Ohnsorge J A K, Weisskopf M, Siebert C H
Orthopädische Universitätsklinik, UKA, RWTH Aachen.
Z Orthop Ihre Grenzgeb. 2005 May-Jun;143(3):316-22. doi: 10.1055/s-2005-836515.
Optoelectronic navigation for computer-assisted orthopaedic surgery (CAOS) is based on a firm connection of bone with passive reflectors or active light-emitting diodes in a specific three-dimensional pattern. Even a so-called "minimally-invasive" dynamic reference base (DRB) requires fixation with screws or clamps via incision of the skin. Consequently an originally percutaneous intervention would unnecessarily be extended to an open procedure. Thus, computer-assisted navigation is rarely applied. Due to their tree-like design most DRB's interfere with the surgeon's actions and therefore are at permanent risk to be accidentally dislocated. Accordingly, the optic communication between the camera and the operative site may repeatedly be interrupted. The aim of the research was the development of a less bulky, more comfortable, stable and safely trackable device that can be fixed truly percutaneously.
With engineering support of the industrial partner the radiolucent epiDRB was developed. It can be fixed with two or more pins and gains additional stability from its epicutaneous position. The intraoperative applicability and reliability was experimentally tested.
Its low centre of gravity and its flat design allow the device to be located directly in the area of interest. Thanks to its epicutaneous position and its particular shape the epiDRB may perpetually be tracked by the navigation system without hindering the surgeon's actions. Hence, the risk of being displaced by accident is minimised and the line of sight remains unaffected.
With the newly developed epiDRB computer-assisted navigation becomes easier and safer to handle even in punctures and other percutaneous procedures at the spine as much as at the extremities without an unproportionate amount of additional trauma. Due to the special design referencing of more than one vertebral body is possible at one time, thus decreasing radiation exposure and increasing efficiency.
计算机辅助骨科手术（CAOS）的光电导航基于骨骼与被动反射器或主动发光二极管以特定三维模式的牢固连接。即使是所谓的“微创”动态参考基座（DRB）也需要通过切开皮肤用螺钉或夹具进行固定。因此，原本经皮的干预会不必要地扩展为开放手术。所以，计算机辅助导航很少应用。由于其树形设计，大多数DRB会干扰外科医生的操作，因此始终存在意外脱位的风险。相应地，摄像头与手术部位之间的光学通信可能会反复中断。该研究的目的是开发一种体积更小、更舒适、稳定且可安全追踪的设备，该设备能够真正经皮固定。
在工业合作伙伴的工程支持下，开发了可透射线的表皮DRB。它可以用两根或更多根针固定，并从其表皮位置获得额外的稳定性。对其术中适用性和可靠性进行了实验测试。
其低重心和平坦设计使该设备能够直接放置在感兴趣的区域。由于其表皮位置和特殊形状，表皮DRB可以被导航系统持续追踪，而不会妨碍外科医生的操作。因此，意外移位的风险降至最低，视线不受影响。
借助新开发的表皮DRB，计算机辅助导航在脊柱以及四肢的穿刺和其他经皮手术中变得更易于操作且更安全，而不会造成不成比例的额外创伤。由于特殊设计，一次可以对多个椎体进行定位，从而减少辐射暴露并提高效率。
