Strauss G, Dittrich E, Baumberger C, Hofer M, Strauss M, Stopp S, Koulechov K, Dietz A, Lüth T
Klinik und Poliklinik für HNO-Heilkunde/Plastische Operationen, Universität Leipzig, Leipzig.
Laryngorhinootologie. 2008 Aug;87(8):560-4. doi: 10.1055/s-2007-995629. Epub 2008 Apr 11.
The goal of this study is the improvement of the surgical accuracy of a navigate-controlled drill for mastoidectomy in a lab test.
For lab tests an artificial model of the temporal bone with color-coded injury identification of the facial nerve (solution of 0.5 mm) was used. Two different registration methods were examined: (group 1) navigation bow with 4 integrated markers at the upper jaw; (group 2) landmark registration with 4 titanium micro screws. An optical navigation system was used. The targets were illustrated by 3 titanium screws within the range of the planum mastoideum. The accuracy of the navigate-controlled drill in drilling the planned cavity were evaluated at 20 temporal bone models. The measurement of the registration accuracy was evaluated by deviation between the target screw and the calculated position in the navigation system. The evaluation of the resulted cavities was done by 5 senior surgeons with the help of the microscope.
The registration accuracy shows a maximum deviation between the real position and the calculated position of 1,73 MM in group of 1 and 0.93 MM in group 2. In group 1 the nerve was hurt in 5/20 cases and a maximum deviation of - 1.5 mm (Std 0.25 mm) (drilled beyond the nerve) was measured. In group 2 the nerve was not hurt, a maximum deviation of 0.5 mm (too early stopped before the nerve) was measured.
Significantly better results of the registration and drilling accuracy show up in group group 2. Thus the preconditions for clinical use are fulfilled.
本研究的目的是在实验室测试中提高用于乳突切除术的导航控制钻头的手术精度。
在实验室测试中，使用了带有面神经颜色编码损伤识别（0.5毫米溶液）的颞骨人工模型。检查了两种不同的配准方法：（第1组）在上颌骨带有4个集成标记的导航弓；（第2组）使用4个钛微螺钉进行地标配准。使用了光学导航系统。目标由乳突平面范围内的3个钛螺钉表示。在20个颞骨模型上评估导航控制钻头钻出计划腔的精度。通过目标螺钉与导航系统中计算位置之间的偏差来评估配准精度的测量。由5名资深外科医生在显微镜的帮助下对所得腔进行评估。
第1组的配准精度显示实际位置与计算位置之间的最大偏差为1.73毫米，第2组为0.93毫米。在第1组中，20例中有5例神经受损，测量到最大偏差为-1.5毫米（标准差0.25毫米）（钻过神经）。在第2组中，神经未受损，测量到最大偏差为0.5毫米（在神经之前过早停止）。
第2组在配准和钻孔精度方面显示出明显更好的结果。因此满足了临床使用的前提条件。
