| Purpose:Through comparison with different methods for preventing post-operative epiduralfibrosis formation and their effects on microendoscopic discectomy, appraise the validity ofthese methods and expect to looking for intervening factors during operation which positivelyimproved patients' symptoms of lumbar disc herniation, give instructions to further clinicatpractices.Method:Filtrated the cases of lumbar disc herniation hospitalized during March 2005 toDecember 2005, grouped the absorbed MED surgical cases at random,respectively traditionalMED as group A, additional using Chitosan in traditional MED as group B,and sparing flavumligament in MED as group C. Each group were enforced with corresponding method duringoperation, assessed in hospital 1 day pre-operation, and took 3 weeks, 3 months and 1 yearfollow-up respectively. Analyse the cases in each group with the pain intensity, low-back-painspecific disability index and body drafts changements by data statistics. Extrally, divide theimprovement rates which related to disability index to 4 grades which denoted the clinicaleffect(＞75% is excellent, 50%～74% is good,25%～49% is favorable,＜24% is bad). Thencombine with patients' satisfaction degrees to treatment which acquired post 1 yearfoUow-up, statisticing and analyzing, synthetic appraising the difference of clinical effectsbetween diverse methods which used to prevent epidural fibrosis formation. During outpatientservice 1 year post-operation, each patient was enforced with computed tomography scan oninjuryed intervertebral disc corresponding spinal section, according to fibrosis levels insurgical section as CT films manifested, compare and statistic the constitution of different graded cases between 3 groups. Finally, make correlative analysis between each CT graded andits corresponding improvement rate derived from ODI value.Result:1. All numerical values of measurement data match to normal distribution, and all atequal variance.2. Both VAS and ODt means were have no significant difference between 3 groups 1 daypre-operation, the F values were 0.050,0.116 and P values were 0.951,0.890 respectively.3. All cases of lumbar disc herniation in group A,B,C were performed by MED therapyand the clinical symptoms were obvious improved compared to pre-operation as a whole (P＜0.001). In each period of time, the VAS and related ODI values were all have significantdifferences (P＜0.01).4. Both VAS and ODI means between group A,C were have no significant difference at 3weeks follow-up (P＞0.05). However, when compared to group B,there were all observedsignificant differences (P＜0.001).Accordingly, changements of VAS and ODI in this period oftime(comparatively to 1day pre-operation) had no significant difference in group A,C, andsignificant differences were observed when compared to group B (P＜0.001).Meanscomparison between 3 groups is B＜A, B＜C.5. Both VAS and ODI means between group B,C were have no significant difference at 3months follow-up (P＞0.05). However, when compared to group A, there were all observedsignificant differences (P＜0.001).Accordingly, changements of VAS and ODI in this period oftime(comparatively to 1day pre-operation) had no significant difference in group B,C,andsignificant differences were observed when compared to group A (P＜0.001).Meanscomparison between 3 groups is B＜A,C＜A.6. Pairwise comparison of VAS and ODI means between group A,B,C at 1 yearfollow-up were all observed significant differences. Accordingly, changements of VAS in thisperiod of time(comparatively to 1day pre-operation) were all have significant differences in 3groups by pairwise comparison (P＜0.001).Changements of ODI were as follows: nosignificant difference between group A,B(P＞0.05), group B,C (P＜0.05) and group A,C(P＜0.01) were all observed significant differences. Means comparison between 3 groups is C＜B＜A. 7. Calculated the improvement rates according to ODI values acquired from each time offollow-up respectively, maked a series of statistics,concluded that result was consistent withforegoing statistics. Few difference between 3 groups was found via computing the excellentand good rate,and going with the time-lapse,the rate fluctuating range observed slight also.Itcould be concern with the result of finite cases in each group and absence of several cases infollow-up.8. During out-patient service at 1 year follow-up, patients in each group were all acquiredifferent improvement levels of clinical symptoms and body drafts.However, the extent ofimprovement was not obvious between 3 groups,no obvious relationship observed bebweenbody drafts and clinical symptoms also.9. Post 1 year follow-up, the percentage of serf-assessed as exellent result in each groupwas 85.71%,95.45% and 95.45% respectively. Compared with cases of different scores in eachgroup manifested no significant difference(P＞0.05). However, in which the most cases offound completely cured was group C(9 cases),followed group B(6 cases), group A was theleast(4 cases).In all patients,none considered that clinical symptoms aggravated compare withpre-operation.10. Post 1 year follow-up, according to CT manifested fibrosis levels in surgicalvertebral canal,different graded cases in 3 group have pairwise significantdifference. Correlative analysis between each CT graded and corresponding improvement raterevealed that exists obvious difference(P＜0.01).Conclusion:1. Traditional MED, MED with additional using chitosan and sparing flavumligamentum were all proved to be effective methods by clinical inspection. Both usingchitosan and sparing flavum ligamentum in MED have acquired better clinical curative effectsthan the traditional MED.2. MED in which chitosan is used has a better short-term clinical curative effects.However, post 1 year follow-up reveals that sparing flavum ligament during MED operationcan get the best curative effects.3. Concluded from post 1 year follow-up that CT films manifested of surgicalsection, there certainly to be somewhat correlative between post-operative fibrosis levels andintervening methods during operation and clinical effects. 4. In this subject,the longest period of time for follow-up is 1 year.We can getapproximately direct impression about short-term clinical effects of methods that MEDoperation in which additional use of chitosan or sparing flavum ligament.However, theireffects of long-term remained to be summarized by further outcome.5. According to the experiences got from operation of sparing the flavum ligamentduring MED, we realized it is not only one operative technique for sparing the flavumligament. It should take somewhat modifications to suit for certain situations, and also needs tobe summarized in clinical applications in future.
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