Orthopaedic Trauma Service, Florida Orthopaedic Institute, Tampa, FL 33606, USA.
J Orthop Trauma. 2013 Jul;27(7):363-6. doi: 10.1097/BOT.0b013e3182828e10.
This study was designed to compare the accuracy, time, and radiation exposure during the insertion of intramedullary nail locking screws using either standard fluoroscopic assistance or an electromagnetic (EM)-based navigational system without fluoroscopy.
Prospective.
Level I academic trauma center.
Patients were divided into 2 groups: group 1 (fluoroscopic assistance), consisted of standard freehand fluoroscopically assisted insertion of locking screws (OEC 9900; G.E. HealthCare, Waukesha, WI), whereas group 2 (EM), consisted of EM navigationally assisted insertion without fluoroscopy (SureShot; Smith & Nephew, Memphis, TN). Technician arrival time, setup (SU) time, screw insertion (SI) time (seconds), fluoroscopy time (seconds), radiation exposure (mrads), and accuracy (hit or miss) were recorded for each screw. For group 1, the SU time was recorded as the time and radiation required to obtain "perfect circles" before insertion, and for group 2, the SU time was recorded as the time required to set up the navigational EM unit. Data collected regarding SI were then compared using standard analysis of variance.
Forty-one locking screws were inserted in group 1, whereas 60 screws were inserted in group 2. Accuracy was 100% for both groups. For group 1, mean technician wait time was 77 seconds plus a mean perfect circle SU time of 105 seconds (9.2 mrads and 10 seconds of fluoroscopy). Mean SU time for group 2 was 94 seconds (no fluoroscopy). Mean insertion time was 342 seconds per screw for group 1 (32.9 mrads and 18 seconds of fluoroscopy) compared with 234 seconds per screw for group 2 (no fluoroscopy). These differences were statistically significant (P = 0.006).
The use of EM navigation (SureShot; Smith & Nephew) for the insertion of intramedullary nail locking screws demonstrated accuracy similar to conventional fluoroscopic-guided insertion. However, EM-guided locking SI resulted in a significantly shorter total procedural time and completely eliminated radiation exposure.
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
本研究旨在比较使用标准透视辅助或基于电磁（EM）的导航系统（无透视）插入髓内钉锁定螺钉时的准确性、时间和辐射暴露。
前瞻性。
一级学术创伤中心。
患者分为两组：组 1（透视辅助），包括标准徒手透视辅助插入锁定螺钉（OEC 9900；G.E. Healthcare，Waukesha，WI），而组 2（EM），包括 EM 导航辅助插入而无透视（SureShot；Smith & Nephew，Memphis，TN）。记录每个螺钉的技术员到达时间、设置（SU）时间、螺钉插入（SI）时间（秒）、透视时间（秒）、辐射暴露（mrads）和准确性（命中或未命中）。对于组 1，SU 时间记录为插入前获得“完美圆圈”所需的时间和辐射，对于组 2，SU 时间记录为设置导航 EM 单元所需的时间。然后使用标准方差分析比较收集到的 SI 数据。
组 1 插入 41 个锁定螺钉，组 2 插入 60 个螺钉。两组的准确性均为 100%。对于组 1，平均技术员等待时间为 77 秒，加上平均完美圆圈 SU 时间为 105 秒（9.2 mrads 和 10 秒透视）。组 2 的平均 SU 时间为 94 秒（无透视）。组 1 的平均插入时间为每个螺钉 342 秒（32.9 mrads 和 18 秒透视），而组 2 为每个螺钉 234 秒（无透视）。这些差异具有统计学意义（P = 0.006）。
使用 EM 导航（SureShot；Smith & Nephew）插入髓内钉锁定螺钉的方法与传统透视引导插入相比具有相似的准确性。然而，EM 引导的锁定 SI 导致总手术时间显著缩短，并完全消除了辐射暴露。
治疗性 III 级。有关证据水平的完整说明，请参阅作者说明。
