Clinical Study On The Treatment Of Lumbar Disc Herniation By Percutaneous Transforaminal Endoscopic Discectomy Combined With Bushen Huoxue Prescription

Background:Lumbar disc herniation is a common and frequently occurring disease in orthopedics and traumatology.It is often treated with integrated traditional Chinese and Western medicine.Although it can improve symptoms,there are still some deficiencies.Therefore,how to treat lumbar disc herniation more effectively has become the focus of clinical research.Objective:To evaluate the therapy of the treatment of percutaneous intervertebral foramen combined with Bushen Huoxue Prescription in lumbar disc herniation;To observe the effect of Jiawei Bushen Huoxue Recipe on postoperative pain and residual symptoms of body function.Methods:From February 2016 to February 2017,patients with lumbar disc herniation who underwent PTED in the Nanjing University of Chinese Medicine Hanlin College affiliated Jingjiang Chinese Medicine Hospital were enrolled in our study.According to the random number table,patients were randomly allocated to the treatment group and control group,the patients in treatment group were treated with the traditional Chinese medicine Bushen Huoxue decoction combined PTED,while the patients in control group were merely under PTED,two groups of patients were given the regular postoperative management.During the 6 months follow up,Visual analog pain score(VAS),Japanese Orthopaedic Association(JOA)and Oswestry disability index(ODI)were used to evaluate the lumbocrural pain,status of lumbar function improvement and quality of life,respectively.At the same time,the modified Macnab curative evaluation criteria were used to assess the clinical efficacy of the patients.The corresponding VAS score.JOA score and ODI index scale were recorded through the outpatient visit or telephone follow-up at 1 week,1 month,3 months,6 months after operation respectively,while the modified Macnab curative efficacy evaluation were collected at 3 months,6 months after operation respectively.Results:Total 60 patients were included.In the treatment group,there were 30 patients,average age(54.50±11.92)years,average duration of disease(4.15±5.23)years,in which the segment of intervertebral disc protrusion located in L3-4,14-5 and L5-S1 were 5,18,and 7 patients,respectively.In the control group,there were 30 patients either,with an average age of(54.20±13.76)years,average course of disease(4.15±5.23)years,in which the segment of intervertebral disc protrusion located in L3-4,L4-5 and L5-S1 were 4,17,and 9 patients,respectively.Two groups of patients showed significant lower VAS scores when compared with that of pre-operation at each point of follow-up(P<0.05),the VAS scores in the treatment group at postoperative 1 week and 1 month decreased more significantly than that of control group(P<0.01),but there were no significant differences on VAS scores reduction between two groups at 3,6 months after operation(P>0.05).Two groups of patients showed significant higher JOA scores when compared with that of pre-operation at each point of follow-up(P<0.05),the JOA scores in the treatment group at postoperative land 3 months increased more significantly than that of control group(P<0.01),however there were no significant differences on JOA scores reduction between two groups at 6 months after operation(P>0.05).The ODI indexes at each point of follow-up demonstrated significant improvement than that of pre-operation in both two groups(P<0.05),the ODI indexes in the treatment group at postoperative 1 month and 3 months showed significant increasement when compared with that of control group(P<0.01),but there were no significant differences on ODI indexes improvement between two groups at 6 months after operation(P>0.05).The total excellent and good rate of the treatment group and the control group were 90%and 86.7%at 3 months respectively while the excellent and good rate was 93.3%and 90%at 6 months,respectively.There were no statistically significant differences between the two groups at two points of follow-up(P>0.05).One patient had transient affected side body’s pain which was released after taking traditional Chinese medicine at the third days after operation and no recurrence was observed in the treatment group.There was one patient had recurrence during the follow-up and received the surgery of intervertebral fenestration at 6 months in the control group.Conclusion:The traditional Chinese medicine Bushen Huoxue decoction combined PTED is safe and effective for the treatment of lumbar disc herniation,which could facilitate relieving the postoperative pain and dysfunction,improving the quality of life,should be promoted in clinical application.