Department of Trauma-, Hand- and Reconstructive Surgery, University Hospital Jena, Erlanger Allee 101, Jena 07747, Germany.
BMC Musculoskelet Disord. 2013 Feb 28;14:74. doi: 10.1186/1471-2474-14-74.
Intramedullary nailing is a standard surgical procedure for fixation of proximal femoral fractures, but is associated with considerable radiation exposure for controlling the implant placement, due to the percutaneous insertion technique.The aim of this study was the evaluation of potential benefits of 2D-fluoroscopic based navigation focused on the reduction of radiation exposure, a decrease of procedure time, as well as an increase of accuracy for Gamma3 nail insertions.
Twenty randomized Gamma3 nail insertions were performed in non-fractured synthetic femora according to the manufactures operation guidelines (group I) or with use of a 2D-fluoroscopic based navigation system (group II). Time of different steps of the procedure and the radiation exposure were measured, as well as the accuracy evaluated in postoperative CT scans.
All Gamma3 nails were placed without any technical problems. Independent of the used procedure, the overall operating time (group I: 584 ± 99.2 sec; group II: 662 ± 64.9 sec; p=0.06) and accuracy of the final nail-positions were equivalent, but the radiation exposure was significantly reduced (92% reduction in fluoroscopic images and 91% reduction in fluoroscopic time, p< 0.01), using the 2D fluoroscopic based navigation procedure.
2D-fluoroscopic based navigation for Gamma3 nail insertion facilitates a relevant reduction of radiation exposure with equivalent accuracy of the final implant position and no prolonged operating time. This promising procedure modification is independent of different cephalomedullary implant manufacturers and specific implant designs, but needs to be evaluated in further clinical settings.
髓内钉固定是治疗股骨近端骨折的标准手术方法，但由于经皮插入技术，需要大量辐射来控制植入物的放置。本研究的目的是评估基于二维透视的导航在降低辐射暴露、缩短手术时间以及提高 Gamma3 钉插入准确性方面的潜在益处。
根据制造商的操作指南（I 组）或使用二维透视导航系统（II 组），在非骨折合成股骨上进行了 20 例随机 Gamma3 钉插入。测量了不同步骤的时间和辐射暴露，以及术后 CT 扫描的准确性。
所有 Gamma3 钉均无任何技术问题插入。无论使用哪种程序，总手术时间（I 组：584±99.2 秒；II 组：662±64.9 秒；p=0.06）和最终钉位的准确性都是等效的，但辐射暴露显著降低（透视图像减少 92%，透视时间减少 91%，p<0.01），使用二维透视导航程序。
用于 Gamma3 钉插入的二维透视导航有助于显著降低辐射暴露，同时保持最终植入物位置的准确性，并且不会延长手术时间。这种有前景的手术改良方法独立于不同的髓内植入物制造商和特定的植入物设计，但需要在进一步的临床环境中进行评估。
