| Background : Lumbar disc herniation in Chinese and all over the world has been plagued the common disease quality of life of people,and in recent years,with the change of people living habits and work pressure rise,LDH more and more by the vast number of people,most early surgical treatment of LDH by Mixter and Barr was founded in 1934,the posterior fenestration operation after a long development has gradually become the treatment of LDH the gold standard in 1999,Young's technology,explore a new era of minimally invasive treatment of LDH in2002,T technology makes free LDH get good treatment,2005 Rutten started full endoscopic interlaminar approach in the treatment of LDH,the L5/S1 segment of intervertebral disc herniation patients get treatment more convenient,because of the steep learning curve it is difficult to avoid the complications,recurrent early surgery.Minimally invasive surgical treatment of lumbar spine with endoscopic technology as the representative of the disc herniation in the treatment of LDH in line with the development trend of spine surgery,the surgical trauma and quick postoperative recovery with a more detailed and excellent choice for spinal surgeons in the treatment of LDH,also makes the part suitable for minimally invasive spine surgery patients to avoid the wound tissue damage and unnecessary surgery on the body.Objective: Through discussing the full endoscopic interlaminar approach(Full-endoscopic Technique,FET)the clinical curative effect of intramedullary discectomy and conventional posterior fenestration L5/S1 lumbar disc herniation.The evaluation comparison of two types of surgery for L5/S1 lumbar disc herniation in patients with clinical efficacy indexes,explore the interlaminar fenestration operation in full endoscopic discectomy surgery compared to traditional efficacy and safety of L5/S1 in the treatment of lumbar disc herniation in the hope that the new technology through this research conforms to the development trend of the minimally invasive spine surgeons for the treatment of patients with LDH surgery provides certain reference value.Methods: This study is a retrospective study.The comparison of thesurgical group divided into interlaminar approach transforaminal endoscopic discectomy and fenestration discectomy,included the implementation of full endoscopic interlaminar approach in patients with L5/S1 36 cases of spinal decompression surgery on 2015-2017 patients with the first people's Hospital of Jining City,in 36 cases,and fenestration surgery included: 1,lumbar disc herniation segment L5/S1(Figure 1),the 2 obvious lumbocrural pain,formal conservative treatment(including bed rest,taking or intravenous non steroidal drugs)for 4 weeks,3 invalid imaging examination confirmed the existence of obvious nerve compression(nerve root compression deformation was 4),patients have underwent interlaminar approach interlaminar approach full endoscopic discectomy or conventional fenestration operation;exclusion criteria: 1,the clinical data of 2 patients with incomplete,lost,3 patients with huge disc herniation and central lumbar disc Protruding(CT or MRI shows the nucleus of the spinal cord above the posterior margin of the vertebral body more than 5mm)4,spinal canal stenosis or intervertebral disc calcificationBased on the size of the incision,operation time,amount of bleeding during operation and the operative complication rate,hospitalization days,how much the cost of surgery,VAS score before and after surgery is the visual analogue scale(Visual Analogue Scale/Score,referred to as VAS)to improve the situation of pain before and after surgery,ODI score thepain ODI(The Oswestry Disability Index standard for evaluation)evaluation before and after the operation of working and living conditions,according to the modified MACNAB(modified Mac Nab criteria)score excellent rate of operation,postoperative use of peripheral blood test of serum creatine kinase(CPK)activity,serum C-reactive protein(CRP)concentration.Results: invasive The total of 72 patients in the two groups were treated with intramedullary intervertebral foraminoscopy and conventional posterior window surgery.The operation was completed successfully.The skin incision in the minimally invasive surgery group was 0.7 ±0.1cm,the amount of bleeding in the operation was 8 ±3.0ml,the operation time was 0.9± 0.3h,and the time for bed rest was 1.The postoperative hospitalization time was 3 ±1.5d and the operation cost was10.6 ±5 thousand yuan,and there were significant statistical significance(P < 0.05)compared with the open window operation(P < 0.05).It showed that the minimally invasive surgery group had less trauma and faster recovery after operation,but the cost of operation was higher.After the minimally invasive group,1 cases of lower extremity hyperalgesia,after symptomatic treatment improved,1 cases had postoperative recurrence,and repeated endoscopic surgery to remove the prominent tissue confirmed that most of the cartilage tissue,two groups did not appear dural tear,nerve root injury,vascular injury,intervertebral spaceinfection and other complications.The two groups were followed up for 6months.The preoperative VAS score of the minimally invasive surgery group was 7.45 ± 1.36,the ODI score was 49.12 ± 6.45,the 72 h VAS score was 1.08 ± 0.12 after the operation,and the ODI score was 7.42±4.01 after the operation.The preoperative and postoperative comparison was statistically significant(P<0.05),and there was no significant statistical significance compared to the traditional open window surgery(P > 0.05).The excellent and good rates of two groups were 6 months after operation,94% in the endoscopic group and 91% in the fenestration group,with no significant difference.The serum creatine kinase activity and serum CRP concentration before and after the operation were compared between the two groups.The difference between the two groups before and after operation was statistically significant,and the minimally invasive surgery group was significantly lower than that of the open window operation group.Through statistical analysis,it was found that the patients with interlaminar intervertebral foraminoscopy were small incision,less bleeding,short hospitalization time,quick recovery after operation,and small injury to soft tissue.There was no significant difference in pain degree,postoperative complications and operation cost in the two groups.Conclusion : Interlaminar approach PELD for L5/S1 LDH has advantages such as small incision,less bleeding,short hospital stay andquick postoperative recovery.Meanwhile,it has good safety and effectiveness. |
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