Von Recum J, Wendl K, Korber J, Wentzensen A, Grützner P A
Klinik für Unfall- und Wiederherstellungschirurgie, BG-Unfallklinik, Ludwigshafen.
Unfallchirurg. 2003 Nov;106(11):929-34. doi: 10.1007/s00113-003-0681-y.
After experimental and preclinical evaluation (HAP Paul Award 2001) of the CT-free image-guided surgical navigation system for acetabular cup placement (SurgiGATE C-arm cup" by Medivision, Switzerland), the system was introduced into clinical routine. The computation of the angular orientation of the cup is based on reference coordinates from the anterior pelvic plane concept. A hybrid strategy for pelvic landmark acquisition has been introduced involving percutaneous pointer-based digitization with the noninvasive biplanar landmark reconstruction using multiple registered fluoroscopy images. From January 2001 to December 2002, a total of 256 consecutive patients with primary osteoarthrosis (mean age 69 years, 161 male, 95 female, 132 left, and 124 right hip joints) were operated on with the hybrid CT-free navigation system. During each operation the angular orientation of the inserted implant was recorded. To determine the placement accuracy of the acetabular components, 50 consecutive patients underwent a CT scan 7-10 days postoperatively to analyze the cup position related to the anterior pelvic plane. This was all done blinded by the same investigator with the planning software of the CT-based navigation system of Medivision. There was no significant learning curve observed for the use of the system. The mean value for postoperative inclination was 43 degrees (SD 3.0, range: 37 degrees -49 degrees ) and for anteversion 19 degrees (SD 3.9, range: 10 degrees -28 degrees ). The resulting system accuracy, i.e., the difference between intraoperatively calculated cup orientation and postoperatively measured implant position showed a mean error of 1.5 degrees for the inclination (maximum 5 degrees, SD 1.1) and 2.4 degrees for the anteversion (maximum 6 degrees, SD 1.3). An accuracy of better than 5 degrees inclination and 6 degrees anteversion was achieved under clinical conditions, which implies that there is no significant difference in performance from the established CT-based navigation methods. Image-guided CT-free cup navigation provides a reliable solution for future THA.
在对用于髋臼杯置入的无CT图像引导手术导航系统（瑞士Medivision公司的“SurgiGATE C型臂髋臼杯”）进行实验和临床前评估（获得2001年HAP Paul奖）后，该系统被引入临床常规应用。髋臼杯角度方位的计算基于骨盆前平面概念的参考坐标。引入了一种混合策略用于骨盆标志点采集，包括基于经皮指针的数字化以及使用多个配准的透视图像进行无创双平面标志点重建。从2001年1月至2002年12月，共有256例连续性原发性骨关节炎患者（平均年龄69岁，男性161例，女性95例，左髋关节132例，右髋关节124例）接受了混合无CT导航系统手术。在每次手术过程中，记录所植入假体的角度方位。为确定髋臼组件的置入准确性，50例连续性患者在术后7 - 10天接受CT扫描，以分析髋臼杯与骨盆前平面相关的位置。这一切均由同一名研究人员使用Medivision公司基于CT的导航系统的规划软件在不知情的情况下完成。使用该系统未观察到明显的学习曲线。术后倾斜度的平均值为43度（标准差3.0，范围：37度 - 49度），前倾角为19度（标准差3.9，范围：10度 - 28度）。由此产生的系统准确性，即术中计算的髋臼杯方位与术后测量的假体位置之间的差异，倾斜度的平均误差为1.5度（最大5度，标准差1.1），前倾角的平均误差为2.4度（最大6度，标准差1.3）。在临床条件下实现了倾斜度优于5度和前倾角优于6度的准确性，这意味着与已确立的基于CT的导航方法在性能上无显著差异。图像引导的无CT髋臼杯导航为未来的全髋关节置换术提供了可靠的解决方案。
