1.1 Design: Retrospective comparative test
1.2 Time and place: The test was completed in the Spinal Surgery Department of the Sixth Affiliated Hospital of Xinjiang Medical University in January 2023 to May 2023.Tis is a retrospective study approved by the Ethics Committee of the Sixth Afliated Hospital of Xin
jiang Medical University, ethical approval number LFYLLSC20230713-01. All of the study subjects signed the informed consent form.
1.3 Inclusion criteria ① The Minimally Invasive Spinal Surgery Department of the Sixth
Affiliated Hospital of Xinjiang Medical University was admitted to hospital from January 2023 to May 2023.② Patients with single-segment lumbar disc herniation have clinical symptoms and signs consistent with imaging results.③ After evaluation by the anesthesiologist, the general anesthesia patient can be tolerated.④ Data and follow-up results are complete.
1.4 Exclusion criteria ① Degenerative scoliosis requires surgery in patients.②
spondylolisthesis or unstable segments require fusion surgery.③ Other spinal diseases, such as ankylosing spondylitis, spinal tumors, tuberculosis, etc.④ Patients with a history of lumbar spine surgery.
Table 1 Disposable RF plasma surgical electrode (blade)
1.6 General information
① Medical records of patients undergoing percutaneous forforamen ectomy of Xinjiang Medical University from January 2023 to May 2023 were collected. A total of 87 cases were collected for retrospective study. Patients were divided into two groups according to the anesthesia method. Two groups were 1) general anesthesia group (n=52) and 2) epidural group (n=35). The general anesthesia group included 52 patients (35 males and 17 females), with a mean age of 53.78 ± 14.90 years. (Detailed age distribution, see Fig. 1)。The epidural group included 35 patients (21 males and 14 females), with a mean age of 49.42 ± 14.63 years. Previous conditions included hypertension (28), diabetes (15), coronary heart disease (9), neurological (3), respiratory (1), endocrine (4) and systemic (1). General data of the two groups include: gender, age, body mass index (BMI), operation time, intraoperative bleeding, postoperative hospitalization, surgical section, previous basic medical history, duration, smoking history, drinking history, waist operating room, hospital costs, surgery satisfaction, Macnab satisfaction and VAS score (preoperative, 1 days, 3 days, 7 days and January).
1.7 Procedure and anesthesia method
1.7.1 Preoperative preparation: Before endoscopic treatment, X-ray, CT, MRI, routine blood routine, liver and kidney function, and evaluation of patients' condition.
1.7.2 Anesthetic protocol
In both groups, venous access was established in the upper limbs to monitor vital signs, such as respiration, blood pressure and heart rate.
(1)Epidural anesthesia group:The patient took the left side decubitus position, bowed down, bent, and held the side leg, taking the L2-3 gap as the puncture point. After successful puncture to the epidural cavity, the epidural catheter was inserted into the tip. After confirming the position, the catheter was fixed.The first dose of 0.33% ropivacaine (Ruiyang Pharmaceutical Co., LTD., National drug approved H20183152, specification: 10ml: 100mg) was 5 mL and observed for 5 min. After the patient had anesthesia plane and no adverse reactions such as local anesthetic poisoning or abnormal extensive block, 0.33% ropivacaine 10 mL was added to the epidural catheter until the anesthesia plane reached T8 level, the effect was perfect and the operation was started.
(2)General anesthesia group:Under general anesthesia under rapidly induced endotracheal intubation, mask oxygen for the following drugs: sufentanyl0.3μg/kg (5mg, Yichang Renfu Pharmaceutical Co., LTD., H20030200), propofol 2.5mg/kg(50ml:0.5g, Sichuan Guorui Pharmaceutical Co., LTD., H20030114), roocuronium 0.7mg / kg (100ml, Sichuan Kelun Pharmaceutical Co., LTD., H51021156). After drug initiation, endotracheal intubation was performed, and after confirming the position of the catheter, the catheter was fixed and mechanical ventilation was performed. Intraoperative anesthesia maintenance was performed with intravenous pump propofol and inhaled sevoflurane anesthesia (adjusting the dose according to the depth of anesthesia), and sufentanyl and rocuronium were added intermittently according to the situation.
1.7.3 Surgical protocol for endoscopic percutaneous foraminal disc removal
After the patient's anesthesia takes effect, The patient was placed in the prone position, Perspective positioning of the waist responsibility stage gap, Use a marker on the spike, The puncture point is 8cm beside the gap of the upper iliac spine, Routine disinfection laying, First with needle abduction and head tilt Angle, To alize the tip of the upper lumbar spine in the responsibility phase space, Refluoroscopy confirmed needle abduction, Head-tilt angle position, Position is satisfactory, The guide wire expansion and fixed step by step, The anterior perspective socket is positioned at the pedicle line, Orthotopic is the internal lateral wall of the pedicle of the responsibility stage, The side is located at the posterior edge of the pushing disc at the base of the pedicle foundation, The working channel sliding mode is fixed in the foramamen, Formation of two upper lumbar articular processes with a trephine, Using a trepher to remove the ventral sides of two lumbar arthroprocesses, The decompression side recess, Endoscopic hemostasis using a radiofrequency ablation blade, Forming the ring with the FA blade, Rotate the working channel, The forceps to clean and decompress surrounding tissue and some articular bony tissue, Visible organization of the exuded nucleus pulposus, Deprolapse of nucleus pulposus tissue from the responsible stage disc was removed by forceps respectively, Some resection of the posterior longitudinal ligament and the protruding pushing disc tissue, The removed tissue was sent for medical examination, Ablating the residual disc with an RF ablation blade, Another exploration of the walking nerve roots, Clear nerve root release, Reexploration for strict hemostasis, After washing, After the correct counting, The surgical incision was closed layer by layer, Fascia and subcutaneous and skin with absorbable suture, Incision dressing dressing and fixation, Corresponding indexes such as operation time and intraoperative bleeding volume were recorded in time.(Disposable RF plasma surgical electrode detailed information ,See Table 1)
1.8 Postoperative management:① Strict postoperative bed rest, ECG monitoring, finger pulse oxygen monitoring, oxygen inhalation, closely observe the patient's condition changes, turn over the axis, avoid falling into bed, active activity of both lower limbs, to avoid deep vein thrombosis.② Blood routine, liver and kidney function and coagulation function were checked regularly to monitor the changes of internal environment.③ After the time according to the recovery of the patient, the time to guide the patient activities.④ After regular dressing change and observe the recovery of surgical incision. According to the healing of the 7th day, and discharged after complete healing of infection and hematoma incision.⑤ All patients were routinely given 5% glucose injection (500 mL: 25mg, Sichuan Kelun Pharmaceutical Co., Ltd.) + Sodium lactate Ringer injection (500 mL, Xinjiang Huashidan Pharmaceutical Co., Ltd.) to supplement blood volume and maintain electrolyte balance. If patients with postoperative pain discomfort, relying on examination tablets (Chengdu Yuandong biological pharmaceutical Co., LTD., the approved H20193304) oral, if necessary to 0.9% sodium chloride injection (100ml, Sichuan London pharmaceutical Co., LTD., the approved H51021156) + paxib sodium (20mg, Hunan London pharmaceutical Co., LTD., the approved H20173309) static drops relieve pain.
1.9 Evaluation index:Patient gender, age, body mass index (BMI), operation time, intraoperative bleeding, postoperative hospitalization, surgical segment, previous basic medical history, duration, smoking history, drinking history, previous lumbar surgery, hospital cost, surgery satisfaction, Macnab satisfaction and VAS score (preoperative, 1 day, 3 days, 7 days and January).
1.10 Statistical Methods: Data analysis was performed using the SPSS 26.0 statistical software. Quantitative data are described by the mean ± standard deviation (X ± S), and qualitative data are represented by the number of cases. Comparison of the quantitative data was performed using the independent samples t-test. For cases not eligible for t-test, rank sum test was used. Comparison of the qualitative data was performed using the χ2 test. P <of 0.05 was considered as statistically significant.