Sternheim Amir, Daly Michael, Qiu Jimmy, Weersink Robert, Chan Harley, Jaffray David, Irish Jonathan C, Ferguson Peter C, Wunder Jay S
Division of Orthopaedic Surgery, Mount Sinai Hospital, 600 University Avenue, Room 476, Toronto, ON M5G 1X5, Canada. E-mail address for A. Sternheim:
GTx Core-Techna Institute, University Health Network, 101 College Street, 7-1001, Toronto Medical Discovery Tower, Toronto, ON M5G 1L7, Canada. E-mail address for M. Daly:
J Bone Joint Surg Am. 2015 Jan 7;97(1):40-6. doi: 10.2106/JBJS.N.00276.
This Sawbones and cadaver study was performed to assess the accuracy and reproducibility of pelvic bone cuts made with use of a novel navigation system with a navigated osteotome and oscillating saw.
Using a novel navigation system and a three-dimensional planning tool, we navigated pelvic bone cuts that were representative of typical cuts made in pelvic tumor resections. The system includes a prototype mobile C-arm for intraoperative cone-beam computed tomography, real-time optical tracking (Polaris), and three-dimensional visualization software. Three-dimensional virtual radiographs were utilized in addition to triplanar (axial, sagittal, and coronal) navigation. In part one of the study, we navigated twenty-four sacral bone cuts in Sawbones models and validated our results in sixteen similar cuts in cadavers. In part two, we developed three Sawbones models of pelvic tumors based on actual patient scenarios and compared three navigated resections with three non-navigated resections for each tumor model. Part three assessed the accuracy of the system with multiple users.
There were ninety navigated cuts in Sawbones that were compared with fifty-four non-navigated cuts. In the navigated Sawbones cuts, the mean entry and exit cuts were 1.4 ± 1 mm and 1.9 ± 1.2 mm from the planned cuts, respectively. In comparison, the entry and exit cuts in Sawbones that were not navigated were 2.8 ± 4.9 mm and 3.5 ± 4.6 mm away from the planned osteotomy site. The navigated cuts were significantly more accurate (p ≤ 0.01). In the cadaver study, navigated entry and exit cuts were 1.5 ± 0.9 mm and 2.1 ± 1.5 mm from the planned cuts. The variation among three different users was 1 mm on both the entry and exit cuts.
Navigation to guide pelvic bone cuts is accurate and feasible. Three-dimensional radiographs should be used for improved accuracy. Navigated cuts were significantly more accurate than non-navigated cuts were. A margin of 5 mm between the target tumor volume and the planned cut plane would result in a negative margin resection in more than 95% of the cuts.
The accuracy of pelvic bone tumor resections and pelvic osteotomies can be improved with navigation to within 5 mm of the planned cut.
本研究使用带导航的骨凿和摆动锯的新型导航系统进行了实体模型和尸体研究，以评估骨盆截骨的准确性和可重复性。
我们使用新型导航系统和三维规划工具，对骨盆肿瘤切除术中典型的截骨进行导航。该系统包括用于术中锥形束计算机断层扫描的原型移动C形臂、实时光学跟踪（北极星）和三维可视化软件。除了三平面（轴向、矢状和冠状）导航外，还使用了三维虚拟射线照片。在研究的第一部分，我们在实体模型上对24处骶骨截骨进行了导航，并在16处尸体上的类似截骨中验证了结果。在第二部分，我们根据实际患者情况制作了三个骨盆肿瘤的实体模型，并对每个肿瘤模型的三次导航切除和三次非导航切除进行了比较。第三部分评估了该系统在多个用户使用时的准确性。
实体模型上有90处导航截骨与54处非导航截骨进行了比较。在实体模型的导航截骨中，平均入刀和出刀截骨分别比计划截骨偏离1.4±1毫米和1.9±1.2毫米。相比之下，非导航实体模型的入刀和出刀截骨分别距离计划截骨部位2.8±4.9毫米和3.5±4.6毫米。导航截骨明显更准确（p≤0.01）。在尸体研究中，导航入刀和出刀截骨分别比计划截骨偏离1.5±0.9毫米和2.1±1.5毫米。三个不同用户之间的差异在入刀和出刀截骨上均为1毫米。
导航引导骨盆截骨准确且可行。应使用三维射线照片以提高准确性。导航截骨比非导航截骨明显更准确。目标肿瘤体积与计划截骨平面之间5毫米的边缘将导致超过95%的截骨实现阴性边缘切除。
骨盆骨肿瘤切除和骨盆截骨的准确性可通过导航提高到距计划截骨5毫米以内。
