| Objective:To describe the details of the full-endoscopic decompression technique for degenerative lumbar spinal stenosis,to demonstrate the clinical outcomes of the patients who have taken bushen huoxue shujin fang after the FE surgery. To test the immune reaction and vascular ingrowth in the specimens those selected from the patients’ nucleus. To detect cytoactive of the nucleus pulposus cells. To analyze the association between the phenomena and the disease,to explore the mechanism of the treatment method.Methods:The lumbar disc specimens were selected from the patients with degenerative lumbar spinal stenosis.Angiopoiesis and gathering of peripheral lymphocytes of the lumbar disc specimens were observed by hematoxylin-eosin staining. Immunohistochemical method was used to detect the distribution of CD34, CD68 and Ki67.Six months of prospective data were collected from 27 consecutive patients with degenerative lumbar spinal stenosis who underwent FE surgery in our hospital from January 2014 to December 2014. The mean age of the 9 female and 18 male patients was 68.26±6.17 years. The surgical outcomes were assessed using the visual analog scale, Oswestry Disability Index, Japanese Orthopedic Association Index and modified MacNab criteria. Three techniques were used during the study,called i-PED,t-PED and ELF.The surgeon chose the right technique for the patient depending on its unique situation.A fullscale decompression can be performed using a burr and punches under endoscopic control and fluoroscopic control.At the last time of postoperative follow-up,the patients were all studied with flexion-extension lateral films to determine the stability of the lumbar spine.Results:Positive expression of CD34,CD68 and Ki67 in the group was 7.41%.There were no injures to nerves,dura mater and no cauda equine syndrome. Theree patients developed a transient postoperative dysesthesia,and one patients experienced transient urinary retention.The mean visual analog scale(back) improved from 5.56±0.75 at baseline to 1.56±0.70 at 1 month, 0.93±0.38 at 3 months, and 0.52±0.51 at 6 months post-surgery (p<0.01).The mean visual analog scale(leg) improved from 6.15±0.72 at baseline to 1.89±0.42 at lmonth,1.22±0.51 at 3 months, and 0.70±0.47 at 6 months post-surgery (p<0.01).The mean Oswestry Disability Index improved from 91.48±3.40 at baseline to 13.07±5.28 at lmonth,8.73±6.84 at 3 months, and 4.41±1.64 at 6 months post-surgery (p<0.01). The mean Japanese Orthopedic Association Index improved from 5.81±2.50 at baseline to 27.81±2.13 at 1 month,28.67±1.39 at 3 months, and 28.81±0.96 at 6 months post-surgery (p<0.01). Based on the modified MacNab criteria, excellent or good results were obtained in 93% of the patients. Compared with other reports using similar technique,there was no significant difference in efficacy.Conclusion:The immune reaction and vascular ingrowth exist in the specimens those selected from the patients’ nucleus.The result may suggest that controlling inflammation and suppress the immune response may be effective for the disease.Using the Full-endoscopic technique and bushen huoxue shujin fang together to treat the degenerative lumbar spinal stenosis is an efficacious and safe method. This method integrates the advantages of modern techniques and traditional Chinese medicine,it may offer safe and reproducible results, especially for elderly or medically compromised patients. 属性不符... |
PDF Full Text Request