Clinical Study On The Treatment Of Multi-segment Lumbar Spinal Stenosis With Precision Medicine And Traditional Diagnosis

Objective: To explore the application and effectiveness of precision medical model in the diagnosis of multi-segment degenerative lumbar spinal stenosis.Methods:A retrospective analysis in October 2017-November2019 in our hospital orthopaedic taking precise medical model(i.e.,using the load test on foot and selective nerve root angiography plus block positioning images to determine responsibility section combined with symptoms and signs of patients with segmental DLSS,and in January 2015-December2016 were based on symptoms and signs image s determine responsibility section of DLSS patients 70 cases as the research object,according to whether the diagnosis in precision medical mode section "responsibility" is divided into group A(observation group)and group B(control group).Both groups were treated with open lamina decompression.Visual analogue scale(VAS),Oswestry Disability Index Questionnaire(ODI),JOA Low back pain scoring system and Macnab were used to evaluate the efficacy.SPSS 26.0 software was used to analyze the results.Results : There was no significant difference in gender,age,duration of disease,follow-up time,postoperative complication rate,responsibility segment and lesion segment between the two groups(P> 0.05);In terms of intraoperative blood loss and hospital stay,group A was less than group B,the difference was statistically significant(P <0.05);by comparing the two groups of patients at different time points(preoperative,1 day after surgery,1 postoperative Months,3 months after surgery,6months after surgery,and last follow-up)VAS,ODI,and JOA scores found that the VAS score,ODI score,and JOA score of the waist and leg of the two groups of patients were significantly lower than those before the operation,and the differences were all Statistical significance(P < 0.05);VAS scores,ODI scores and JOA scores of the legs of the positioning group were statistically significant compared with those of the non-positioning group 1 day,1 month and 3 months after surgery(P < 0.05).The VAS score of the positioning group was also significantly lower than that of the non-positioning group one day and one month after the operation(P < 0.05).The excellent and good rate of the positioning group was 93.75%,and the excellent and good rate of the lamina decompression group was 90.63%.There was no statistically significant difference in the incidence of postoperative complications between the two groups(P > 0.05).Conclusions : 1.The determination of the "responsibility segment" based on the precision medical model can improve the accuracy of the treatment of multi-segment degenerative lumbar spinal stenosis and provide a reference for accurate intraoperative decompression.2.In the localization diagnosis of multi-segment degenerative lumbar spinal stenosis,walking load test combined with nerve root block and imaging technique is an effective method to identify the "responsible segment".3.The definition of the "responsibility segment" based on the precision medicine model can avoid the expansion of the surgical scope,so as to reduce the operation time,the incision range,the length of hospitalization,and the intraoperative blood loss.