Percutaneous Lumbar Intervertebral Foramen Puncture Locator And Clinical Application Research

Objective:Invent percutaneous intervertebral foramenpuncture locator，to avoid the blindness of puncture when operating，improve the accuracy and the success rate of puncture，reduce the surgeonand patient X-ray radiation，shorten the operating time，reduce thepuncture complications. Methods:(1) According to the percutaneouslumbar intervertebral foramen puncture principle， design and makepercutaneous lumbar intervertebral foramen puncture locator，which hasa higher precision adjustment of the puncture depth and angle，thecorresponding intervertebral foramen surface projection can bemarked，and it was made by Chengdu Measuring and Cutting Toolcompany.(2) Opt-in40cases accepted by the percutaneoustransforaminal endoscopic discectomy for lumbar disc herniation in theorthopedic of Luzhou medical collegel affiliated hospital of chengdu363.Age24-72years old，L4/5section22cases，L5S1section18cases. Theywere randomly divided into two groups，the experimental group and thecontrol group. Each group has20cases. The experimental group use thepercutaneous intervertebral foramen puncture locator. According to eachpatient preoperative personalized CT related data，make the the junctionof corresponding upper edge of the next bit of vertebral and pedicle inner edge as the internal target puncture point. Measuring the angle formed bythe puncture needle and skin，the depth of the puncture needle in theoperation，as well as the distance to spinous. According to the measureddata，adjust puncture locator，puncture as the pre-determination of theangle and depth，and confirmed by the C-arm X-ray machine. The controlgroup use the conventional puncture positioning method， and alsoconfirmed by the C-arm X-ray machine. Compare the two puncturemethods, including one-time puncture success rate， the number ofpuncture, puncture time needed for success, the number of X-rayfluoroscope, puncture complications, clinical curative effect，and use theSPSS17.0software to do a statistics analysis. Make statistical analysis.Results:(1) By means of the C-arm X-ray fluoroscopy，percutaneouslumbar intervertebral foramen puncture locator can precisely locate thepuncture needle in the intervertebral foramen.12cases had a successfulpuncture with only one time （12/20）. One-time puncture in theintervertebral foramen success rate of60%. Only3cases had theone-time successful puncture in the traditional empirical puncture (3/20).One-time puncture success rate of15%，P value＜0.01，the result hasstatistical differences.(2) Number of puncture: Using the percutaneouslumbar intervertebral foramen puncture locator puncture20cases，thetotal number of puncture is43，while the total number of the traditionalpuncture method is81. P value＜0.01，the result has statistical differences. (3)Puncture time: Using the percutaneous lumbar intervertebral foramenpuncture locator puncture20cases，the total puncture time is153minutes，an average of7.65minutes，while the total puncture time of thetraditional puncture method is257minutes，an average of12.85minutes，P value＜0.01，the result has statistical differences.(4) X-ray fluoroscopynumber：Using the percutaneous lumbar intervertebral foramen puncturelocator puncture20cases，the total fluoroscopy time is79，an average of3.95times，while the total X-ray fluoroscopy number of the traditionalpuncture method is97times，an average of4.85times，P value＜0.01，the result has statistical differences.(5) Incidence of complications：Theexperimental group use the percutaneous lumbar intervertebral foramenpuncture locator has no puncture complications occurred，the controlgroup has one case of vertebral infection（5%）. P value=0.30，the resulthas no statistical differences.（6）Clinical efficacy: According to themodified Macnab clinical efficacy assessment standards， in theexperimental group the excellent and good rate is84.2%，the controlgroup is88.9%. P value=0.64，the result has no statistical differences.VAS score of the experimental group and the control group，one monthafter operation，last follow up compare with preoperation，the VAS scoredecreased significantly， P value＜0.01， the result has statisticaldifferences. Well compared with the control group， preoperation（P=0.39），one month after operation（P=1.00），last follow up（P=0.72） in the experimental group has no statistical differences. Conclusions:(1)Percutaneous lumbar intervertebral foramen puncture locator is safe aneffective，which can make the puncture needle accurately positioning inthe intervertebral foramen，with good accuracy.(2) Percutaneous lumbarintervertebral foramen puncture locator can reduce the number ofpuncture，improve the success rate of the puncture，shorten the operatingtime，reduce the X-ray exposure to the surgeon and patient. Having thefeasibility of clinical application and a vast potential for futuredevelopment.(3)Percutaneous lumbar intervertebral foramen puncturelocator does not increase the incidence of puncture complications.(4)Percutaneous lumbar intervertebral foramen puncture locator make theclinical efficacy no significant differences compared with the traditionalpuncture method.