Percutaneous pelvic fracture stabilization using CT-based 3D navigation software combined with targeting mechanical arm: a cadaver model trial / 中华外科杂志

<p><b>OBJECTIVES</b>To investigate a new targeting mechanical arm for CT-based navigated percutaneous fixation of pelvic fractures, and to evaluate the safety and efficiency of the procedures.</p><p><b>METHODS</b>Using CT-based 3D navigation software combined with targeting mechanical arm, percutaneous insertion of pelvic models (3 dry human cadaver pelvic skeletons and 5 plastic Sybone pelvic models) were performed, 8 pelvic models allowed percutaneous cannulated screw insertion of both S-I joint (2 S-I screws placement for each side, total 32 screws in this experiment) and both superior ramus (1 ramus medullary screw placement for each side, total 16 screws in this experiment). Percutaneous insertion of pelvic models (4 dry human cadaver pelvic skeletons and 4 plastic Sybone pelvic models, 1 S-I screws and 1 ramus medullary scre placement for each side, 32 screws in this experiment) were performed using fluoro-navigation system (Stryker, USA). Time necessary for every screw insertion were recorded. Accuracy of screw placement was assessed using C-arm imaging and direct eyes inspecting. The time and accuracy of the two methods were compared.</p><p><b>RESULTS</b>The time required for the CT-based 3D navigation procedure (3.6 ± 1.2) min was significantly less than using the targeting mechanical arm compared to drilling freehand with navigation (9.1 ± 0.8) min (t = 2.50, P < 0.01). There was no significant difference in accuracy between the two methods.</p><p><b>CONCLUSION</b>CT-based 3D navigation software combined with targeting mechanical arm should be potential to apply percutaneous sacroiliac screwing for pelvic fractures with more accurate and more reliable.</p>

Computer-assisted navigation systems for insertion of cannulated screws in femoral neck fractures: a comparison of bi-planar robot navigation with optoelectronic navigation in a Synbone hip model trial / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Computer-assisted procedures have recently been introduced for navigated femoral neck screw placement. Currently there is little information available regarding accuracy and efficiency of the different navigated procedures. The aim of this study was to compare two fluoroscopic navigation tracking technologies, a novel bi-planar robot navigation and standardized optoelectronic navigation, versus standard freehand fluoroscopic insertion in a Synbone hip model.</p><p><b>METHODS</b>Eighteen fixed Synbone hip models were divided into 3 groups. C-arm navigated cannulated screws (AO-ASIF, diameter 7.3 mm) were inserted using freehand targeting (control group). A novel bi-planar robot system (TINAV, GD2000) and an optoelectronic system (Stryker OTS Navigation System) were used for the navigated procedures (robot group and optoelectronic group). Accuracy was measured using radiographic evaluation including the measurement of screw parallelism and decentralization, and joint penetration. To evaluate the efficiency, the number of guidewire passes, operative time and fluoroscopic images taken were noted.</p><p><b>RESULTS</b>The two computer-assisted systems provided significantly improved accuracy compared to the freehand technique. Each of the parameters, including guidewire passes and number of fluoroscopy images, was significantly lower when using the computer-assisted systems than for freehand-unguided insertion (P <0.05), but operative time was significantly shorter when using freehand-unguided insertion than for the computer-assisted systems (P <0.05). Accuracy, operative time and number of fluoroscopy images taken were similar among the two navigated groups (P >0.05), but guidewire passes in the robot group were significantly less than in the optoelectronic group (P <0.05).</p><p><b>CONCLUSIONS</b>Both bi-planar robot navigation and optoelectronic navigation were similarly accurate and have the potential to improve accuracy and reduce radiation for freehand fluoroscopic targeting for insertion of cannulated screws in femoral neck fractures. Guidewire passes in the robot group were significantly less than in the optoelectronic group. However, both navigated procedures were associated with time-consuming registration and high rates of failed matching procedures.</p>

A perspective on medical robotics / 中国医疗器械杂志

Medical robotics has played an increasingly important role in the recent years in robotics field. An overview of the minimally invasive surgery robots, rehabilitative robots and hospital service robots are offered here, and relevant tendencies are also referred to.

Clinical application of robotic tele-manipulation system in stereotactic surgery / 中华外科杂志

<p><b>OBJECTIVE</b>To assess the clinical usefulness, accuracy, and safety of tele-manipulation for frameless stereotactic surgery using the CAS-R-5 robot system.</p><p><b>METHODS</b>We prospectively evaluated 32 patients underwent tele-manipulation of frameless stereotactic operations from Sep. 2005 to Sep. 2006. Tele-manipulations were performed via a digital data network by a neurosurgeon in Beijing while the patients were located in Yan'an. The distance is 1300 kilometers away. The accuracy of location and improvement of symptom were observed after operation. The period of follow-up was from 3 to 14 months (the average was 12 months).</p><p><b>RESULTS</b>The surgical operations in 32 cases were successful. Remote fiducial registration was performed with a mean accuracy of 1. 50 mm and the standard difference were 0.32 mm between the planned and actual target. There were no complications.</p><p><b>CONCLUSIONS</b>Diagnosis and treatment for intracranial disease by tele-manipulation frameless stereotactic surgeries are reliable and safe.</p>

Computer-assisted auto-frame navigation system for distal locking of tibial intramedullary nails: a preliminary report on clinical application / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To evaluate the clinical feasibility and effect of the computer-assisted auto-frame navigation system for distal locking of tibial intramedullary nails.</p><p><b>METHODS</b>The hardware components of the system included a PC computer with a monitor, auto mechanical stereotactical localization cubic frame, foot holder and localization operative apparatus. Special navigation software can be used for registration of X-ray fluoroscopic images and real-time controlling navigation of tools. Twenty-one cases of close tibial and fibular fractures were treated with closed intramedullary nailing, 6 of which involved in middle third, 12 in middle and lower third, 3 in lower third. C-arm alignment and registration time, fluoroscopic time and drilling time involved in the locking procedure were recorded. The size of unreamed or reamed tibial nails ranged from 8/300-11/330.</p><p><b>RESULTS</b>All distal holes except 1 were locked successfully. In 9 of 41 locked holes (21.95%), the drill bit touched the canal of locking hole without damage of the nail and clinical consequences. The fluoroscopy time per pair of screws was 2.23+/-0.31 s.</p><p><b>CONCLUSIONS</b>The computer-assisted auto-frame navigation system for distal locking is well designed, easy to operate and do not need additional instruments during the procedure. The developed system enables the physician to precisely navigate surgical instruments throughout the anatomy using just a few computer-calibrated radiographic images. The total time of X-ray exposure per procedure can be significantly reduced.</p>

Design and experimental study of computer-assisted orthopaedic system for distal locking of intramedullary nails / 中华外科杂志

<p><b>OBJECTIVE</b>To test the safety and accuracy of the computer-assisted orthopaedic system for distal locking of intramedullary nails and apply it to internal fixation with intramedullary nails in the lower limb.</p><p><b>METHODS</b>According to the theory of mechanical arms stereotactic localization in computer-assisted orthopaedic surgery (CAOS), we design a CAOS system for distal locking of intramedullary nails. The system comprised 2 independent modules: computer-assisted imaging and registration workstation; mechanical stereotactic framework. Ten plastic tibia models, 20 plastic femur models (Synbone AG, Malans, Switzerland) and 6 human cadaver lower limbs were randomly divided into 2 groups undergoing internal fixation with intramedullary nails (Orthofix, Germany). The first group (CAOS group with 5 plastic tibia models, 10 plastic femur models, 6 human cadaver tibia, 6 human cadaver femur; each nail had 2 holes, and 2 distal locking screws were inserted in each bone, which gave a total number of 54 holes) used a computer-assisted orthopaedic system, the second group (CONTROL GROUP is the same as CAOS group) used Orthofix mechanical targeting device for distal locking. Comparison between 2 groups was made in radiation exposure time, operating time, percentage of correctly placed screws.</p><p><b>RESULTS</b>CAOS group: operating time was (4.44 +/- 2.99) min; radiation exposure time was (1.16 +/- 0.38) min; correctly placed screws rate was (100 +/- 0)%.</p><p><b>CONTROL GROUP</b>operating time was (10.42 +/- 4.18) min; radiation exposure time was (4.71 +/- 3.86) min; correctly placed screws rate was (94.44 +/- 0.36)%. Operating time and radiation exposure time in CAOS group were significantly shorter than those in control group (P < 0.05), no differences were found between 2 groups in relation to the percentage of correctly placed screws.</p><p><b>CONCLUSIONS</b>By using CAOS system for distal locking of intramedullary nails, the locking holes can be drilled accurately and safely. Radiation exposure significantly reduced.</p>