Department of Pediatric Orthopedics, Altonaer Children's Hospital, Bleickenallee 38, 22763, Hamburg, Germany.
Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
BMC Musculoskelet Disord. 2021 Feb 3;22(1):135. doi: 10.1186/s12891-021-04010-4.
Retrograde drilling in osteochondrosis dissecans (OCD) is a widely used surgical intervention. A radiation-free electromagnetic navigation system (ENS)-based method was compared with the standard freehand fluoroscopic (SFF) method regarding clinical applicability.
We performed a clinical cohort study at a department of Orthopaedics in a Level 1 children's hospital with 40 patients (20 SFF and 20 ENS). Retrograde drilling of the talar dome was used in patients with unstable medial OCD (MRI stage 2 according to Hepple's revised classification; stage 2 according to the International Cartilage Repair Society). The outcome measurements were: (a) Intraoperative fluoroscopy exposure and length of surgery and (b) Postoperative serial follow-up MRIs every 6 months.
22 female and 18 male patients aged 13.8 ± 1.6 years (range: 11-17 years) were included. Using the ENS technique, length of surgery was significantly reduced to 20.2 ± 6.4 min compared to 36.1 ± 11.8 min (p < 0.01) for the SFF technique. The average x-ray radiation time for the SFF technique was 23.5 ± 13.5 sec and 1.9 ± 1.7 sec for the ENS technique (p < 0.01). Radiation exposure was significantly reduced from 44.6 ± 19.7 mSv (SFF technique) to 5.6 ± 2.8 mSv (ENS technique) (p < 0.01). Intraoperative perforation of cartilage occurred once in the SFF group. Correct placement of the drilling channel was verified in all patients on follow-up MRI after six months and a timely healing was seen after two years.
The ENS method provides for a significant reduction in length of surgery and radiation exposure. ENS was without intraoperative cartilage perforation. The clinical and radiological follow-up parameters are comparable for SFF- and ENS-guided retrograde drilling.
WF - 085/20, 05/2020 "retrospectively registered" https://www.aerztekammer-hamburg.org/ethik_kommission.html .
在剥脱性骨软骨炎（OCD）中逆行钻孔是一种广泛应用的手术干预方法。我们比较了一种基于无辐射电磁导航系统（ENS）的方法与标准的透视游离手（SFF）方法的临床适用性。
我们在一家 1 级儿童医院的骨科进行了一项临床队列研究，共有 40 名患者（20 名 SFF 和 20 名 ENS）。对于不稳定的内侧 OCD 患者（根据 Hepple 修订分类为 MRI 分期 2；根据国际软骨修复协会为分期 2），采用经跗骨穹窿逆行钻孔。主要的观察指标包括：（a）术中透视曝光和手术时间；（b）术后每 6 个月的连续 MRI 随访。
共纳入 22 名女性和 18 名男性患者，年龄 13.8±1.6 岁（范围：11-17 岁）。与 SFF 技术相比，使用 ENS 技术时，手术时间明显缩短至 20.2±6.4 分钟，而 SFF 技术为 36.1±11.8 分钟（p<0.01）。SFF 技术的平均 X 射线辐射时间为 23.5±13.5 秒，ENS 技术为 1.9±1.7 秒（p<0.01）。辐射暴露量从 SFF 技术的 44.6±19.7 mSv 显著降低至 5.6±2.8 mSv（ENS 技术）（p<0.01）。在 SFF 组中，术中出现了一次软骨穿孔。所有患者在术后 6 个月的 MRI 随访中均证实了钻孔通道的正确放置，并且在 2 年后均可见及时愈合。
ENS 方法可显著缩短手术时间和减少辐射暴露。ENS 无术中软骨穿孔。SFF 和 ENS 引导的逆行钻孔的临床和影像学随访参数是可比的。
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