导航下长骨骨折复位

Navigated long-bone fracture reduction.

作者信息

Kahler David M

机构信息

Department of Orthopaedic Surgery, University of Virginia Health System, Box 800159, Charlottesville, VA 22908-0159, USA.

出版信息

J Bone Joint Surg Am. 2009 Feb;91 Suppl 1:102-7. doi: 10.2106/JBJS.H.01286.

Abstract

The first computer-assisted orthopaedic trauma procedures were limited to navigated drill-guide applications, in which the computer was used to predict the trajectory of the drill guide relative to stored radiographic images. By 2003, software for fracture reduction was commercially available. The ability to perform a minimally invasive fracture reduction with the aid of stored images, combined with navigated insertion of internal fixation, has long been considered the highest achievement in image-guided fracture surgery. It is now possible to apply computer-assisted techniques to all fractures that have traditionally been treated with the aid of intraoperative fluoroscopic control. Less-invasive fixation of long-bone fractures is often complicated by malrotation or shortening of the injured extremity, sometimes requiring reoperation. Recent developments in computer-assisted surgery now allow the orthopaedic surgeon to precisely match the anatomy of the injured extremity to that of the uninjured limb with respect to length and rotational alignment. This is particularly important in comminuted fractures, for which there are no anatomic clues to guide accurate reduction, and in the correction of malreduced fractures. Although computer-assisted technology is now readily available, it has not yet found widespread acceptance in the orthopaedic trauma community. New software workflows (i.e., the step-by-step progression through various screens in the software program during a computer-guided procedure) specific to individual procedures and implants may hasten adoption of these techniques.

摘要

首批计算机辅助骨科创伤手术仅限于导航钻孔导向应用,即利用计算机相对于存储的放射影像预测钻孔导向器的轨迹。到2003年,用于骨折复位的软件已上市销售。借助存储图像进行微创骨折复位,再结合导航下内固定置入,长期以来一直被视为影像引导骨折手术的最高成就。现在,对于传统上借助术中透视控制进行治疗的所有骨折,均可应用计算机辅助技术。长骨骨折的微创固定常因受伤肢体的旋转不良或短缩而变得复杂,有时需要再次手术。计算机辅助手术的最新进展现在使骨科医生能够在长度和旋转对线方面将受伤肢体的解剖结构与未受伤肢体精确匹配。这在粉碎性骨折中尤为重要,因为此类骨折没有解剖线索来指导精确复位,在纠正复位不良的骨折时也很重要。尽管计算机辅助技术现已 readily available(此处原文有误,推测应为readily available,意为容易获得),但在骨科创伤领域尚未得到广泛接受。针对个别手术和植入物的新软件工作流程(即在计算机引导手术过程中逐步通过软件程序中的各个屏幕)可能会加速这些技术的采用。

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