Department of Orthopaedics and Traumatology, Beijing Jishuitan Hospital, Beijing 100035, China.
Chin Med J (Engl). 2011 Dec;124(23):3906-11.
Computer-assisted procedures have recently been introduced for navigated femoral neck screw placement. Currently there is little information available regarding accuracy and efficiency of the different navigated procedures. The aim of this study was to compare two fluoroscopic navigation tracking technologies, a novel bi-planar robot navigation and standardized optoelectronic navigation, versus standard freehand fluoroscopic insertion in a Synbone hip model.
Eighteen fixed Synbone hip models were divided into 3 groups. C-arm navigated cannulated screws (AO-ASIF, diameter 7.3 mm) were inserted using freehand targeting (control group). A novel bi-planar robot system (TINAV, GD2000) and an optoelectronic system (Stryker OTS Navigation System) were used for the navigated procedures (robot group and optoelectronic group). Accuracy was measured using radiographic evaluation including the measurement of screw parallelism and decentralization, and joint penetration. To evaluate the efficiency, the number of guidewire passes, operative time and fluoroscopic images taken were noted.
The two computer-assisted systems provided significantly improved accuracy compared to the freehand technique. Each of the parameters, including guidewire passes and number of fluoroscopy images, was significantly lower when using the computer-assisted systems than for freehand-unguided insertion (P <0.05), but operative time was significantly shorter when using freehand-unguided insertion than for the computer-assisted systems (P <0.05). Accuracy, operative time and number of fluoroscopy images taken were similar among the two navigated groups (P >0.05), but guidewire passes in the robot group were significantly less than in the optoelectronic group (P <0.05).
Both bi-planar robot navigation and optoelectronic navigation were similarly accurate and have the potential to improve accuracy and reduce radiation for freehand fluoroscopic targeting for insertion of cannulated screws in femoral neck fractures. Guidewire passes in the robot group were significantly less than in the optoelectronic group. However, both navigated procedures were associated with time-consuming registration and high rates of failed matching procedures.
计算机辅助技术最近已被应用于导航股骨颈螺钉的置入。目前，关于不同导航技术的准确性和效率的信息很少。本研究的目的是比较两种透视导航跟踪技术，一种新型的双平面机器人导航和标准化的光电导航，与标准的徒手透视插入法在 Synbone 髋关节模型中的效果。
将 18 个固定的 Synbone 髋关节模型分为 3 组。使用 C 臂导航的空心螺钉（AO-ASIF，直径 7.3 毫米）通过徒手定位（对照组）插入。新型双平面机器人系统（TINAV，GD2000）和光电系统（Stryker OTS 导航系统）用于导航手术（机器人组和光电组）。准确性通过放射学评估测量螺钉平行度和偏心度以及关节穿透来测量。为了评估效率，记录导丝的数量、手术时间和拍摄的透视图像数量。
与徒手技术相比，两种计算机辅助系统显著提高了准确性。使用计算机辅助系统时，每个参数，包括导丝数量和透视图像数量，均显著低于徒手无引导插入时（P<0.05），但使用徒手无引导插入时手术时间明显短于计算机辅助系统（P<0.05）。在导航组之间，准确性、手术时间和透视图像数量相似（P>0.05），但机器人组的导丝数量明显少于光电组（P<0.05）。
双平面机器人导航和光电导航同样准确，有可能提高准确性并减少徒手透视导向下股骨颈骨折空心螺钉插入的辐射。机器人组的导丝数量明显少于光电组。然而，两种导航手术都需要耗时的注册和高失败匹配程序的发生率。
