| Background: Lumbar disc herniation(LDH)is a common disease in orthopedics,often resulting in back and leg pain.When conservative treatment is ineffective,surgical treatment is often used to improve the patient’s symptoms,the common clinical treatment is interlaminar decompression.With the development of technological advances and enhanced recovery after surgery,minimally invasive surgery is gradually replacing traditional surgery.As one of the minimally invasive methods of disc herniation,percutaneous endoscopic lumbar discectomy can be performed under endoscope to remove the prominent nucleus pulposus tissue,which can directly release compression of prominent nucleus pulposus tissue on the nerve roots,The whole process had little trauma and quick postoperative recovery.And PELD operated outside the canalis spinalis,which reduces the disturbance to the dural capsule and nerve roots.It has certain advantages in clinic.Minimally invasive surgery is gradually replacing traditional open surgery as the common clinical treatment of lumbar disc herniation.The inchoate PELD,ring saw or bone drill was used to Foraminoplasty for exposing incision during intraoperative.Because the whole process is blind,there is a risk of injury to the dural capsule and nerve roots during the operation,once the dural capsule and nerve roots injuryed in the operation,it is extremely difficult solved during the operation.In clinical,in order to improve the safety of percutaneous endoscopic lumbar discectomy,how to ensure the safety of foraminoplasty is a problem that must be paid attention to and properly solved.In this paper,Spinal surgery of First Affiliated Hospital of Wan Nan Medical College from 2018.08 to 2019.09 was selected for the treatment of lumbar disc herniation through percutaneous endoscopic lumbar discectomy with ring saw or full-endoscopic dynamic system in foraminoplasty.The efficacy of surgery and the articular surface retention of postoperative foramen oplasty were analyzed to understand the safety of the dynamic system under full endoscope in the application of foramenoplasty.Objective: To evaluate the safety of ring saw and the full-endoscopic dynamic system in foraminoplasty.Methods: From August 2018 to September 2019,60 patients with lumbar disc herniation were treated in spinal surgery of First Affiliated Hospital of Wan Nan Medical College were selected as subject investigated.This study was approved by the Ethics Committee of the First Affiliated Hospital of Wan Nan Medical College,The patients were randomly divided into two groups,the observation group based on the use of full-endoscopic dynamic system and control group based on the use of ring saw.To ensure surgical consistency,all patients in this study were operated by the same spinal surgeon.The observation group consisted of 32 persons with 25 males and 7 females whose average age 44.53±15.21.Pathology disc was L3/4 in 2 cases,L4/5 27 cases,L5/S1 3cases;Control group consisted of 28 persons with 22 males and 6 females whose average age was 45.64±10.58.Pathology disc was L3/4 4 cases,L4/5 13 cases,L5/S1 11 cases.IN the two groups,their age,sex,pathology disc,hospitalization days,operation time,intraoperative fluoroscopy times,surgical complications were counted,and preoperative and postoperative VAS score and ODI score were made comparisons.Results: There are 60 subjects selected for this experiment,and all the subjects have received the operation successfully and have been followed up for more than 3 months.The control group have 3 complications in the operation,including 1 case of residual nucleus pulposus constrict nerve root.Two cases of nerve root partial injuryed were treated with neurotrophic drugs,one case recovered completely 2 weeks after operation,the other case showed partial muscle strength decline but defecation and urine properly.The difference of gender,age between the observation group and the control group is not statistically significant.In the observation group,the length of hospitalization is(5.93 ± 2.58),while in the control group,the length of hospitalization is(8.00 ±3.53),P=0.013,the difference has statistically significant..In the observation group,the preoperative VAS score is(5.97±1.17),and the postoperative VAS score is(2.56±0.87),P=0.000;while in the control group,the preoperative VAS score is(6.36±1.22),and postoperative VAS score is(2.64±0.87),P=0.000,comparison of VAS scores between the two groups before and after operation has statistically significant.The VAS scores of the two groups of subjects before surgery are P=0.216,and P=0.724 after surgery,the difference between the preoperational VAS and the post-operational VAS scores of the two groups has no statistically significant.In the observation group,the preoperative ODI of was(38.16±8.48),the postoperative ODI was(15.28±4.25),P=0.000;while in the control group,the preoperative ODI was(36.36±8.60),the postoperative ODI was(16.96±4.84),P=0.000.Comparison of difference of the preoperative ODI and postoperative ODI of two group has statistically significant.In the two groups,the preoperative ODI P=0.419,and the postoperative ODI P=0.157,The comparison of the difference between the preoperational ODI and the post-operational ODI of the two group has no statistical significance.The operation time of the observation group was 71.25±16.60 mins,and the operation time of the control group was 102.14±56.24 mins,P=0.009.The number of times of the fluoroscopy of the observation group was 9.59±4.20,the control group was 27.89±5.30,P=0.000,Comparison of the difference of the operation time and the number of times of fluoroscopy has statistically significant.Conclusion: As a minimally invasive technique for lumbar disc herniation,PELD is a kind of minimally invasive treatment that can deal with lumbar disc herniation.PELD is characterized by small trauma,quick rehabilitation and less complications.The dynamic system effectively reduces the operation time and the number of intraoperative fluoroscopy,improves the efficiency of the operation,and reduces the radiation damage to the doctor and patient.It is of fixed practical and generalized value. |
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