Burgkart R, Gottschling H, Roth M, Gradinger R, Schweikard A
Klinik für Orthopädie und Sportorthopädie, Technische Universität, München.
Orthopade. 2005 Nov;34(11):1137-43. doi: 10.1007/s00132-005-0859-9.
Despite great advances in hip alloarthroplasty there are still numerous indications for joint-saving procedures such as correction osteotomies. Often these procedures include complex 3D rearrangements of the proximal femur, which are for the surgeon technically very demanding. The project aim was to develop a precise intraoperative virtual 3D planning tool including a detailed biomechanical analysis and enable the surgeon to realize exactly this plan by using computer-assisted techniques.
Using only two different angled fluoro frames a simplified femoral model was inversely constructed. For navigation a passive optical system was used with a C-arm calibration kit and PC-based software. For in vitro evaluation complex osteotomies were performed on ten femora under simulated OR conditions.
The mean difference between the planning and real surgical outcome for the wedge size was less then 2 degrees and for the femur head center position less then 4 mm. No implant penetrated the femur neck isthmus.
Without changing the standard operative procedure the method can be of high clinical importance to improve planning accuracy and consecutive operative realization for precise fragment positioning and plate location without penetrating the isthmus of the femoral neck. And -- besides precision -- it can potentially help to reduce intraoperative complications such as implant penetration and minimize X-ray use.
尽管髋关节置换术取得了巨大进展，但诸如截骨矫正等保关节手术仍有大量适应证。这些手术通常包括股骨近端复杂的三维重排，对外科医生来说技术要求非常高。该项目的目标是开发一种精确的术中虚拟三维规划工具，包括详细的生物力学分析，并使外科医生能够通过计算机辅助技术准确实现该计划。
仅使用两个不同角度的荧光透视框架反向构建简化的股骨模型。对于导航，使用带有C形臂校准套件和基于PC的软件的被动光学系统。为了进行体外评估，在模拟手术室条件下对十根股骨进行了复杂截骨术。
楔形尺寸的规划与实际手术结果之间的平均差异小于2度，股骨头中心位置的平均差异小于4毫米。没有植入物穿透股骨颈峡部。
在不改变标准手术操作的情况下，该方法对于提高规划准确性以及精确实现骨折块定位和钢板放置而不穿透股骨颈峡部的后续手术具有很高的临床重要性。而且——除了精确性之外——它还可能有助于减少术中并发症，如植入物穿透，并减少X射线的使用。
