Department of Trauma-, Hand-, and Reconstructive Surgery, Friedrich-Schiller-University Jena, Erlanger Allee 101, 07740 Jena, Germany.
Foot Ankle Int. 2010 Oct;31(10):897-904. doi: 10.3113/FAI.2010.0897.
Retrograde drilling of symptomatic osteochondral lesions (OCL) is usually controlled by fluoroscopy. Due to the limited visualization of the OCLs in the acquired images and the narrow access to the talar dome, this approach can be demanding. Several navigation procedures have been reported (2D- or 3D- fluoroscopy or intraoperative CT-based) to increase the accuracy and reduce the radiation exposure. We developed a new arthroscopic-controlled navigation procedure which is free of radiation exposure and free of a reference base rigidly fixed to the bone. We hypothesized that this procedure (Fluoro-Free) is at least as precise as the standard 2D-Fluoro navigation (2D-Fluoro). Furthermore, our first clinical experiences are described and discussed.
Sixteen drillings per group (standard 2D-Fluoro vs. Fluoro-Free) were performed in artificial sawbones. Times for the different steps of each drilling procedure were recorded and the precision evaluated by measuring the deviation and depth of drilling.
The accuracy of the Fluoro-Free navigation was as precise as the standard 2D-Fluoro based navigation (axis deviation of drill tip to the target point: 1.07 ± 0.11 versus 1.14 ± 0.15 mm). Due to the simplified workflow without radiation exposure and fixation of a reference base, the Fluoro-Free procedure was significantly faster (mean procedure time per drilling: 23.7 ± 11.6 versus 165 ± 9 seconds) and easy to use. Its clinical usefulness was demonstrated during three retrograde drillings of a talar OCL in a 16-year-old patient.
The Fluoro-Free navigation procedure is a simplified approach for retrograde drilling of OCL in the talus under arthroscopic control without radiation exposure and without the need for fixation of a dynamic reference base to the bone.
有症状的骨软骨病变（OCL）的逆行钻孔通常通过透视控制。由于在获得的图像中 OCL 的可视化有限，并且到达距骨穹顶的通道狭窄，因此该方法可能具有挑战性。已经报道了几种导航程序（二维或三维透视或术中基于 CT 的导航）来提高准确性并减少辐射暴露。我们开发了一种新的关节镜控制导航程序，该程序无辐射，并且无需将参考基准刚性固定在骨头上。我们假设该程序（无射线）至少与标准的二维透视导航（2D-Fluoro）一样精确。此外，还描述和讨论了我们的初步临床经验。
在人造骨上，每组进行 16 次钻孔（标准 2D-Fluoro 与 Fluoro-Free）。记录每个钻孔过程的不同步骤的时间，并通过测量钻孔的偏差和深度来评估精度。
无射线 Fluoro-Free 导航的准确性与标准的 2D-Fluoro 基于导航一样精确（钻头尖端到目标点的轴偏差：1.07±0.11 与 1.14±0.15 毫米）。由于简化了工作流程，无辐射暴露且无需固定参考基准，因此 Fluoro-Free 程序的速度明显更快（每次钻孔的平均程序时间：23.7±11.6 与 165±9 秒），并且易于使用。在一名 16 岁患者的距骨 OCL 的三个逆行钻孔中证明了其临床实用性。
无射线 Fluoro-Free 导航程序是一种简化的方法，可在关节镜控制下进行距骨 OCL 的逆行钻孔，无需辐射暴露，也无需将动态参考基准固定在骨头上。
