Clinical data of 1
1. 1 Efficacy criteria The efficacy criteria refer to Macanab four-level evaluation criteria. Excellent: the pain disappears, there is no restriction on motor function, and the work and life are normal; Good: occasional pain, able to engage in lighter work and activities; Ke: The pain has eased, and I can't work and move normally; Poor: the same manifestations still exist before operation, and further operation is needed.
1.2 case data 1000 patients in this group, including 663 males and 337 females, aged 18 ~ 75 years old. 1000 patients were followed up for 3 months with an average of 15.5 months (3 ~ 28 months).
1.3 The follow-up results showed that the curative effect was excellent in 450 points, good in 406 points, fair in 96 points and poor in 48 points, and the excellent and good rate was 85.6%.
2 nursing
2. 1 Do targeted psychological care. Lumbar disc herniation is a common clinical disease [1] and frequently-occurring disease with great pain, which affects normal work and life. Most of these patients have anxiety, fear of recurrence, fear of paralysis, fear of family career being affected and so on. Their psychological burden is heavy. Traditional surgical methods are not easy for patients to accept because of the high risk. When PLD is an advanced treatment method with little pain and high curative effect, the expectation of surgical effect is often too high. If we can't guide this kind of psychology correctly, it will sometimes turn into a negative mentality that is not conducive to the recovery after PLD. Therefore, it is very important to carry out patient and meticulous health education before operation. Through pictures and models, the principle, curative effect and possible discomfort of PLD are introduced in detail and objectively, so that patients can correctly understand PLD and actively cooperate with treatment and nursing.
2.2 Do a good job in postoperative care. Patients were required to lie flat for 4 hours after operation to avoid early internal bleeding and hematoma formation. Ask patients to avoid coughing and sneezing as much as possible, which may lead to a sudden increase in abdominal pressure. You can get out of bed for exercise 3 days after operation, emphasizing the gradual increase of activity.
2.3 Observe and care for complications. Pay attention to the patient's waist If you suddenly have unexplained spasmodic pain in your waist, accompanied by low fever and increased ESR, and your blood routine is generally normal, you can consider infection. Three cases of infection in this group were cured by the above treatment 10 day. After half a year's follow-up, the postoperative effect is good. If there is local swelling, tenderness, no fever and normal hemogram in a short time after operation, vascular injury should be considered to keep the drainage tube unobstructed, such as sympathetic response, which is related to the dysfunction of bladder sphincter caused by surgical stimulation of sympathetic response. Therefore, attention should be paid to the patient's urination within 24 hours after operation. In case of urinary retention, neostigmine injection or catheterization should be given according to the condition.
3 discharge guidance
PLD/KLOC-0 can be discharged after a week, but the recurrence rate of symptoms of disc herniation is 60% ~ 85% [2], which seriously affects work and life. Giving detailed discharge guidance to patients who are about to leave the hospital and teaching them to master the function of self-protection of lumbar spine and exercise methods will help reduce the recurrence rate and improve the quality of life.
3. 1 Self-protection in daily life In daily life, don't keep the lumbar spine in a posture for too long, whether standing or sitting, unless you lie down. You have to stand forward gently; Try to avoid bending for too long and lifting heavy objects. When picking up things from the ground, bend your knees first and then bend over. If the low back pain is serious, if you lie flat on a hard bed, you can put a small pillow on your waist to avoid hanging it on your waist. If it is acute low back pain, you can use an ice pack or a hot water bag (ice or hot water in a plastic or rubber bag) for local application. You can also use a hyperthermia instrument (such as Zhou Lin spectrometer or infrared lamp) for local hyperthermia, which can alleviate and relieve symptoms.
3.2 Self-exercise waist function Exercise back muscles and abdominal muscles to make them strong, which can reduce segmental instability caused by lumbar degeneration, thus alleviating symptoms. There are two ways to exercise back muscles. (1) Lie flat on the bed, bend your knees, put your feet on the bed, and then lift your hips hard, leaving the bed surface about 10cm. At this time, you will feel the strength of your back muscles. Hold for about 3 ~ 5 seconds and repeat 10 times. Do this three times a day. (2) Lie prone on the bed, put both upper limbs straight at the sides of your body, lift the upper body forcibly for about 10cm, and put it down for 3 ~ 5 seconds. Repeat this for 10 times, and do this three times a day; The exercise of abdominal muscles is to do sit-ups, 10 times each time, 3 times a day. Through the above exercise methods, patients can gain strong muscles to support and protect the lumbar spine, thus reducing the recurrence of lumbar disc herniation.