Correlation Between Postoperative Lumbar Disc Herniation With Residual Symptoms And Multiple Peripheral Nerve Compression And Observation On The Therapeutic Effect Of "Triple Rehabilitation Therapy Of Traditional Chinese Medicine"

Objective To understand the clinical features of patients with residual neurological symptoms after lumbar disc herniation(LDH),to provide reference for the clinical basic research and diagnosis and treatment of this disease;to identify the relationship between residual neurological symptoms after LDH and peripheral nerve multiple compression syndrome,and propose Corresponding diagnosis and treatment ideas;observe the "Traditional Chinese Medicine Triple Rehabilitation Therapy" on the rehabilitation of peripheral nerve multiple compression in patients with residual neurological symptoms after LDH,and provide new ideas for the rehabilitation of the disease.Methods1.Literature review:Literature combing: Search Chinese and foreign databases such as China Knowledge Network(CNKI),VIP,Wanfang(Wanfang Data)and Pub Med through computer,review the literature of residual neurological symptoms and peripheral nerve multiple compression after LDH,and summarize their respective literatures.The status of understanding and rehabilitation of Chinese and Western medicine.2.Survey of clinical characteristics:Based on the combing of the literature,a questionnaire for the clinical characteristics of residual neurological symptoms after LDH was developed.Randomly selected from June2017 to December 1818,600 patients with residual neurological symptoms after LDH in Luoyang bonesetting hospital of henan province were collected.The general data,clinical manifestations,nerve compression points and incidence of patients were collected through clinical investigation.Relevant data such as influencing factors,TCM syndromes,etc.,were compiled into Microsoft Excel 2016,and statistical analysis was performed using SPSS 20.0statistical software.3.Analysis of diagnosis and rehabilitation:On the basis of literature review and clinical characteristics investigation,the clinical symptoms,physical examination,medical history and auxiliary examination of patients with residual neurological symptoms after LDH were correlated with peripheral nerve multiple compression syndrome to distinguish multi-card type.Patients with residual neurological symptoms after LDH.Through the typical case to further verify the relevance of the two,and to sum up the corresponding rehabilitation treatment ideas,explain the rationality of "Chinese medicine triple rehabilitation therapy".4.Observation on curative effect of rehabilitation:A randomized controlled method was used to randomly select 128 patients with residual neurological symptoms after multi-card syndrome LDH in accordance with the diagnostic reference criteria.The patients were randomly divided into the experimental group and the control group,with 64 patients in each group.The two groups of patients were given health education and taking mecobalamin as a basic treatment,and all of them were combined with non-steroidal anti-inflammatory drugs in the daily activities of VAS ? 4 points.The experimental group used traditional Chinese medicine triple rehabilitation therapy(electroacupuncture + Chinese medicine fumigation + exercise exercise);the control group used conventional rehabilitation therapy(low frequency electrotherapy + hyperthermia +Mc Kenzie back extension training).Before the intervention and 2 weeks after the intervention,the VAS score,the JOA lower back pain score table,the modified Oswestry low back pain questionnaire,the lower extremity muscle strength,and the neuroelectrophysiology were evaluated.The serum was used to detect IL-6 and TNF-in serum.Alpha content and SOD activity,and the overall clinical efficacy of the two groups was evaluated after 2 weeks of intervention.Results1.Literature review:The incidence of residual neurological symptoms after LDH is high.The clinical symptoms mainly include low back pain,lower extremity radiation pain,numbness,swelling,skin sensory disturbance,muscle weakness and lameness.These symptoms can be light and heavy,and in special position.After exertion,the body is obviously aggravated;its pathogenesis mainly involves inflammatory reaction caused by LDH,peripheral sensitization,nerve root repression,excessive traction or stimulation during surgery,postoperative stability of spinal column,postoperative scar tissue formation and society Psychological and other aspects;Western medicine rehabilitation still mainly follows the treatment of LDH,such as oral medication,physical therapy,re-operation,etc.,as well as targeted local closure therapy.The disease belongs to the category of "lumbar palsy" and "low back pain" in Chinese medicine.It is related to kidney deficiency,exogenous invasion,golden blade injury,qi stagnation and blood stasis.The treatment mainly involves single Chinese medicine for internal and external use,acupuncture therapy,Exercises such as exercises,and comprehensive rehabilitation therapy combined with multiple treatments.Peripheral nerve multiple compression is mainly manifested by pain,numbness and limb sensory disturbance in the relevant compressional innervation area.The pathogenesis includes axonal transport obstruction,proton pump up/down,nervous system immune inflammation,central sensitivity,microcirculation.Various theories such as damage and changes in neurobiological motor patterns;diagnosis is based on medical history,clinical manifestations,and neurophysiological examinations;Western medicine rehabilitation methods include nutritional neuropharmaceuticals,physical therapy to improve the state of nerves and surrounding tissues,and resistance Closed therapy of nerve conduction and surgical treatment for releasing compression.The disease belongs to the category of "stagnation syndrome" of traditional Chinese medicine,and is related to acute and chronic injury,liver and kidney deficiency,wind,cold and dampness,and phlegm.The traditional Chinese medicine rehabilitation methods mainly include oral and external use of traditional Chinese medicine,acupuncture therapy,needle knife treatment,and massage.Treatment and other comprehensive rehabilitation therapy.At present,there is no clinical clinical study on patients with multiple peripheral compression of peripheral nerves in residual neurological symptoms after LDH.2.Survey of clinical characteristics:(1)Normal information: Of the 600 patients with residual neurological symptoms after LDH,322 were males and 278 were females,with an average age of(61.78±7.51)years,the patients aged between 61 and 70 years are most distributed;the average duration of(5.85±3.61)years,the average height of(167.86±7.98)cm,and the average body weight of(62.09±11.46)kg,the average BMI value of(22.05±3.89)kg/m~2.(2)Clinical manifestation: In the 600 patients with residual neurological symptoms after LDH,more than half of the patients had hip pain(63.17%)and lower limb paresthesia(62.67%),most of them had radiation pain in lower limbs(54.67%),and continued pain without relief(54.50%);some patients presented with symptoms of low back pain(45.50%),intermittent claudication(39.00%),weakness of lower limbs(37.83%),and misnicturition(30.67%),limited waist movement(26.00%).(3)Nerve compression point: In the patients with residual neurosymptoms of 600 cases,the sciatic nerve and the branch of the branch course were sensitive to the compression and the Tinel sign was positive.from high to low frequency,the sciatic nerve and its branches were respectively piriformis muscle(48.67%),fibula neck(43.17%),tarsal tunnel(37.83%),popliteal fossa(30.67%),between ischial tuberosity and great trochanter(25.67%),plantar metatarsal(21.83%),middle and lower 1/3 junction of crus(19.83%),and femoral condyle(17.83%).Among them,44.67% of the sciatic nerve and its branches had single card(nerve entrapment at one place),and 40.83% of them had multiple CARDS(nerve entrapment at two or more places).(4)Risk factors: In 600 patients with residual neurological symptoms after LDH,more patients underwent posterior approach(63.83%)than intervertebral space approach(36.17%).Among them,moderate manual workers account for 44.67% and heavy manual workers account for 30.50%.Among them,small amount of drinking accounted for 36.00% and large amount of drinking accounted for 32.50%.(5)TCM syndrome characteristics: Kidney(56.33%),liver(27.50%)and spleen(11.17%)are the top three syndrome factor of 600 patients with residual neurological symptoms after LDH.Syndrome elements were mostly intermingled deficiency and excess(81.17%),among which deficiency syndrome elements accounted for the largest proportion of qi deficiency(41.54%).Blood stasis was the largest proportion of empirical syndrome factor(57.59%).3.Observation on curative effect of rehabilitation:(1)General information: Of the 128 patients included in the study,31 were male and 33 were female,with an average age of(60.31±7.69)years,duration of disease(8.05±4.43)years,and BMI(22.10±2.70)kg/m~2;35 males in the control group,19 females,mean age(62.23±7.17)years,duration of disease(7.89±3.94)years,BMI(23.00±4.33)kg/m~2.There were no significant differences in gender,age,duration of disease and BMI between the two groups(P>0.05).(2)Comparison of curative effects: overall clinical efficacy: the total effective rate of the experimental group was 93.7%,and the total effective rate of the control group was 79.9%,but the total effective rate of the experimental group was significantly higher than that of the control group(P<0.05);2 pain: after treatment The VAS scores of the two groups were significantly lower than those before treatment(P<0.05),and the test group was better than the control group(P<0.05).3 Function: After treatment,the JOA scores of the two groups were significantly higher than those before treatment,and the improved ODI scores were better.There was a significant decrease before treatment(P<0.05),and the JOA score and modified ODI score of the experimental group were better than the control group(P<0.05).4Lower extremity muscle strength: After treatment,knee flexion extension and ankle flexion extension were significantly improved(P<0.05),and the experimental group was superior to the control group(P<0.05)After treatment,the conduction velocity of the sural nerve,superficial temporal nerve,radial nerve and common peroneal nerve was significantly higher than that before treatment(P<0.05),and the experimental group was superior to the control group(P<0.05).After treatment,the mean myoelectric amplitude(AEMG),median frequency slope(MFs),and mean power frequency(MPF)of the back muscles of the two groups were significantly improved(P<0.05),and the test group was superior to the control group(P<0.05).6 Biochemical indicators: After treatment,the activity of SOD in serum of the experimental group was significantly higher than that before treatment,and it was better than that of the control group,but there was no significant difference before and after treatment in the control group.The serum levels of IL-6 and TNF-? in the two groups were significantly lower than those before treatment.(P<0.05),and the test group was lower than the control group(P<0.05).Conclusion1.Literature review:The residual neurological symptoms after LDH are more common in clinical practice,and the treatment is still based on LDH treatment.The disease belongs to the category of "lumbar palsy" of Chinese medicine,and the treatment mainly uses single or comprehensive rehabilitation therapy.The more commonly recognized mechanism of multiple compression of peripheral nerves is "damage of axonal transport".Western medicine rehabilitation often includes nutritional neuropharmaceuticals,physical therapy,closure and surgical treatment;traditional Chinese medicine rehabilitation includes traditional Chinese medicine treatment,acupuncture therapy,needle knife Treatment,massage treatment,etc.There is a certain correlation between residual neurological symptoms after LDH and multiple compression of peripheral nerves,but there is still no correlation analysis and targeted treatment research on residual neurological symptoms after LDH caused by multiple compression of peripheral nerves.2.Survey of clinical characteristics:600 patients with residual neurological symptoms after LDH were mainly painful in the lower extremities,buttocks and lower back,and more often accompanied by,lower limb skin paresthesia and weakened muscles.The sciatic nerve and its branches are easy to be compressed,mainly piriformis,humeral neck,fistula,etc.,and about 40% of patients with residual neurological symptoms after multi-card LDH.The incidence of the disease is related to factors such as BMI,surgical approach,physical labor intensity,smoking,etc.,suggesting that avoiding overwork or avoiding smoking in daily work.The syndromes of TCM patients in this class are mainly kidney and liver;the syndromes are mainly composed of deficiency and deficiency,and more common qi deficiency,blood deficiency,yang deficiency,blood stasis,qi stagnation,cold evil,etc.It is mainly based on nourishing the liver and benefiting the kidney,strong gluten and strong bones,as well as spleen and qi,promoting blood circulation and removing blood stasis.3.Analysis of diagnosis and rehabilitation:The diagnosis of residual neurological symptoms after multi-card type LDH should be combined with clinical symptoms,physical examination,medical history,and auxiliary examination to comprehensively judge,and it needs to be caused by metabolic diseases such as lumbar spinal stenosis,ankle arthritis,diabetes and thyroid dysfunction.Peripheral nerve card pressure phase identification.In the rehabilitation of this disease,in order to relieve the nerve compression,follow the principle of "easy first,then difficult,first simple and then complicated,first distal and proximal",comprehensive rehabilitation therapy should be adopted."Triple Rehabilitation Therapy of Traditional Chinese Medicine"(Electric Needle +Chinese Medicine Fumigation + Exercise Exercise),for the pathological features of multiple nerve compression,can remove the compression at multiple angles,block the abnormality of the axial flow,lead to multiple card compression superimposed and aggravate the vicious circle,restore nerve conduction,form a virtuous circle,thereby improving symptoms.4.Observation on curative effect of rehabilitation: "Triple Rehabilitation Therapy of Traditional Chinese Medicine" can significantly improve the symptoms of back and hip pain,and improve the function of the lower back and lower limbs,enhance the muscle strength of the lower back muscles,and improve the sensory and motor nerve conduction.Speed,and can reduce serum IL-6 and TNF-? levels,increase SOD activity.