The Clinical Effect Of Two Different Approaches Of Lumbar Endoscopy On The Treatment Of Lumbar Intervertebral Disc Herniation

Objective1.To explore the syndrome type of lumbar intervertebral disc herniation and analyze the syndrome type distribution and characteristics of patients with lumbar intervertebral disc herniation.2.To explore the clinical effect of lumbar endoscopy operation on lumbar disc herniation by two different approaches.3.To explore the risk factors of complications of lumbar endoscopy operation in the treatment of lumbar disc herniation in order to improve the clinical safety and efficacy.Methods1.In the first part,a total of 324 patients with lumbar endoscopic operation for lumbar disc herniation from November 2016 to August 2018 were retrospectively analyzed.TCM dialectical analysis was conducted on the patients according to TCM Diagnosis and Efficacy Criteria,and the distribution characteristics of TCM syndrome types of all patients were observed.2.In the second part,it is a retrospective analysis of 106 patients with lumbar endoscopic surgery.According to different surgical approaches,they are divided into percutaneous endoscopic transforaminal discectomy group(PETD)and percutaneous Endoscopic discectomy group(PEID).The operation time,intraoperative removal of nucleus pulposus volume,blood loss,and surgical complications were recorded in the two groups;VAS score,JOA score,and intervertebral space height Farfan index were recorded in different periods,and the Mac Nab score was used to evaluate the clinical efficacy at the last follow-up.And through binary Logistic regression analysis of risk factors for surgical complications.Results1.There were 324 patients in the study group,including 219 males and 104 females,with an average age of 43.36±14.60(16-84)years old.There were 167 cases of blood stasis syndrome,51 cases of damp-heat syndrome,56 cases of cold-dampness syndrome and 50 cases of kidney deficiency syndrome.2.A total of 106 patients were included in the study group,including 77 males and 29 females,with an average age of 38.88±9.08(24-54)years old and BIM index of 23.25±3.48.According to the surgical approach,they were divided into PETD group(52 patients,36 males and 16 females,including 26 patients with L4/5.26 patients with L5/S1)and PEID group(54 patients,41 males and 13 females,with an average age of 35.48±10.00(18-54)years,BIM index of 24.07±3.74,including 25 patients with L4/5 and 29 patients with L5/S1).(1)The comparison of general data between the PETD group and the PEID group showed that there was no statistical difference in gender,age,height,weight,duration of symptoms,and follow-up time(P>0.05),and the data were comparable.(2)The results showed that compared with PEID group,the operation time of PETD group was shorter,the time of X-ray transmission was less,and the influence on vertebral stability was less.The comparison between the PETD group and the PEID group showed that there were statistical differences in the time of X-ray transmissions,the operation time,the Farfan index in 3 months after the operation,and the Farfan index at the last follow-up(P<0.05),but there was no statistical difference in the amount of blood loss,nucleus pulposus,VAS score,JOA score,complications,length of hospital stay,and modified Mac Nab(P>0.05);the results showed that the PEID group had shorter operation time for PETD group,fewer intraoperative X-ray transmissions,and stable vertebral body Sexual influence is smaller.(3)The comparison of two groups showed that the Farfan index,VAS score and JOA score were statistically different between before operation and the last follow-up(P<0.05).The results show that PETD group and PEID group treatment of LDH can significantly relieve pain and improve lumbar spine function after surgery.(4)Through multivariate logistic regression analysis of complications,the results showed that gender,age,weight,BMI,follow-up time,X-ray fluoroscopy,symptom duration,operation time,preoperative Farfan index,VAS preoperative and JOA score were no statistical difference in the influence of the former on the complications(P>0.05).Show that the above factors are not related risk factors leading to postoperative complications.Conclusion1.Lumbar intervertebral disc herniation has the most blood stasis syndrome in TCM syndrome,followed by cold-damp syndrome,damp-heat syndrome,and kidney deficiency syndrome.The incidence rate is higher in men than in women.The L4/5 and L5/S1 segments have the highest incidence.2.The VAS score and JOA score of the PETD group and the PEID group at the last follow-up were significantly different from those before the operation.The excellent rate of Mac Nab score was high,and the clinical efficacy of PETD and PEID was reliable,but two groups were no statistical difference.