Kuhl Mitchell, Beimel Claudia
Department of Orthopaedic Surgery, St. Cloud Orthopedics and St. Cloud Hospital, St. Cloud, MN, United States.
Scientific Research and Statistics with Stryker, Trauma and Extremities, Kiel, Germany.
Injury. 2016 Oct;47(10):2155-2160. doi: 10.1016/j.injury.2016.07.018. Epub 2016 Jul 19.
The goal of this study was to evaluate the ability of a novel computer assisted surgery system to guide ideal placement of a lag screw during cephalomedullary nailing and then accurately measure the tip-apex distance (TAD) measurement intraoperatively.
Retrospective case review.
Level II trauma hospital.
The initial 98 consecutive clinical cases treated with a cephalomedullary nail in conjunction with a novel computer assisted surgery system were retrospectively reviewed.
A novel computer assisted surgery system was utilized to enhance lag screw placement during cephalomedullary nailing procedures. The computer assisted surgery system calculates the TAD intraoperatively after final lag screw placement.
The ideal TAD was considered to be within a range of 5mm-20mm. The ability of the computer assisted surgery system (CASS) to assist in placement of a lag screw within the ideal TAD was evaluated. Intraoperative TAD measurements provided by the computer assisted surgery system were then compared to standard postoperative TAD measurements on PACS (picture archiving and communication system) images to determine whether these measurements are equivalent.
79 cases (80.6%) were available with complete information for a retrospective review. All cases had CASS TAD and PACS TAD measurements >5mm and<20mm. In addition, no significant difference could be detected between the intraoperative CASS TAD and the postoperative PACS TAD (p=0.374, Wilcoxon Test; p=0.174, paired T-Test). A cut-out rate of 0% was observed in all patients who were treated with CASS in this case series (95% CI: 0 - 3.01%).
The novel computer assisted surgery system tested here is an effective and reliable adjunct that can be utilized for optimal lag screw placement in cephalomedullary nailing procedures. The computer assisted surgery system provides an accurate intraoperative TAD measurement that is equivalent to the standard postoperative measurement utilizing PACS images.
Therapeutic Level IV.
本研究的目的是评估一种新型计算机辅助手术系统在股骨髁上髓内钉固定术中引导拉力螺钉理想置入并在术中准确测量尖顶距（TAD）的能力。
回顾性病例分析。
二级创伤医院。
对最初连续98例使用股骨髁上髓内钉结合新型计算机辅助手术系统治疗的临床病例进行回顾性分析。
使用新型计算机辅助手术系统以在股骨髁上髓内钉固定术中优化拉力螺钉的置入。计算机辅助手术系统在最终置入拉力螺钉后术中计算TAD。
理想TAD范围被认为是5mm - 20mm。评估计算机辅助手术系统（CASS）在理想TAD范围内辅助置入拉力螺钉的能力。然后将计算机辅助手术系统提供的术中TAD测量值与PACS（图像存档与通信系统）图像上的标准术后TAD测量值进行比较，以确定这些测量值是否相等。
79例（80.6%）有完整信息可用于回顾性分析。所有病例的CASS TAD和PACS TAD测量值均>5mm且<20mm。此外，术中CASS TAD与术后PACS TAD之间未检测到显著差异（Wilcoxon检验，p = 0.374；配对T检验，p = 0.174）。在本病例系列中，所有接受CASS治疗的患者均观察到0%的穿出率（95%CI：0 - 3.01%）。
此处测试的新型计算机辅助手术系统是一种有效且可靠的辅助工具可用于股骨髁上髓内钉固定术中最佳拉力螺钉的置入。计算机辅助手术系统提供的术中TAD测量值与使用PACS图像的标准术后测量值相当。
治疗性四级。
