Beckmann J, Tingart M, Perlick L, Lüring C, Grifka J, Anders S
Asklepios Klinik Bad Abbach, Orthopädische Klinik und Poliklinik der Universität Regensburg, Kaiser-Karl-V-Allee 3, 93077, Bad Abbach.
Orthopade. 2007 May;36(5):458-65. doi: 10.1007/s00132-007-1086-3.
In the early stages of osteonecrosis of the femoral head, core decompression by exact drilling into the ischemic areas can reduce pain and achieve reperfusion. Using computer aided surgery, the precision of the drilling can be improved while simultaneously lowering radiation exposure time for both staff and patients. We describe the experimental and clinical results of drilling under the guidance of the fluoroscopically-based VectorVision navigation system (BrainLAB, Munich, Germany).
A total of 70 sawbones were prepared mimicking an osteonecrosis of the femoral head. In two experimental models, bone only and obesity, as well as in a clinical setting involving ten patients with osteonecrosis of the femoral head, the precision and the duration of radiation exposure were compared between the VectorVision system and conventional drilling.
No target was missed. For both models, there was a statistically significant difference in terms of the precision, the number of drilling corrections as well as the radiation exposure time. The average distance to the desired midpoint of the lesion of both models was 0.48 mm for navigated drilling and 1.06 mm for conventional drilling, the average drilling corrections were 0.175 and 2.1, and the radiation exposure time less than 1 s and 3.6 s, respectively. In the clinical setting, the reduction of radiation exposure (below 1 s for navigation compared to 56 s for the conventional technique) as well as of drilling corrections (0.2 compared to 3.4) was also significant.
Computer guided drilling using the fluoroscopically based VectorVision navigation system shows a clearly improved precision with a enormous simultaneous reduction in radiation exposure. It is therefore recommended for clinical routine.
在股骨头坏死的早期阶段，通过精确钻孔进入缺血区域进行髓芯减压可减轻疼痛并实现再灌注。使用计算机辅助手术，可提高钻孔的精度，同时减少工作人员和患者的辐射暴露时间。我们描述了在基于荧光透视的VectorVision导航系统（德国慕尼黑BrainLAB公司）引导下钻孔的实验和临床结果。
共制备了70个模拟股骨头坏死的人工骨。在两种实验模型（仅骨模型和肥胖模型）以及涉及10例股骨头坏死患者的临床环境中，比较了VectorVision系统与传统钻孔在精度和辐射暴露持续时间方面的差异。
无靶点遗漏。对于两种模型，在精度、钻孔校正次数以及辐射暴露时间方面均存在统计学显著差异。两种模型中，导航钻孔到病变预期中点的平均距离为0.48毫米，传统钻孔为1.06毫米；平均钻孔校正次数分别为0.175和2.1；辐射暴露时间分别小于1秒和3.6秒。在临床环境中，辐射暴露的减少（导航时低于1秒，传统技术为56秒）以及钻孔校正的减少（分别为0.2和3.4）也很显著。
使用基于荧光透视的VectorVision导航系统进行计算机引导钻孔显示精度明显提高，同时辐射暴露大幅减少。因此推荐用于临床常规操作。
