Zheng Chaoshun, Li Jiajun, Zeng Gang, Ye Wei, Sun Jianchao, Hong Junmin, Li Chunhai
Department of Orthopedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.
Sino-Dutch Biomedical and Information Engineering School, Northeastern University, Shenyang, China.
World Neurosurg. 2019 Mar;123:e1-e8. doi: 10.1016/j.wneu.2018.08.082. Epub 2018 Aug 23.
Percutaneous endoscopic lumbar discectomy is an effective way to treat lumbar disc herniation. Traditional preoperative planning based on a 2-dimensional method by magnetic resonance/computed tomography may cause inaccuracy of puncture during surgery. We used virtual reality to stimulate a surgery environment and measured relevant 3-dimensional data. We then explored its applicability for increasing puncture accuracy during actual surgeries.
A prospective randomized trial of lumbar disc herniation was conducted. Both conventional and virtual reality methods were used for preoperative planning and relevant data (planned puncture point and entry angle) were measured. Data were used during surgery and adjusted to complete the operation. The final entry point and entry angle were recorded and compared with relevant planned data statistically. Fluoroscopic times and location time also were included to access the puncture accuracy during surgery.
Thirty cases were included in our study. Both groups achieved good results after surgery, except for 1 case of postoperative dysesthesia in the traditional planning group and 1 case of residual disc in the virtual reality group. The use of virtual reality can predict a surgery-related angle and distance accurately except for depth. Compared with the traditional planning group, the fluoroscopic time (13.18 ± 4.191 vs. 32.00 ± 4.52) and location time (17.91 ± 4.74 vs. 33.22 ± 3.90) were statistically different, which indicates that this method can increase puncture accuracy.
A virtual reality planning system is an accurate preoperative planning method that can significantly improve the puncture accuracy of percutaneous endoscopic lumbar discectomy and reduce fluoroscopic and location times.
经皮内镜下腰椎间盘切除术是治疗腰椎间盘突出症的有效方法。基于磁共振成像/计算机断层扫描的二维方法进行的传统术前规划可能会导致手术中穿刺不准确。我们使用虚拟现实技术模拟手术环境并测量相关三维数据。然后探讨其在提高实际手术中穿刺准确性方面的适用性。
对腰椎间盘突出症进行前瞻性随机试验。术前规划同时采用传统方法和虚拟现实方法，并测量相关数据（计划穿刺点和进针角度）。手术中使用这些数据并进行调整以完成手术。记录最终进针点和进针角度，并与相关计划数据进行统计学比较。还纳入了透视次数和定位时间以评估手术中的穿刺准确性。
本研究纳入30例患者。两组术后均取得良好效果，传统规划组有1例术后感觉异常，虚拟现实组有1例椎间盘残留。除深度外，虚拟现实技术能够准确预测与手术相关的角度和距离。与传统规划组相比，透视时间（13.18±4.191对32.00±4.52）和定位时间（17.91±4.74对33.22±3.90）有统计学差异，这表明该方法可提高穿刺准确性。
虚拟现实规划系统是一种准确的术前规划方法，可显著提高经皮内镜下腰椎间盘切除术的穿刺准确性，并减少透视和定位时间。
