| IntroductionLumbar disc herniation is a more common disease in orthopaedics and it is also a most common cause of low back pain and leg pain. LDH have an important effect on the patients'daily life and work and make them suffer a lot of distress. However, we can relieve their distress and restore their abilities of daily life and work by further research and the correct selection of clinical treatment. It is very significant for the clinical management and the whole society.Although the standard discectomy ( SD ) of LDH has been widely accepted and has achieved a satisfactory short ?term result, it may have a poor long - term result. The reasons are that it can interfere with the vertebral canal, stimulate the nerve roots, result in epidural fibrosis, the instability of the lumbar spine, the progressive degeneration of articular facets and intervertebral disc, the recurrence of LDH and the segmental stenosis. While from the angels of etiology, anatomy, pathology and biomechanism of LDH, the technique of anterior discectomy and interbody fusion ( ADIF) is more reasonable if the patients are correctly selected.Although the results of ADIF and SD have been reported, there is no report about the prospective study of their clinical long - term results in the same period performed by the same surgeon.The aim of the present study is to make a prospective study on thelong - term results of ADIF and SD and analyze their respective advantages and disadvantages by which we can increase the methods of treatment, supply more selection for the surgeons and relieve the patients'distress.Materials and methods1. materials:We analyzed the records of all patients who underwent operations with LDH performed by the same surgeon at the first affiliated hospital of China medical university between January 1991 and December 2000. All patients were divided into two groups. ( 1 ) The patients were operated with standard discectomy ( SD ) . ( 2 ) The patients were operated with anterior discectomy and interbody fusion (ADIF). All patients were operated with ADIF or SD based on their respective indications.2. methodsA: clinical investigationsWe will investigate clinical results of the patients who can be followed up. The items of the investigation include symptoms, signs, a-bilities of daily life, the situations of placement and the changes of clinical results after operations with the time passing. Every patient will be investigated four times at least through direct investigation, questionaire and telephone. The investigations will be at the three months, six months, one year and two to ten years after the operations. The primary tentative score rating system designed by the low back pain committee of the Japanese Orthopaedic Association will be used to compare the patients' preoperative and postoperative status.The tentative score rating system designed by the Chiba University will be adapted to evaluate the clinical results changed with the time. There are excellent, good, fair and poor four grades in this system.B: The researches on roentgenographyThe findings of plain radiographs, CT and MRI before and after operation.The research of plain radiographs includes the tract spurs, the disc space, the intervertebral motion and the intervertebral stability.The researches of CT and MRI include the type of LDH, the degree of disc degeneration and articular facets degeneration and the seg-mental stenosis.C: data processingAll clinical status will be put into the database of the statistic software SPSSIO. 0 and the significance of the differences will be assessed using the chi ?square test, the T ?test and the analysis of correlation. The results will be expressed as means plus or minus standard deviation.We reviewed the records of all patients who underwent ADIF or SD performed by the same surgeon at the first affiliated hospital of China medical university between January 199land December 2000. We found 121 patients having ADIF or SD. Of the original 121 patients, we were abl...
|
PDF Full Text Request