is apparent effect on discs in the macropathological and morphocytological observation; The morphocytological changes mean PLDD has good safety; 3.PLDD has significant effect on apoptosis in discs, the content of collagenⅣ, Bax and Bcl-2, and the cataplastic discs have more apparent effct; 4 After PLDD, the histological and cytological index would be recovered with the time gone, and the recovery of cataplastic discs is worse than normal ones, it means the Treatment-Effect of PLDD is better to the young patients than to the old ones. Objective:Study 1:By PLDD of patients with postoperative imaging changes and conducted a study on the efficacy of imaging and the correlation between the effect of raising PLDD provide a theoretical basis; Study 2:Through the early postoperative complications PLDD treatment of illness PLDD Chinese plane changes on Chinese medicine in the early postoperative PLDD the mechanism for the improvement of clinical efficacy PLDD provide a theoretical basis.Methods:Study 1:36 cases of patients with lumbar disc herniation PLDD treatment, the treatment of patients at different time points after the symptoms and signs to score to observe six months PLDD effect changes; measuring preoperative and postoperative instantly, three months, six months CT and changes in the intervertebral space height, satisfied to observe the extent and effect of change and imaging correlation analysis. Study 2:120 patients with lumbar disc herniation PLDD Patients were randomly divided into control group, Chinese medicine treatment group, Chinese medicine and western medicine control the control group,30 patients in each group, the treatment at different time points after four patients symptoms, signs a score to observe patients symptoms, signs and objective indicators score changes of serum levels of inflammatory cytokines, PLDD after the etiology and pathogenesis of Chinese medicine to explore.Results:Study 1:1.PLDD method can be significantly improved in patients with lumbar disc herniation clinical symptoms, signs, fine rate of 83.3%, the exact effect of 2. PLDD after six months of CT in patients with prominent intervertebral space height measurement and X-ray determination did not change significantly, youth PLDD prominence after some back admittance; 3, the curative effect of PLDD Imaging and no significant changes related, age, size and the prominence of returning to the satisfaction of the intervertebral space height changes are obvious relevance. Study 2:1, in the medical symptoms after PLDD designate a "Qichixieyu" and "reduneiyun" features; 2, Chinese proprietary qihuakeyantang, and western medicine capsules have to revise their labels to improve after PLDD Early symptoms of low back pain, inflammation qihuakeyantang better than the other two groups; 3, from Single Oral Administration confirmed PLDD efficacy of Chinese medicine after etiology new scientific hypothesis. Conclusion:Study 1:1.PLDD technology is the treatment of lumbar disc herniation better way of precise and worthy of promotion; 2, PLDD within six months after its image did not change significantly, back to prominence not obvious satisfaction, efficacy and no apparent correlation between image; 3.PLDD after six months intervertebral space height unchanged after security confirmed that PLDD small, less side effects.4, age, size and the prominence of PLDD was significantly correlated. Study 2:Chinese "Qichixieyu" and " reduneiyun " is the main PLDD after Syndrome; 2, qihuakeyantang against PLDD postoperative pathology key treatment, the scientific group, the result is good, worthy of promotion,3, Integrated Treatment can improve the treatment of lumbar disc herniation PLDD of the therapeutic effect.