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Yu P, Li Y, Zhao Q, Chen X, Wu L, Jiang S, Rao L, Rao Y. Three-dimensional analysis of puncture needle path through safety triangle approach PLD and design of puncture positioning guide plate. JOURNAL OF X-RAY SCIENCE AND TECHNOLOGY 2024; 32:825-837. [PMID: 38517837 DOI: 10.3233/xst-230267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/24/2024]
Abstract
OBJECTIVE In this study, the three-dimensional relationship between the optimal puncture needle path and the lumbar spinous process was discussed using digital technology. Additionally, the positioning guide plate was designed and 3D printed in order to simulate the surgical puncture of specimens. This plate served as an important reference for the preoperative simulation and clinical application of percutaneous laser decompression (PLD). METHOD The CT data were imported into the Mimics program, the 3D model was rebuilt, the ideal puncture line N and the associated central axis M were developed, and the required data were measured. All of these steps were completed. A total of five adult specimens were chosen for CT scanning; the data were imported into the Mimics program; positioning guide plates were generated and 3D printed; a simulated surgical puncture of the specimens was carried out; an X-ray inspection was carried out; and an analysis of the puncture accuracy was carried out. RESULTS (1) The angle between line N and line M was 42°~55°, and the angles between the line M and 3D plane were 1°~2°, 5°~12°, and 78°~84°, respectively; (2) As the level of the lumbar intervertebral disc decreases, the distance from point to line and point to surface changes regularly; (3) The positioning guide was designed with the end of the lumbar spinous process and the posterior superior iliac spine on both sides as supporting points. (4) Five specimens were punctured 40 times by using the guide to simulate surgical puncture, and the success rate was 97.5%. CONCLUSION By analyzing the three-dimensional relationship between the optimal puncture needle path and the lumbar spinous process, the guide plate was designed to simulate surgical puncture, and the individualized safety positioning of percutaneous puncture was obtained.
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Affiliation(s)
- Penghui Yu
- School of Basic Medical Science, Hunan University of Medicine, Huaihua, Hunan, China
- Huaihua Key Laboratory of Digital Anatomy and 3D Printing for Clinical Translational Research, Huaihua, Hunan, China
| | - Yanbing Li
- School of Basic Medical Science, Southern Medical University, Guangzhou, Guangdong, China
| | - Qidong Zhao
- Imaging Department, The First Affiliated Hospital of Hunan University of Medicine, Huaihua, Hunan, China
| | - Xia Chen
- School of Basic Medical Science, Hunan University of Medicine, Huaihua, Hunan, China
| | - Liqin Wu
- International Education School, Hunan University of Medicine, Huaihua, Hunan, China
| | - Shuai Jiang
- School of Basic Medical Science, Hunan University of Medicine, Huaihua, Hunan, China
- Huaihua Key Laboratory of Digital Anatomy and 3D Printing for Clinical Translational Research, Huaihua, Hunan, China
| | - Libing Rao
- School of Basic Medical Science, Hunan University of Medicine, Huaihua, Hunan, China
- Huaihua Key Laboratory of Digital Anatomy and 3D Printing for Clinical Translational Research, Huaihua, Hunan, China
| | - Yihua Rao
- Huaihua Key Laboratory of Digital Anatomy and 3D Printing for Clinical Translational Research, Huaihua, Hunan, China
- Neurosurgery Department, Hunan University of Medicine General Hospital, Huaihua, Hunan, China
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Dannebrock FA, Zardo EDA, Ziegler MS, Vialle E, Soder RB, Schwanke CHA. Lumbar safety triangle: comparative study of coronal and coronal oblique planes in 3.0-T magnetic resonance imaging. Radiol Bras 2023; 56:327-335. [PMID: 38504808 PMCID: PMC10948153 DOI: 10.1590/0100-3984.2023.0022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 07/31/2023] [Accepted: 09/26/2023] [Indexed: 03/21/2024] Open
Abstract
Objective To compare the measurements of the lumbar safety triangle (Kambin's triangle) and the invasion of the dorsal root ganglion in the triangle in coronal and coronal oblique planes. Materials and Methods A cross-sectional study, in which 210 3.0-T magnetic resonance images of L2-L5 were analyzed in coronal and coronal oblique planes. Exams with lumbar spine anomalies were excluded. Demographic (sex and age) and radiological variables were recorded by a single evaluator. Results Most sample was female (57.1%), mean age 45.5 ± 13.3 (18-98 years). The measurements average, as well as the areas, gradually increased from L2 to L5. The dorsal root ganglion invaded the triangle in all images. The safety triangle average area was smaller in the coronal oblique plane than in the coronal plane. Of the seven dimensions of safety triangle obtained for each level of the lumbar spine, six were significantly smaller in the coronal oblique plane than in the coronal plane. The only dimension that showed no difference was the smallest ganglion dimension. Conclusion The dimensions and areas investigated were smaller in coronal oblique plane, especially the area (difference > 1 mm). The analysis of the triangular zone in this plane becomes important in the preoperative assessment of minimally invasive procedures.
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Affiliation(s)
| | - Erasmo de Abreu Zardo
- Pontifícia Universidade Católica do Rio Grande do Sul
(PUCRS), Porto Alegre, RS, Brazil
- Instituto Gaúcho de Cirurgia da Coluna Vertebral, Porto
Alegre, RS, Brazil
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Qi F, Gan Y, Wang S, Tie Y, Chen J, Li C. Efficacy of a virtual reality-based basic and clinical fused curriculum for clinical education on the lumbar intervertebral disc. Neurosurg Focus 2021; 51:E17. [PMID: 34333480 DOI: 10.3171/2021.5.focus20756] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 05/18/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Today, minimally invasive procedures have become mainstream surgical procedures. Percutaneous endoscopic transforaminal discectomy for lumbar disc herniation (LDH) requires profound knowledge of the laparoscopic lumbar anatomy. Immersive virtual reality (VR) provides three-dimensional patient-specific models to help in the process of preclinical surgical preparation. In this study, the authors investigated the efficacy of VR application in LDH for training orthopedic residents and postgraduates. METHODS VR images of the lumbar anatomy were created with immersive VR and mAnatomy software. The study was conducted among 60 residents and postgraduates. A questionnaire was developed to assess the effect of and satisfaction with this VR-based basic and clinical fused curriculum. The teaching effect was also evaluated through a postlecture test, and the results of the prelecture surgical examination were taken as baselines. RESULTS All participants in the VR group agreed that VR-based education is practical, attractive, and easy to operate, compared to traditional teaching, and promotes better understanding of the anatomical structures involved in LDH. Learners in the VR group achieved higher scores on an anatomical and clinical fusion test than learners in the traditional group (84.67 ± 14.56 vs 76.00 ± 16.10, p < 0.05). CONCLUSIONS An immersive VR-based basic and clinical fused curriculum can increase residents' and postgraduates' interest and support them in mastering the structural changes and complicated symptoms of LDH. However, a simplified operational process and more realistic haptics of the VR system are necessary for further surgical preparation and application.
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Affiliation(s)
- Fangfang Qi
- 1Teaching and Research Bureau of Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University.,2Department of Anatomy and Neurobiology, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou.,3Guangdong Province Key Laboratory of Brain Function and Disease, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou
| | - Yixiang Gan
- 4School of Medicine, Sun Yat-sen University, Shenzhen
| | - Shengwen Wang
- 5Department of Neurosurgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou.,6Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou
| | - Yizhe Tie
- 7Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou; and
| | - Jiewen Chen
- 8Department of Orthopedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Chunhai Li
- 1Teaching and Research Bureau of Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University.,8Department of Orthopedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
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Feng Q, Zhang L, Zhang M, Wen Y, Zhang P, Wang Y, Zeng Y, Wang J. Morphological parameters of fourth lumbar spinous process palpation: a three-dimensional reconstruction of computed tomography. J Orthop Surg Res 2020; 15:227. [PMID: 32571368 PMCID: PMC7309970 DOI: 10.1186/s13018-020-01750-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Accepted: 06/16/2020] [Indexed: 12/20/2022] Open
Abstract
Background The localization of lumbar fourth spinous process (L4-SP) is an important anatomical landmark, and identifying its accurate position is essential for the diagnosis and treatment of waist diseases. Methods Five hundred participants were scanned with positive and lateral computed tomography (CT), which aimed to clarify anatomic characteristics of L4-SP. Anatomical parameters of the surface localization of L4-SP were measured and recorded through a three-dimensional (3D) reconstruction. Results Five hundred participants were classified into three types according to the position of BC with the iliac spine. There are just 266 that the line between the highest point of the iliac spine on both sides located on L4-SP (type I, 53.20%), 16 above L4-SP (type II, 3.20%), and 218 below L4-SP (type III, 43.60%). BC in type I (15.92 ± 1.30 mm) is longer than type III (15.56 ± 1.32 mm). While the angle combined with AB and BC is different in the three groups, the angle in type I (173.00 ± 4.83°) is larger than that in type II (164.69 ± 5.50°) and type III (159.45 ± 8.39°). Other measurements were not found any significant differences between above. Conclusion The traditional palpation for L4-SP is not absolutely exact. The accuracy rate is only 53.20%, and the errors may cause serious consequences.
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Affiliation(s)
- Qi Feng
- School of Clinical Medicine, Southwest Medical University, Luzhou, China.,Academician Workstation in Luzhou, Luzhou, China
| | - Lei Zhang
- Academician Workstation in Luzhou, Luzhou, China. .,Department of Orthopedics, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, 646000, China. .,National Key Discipline of Human Anatomy, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China.
| | - Mengyao Zhang
- School of Clinical Medicine, Southwest Medical University, Luzhou, China.,Academician Workstation in Luzhou, Luzhou, China
| | - Youliang Wen
- School of Rehabilitation Medicine, Gannan Medical University, Ganzhou, China
| | - Ping Zhang
- Operating Room, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, China
| | - Yi Wang
- Academician Workstation in Luzhou, Luzhou, China.,School of Chinese and Western Clinical Medicine, Southwest Medical University, Luzhou, China
| | - Yan Zeng
- Department of Nephropathy, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, China
| | - Junqiu Wang
- Academician Workstation in Luzhou, Luzhou, China.,School of Chinese and Western Clinical Medicine, Southwest Medical University, Luzhou, China
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