Wang Jun-qiang, Zhao Chun-peng, Wang Man-yi, Su Yong-gong, Hu Lei, Sun Lei, Zhang Li-dan, Liu Wen-yong, Zhang Hui, Gao Yi-fei, Wang Tian-miao
Department of Orthopaedics and Traumatology, Jishuitan Hospital, Beijing 100035, China.
Chin J Traumatol. 2006 Jun;9(3):138-45.
To evaluate the clinical feasibility and effect of the computer-assisted auto-frame navigation system for distal locking of tibial intramedullary nails.
The hardware components of the system included a PC computer with a monitor, auto mechanical stereotactical localization cubic frame, foot holder and localization operative apparatus. Special navigation software can be used for registration of X-ray fluoroscopic images and real-time controlling navigation of tools. Twenty-one cases of close tibial and fibular fractures were treated with closed intramedullary nailing, 6 of which involved in middle third, 12 in middle and lower third, 3 in lower third. C-arm alignment and registration time, fluoroscopic time and drilling time involved in the locking procedure were recorded. The size of unreamed or reamed tibial nails ranged from 8/300-11/330.
All distal holes except 1 were locked successfully. In 9 of 41 locked holes (21.95%), the drill bit touched the canal of locking hole without damage of the nail and clinical consequences. The fluoroscopy time per pair of screws was 2.23+/-0.31 s.
The computer-assisted auto-frame navigation system for distal locking is well designed, easy to operate and do not need additional instruments during the procedure. The developed system enables the physician to precisely navigate surgical instruments throughout the anatomy using just a few computer-calibrated radiographic images. The total time of X-ray exposure per procedure can be significantly reduced.
评估计算机辅助自动框架导航系统用于胫骨髓内钉远端锁定的临床可行性及效果。
该系统的硬件组件包括一台带显示器的个人电脑、自动机械立体定位立方框架、足部固定器及定位手术器械。专用导航软件可用于X线透视图像配准及工具实时控制导航。21例胫腓骨闭合性骨折采用闭合髓内钉固定治疗，其中6例位于中1/3，12例位于中下段1/3，3例位于下段1/3。记录锁定过程中C形臂校准和配准时间、透视时间及钻孔时间。未扩髓或扩髓胫骨髓内钉尺寸范围为8/300 - 11/330。
除1个远端孔外，其余均成功锁定。在41个锁定孔中的9个（21.95%），钻头触及锁定孔通道，但未损伤髓内钉且无临床后果。每对螺钉的透视时间为2.23±0.31秒。
用于远端锁定的计算机辅助自动框架导航系统设计良好，操作简便，术中无需额外器械。所开发的系统使术者仅通过几张计算机校准的放射影像就能在整个解剖结构中精确导航手术器械。每次手术的X线暴露总时间可显著减少。
