Department of Orthopaedics, Balgrist University Hospital, University of Zürich, Forchstrasse 340, 8008, Zürich, Switzerland.
Department of Radiology, Balgrist University Hospital, University of Zürich, Forchstrasse 340, 8008, Zürich, Switzerland.
J Orthop Surg Res. 2020 Nov 17;15(1):540. doi: 10.1186/s13018-020-02066-x.
The Ganz' periacetabular osteotomy (PAO) consists of four technically challenging osteotomies (OT), namely, supraacetabular (saOT), pubic (pOT), ischial (iOT), and retroacetabular OT (raOT).
We performed a proof of concept study to test (1) the feasibility of augmented reality (AR) guidance for PAO, (2) precision of the OTs guided by AR compared to the freehand technique performed by an experienced PAO surgeon, and (3) the effect of AR on performance depending on experience.
A 3D preoperative plan of a PAO was created from segmented computed tomography (CT) data of an anatomic plastic pelvis model (PPM). The plan was then embedded in a software application for an AR head-mounted device. Soft tissue coverage was imitated using foam rubber. The 3D plan was then registered onto the PPM using an anatomical landmark registration. Two surgeons (one experienced and one novice PAO surgeon) each performed 15 freehand (FH) and 15 AR-guided PAOs. The starting point distances and angulation between the planned and executed OT planes for the FH and the AR-guided PAOs were compared in post-intervention CTs.
AR guidance did not affect the performance of the expert surgeon in terms of the mean differences between the planned and executed starting points, but the raOT angle was more accurate as compared to FH PAO (p = 0.0027). AR guidance increased the accuracy of the performance of the novice surgeon for iOT (p = 0.03). An intraarticular osteotomy performed by the novice surgeon with the FH technique could be observed only once.
AR guidance of osteotomies for PAOs is feasible and seems to increase accuracy. The effect is more accentuated for less-experienced surgeons.
This is the first proof of concept study documenting the feasibility of AR guidance for PAO. Based on these findings, further studies are essential for elaborating on the potential merits of AR guidance to increase the accuracy of complex surgical procedures.
Ganz 髋臼周围截骨术（PAO）由四个具有挑战性的技术截骨术（OT）组成，分别为髋臼上（saOT）、耻骨（pOT）、坐骨（iOT）和髋臼后（raOT）OT。
我们进行了一项概念验证研究，以测试（1）增强现实（AR）引导 PAO 的可行性，（2）AR 引导的 OT 与经验丰富的 PAO 外科医生徒手技术相比的精度，以及（3）AR 对性能的影响取决于经验。
从解剖塑料骨盆模型（PPM）的分割 CT 数据中创建 PAO 的术前 3D 计划。然后，该计划被嵌入到用于 AR 头戴式设备的软件应用程序中。使用泡沫橡胶模拟软组织覆盖。然后使用解剖学标志注册将 3D 计划注册到 PPM 上。两位外科医生（一位经验丰富，一位新手 PAO 外科医生）每人进行了 15 次徒手（FH）和 15 次 AR 引导的 PAO。在干预后的 CT 中比较了 FH 和 AR 引导的 PAO 中计划和执行的 OT 平面之间的起始点距离和角度。
AR 引导并没有影响专家外科医生的表现，因为计划和执行的起始点之间的平均差异，但与 FH PAO 相比，raOT 角度更准确（p = 0.0027）。AR 引导提高了新手外科医生 iOT 的准确性（p = 0.03）。新手外科医生使用 FH 技术进行的关节内截骨术只能观察到一次。
PAO 的 OT 的 AR 引导是可行的，并且似乎可以提高准确性。对于经验较少的外科医生，效果更为明显。
这是第一项证明概念的研究，记录了 AR 引导 PAO 的可行性。基于这些发现，进一步的研究对于阐述 AR 引导提高复杂手术准确性的潜在优势至关重要。
