遠位外側腰椎椎間板ヘルニアに対する経皮内視鏡下腰椎椎間板摘出術における3D再構成と体表面メッシュングを組み合わせた術前計画
Liang Jiao1,2, Shuang Wang2, Xiao Yang3
1Jinzhou Medical University, Jinzhou, Liaoning, China.
Background:
Percutaneous endoscopic lumbar discectomy (PELD) is effective for far lateral lumbar disk herniation (FLLDH), requiring precise puncture. This study assessed 3D reconstruction combined with body-surface meshing for preoperative planning.
Methods:
This prospective randomized controlled trial enrolled 53 FLLDH patients (L4-5/L5-S1) from 2023 to 2024, who were randomized to Group A (n = 29; CT-based 3D-planning with surface grids) or Group B (n = 24; conventional X-ray planning). Outcomes included puncture time, operative time, fluoroscopy frequency, and Oswestry Dysfunction Index (ODI).
Results:
Baseline data were comparable (p > .05). Group A showed shorter puncture time (7.7 ± 2.1 min, 95% CI: 6.9-8.5 vs. 10.5 ± 3.8 min, 95% CI: 9.0-12.0), reduced operative time (48.7 ± 7.2 min, 95% CI: 46.2-51.2 vs. 55.2 ± 10.3 min, 95% CI: 51.0-59.4), and fewer fluoroscopy exposures (5.1 ± 1.9, 95% CI: 4.4-5.8 vs. 14.8 ± 3.9, 95% CI: 13.3-16.3; all p < .05). Both groups had improved ODI/VAS postoperatively (p < .05), with no intergroup clinical difference (p > .05).
Conclusions:
3D reconstruction enhances puncture precision and reduces intraoperative fluoroscopy reduction in FLLDH-PELD, with clinical outcomes comparable to those of conventional methods.
