Application value of ultrasound combined with X-ray localization in percutaneous transforaminal endoscopic lumbar discectomy

doi:10.3877/cma.j.issn.1672-6448.2019.12.007

Abstract

Abstract:

Objective

To evaluate the value of ultrasound combined with X-ray localization in percutaneous transluminal percutaneous endoscopic lumbar discectomy (PELD).

Methods

Sixty patients with lumbar disc herniation who underwent PELD surgery at the General Hospital of the People's Liberation Army were enrolled in the study and randomly assigned to an ultrasound combined with X-ray group and an X-ray alone group. The differences in puncture time, catheterization time, operation time, number of fluoroscopic examinations, and radiation dose were analyzed. The clinical effects of PELD were assessed using the straight leg raising test, visual analog scale (VAS), and Oswestry dysfunction index (ODI).

Results

The catheterization time was significantly shorter in the combination group than in the X-ray alone group [(2.60±0.83) min vs (3.03±0.71) min, t=2.161, P<0.05], although there was no significant difference in puncture time and total operation time between the two groups (P>0.05). The combination group received significantly fewer fluoroscopic examinations than the X-ray alone group [(3.10±0.40) vs (8.30±1.12), t=23.954, P<0.001]. The radiation dose was significantly lower in the combination group than in the X-ray alone group [(8.01±0.94) mGy vs (18.25 ± 6.11) mGy, t=9.074, P<0.001]. The puncture time in patients undergoing L5-S1 surgery was significantly longer than that of patients undergoing L3-4 and L4-5 surgery [(4.94±2.75) min vs (3.06±1.55) min, t=2.327, P<0.05]. In patients undergoing L3-4 and L4-5 surgery, the puncture time of patients with a BMI≥28 kg/m² was longer than that of patients with a BMI<28 kg/m² [(4.57±1.62) min vs (2.98±1.02) min, t=2.865, P<0.01]. In patients undergoing L5-S1 operation, the puncture time in patients with high-ridge type lesions was significantly longer than that in patients low-ridge type lesions [ (8.00±1.41) min vs (3.32±1.54) min, t=3.690, P<0.05]. VAS scores at 1 h and 3 mo after operation were significantly lower than those before PELD in both groups (t=30.115 and 38.760 in the combination group, and t=33.397 and 38.140 in the X-ray alone group, respectively; P<0.001). The ODIs at 3 mo after PELD were also significantly lower than that before operation in both groups (t=132.628 in the combination group, and t=123.120 in the X-ray alone group; P<0.001). No complications such as soft tissue or intervertebral disc infection and nerve injury were observed in either group.

Conclusion

Compared with X-ray guidance alone, PELD catheterization guided by ultrasound combined with X-ray localization can reduce the number of X-ray examinations and radiation dose and improve the efficiency of surgery. Ultrasound combined with X-ray localization can be used as a new method to guide PELD catheterization.

Key words: Ultrasonography, interventional, X-Rays, Lumbar disc herniation, Intervertebral foramen, Punctures

Shoupeng Li, Mingbo Zhang, Peng Huang, Yuexiang Wang, Yukun Luo. Application value of ultrasound combined with X-ray localization in percutaneous transforaminal endoscopic lumbar discectomy[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2019, 16(12): 919-926.

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Figures/Tables 12

References 19

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临床资料		超声联合X线组（30例）	单纯X线组（30例）	统计值	P值
年龄（岁，±s）		48.4±18.2	42.8±13.8	t=1.332	0.188
性别（男/女，例）		21/9	20/10	χ²=0.524	0.469
身高（cm，±s）		170.4±8.0	168.2±7.6	t=1.131	0.263
体质量（kg，±s）		75.7±12.5	73.9±19.2	t=0.425	0.672
BMI（kg/m²，±s）		25.9±3.4	25.9±5.5	t=0.009	0.993
手术节段（例，%）		?	?	χ²=3.606	0.462
?	L3-4	5（16.7）	1（3.3）	?	?
?	L4-5	18（60.0）	17（56.7）	?	?
?	L5-S1	7（23.3）	12（40.0）	?	?
髂嵴高度［手术节段为L5-S1，（例，%）］		?	?	χ²=7.333	0.091
?	高嵴型（髂嵴高于　L5水平）	2（28.6）	3（25.0）	?	?
?	低嵴型（髂嵴低于　L5水平）	5（71.4）	9（75.0）	?	?
术前VAS		8.20±0.81	8.03±0.76	t=0.822	0.414
术前ODI		54.8±2.11	55.17±1.95	t=0.572	0.570

临床资料		超声联合X线组（30例）	单纯X线组（30例）	统计值	P值
年龄（岁，±s）		48.4±18.2	42.8±13.8	t=1.332	0.188
性别（男/女，例）		21/9	20/10	χ²=0.524	0.469
身高（cm，±s）		170.4±8.0	168.2±7.6	t=1.131	0.263
体质量（kg，±s）		75.7±12.5	73.9±19.2	t=0.425	0.672
BMI（kg/m²，±s）		25.9±3.4	25.9±5.5	t=0.009	0.993
手术节段（例，%）		?	?	χ²=3.606	0.462
?	L3-4	5（16.7）	1（3.3）	?	?
?	L4-5	18（60.0）	17（56.7）	?	?
?	L5-S1	7（23.3）	12（40.0）	?	?
髂嵴高度［手术节段为L5-S1，（例，%）］		?	?	χ²=7.333	0.091
?	高嵴型（髂嵴高于　L5水平）	2（28.6）	3（25.0）	?	?
?	低嵴型（髂嵴低于　L5水平）	5（71.4）	9（75.0）	?	?
术前VAS		8.20±0.81	8.03±0.76	t=0.822	0.414
术前ODI		54.8±2.11	55.17±1.95	t=0.572	0.570

组别	例数	穿刺时间	置管时间	手术时间
超声联合X线组	30	3.50±2.02	2.60±0.83	51.73±21.73
单纯X线组	30	3.58±0.91	3.03±0.71	52.67±24.32
t值	?	0.215	2.161	0.157
P值	?	0.831	0.035	0.876

组别	例数	穿刺时间	置管时间	手术时间
超声联合X线组	30	3.50±2.02	2.60±0.83	51.73±21.73
单纯X线组	30	3.58±0.91	3.03±0.71	52.67±24.32
t值	?	0.215	2.161	0.157
P值	?	0.831	0.035	0.876

组别	例数	X线拍摄次数（次）	辐射剂量（mGy）
超声联合X线组	30	3.10±0.40	8.01±0.94
单纯X线组	30	8.30±1.12	18.25±6.11
t值	?	23.954	9.074
P值	?	0.000	0.000

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