Stöckle U, König B, Dahne M, Raschke M, Haas N P
Unfall- und Wiederherstellungschirurgie, Virchow-Klinikum, Humboldt-Universität, Berlin, Germany.
Unfallchirurg. 2002 Oct;105(10):886-92. doi: 10.1007/s00113-002-0438-z.
CT based navigation has been used in spine surgery since 1994. Several clinical studies could show an increase in precision compared to the conventional technique and thus nowadays the navigated pedicle screw placement is a routine procedure in many hospitals. Based upon the experience in spine surgery the CT based navigation module was used for percutaneous screw fixations in minimally displaced pelvic ring and acetabular fractures. After preclinical experimental trials the C-arm navigation was used for 19 screw fixations. The postoperative control of the screw position was performed with postop. X-ray and CT. Overall 23 of the 24 screws were placed correctly. In one SI screw the postoperative CT could reveal a ventral cortex perforation of the sacrum without any clinical symptoms. Based upon this limited clinical experience we see the indication for CT based navigation in minimally displaced acetabular fractures or in SI screw fixations in case of sacral dysplasia. The C-arm based navigation with adequate image quality is our method of choice for SI screw fixation in traumatic or degenerative instabilities, especially if reduction maneuvers are necessary.
自1994年以来，基于CT的导航技术已应用于脊柱手术。多项临床研究表明，与传统技术相比，其精度有所提高，因此如今在许多医院，导航下椎弓根螺钉置入已成为常规手术。基于脊柱手术的经验，基于CT的导航模块被用于微创移位骨盆环和髋臼骨折的经皮螺钉固定。经过临床前实验性试验后，C型臂导航用于19例螺钉固定。术后通过术后X线和CT对螺钉位置进行检查。24枚螺钉中共有23枚放置正确。在一枚骶髂螺钉中，术后CT显示骶骨腹侧皮质穿孔，但无任何临床症状。基于这一有限的临床经验，我们认为对于微创移位髋臼骨折或骶骨发育不良情况下的骶髂螺钉固定，基于CT的导航有应用指征。对于创伤性或退行性不稳定情况下的骶髂螺钉固定，尤其是在需要复位操作时，具有足够图像质量的基于C型臂的导航是我们的首选方法。
