| Objective：Lumbar disc degeneration, fibrous ring rupture, impairedherniated nucleus stimulation or corresponding level of nerve root after theclinical syndrome for lumbar disc herniation. The incidence rate is about15.2%, good hair age2040years, accounting for about75%of. Lumbar discdegeneration is the most common pathogenic factors, disc herniation oflumbar in addition, trauma, long time sedentary, male, weight, fat and thin arepredisposing factors for lumbar disc herniation. The clinical manifestation ofintermittent pain, and repeated episodes of radicular pain, serious when canappear on one side of lower limb, a horsetail nerve damage can occur in caudaequina syndrome, often expressed as a saddle area numbness, defecationdysfunction, severe cases can lead to paralysis, lumbar intervertebral discherniation most signs the clinical manifestation of low back pain and radiatingpain is associated with unilateral or bilateral sciatic nerve and femoral nerve.Lumbar disc herniation according to a prominent degree can be divided into3types, prominent type, extrusion type. Protrusion of intervertebral disc to studythe pathogenesis of low back pain caused by many, the mechanism isrecognized: mechanical compression theory, nerve root inflammation,autoimmune theory. For the treatment of lumbar disc herniation is mainlydivided into non operation treatment and operation treatment. Non operationtreatment of traction, massage, acupuncture, mainly including, injection,infusion, nerve root block and other conservative treatment, because of notremove intervertebral disc pressure on the nerve root, often the effect is notsure. Operation treatment is mainly divided into open operation and minimallyinvasive operation. In1934the M ixte R and Barr for the first time, thesuccessful implementation of lumbar discectomy operation, then openoperation has gradually become the main means of treatment of lumbar disc herniation by non operation treatment is invalid, the interlaminar "window"technique gradually become classical surgical operation in the treatment oflumbar disc herniation. But this kind of operation due to the exposure range ofless, there are often incomplete removal of nucleus pulposus, nerve rootdecompression and other defects, especially for large disc prolapse, combinedwith nerve canal stenosis treatment there are some limitations. This paper aimsto study the internal fixation by implantation of the increase, and also exportto the root segment of decompression for the treatment of severe prolapse oflumbar intervertebral disc operation effect, the relationship between thedegeneration of the adjacent segments of the same segment export rootdecompression and lumbar surgery.Method: select2011May to2012March due to severe prolapse oflumbar intervertebral disc were treated in our hospital,70patients underwentoperation treatment, except for tuberculosis, tumor, infection, trauma, spinalinstability, spondylolisthesis, scoliosis and previous spinal operation, age,gender not limited. All patients were routinely preoperative lumbar vertebrae,lumbar X-ray imaging and MRI scanning of lumbar vertebrae, postoperativefollow-up of6months, lumbar vertebrae and lumbar radiograph. Patientshospitalized after the date of admission single determines the packet to the testgroup, odd, even into the control group, patients in control group if found inpatients with segmental export root stenosis, decompression treatment need, isnot used in this study. The experimental group36cases, male18cases, female15cases; age27~68years old, average45.6years of age, duration of3daysto6years. A control group of30cases, male16cases, female13cases; age22~65years old, average42.5years of age, duration of20days to4years. Thetwo groups of patients with preoperative preparation and postoperativetreatment were the same. All patients were followed up for6months, wererecorded before operation and7days postoperative JOA score, JOAimprovement index, JOA index=improve preoperative JOA score ofpostoperative JOA score. Measurement of preoperative and postoperative6months operation segment intervertebral space average height of intervertebral disc. The average height of intervertebral disc of lumbar lateral film and theaverage intervertebral height and intervertebral disc height value, before as thecentrum lower endplate front and lower vertebral endplate front distance,intervertebral height after centrum lower edge of the lumbar endplate and platedistance from the trailing edge (Figure2), calculation of the height ofintervertebral disc poor, intervertebral height difference=preoperativeadjacent segment disc height and postoperative adjacent segment disc height.Lumbar activity were measured before and after6months of operationsegment intervertebral space, lumbar activity=hyperextension angle asuperior-inferior endplate extension flexion angle of inferior endplateextension lines (Figure3, figure4), calculation of lumbar poor activity, lumbaractivity difference=postoperative lumbar activity of preoperative lumbaractivity.Results:70cases of patients with a smooth operation, postoperativerecovery was good, no serious complications, operation incision healed. In thecontrol group,4cases were found in the same segment exports around rootstenosis, required decompression treatment, discharge in this study. Follow-upof60cases, including32cases in the experimental group, the control group of28cases. The average JOA of the experimental group improved index was19±3.26, the average JOA of control group improved index was11±2.58, usingpaired t test between the experimental group and the control group the JOAscore was statistically significant (t=10.260, P<0.05); the mean lumbar activityof experimental group difference (degree) was8.4±0.81, the average lumbaractivity the difference of the control group (8.2±0.37degrees), there was nosignificant difference in the average height of intervertebral disc between thetwo groups (t=1.202, P>0.05); the experimental group the averageintervertebral height difference (mm) was1.5±0.24, control group meanintervertebral height difference (mm) was1.6±0.26, two groups of lumbarspinal motion no statistical difference (t=-1.547, p>0.05).Conclusion:The patients with prolapse of lumbar intervertebral disc treatedwith PLIF and exiting nerve roots depresssion can relief symptom effectively.and will not increase the risk of adjacent segment degeneration in6months after operation. |
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