Stöckle U, König B, Schaser K, Melcher I, Haas N P
Unfall- und Wiederherstellungschirurgie, Charité, Campus Virchow-Klinikum, Humboldt Universität zu Berlin.
Unfallchirurg. 2003 Nov;106(11):914-20. doi: 10.1007/s00113-003-0677-7.
Navigation procedures based upon CT data were introduced into spine surgery in 1994. Since then the method has been used in other areas, such as joint replacement, reconstructive surgery and tumor surgery, because of its high precision and reduced radiation exposure. The original CT-based spine module can be adapted for pelvic surgery with the prerequisite, that the positioning of the fragments is identical in CT and at operation; otherwise, a new data set has to be acquired. The experience with CT-based navigation in pelvic surgery will be explained in the context of five percutaneous screw fixations and three tumor resections. The technique will be described. The fluoroscopy-based navigation has been used in trauma surgery since the late 1990 s. Since than the method has gained wide acceptance in the field of joint replacement and reconstructive surgery as well. Between June 2000 and December 2002 we performed 36 percutaneous screw fixations in the pelvis with postoperative X-ray and CT control. Thirty five of the 36 screws were placed correctly. In one screw an anterior cortex perforation of the sacrum was seen on CT, but without neurological consequences. Based upon our clinical experience we believe that CT-based navigation is indicated in screw fixations for minimally displaced pelvic injuries or dysplasia and, with increasing importance, in tumor surgery. Fluoroscopy based navigation with adequate image quality is the method of choice for SI screw fixations in traumatic or degenerative instabilities, especially if an update of the images is needed.
基于CT数据的导航技术于1994年被引入脊柱外科手术。从那时起，由于其高精度和减少辐射暴露，该方法已被应用于其他领域，如关节置换、重建手术和肿瘤手术。基于CT的原始脊柱模块可用于骨盆手术，但前提是CT图像和手术中骨折块的定位必须一致；否则，必须获取新的数据集。本文将结合5例经皮螺钉固定术和3例肿瘤切除术，阐述基于CT导航在骨盆手术中的应用经验，并描述该技术。基于荧光透视的导航技术自20世纪90年代末开始应用于创伤外科手术。从那时起，该方法在关节置换和重建手术领域也得到了广泛认可。在2000年6月至2002年12月期间，我们对36例骨盆经皮螺钉固定术患者进行了术后X线和CT检查。36枚螺钉中有35枚位置正确。在1枚螺钉的CT图像上可见骶骨前皮质穿孔，但未出现神经损伤后果。基于我们的临床经验，我们认为基于CT的导航技术适用于骨盆轻度移位损伤或发育异常的螺钉固定，以及在肿瘤手术中的应用，且其重要性日益增加。对于创伤性或退行性不稳定的骶髂关节螺钉固定，尤其是需要更新图像时，具有足够图像质量的基于荧光透视的导航技术是首选方法。
