| Objective: To analyze the influential factors of therapeutic effect to lumbar disc herniation , investigate the alternative operative treatment for lumbar disc herniation and the indication of lumbar interbody fusion and internal fixation in the treatment of lumbar disc herniation.Methods:It was a retrospective contrast study to the result of surgical treatment done in our hospital in 91 patients with lumbar disc herniation (LDH) from January 2004 to March 2008. 91 cases of LDH were divided into 2 groups:traditional nucleus pulposus extraction group (47 cases) and interbody fusion and fixation group (44 cases).Influential factors were as follows: lumbar vertebrae olisthy,lumbar spinal canal stenosis,different affection segments and different ages. The documents of 2 groups were recorded at the end of discharge and final follow-up studies respect- tively.The clinical data was summarized according to the low back pain score of Japanese Orthopaedic Association (JOA) and Staufer Coventry( SC) to evaluate the postoperative therapeutic effect. The data was contrast analyzed statistically by t-test and chi spuare test(χ2-test) with SPSS13.0 software according to JOA score's improvement rate and SC results. The difference was statistical significance when P<0.05.Results: To simple nucleus pulposus extraction group: There were 2 cases relapse by the end of follow-up studies.The recurrence rate was 4.3%.The mean JOA score before operation was 5.96±1.38,while during follow-up period,the mean JOA score improved to 11.23±0.93, 12.62±0.97 respectively at the end of postoperative discharge and final follow-up studies. To interbody fusion and fixation group:1 case's neck of vertebral arch screws were extracted and 1 case got even serious in symptoms after operation. The mean JOA score before operation was 5.75±1.16,while during follow-up period,the mean JOA score got to 11.25±0.97, 12.73±1.17 respectively at the end of postoperative discharge and final follow-up studies. The average operative time was 59.47min and the intraoperative blood volumn was 149.86m1 in traditional nucleus pulposus extraction group,while it was 124.10min,572.00m1 respectively in interbody fusion and fixation group.According to Staufer Coventry,the result of final follow-up studies were as fllows: in traditional treatment group,excellent 24(51.06%),good 11(23.40%),general 10(21.28%),poor 2(4.26%),while in spinal fusion group excellent 26(59.09%),good l6(13.64%),general 8(18.18%),poor 4(9.09%).Concerning chi spuare test, the result was P>0.05. It has the same therapeutic effect.Concerning the improvement rate of JOA score between different age group and affection segments in both preoperation and postoperation,all the One-Way ANOVA results were P>0.05.There was no statistical significance. The improvement rate didn't meant difference. According to LDH complicating with lumbar vertebrae olisthy and lumbar spinal canal stenosis had a t-test to the improvement rate of final follow-up studies of these two treatments respectively, P<0.001, interbody fusion and fixation group had a better improvement rate than simple nucleus pulposus extraction group. During final follow-up studies to simple nucleus pulposus extraction group, there was t-test of improvement rate respectively between simple LDH( 82.87±6.08% ) and LDH complicating with lumbar vertebrae olisthy(69.69±6.80%)and lumbar spinal canal stenosi(s71.50±5.02%), P<0.001, the improvement rate of simple LDH did better than multiple LDH. To postoperative improvement rate between low back pain and lower limb sciatica, there was 2×C chi spuare test to final follow-up studies documents between these two treatments.In simple nucleus pulposus extraction group ,the result was P<0.05. It meant that the improvement rate of lower limb sciatica did better than low back pain .On the contrary ,in interbody fusion and fixation group, P>0.05 ,there was no different between low back pain and lower limb sciatica of postoperative improvement rate.Conclusion: There were perfect postoperative therapeutic effect both simple nucleus pulposus extraction and interbody fusion and fixation according to LDH during recent follow-up studies. According to LDH complicating with lumbar vertebrae olisthy, lumbar spinal canal stenosis and low back pain serious than lower limb sciatica, interbody fusion and fixation had a relatively better therapeutic effect than simple nucleus pulposus extraction.LDH complicating with lumbar spinal canal stenosis which forecasting a iatrogenic lumbar vertebrae unsteadiness of posto- peration is a indicatio to interbody fusion and fixation. The factors that influent postoperative therapeutic effect of LDH were lumbar vertebrae olisthy and lumbar spinal canal stenosis.It has nothing to do with ages and affection segments.
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