Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.
Dartmouth College, Hanover, NH, USA.
Hand (N Y). 2022 Jan;17(1):134-140. doi: 10.1177/1558944720906502. Epub 2020 Feb 28.
Percutaneous guide wire insertion for scaphoid screw fixation can be challenging and often requires multiple attempts with significant radiation exposure to the surgical team. A 3-dimensional (3D) printed targeting device has the potential to reduce procedure time and intraoperative radiation exposure. Our targeting device protocol included a preprocedure computed tomography (CT) scan of a casted cadaver wrist, followed by 3D printing of a customized targeting guide. In a comparison trial, seven orthopedic surgery residents performed percutaneous scaphoid guide wire insertion on different cadaver specimens by both freehand technique and using our targeting device. Radiation exposure and procedure times were compared. All specimens underwent postprocedure CT to assess Kirschner wire (K-wire) accuracy, determined by central third placement. Pre- and postprocedure CT scans from the targeting device group were co-registered to compare planned and actual K-wire trajectories. Using the freehand technique, mean fluoroscopy time was 120 seconds (standard deviation: ±53 seconds) generating 2.45 milligray of radiation. Average procedure time was 21 minutes with a mean of 6.4 (range: 3-9) insertion attempts. A single insertion attempt was made using the targeting device with an average procedure time of 30 seconds and no fluoroscopy exposure. Four K-wires were placed within the central scaphoid in both groups. Using the targeting device, average linear deviation from the planned trajectory was 2.1 mm, while the maximum linear deviation was 3.75 mm. : When compared to freehand scaphoid guide wire insertion, our targeting device provides similar accuracy while significantly reducing intraoperative radiation exposure and procedure time.
经皮导丝插入术用于舟骨螺钉固定可能具有挑战性，通常需要多次尝试，并对手术团队造成大量辐射。3 维（3D）打印的靶向装置具有减少手术时间和术中辐射暴露的潜力。我们的靶向装置方案包括对铸模的尸体腕关节进行术前计算机断层扫描（CT），然后对定制的靶向引导器进行 3D 打印。在一项对比试验中，七名骨科住院医师通过徒手技术和使用我们的靶向装置对不同的尸体标本进行经皮舟骨导丝插入术。比较了辐射暴露和手术时间。所有标本均行术后 CT 检查，以评估克氏针（K 线）的准确性，通过中央三分之一的位置来确定。将靶向装置组的术前和术后 CT 扫描进行配准，以比较计划和实际 K 线轨迹。使用徒手技术，平均透视时间为 120 秒（标准差：±53 秒），产生 2.45 毫戈瑞的辐射。平均手术时间为 21 分钟，平均插入尝试 6.4 次（范围：3-9 次）。使用靶向装置进行单次插入尝试，平均手术时间为 30 秒，无透视暴露。两组均有 4 根 K 线位于舟骨中央。使用靶向装置，从计划轨迹的平均线性偏差为 2.1 毫米，而最大线性偏差为 3.75 毫米。与徒手舟骨导丝插入相比，我们的靶向装置在提供相似准确性的同时，显著减少了术中辐射暴露和手术时间。
