Application of CT 3D reconstruction technology and locator to improve the accuracy of percutaneous endoscopic operation
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摘要:
目的通过术前三维重建技术与体外穿刺定位器联合使用，判断是否能提高椎间孔镜侧入路椎间孔穿刺置管的准确性。 方法腰椎间盘突出患者分别置于定位器使用组12人和常规手术组10人，定位器使用组由经验丰富的熟练操作者穿刺置管者6人，由初学者穿刺置管者6人；常规手术组由熟练操作者和初学者操作各5人。镜下操作均由经验丰富的手术操作者进行。术中对比穿到达第一着陆点和第二着陆点的透视次数和透视时间。 结果常规手术组，初学者和熟练者第一着陆点操作时间分别为8.50±1.64、3.30±0.52 mins，透视次数18.50±2.35次、7.70±0.82次；第二着陆点时间分别9.80±2.79、3.70±1.03 mins，透视次数9.00±3.52次、4.70±2.07次。定位器使用组初学者、熟练者第一着陆点操作时间分别为3.00±0.71、2.60±0.55 mins，透视次数5.20±1.10次、4.80±1.10次；第二着陆点时间分别7.00±0.71、3.40±0.55 mins，透视次数6.40±0.89次、5.60±1.67次。 结论三维重建技术与穿刺定位器联合可减少椎间孔镜术中穿刺次数、缩短穿刺时间。 Abstract:ObjectiveTo determine the combined preoperative application of three-dimensional reconstruction technique with the percutaneous transforaminal puncture locator whether can improve the accuracy of lumbar disc removal operation. MethodsPatients with lumbar disc herniation were divided into 12 in the locator used groups and 10 in the conventional surgery groups. Six patients in the locator used groups were performed by experienced and skilled operators and 6 were performed by beginners. In the conventional surgery groups, 5 patients were performed by the beginners and 5 by experienced and skilled operators. During the operation, the number of perspectives and the perspective time of reaching the first landing point and the second landing point were compared. ResultsIn the conventional surgery groups, the first landing time of beginners and skilled persons were 8.50±1.64 and 3.30±0.52 mins, times of perspectives were 18.50±2.35 and 7.70±0.82. The second landing time were 9.80±2.79 and 3.70±1.03 mins. Times of perspectives were 9.00±3.52 and 4.70±2.07. The operation time of the first landing point of the locator used groups were 3.00±0.71 and 2.60±0.55 mins, and times of perspectives were 5.20±1.10 and 4.80±1.10. The second landing time were 7.00±0.71 and 3.40±0.55 mins. Times of perspectives were 6.40±0.89 and 5.60±1.67. ConclusionThe combination of three-dimensional reconstruction technique and puncture locator can reduce the number of punctures and shorten the puncture time during intervertebral foramen -
图 1 经皮腰椎间孔侧路镜穿刺定位器外观图
A:穿刺定位器整体外观察图; B:展开延长杆的定位器外观; C:穿刺定位器俯视图
Figure 1. Appearance of percutaneous transforaminal puncture locator
图 2 mimics软件进行术前测量操作图
A: mimics重建腰椎和椎间盘; B:模拟穿刺针穿刺方向和位置; C:包括皮肤显示的穿刺图像
Figure 2. Operation diagram of mimics software for preoperative measurement
图 3 患者检查和术前的体位照
A:患者术前检查俯卧体位; B:患者手术俯卧体位
Figure 3. Patient check-up and preoperative postures
表 1 椎间孔镜侧路椎间盘髓核摘除术各组操作时间及透视次数比较（Mean±SD)
Table 1. Comparison of operation time and fluoroscopy times in each group of intervertebral discectomy with foraminal lateral approach
组别 人员 第一着陆点 第二着陆点 操作时间(min) 透视次数(次) 操作时间(min) 透视次数(次) 常规手术组(n=5） 初学者 8.50±1.64 18.50±2.35 9.80±2.79 9.00±3.52 熟练者 3.30±0.52 7.70±0.82 3.70±1.03 4.70±2.07 定位器使用组(n=6） 初学者 3.00±0.71 5.20±1.10 7.00±0.71 6.40±0.89 熟练者 2.60±0.55 4.80±1.10 3.40±0.55 5.60±1.67 
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