Clinical Analysis Of Percutaneous Transforaminal Endoscopic Discectomy And Semi-laminectomy Decompression Interbody Fusion And Internal Fixation In The Treatment Of Severe Prolapsed LDH

Objective: To observe the clinical effect of percutaneous transforaminal endoscopic discectomy and semi-laminectomy interbody fusion in the treatment of patients with severe prolapsed lumbar disc herniation.Methods: thirty patients with severe prolapsed lumbar disc herniation who were treated in Shandong Provincial Hospital of Traditional Chinese Medicine from June 2016 to June 2017 were selected as the study object,according to the simple randomized method is divided into percutaneous transforaminal endoscopic discectomy group and semi-lamina group.Record the intraoperative blood loss,incision length,operation time,postoperative bed rest,postoperative complications,hospital stay.Visual analogue scale(VAS,10 points)were observed preoperatively,1 week,3 months,and 6 months after surgery.The preoperative and postoperative 6th month scores of ODI dysfunction index(version 2.0,total score 50)and the modified MacNab criteria at the final follow-up were observed.Results:1.surgery related indicators: intraoperative bleeding,incision length,postoperative bed rest,hospital stay,p <0.05,the difference was statistically significant;operation time,disease incidence,P> 0.05,The difference was not statistically significant.2.surgical efficacy indicators:2.1.VAS score: The VAS scores of the two groups were respectively compared with those of 1 week,3 months and 6 months after operation,P <0.05,the difference was statistically significant;P value of VAS score> 0.05 after operation,No significant difference between the two groups at any time point after the comparison P> 0.05,the difference was not statistically significant2.2 ODI dysfunction index: ODI dysfunction index of two groups were significantly lower than preoperative,P <0.05,the difference was statistically significant.Compared with the ODI dysfunction index of two groups before and after operation,P> 0.05,the difference No statistical significance2.3 the modified Macnab score standard curative effect: The rate of excellence was 86.67% in the percutaneous transforaminal endoscopic discectomy group and 93.33% in the semi-lamina group,there was no statistically significant difference between the two groups(P=0.500).3.complications: The incidence of complications in the percutaneous transforaminal endoscopic discectomy group and the semi-lamina group were 6.7% and 20% respectively,with no significant difference in the incidence of complications(P = 0.598)Conclusion:(1)the clinical efficacy of percutaneous transforaminal endoscopic discectomy in the treatment of severe prolapse of lumbar intervertebral disc is reliable,which is equivalent to that of semi-laminectomy fusion fixation.(2)percutaneous transforaminal endoscopic discectomy for severe prolapse of lumbar disc herniation(especially complex L5 / S1 segment)is difficult to operate,according to the patient's imaging data before surgery,careful analysis of the size,shape,direction of the prolapse,invasion rate of spinal canal,the height of iliac spine,L5 transverse process and other factors,so as to formulate a personalized surgical plan,the surgical process should be calculated prolapse removal volume consistent with the preoperative imaging to prevent residual.(3)percutaneous transforaminal endoscopic discectomy does not destroy the bone structure of the spine,and has little interference to the spinal canal.It will not cause extensive adhesions and iatrogenic spinal stenosis.It has shorter postoperative bed time and fewer complications.It is more minimally invasive and can be used as a good choice for ladder therapy.(4)the number of cases that met the inclusion criteria is relatively small,and the follow-up time is shorter.If there is a significant loss of disc height and segmental instability of the percutaneous transforaminal endoscopic discectomy group after operation,long-term follow-up is needed.