From the Department of Orthopaedic Surgery, Montefiore Medical Center, the Children's Hospital at Montefiore, and Albert Einstein College of Medicine, New York, NY.
J Am Acad Orthop Surg. 2019 Oct 1;27(19):e849-e858. doi: 10.5435/JAAOS-D-18-00478.
An orthopaedic surgeon's knowledge of anatomical landmarks is crucial, but other modalities supplement this by providing guidance and feedback to a surgeon. Advances in imaging have enabled three-dimensional visualization of the surgical field and patient anatomy, whereas advances in computer technology have allowed for real-time tracking of instruments and implants. Together, these innovations have given rise to intraoperative navigation systems. The authors review these advances in intraoperative navigation across orthopaedic subspecialties, focusing on the most recent evidence on patient outcomes and complications, the associated learning curve, and the effects on operative time, radiation exposure, and cost. In spine surgery, navigated pedicle screw placement may increase accuracy and safety, especially valuable when treating complex deformities. Improved accuracy of pelvic and peri-articular tumor resection and percutaneous fixation of acetabular and femoral neck fractures has also been achieved using navigation. Early applications in arthroscopy have included surface-based registration for tunnel positioning for anterior cruciate ligament reconstruction and osteochondroplasty for femoro-acetabular impingement. Navigated arthroplasty techniques have addressed knee gap balancing and mechanical axis restoration as well as acetabular cup and glenoid baseplate positioning. Among these orthopaedic subspecialties, significant variation is found in the clinical relevance and dedication to research of navigation techniques.
骨科医生对解剖标志的了解至关重要，但其他方式通过为外科医生提供指导和反馈来补充这一点。成像技术的进步使手术领域和患者解剖结构的三维可视化成为可能，而计算机技术的进步则允许实时跟踪器械和植入物。这些创新共同催生了术中导航系统。作者回顾了骨科各亚专业领域的术中导航技术的这些进展，重点关注患者结局和并发症的最新证据、相关的学习曲线，以及对手术时间、辐射暴露和成本的影响。在脊柱手术中，导航椎弓根螺钉放置可能会提高准确性和安全性，尤其是在治疗复杂畸形时。导航还可以提高骨盆和关节周围肿瘤切除以及髋臼和股骨颈骨折经皮固定的准确性。关节镜早期应用包括用于前交叉韧带重建和股骨髋臼撞击症骨软骨成形术的隧道定位的基于表面的配准。导航关节置换技术解决了膝关节间隙平衡和机械轴恢复以及髋臼杯和关节盂基底部定位的问题。在这些骨科亚专业中，导航技术的临床相关性和对研究的投入存在显著差异。
