| Objective:Through the clinical research of PELD surgical treatment of lumbar disc herniation and between groups to parallel control principle to evaluate the difference of clinical effect bet--ween foraminoplasty and without foraminoplasty in PELD to promote the application of PELD treatment program.Methods:Choose from February 2013 and April 2015,a total of 34 cases lumbar disc herniation (L4/5) patients living in Changzhou Hospital of Traditional Chinese Medicine Department of Orthopaedics and traumatology suffered from PELD treatment. Among them,17 cases (male:8 cases, female:9 cases) were selected to be experimental group who underwent foraminoplasty, age 26 to 49 years, the average age was 41.0 years.17 cases (male:9 cases, female:8 cases) were enrolled in the control group who didn’t undergo foraminoplasty, age 16 to 47 years, the average age was 36.4 years.All of the patients were enrolled in the anterior lateral position, dynamic position and pelvic flat plate, CT and MRI examination, and informed consent to participate in this study. All patients’intervertebral disc posterior height (H1), height of intervertebral foramen (H2) were measured preoperatively, and the C-arm irradiation times were recorded intraoperatively. Follow-up survey of 3 days ago, after 1 week,1 month,3 months,6 months underwent lumbocrural pain VAS score, ODI score and postoperative accept the modified Macnab criteria. Images data of all of the 34 patients through regional positioning principle to distinguish the type of herniation.Results:Patients in the experimental group underwent PELD intervertebral foramen angioplasty, the operation time was 50 to 80 min, average 59.41min; C-arm irradiation times 6-10 times, average 7.59 times. Postoperative first bed time 4-6 h, average initial bed time 4.71 h; hospitalization for 5 to 7 d average 5.71 D; surgery Qianyao, leg VSA score and ODI and operation after a week, January, March and June’s waist, leg vas and ODI has statistically significant difference (P< 0.05); comprehensive evaluation macnab. The excellent and good rate was 100%. Control Patients underwent PELD operation without interbody hole forming, operation time was 55-120 min, the average operation time was 77.19 min; C-arm irradiation number 5 to 24 times, average 10.75 times. After initial bed time 4-12 h, average initial bed time 5.76 h; hospitalization days 4 to 7 days, the average hospitalization days 5.19 days; surgery Qianyao, leg VSA score and ODI and operation after a week, January, March and June’s waist, leg vas and ODI has statistically significant difference (P< 0.05); comprehensive evaluation macnab, and Yield of 76.4%. The patients in the two groups in preoperative H1, H2 height measurement without statistically significant difference (P>0.05). One week after operation, the patients in the two groups at the waist VAS, ODI no statistically significant difference (P>0.05), the vas leg in a statistically significant difference (P<0.05); one month after operation, two groups in lumbar VAS, leg vas and ODI no statistically significant difference (P>0.05). Three months after surgery, the two groups in the waist follow-up vas no statistically significant difference (P>0.05). In the leg vas and ODI had statistically significant difference (P<0.05); in June, two groups in the lumbar VAS, leg VAS and ODI index were significantly different (P<0.05). According to the principle of regional positioning, transversal (central 6 cases; 18 cases of adjacent central; lateral region of 10 cases; no extremely lateral herniation), sagittal position (13 cases in region Ⅰ; 3 cases in region Ⅱ; 18 cases in region Ⅲ). Foraminoplasty group (calculation for the area percentage), according to the axial zoning:central 6 cases (100%), adjacent central type in 11 cases (61.1%); according to the sagittal partition:region Ⅰ in 4 cases (30.8%), region Ⅲ in 13 cases (72.2%).Conclusion:PELD with or without foraminoplasty in the patients could effectiv- -ely improve the symptoms of lumbar disc herniation; PELD with foraminoplasty can effectively shorten the operation time and reduce the number of C arm irradiation.There was no significant difference between the two groups in the evaluation of the curative effect after 1 week and 1 month after surgery. After 3 months, in the case of lower limb symptoms, the PELD with foraminoplasty was superior to that in the patients without foraminoplasty.,after the operation 6 months, the patients in the experimental group were better than those in the patients without foraminoplasty. |
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