Department of Trauma, Reconstructive and Plastic Surgery, University of Leipzig, Liebigstrasse 20, 04103, Leipzig, Germany.
Int J Comput Assist Radiol Surg. 2012 Mar;7(2):249-55. doi: 10.1007/s11548-011-0652-7. Epub 2011 Sep 18.
Image guidance is essential in some orthopedic surgical procedures, especially iliosacral screw fixation. Currently, there is no consensus regarding the best image guidance technique. An ex-vivo study was performed to compare conventional, 2-dimensional (2D), and 3D imaging techniques and determine the optimal image guidance technique for pelvic surgery.
Plastic (n = 9) and donated cadaver pelvises (n = 8) were evaluated in the laboratory. The pelvises were positioned on radiolucent operation tables in a prone position. Transiliosacral screws were inserted without or with 2D- and 3D-navigational support. A digital mobile X-ray unit with flat-panel fluoroscopy and navigation software was used to measure precision, radiation exposure, and time requirements.
2D-navigation resulted in 40% incorrect screw positioning for the cadavers, 6% for the plastic phantoms, and 21% overall. The highest accuracy was accomplished with 3D-navigation (plastic: 100%; cadavers: 83%; p < 0.05). The dose-area product showed that both 2D- and 3D-navigation required increased exposure compared to the conventional technique (p < 0.01). For both plastic and cadaver specimens, navigated techniques required significantly longer times for screw insertion than the conventional technique (p < 0.01).
3D image guidance for transiliosacral screw fixation enabled more accurate screw placement in S1 and S2 vertebrae. However, radiation exposure in 3D-navigation was excessive; thus, we recommend avoiding 3D-navigation in young patients. A primary advantage of 3D-navigation was that the operating team could leave the room during the scan; thus, it reduced their radiation exposure. Moreover, the time required for screw insertion with 3D-navigation was similar to that required in the conventional technique; thus, 3D-navigation is recommended for older patients.
在一些骨科手术中，图像引导至关重要，尤其是骶髂螺钉固定。目前，对于最佳的图像引导技术尚未达成共识。本研究进行了一项尸体外实验，旨在比较传统二维（2D）和三维（3D）成像技术，并确定用于骨盆手术的最佳图像引导技术。
在实验室中评估了塑料（n=9）和捐赠的尸体骨盆（n=8）。将骨盆置于可透光手术台上呈俯卧位。在没有或有 2D-和 3D-导航支持的情况下插入经髂骶螺钉。使用数字移动 X 射线单元进行平板透视和导航软件，以测量精度、辐射暴露和时间要求。
2D 导航导致尸体的 40%的螺钉定位不正确，塑料模型的 6%不正确，总体的 21%不正确。3D 导航的准确性最高（塑料：100%；尸体：83%；p<0.05）。剂量面积乘积显示，与传统技术相比，2D-和 3D-导航都需要增加辐射暴露（p<0.01）。对于塑料和尸体标本，导航技术的螺钉插入时间明显长于传统技术（p<0.01）。
3D 图像引导用于经髂骶螺钉固定可使 S1 和 S2 椎骨的螺钉更准确地放置。然而，3D 导航的辐射暴露过高；因此，我们建议避免在年轻患者中使用 3D 导航。3D 导航的主要优势在于手术团队可以在扫描过程中离开房间，从而减少了他们的辐射暴露。此外，3D 导航的螺钉插入时间与传统技术相似，因此建议在老年患者中使用 3D 导航。
