Rush Raphael, Ginsberg Howard J, Jenkinson Richard, Whyne Cari M
Orthopaedic Biomechanics Laboratory, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
Surg Innov. 2008 Dec;15(4):321-3. doi: 10.1177/1553350608327170.
Current teaching techniques for orthopedic screw insertions involve "learning by doing" in the operating room. Minimally invasive insertion of sacroilliac (SI) screws is a relatively uncommon operation, providing scant opportunity for training outside of a few major centers. As such, SI screw insertion is a prime candidate for simulator-based training. This work describes the development and implementation of a simulator for minimally invasive SI screw insertion using accurate 3-dimensional (3D) computed tomography (CT)-based visualization of the pelvic and upper sacral anatomy. The simulator was designed in Tool Command Language atop the Amira 3D visualization package. CT images of pelvic regions were automatically segmented to generate 3D surfaces. Using inlet and outlet 3D views, guidewire insertion can be performed followed by an appropriately sized SI screw. The simulator was found to provide a realistic representation of the pelvis, and test users reported increased understanding of the procedure of SI screw insertion following use. The 3D reconstructions of the pelvis allowed for visual correlations between CT slices and inlet and outlet x-ray views. Pilot work with surgical trainees suggests the tool's value in increasing the familiarity of surgical trainees to visualize the pelvis in 3D and perform SI screw insertion.
目前用于骨科螺钉植入的教学技术包括在手术室中“边做边学”。骶髂螺钉的微创植入是一种相对不常见的手术，在少数几个主要中心之外几乎没有培训机会。因此，骶髂螺钉植入是基于模拟器训练的主要候选对象。这项工作描述了一种用于骶髂螺钉微创植入模拟器的开发和实施，该模拟器使用基于精确三维（3D）计算机断层扫描（CT）的骨盆和上骶骨解剖结构可视化。模拟器是在Amira 3D可视化软件包之上用工具命令语言设计的。骨盆区域的CT图像被自动分割以生成3D表面。使用入口和出口3D视图，可以进行导丝插入，然后插入尺寸合适的骶髂螺钉。结果发现，该模拟器能够逼真地呈现骨盆，测试用户报告称，使用该模拟器后对骶髂螺钉植入过程的理解有所增加。骨盆的3D重建实现了CT切片与入口和出口X光视图之间的视觉关联。对外科实习生的初步研究表明，该工具在提高外科实习生对3D骨盆可视化和进行骶髂螺钉植入的熟悉程度方面具有价值。
