Lumbar disc herniation refers to the rupture of the fibrous ring of the lumbar intervertebral disc, and the nucleus pulposus within it, together with the remaining fibrous ring and the posterior longitudinal ligament tissue covering the ring, protrudes into the spinal canal or the posterior side of the disc, compressing the nearby spinal nerve. Clinical manifestations Low back pain and radiating lower limb pain are the main symptoms, most of which are preceded by low back pain and followed by leg pain, or there are only leg pain without low back disease. It is often a stabbing canker, burning-like pain or knife-cutting disease, accompanied by numbness and account feeling. The lighter ones can insist on working, but cannot engage in labor; the heavier ones have unbearable pain and are bedridden, and even taking painkillers cannot relieve them. The pain seat has the following characteristics: 1. Lower limb canker sores radiate along the nerves Pain generally radiates along the buttocks, the back of the thigh to the calf or foot, and may also radiate along the front side of the thigh to the front inner side of the calf. 2.Pain is related to abdominal pressure All factors that increase amine pressure and cerebrospinal fluid pressure, such as coughing, sneezing, row making, laughing or loud talking, can cause increased lumbar and leg pain. 3, pain and activity, position related General talk or exertion after aggravation, bed rest to reduce; a day in the morning light, heavy in the afternoon; long duration of the disease has intermittent period, pain and position related, in order to reduce pain, the patient is often forced to take a particular position, such as bending hip and knee side, a few people forced to squat position, or bending hip and knee kneeling bed, etc.. There are also cases of acute and persistent severe pain, and no position can reduce the symptoms. Psychological guidance Patients are afraid of unsatisfactory results and pain after surgery, and are worried about paralysis due to surgery, so they are prone to fear, anxiety, pessimism and other psychological reactions. (2) Ask patients who have undergone surgery and have satisfactory results to communicate with them about the absence of pain during surgery, the duration of postoperative pain and methods of pain relief and precautions, so that patients can be fully prepared psychologically and cooperate with treatment. (3) Explain the relationship between emotion and disease, and explain that a good psychological state will promote the recovery and healing of the organism, otherwise the opposite, in order to obtain a positive and optimistic attitude of cooperation from the patient. (4) Introduce the skills of the surgeon and the quality of the team service, so that the patient can eliminate concerns and actively cooperate with the surgery. Dietary guidance 1. Before surgery, protein should be supplemented appropriately, about 100-150 grams per day. Try to choose foods rich in high quality protein, such as fresh milk and milk products (older patients are better off with nonfat fresh milk or milk powder), eggs, soybean powder, animal’s liver and kidney, lean meat, fish, chicken, etc. 6 meals per day. The night before surgery (if you do not have diabetes) you can eat more fat-free sweets. The arrangement of the recipe should be arranged to add 1 part of whole or nonfat milk, 1 to 2 parts of yogurt, 1 egg, an appropriate amount of soybean powder or 1 part of tofu, and an appropriate amount of animal liver or kidney to the original diet. 2.After the surgery, when you can eat, first of all, mainly vegetables and fruits, vegetables cooked with a little salt and oil, eat vegetables and drink soup; drink more fresh juice. Pay attention to protein supplementation, preferably with milk, egg yolk, yogurt, etc. Drink less tea and coffee. If you lose too much blood during the operation, add a little animal liver, blood products and tofu to your diet. In addition, pay attention to eating less and more meals (more than 6 meals per day). 3. During the recovery period: pay attention to the supplementation of calcium, magnesium, vitamin D and vitamin B group, etc. Calcium-rich foods such as milk, beans, small shrimps, kelp, etc., more fresh fruits and vegetables, appropriate supplementation of animal liver, diversification of diet, less cola-type drinks. If the diet is low, you can take some nutritional supplements appropriately. 4.Patients should eat more fiber-rich foods such as celery, fungus, bamboo shoots, apples and bananas before surgery, after surgery and during the recovery period to keep the bowels open. If the stool is not smooth, you can drink light honey water or light salt water in the morning. Rest and activity guidance 1. Pre-operative guidance (1) Rest in a hard bed, you can turn over in bed. (2) Prone position training: prone for half an hour on the first day, increasing day by day, to be able to stay prone for 2 hours within 2-3 days. (3) Practice the ability to urinate and defecate in the prone position and self-care in the prone position. 2, post-surgery guidance (1) rest: patients undergoing intervertebral discoscopy need to be bedridden for 3 weeks; patients undergoing simple nucleus pulposus removal are bedridden for 2 weeks; patients undergoing internal fixation surgery are bedridden under the guidance of physicians, and are protected by lumbar brace or lumbar girth to get out of bed 3 to 5 days after surgery; in addition, for patients with complex surgery, more gaps explored or total lamina decompression, the bedridden time is appropriately extended under the guidance of physicians . Axial turning can be performed during bed rest. (2) Straight leg elevation exercises: straight leg elevation exercises from the first postoperative day, starting with elevation of 20 to 30 degrees, and then gradually elevating to 30 to 50 degrees, and after 3 days the patient’s independent straight leg elevation reaches 70 to 90 degrees, which can effectively prevent nerve root adhesions. Exercise method: the body lies flat, both legs are straight, the helper lifts the patient’s lower limbs with his hands, gradually raises the height of the leg lift, and teaches the patient to master the method of leg lift by himself, so that he can perform active exercises, 2-3 groups/day, 5, 30 times/group, alternating legs. (3) lumbar back muscle exercise: lumbar back muscle exercise can improve muscle strength and enhance the stability of the spine. Therefore, one week after surgery should start lumbar back muscle level refining, adhere to the daily exercise 3 to 4 times, gradually, gradually increase the number of times, exercise time should be more than six months. The exercise should be terminated when the symptoms are aggravated after the exercise. Such as internal fixation implantation, infectious diseases, old and weak people are not suitable. Swallow point water method is appropriate, swallow point water method: that is, sleep on the bed so that the body rest in a prone position, hands back, the upper body and legs backward lift, adhere to 3-5 minutes to restore the action, each time repeat 10 times. Medication guidance 1, preventive antibacterial drug application. 2.Application of calcium supplementation drugs, Calcium D, Icariin, etc. 3.The application of pain medication: such as Ciloxib, etoricoxib, etc. Common complications prevention nursing guidance 1. Risk of wound infection (1) Keep all kinds of tubes open and drainage tubes below the wound site. (2) Closely monitor the change of body temperature. 2. There is a possibility of nerve root adhesions Early postoperative straight leg raising exercises are an effective measure to prevent nerve root adhesions. (1) Instruct the patient to do straight leg elevation on the first day of postoperative examination, starting from 30° and increasing the magnitude day by day. (2) After the 3rd day, encourage the patient to take the initiative to do straight leg elevation and do passive activities such as knee and hip compression with the assistance of nursing staff. (3) There is a possibility of muscle atrophy (1) During the early postoperative bed rest period, limb activities and functional exercises should be insisted on, such as chest expansion and deep breathing, which can increase lung capacity, promote gas exchange and prevent pulmonary complications; abdominal massage can enhance abdominal muscle strength, reduce abdominal distension, constipation and urinary retention. Foot and ankle, knee joint activities can avoid affecting the future walking on the ground. (2) Start low back exercise 1 week after surgery to improve the strength of low back muscles and enhance spinal stability. The exercise method can be used first with the flying swallow and then with the five-point support method. (4) Risk of decubitus ulcers (1) Exercise deep breathing before surgery, and strengthen respiratory exercise and improve inspiratory function after surgery to make the lungs expand. (2) Active control of respiratory infectious diseases before surgery, avoid smoking for 1-2 weeks before surgery for smoking patients, and pay attention to oral hygiene. (3) Effective coughing: change the position and pat the patient’s back with the palm of your hand to help the patient cough to help eliminate bronchial secretions. (4) Prevent aspiration of postoperative vomitus. (5) If the sputum is sticky and not easy to be coughed out, take oral amyl chloride, Bisopin and other expectorants, or perform ultrasonic nebulized inhalation. 5, there is a possibility of cerebrospinal fluid leakage after surgery should be closely observed the amount, color and nature of the wound drainage fluid, such as from dark red bloody fluid to light red or yellow cool liquid, should be alert to the occurrence of cerebrospinal fluid leakage, immediately notify the doctor, and give the patient to the pillow lying position. The drainage device is changed to positive pressure drainage. If the patient has symptoms of dizziness, nausea and vomiting, elevate the end of the bed by 30~45 degrees, give a head-low-foot-high position, input balanced fluid and apply antibiotics to prevent infection as prescribed by the doctor, supplement albumin, and prevent coughing and coughing to avoid increasing the outflow of cerebrospinal fluid. Examination guidance 1.Neurological examination, including: electromyography, various physiological reflexes and abnormalities of sensation. 2.Lateral and frontal X-ray of lumbar spine: mainly to exclude lesions other than disc herniation, such as tumor and tuberculosis, etc. 3.CT or magnetic resonance imaging (MRl) examination of the lumbar spine is a good method for diagnosis and localization. Discharge instruction 1. Instruct the patient on the correct method of getting out of bed (1) Roll the body and trunk consistently to the side of the bed. (2) Start to raise the head of the bed. (3) Use the upper body to support the upper body. (4) Sit on the side of the bed and place the feet on the floor. (5) Use leg muscle contraction to make the body return to the bed from sitting to standing position with the opposite procedure. 2. Instruct the patient to avoid bending movements in daily life. (1) Bend the hips and knees to squat and straighten the back to complete the movement. (2) Under the guidance of the physician, the patient can bring the waist brace to the floor. (3) Continue functional exercise of the low back muscles. (4) No weight-bearing on the low back for six months. (5) Follow the doctor’s instructions to follow-up at the surgery hospital after discharge.