Occurrence and prevention of complications after percutaneous endoscopic lumbar discectomy / 局解手术学杂志

Objective To analyze the occurrence of the complications after percutaneous endoscopic lumbar discectomy (PELD) for lumbar disc herniation or stenosis,and to reveal the effective prevention methods.Methods Retrospectively analyzed the clinical data of 568 cases who undertaken PELD,and all the related complications,possible causes,prevention and treatment methods were analyzed.Results There were 24 cases of complications occured in all the 568 cases treated with PELD,and the gross incidence rate was 4.23％,including 4 cases of dural laceration(0.70％),3 cases of hemorrhage of intravertebral vein plexus injury(0.53％),6 cases of postoperative wound pain (1.06％),8 cases of postoperative recurrence (1.41％),1 case with persistent symptoms after surgery (0.18％),2 cases of postoperative paresthesia(0.35％).Conclusion PELD is a minimally invasive surgery with high security and low incidence of complications.The effective preventions including careful decision-making,elaborate operation,and precise identification of the anatomical abnormality.

Epidural injection of Ropivacaine Mesylate anesthesia in transforaminal endoscopic surgery / 中国生化药物杂志

Objective To compare and analyze the clinical effects of different local anesthetics on continuous epidural anesthesia for percutaneous enucleation of nucleus pulposus. Methods A total of 40 patients underwent lumbar intervertebral discoscopy (PTED) from November 2015 to November 2016, according to the choice of anesthesia is divided into group A and group B, 20 cases in each group. Group A used 0.5％lidocaine local anesthesia, group B treated with continuous epidural anesthesia (1 ％ lidocaine 3 mL+0.5％ ropivacaine).Analysis of two groups before operation, the curative effect, VAS score, modified Bromage score, intraoperative pain perception includes four criteria, namely, mild, moderate and severe, the former two satisfactory anesthetic effect; the latter two are not satisfied with the anesthesia. Results Two cases without postoperative cerebrospinal fluid leakage occurred, nerve root injury and other complications; two groups of patients with pain satisfaction difference was statistically significant (P<0.05); compared with group A, the levels of HR and MAP in group B were more stable (P<0.05). Conclusion Continuous epidural anesthesia is more suitable for PTED than local anesthesia. It can reduce the pain and the occurrence of cardiovascular and cerebrovascular accidents in patients, and does not affect the patients' lower limb movement score.

Clinical efficacy of percutaneous transforaminal endoscopic discectomy treatment on patients with protrusion of lumbar intervertebral disc / 中国综合临床

Objective To explore clinical efficacy of percutaneous tiansforaminal endoscopic discectomy on postoperative complications of patients with the protrusion of lumbar intervertebral disc.Methods Sixty cases of lumbar protrusion of the intervertebral disc were selected as our subjects from Nov.2012 to Nov.2013 who were hospitalized in the Seven People's Hospital of Zibo.Of which,30 cases were preformed lumbar protrusion of the intervertebral disc through transforaminal endoscopic treatment.Another 30 case were with small incision fenestration laminectomy discectomy.The information of hospitalized periods,bleeding volume,operation incision length and periods within the bed were collected.Visual analogue scale (VAS) was performed at postoperative 24,48 h.The Oswestry disability index (ODI) was applied to evaluated the daily life ability assessment of patients before surgery,1 month and 6 months after surgery.Results The incision length,intraoperative bleeding volume,postoperative bed and hospitalization periods in patients with transforaminal endoscopic treatment were ((0.7 ± 0.2) cm,(11.6 ± 2.2) ml,(27.5 ± 8.2) d,(3.3 ± 1.1) d respectively,less than that in patients with small incision fenestration laminectomy discectomy ((4.9 ± 0.2) cm,(102.9 ±16.3) ml,(94.1 ±19.7) d,(8.3 ±2.1) d).The differences were significant (t =81.332,30.403,17.095 and 11.552;P＜0.05).VAS in patients with transforaminal endoscopic treatment and in patients with small incision fenestration laminectomy discectomy were (3.7 ± 1.2) and (6.8 ± 1.9),(2.1 ± 1.1) and (5.3 ±1.6),(1.4 ±0.9) and (4.4 ± 1.5) respectively,and the differences were significant(t =7.555,9.026,9.393 ; P ＜ 0.05).The ODI in patients with transforaminal endoscopic treatment at 1 and 6 months after surgery were 12.1 ± 4.7 and 18.6 ± 3.6,higher than that in patients with small incision fenestration laminectomy discectomy(5.4 ± 2.3,13.2 ± 2.7),and the differences were significant (t =6.013,12.045 ; P ＜ 0.05).Conclusion Lumbar percutaneous transforaminal endoscopic discectomy is with obvious superiority than the method of small incision fenestration laminectomy discectomy in terms of the operation incision,intraoperative bleeding volume,postoperative bed and hospitalization time.Meanwhile,it shows the less damage to the spinal stability structure,and quick recovery.

A Case-control Study about the Pain in the Patients with Protrusion of Lumbar Intervertebral Disc / 中国医师杂志

Objective To assess the intensity of the pain and its negative impact on patients with protrusion of lumbar intervertebral disc (PLID) through using a case-control study. Methods 94 patients with PLID and 398 control individuals were enrolled in this study. The pains were assessed using McGill questionnaire. Results The sensory pain score(5.22?2.22), affective pain score (2.68?0.81)and VAS score (7.79?1.42)in the patient group were significantly higher than those in the control group (P