Zhang Liyan, Zhang Xifeng, Xiao Songhua, Liu Zhengsheng, Liu Baowei, Zhang Yonggang
Department of Orthopedics, Hospital Affiliated Beihua University, Jilin Jilin 132011, PR China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2011 Oct;25(10):1164-7.
To evaluate the effectiveness of interrupt percutaneous endoscopy lumbar discectomy (PELD) through interlaminar approach for L5, S1 disc protrusion.
Between November 2006 and August 2010, 115 patients with L5, S1 disc protrusion were treated, including 79 males and 36 females with an average age of 38 years (range, 14-79 years). All patients showed the dominated symptom of the S1 nerve root. The working channel was established by puncturing through interlaminar approach under the local anesthesia. After the needle was used to make sure no nerve root or dural sac on working face, the disc tissue was excised directly by blind sight. Then the nerve root decompression was observed through the endoscope. In patients with free type, fragment compression was observed through the endoscope, and the disc tissue around the nerve roots was removed, then the free disc tissue around intervertebral space was excised.
One patient who failed to puncture changed to miniopen discectomy; 3 patients who failed changed to post lateral approach; and the others underwent interrupt PELD through interlaminar approach. Eighty patients were followed up 18 months on average (range, 12-36 months). The average Oswestry Disability Index (ODI) was reduced to 13% +/- 5% at 12 months after operation and to 12% +/- 8% at last follow-up from 73% +/- 12% at preoperation, showing significant differences (P < 0.01). According to modified Macnab's criterion, the results were excellent in 59 cases, good in 15 cases, fair in 3 cases, and poor in 3 cases at last follow-up, and the excellent and good rate was 92.5%.
For the treatment of disc protrusion at the L5, S1 level, interrupt PELD through interlaminar approach should be ideal with short operation time, small trauma, and quick recovery.
评估经椎板间隙入路间断式经皮内镜下腰椎间盘切除术（PELD）治疗L5、S1椎间盘突出症的有效性。
2006年11月至2010年8月，对115例L5、S1椎间盘突出症患者进行治疗，其中男性79例，女性36例，平均年龄38岁（14 - 79岁）。所有患者均以S1神经根支配症状为主。在局部麻醉下经椎板间隙入路穿刺建立工作通道。穿刺针确认工作面上无神经根或硬膜囊后，直视下直接切除椎间盘组织。然后通过内镜观察神经根减压情况。对于游离型患者，通过内镜观察碎块压迫情况，切除神经根周围的椎间盘组织，再切除椎间隙周围的游离椎间盘组织。
1例穿刺失败患者改行小切口椎间盘切除术；3例失败患者改行后外侧入路；其余患者行经椎板间隙入路间断式PELD。80例患者平均随访18个月（12 - 36个月）。术前Oswestry功能障碍指数（ODI）平均为73%±12%，术后12个月降至13%±5%，末次随访时降至12%±8%，差异有统计学意义（P < 0.01）。根据改良Macnab标准，末次随访时优59例，良15例，可3例，差3例，优良率为92.5%。
对于L5、S1节段椎间盘突出症的治疗，经椎板间隙入路间断式PELD手术时间短、创伤小、恢复快，应为理想术式。
