在形态异常的骶骨中，三维导航在经皮骶髂螺钉固定方面比二维导航或传统透视更准确：一项随机多中心研究。
Three-dimensional navigation is more accurate than two-dimensional navigation or conventional fluoroscopy for percutaneous sacroiliac screw fixation in the dysmorphic sacrum: a randomized multicenter study.
作者信息
Matityahu Amir, Kahler David, Krettek Christian, Stöckle Ulrich, Grutzner Paul Alfred, Messmer Peter, Ljungqvist Jan, Gebhard Florian
机构信息
*Department of Orthopaedic Surgery, Orthopaedic Trauma Institute, San Francisco General Hospital, San Francisco, CA; †Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, VA; ‡Orthopaedic Trauma Department, Hannover Medical School, Hannover, Germany; §Department of Trauma and Restorative Surgery, BGU Hospital Tübingen, Tübingen, Germany; ‖Clinic of Trauma Surgery and Orthopaedic Surgery, BG Clinic Ludwigshafen, Ludwigshafen, Germany; ¶Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates; **AO Clinical Investigation and Documentation, Dübendorf, Switzerland; and ††Clinic for Trauma Surgery, Hand Surgery, Plastic Surgery and Reconstructive Surgery, Ulm University, Ulm, Germany.
出版信息
J Orthop Trauma. 2014 Dec;28(12):707-10. doi: 10.1097/BOT.0000000000000092.
OBJECTIVES
To evaluate the accuracy of computer-assisted sacral screw fixation compared with conventional techniques in the dysmorphic versus normal sacrum.
DESIGN
Review of a previous study database.
SETTING
Database of a multinational study with 9 participating trauma centers.
PATIENTS
The reviewed group included 130 patients, 72 from the navigated group and 58 from the conventional group. Of these, 109 were in the nondysmorphic group and 21 in the dysmorphic group.
INTERVENTION
Placement of sacroiliac (SI) screws was performed using standard fluoroscopy for the conventional group and BrainLAB navigation software with either 2-dimensional or 3-dimensional (3D) navigation for the navigated group.
MAIN OUTCOME MEASUREMENTS
Accuracy of SI screw placement by 2-dimensional and 3D navigation versus conventional fluoroscopy in dysmorphic and nondysmorphic patients, as evaluated by 6 observers using postoperative computerized tomography imaging at least 1 year after initial surgery. Intraobserver agreement was also evaluated.
RESULTS
There were 11.9% (13/109) of patients with misplaced screws in the nondysmorphic group and 28.6% (6/21) of patients with misplaced screws in the dysmorphic group, none of which were in the 3D navigation group. Raw agreement between the 6 observers regarding misplaced screws was 32%. However, the percent overall agreement was 69.0% (kappa = 0.38, P < 0.05).
CONCLUSIONS
The use of 3D navigation to improve intraoperative imaging for accurate insertion of SI screws is magnified in the dysmorphic proximal sacral segment. We recommend the use of 3D navigation, where available, for insertion of SI screws in patients with normal and dysmorphic proximal sacral segments.
LEVEL OF EVIDENCE
Therapeutic level I.
目的
评估在形态异常与正常的骶骨中，计算机辅助骶骨螺钉固定术与传统技术相比的准确性。
设计
回顾先前的研究数据库。
背景
一个有9个参与创伤中心的跨国研究数据库。
患者
回顾的组包括130例患者，72例来自导航组，58例来自传统组。其中，109例在非形态异常组，21例在形态异常组。
干预
传统组使用标准荧光透视法置入骶髂（SI）螺钉，导航组使用BrainLAB导航软件进行二维或三维（3D）导航置入SI螺钉。
主要观察指标
由6名观察者使用初次手术后至少1年的术后计算机断层扫描成像，评估二维和三维导航与传统荧光透视法在形态异常和非形态异常患者中置入SI螺钉的准确性。还评估了观察者内一致性。
结果
非形态异常组有11.9%（13/109）的患者螺钉位置不当，形态异常组有28.6%（6/21）的患者螺钉位置不当，3D导航组均无。6名观察者关于螺钉位置不当的原始一致性为32%。然而，总体一致性百分比为69.0%（kappa = 0.38，P < 0.05）。
结论
在形态异常的近端骶骨节段，使用3D导航改善术中成像以准确插入SI螺钉的作用更为显著。我们建议在有条件的情况下，对正常和形态异常的近端骶骨节段患者使用3D导航插入SI螺钉。
证据水平
治疗性I级。
Zotero 插件