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计算机辅助骨科和创伤外科。

Computer-Assisted Orthopedic and Trauma Surgery.

机构信息

Department of Traumatology, Hannover Medical School; Department of Orthopedic Surgery, Hannover Medical School, Annastift.

出版信息

Dtsch Arztebl Int. 2020 Nov 20;117(47):793-800. doi: 10.3238/arztebl.2020.0793.

Abstract

BACKGROUND

There are many ways in which computer-assisted orthopedic and trauma surgery (CAOS) procedures can help surgeons to plan and execute an intervention.

METHODS

This study is based on data derived from a selective search of the literature in the PubMed database, supported by a Google Scholar search.

RESULTS

For most applications the evidence is weak. In no sector did the use of computer-assisted surgery yield any relevant clinical or functional improvement. In trauma surgery, 3D-navigated sacroiliac screw fixation has become clinically established for the treatment of pelvic fractures. One randomized controlled trial showed a reduction in the rate of screw misplacement: 0% with 3D navigation versus 20.4% with the conventional procedure und 16.6% with 2D navigation. Moreover, navigation-assisted pedicle screw stabilization lowers the misplacement rate. In joint replacements, the long-term results showed no difference in respect of clinical/functional scores, the time for which the implant remained in place, or aseptic loosening.

CONCLUSION

Computer-assisted procedures can improve the precision of certain surgical interventions. Particularly in joint replacement and spinal surgery, the research is moving away from navigation in the direction of robotic procedures. Future studies should place greater emphasis on clinical and functional results.

摘要

背景

计算机辅助骨科和创伤手术(CAOS)程序有许多方法可以帮助外科医生规划和执行干预措施。

方法

本研究基于从 PubMed 数据库中进行选择性文献搜索获得的数据,并辅以 Google Scholar 搜索。

结果

对于大多数应用,证据较弱。在任何领域,计算机辅助手术的使用都没有带来任何相关的临床或功能改善。在创伤外科中,3D 导航骶髂螺钉固定已成为骨盆骨折治疗的临床标准。一项随机对照试验显示螺钉错位率降低:3D 导航组为 0%,传统手术组为 20.4%,2D 导航组为 16.6%。此外,导航辅助椎弓根螺钉稳定术可降低螺钉错位率。在关节置换中,长期结果在临床/功能评分、植入物保持在位的时间或无菌性松动方面没有差异。

结论

计算机辅助手术可以提高某些手术干预的精度。特别是在关节置换和脊柱外科中,研究正从导航转向机器人手术。未来的研究应更加重视临床和功能结果。

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