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首页> 外文期刊>Journal of orthopaedic trauma >Novel computer-assisted fluoroscopy system for intraoperative guidance: feasibility study for distal locking of femoral nails.
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Novel computer-assisted fluoroscopy system for intraoperative guidance: feasibility study for distal locking of femoral nails.

机译：用于术中指导的新型计算机辅助荧光检查系统：股骨钉远端锁定的可行性研究。

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OBJECTIVES: Orthopaedic procedures that use fluoroscopy require intraoperative mental navigation of the surgical tools in a three-dimensional space. Moreover, because of their reliance on real-time monitoring, such procedures are frequently associated with increased x-ray exposure. The goal of this study was to develop a computer-guided surgical navigation system based on fluoroscopic images that not only facilitates direction of surgical tools within anatomy, but also provides constant feedback without the need for radiologic updates. To evaluate the feasibility of the new technology, the authors used it on cases requiring distal locking of femoral nails. METHODS: The hardware components of the system include an instrumented C-arm, optoelectronic position sensor, stereotactic tools, and custom-made software. Computer integration of these devices permitted C-arm alignment assistance and real-time navigation control without constant x-ray exposure. The nails were locked in a variety of media, including plastic femurs, dry human femoral specimens, human cadavers, and one clinical case. Unreamed femoral nail sizes ranged from 9/340 to 12/400. Radiographs were taken to confirm that screws were positioned correctly, and fluoroscopic time associated with the locking procedure was recorded. RESULTS: All distal holes were locked successfully. In eight (11 percent) of seventy-six holes, the drill bit touched the canal of the locking hole, albeit with no damage to the nail and no clinical consequences. The fluoroscopy time per pair of screws was 1.67 seconds. CONCLUSIONS: The developed system enables the physician to precisely navigate surgical instruments throughout the anatomy using just a few computer-calibrated radiographic images. The total radiation time per procedure can be significantly reduced because additional x-ray exposure is not required for tool navigation.
机译：目的：使用透视检查的骨科手术需要在三维空间内对手术工具进行术中心理导航。此外，由于它们依赖实时监测，因此这些程序通常与增加的X射线照射有关。这项研究的目的是开发一种基于荧光镜图像的计算机引导手术导航系统，该系统不仅可以促进解剖结构内手术工具的方向，还可以提供持续的反馈，而无需进行放射学更新。为了评估这项新技术的可行性，作者将其用于需要远端锁定股骨钉的病例。方法：系统的硬件组件包括仪表化的C型臂，光电位置传感器，立体定位工具和定制软件。这些设备的计算机集成允许C臂对准辅助和实时导航控制，而无需持续的X射线暴露。指甲被钉在多种介质中，包括塑料股骨，干燥的人类股骨标本，人类尸体和一个临床病例。未矫正的股骨指甲尺寸范围为9/340至12/400。拍摄射线照片以确认螺钉正确定位，并记录与锁定过程相关的荧光检查时间。结果：所有远端孔均成功锁定。在76个孔中的八个（11％）中，钻头碰到了锁孔的通道，尽管没有损坏指甲，也没有临床后果。每对螺钉的荧光检查时间为1.67秒。结论：所开发的系统使医生仅需使用几台计算机校准的放射线图像即可精确地导航整个解剖结构中的手术器械。每次操作的总辐射时间可以大大减少，因为工具导航不需要额外的X射线曝光。

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