| Objective:To observe the effect and safety of percutaneous fora minal lumbar nucleus pulposus removal combined with platelet-rich plasma(PRP)in the treatment of lumbar disc herniat ion.Methods:A total of 120 patients with single-stage lumbar disc herniatio n who were diagnosed in our department from April 2019 to Ap ril 2020 were selected.All patients underwent lumbar nucleus pulposus removal under intervertebral foraminal microsco pe,and were randomly divided into observation group(60 cases)and control gr oup(60 cases)according to whether or not autologous platel et-rich plasma injection was performed after surgery.Preoperative clinical symptoms of the two groups of patients were mainly low back pain and lower limb radiation pain.There was no statistical significance in age,gender,prominent segment and other general data between the two groups(P>0.05).The observation group(PRP group)received CT-guided intra-disc injection of platelet-rich plasma on the second day after surgery,once a week,a total of 3 times.Control group received routine intervertebral fo raminal surgery,and did not receive any postoperative injection.The pain numerical ra ting scale(Numerical rating sc ale,NRS),functional disturbance index(Oswestry disability index,ODI)evalu ate the efficacy of the two groups of treatment.The mean CT values of intervertebral discs(HU)at the preoperative and postoperative follow-up time points in 2 groups were obta ined by thin-slice CT scan of lumbar intervertebral discs.Results:1.A total of 120 patients with simple lumbar disc herniation treated by percutaneous foraminal microscopy who met the standards were included in this study.A total of 20 patients dropped o ut of the study due to different reasons during the whole study process,inclu ding 10 cases in the experimental group and 10 cases in the c ontrol group of the remaining 100 patients,all were followed up for more than 6 months and up to 12 months.2.At the last follow-up,we found that patients who received intradisc injection of PRP had significantly better improvement in mean CT values of intervertebral discs than before surgery,and HU values were significantly lower than befo re surgery about 41.3±5.75 Hu.At each follow-up time point,the NRS score and ODI index in the two groups we re significantly better than those before surgery(P< 0.01),and the average CT value of intervertebral disc in the observation group was significantly lower than that in the co ntrol group,the differenc e between the two groups was statistically significan t(P<0.05).At the last follow-up,NRS and ODI of the observation gro up were basically the same as those of the control group.3.In the analysis of adverse ev ents,there were 2 pat ients with lower back pain aggravation after injection of PRP,but no lower lim b pain aggravation.After symptomatic analgesia was given,the sympt oms were significantly relieved one month later,and there was no aggravation in the follow-up.One patient i n the control group had recurrent symptoms 3months after surgery and underwent a second foraminal surgery.No serious infection or neurological im pairment occurred in both groups.Conclusions:1.Percutaneous foraminal nucleus pulposus extirpation in the treatment of lumbar disc herniation has the advantages of less trauma,less complications,quick postoperative recovery and reliable short-term curative effect.2.CT-guided intervertebral disc target injection of autologous blood platelet rich plasma can signi ficantly repair the damaged intervertebral discs,reduce the average CT value o f the intervertebral discs,increase the water content of the interv ertebral discs,and delay their further degeneration.The clinical effect is good and t he safety is satisfied. |
