The Study On The Treatment Of Protrusion Of Lumbar Intervertebral Disc By Extirpation Of Nucleus Pulposus Under Intervertebral Foraminoscopy And By Fenestration Discectomy

Objective:To observe the clinical effect of transforaminal endoscopic discectomy and fenestration discectomy in the treatment of lumbar disc herniation.Methods:The subjects of this study were 96 patients with L4-5 lumbar disc herniation treated in our hospital from January 2014 to-December 2014.All patients were divided into the transforaminal endoscope group(observation group)(n = 51),and the patients were treated with nucleus pulposus resection under endoscope,and the vertebral plate fenestration group(the control group)(n = 45).Patients were followed up for 2 years,observe two groups of patients after treatment by the clinical efficacy,improvement of the clinical evaluation of Macnab surgery related conditions,the Japanese Association for Department of orthopedics treatment assessment(JOA)scores before and after surgery,VAS evaluation score changes and ODI index changes before and after operation.Result:Two groups of patients before treatment,JOA scores were(13.4 ± 2.5),(14.1 ±2.7),no significant difference between the two(p>0.05),JOA scores of the two groups were improved after treatment,but after 3 months the transforaminal endoscope group were(17.9±3.4)%was significantly higher than the vertebral plate fenestration group(16.1±2.7),and the difference was statistically significant p(<0.05),compared the JOA score in comparison,treatment for three months and six months of treatment,there are significant differences,but the score of the two groups respectively(21.3±2.4)%and(20.9±2.9),no significant differences between the groups(p>0.05).There was no significant difference in JOA score between 6 months and 2 years after treatment.Followed up for 2 years,the total effective rate in the treatment group,the vertebral plate fenestration group 89.9%was slightly lower than the transforaminal endoscope group of patients with 94.1%,no statistical difference(p>0.05).After 2 years of follow-up,to evaluate the clinical efficacy of two groups of patients using the modified Macnab method,in comparison with the total efficiency of treatment,the vertebral plate fenestration group 64.4%slightly less than 68.6%in the transforaminal endoscope group,after comparison,but there was no difference in the excellent rate of the two groups of patients(p>0.05)The operation time of the transforaminal endoscope group()observation group(83.4±11.1)min was significantly longer than that of the vertebral plate fenestration group(62.3±9.5)min,and the intraoperative blood loss,length of incision,bed time in the transforaminal endoscope group were(21.4±8.7)ml,(0.9±0.3)cm,(10.3±3.8)d were lower than the vertebral plate fenestration group(94.5±37.1)ml,(4.7 ±1.3),cm(24.5±5.6)d,and the difference was statistically significant(p<0.05).There were three cases of complications in the transforaminal endoscope group,all of which were abnormal feeling in the related nerve area after operation,and the symptoms disappeared after the treatment of nutritional nerve.The vertebral plate fenestration group of 4 patients with complications,of which 1 patients in the area of blood oozing,pressure dressing after healing.Dural micro tears separate dural sac in 1 patients,timely use of gelatin sponge,postoperative timely rehydration,be Trendelenburg,no wound exudate,dorsal muscle pain occurred in 1 cases after surgery,intraoperative dissection into the paraspinal muscles,causing local vascular nerve injury.There was another case of intervertebral space infection,which was cured by percutaneous transforaminal surgery.All patients had no nerve root injury.There was no significant difference between the two groups(p>0.05)Two groups of patients before treatment,VAS scores were(6.8±2.0),(6.6 + 2.1)points,through statistical analysis,no significant difference compared(p>0.05).Followed up to 3 months,compared the VAS score in the vertebral plate fenestration group,(4.1 ±1.4)than for the transforaminal endoscope group(3.1±1.1),there are significant differences,with statistical significance(p<0.05).The clinical efficacy of the two operations was basically the same for 6 months to 2 years.Conclusion:1 The two surgical methods can significantly relieve the clinical symptoms of patients.2 Compared with discectomy and discectomy,intervertebral nucleus pulposus discectomy has the characteristics of shorter incision,less bleeding and shorter bed time,and there is no significant difference between them.3 Compared with discectomy and discectomy,the clinical efficacy was better in the short term(3 months),but the clinical efficacy of the two methods was the same as that in the more than 6 months.