Clinical Study Of Seven Different Kinds Of Mini-invasive Therapy In Treating Protrusion Type Of L₄-L₅ Intervertebral Disc Herniation

Objective: To investigate clinical effects of Seven Different Kinds of Mini-invasive Therapy in Treating Protrusion Type of L4-L5 Intervertebral Disc Herniation and discuss the relationship between the clinical effect and image review outcome.Method: According to the various therapies, 138 qualified cases were randomly divided into 7 groups: Collagenase Chemonucleolysis(CCNL) 3 groups including intradiscal injection group, epidural injection group and intradiscal united epidural injection group Automated Percutaneous Lumbar Discectomy(APLD)group and APLD +3 groups of CCNL respectively , which were followed up more than 4 months and re-examined by CT scan in order to analyze and compare the clinical effect and image review outcome.Result: 1, All of the patients in mini-invasive therapy groups shows 71.01% of success rate and 94.20% of valid rate respectively in the short-term compared with 70.29% and 84.78% in the long-term. In the long-time, the success rate(83.33%) and valid rate(94.44%) of the APLD +CCNL(intradiscal united epidural injection) group is superior to the other groups and was significant difference with the APLD group. 2 14.29% protrusion disc of of epidural group and 38.46% of APLD +CCNL(epidural injection) group shrank while other rest five groups showed above 50%.The value ofCT between pre-treation and post-treation was insignificant in epidural injection group while other six groups had very significant result. 3 Except two CCNL groups (intradiscal injection group and epidural injection group), the effect between the shrunken and non-shrunken protrusion disc had significant difference in mini-invasive therapy groups respectively. 4 The incidence rate of epidural injection group is 4.76% and has very significant difference with other six groups respectively which is between 53% to 67% and has insigficant difference among them when they are compared with each other. (P>0.05) 5.The incidence rate of intradiscal injection group and intradiscal united epidural injection group are 58.82% and 54.17% respectively which are higher than other five groups, Automated Percutaneous Lumbar Discectomy(APLD)group is lowest of seven groups which is 5.88%.Conclusion: 1 All of mini-invasive therapies were effective methods in treating protrusion type of L4-L5 intervertebral disc herniation. 2 Protrusion disc and the high of affected disc of seven groups had obvious change except epidural injection group and re-examination of CT scan had much clinical meaning. 3 Except of intradiscal injection group and epidural injection group, the clinical effects of other five groups has certain relevant with shrunken Herniation.So.lt is important that to recheck with CT after Mini-invasive Therapy. 4 The incidence rate of intradiscal injection group or epidural injection group is high.lt is better if it is united with Automated Percutaneous Lumbar Discectom. 5 Through this study, we can draw a conclusion that APLD + epidural united intradiscal injection is good at treating protrusion type of L4-L5 intervertebral disc herniation and it has few side effects.lt is recommended to broad applying.