Schep N W L, van Vugt A B
Erasmus MC, afd Chirurgie, Rotterdam.
Ned Tijdschr Geneeskd. 2006 Oct 21;150(42):2301-6.
During operative fracture treatment the surgeon depends on fluoroscopic or X-ray radiological images as well as CT scans or MRI scans. This means that the surgeon sees only images at a given moment. Continuous imaging is technically complex and is accompanied by considerable exposure to radiation. Between images the surgeon has to depend on his or her knowledge of anatomical relationships and three-dimensional orientation. This may lead to the incorrect positioning of implants with ensuing morbidity and sometimes even death. Throughout the surgical procedure, computer assisted surgery (CAS) informs the surgeon of the exact position of the instruments in relation to the affected bone. The concept can be compared to that of the global positioning system (GPS) that is used by motorists. Clinical applications of CAS have been described for the operative treatment of vertebral fractures as well as fractures of the pelvis, hip and long bones. In reconstructive surgery, CAS is used for positioning the patient for total hip and knee surgery. The potential advantages of CAS are: increased accuracy, safety and reproducibility combined with lower radiation levels. Currently CAS is not widely used. There are a number of reasons for this. The technique is expensive and complex although the newer systems are more user friendly. It is possible that in the future CAS will be in standard use in orthopaedic and trauma surgery.
在骨折手术治疗过程中，外科医生依赖于荧光透视或X线放射影像以及CT扫描或MRI扫描。这意味着外科医生只能看到特定时刻的图像。连续成像技术复杂，且伴随着大量的辐射暴露。在图像之间，外科医生不得不依靠其对解剖关系和三维定位的了解。这可能会导致植入物定位错误，继而引发并发症，有时甚至会导致死亡。在整个手术过程中，计算机辅助手术（CAS）会告知外科医生器械相对于患骨的确切位置。这个概念可以与驾车者使用的全球定位系统（GPS）相比较。CAS的临床应用已被描述用于椎体骨折以及骨盆、髋部和长骨骨折的手术治疗。在重建手术中，CAS用于全髋关节和膝关节手术时患者的定位。CAS的潜在优势包括：提高准确性、安全性和可重复性，同时降低辐射水平。目前，CAS尚未得到广泛应用。原因有很多。尽管更新的系统更便于用户使用，但该技术昂贵且复杂。未来，CAS有可能在骨科和创伤手术中成为标准应用。
