Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland.
Research in Orthopaedic Computer Science, Balgrist University Hospital, University of Zurich, Zurich, Switzerland.
Arch Orthop Trauma Surg. 2024 Mar;144(3):1077-1089. doi: 10.1007/s00402-023-05167-4. Epub 2023 Dec 22.
The periacetabular osteotomy is a technically demanding procedure with the goal to improve the osseous containment of the femoral head. The options for controlled execution of the osteotomies and verification of the acetabular reorientation are limited. With the assistance of augmented reality, new possibilities are emerging to guide this intervention. However, the scientific knowledge regarding AR navigation for PAO is sparse.
In this cadaveric study, we wanted to find out, if the execution of this complex procedure is feasible with AR guidance, quantify the accuracy of the execution of the three-dimensional plan, and find out what has to be done to proceed to real surgery. Therefore, an AR guidance for the PAO was developed and applied on 14 human hip cadavers. The guidance included performance of the four osteotomies and reorientation of the acetabular fragment. The osteotomy starting points, the orientation of the osteotomy planes, as well as the reorientation of the acetabular fragment were compared to the 3D planning.
The mean 3D distance between planned and performed starting points was between 9 and 17 mm. The mean angle between planned and performed osteotomies was between 6° and 7°. The mean reorientation error between the planned and performed rotation of the acetabular fragment was between 2° and 11°.
The planned correction can be achieved with promising accuracy and without serious errors. Further steps for a translation from the cadaver to the patient have been identified and must be addressed in future work.
髋臼周围截骨术是一项技术要求很高的手术，目的是改善股骨头的骨性包容。截骨术的可控执行和髋臼再定位的验证选择有限。借助增强现实，出现了新的引导这种干预的可能性。然而，关于 AR 导航在 PAO 中的应用的科学知识还很缺乏。
在这项尸体研究中，我们想了解 AR 引导是否可以执行这种复杂的手术，量化执行三维计划的准确性，并找出实际手术前需要做些什么。因此，我们开发并应用了一种 AR 引导系统来进行 PAO，共对 14 个人体髋关节进行了研究。引导系统包括进行四个截骨术和髋臼片段的再定位。比较了截骨术的起始点、截骨平面的方向以及髋臼片段的再定位与 3D 规划。
计划和执行的起始点之间的平均三维距离为 9 到 17 毫米。计划和执行的截骨术之间的平均角度为 6°至 7°。计划和执行的髋臼片段旋转之间的平均再定位误差为 2°至 11°。
可以实现有希望的准确性，且不会出现严重错误，实现计划的纠正。已经确定了从尸体到患者的进一步步骤，并且必须在未来的工作中解决这些步骤。
