Clinical Observation On The Improvement Of Residual Pain And Limitation Of Movement After PTED In Patients With LDH By Buyang Huanwu Decoction

OBJECTIVE:To observe the clinical efficacy of using Buyang Huanwu Decoction in treating residual pain and dysfunction in patients with lumbar disc herniation（LDH）after Percutaneous transforaminal endoscopic discectomy（PTED）.The mechanism of action and research progress were analyzed and discussed to provide ideas for the clinical application of this formula for the treatment of residual pain and dysfunction after PTED in patients with LDH.METHODS:Clinical data were obtained from patients who underwent PTED surgery at the department of orthopedic injury in Hubei Provincial Hospital of traditional Chinese medicine from June 2020 to September 2021,and 64 patients with residual pain and dysfunction symptoms within one week after PTED surgery treated at the department of orthopedic injury in Hubei Provincial Hospital of traditional Chinese medicine were screened according to the inclusion and exclusion criteria in this study,and the follow-up process Shedding 4cases,the actual number of inclusion was 60,34 men and 26 women.There were 11 cases of central lumbar disc herniation,17 cases of paracentral lumbar disc herniation,29 cases of paracentral lumbar disc herniation,and 3 cases of extreme lateral lumbar disc herniation.The segments involved in the surgery were L4/5segment in 32 cases and L5/S1 segment in 28 cases.According to the treatment method of this study,the cases were divided into treatment group and control group,with 30 patients in each group.In the control group,in addition to the regular instruction of functional exercise,the patients were given methylcobalamin dispersible tablets,0.5 mg three times a day,and celecoxib capsules,100 mg twice a day,starting one week after surgery,and in the treatment group,in addition to the above treatment,the patients were given Buyang Huanwu Decoction,200 ml twice a day,for 4 weeks.The clinical outcomes of the two methods were assessed by the degree of improvement of the patient’s symptoms.The degree of pain was assessed by visual analog scale（VAS）,while the improvement of patients’lumbar spine function and quality of life was assessed by using the JOA Lumbar Spine Scale and ODI questionnaire of the Japanese Orthopaedic Association.The VAS,JOA,and ODI scores of each patient undergoing PTED surgery in the inpatient unit were recorded before treatment,and 64 cases with residual symptoms within one week after surgery were collected into the group,of which 4 patients were lost to follow-up,and their VAS,JOA,and ODI scores at the end of the first postoperative week were also recorded,and the VAS,JOA,and ODI scores at the end of the fifth postoperative week were recorded while grouped as described above for four weeks of simultaneous treatment,and The patients’total effective rate at the end of month 3 was recorded to further assess the effectiveness of the therapy.All collected data were statistically analyzed using SPSS 26.0 software.Results.1.In this study,one case in the treatment group was lost due to nausea and vomiting and other stomach discomfort symptoms,and one case was lost due to failure to take medication as required,and two cases in the control group were lost due to their own work-related loss of contact,so the number of cases included in this trial was 30 in each of the two groups.2.There was no statistically significant difference in the balance of preoperative gender,duration of disease,surgical segment and age of the enrolled cases（p>0.05）,and there was no statistically significant difference in the analysis of the data at the end of the first postoperative week（p>0.05）,which can be used to compare the effectiveness of group treatment.3.VAS score:The VAS scores of both groups decreased in the first postoperative week,and the difference was statistically significant（p<0.05）.After 4 weeks of postoperative treatment,the VAS scores decreased in both groups,and the difference was statistically significant（P<0.05）.The VAS score at 5 weeks postoperatively was 1.17±0.91 in the treatment group and 2.67±1.77 in the control group.Intergroup analysis showed that the improvement of pain in the treatment group was higher than that in the control group at5 weeks postoperatively,and the difference was statistically significant（P=0.001,<0.05）.4.JOA scores:JOA scores increased in the first postoperative week in both groups,and the difference was statistically significant（P<0.05）.The JOA scores of both groups increased after 4 weeks of postoperative treatment,and the difference was statistically significant（P<0.05）.The JOA score at 5weeks postoperatively was 22.67±3.10 in the treatment group and 20.33±2.73 in the control group.Intergroup analysis showed that the treatment group was better than the control group in reducing the functional impairment of patients,and the difference was statistically significant（P=0.003,<0.05）.5.ODI score:The ODI scores of both groups decreased in the first postoperative week,and the difference was statistically significant（P<0.05）.The ODI scores of both groups decreased after 4 weeks of postoperative treatment,and the difference was statistically significant（P<0.05）.The ODI score was15.40±5.75 at 5 weeks postoperatively in the treatment group and 20.63±11.10 at 5 weeks postoperatively in the control group.Intergroup analysis showed that the treatment group was superior to the control group in reducing the functional impairment of the patients,and the difference was also statistically significant（P=0.027,<0.05）.6.Analysis of modified Mac Nab assessment criteria:the results of the treatment group showed 8 cases of excellent,19 cases of good,3 cases of acceptable,and 0 cases of poor,with an excellent rate of 90.00%;the results of the control group showed 5 cases of excellent,12 cases of good,10 cases of acceptable,and 3 cases of poor,with an excellent rate of66.67%,and the difference was statistically significant（χ~2=8.524,p=0.004,<0.05）.7.Safety assessment:patients in both groups had stable vital signs during the study period,no serious adverse reactions such as allergy or palpitations were observed,and only one patient in the treatment group was lost to visit due to gastric discomfort.Conclusion.1.Buyang Huanwu Decoction can effectively reduce pain,improve lumbar function and improve quality of life in LDH patients after PTED.2.The clinical outcomes of Buyang Huanwu Decoction in reducing postoperative pain and in improving lumbar function and quality of life in LDH patients with PTED were superior to those of the conventional use of mecobalamin tablets in combination with celecoxib capsules.