| Objects:A clinical retrospective study was based on a group of ruptured lumber disc herniation patients which were treated by Xiaosui and Huahe Decoction were analyzed,and the charicteristics on MRI and clinical feature to prodict whether the herniation resorption was screened,and the Outcome Prediction Evaluation System of Ruptrued Lumbar Disc Herniation(OPERL)were developed.Then prospective studies were developed to find the key factors of the herniation outcome prodiction on enhanced MRI,which was developed a correlation analysis of a group of massive ruptured lumbar disc herniation treated by Xiaosui and Huahe Decoction.Finally,further improve the methods of prodiction of the resorption of ruptured lumbar disc herniation,and to improve the successful rate of the ruptured lumbar die herniation treated by Chinese medicine.Methods:(1)Database of clinical researches about the resorption of ruptured lumbar disc herniation which met the inclusion criteria was researched by Pubmed,etc,during January 1990 and Februat 2018,the data extraction and Meta analysis was used to prove the feasibility of this research.(2)①During June 2009 to June 2016,clinical features and MRI of 147 patients which were treated by Xiaosui and Huahe Decoction with ruptured lumbar disc herniation and other non-operative treatment were retrospectively analyzed,using multi-factor unconditioned Logistic regression analysis(backward stepwise regression method),analysis of patients with gender(XI),age(X2),the course of disease(X3),herniatied rate(X4),Komori classification(X5),MSU type(X6),Iwabuchi type(X7),Pfirrmann grading(X8),Modic changes on adjacent vertebral(X9),vertebral canal morphology(X10),nerve root sedimentation sign of Schizas classification(X11),a total of 11 binary classification variables to the resorption rate.②According to the analysis results,the key factors to influence the resorption of the hreniation were found out,and the prediction evaluation system of the ruptured lumbar disc herniation(OPERL)was developed.(3)①During January 2016 to June 2016,a prospective cohort study about a total of 30 patients with ruptured lumbar disc herniation was developed to analyse the reliability and validity respectively of the OPERL scale using Cronbach’s Alpha coefficient.KMO and Barlett sphere inspection.②The correlation coefficient of Spearman rank correlation was used to analyze the correlation between the final score and the resotption rate of the herniation.(4)①During January 2016 to December 2016,a prospectie cohort study of 26 patients with massive ruptured lumbar disc herniation which were first treated by Xiaosui and Huahe Decoction and other concervative treatment were developed,the study lasted for 12 months by enhanced MRI and clinical follow-up,ODI and the resorption rate were evaluatied.The incidence of operation,cauda equina syndrome and adverse reaction were also evaluated.②According to the MRI observation,the patients were divided into the positive group and the negative group of Bull’s Eye Configuration.The mann-whitney U test was used to compare the differences in OPERL score,the resorption rate of herniation,the improvement rate of ODI between the two groups.③ The relationship between the thickness of the herniation’s ring edge Tr(mm),the enhancement degree of the ring Er%.the herniated rate HR%and the resorption rate RR%was analysed by a Spearman rank correlation analysisResults:(1)According to the results of screening were brought into 21 articles,which were observed by conservative treatment of 1425 cases of patients with lumbar disc herniation,1056 cases happened protrusions heavy absorption phenomenon,rate of 66%(95%Cl 55%～78%),among them the occurring rate of South Korea’s clinical research into the highest(79%),followed by the UK(78%).Japan has the most literature(7),followed by South Korea(4).(2)① In the 147 cases of retrospective study,A total of 64 patients there was an obvious phenomenon of resorption(RR≥30%).The course<1 year(P = 0.006),the MSU parting type 3(P = 0.001),1 or 5 Iwabuchi type(P= 0.000),nerve root sedimentation sign of Schizas type A and type B(P = 0.004)were most likely to resorption.Regression equation Y=-10.363+1.916X3+1.446X4 +1.445X5 +2.070X6 +4.679X7 +1.125X9 +1.023 X10+2.223X11.The effects of age,gender,Pfirrmann classification and spinal canal morphology on the resorption of herniations were not statistically significant.② According to the coefficients of the regression equation,the OPERL system was formulated to predict whether the protrusion of ruptured lumbar disc herniation could be resorption(3)①In 30 cases of prospectie cohort study,the reliability analysis of the 4 subgroups OPERL.score and total score were respectively developed.Cronbach’s Alpha coefficients were 1.000.0.987,0.896,0.829,0.968,the reliability was good or acceptable;The 7 observation indexes of OPERL system were tested by KMO and Barlett spheres as factors,and the KMO coefficient =0.721,and Barlett test X squared =59.772,P=0.000,with structural validity.②For 2～12 months follow-up.patients with protrusion average resorption rate was(47.90±28.01)%.OPERL score was(10.20±3.16).the correlation between absorption and OPERL score by the Spearman rank correlation analysis.correlation coefficient r=0.894.P=0.000.shows a strong positive correlation.(3)There were 13 cases with a score of more than 12.and 11 cases showed significant resorption(the resprtion rate greater than 50%).and the exact probability of Fisher was calculated.P=0.000.(4)①26 cases of enhanced MRI prospectic cohort study.bull’s eye configuration positive group of 17 cases OPERL average score was 12.35±1.5,Bull ’s-eye configuration negative group of 9 cases of score was 10.11±1.76,have examined the Mann-Whitney U,statistically significant difference(P= 0.013).②26 cases with 4 routine surgery(surgical rate 15.38%),including 2 cases with cauda equina syndrome incidence(7.69%),and finally into an average follow-up of 22 patients ODI period(72.45±19.04)%,the average resorption rate was(62.63±7.00)%,no adverse reaction occurred.③Among the 22 cases,15 cases of Bull ’s-eye configuration positive group had resorption,of which 14 cases had the absorption rate of>50%,the average absorption rate was(69.68±13.39)%,and the ODI improvement rate was(71.51±21.37)%.Bull’s eye configuration negative 7 cases,6 cases happened resorption,among them 2 cases of resorption rate>50%,the average resorption rate was(35.35±24.48)%,ODI period(53.28±17.89)%,examined by Mann-Whitney U,the resorption rate difference between the two groups have significant statistical significance(P = 0.001),ODI improvement rates difference were statistically significant(P = 0.039).④The correlation coefficient r=0.886,P=0.000,was positively correlated with the Spearman rank correlation analysis of the maximum thickness of the herniation edge(Tr)and the resorption rate(RR).The correlation coefficient r=0.536,P=0.039,and the correlation coefficient was moderately positive.Spearman rank correlation analysis was carried out on the enhancement degree of the ring(Er)and the resorption rate(RR).The correlation coefficient r=-0.386,P=0.156,and there was no significant correlation.Spearman rank correlation analysis was carried out on the herniated rate(HR)and the resorption rate(RR).Conclusions:(1)Systematic evaluation of literature research shows that the resorption phenomenon of lumbar disc herniation is ubiquitous.(2)Ruptured lumbar disc herniation after non-operative treatment prone to the resorption phenomenon,the course<1 years,the MSU type 3,Iwabuchi type 1 or 5,nerve root sedimentation sign Schizas type A or B of patients most likely to occur resorption;(3)When the patient underwent normal MRI examination,the OPERL score could predict the outcome of the herniation Especially when the score ≥ 12,it can predict the obvious resorption of the herniation(4)When patients’ enhance MRI on protrusions maximum cross-sectional,bull’s-eye configuration outcome could be used to predict protrusions of bull’s eye configuration rim thickness Tr and enhancement extent Er,the greater the degree of resorption rate is higher,and the bull ’s-eye configuration positive patients with higher OPERL score.(5)It is safe and effective to choose conservative treatment for the treatment of massive ruptured lumbar intervertebral disc with the Xiaosui and Huahe Decoction.However,it is necessary to observe the condition closely,and surgical indications should be performed immediately if the indications of operation appears. |
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