Department of Orthopaedics and Trauma Surgery, University Hospital of Bonn, Sigmund-Freud-Straße 25, 53105, Bonn, Germany.
Int Orthop. 2012 Jul;36(7):1463-9. doi: 10.1007/s00264-012-1496-7. Epub 2012 Feb 23.
Medial femoral neck fractures are common, and closed reduction and internal fixation by three cannulated screws is an accepted method for the surgical treatment. Computer navigation for screw placement may reduce fluoroscopy time, the number of guidewire passes and optimise screw placement.
In the context of a sawbone study, a computer-assisted planning and navigation system based on 3D-imaging for guidewire placement in the femoral neck was tested to improve screw placement. Three screws were inserted into 12, intact, femoral sawbones using the conventional technique and into 12, intact, femoral sawbones guided by the computer-based navigation system. Guidewire and subsequent screw placement in the femoral neck were evaluated.
Use of the navigation system resulted in a significant reduction of the number of drilling attempts (p≤0.05) and achieved optimised accuracy of implant placement by attaining significantly better screw parallelism (p≤0.05) and significantly enlarged neck-width coverage by the three screws (p≤0.0001). Computer assistance significantly increased the number of fluoroscopic images (p≤0.001) and the operation time (p≤0.0001).
Three-dimensional computer-assisted navigation improves accuracy of cannulated screw placement in femoral neck while increasing the number of fluoroscopic images and operation time. Additional studies including fractured sawbones and cadaver models with the goal of reducing operation time are indispensable before introduction of this navigation system into clinical practice.
股骨颈骨折较为常见，经皮三枚空心螺钉内固定是一种常用的外科治疗方法。计算机导航下螺钉置入可减少透视时间、导丝数量并优化螺钉的置入。
在一项模拟骨研究中，我们测试了一种基于三维成像的计算机辅助规划和导航系统，以改善导丝在股骨颈中的置入。我们使用传统技术将三根螺钉分别置入 12 根完整的股骨模拟骨中，然后使用基于计算机的导航系统将三根螺钉分别置入 12 根完整的股骨模拟骨中。评估导丝和后续股骨颈螺钉的置入情况。
使用导航系统可显著减少钻孔次数（p≤0.05），通过实现更好的螺钉平行度（p≤0.05）和显著增加三根螺钉对颈宽的覆盖范围（p≤0.0001），从而实现更优化的植入物放置准确性。计算机辅助显著增加了透视图像的数量（p≤0.001）和手术时间（p≤0.0001）。
三维计算机辅助导航可提高股骨颈空心螺钉置入的准确性，同时增加透视图像的数量和手术时间。在将该导航系统引入临床实践之前，需要进行包括骨折模拟骨和尸体模型在内的进一步研究，以减少手术时间。
