Department of Trauma, Hand and Reconstructive Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Am J Sports Med. 2012 Apr;40(4):920-6. doi: 10.1177/0363546511434407. Epub 2012 Feb 1.
Retrograde drilling for osteochondritis dissecans (OCD) remains a challenging operation.
A novel radiation-free electromagnetic navigation system (ENS)-based method was developed and its feasibility and accuracy for retrograde drilling procedures evaluated and compared with the standard freehand fluoroscopic method in an experimental setting.
Controlled laboratory study.
A controlled laboratory study with 16 standard freehand fluoroscopically and 16 electromagnetically guided retrograde drilling procedures was performed on 8 cadaveric human knees. Four artificial cartilage lesions (2 on each condyle) were set per knee. Drilling accuracy was determined by final distance from the tip of the drill bit to the tip of the probe hook (D1) and distance between the tip of the drill and the marked lesion on the cartilage surface (D2). Intraoperative fluoroscopy exposure times were documented, as were directional readjustments or complete restarts. All procedures were timed using a stopwatch.
Successful retrograde drilling was accomplished in all 16 cases using the novel ENS-based method and in 11 cases using the standard fluoroscopic technique. The overall mean time for the fluoroscopy-guided procedures was 10 minutes 55 seconds ± 3 minutes 19 seconds and for the ENS method was 5 minutes 34 seconds ± 38 seconds, providing a mean time benefit of 5 minutes 35 seconds (P < .001). Mean D1 was 3.8 ± 1.6 mm for the standard and 2.3 ± 0.6 mm using the ENS technique (P = .021), and mean D2 was 2.5 ± 1.3 mm for the standard and 0.9 ± 0.7 mm for the ENS-based method (P < .001).
Compared with the standard fluoroscopic technique, the novel ENS-based method used in this study showed superior accuracy, required less time, and utilized no radiation.
The novel method improves a standard operating procedure in terms of accuracy, operation time for the retrograde drilling procedure, and radiation exposure.
对于骨软骨剥脱症（OCD）的逆行钻孔仍然是一项具有挑战性的操作。
开发了一种新型无辐射电磁导航系统（ENS）为基础的方法，并在实验环境中将其与标准徒手透视法的可行性和准确性进行了评估和比较，用于逆行钻孔程序。
对照实验室研究。
在 8 个尸体膝关节上进行了 16 次标准徒手透视和 16 次电磁引导逆行钻孔的对照实验室研究。每个膝关节设置 4 个人工软骨病变（每个髁各 2 个）。通过钻头尖端与探针钩尖端的最终距离（D1）和钻头尖端与软骨表面标记病变之间的距离（D2）来确定钻孔精度。记录术中透视曝光时间，以及方向调整或完全重新开始。所有程序均使用秒表计时。
使用新型 ENS 为基础的方法成功完成了所有 16 例逆行钻孔，而使用标准透视技术完成了 11 例。透视引导程序的总平均时间为 10 分 55 秒±3 分 19 秒，而 ENS 方法为 5 分 34 秒±38 秒，平均节省时间为 5 分 35 秒（P<0.001）。标准组的平均 D1 为 3.8±1.6mm，ENS 组为 2.3±0.6mm（P=0.021），标准组的平均 D2 为 2.5±1.3mm，ENS 组为 0.9±0.7mm（P<0.001）。
与标准透视技术相比，本研究中使用的新型 ENS 为基础的方法具有更高的准确性，所需时间更短，并且不使用辐射。
新型方法在准确性、逆行钻孔操作时间和辐射暴露方面改善了标准操作程序。
