| BackgroundPercutaneous endoscopic lumbar discectomy(PELD)technique is an assistive technique for minimally invasive spinal surgery,due to the advantages of less trauma,less postoperative pain,fewer complications and faster recovery,it has become a routine operation for the treatment of lumbar disc herniation.But the procedure still has a high learning curve.The general steps of PELD include localization of puncture,expansion of soft tissue,intervertebral foraminoplasty,placement of work channels and endoscopic removal of diseased tissue,puncture and placement of the working channel is the first step and also the key step of successful operation.These operations are performed by hand under X-ray with good three-dimensional imagination and puncture operation experience.For beginners and experienced surgeons,placing the work channel in the area of a herniated disc(targeted channel establishment)often requires repeated punctures.In order to reduce the complications caused by repeated puncture,the longer operation time and the number of fluoroscopy,the purpose of this study is to adjust the working channel to the target point by using the designed eccentric guiding instruments when the puncture is not completely satisfactory,and explore its application effect through clinical researchObjectiveTo develop an eccentric guiding instruments which conforms to the existing instrument parameters and has the ability of eccentric adjustment;To study the clinical application effect of PELD by using the eccentric guiding instruments for working channel establishment comparing with traditional method through clinical randomized controlled study.MethodsDevice development:to measure the parameters of the fourth-stage guiding rod or guiding tube in the TESSYS surgical system,and to design the Guiding rod which can be eccentrically adjusted in coordination with the Crown reamer.The guiding rod was made by Shandong Weigao Orthopedic Device Company after CAD drawing.The data of 52 patients with single segmental lumbar disc herniation(LDH)were recorded in the General Hospital of Central Theatre Command from November 2018 to December 2019,52 cases with LDH were randomly divided into eccentric guiding group and and traditional TESSYS technology group by random number table,25 patients underwent targeted channel establishment using a designed eccentric guiding instruments,27 patients underwent targeted puncture and channel establishment using traditional TESSYS technology.Both groups were performed by the same doctor.The punctured times,punctured and channel establishment time,fluoroscopy times,the total operation time and complications related to puncture and channel establishment were compared between two groups.Visual analogue scale and,Oswestry disability index were applied to evaluate clinical functional recovery.The modified MacNab criteria were used to evaluate the patients' post-operative satisfactory.ResultsA kind of eccentric guiding instruments was successfully made,which can replace the original four-stage guiding rod to complete the operation successfully;There were statistically significant differences in punctured times,punctured and channel establishment,fluoroscopy times and the total operation time between the two groups(P<0.05),and the eccentric guiding group was superior to the traditional method group in all indicators.There was no significant difference between VAS,ODI and the modified MacNab score(P>0.05).ConclusionThe eccentric guiding instruments can successfully complete the operation without adding additional surgical auxiliary instruments,which has a good clinical effect Meanwhile,it can reduce the number of puncture,radiation exposure and related complications caused by repeated puncture,which can improve the efficiency of targeted working tube establishment to a certain extent. |
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