Three-dimensional analysis of puncture needle path through safety triangle approach PLD and design of puncture positioning guide plate

Issue title: Special Section: Medical Applications of X-ray Imaging Techniques

Article type: Research Article

Authors: Yu, Penghui^{a; b; 1} | Li, Yanbing^{c; 1} | Zhao, Qidong^d | Chen, Xia^a | Wu, Liqin^e | Jiang, Shuai^{a; b} | Rao, Libing^{a; b; *} | Rao, Yihua^{b; f; *}

Affiliations: [a] School of Basic Medical Science, Hunan University of Medicine, Huaihua, Hunan, China | [b] Huaihua Key Laboratory of Digital Anatomy and 3D Printing for Clinical Translational Research, Huaihua, Hunan, China | [c] School of Basic Medical Science, Southern Medical University, Guangzhou, Guangdong, China | [d] Imaging Department, The First Affiliated Hospital of Hunan University of Medicine, Huaihua, Hunan, China | [e] International Education School, Hunan University of Medicine, Huaihua, Hunan, China | [f] Neurosurgery Department, Hunan University of Medicine General Hospital, Huaihua, Hunan, China

Correspondence: [*] Corresponding authors: Yihua Rao (E-mail: neuroraoyihua@126.com); Libing Rao (E-mail: 546434918@qq.com).

Note: [1] Penghui Yu and Yanbing Li contributed equally to this work.

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.

Keywords: Discectomy, safety triangle, puncture channel, 3D printing, puncture guide

DOI: 10.3233/XST-230267

Journal: Journal of X-Ray Science and Technology, vol. 32, no. 3, pp. 825-837, 2024