Corenman Donald S, Strauch Eric L, Dornan Grant J, Otterstrom Eric, Zalepa King Lisa
The Steadman Clinic, Vail, Colorado, USA.
Steadman Philippon Research Institute, Vail, Colorado, USA.
J Spine Surg. 2017 Sep;3(3):392-397. doi: 10.21037/jss.2017.08.14.
Advancements in surgical navigation technology coupled with 3-dimensional (3D) radiographic data have significantly enhanced the accuracy and efficiency of spinal fusion implant placement. Increased usage of such technology has led to rising concerns regarding maintenance of the sterile field, as makeshift drape systems are fraught with breaches thus presenting increased risk of surgical site infections (SSIs). A clinical need exists for a sterile draping solution with these techniques. Our objective was to quantify expected accuracy error associated with 2MM and 4MM thickness Sterile-Z Patient Drape using Medtronic O-Arm Surgical Imaging with StealthStation S7 Navigation System. Camera distance to reference frame was investigated for contribution to accuracy error.
A testing jig was placed on the radiolucent table and the Medtronic passive reference frame was attached to jig. The StealthStation S7 navigation camera was placed at various distances from testing jig and the geometry error of reference frame was captured for three different drape configurations: no drape, 2MM drape and 4MM drape. The O-Arm gantry location and StealthStation S7 camera position was maintained and seven 3D acquisitions for each of drape configurations were measured. Data was analyzed by a two-factor analysis of variance (ANOVA) and Bonferroni comparisons were used to assess the independent effects of camera angle and drape on accuracy error.
Median (and maximum) measurement accuracy error was higher for the 2MM than for the 4MM drape for each camera distance. The most extreme error observed (4.6 mm) occurred when using the 2MM and the 'far' camera distance. The 4MM drape was found to induce an accuracy error of 0.11 mm (95% confidence interval, 0.06-0.15; P<0.001) relative to the no drape testing, regardless of camera distance. Medium camera distance produced lower accuracy error than either the close (additional 0.08 mm error; 95% CI, 0-0.15; P=0.035) or far (additional 0.21mm error; 95% CI, 0.13-0.28; P<0.001) camera distances, regardless of whether a drape was used.
In comparison to the 'no drape' condition, the accuracy error of 0.11 mm when using a 4MM film drape is minimal and clinically insignificant.
手术导航技术的进步与三维（3D）放射影像数据相结合，显著提高了脊柱融合植入物放置的准确性和效率。此类技术使用的增加引发了对无菌区域维护的日益关注，因为临时的铺巾系统存在诸多漏洞，从而增加了手术部位感染（SSI）的风险。对于这些技术，临床上需要一种无菌铺巾解决方案。我们的目标是使用美敦力O型臂手术成像系统与StealthStation S7导航系统，量化与2毫米和4毫米厚的Sterile-Z患者铺巾相关的预期准确性误差。研究了相机到参考框架的距离对准确性误差的影响。
将一个测试夹具放置在可透射线的手术台上，并将美敦力被动参考框架连接到夹具上。将StealthStation S7导航相机放置在距测试夹具不同距离处，针对三种不同的铺巾配置（无铺巾、2毫米铺巾和4毫米铺巾）捕获参考框架的几何误差。保持O型臂机架位置和StealthStation S7相机位置不变，对每种铺巾配置进行七次三维采集并测量。数据通过双因素方差分析（ANOVA）进行分析，并使用Bonferroni比较来评估相机角度和铺巾对准确性误差的独立影响。
对于每个相机距离，2毫米铺巾的中位（和最大）测量准确性误差高于4毫米铺巾。观察到的最极端误差（4.6毫米）出现在使用2毫米铺巾且相机距离为“远”时。无论相机距离如何，相对于无铺巾测试，发现4毫米铺巾导致的准确性误差为0.11毫米（95%置信区间，0.06 - 0.15；P < 0.001）。中等相机距离产生的准确性误差低于近（额外0.08毫米误差；95%置信区间，0 - 0.15；P = 0.035）或远（额外0.21毫米误差；95%置信区间，0.13 - 0.28；P < 0.001）相机距离，无论是否使用铺巾。
与“无铺巾”情况相比，使用4毫米胶片铺巾时0.11毫米的准确性误差极小，在临床上无显著意义。
