Kumar Vishal, Baburaj Vishnu, Patel Sandeep, Sharma Siddhartha, Vaishya Raju
Department of Orthopaedics, Postgraduate Institute of Medial Education and Research, Chandigarh, India.
Department of Orthopaedics, Indraprastha Apollo Hospitals, New Delhi, India.
J Clin Orthop Trauma. 2021 May 15;18:216-223. doi: 10.1016/j.jcot.2021.04.030. eCollection 2021 Jul.
Intraoperative imaging is frequently made use of in Orthopaedic surgery. Historically, conventional 2-dimensional fluoroscopy has been extensively used for this purpose. However, 2D imaging falls short when it is required to visualise complex anatomical regions such as pelvis, spine, foot and ankle etc. Intraoperative 3D imaging was introduced to counter these limitations, and is increasingly being employed in various sub-specialities of Orthopaedic Surgery.
This review aims to outline the clinical and radiological outcomes of surgeries done under the guidance of intraoperative 3D imaging and compare them to those done under conventional 2D fluoroscopy.
Three electronic databases (PubMed, Embase and Scopus) were searched for relevant studies that directly compared intraoperative 3D imaging with conventional fluoroscopy. Case series on intraoperative 3D imaging were also included for qualitative synthesis. The outcomes evaluated included accuracy of implant placement, mean surgical duration and rate of revision surgery due to faulty implants.
A total of 31 studies from sub-specialities of spine surgery, pelvi-acetabular surgery, foot and ankle surgery and trauma surgery, having data on a total of 658 patients were analysed. The study groups which had access to intraoperative 3D imaging was found to have significantly increased accuracy of implant positioning (Odds Ratio 0.35 [0.20, 0.62], p = 0.0002) without statistically significant difference in mean surgical time (p = 0.57). Analysis of the studies that included clinical follow up showed that the use of intraoperative 3D imaging led to a significant decrease in the need for revision surgeries due to faulty implant placement.
There is sufficient evidence that the application of intraoperative 3D imaging leads to precise implant positioning and improves the radiological outcome. Further research in the form of prospective studies with long term follow up is required to determine whether this superior radiological outcome translates to better clinical results in the long run.
术中成像在骨科手术中经常被使用。从历史上看，传统的二维荧光透视已被广泛用于此目的。然而，当需要可视化复杂的解剖区域，如骨盆、脊柱、足踝等时，二维成像就显得不足。术中三维成像被引入以克服这些局限性，并越来越多地应用于骨科手术的各个亚专业。
本综述旨在概述在术中三维成像引导下进行的手术的临床和放射学结果，并将其与传统二维荧光透视下进行的手术结果进行比较。
检索了三个电子数据库（PubMed、Embase和Scopus），以查找直接比较术中三维成像与传统荧光透视的相关研究。关于术中三维成像的病例系列也被纳入进行定性综合分析。评估的结果包括植入物放置的准确性、平均手术时间以及因植入物故障导致的翻修手术率。
共分析了来自脊柱外科、骨盆髋臼外科、足踝外科和创伤外科亚专业的31项研究，这些研究的数据涉及总共658名患者。发现能够使用术中三维成像的研究组植入物定位的准确性显著提高（优势比0.35 [0.20, 0.62]，p = 0.0002），而平均手术时间无统计学显著差异（p = 0.57）。对包括临床随访的研究进行分析表明，使用术中三维成像导致因植入物放置不当而进行翻修手术的需求显著减少。
有充分证据表明术中三维成像的应用可实现精确的植入物定位并改善放射学结果。需要进行长期随访的前瞻性研究，以进一步确定这种优越的放射学结果从长远来看是否能转化为更好的临床效果。
