| Objectives:A retrospective study about two procedures Clinical observation of treatment of lumbar disc herniation between modified posterior lumbar fusion and posterior lumbar fusion surgery.Method:From 2015.02 to 2016.02, in the Affiliated Hospital of Chengdu University of Traditional Chinese Orthopedics Department,60 patients with lumbar disc herniation were surgical treated by PLIF (30 cases) and MPLIF (30 patients).These patients were composed 23 males and 37 females. The minimum age is 48 years old, maximum 73 years, mean 60.52 years.All the patients were single Disc segment,and all of them should be completed the preoperative examination, especially lateral lumbar spine X-ray, X-bit power lumbar sheet, lumbar CT, lumbar magnetic resonance imaging.Recorded the VAS score about preoperative?1 week after surgery?1 month after surgery,and the ODI score about preoperative?1 month after surgery,and computing the improvement rates about all above.And recording the operation time?blood loss?postoperative drainage?postoperative ambulation time, counting the occurrence of complications.And accounting the excellent rate of surgery in last following-up according to ?Chinese Orthopaedic Association study group back pain spine surgery score?.Results:1?All patients'surgical incisions were healed,no surgical wound infection and dehiscence occurring.After review of all patients with lumbar spine X film prompted pedicle screw and cage were good location, does not appear broken nails, broken rods, screw loose, slide, cage prolapse and so on.2?PLIF group of the VAS score before surgery was 7.49±0.46, last follow-up was 2.65±0.63, the ODI score before surgery was 59.50±4.39, last follow-up was 17.23 ±7.10; MPLIF group of VAS score before surgery was 7.39±0.44, last follow-up was 2.53±0.78, the ODI score before surgery was 58.43±4.53, last follow-up 43.23 ±6.38; compare two groups of patients in their own group, the last follow-up compared with the preoperative VAS and ODI scores were significantly improved (P <0.05), there were significant differences between the two sets of data; the two groups comparison between patients before surgery and at last follow-up VAS and ODI indexs, there was no significant difference between the two sets of data; within two groups of patients after 1 week and 3 months VAS score, there was no significant difference between the two sets of data (P> 0.05); comparison between the two groups of patients after 1 week and 3 months VAS score, there was no significant difference between the two groups data (P>0.05)3?PLIF group's operative time was 133.60±7.16min, blood loss was 293.67± 10.25ml, postoperative drainage was 132.83±10.23ml, ambulation time was 7.54± 0.46 days, MPLIF group's operative time was 155.60±8.99min, blood loss was 299.17±12.39 ml, postoperative drainage was 92.67±10.23ml, ambulation time was 3.52±0.46 days. PLIF group's operation time was fewer than MPLIF, the difference between the two groups was statistically significant (P<0.05); PLIF group's blood loss was less than MPLIF group, there was no significant difference between the two groups (P> 0.05); The postoperative drainage of PLIF group was larger than MPLIF, the difference between the two groups was statistically significant (P<0.05); The postoperative ambulation time of PLIF group was greater than MPLIF, the difference between the two groups was statistically significant (P<0.05).4?In surgery appears dural tear 1 case, with PLIF group 0 case and MPLIF group 1 case,it was dealed with by soft tissue covering,and no cerebrospinal fluid leakage occur. Last follow-up appeared a total of two cases of lower back discomfort, PLIF group 2 patients, MPLIF group 0 patient. Giving non-steroidal anti-inflammatory analgesics, dehydration and hyperthermia swelling, herbal smoke drugs, bed rest and other treatment. Emerging lower extremity nerve root symptoms of nerve root or residual symptoms altogether two cases, PLIF group 0 case and MPLIF group 2 cases, giving non-steroidal anti-inflammatory analgesics, dehydration, swelling, nerve nutrition and bed rest,and the symptoms were disappeared when last follow-up. Two groups of patients had a total of five cases of complications, PLIF group 2 patients, MPLIF 3 patients, the incidence of PLIF group was 6.67%, MPLIF group was 10.00%, the two groups of patients of the incidence of complications was not statistically significant (P> 0.05).5?According to "Chinese Orthopaedic Association study group spine surgery back pain score" calculate the excellent rate of surgery in the last follow-up, PLIF group was 86.67%, MPLIF group was 90.00%, the excellent rate of operation between the two groups had no statistical significance(P> 0.05).Conclusion:The surgical treatment of PLIF and MPLIF to cure Lumbar disc herniation,in the aparts of pain relief and function improving,all of them were able to obtain good results,and no significant differences.The group of MPLIF have less postoperative drainage and residual lower back discomfort,and shimoji sooner,but the surgery was more difficult, and longer operative time, more blood losing. The group of PLIF have shorter operative time, less blood lossing, less damage to the nerve root and dural sac. However,they have more postoperative drainage and residual lower back discomfort,and ambulation time was later. Accordingly, the above observation indexes should not be used as the main basis for selection of the two procedures, but more should be determined by the surgeon's surgical experience related. |
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