Analysis Of Factors Related To The Clinical Efficacy Of Full-endoscopic Treatment Of Lumbar Disc Herniation And The Effect Of DTI Combined With Neuroelectrophysiology On The Evaluation Of Postoperative Efficacy

Objective:Full-endoscopic lumbar discectomy is a popular surgical method for the treatment of lumbar disc herniation.However,a small number of patients have poor surgical outcomes.We retrospectively analyzed the influencing factors of poor postoperative efficacy.In order to solve the problem that the postoperative nerve root recovery cannot be objectively and quantitatively evaluated,we explore the clinical value of Magnetic resonance diffusion tensor imaging and electrophysiological studies in the diagnosis of lumbar disc herniation and in the evaluation of the therapeutic effect of Full-endoscopic lumbar discectomy and modified Sanbi Decoction.Method:(1)A retrospective analysis was performed on 296 patients who underwent full-endoscopic lumbar discectomy for lumbar disc herniation at the Department of Orthopaedics and Traumatology of Jiangsu Province Hospital Integration on Chinese and Western Medicine from January 2017 to February 2019.We Summarize the general information of the patient(including gender,age,surgical segment,duration of disease,duration of preoperative motor dysfunction,preoperative muscle strength,duration of preoperative radiation pain,and postoperative medication),imaging Observation factors(including the division of the herniation,the shape of the herniation,the degree of intervertebral disc degeneration,Modic sign,HIZ)and other factors that may affect the postoperative efficacy.The curative effect was evaluated by the VAS visual pain score,lumbar spine JOA function score,and the modified Macnab standard.Firstly,univariate analysis was performed.Chi-square test was used to analyze the relationship between general factors and MRI factors and postoperative efficacy.Remove variables that have no statistical significance one by one.Based on univariate analysis,multivariate regression analysis was used to analyze the factors influencing postoperative efficacy..(2)A prospective study was carried out.From September 2019 to December 2019,patients with lumbar disc herniation admitted to the Department of Orthopaedics and Traumatology of Jiangsu Province Hospital Integration on Chinese and Western Medicine were treated with full-endoscopic lumbar discectomy combined with Modified Sanbi Decoction.Magnetic resonance diffusion tensor imaging and electromyography were used to evaluate the microstructural changes of patients’ compressed nerve roots.At the same time,the correlation between DTI parameters,electromyography results and clinical function scores(lumbar JOA score)was investigated.The clinical value of Magnetic resonance diffusion tensor imaging and electrophysiological research in the diagnosis of lumbar disc herniation and the efficacy evaluation of full-endoscopic lumbar discectomy combined with Modified Sanbi Decoction.Result:(1)In retrospective analysis,37 patients(12.5%)had poor postoperative results.Univariate Logistic regression analysis showed that there were no statistically significant differences in gender,surgical segment,duration of disease,duration of preoperative radiation pain,preoperative muscle strength,morphology of herniations,degree of intervertebral disc degeneration,and HIZ(p>0.05);age,duration of preoperative motor dysfunction,and the use of traditional Chinese medicine are the influencing factors for patients’ postoperative curative effect(p<0.05);among the MRI observation factors,divisions of disc herniation and Modic sign are the influencing factors for patients’ postoperative curative effect(p<0.05).(2)In the prospective study,the results are the followings:a.After the treatment of full-endoscopic discetomy combined with Jiawei Sanbi Decoction,The VAS low back pain score decreased from 3.55±1.33 before surgery to 1.55±0.77 after surgery,with significant difference,p<0.01;the VAS leg pain score decreased from 6.50±1.50 before surgery to 2.14±1.00 after surgery,with significant difference,p<0.01.The JOA scores of patients before and after surgery were 13.86±3.29 and 23.48±2.94,the difference was statistically significant,p<0.01.b.The patient’s FA value(0.30±0.05)of compressed nerve roots before surgery was significantly lower than that of the healthy side(0.40±0.03)(p<0.01).The FA value of this nerve root(0.38±0.05)at 3 months after operation was significantly different from that before operation(p<0.01).c.After FELD,the conduction velocity of the peroneal and tibial nerves did not increase significantly,p>0.05.The F-wave latency(ms)of patients with lumbar 5 nerve root compression decreased from 42.82±5.29 before surgery to 36.37±1.59,which was significantly different(p<0.01).The incidence of F wave(%)in the lumbar 5 nerve roots increased from 51.30±23.22 before operation to 62.61 ± 20.72,and the difference was statistically significant(p<0.05).No significant difference was found in the electrophysiological examination of the nerve roots in S1 nerve(p>0.05)..d.Correlation study:The preoperative FA value was significantly related to the preoperative JOA score,r=0.79,p<0.01;the postoperative FA value was significantly related to the postoperative JOA score,r=0.77,p<0.01.There was a correlation between FA value of L5 nerve root and F wave latency of tibial nerve,r=-0.493,p<0.05.There was no significant correlation between the FA value of the S1 nerve root and the F wave latency and occurrence rate of the tibial/peroneal nerve.Conclusion:(1)The relevant factors affecting the efficacy of full-endoscopic lumbar discectomy in the treatment of lumbar disc herniation are age,duration of preoperative motor dysfunction,the use of Chinese medicine,the division of disc herniation,Modic sign.(2)Full-endoscopic lumbar discectomy combined with modifid Sanbi Decoction for the treatment of lumbar disc herniation can improve the patient’s neurological function and has a significant effect.DTI and electromyography can be used in the diagnosis of lumbar disc herniation and the quantitative evaluation of postoperative efficacy.Full-endoscopic lumbar discectomy combined with modified Sanbi Decoction for the treatment of lumbar disc herniation can improve the patient’s neurological function and has a significant effect.There is a certain correlation between FA value of DTI and JOA score of lumbar spine.There was a correlation between FA value of L5 nerve root and F wave latency of tibial nerve.DTI and neuroelectrophysiological tests can be used in the diagnosis of lumbar disc herniation and in the quantitative evaluation of postoperative efficacy..