Development And Application Of Individualized Preoperative Design Combined With Localization Puncture Guide In Percutaneous Endoscopic Lumbar Discectomy

Objective:To explore a simple and practical method to reduce the difficulty of puncture and the Times of fluoroscopy in the operation of intervertebral Foramina.Method:1.Design and measurement of puncture routes on orthophotos,lateral radiographs,and CT or MRI cross-section images of patients undergoing Percutaneous Endoscopic Lumbar Discectomy(PELD),the obliquity of the head,the distance of side opening,the angle and the depth of the needle insertion were calculated by transforming the measured data into geometric figures and editing formulas in Excel.2.The 3D drawing of UG software is used to design the location puncture guide device,and the device is made by the method of instrument manufacture.3.Volunteers were recruited to carry out CT thin-layer scanning to obtain the image data in DICOM format of L2-S5 segments,and the three-dimensional reconstruction of bone-muscle tissue was carried out under the E3 D digital medical modeling software,and the working channel was modeled by CAD,according to the data measured before individual operation,define the space position of the channel,simulate the operation puncture,observe the position and adjacent of the channel through 360 rotation model and rolling layer,and discuss the safety of the individual preoperative design method.4.A total of 150 patients scheduled to undergo PELD surgery in Loudi Central Hospital were assigned according to the time sequence.The patients were divided into a routine Group A,pre-operative design Group B,and pre-operative design Group C,the preoperative,intraoperative and postoperative data of three groups were collected and compared.The incidence of PELD complications were recorded.The results were evaluated by modified MacNab score at the last follow-up.Result:1.A method of individualized preoperative design for Percutaneous Endoscopic Lumbar Discectomy is presented.2.The invention relates to a positioning puncture guide used in the operation of Intervertebral Foramina,and the invention patent column of the State Intellectual Property Office discloses the design,manufacture and use method of the positioning puncture guide.3.The L3/4,L4/5,L5/S1 segments and the left and right sides of the 3 volunteers were punctured 18 times,and the end points of the punctures could reach the designed target.4.50 cases in A,B and C groups.The average age of the three groups was(49.70±12.10 y),the preoperative VAS score was(49.70±12.10).there was no significant difference in preoperative data among the three groups(age,sex,body mass index,preoperative VAS score)(p>0.05).The times of intraoperative fluoroscopy were(9.48±4.05),(5.90±1.56)in Group A and B,(1.14±0.35)in Group C;The times of fluoroscopy were(9.48±4.05),(5.90±1.56)in Group A and B,(4.12±1.02)in Group C;The time of puncture in Group A,B and C is(26.14 ± 6.03),(19.00 ±3.01)and(14.74±1.94)min.There were significant differences in the times of fluoroscopy and the time of puncture among the three groups(p<0.05).Compared with group A,the times of fluoroscopy in Group B was reduced by 3.5 times and the time of puncture was shortened by 7.1 minutes,the times of location perspective in Group C was reduced by 3.4 times,the times of general perspective was reduced by 8.5 times and there were 11.3 minutes less in puncture time.The three groups had(4.52±1.45 day)in hospital and(30.57±19.27 ml)of wound drainage in 24 hours after operation(p>0.05).5.In 150 cases,open operation was performed in 0 cases,postoperative intervertebral space infection in 0 cases,head and neck pain in 4 cases,dural tear in 2 cases and nerve injury in 1 case,there was no significant difference in the complications among the three groups(p>0.05).6.A total of 137 patients were followed up for 4-15 months(8.4 months on average).Among them,108,17,9 and 3 was scored excellent,good,medium and poor respectively.There was no significant difference in MacNab score among the three groups(p>0.05).The excellent and good rates of MacNab score were 91.2%(125/137).Conclusion:The method of individualized pre-operative planning can achieve safe and accurate puncture route planning,and the guidance device has dual functions of localization and assistant puncture,which is simple and practical.The application of individualized preoperative design can reduce the times of fluoroscopy and the time of puncture,but the effect of combined guidance device is better.