National Unit of Orthopaedic Oncology, Tel Aviv Medical Center, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Division of Orthopaedic Surgery, Queen's University, Kingston, Ontario, Canada.
J Bone Joint Surg Am. 2018 May 16;100(10):e67. doi: 10.2106/JBJS.16.01304.
The objective of this study was to assess the accuracy and reproducibility of a novel cone-beam computed tomography (CBCT)-guided navigation system designed for osteotomies with joint-sparing bone cuts.
Eighteen surgeons participated in this study. First, 3 expert tumor surgeons resected bone tumors in 3 Sawbones tumor models identical to actual patient scenarios. They first performed these osteotomies without navigation and then performed them using a navigation system and 3-dimensional (3D) planning tools based on CBCT imaging. The 2 sets of measurements were compared using image-based measurements from post-resection CBCT. Next, 15 residents, fellows, and orthopaedic staff surgeons were instructed on the use of the system, and their navigated resections were compared with navigated resections performed by the 3 expert tumor surgeons.
One hundred and twenty-six navigated cuts done by the orthopaedic oncologists were compared with 126 non-navigated cuts by the same surgeons. The cuts violated the tumor in 22% (6) of the 27 non-navigated resections compared with none of the 27 navigated resections. The navigated cuts were significantly more accurate in terms of entry point, pitch, and roll (p < 0.001). The variation among the 3 surgeons when they used navigation was <0.6 mm for the entry cut and, on average, 1.5° for pitch and roll. All 18 surgeons then completed a total of 144 navigated cuts. The level of experience did not result in a significant difference among groups with regard to cut accuracy. Two cuts went into the tumor. The mean distance from the planned bone cuts to the actual entry points into bone was 1.5 mm (standard deviation [SD] = 1.4 mm) for all users. The mean difference in pitch and roll between the planned and actual cuts was 3.5° (SD = 2.8°) and 3.7° (SD = 3.2°) for all users.
Even in expert hands, navigated cuts were significantly more accurate than non-navigated cuts. When the osteotomies were aided by navigation, their accuracy did not differ according to the level of professional experience. CBCT-based metrics enable intraoperative assessments of cut accuracy and reconstruction planning.
CBCT-guided navigated osteotomies can improve accuracy regardless of surgeon experience and decrease the variability among different surgeons.
本研究旨在评估一种新型的基于锥形束 CT（CBCT）的导航系统在关节保留骨切开术中的准确性和可重复性，该系统用于骨切开术。
18 名外科医生参与了这项研究。首先，3 名肿瘤专家在 3 个与实际患者情况相同的 Sawbones 肿瘤模型中切除骨肿瘤。他们首先在没有导航的情况下进行这些骨切开术，然后使用导航系统和基于 CBCT 成像的 3D 规划工具进行骨切开术。使用术后 CBCT 的基于图像的测量值对两组测量值进行比较。接下来，15 名住院医师、研究员和骨科医生接受了系统使用的指导，将他们的导航切除与 3 名肿瘤专家的导航切除进行了比较。
将 126 名骨科肿瘤医生的导航切割与同一位医生的 126 次非导航切割进行了比较。在 27 次非导航切除中，有 22%（6 次）的肿瘤被切开，而在 27 次导航切除中，没有一次切开肿瘤。在入口点、倾斜度和滚动方面，导航切割明显更准确（p < 0.001）。当 3 名外科医生使用导航时，他们之间的变化<0.6 毫米，平均倾斜度和滚动度为 1.5°。所有 18 名外科医生共完成了 144 次导航切割。经验水平并没有导致组间在切割准确性方面存在显著差异。有两刀进入了肿瘤。所有用户的计划骨切割与实际骨进入点之间的平均距离为 1.5 毫米（标准差[SD]=1.4 毫米）。计划和实际切割之间的俯仰和滚动差异平均值分别为 3.5°（SD=2.8°）和 3.7°（SD=3.2°）。
即使是在专家手中，导航切割也明显比非导航切割更准确。当使用导航辅助骨切开时，其准确性不因专业经验水平而异。基于 CBCT 的指标可实现术中切割准确性评估和重建规划。
基于 CBCT 的导航引导的骨切开术可以提高准确性，而与外科医生的经验无关，并降低不同外科医生之间的差异。
