| Objective Lumbar intervertebral disc herniation(LIDH) is a common and frequently encountered disease of orthopaedics. The cardinal symptom of LIDH is backleg pain, the low back pain and skelalgia can occur at the same time or one after another. The pain generally radiates to upper leg, leg, foot. The pain frequently aggravate and accompany with the lower limbs chilly, numbness, spasm or asthenia when the patients coughing, sneezing, standing, walking, exertion or catching cold. When the coccygeal nerve is compressed, the patients will occur urine and stool disturbance, sexual disturbance or saddle area numbness. Superior position LIDH some time occurs inguinal region pain or anterior thigh pain because of the conspicuous disc intervertebrales compresses the nerve root of lumbar nerves 1,2,3. We found part low-set LIDH patients occur inguinal region pain, anterior thigh pain, coxa lateral pain or bythus pain, the pain commonly is burning pain. And some patients with low-set LIDH occurs bladder smooth muscle functional disturbance and saddle area numbness. These especially clinical situation frequently lead to misdiagnosis.We summarized the clinical data of 33 patients with the especially clinical situation, analysis the inception rate and clinic feature to approach the contribution of different therapy method to remission rate of the especially clinical situation. To approach the best therapy method to patients with the especially clinical situation.Method During the study we diagnosed and treated 1276 patients with LIDH, there are 722 males and 554 females, the average age was 54.7 years old(rang, 29～73). 33 LIDH patients with the especially clinical situation, there are 19 males and 14 females, the average age was 55.9 years old(rang, 29-70); 3 patients had trauma history, 26 patients had ponderosus physical strength work history, others had no obvious inducement; mean course was 6.6 months(rang, 7d～13months). Lumbar interspace protrusion plane: 15 patients with L4/5,13 patients with L5/S1, 2 patients with L3～5, 3 patients with L4～S1. All patients were divided into three groups by different therapy method: conservative group, half laminectomy group and interbody fusion group. Use the Japanese orthopedics Association(JOA) as the objective evaluation standard. Compared the JOA score of pretherapy and posttherapy, statisticsed the remission rate of the especially clinical situation, analyze the incident rate of LIDH patients with the especially clinical situation. Statistical analysis used the Spss 13.0 statistics software.Results1. The morbidity of LIDH patients with especially clinical situation was 2.58%. The morbidity in male was 1.49% and in female it was 1.10%, there was no significant difference between male and female. The incident rate significantly increased when the LIDH patients older than 35year (p<0.01), but There was no significant difference between older than 35year and older than 55year(p>0.05).2. 2 months after treatment the JOA scores in interbody fusion group and half laminectomy group were significant higher than that in conservative group(p<0.01), the interbody fusion group were significant higher than that in half laminectomy group(p<0.05). The significant difference between interbody fusion group and half laminectomy group still existed till 6 months after treatment, 10 months after treatment the significant difference was increased (p<0.01).3. 2 months after treatment the remission rate of the especially clinical situation in interbody fusion group was higher than that in conservative group(p<0.05). There was no significant difference between interbody fusion group and half laminectomy group, there was no significant difference either between half laminectomy group and conservative group(p>0.05). 6 months after treatment the remission rate of the especially clinical situation in interbody fusion group was significant higher than that in both conservative group and half laminectomy group(p<0.01), and there was significant difference between interbody fusion group and half laminectomy group(p<0.01), the significant difference still existed till 10months after treatment. During the whole progress of treatment there was no significant difference between half laminectomy group and conservative group(p>0.05).Conclusion1. The morbidity of the lumbar intervertebral disc herniation with especially clinical situation is not low. The morbidity was 2.58%. The incident rate significantly increased when the LIDH patients older than 35year, but There was no significant difference between older than 35year and older than 55year.2. Mostly of these patients combined with spinal stenosis and lumbar unsteadiness. Interbody fusion can significantly improve JOA scores and the remission rate of the especially clinical situation.3. The lumbar intervertebral disc herniation with especially clinical situation possesses indication of interbody fusion. |
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