距骨剥脱性骨软骨炎病变逆行钻孔：新型电磁导航方法与标准透视方法的可行性和准确性分析。

Retrograde drilling of talar osteochondritis dissecans lesions: a feasibility and accuracy analysis of a novel electromagnetic navigation method versus a standard fluoroscopic method.

机构信息

Department of Trauma, Hand and Reconstructive Surgery, University Medical Center Hamburg-Eppendorf, Germany.

出版信息

Arthroscopy. 2012 Oct;28(10):1547-54. doi: 10.1016/j.arthro.2012.03.003. Epub 2012 Jun 9.

DOI:10.1016/j.arthro.2012.03.003

PMID:22683373

Abstract

PURPOSE

A novel method using an electromagnetic navigation system (ENS) was developed, and its feasibility and accuracy for retrograde drilling procedures were evaluated and compared with the standard freehand fluoroscopic method in an experimental setting.

METHODS

A controlled laboratory study of 16 standard freehand fluoroscopically guided and 16 electromagnetically navigated retrograde drilling procedures was performed on 4 cadaveric human ankle joints. Four artificial cartilage lesions were consecutively set, 2 on the medial and 2 on the lateral talar dome. Drilling accuracy was measured in terms of the distance from the final position of the drill bit to the tip of the probe hook and the distance between the tip of the drill bit and the center of the cartilage lesion on the articular cartilage surface. Intraoperative fluoroscopy exposure times were documented, as were readjustments of drilling directions or complete restarts. All procedures were timed with a stopwatch.

RESULTS

Successful retrograde drilling was accomplished in 12 cases with the standard fluoroscopy-guided technique and in all 16 ENS-guided procedures. The overall mean time for the fluoroscopy-guided procedures was 660.00 ± 239.87 seconds and the overall mean time for the ENS method was 308.06 ± 54.03 seconds, providing a mean time benefit of 420.13 seconds. The mean distance from the final position of the drill bit to the tip of the probe hook was 3.25 ± 1.29 mm for the standard method and 2.19 ± 0.54 mm for the ENS method, and the mean distance between the tip of the drill bit and the center of the cartilage lesion on the articular cartilage surface was 2.50 ± 0.97 mm for the standard method and 0.88 ± 0.81 mm for the ENS method.

CONCLUSIONS

Compared with the standard fluoroscopic technique, the ENS method used in this study showed higher accuracy and a shorter procedure time and required no X-ray radiation.

CLINICAL RELEVANCE

The novel method considerably improves on the standard operating procedure in terms of safety, operation time, and radiation exposure.

摘要

目的

开发了一种使用电磁导航系统（ENS）的新方法，并在实验环境中评估了其逆行钻取程序的可行性和准确性，并与标准徒手透视法进行了比较。

方法

对 4 个人类踝关节进行了 16 例标准徒手透视引导和 16 例电磁导航逆行钻取程序的对照性实验室研究。连续设置了 4 个人工软骨病变，2 个位于内侧距骨穹窿，2 个位于外侧距骨穹窿。以钻头最终位置到探针钩尖端的距离和软骨病变在关节软骨表面的中心点之间的距离来衡量钻取精度。记录术中透视曝光时间，以及钻头方向的调整或完全重新开始的次数。所有手术均使用秒表计时。

结果

12 例采用标准透视引导技术和 16 例 ENS 引导程序成功完成逆行钻取。透视引导程序的总平均时间为 660.00±239.87 秒，ENS 方法的总平均时间为 308.06±54.03 秒，平均节省时间为 420.13 秒。钻头最终位置到探针钩尖端的平均距离，标准方法为 3.25±1.29mm，ENS 方法为 2.19±0.54mm；钻头尖端到关节软骨表面软骨病变中心的平均距离，标准方法为 2.50±0.97mm，ENS 方法为 0.88±0.81mm。