Objective To retrospectively study the surgical strategy and clinical outcomes of percutaneous endoscopic interlaminar discectomy for L5-S1disc herniation under local anesthesia. Method 56 cases of L5-S1disc herniation were treated percutaneous endoscopic interlaminar discectomy under local anesthesia between 2015.1 to 2017.1. There were 32 males and 24 females, average age (39.9±11.7) years, and duration of disease (7.4±5.6) months. 17 cases were shoulder type of disc herniation, 23 cases were axillary type of disc herniation, and 16 cases were free herniation. The visual analogue scale (VAS), Oswestry disability index (ODI) score and modified MacNab efficacy evaluation criteria were used to evaluate the surgical outcome. Result All surgeries were completed without converting to other surgical techniques. The average X ray exposure was (4.6±1.1) times and operation time was (39.3±9.5) min. 4 cases complained posterior neck pain during operation, and recovered well for further raising head and lower infusion pressure. All cases had obvious relief of leg and low back pain after operation, no infection, epidural and nerve root injury occurred. 4 cases were not satisfied with the surgical and nerve nutritional treatment with residual lower limb numbness. 1 reoccurrence case was revised with same surgical technique and recovered well at end of follow-up. The VAS and ODI for low back pain and sciatica were significantly decreased at 3 months of post-operation compared with before surgery (P＜0.05). The MacNab scores at the end follow-up included 37 excellent, 15 good, 3 fair, and 1 poor results. Conclusion Percutaneous endoscopic interlaminar discectomy for L5-S1disc herniation under local anesthesia with characteristic of minimally trauma, less explosion to X-ray, and quickly recovery after operation, which is an effective and safety surgical technique for L5-S1disc herniation.%目的 探讨局麻经椎板间孔入路脊柱内窥镜下L5-S1椎间盘切除术的手术技巧及临床疗效.方法 选择2015年1月至2017年1月在本院确诊并采用局麻经椎板间孔入路脊柱内窥镜下手术治疗的L5-S1椎间盘突出症患者56例,其中男32例,女24例;年龄19～75岁,平均(39.9±11.7)岁;病程2～22个月,平均(7.4±5.6)个月;肩上型突出17例,腋下型突出23例,游离型突出16例.分别采用疼痛视觉模拟评分(visual analogue scale,VAS)、Oswestry功能障碍指数(Oswestry disability index,ODI)评分、改良MacNab疗效评定标准评价其手术效果.结果 56例患者均顺利完成手术,手术时间(39.3±9.5)分钟,术中C型臂透视(4.6±1.1)次.4例患者术中出现颈部疼痛,给予抬高头部、降低灌注压治疗后疼痛消失.术后所有患者腰腿痛均有明显缓解,无感染或硬脊膜、神经根损伤发生;术后12例残留下肢麻木,其中4例给予营养神经治疗效果欠佳;1例术后复发,再次行局麻下经椎板间孔内窥镜下髓核摘除术后症状缓解.本组患者术后3个月腰腿痛VAS评分、ODI指数评分较术前明显降低,差异有显著性(P＜0.05).末次随访时根据改良MacNab标准评价疗效,优37例,良15例,中3例,差1例,优良率92.8%.结论 局麻经椎板间孔入路脊柱内窥镜下L5-S1椎间盘切除术具有创伤小、术中透视次数少、术后恢复快等优点,是L5-S1椎间盘突出症安全有效的治疗方法.
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