Institute of Research in Rehabilitation Medicine, Ulm University, Wuhrstrasse 2/1, 88422, Bad Buchau, Germany.
Int J Med Robot. 2013 Mar;9(1):52-7. doi: 10.1002/rcs.1476. Epub 2013 Jan 14.
Computer assisted systems in orthopaedic trauma depend in most cases on fixed reference markers. This work evaluated a reference-free image-based guidance system. Outcome parameters were the number of trials needed to achieve an optimal wire position, the radiation and procedure time, and the learning curve.
Forty artificial proximal femora covered in polyurethane foam were used and randomized in two groups. Each bone was equipped with a target marker at the fovea capitis femoris. Two surgeons each inserted 20 K-wires, 10 with and 10 without assistance from the guidance system. The aim was to bring the tips of the K-wires as close as possible to the target marker. Both procedures were performed under fluoroscopic control. The new guidance system is based on 2D-C-arm images. Following the procedure the result was determined using computed tomography.
The same accuracy (P = 0.34) was achieved with less time (P = 0.0008) and less radiation (P = 0.0002) with the guidance system. However, use of the guidance system did shorten the learning curve of both surgeons, leading to a reduced number of trials (P <0.0001). The learning curve of both surgeons was strongly correlated. From the first trial, the performance of both surgeons while using the guidance system, improved over their performance without the guidance system.
The guidance system helped to achieve an optimal K-wire position with less radiation and less time. The major advantage is the ability of the guidance system to be integrated into the workflow and the short and flat learning curve.
矫形创伤骨科中的计算机辅助系统在大多数情况下都依赖于固定的参考标记。本研究评估了一种无参考图像引导系统。评估参数包括达到最佳导丝位置所需的尝试次数、辐射和手术时间以及学习曲线。
使用 40 个覆盖有聚氨酯泡沫的人工股骨近端，并将其随机分为两组。每个骨头的股骨头凹处都配备有一个靶标标记。两位外科医生每人插入 20 根 K 线，其中 10 根有引导系统辅助，10 根没有。目的是使 K 线的尖端尽可能接近靶标标记。两种操作都是在透视控制下进行的。新的引导系统基于二维 C 臂图像。手术完成后，使用计算机断层扫描确定结果。
使用引导系统可达到相同的准确性（P = 0.34），但手术时间更短（P = 0.0008），辐射量更小（P = 0.0002）。然而，引导系统的使用确实缩短了两位外科医生的学习曲线，从而减少了尝试次数（P <0.0001）。两位外科医生的学习曲线具有很强的相关性。从第一次尝试开始，使用引导系统时，两位外科医生的表现都优于没有引导系统时的表现。
引导系统有助于以更少的辐射和时间达到最佳 K 线位置。其主要优势在于引导系统能够集成到工作流程中，并且学习曲线短而平。
