Hinsche A F, Giannoudis P V, Smith R M
Department of Trauma and Orthopaedics, St James's University Hospital, Leeds, United Kingdom.
Clin Orthop Relat Res. 2002 Feb(395):135-44. doi: 10.1097/00003086-200202000-00014.
A prospective controlled experimental study was done to assess the value of fluoroscopy-based, computer-assisted orthopaedic surgery for the insertion of sacroiliac screws and to compare this new technology with the conventional technique, using image intensification. In a simulated surgical setup, 140 cannulated screws were placed into the S1 and S2 vertebral bodies of 35 pelvic models. The screws were inserted under fluoroscopy-based image guidance or with the conventional technique. Different drills were tested with both techniques, including a 2.8-mm guide wire and a 5-mm solid drill. The 2.8-mm guide wire proved inaccurate with the computer-assisted image guidance system because of guide wire flexibility. Using the more rigid 5-mm drill, the results of computer-assisted image guidance were comparable with the image intensifier technique. The radiation exposure during screw insertion was reduced considerably when using the image guidance system. System-specific requirements warranted adjustment of surgical technique and instruments. The major advantages of this new technology are immediate intraoperative image acquisition and provision of surgical guidance in as much as four planes simultaneously. The results of this experimental study are encouraging and have led to initiation of a clinical trial.
进行了一项前瞻性对照实验研究，以评估基于荧光透视的计算机辅助骨科手术在骶髂螺钉置入中的价值，并将这项新技术与使用影像增强的传统技术进行比较。在模拟手术环境中，将140枚空心螺钉置入35个骨盆模型的S1和S2椎体。螺钉在基于荧光透视的影像引导下或采用传统技术置入。两种技术均测试了不同的钻头，包括一根2.8毫米导丝和一根5毫米实心钻头。由于导丝的柔韧性，2.8毫米导丝在计算机辅助影像引导系统中显示不准确。使用更硬的5毫米钻头时，计算机辅助影像引导的结果与影像增强技术相当。使用影像引导系统时，螺钉置入过程中的辐射暴露显著减少。特定系统的要求需要调整手术技术和器械。这项新技术的主要优点是术中可立即获取影像，并能同时在多达四个平面提供手术引导。这项实验研究的结果令人鼓舞，并已促成一项临床试验的开展。
