| ObjectiveLumbar disc herniation is a common clinical disease,up to 80% of people suffer from back pain or limb radiating pain in their daily lives,and more than 90% of them are caused by LDH(lumbar disc herniation,LDH).Conservative treatment of LDH is the main method,but acute lumbar disc herniation pain is very intense,the general patient is difficult to tolerate,and long-term compression can lead to nerve damage,about 2-3% of patients required for surgical treatment.At present,the minimally invasive operation of lumbar disc herniation has developed rapidly,of which the present traumatic minimal is the PELD(Percutaneous Endoscopic Lumbar Discectomy,PELD).There are two kinds of position--prone position and lateral position.Due to the certain compliance of the human body,The location of the iliac crest is different for the degree of blocking of the surgical access under different positions.Intervertebral mirror for local anesthesia surgery,prone position and lateral position is not the body's natural comfortable position,to varying degrees,patients with psychological changes,aggravating their fear of surgery,blood pressure,and then increase Bleeding and complications in the possibility of occurrence.However,there is no evidence of any difference between the above two positions.This study mainly discussed whether the difficulty of puncture in different positions is the same,and the patient's tolerance to the operation in different positions.MethodsA total of 20 patients undergoing PELD between June 2016 and January 2017 were selected,including 11 males and 9 females,with an average age of 64 ± 3.2 years.Surgery was completed by the hospital with the same senior surgeon.By X-ray,CT,and MR examination,a clear responsibility for the L5 / S1 segment 3,4 lumbar disc herniation.Using random number generation software,the subjects were randomly divided into two groups.The two groups of patients in the prone position and lateral position accepted PELD surgery,prone position with the standard prone spine pad,the abdomen vacant,body flexion to protect genitalia,armpit and other parts of the pressure to protect the vulnerable tissues.Lateral position in the armpit and iliac crest pad soft surgical pillow to protect the brachial plexus,while the maximum change in the iliac crest position.Each patient was placing in two kinds of position before operation,and took a C-arm images,and recorded images were prepared for measurement.And in the positive position to do lumbar 5 lower end plate coronal plane horizontal line,the lower edge of the affected side of the pedicle and the highest point of iliac crest line,record the angle between the two lines(P).Intraoperative recording puncture and into the working sleeve time and the process of fluoroscopy times.All the patients were followed up and recorded VAS scores before surgery,one day after surgery and three months after surgery.ResultsAll patients successfully completed the operation without complications.Compared with the prone position,the lateral iliac crest relative down,P angle was significantly reduced,with significant differences(P< 0.01).At the same time due to the reduction of iliac crest interference,lateral declination PELD surgery,puncture time and fluoroscopy times less prone position,with statistical differences.Psychological status of patients in both groups changed during surgery.Among them,the VAS-A scores of 30 min after the start of operation in prone position group were significantly increased,and the statistics had significant difference.However,there was no significant difference in VAS-A scores of lateral position group.Twenty patients were followed up for 3 months and the results were good.ConclusionPELD is a new technology in recent ten years,its surgical safety is higher,the effect is good,and has gradually been accepted by the majority of surgeon and patients.Lateral position can reduce the difficulty of operation,as well as operation time and the number of fluoroscopy. |
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