| Part one:The Retrospectively Analysis and the Establishment of a Database about 20 Years' Surgical Inpatient Cases of Lumbar Disc Herniation——the Shanghai Clinical Spinal Surgery Center,Changzheng HospitalObjective:Through the medical records' survey and analysis of the 20 years' postoperative lumbar disc herniation(LDH) from the Shanghai clinical Spinal Surgery Center,Changzheng Hospital during 1988-2007,the database of the cases with LDH in Changzheng Hospital is established.To further study the causes,type,diagnosis and treatment of LDH and provide a good foundation for the effect of catching different surgical interventions.Methods:According to analysing the 4312 cases of patients with LDH in my hospital from 1988 to 2007 years,to collect the following parameters and data:gender,age, occupation,diagnosis,protruded segments,symptoms,signs,the time of hospitalization, the surgery methods,anesthesia methods,the amount of bleeding,etc.And have a preliminary analysis.Results:(1)Gender:①The gender differences in the incidence of LDH don't change significantly from 1988 to 2007,and more male patients with LDH than female ones,the overall male to female ratio of 1.36:1,but more female in the patients with LDH and lumbar false spondylolisthesis or instability,male to female ratio of 1:1.27;②LDH in age,≤35-year-old crowd,the male to female ratio was significantly higher than that of other age groups,more men in incidence,particularly in the≤25-year-old crowd,the male to female ratio of 2.89,but the＞65-year-old crowd,men and women almost have equal opportunities in incidence,35～65-year-old crowd,male to female ratio all under 1.3,but still more male in incidence;③Female later nearly 2 years old than male in the overall onset.And more male in the high level of LDH,male to female ratio of 3.07:1;④Occupational,excessive female in the service occupation,retirement and workers in home group,but excessive male in the production of transport workers, particularly in Office.Above all,there are gender differences in the vocations themselves, so the clinical significance is small,but in students,male to female ratio of 4.0,and illustrate the young men higher than women in incidence.(2)Age:①The mean age of LDH is increasing year by year in 20 years,changing little in the front 10 years,rising faster in the latest 10 years.②The mean age of LDH with lumbar degenerative disease is later about 3.6-9.6 years than those of simply LDH,and the mean age higher with more serious in lumbar degeneration.And the high-incidence-age range is also similar to the mean age.③single level of LDH:L5-S1,L4-5 and the high level are gradually increased in average age,and respectively,42.09±10.04 years old, 44.71±11.27 years old,47.31±11.55 years old,there is an obvious difference between the first two,but the latter two little difference,and L4-S1,L3-5 and multi-segment protruded group(including two of the jumping levels and 2 levels above) are also gradually increasing in age,45.39±11.51 years old,49.84±13.11 years old,50.11±11.82 years old,respectively.That is,the higher level or the more levels are older in age.(3)Occupation:There is different in the gender ratio of occupations.The patients of LDH with cauda equina syndrome nearly 50%work in the office staff,and the ones of LDH with lumbar spinal canal stenosis nearly 50%in the workers and transporters.(4)Diagnosis:LDH's frequent segments of the L4-5 and L5-S1,which accounted for 75.48%.Simple LDH at L5-S1 level is highest-incidence,and LDH recurrence and LDH with lumbar degenerated diseases at L4-5 level highest-incidence,but LDH with cauda equina syndrome equal opportunity between L4-5 and L5-S1 level.(5) The clinical manifestations:①the positive rate of low back pain,lumbosacral tenderness,or lower extremity feeling and strength abnormal are more in female than in male,but the motivation and the sign of straight-leg raise more men.While the lower extremity weakness flu no difference between men and women,however,the left-positive rate is higher in male,on the contrary,the right high in female.The rest of the symptoms and signs is no statistical difference in gender.②The patients of the lower extremity numbness or weakness flu,middle or severe walk- limitation,lower extremity muscle strength or feeling diminish,and no motivations,etc.are older about 3-6 years-old than the ones of the absence of such a clinical manifestations and have motivations,and most of these clinical manifestations are all related with lumbar degenerative disease.So when these signs appear,we should also consider whether there are lumbar degenerative diseases in LDH and needing to be done in the surgical treatment to achieve better outcomes.These symptoms in pairs are more meaningful than the ones of the unilateral side.③The positive rate of LDH recurrence in low back pain,lumbosacral tenderness was significantly lower than that of other groups,lower limb pain,especially unilateral lower limb pain in simply LDH is more,but less than other groups in the bilateral;④The performance of LDH related with cauda eguina compression,the patients with cauda equina syndrome are naturally significantly more than other groups,such as the sellar region sensory dysfunction,urination and defecation dysfunction,anal reflex,muscle strength decrease, CT / MRI indicated central protrusion;⑤Straight-leg raise,the positive younger than the negative,and the limited extent of the more serious in younger.The positive rate of simple LDH and LDH recurrence was higher than the ones of complex LDH,and more severe limitation.LDH with cauda equina syndrome is mainly limited to moderate;⑥Knee reflex, the patients LDH with spondylolisthesis or unstable lumbar and spinal canal stenosis in abnormal knee reflex are more,and most of them are reflex declined,and other relatively less.Knee tendon reflexes,in the age of Achilles tendon reflex followed the rule: accentuation - normal - disappear gradually increased,in the Achilles tendon reflection of this more obvious⑦And these of hip pain,muscular atrophy,Achilles tendon reflex,the lower limb paresthesia are unrelated with the lumbar degenerative disease in LDH;⑧Lower extremity symptoms,signs and imaging suggested that the protruded direction of lumbar disc herniation is obvious correlation,but there are also some which do not conform rate.The lower extremity symptoms and signs in left are more than that in right, which is related with the habit of the right-handed people.(6)Surgery:The surgery of internal fixation gradually applies in the treatment of lumbar disc herniation,and the situation was gradually increased,particularly in the LDH Recurrence and Complex LDH.The surgery of LDH with lumbar false spondylolisthesis or instability is mainly within internal fixation,and the rest are mainly without internal fixation.Patients with internal fixation compared with the ones without internal fixation are older about 5 to 7 years.In the trauma extent,fixation group was significantly greater than non-fixed group.(7)Anesthesia and hospitalization time:The duration of hospitalization showed a downward trend with years,and the preoperative average duration of hospitalization declines more largely,quickly than the postoperative one.The anesthesia method of LDH has appeared in the development of a qualitative change from the local anesthesia,spinal anesthesia,epidural anesthesia mainly into almost all use of general anesthesia.Conclusion:The establishment of the lumbar disc herniation database is informative. In the span of 20 years,surgical methods,anesthesia methods,the time of hospitalization and age obviously have changed,and find that age,gender,occupation and clinical manifestations and lumbar disc hemiation types are inter-linked with a certain degree of difference. Part Tow:The Long-term Follow-up Study of the Different Operations with Lumbar Disc Herniation and the Contrast and Analysis of the Influencing FactorsObjective:Through the follow-up study of the postoperative lumbar disc herniation to evaluate the long-term effects,and analysis impacting effects of the relevant factors, and provide some reasons and preliminary advices for standardized the treatment of lumbar disc herniation.Methods:Do a follow-up study of patients during 1997-2003.Finally,163 cases are followed up,follow-up time 54-133 months(mean 83 months),as well JOA(29 points), the assessment of the curative effect,analyse and compare the influencing factors.Results:The improvement rate of surgery is significant,and the postoperative long-term excellent rate 91.41%.Weight,education,motivations,postoperative labor intensity,postoperative rest time,preoperative diagnosis and surgical method all have no effect on long-term effect evaluation,but smoking,drinking and surgical segment all have effect on it,I.e.smoking and drinking reducing the long-term effect,and L4-5 better than L5-S1 in the long-term effect.To a certain extent age on the long-term effect,the younger group(≤30-year-old) was significantly superior to old age group(＞60 years),and ages among 30-60 years have no significance.Prediction of influencing factors for the long-term effect:The long-term effect is positive correlation with surgical satisfaction,but little clinical significance,and the rest negatively correlated.Effective extent by the order: smoking,protruded segment,postoperative rest time and age,particularly smoking and protruded segments will be important influencing factors in the postoperative long-term effect.Conclusion:surgery is a safe and effective method of the treatment to lumbar disc herniation,and there is a good long-term curative effect;smoking,drinking,surgical segment and age affect the long-term curative effect.
|
PDF Full Text Request