| Objectives: To investigate and analyze the early clinical efficacy of intervertebral foraminoscope in the treatment of different types of lumbar disc herniation(LDH)through the remission of clinical symptoms in patients with different types of LDH after intervertebral foraminal border surgery.Methods: From January 2017 to May 2018,185 patients with lumbar intervertebral disc herniation who received percutaneous surgery for lumbar and leg pain in our hospital were collected,including 106 male patients and 79 female patients.The patients were 22~88 years old,with an average age of 48.65±4.6.All the patients were admitted to our hospital for lumbar X-ray,CT and MRI imaging before and after surgery.According to the location of vertebral disc nucleus pulposus prolapsed,patients were divided into the following four groups: group A: 60 patients with central type;group B: 85 patients with central paracenter type;group C: 19 patients with intervertebral foramen type and group D: 21 patients with extremely lateral type,including 13 patients with 3/4 lumbar segment,93 patients with 4/5 lumbar segment,and 79 patients with 1 lumbar segment.The preoperative diagnosis and surgical method of all patients were discussed by all the doctors in the department,and all the patients agreed that the surgical method was lateral posterior transpedicular endoscopic nucleus pulposus excision by the same surgeon.Patients in all the groups were assessed by VAS of leg pain,VAS of low back pain and ODI scores on 1 day before surgery and 1 day,1 month,3 months and 6 months after surgery,Index score,operative time,intraoperative blood loss,dural rupture and other surgical complications of patients in each group,and improved Macnab efficacy evaluation criteria were used for postoperative efficacy evaluation.Results: All of the 185 patients who met the requirements of this study were successfully treated and effectively followed up.VAS score: central type: preoperative 7.56±1.02 points vs.postoperative day 1 3.10±0.86 points vs.postoperative month 1 2.21±1.05 points,the difference was statistically significant(P<0.05).Para-central type: 7.53± 0.69 points before surgery vs.2.92± 0.77 points on day 1 after surgery vs.2.30± 0.72 points 1 month after surgery,the difference was statistically significant(P<0.05).Intervertebral foramen: 8.28±0.70 points before surgery vs.3.51± 0.58 points on day 1 after surgery vs.2.50± 0.71 points 1 month after surgery,the difference was statistically significant(P<0.05).Extreme lateral: preoperative 7.90± 0.72 points Vs 2.86± 0.67 points Vs 2.36± 0.92 points Vs 1 month after surgery,the difference was statistically significant(P<0.05),ODI score: central type,43.64±11.61 points Vs 1 day after surgery 10.27±9.03 points Vs 1 month after surgery 9.58±10.05 points,the difference was statistically significant(P<0.05).Paracentric type: 42.68±12.16 points preoperatively vs.12.01±6.17 points postoperatively vs.1 month postoperatively7.62±5.14 points,the difference was statistically significant(P<0.05).Intervertebral foramen: preoperative 44.02±7.26 points vs.postoperative 12.89±12.30 points on day 1 vs.postoperative 8.46±6.72 points on month 1,the difference was statistically significant(P<0.05).Extreme lateral type: preoperative 43.26±13.05 points vs.postoperative day 1 12.35±9.76 points vs.postoperative month 1 9.21±7.23 points,the difference was statistically significant(P<0.05).VAS and ODI scores of patients with various types of intervertebral disc herniation at 3 months and 6 months after surgery were compared with each other,and the differences were not statistically significant(P>0.05),that is,the postoperative symptoms of lumbar and leg pain were significantly better than those before surgery,and the treatment effect was clear.Ten people in all patients with surgery related complications:group A patients who 1 catheter fracture,2 relapsed;group B patients who 1 person bleeding,1 postoperative symptoms without mitigation,2 relapsed;1 person had a bleeding in group C;group D patients who 1 postoperative symptoms without mitigation and 1 people relapsed,all complications of patients to communicate with the patient and family to corresponding patients improve after symptomatic treatment after discharge.Conclusion: On the premise of strictly grasp the surgical indications,percutaneous vertebral asked hole mirror clinical curative effect of treating lumbar intervertebral disc protrusion,but different types of vertebral asked dish outstanding patients early postoperative symptoms and postoperative relapse,near the central type and intervertebral pass patients postoperative day 1 lumbocrural pain symptoms obviously,the central and the central near the probability of patients with postoperative recurrence and complications occurred more than the other two types,according to different types of patients with lumbar disc surgery should be careful physical examination,detailed reading and evaluation of patients with lumbar spinal CT and MRI combined with patients’ willingness to formulate individualized treatment plan. |
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