Application Of Surgical Planning Combined With Mixed Reality In Percutaneous Transforaminal Endoscopic Discectomy

Background:Accurate puncture is the core step of percutaneous transforaminal endoscopic discectomy(PTED).Due to the lack of clinical experience and good spatial imagination,it is difficult for beginners to perform puncture.Repeated puncture will lead to prolonged operation time,increased X-ray radiation exposure and increased risk of dural sac and nerve root injury.In recent years,mixed reality(MR)has been applied to various disciplines,which show great advantages in the fields of medical education,surgical planning,intraoperative guidance,and surgical navigation.The MR provides a new direction for surgeons to make personalized surgery design,to improve the accuracy of surgery,and to shorten the operation time and the learning curve.In this study,we aimed to explore the effect of MR in the surgical planning of PTED through clinical application.Methods:A total of 40 patients were included in this study from June 2020 to October 2020.The patients included in the study were randomly divided into the experimental group(n=20)and control group(n=20).All patients were treated by percutaneous transforaminal endoscopic discectomy in our hospital.In the experimental group,the holographic model of surgery design was constructed by mixed reality.Then,the surgeon performed PTED according to the surgical planning.In the control group,PTED was performed with the traditional empirical method by the surgeon.The data of the puncture time,operation time,frequency of puncture,frequency of X-ray fluoroscopy,clinical curative effect and complications of the two groups were recorded and analyzed.Results:No significant difference was found between the two groups in general data and preoperative Visual analogue scale(VAS)and Oswestry disability index(ODI)(P>0.05).There were no complications such as hematoma,infection and nerve injury in the both groups.Compared with the control group,the experimental group could effectively shorten the puncture time and operation time,and reduce the frequency of intraoperative puncture and X-ray fluoroscopy(P<0.05).In addition,the postoperative VAS and ODI scores of the two groups were improved compared with those before operation(P<0.05).There was no significant difference in VAS,ODI scores and modified Macnab evaluation criteria between the two groups(P>0.05).Conclusion:The surgical planning assisted with mixed reality could effectively guide surgeons to carry out the puncture of PTED.In addition,it effectively shortened the puncture time and operation time,and reduced the frequency of the intraoperative puncture and X-ray fluoroscopy.In terms of clinical outcomes,the short-term clinical effects of the two groups were comparable.The surgical planning with mixed reality was safe and effective.The application of mixed reality in surgical planning of PTED provided a new idea for surgeons to reduce the difficulty of puncture.