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Objective:To study the application value of nerve root decompression through posterior approach in minimally invasive surgery of lumbar disc herniation (LDH).Methods:From June 2016 to June 2018, 80 patients with unilateral single segment LDH were selected and diagnosed in Yunnan Puer People′s Hospital.The patients were divided into control group and observation group according to the random number table method, 40 cases in each group.The control group was treated with posterior fenestration and nucleus pulposus extraction, and the observation group was treated with posterior neurolysis and decompression through 5.3 mm intervertebral foramen.The incision length, operation time, intraoperative blood loss and postoperative hospital stay were compared between the two groups.The visual analog scale (VAS) of pain before operation and 1, 2, 7 days after operation was compared.The Japanese Orthopedic Association (JOA) score and the Oswestry disability index (ODI) questionnaire score before operation and 1, 3, 12 months after operation were compared.The effect of lumbar function recovery 12 months after operation was compared.Results:The incision length, operation time, days in-hospital after operation, and bleeding amount in observation group were (0.9±0.2) cm, (50.8±8.6) min, (16.5±5.9) ml, (4.3±0.5)d, and in control group were (4.6±0.8) cm, (72.3±15.2) min, (52.5±10.3) ml, (7.2±0.9)d.The differences between the two groups were statistically significant ( t=8.625, 14.623, 32.625, 6.524, all P<0.001). The VAS scores of the observation group and the control group were (5.7±1.1), (3.3±0.6), (1.2±0.3), (0.5±0.1) and (5.5±1.2), (4.2±0.8), (1.9±0.4), (1.1±0.3) before and 1, 3 and 7 days after the operation, respectively.The differences 1, 3, 7 days after operation between the observation group and the control group were statistically significant (all P<0.05). The JOA scores of the observation group were (8.1±1.6), (19.3±4.2), (23.2±4.9), (25.8±5.2) before and 1, 3 and 12 months after operation, respectively, and those of the control group were (8.3±1.5), (15.2±3.3), (19.3±4.2), (20.6±5.5) after operation.The differences 1, 3, 12 months after operation between the observation group and the control group were statistically significant (all P<0.05). The ODI scores of the observation group were (43.7±10.6), (18.3±5.2), (10.2±3.9), (1.8±0.5) before and 1, 3 and 12 months after the operation, respectively, and those of the control group were (42.5±9.4), (25.2±5.3), (14.3±4.2), (4.6±0.9) after the operation.The differences 1, 3, 12 months after operation between the observation group and the control group were statistically significant (all P<0.05). The effective rate of the observation group was significantly higher than that of the control group (92.5%(30/40) vs.75.0%(37/40), χ 2=4.501, all P=0.034). Conclusion:It can bring less trauma and faster recovery with 5.3mm intervertebral endoscopy by posterior approach of nerve root decompression for LDH patients, which is better safety and efficacy.
ABSTRACT
Objective@#To study the application value of nerve root decompression through posterior approach in minimally invasive surgery of lumbar disc herniation (LDH).@*Methods@#From June 2016 to June 2018, 80 patients with unilateral single segment LDH were selected and diagnosed in Yunnan Puer People′s Hospital.The patients were divided into control group and observation group according to the random number table method, 40 cases in each group.The control group was treated with posterior fenestration and nucleus pulposus extraction, and the observation group was treated with posterior neurolysis and decompression through 5.3 mm intervertebral foramen.The incision length, operation time, intraoperative blood loss and postoperative hospital stay were compared between the two groups.The visual analog scale (VAS) of pain before operation and 1, 2, 7 days after operation was compared.The Japanese Orthopedic Association (JOA) score and the Oswestry disability index (ODI) questionnaire score before operation and 1, 3, 12 months after operation were compared.The effect of lumbar function recovery 12 months after operation was compared.@*Results@#The incision length, operation time, days in-hospital after operation, and bleeding amount in observation group were (0.9±0.2) cm, (50.8±8.6) min, (16.5±5.9) ml, (4.3±0.5)d, and in control group were (4.6±0.8) cm, (72.3±15.2) min, (52.5±10.3) ml, (7.2±0.9)d.The differences between the two groups were statistically significant (t=8.625, 14.623, 32.625, 6.524, all P<0.001). The VAS scores of the observation group and the control group were (5.7±1.1), (3.3±0.6), (1.2±0.3), (0.5±0.1) and (5.5±1.2), (4.2±0.8), (1.9±0.4), (1.1±0.3) before and 1, 3 and 7 days after the operation, respectively.The differences 1, 3, 7 days after operation between the observation group and the control group were statistically significant (all P<0.05). The JOA scores of the observation group were (8.1±1.6), (19.3±4.2), (23.2±4.9), (25.8±5.2) before and 1, 3 and 12 months after operation, respectively, and those of the control group were (8.3±1.5), (15.2±3.3), (19.3±4.2), (20.6±5.5) after operation.The differences 1, 3, 12 months after operation between the observation group and the control group were statistically significant (all P<0.05). The ODI scores of the observation group were (43.7±10.6), (18.3±5.2), (10.2±3.9), (1.8±0.5) before and 1, 3 and 12 months after the operation, respectively, and those of the control group were (42.5±9.4), (25.2±5.3), (14.3±4.2), (4.6±0.9) after the operation.The differences 1, 3, 12 months after operation between the observation group and the control group were statistically significant (all P<0.05). The effective rate of the observation group was significantly higher than that of the control group (92.5%(30/40) vs.75.0%(37/40), χ2=4.501, all P=0.034).@*Conclusion@#It can bring less trauma and faster recovery with 5.3mm intervertebral endoscopy by posterior approach of nerve root decompression for LDH patients, which is better safety and efficacy.
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Objective:To prevent postoperative reflux symptoms in patients undergoing proximal gastrectomy for esophagogastric junction cancer by using a new method of anti-reflux anastomosis.Methods:The clinical data of 15 patients with esophagogastric junction cancer at Department of Gastrointestinal Surgery , Second Hospital of Hebei Medical University from Jan 2018 to Apr 2019 were analyzed, and a new method of anti-reflux anastomosis was used to compare the difference of reflux between preoperative and postoperative status.Results:All patients recovered well after operation, 2 patients suffered moderate swallow disturbance after one month of operation, and the symptoms disappeared by gastroscope anastomosis dilation. The scores of reflux disease questionnaire before and after operation were in accordance with normal distribution (16 ±12 vs. 10 ±4, t=1.877, P=0.081), the results showed that there was no significant difference. Conclusion:This new method of anti-reflux anastomosis has a definite anti-reflux effect on postoperative patients with esophagogastric junction cancer.
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Objective To analyze the hidden blood loss following primary total hip arthroplasty (THA) and put forward corresponding treatment measures.Methods A retrospective study was done on the 138 patients with hip disease managed with THA for the preliminary unilateral replacement from January 2009 to January 2011.There were 48 males and 90 females,at age range of 45-71 years (mean,62 years).The pre-and post-operative blood routine and intra-and post-operative blood loss and transfusion were analyzed and hidden blood loss during peri-operation period was evaluated.Results All the patients were trnsfused with autologous blood intra-operatively.Intra-operative blood loss was (495 ± 105) ml and postoperative drainage volume was ( 121 ±29) ml.In addition,116 patients were given red cell suspension (RCS) and blood plasma to raise the level of hemoglobin and the RCS transfusion volume was (600 ± 225) ml.The total blood loss was (1 521 ±156) ml including hidden blood loss of (822 ±96) ml (57.2％).No obvious differences were observed in the indicators between males and females.Conclusions Hidden blood loss is an important factor that affects the prognosis of the patients treated by THA.In order to secure their safety in perioperative period and benefit their recovery,assessment of the amount of bleeding in THA should fully take the hidden blood loss into consideration and prompt treatment measures should be taken to fully and effectively recover their effective circulation blood volume.