Müller Matthias, Gras Florian, Marintschev Ivan, Mückley Thomas, Hofmann Gunter O
Department of Trauma, Hand and Reconstructive Surgery, Friedrich Schiller University, Jena, Germany.
Comput Aided Surg. 2009;14(4-6):109-16. doi: 10.3109/10929080903306305.
A novel, radiation- and reference base-free procedure for placement of navigated instruments and implants was developed and its practicability and precision in retrograde drillings evaluated in an experimental setting.
Two different guidance techniques were used: One experimental group was operated on using the radiation- and reference base-free navigation technique (Fluoro Free), and the control group was operated on using standard fluoroscopy for guidance. For each group, 12 core decompressions were simulated by retrograde drillings in different artificial femurs following arthroscopic determination of the osteochondral lesions. The final guide-wire position was evaluated by postoperative CT analysis using vector calculation.
High precision was achieved in both groups, but operating time was significantly reduced in the navigated group as compared to the control group. This was due to a 100% first-pass accuracy of drilling in the navigated group; in the control group a mean of 2.5 correction maneuvers per drilling were necessary. Additionally, the procedure was free of radiation in the navigated group, whereas 17.2 seconds of radiation exposure time were measured in the fluoroscopy-guided group.
The developed Fluoro Free procedure is a promising and simplified approach to navigating different instruments as well as implants in relation to visually or tactilely placed pointers or objects without the need for radiation exposure or invasive fixation of a dynamic reference base in the bone.
开发一种新型的、无需辐射和参考基座的导航器械及植入物放置方法，并在实验环境中评估其在逆行钻孔中的实用性和精度。
采用两种不同的引导技术：一个实验组采用无需辐射和参考基座的导航技术（无荧光透视）进行手术，对照组采用标准荧光透视引导进行手术。对于每组，在关节镜确定骨软骨损伤后，通过在不同人工股骨中进行逆行钻孔模拟12次髓芯减压。术后通过CT分析使用向量计算评估最终导丝位置。
两组均实现了高精度，但与对照组相比，导航组的手术时间显著缩短。这是由于导航组钻孔的首次通过准确率为100%；对照组每次钻孔平均需要2.5次校正操作。此外，导航组手术过程中无辐射，而荧光透视引导组测量到17.2秒的辐射暴露时间。
所开发的无荧光透视方法是一种有前景且简化的方法，可用于相对于视觉或触觉放置的指针或物体导航不同器械及植入物，无需辐射暴露或在骨中进行动态参考基座的侵入性固定。
