Smith Erin J, Al-Sanawi Hisham, Gammon Braden, Pichora David R, Ellis Randy E
Department of Mechanical Engineering, Queen's University, Kingston, ON, Canada.
Proc Inst Mech Eng H. 2013 Apr;227(4):384-92. doi: 10.1177/0954411912470243. Epub 2012 Dec 20.
Percutaneous fixation of scaphoid fractures offers potential advantages to cast treatment but can be difficult to perform with conventional two-dimensional imaging. This study aimed to evaluate the use of a novel navigation technique using volume-rendered images derived from intraoperative cone-beam computed tomography imaging, without the need for typical patient-based registration. Randomized in vitro trials in which a guidewire was inserted into a scaphoid model were conducted to compare volumetric navigation to conventional fluoroscopic C-arm (n = 24). Central wire placement, surface breach, procedure time, drilling attempts, and radiation exposure were compared between groups. Compared to conventional percutaneous insertion, navigation achieved equal or significantly better placement of the guidewire with fewer drilling attempts and less radiation exposure. On average, navigation took 74 s longer to perform than the conventional method, which was statistically significant but clinically irrelevant. This evaluation suggests that the technology is promising and may have many clinical benefits including improved fixation placement, fewer complications, and less radiation exposure. The intraoperative workflow is more efficient and eliminates the need for preoperative computed tomography, image segmentation, and patient-based registration typical of traditional navigated procedures.
舟骨骨折的经皮固定相对于石膏治疗具有潜在优势，但使用传统二维成像进行操作可能会有困难。本研究旨在评估一种新型导航技术的应用，该技术使用术中锥形束计算机断层扫描成像生成的容积再现图像，无需进行典型的基于患者的配准。进行了随机体外试验，将导丝插入舟骨模型，以比较容积导航与传统荧光透视C形臂（n = 24）。比较了两组之间导丝的中心放置、表面突破、手术时间、钻孔尝试次数和辐射暴露情况。与传统经皮插入相比，导航在减少钻孔尝试次数和降低辐射暴露的情况下，实现了导丝同等或明显更好的放置。平均而言，导航操作比传统方法耗时多74秒，这在统计学上具有显著意义，但在临床上无关紧要。该评估表明该技术很有前景，可能具有许多临床益处，包括改善固定位置、减少并发症和降低辐射暴露。术中工作流程更高效，无需传统导航手术中典型的术前计算机断层扫描、图像分割和基于患者的配准。
