Clinical Study On The Relationship Between The Efficacy Of Percutaneous Endoscopic Lumbar Discectomy And The Difference Of Zygapophysial Joint Angles

Objective: To investigate the effect of different Zygapophysial Joint angles on the postoperative effect of Percutaneous endoscopic lumbar discectomy for lumbar disc herniation.Methods: Retrospective analysis was performed on patients who met the diagnostic criteria for lumbar disc herniation and received Percutaneous endoscopic lumbar discectomy treatment in our orthopaedic inpatient department from October 2018 to February 2020.78 patients were screened according to the inclusion and exclusion criteria,and the included patients were divided into two groups according to the presence of(Facet Tropism,FT)at surgical segments: The FT group(Zygapophysial Joints angles < 10°)52 cases,FT group(Zygapophysial Joints angles ≥ 10°)26 patients,two groups of patients with general information collected included age,gender,duration of symptoms,segmental,BMI,diabetes history,smoking history,heavy manual workers number,and the operation time,intraoperative blood loss,hospitalization days,postoperative complications,postoperative lumbar motion score.Before surgery,1 day after surgery,3 months after surgery,and6 months after surgery,questionnaire survey and telephone follow-up were used to collect the VAS score,ODI index,JOA score and Nakai evaluation of patients in 2 groups to assess the overall situation of surgical efficacy.Results: A total of 78 patients were included in this study,including 47 males and 31 females,ranging in age from 19 to 64 years old and symptom duration from 1 to 17 months.There were no significant differences between the two groups in gender,age,symptom duration,BMI,smoking history,number of heavy physical labor,history of diabetes and prominent segments(P > 0.05).There was no significant difference between the two groups in operative time,intraoperative blood loss,discharge time and postoperative lumbar range of motion score(P > 0.05).Comparison of postoperative efficacy indicators: VAS scores of low back pain before and 1 day after surgery,VAS scores,ODI index and JOA scores of leg pain before and 1 day after surgery,3 months after surgery and 6 months after surgery showed no statistical significance between the two groups(P > 0.05).However,there was a statistically significant difference in VAS scores of low back pain between 3months and 6 months after surgery(P < 0.05).The VAS score of lumbar and leg pain,ODI index and JOA score Within the group were significantly different before and 1 day after surgery,1 day after surgery and 3 months after surgery,and 3 months after surgery and 6 months after surgery(P < 0.05).The excellent and good rates of the two groups were 90.38% and 88.46%,respectively,and the difference was not statistically significant(P > 0.05).Conclusion(s): Percutaneous endoscopic lumbar discectomy is effective,safe and less complicated in the treatment of lumbar disc herniation.However,Angle difference greater than 10°,Facet Tropism,may affect the relief of postoperative low back pain,but does not affect lower limb pain,functional activities,and overall efficacy.We should pay attention to the assessment of the symmetry of the patients’ facet joints,pay attention to the protection of the lumbar spine,wear the waist circumference,and properly exercise the lumbar back muscle function,so as to improve the curative effect of the operation and promote functional rehabilitation.