Fan Guoxin, Guan Xiaofei, Zhang Hailong, Wu Xinbo, Gu Xin, Gu Guangfei, Fan Yunshan, He Shisheng
From the Orthopedic Department, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China.
Medicine (Baltimore). 2015 Dec;94(49):e2189. doi: 10.1097/MD.0000000000002189.
Prospective nonrandomized control study.The study aimed to investigate the implication of the HE's Lumbar LOcation (HELLO) system in improving the puncture accuracy and reducing fluoroscopy in percutaneous transforaminal endoscopic discectomy (PTED).Percutaneous transforaminal endoscopic discectomy is one of the most popular minimally invasive spine surgeries that heavily depend on repeated fluoroscopy. Increased fluoroscopy will induce higher radiation exposure to surgeons and patients. Accurate puncture in PTED can be achieved by accurate preoperative location and definite trajectory.The HELLO system mainly consists of self-made surface locator and puncture-assisted device. The surface locator was used to identify the exact puncture target and the puncture-assisted device was used to optimize the puncture trajectory. Patients who had single L4/5 or L5/S1 lumbar intervertebral disc herniation and underwent PTED were included the study. Patients receiving the HELLO system were assigned in Group A, and those taking conventional method were assigned in Group B. Study primary endpoint was puncture times and fluoroscopic times, and the secondary endpoint was location time and operation time.A total of 62 patients who received PTED were included in this study. The average age was 45.35 ± 8.70 years in Group A and 46.61 ± 7.84 years in Group B (P = 0.552). There were no significant differences in gender, body mass index, conservative time, and surgical segment between the 2 groups (P > 0.05). The puncture times were 1.19 ± 0.48 in Group A and 6.03 ± 1.87 in Group B (P < 0.001). The fluoroscopic times were 14.03 ± 2.54 in Group A and 25.19 ± 4.28 in Group B (P < 0.001). The preoperative location time was 4.67 ± 1.41 minutes in Group A and 6.98 ± 0.94 minutes in Group B (P < 0.001). The operation time was 79.42 ± 10.15 minutes in Group A and 89.65 ± 14.06 minutes in Group B (P = 0.002). The hospital stay was 2.77 ± 0.95 days in Group A and 2.87 ± 1.02 days in Group B (P = 0.702). There were no significant differences in the complication rate between the 2 groups (P = 0.386).The highlight of HELLO system is accurate preoperative location and definite trajectory. This preliminary report indicated that the HELLO system significantly improves the puncture accuracy of PTED and reduces the fluoroscopic times, preoperative location time, as well as operation time. (ChiCTR-ICR-15006730).
前瞻性非随机对照研究。本研究旨在探讨HE腰椎定位（HELLO）系统在提高经皮椎间孔镜下椎间盘切除术（PTED）穿刺准确性及减少透视次数方面的作用。经皮椎间孔镜下椎间盘切除术是最常用的微创脊柱手术之一，该手术严重依赖反复透视。增加透视次数会使术者和患者受到更高的辐射暴露。PTED手术中准确穿刺可通过术前精确定位和明确的穿刺路径来实现。HELLO系统主要由自制的体表定位器和穿刺辅助装置组成。体表定位器用于确定准确的穿刺靶点，穿刺辅助装置用于优化穿刺路径。纳入研究的患者为单节段L4/5或L5/S1腰椎间盘突出症并行PTED手术者。接受HELLO系统的患者被分配至A组，采用传统方法的患者被分配至B组。研究的主要终点是穿刺次数和透视次数，次要终点是定位时间和手术时间。本研究共纳入62例行PTED手术的患者。A组患者平均年龄为45.35±8.70岁，B组为46.61±7.84岁（P = 0.552）。两组患者在性别、体重指数、保守治疗时间及手术节段方面无显著差异（P>0.05）。A组穿刺次数为1.19±0.48次，B组为6.03±1.87次（P<0.001）。A组透视次数为14.03±2.54次，B组为25.19±4.28次（P<0.001）。A组术前定位时间为4.67±1.41分钟，B组为6.98±0.94分钟（P<0.001）。A组手术时间为79.42±10.15分钟，B组为89.65±14.06分钟（P = 0.002）。A组住院时间为2.77±0.95天，B组为2.87±1.02天（P = 0.702）。两组并发症发生率无显著差异（P = 0.386）。HELLO系统的亮点在于术前精确定位和明确的穿刺路径。本初步报告表明，HELLO系统显著提高了PTED的穿刺准确性，减少了透视次数、术前定位时间及手术时间。（ChiCTR-ICR-15006730）
