Ohnsorge J A K, Portheine F, Mahnken A H, Prescher A, Wirtz D C, Siebert C H
Orthopädische Universitätsklinik, UK Aachen, Germany.
Z Orthop Ihre Grenzgeb. 2003 Jul-Aug;141(4):452-8. doi: 10.1055/s-2003-41558.
Due to the narrow access to the talar dome and the proximity of osteochondritic lesions to the joint surface, the therapeutic retrograde drilling often requires multiple attempts and repeated intraoperative X-ray-control. The advantages of a fluoroscopy-based computer-assisted navigation system regarding efficient planning and easy performance of the ideal drill path are evaluated in respect to accuracy and radiation exposure, as well as to time requirements.
A 5 mm spherical target was subcortically implanted in the medial aspect of the talar dome of 16 human cadaver specimens. Free-hand drilling was performed using the FluoroNav TM system in one group and conventional repetitive C-arm control in the other. The computed evaluation of the operative results was realized in a CT-generated 3D-model with the help of the DISOS planning and calculation program. The distance of the tip of the drill to the center of the lesion was measured, as well as X-ray exposure and total operating time.
The CAS procedure missed the lesion only once. The mean deviation of the computer-guided drill path was measured to be 2 mm, whereas the conventional method led to a mean distance of 5 mm from the target. Conventional drilling failed to reach the target in 5 cases, violating the articular cartilage twice. Navigation reduced the traditionally required multiple attempts of the intervention to just one drill canal and reduced radiation time to 25 %. Despite the increased technical preparation required, the navigated procedure only exceeded the conventional operating time by 2 minutes.
Thanks to the significantly increased accuracy, fluoroscopic navigation offers a high degree of safety and efficacy for this minimally invasive procedure. The operation can easily be performed successfully causing only minimal collateral damage to the bone, preserving the joint surface. The inherent risks of the retrograde drilling of osteochondritic lesions are lower with navigation, while the radiation exposure of the patient and the staff is significantly reduced.
由于距骨穹窿的入路狭窄且骨软骨损伤靠近关节面，治疗性逆行钻孔通常需要多次尝试并在术中反复进行X线检查。基于荧光透视的计算机辅助导航系统在有效规划和轻松实现理想钻孔路径方面的优势，在准确性、辐射暴露以及时间要求方面进行了评估。
在16具人类尸体标本的距骨穹窿内侧皮质下植入一个5毫米的球形靶点。一组使用FluoroNav TM系统进行徒手钻孔，另一组使用传统的重复C形臂控制。借助DISOS规划和计算程序，在CT生成的三维模型中对手术结果进行计算机评估。测量钻头尖端到病变中心的距离，以及X线暴露和总手术时间。
计算机辅助手术（CAS）仅一次未命中病变。计算机引导的钻孔路径平均偏差为2毫米，而传统方法导致与靶点的平均距离为5毫米。传统钻孔在5例中未能到达靶点，两次侵犯关节软骨。导航将传统上所需的多次干预尝试减少到仅一条钻孔通道，并将辐射时间减少到25%。尽管所需的技术准备增加，但导航手术仅比传统手术时间多2分钟。
由于准确性显著提高，荧光透视导航为这种微创手术提供了高度的安全性和有效性。该手术可以轻松成功进行，仅对骨骼造成最小的附带损伤，保留关节面。骨软骨损伤逆行钻孔的固有风险在导航下较低，同时患者和工作人员的辐射暴露显著减少。
