Wang Gongli, Zheng Guoyan, Keppler Peter, Gebhard Florian, Staubli Alex, Mueller Urs, Schmucki Daniel, Fluetsch Simon, Nolte Lutz-Peter
Maurice E. Mueller Research Center for Orthopaedic Surgery, University of Bern, Bern, Switzerland.
Comput Aided Surg. 2005 Mar;10(2):73-85. doi: 10.3109/10929080500228837.
The objectives of this study are to design and evaluate a CT-free intra-operative planning and navigation system for high tibial opening wedge osteotomy. This is a widely accepted treatment for medial compartment osteoarthritis and other lower extremity deformities, particularly in young and active patients for whom total knee replacement is not advised. However, it is a technically demanding procedure. Conventional preoperative planning and surgical techniques have so far been inaccurate, and often resulting in postoperative malalignment representing either under- or over-correction, which is the main reason for poor long-term results. In addition, conventional techniques have the potential to damage the lateral hinge cortex and tibial neurovascular structures, which may cause fixation failure, loss of correction, or peroneal nerve paralysis. All these common problems can be addressed by the use of a surgical navigation system.
Surgical instruments are tracked optically with the SurgiGATE((R)) navigation system (PRAXIM MediVision, La Tronche, France). Following exposure, dynamical reference bases are attached to the femur, tibia, and proximal fragment of the tibia. A patient-specific coordinate system is then established, on the basis of registered anatomical landmarks. After intra-operative deformity measurement and correction planning, the osteotomy is performed under navigational guidance. The deformities are corrected by realigning the mechanical axis of the affected limb from the diseased medial compartment to the healthy lateral side. The wedge size, joint line orientation, and tibial plateau slope are monitored during correction. Besides correcting uni-planar varus deformities, the system provides the functionality to correct complex multi-planar deformities with a single cut. Furthermore, with on-the-fly visualization of surgical instruments on multiple fluoroscopic images, penetration of the hinge cortex and damage to the neurovascular structures due to an inappropriate osteotomy can be avoided.
The laboratory evaluation with a plastic bone model (Synbone AG, Davos, Switzerland) shows that the error of deformity correction is <1.7 degrees (95% confidence interval) in the frontal plane and <2.3 degrees (95% confidence interval) in the sagittal plane. The preliminary clinical trial confirms these results.
A novel CT-free navigation system for high tibial osteotomy has been developed and evaluated, which holds the promise of improved accuracy, reliability, and safety of this procedure.
本研究的目的是设计并评估一种用于胫骨高位开口楔形截骨术的无CT术中规划与导航系统。这是治疗内侧间室骨关节炎和其他下肢畸形的一种广泛接受的方法，尤其适用于不建议进行全膝关节置换的年轻活跃患者。然而，这是一项技术要求很高的手术。到目前为止，传统的术前规划和手术技术一直不准确，常常导致术后出现内翻或外翻畸形，这是长期效果不佳的主要原因。此外，传统技术有可能损伤外侧铰链皮质和胫骨神经血管结构，这可能导致固定失败、矫正丢失或腓总神经麻痹。所有这些常见问题都可以通过使用手术导航系统来解决。
使用SurgiGATE((R))导航系统（法国拉特朗什的PRAXIM MediVision公司）对手术器械进行光学跟踪。暴露后，将动态参考基座附着于股骨、胫骨和胫骨近端碎片。然后，基于注册的解剖标志建立患者特定的坐标系。在术中畸形测量和矫正规划后，在导航引导下进行截骨术。通过将患肢的机械轴从患病的内侧间室重新调整到健康的外侧来矫正畸形。在矫正过程中监测楔形大小、关节线方向和胫骨平台坡度。除了矫正单平面内翻畸形外，该系统还提供了通过单次截骨矫正复杂多平面畸形的功能。此外，通过在多个荧光透视图像上实时可视化手术器械，可以避免因不适当的截骨术导致的铰链皮质穿透和神经血管结构损伤。
使用塑料骨模型（瑞士达沃斯的Synbone AG公司）进行的实验室评估表明，在额平面上畸形矫正误差<1.7度（95%置信区间），在矢状平面上<2.3度（95%置信区间）。初步临床试验证实了这些结果。
已开发并评估了一种用于胫骨高位截骨术的新型无CT导航系统，该系统有望提高该手术的准确性、可靠性和安全性。
