Easley Mark, Chuckpaiwong Bavornrit, Cooperman Nathan, Schuh Reinhard, Ogut Tahir, Le Ian L D, Reach John
Division of Orthopaedic Surgery, Duke University Medical Center, Durham, NC 27704, USA.
J Bone Joint Surg Am. 2008 Aug;90(8):1628-36. doi: 10.2106/JBJS.G.00513.
Despite considerable recent interest in computer navigation for orthopaedic surgery, few investigations of computer-assisted surgery for foot and ankle operations have been reported. The purpose of the present study was to compare subtalar arthrodesis with and without computer navigation in a cadaver model.
Subtalar arthrodesis was performed on thirty-six matched-pair cadaver lower extremities with intact soft tissues, with an attempt being made to orient two screws in the optimal configuration based on unpublished data from a preceding biomechanical study. Each matched pair was randomly assigned either to a group of surgeons who were experienced in subtalar arthrodesis or to a group of inexperienced operators. Neither surgical group was experienced in computer-assisted surgery. We compared optimal first-pass guidewire placement, fluoroscopic time, total operative time, screw placement accuracy, and adverse screw placement events between conventional (fluoroscopically guided) and computer-assisted subtalar arthrodesis.
The number of passes needed to achieve optimal guidewire placement decreased with the use of computer assistance for both experienced surgeons and inexperienced operators (p < 0.001), with ideal placement occurring on the first attempt in 95% of the procedures performed with use of computer assistance. While the experienced surgeons required less time and fewer guidewire passes during conventional subtalar arthrodesis than the inexperienced operators did (p < 0.001), both groups used less fluoroscopy with computer assistance (p < 0.001). There was no significant difference in operative time between the two techniques when performed by the inexperienced operators, yet the total procedure time doubled for the experienced surgeons when the procedure was performed with use of computer assistance (p < 0.001). There was no significant difference between experienced surgeons and inexperienced operators or between conventional and computer-assisted subtalar arthrodesis with respect to adverse screw placement events or the ability to accurately place both screws.
Computer-assisted subtalar arthrodesis resulted in screw placement accuracy that was equivalent to that of conventional (fluoroscopically guided) subtalar arthrodesis while decreasing the number of suboptimal guidewire passes and fluoroscopic time. The computer-assisted surgery technique increased the operative time for surgeons who were more experienced in conventional subtalar arthrodesis, but there was no difference in operative time for the group of operators who were inexperienced in subtalar arthrodesis.
尽管近期对骨科手术的计算机导航技术有了相当浓厚的兴趣，但关于计算机辅助足踝手术的研究报道较少。本研究的目的是在尸体模型中比较有无计算机导航的距下关节融合术。
在36对软组织完整的尸体下肢上进行距下关节融合术，根据之前一项生物力学研究的未发表数据，尝试将两枚螺钉以最佳构型置入。每对匹配的下肢随机分配给一组有距下关节融合术经验的外科医生或一组无经验的操作者。两个手术组均无计算机辅助手术经验。我们比较了传统（透视引导）和计算机辅助距下关节融合术在首次置入导丝的最佳位置、透视时间、总手术时间、螺钉置入准确性以及不良螺钉置入事件方面的差异。
对于有经验的外科医生和无经验的操作者，使用计算机辅助时达到最佳导丝置入所需的穿刺次数均减少（p < 0.001），在95%使用计算机辅助进行的手术中，首次尝试即可实现理想置入。虽然有经验的外科医生在传统距下关节融合术中所需时间和导丝穿刺次数比无经验的操作者少（p < 0.001），但两组在计算机辅助下透视时间均减少（p < 0.001）。无经验的操作者进行两种技术操作时手术时间无显著差异，但有经验的外科医生在使用计算机辅助进行手术时总手术时间翻倍（p < 0.001）。在不良螺钉置入事件或准确置入两枚螺钉的能力方面，有经验的外科医生与无经验的操作者之间以及传统与计算机辅助距下关节融合术之间均无显著差异。
计算机辅助距下关节融合术的螺钉置入准确性与传统（透视引导）距下关节融合术相当，同时减少了不理想的导丝穿刺次数和透视时间。计算机辅助手术技术增加了在传统距下关节融合术方面经验更丰富的外科医生的手术时间，但在距下关节融合术无经验的操作者组中手术时间无差异。
