Beerekamp M S H, Backes M, Schep N W L, Ubbink D T, Luitse J S, Schepers T, Goslings J C
Trauma Unit, Department of Surgery, Academic Medical Center, 1105 AZ, Amsterdam, The Netherlands.
Department of Surgery, Maasstad Hospital, Rotterdam, The Netherlands.
Arch Orthop Trauma Surg. 2017 Dec;137(12):1667-1675. doi: 10.1007/s00402-017-2787-7. Epub 2017 Sep 21.
Previous studies demonstrated that intra-operative fluoroscopic 3D-imaging (3D-imaging) in calcaneal fracture surgery is promising to prevent revision surgery and save costs. However, these studies limited their focus to corrections performed after 3D-imaging, thereby neglecting corrections after intra-operative fluoroscopic 2D-imaging (2D-imaging). The aim of this study was to assess the effects of additional 3D-imaging on intra-operative corrections, peri-operative imaging used, and patient-relevant outcomes compared to 2D-imaging alone.
In this before-after study, data of adult patients who underwent open reduction and internal fixation (ORIF) of a calcaneal fracture between 2000 and 2014 in our level-I Trauma center were collected. 3D-imaging (BV Pulsera with 3D-RX, Philips Healthcare, Best, The Netherlands) was available as of 2007 at the surgeons' discretion. Patient and fracture characteristics, peri-operative imaging, intra-operative corrections and patient-relevant outcomes were collected from the hospital databases. Patients in whom additional 3D-imaging was applied were compared to those undergoing 2D-imaging alone.
A total of 231 patients were included of whom 107 (46%) were operated with the use of 3D-imaging. No significant differences were found in baseline characteristics. The median duration of surgery was significantly longer when using 3D-imaging (2:08 vs. 1:54 h; p = 0.002). Corrections after additional 3D-imaging were performed in 53% of the patients. However, significantly fewer corrections were made after 2D-imaging when 3D-imaging was available (Risk difference (RD) -15%; 95% Confidence interval (CI) -29 to -2). Peri-operative imaging, besides intra-operative 3D-imaging, and patient-relevant outcomes were similar between groups.
Intra-operative 3D-imaging provides additional information resulting in additional corrections. Moreover, 3D-imaging probably changed the surgeons' attitude to rely more on 3D-imaging, hence a 15%-decrease of corrections performed after 2D-imaging when 3D imaging was available. No substantiation for cost reduction was found through reduction in peri-operative imaging or in terms of improved patient-relevant outcomes.
先前的研究表明，跟骨骨折手术中的术中透视三维成像（3D成像）有望预防翻修手术并节省成本。然而，这些研究仅关注3D成像后进行的矫正，从而忽略了术中透视二维成像（2D成像）后的矫正。本研究的目的是评估与单独使用2D成像相比，额外的3D成像对术中矫正、围手术期使用的成像以及与患者相关的结局的影响。
在这项前后对照研究中，收集了2000年至2014年期间在我们的一级创伤中心接受跟骨骨折切开复位内固定术（ORIF）的成年患者的数据。自2007年起，外科医生可自行决定是否使用3D成像（BV Pulsera with 3D-RX，飞利浦医疗保健公司，荷兰贝斯特）。从医院数据库中收集患者和骨折特征、围手术期成像、术中矫正以及与患者相关的结局。将应用额外3D成像的患者与仅接受2D成像的患者进行比较。
共纳入231例患者，其中107例（46%）使用3D成像进行手术。基线特征方面未发现显著差异。使用3D成像时，手术中位时长显著更长（2:08对1:54小时；p = 0.002）。53%的患者在额外的3D成像后进行了矫正。然而，当有3D成像可用时，2D成像后进行的矫正显著减少（风险差异（RD）-15%；95%置信区间（CI）-29至-2）。两组之间，除了术中3D成像外，围手术期成像以及与患者相关的结局相似。
术中3D成像可提供额外信息从而带来额外的矫正。此外，3D成像可能改变了外科医生更多依赖3D成像的态度，因此当有3D成像可用时，2D成像后进行的矫正减少了15%。未发现通过减少围手术期成像或改善与患者相关的结局来降低成本的依据。
