Chabihi Zakaria, Nouidi Nizar, Demnati Brahim, Benhima Mohamed Amine, Abkari Imad
Trauma and Orthopedics Department B, Mohammed VI University Hospital, Marrakesh, Morocco.
Laboratory of clinical and epidemiological research in bone and joint pathology, Cadi Ayyad University, Marrakesh, Morocco.
3D Print Med. 2024 Aug 7;10(1):28. doi: 10.1186/s41205-024-00221-2.
Distal locking is a challenging and time-consuming step in interlocked intramedullary nailing of long bone fractures. Current methods have limitations in terms of simplicity, universality, accuracy, speed, and safety. We propose a novel device and software for distal locking using computer vision.
The device consists of an universal ancillary clamp, a telescopic arm, a viewfinder clamp, and a radio-opaque cross. The software uses a camera photo from the C-arm intensifier and adjusts for geometric projection deformities. The software employs edge detection, Hough transform, perspective interpolation, and vector calculation algorithms to locate the distal hole center. The device and software were designed, manufactured, and tested using 3D CAD, FEM, DRR, and performance testing on phantom bones.
The device and software showed high accuracy and precision of 98.7% and 99.2% respectively in locating the distal hole center and calculating the correctional vector. The device and software also showed high success ratio in drilling the hole and inserting the screw. The device and software reduced the radiation exposure for the surgeon and the patient. The success ratio of the device and software was validated by the physical testing, which simulated the real clinical scenario of distal locking. The radiation exposure was as low as 5 s with a radiation dose of 0.2mSv, drastically reducing radiation exposure during distal locking.
Our device and software have several advantages over other distal locking methods, such as simplicity, universality, accuracy, speed, and safety. Our device and software also have some disadvantages, such as reliability and legislation. Our device and software can be compared with other distal locking methods based on these criteria. Our device and software have some limitations and challenges that need to be addressed in the future, such as clinical validation, and regulatory approval.
The device showed promising results in terms of low-cost, reusability, low radiation exposure, high accuracy, fast distal locking, high stiffness, and adaptability. The device has several advantages over other distal locking techniques, such as free-hand technique, mechanical aiming devices, electromagnetic navigation systems, and computer-assisted systems. We believe that our device and software have the potential to revolutionize the distal locking technique and to improve the outcomes and quality of life of the patients with long bone fractures.
在长骨骨折的带锁髓内钉固定术中，远端锁定是一个具有挑战性且耗时的步骤。当前的方法在简单性、通用性、准确性、速度和安全性方面存在局限性。我们提出了一种使用计算机视觉进行远端锁定的新型设备和软件。
该设备由一个通用辅助夹具、一个伸缩臂、一个取景器夹具和一个不透射线十字组成。该软件使用来自C形臂增强器的相机照片，并针对几何投影变形进行调整。该软件采用边缘检测、霍夫变换、透视插值和向量计算算法来定位远端孔中心。使用3D CAD、有限元法、数字重建放射影像（DRR）以及在模拟骨上进行性能测试对该设备和软件进行了设计、制造和测试。
该设备和软件在定位远端孔中心和计算校正向量方面分别显示出98.7%和99.2%的高精度和高精准度。该设备和软件在钻孔和插入螺钉方面也显示出高成功率。该设备和软件减少了外科医生和患者的辐射暴露。通过模拟远端锁定真实临床场景的物理测试验证了该设备和软件的成功率。辐射暴露低至5秒，辐射剂量为0.2毫希沃特，极大地减少了远端锁定期间的辐射暴露。
我们的设备和软件相对于其他远端锁定方法具有若干优势，例如简单性、通用性、准确性、速度和安全性。我们的设备和软件也存在一些缺点，例如可靠性和法规问题。可以基于这些标准将我们的设备和软件与其他远端锁定方法进行比较。我们的设备和软件存在一些需要在未来解决的局限性和挑战，例如临床验证和监管批准。
该设备在低成本、可重复使用、低辐射暴露、高精度、快速远端锁定、高刚度和适应性方面显示出有前景的结果。该设备相对于其他远端锁定技术具有若干优势，例如徒手技术、机械瞄准装置、电磁导航系统和计算机辅助系统。我们相信我们的设备和软件有潜力彻底改变远端锁定技术，并改善长骨骨折患者的治疗效果和生活质量。
