Department of Spinal Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200120, PR China.
Department of Spinal Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200120, PR China.
Int J Surg. 2017 May;41:97-103. doi: 10.1016/j.ijsu.2017.03.059. Epub 2017 Mar 23.
Preoperative planning software has been widely used in many other minimally invasive surgeries, but there is a lack of information describing the clinical benefits of existing software applied in percutaneous endoscopic lumbar discectomy (PELD). This study aimed to compare the clinical efficacy of preoperative planning software in puncture and channel establishment of PELD with routine methods in treating lumbar disc herniation (LDH).
From June 2016 to October 2016, 40 patients who had single L4/5 or L5/S1 disc herniation were divided into two groups. Group A adopted planning software for preoperative puncture simulation while Group B took routine cases discussion for making puncture plans. The channel establishment time, operative time, fluoroscopic times and complications were compared between the two groups. The surgical efficacy was evaluated according to the Visual Analogue Scale (VAS), Oswestry Disability Index (ODI) and modified Macnab's criteria.
The mean channel establishment time was 25.1 ± 4.2 min and 34.6 ± 5.4 min in Group A and B, respectively (P < 0.05). The mean operative time was 80.8 ± 8.4 min and 92.1 ± 7.3 min in Group A and B, respectively (P < 0.05). The fluoroscopic times were 21.5 ± 5.2 in Group A and 29.3 ± 5.5 in Group B (P < 0.05). There were no significant differences in VAS and ODI scorings between the two groups either preoperatively or postoperatively (P > 0.05). The findings of modified Macnab's criteria at each follow-up also showed no significant differences (P > 0.05).
The application of preoperative planning software in puncture and cannula insertion planning in PELD was easy and reliable, and could reduce the channel establishment time, operative time and fluoroscopic times of PELD significantly.
术前规划软件已广泛应用于许多其他微创手术中，但缺乏描述现有软件在经皮内镜腰椎间盘切除术（PELD）中应用的临床获益的信息。本研究旨在比较术前规划软件在经皮内镜腰椎间盘切除术（PELD）穿刺和通道建立中的临床疗效与常规方法治疗腰椎间盘突出症（LDH）的疗效。
2016 年 6 月至 2016 年 10 月，将 40 例单节段 L4/5 或 L5/S1 椎间盘突出症患者分为两组。A 组采用术前规划软件进行穿刺模拟，B 组采用常规病例讨论制定穿刺方案。比较两组患者的通道建立时间、手术时间、透视次数和并发症。根据视觉模拟评分（VAS）、Oswestry 功能障碍指数（ODI）和改良 Macnab 标准评估手术疗效。
A 组和 B 组的平均通道建立时间分别为 25.1±4.2min 和 34.6±5.4min（P<0.05）。A 组和 B 组的平均手术时间分别为 80.8±8.4min 和 92.1±7.3min（P<0.05）。A 组和 B 组的透视次数分别为 21.5±5.2 次和 29.3±5.5 次（P<0.05）。两组患者术前和术后 VAS 和 ODI 评分均无统计学差异（P>0.05）。每个随访时间点改良 Macnab 标准的评估结果也无统计学差异（P>0.05）。
术前规划软件在 PELD 穿刺和套管插入规划中的应用简单可靠，可显著缩短 PELD 的通道建立时间、手术时间和透视次数。
