| Objective: Lumbar disc herniation is a common and frequently occurring disease in The orthopaedic,and is the main cause of lumbocrural pain in the clinical.Most of the patients are because of fibrous ring of lumbar disc degeneration,the nucleus pulposus are extruded or prolapsed from the rear or the spinal canal,stimulate or oppression dural sac and nerve root,lead to lumbocrural pain and neural dysfunction;When it is serious,it can lead to the saddle zone paresthesia and sphincter dysfunction,and even lead to paraplegia.As medical technology continues to progress,the treatment methods are also diverse,clinical effects are getting better and better,the cure rate has been greatly improved.Surgery is an important and effective method on the treatment of lumbar intervertebral disc protrusion.This study by comparing percutaneous transforaminal endoscopic discectomy(TESSYS)and traditional fenestratation discectomy for the treatment of lumbar intervertebral disc in obese patients(BMI≧28 ㎏/㎡)to evaluate and discuss the advantages and disadvantages of the two methods of operation.Methods: Clinical data 36 cases of obesity in patients with lumbar disc herniation from June 2013 to September 2014 in the spine surgery of our hospital were retrospectively analyzed.General information: 36 cases of obese patients with lumbar disc herniation ≧(BMI 28 ㎏ / m)the average age of 37.8 years old,,22 males and 14 females,duration of 1 month-24 months,an average of 8.8 months.Protruding segments L4-5 19 cases,L5-S1 17 cases.Preoperative radiological varying degrees of lower extremity pain and lumbosacral pain.Inclusion criterion included the following : 1 BMI ≧28 ㎏/㎡;2 CT or MRI confirmed lumbar disc corresponding single stage,and the protruding sections of signs and symptoms consistent;3 low back pain with lower extremity pain radiation on one side and(or)numbness,straight leg raising test(+);4 regular conservative treatment is not valid for 3 months or recurrent symptoms.They were divided into 2 groups,open operation group(n=20)and TESSYS group(n=16).The clinical efficacy of Signs and symptoms were assessed using the visual analog scale(VAS)and modified MacNab evaluation criteria.operation time,intraoperative bleeding volume,postoperative hospital stay,length of incision,postoperative complications were compared between 2 groups.Using SPSS13.0 statistical software for statistical analysis.Count data using X 2 test,measurement data is displayed by sx ±,measurement data using t test,with P < 0.05 for the difference was statistically significant.Results: Two groups of patients were successfully completed surgery,and all patients were followed up.Two groups of patients with preoperative back pain VAS scores respectively(6.75±0.71)and(6.63±0.72),There was no significant difference in VAS scores between 2 groups preoperatively(P >0.05);Preoperative leg pain VAS scores respectively(7.20±0.69)and(7.00±0.73),There was no significant difference in VAS scores between 2 groups preoperatively(P>0.05).The VAS score of low back pain in patients with Open group: preoperative and 24 hours,3 months,6 months,12 months after operation were(6.75±0.71),(3.20±0.52),(1.60±0.68),(1.00±0.64),(0.55±0.51),and 24 hours,3 months,6 months,12 months after operation were Significantly lower than preoperative,and the difference was statistically significant(P < 0.05).The VAS score of leg pain in patients with Open group: preoperative and 24 hours,3 months,6 months,12 months after operation were(7.20±0.69),(2.95±0.60),(1.50±0.51),(0.90±0.64),(0.45±0.51),and 24 hours,3 months,6 months,12 months after operation were Significantly lower than preoperative,and the difference was statistically significant(P<0.05).The VAS score of low back pain in patients with TESSYS group: preoperative and 24 hours,3 months,6 months,12 months after operation were(6.63±0.72),(2.44±0.63),(0.94±0.44),(0.38±0.50),(0.19±0.40),and 24 hours,3 months,6 months,12 months after operation were Significantly lower than preoperative,and the difference was statistically significant(P<0.05).The VAS score of leg pain in patients with TESSYS group: preoperative and 24 hours,3 months,6 months,12 months after operation were(7.00±0.73),(2.19±0.54),(0.94±0.57),(0.31±0.47),(0.13±0.34),and 24 hours,3 months,6 months,12 months after operation were Significantly lower than preoperative,and the difference was statistically significant(P<0.05),and the VAS score between the two groups was statistically difference(P<0.05).two groups of patients in accordance with the modified MacNab evaluation standard assessment excellent rate of 90%、87.5%,There was no significant difference between the two groups preoperatively(P>0.05).TESSYS group in Operation time,intraoperative bleeding volume,postoperative hospital stay,length of incision were significantly smaller than the open operation group(P<0.05).The postoperative complication rate was 15%(3/20)and 12.5%(2/16)in open operation group and TESSYS group.Conclusions: transforaminal endoscopic discectomy(TESSYS)and traditional fenestratation discectomy in obese patients with lumbar disc prolapse can achieve good operation effect,percutaneous transforaminal endoscopic discectomy(TESSYS)has significant advantages in terms of operative time,intraoperative bleeding volume,relieve low back pain.It is an effective surgery for the treatment of lumbar intervertebral disc in obese patients. |
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