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OBJECTIVE@#To investigate the early effectiveness of transiliac-transsacral screws internal fixation assisted by augmented reality navigation system HoloSight (hereinafter referred to as "computer navigation system") in the treatment of posterior pelvic ring injuries.@*METHODS@#A retrospective analysis was made in the 41 patients with posterior pelvic ring injuries who had been treated surgically with transiliac-transsacral screws between June 2022 and June 2023. The patients were divided into navigation group (18 cases, using computer navigation system to assist screw implantation) and freehand group (23 cases, using C-arm X-ray fluoroscopy to guide screw implantation) according to the different methods of transiliac-transsacral screws placement. There was no significant difference in gender, age, body mass index, causes of injuries, Tile classification of pelvic fracture, days from injury to operation, usage of unlocking closed reduction technique between the two groups ( P>0.05). The time of screw implantation, the fluoroscopy times, the guide wire adjustment times of each screw, and the incidence of complications were recorded and compared between the two groups. The position of the transiliac-transsacral screw was scanned by CT within 2 days after operation, and the position of the screw was classified according to Gras standard.@*RESULTS@#The operation was successfully completed in both groups. The time of screw implantation, the fluoroscopy times, and the guide wire adjustment times of each screw in the navigation group were significantly less than those in the freehand group ( P<0.05). There were 2 cases of incision infection in the freehand group, and the incision healed by first intention after active dressing change; there was no screw-related complication in the navigation group during operation and early period after operation; the difference in incidence of complications between the two groups (8.7% vs. 0) was not significant ( P=0.495). According to the Gras standard, the screw position of the navigation group was significantly better than that of the freehand group ( P<0.05).@*CONCLUSION@#Compared with the traditional freehand method, the computer navigation system assisted transiliac-transsacral screws internal fixation in the treatment of posterior pelvic ring injuries has advantages of improving the accuracy of screw implantation and reducing radiation damage and the time of screw implantation.
Assuntos
Humanos , Estudos Retrospectivos , Infecção da Ferida Cirúrgica , Reimplante , Índice de Massa CorporalRESUMO
Fluoro-navigation technology becomes more and more important in orthopaedic surgery. Because of preoperative alteration in fracture fragment orientation it is necessary to complete the fracture reduction before fluoroscopic image acquisition and surgery assisted with navigation. The advantages of the fluoro-navigation technology include minimal X-ray exposure, accurate positioning of implants, real time interactive quantitative data of the images, and minimally invasive surgery. With further development and improvement of both software and hardware, many operations, which require X-ray monitoring, can be conducted with the help of fluoro-navigation technology. Our past 4-year clinical experiences confirm the above advantages and its potential applications. As the technology of fluoro-navigation is still under improvement, further evaluation and validation is necessary to confirm its clinical values. In addition, fluoro-navigationsystems may play an important role in virtual surgical training and assessment. It may provide not only training opportunities to young surgeons but also an objective assessment system for evaluating proficiency of surgical techniques.
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Objective This paper illustrates the application of fluoronavigation in intramedullary nailing in long bone fractures (femur and tibia), especially during the procedure of distal locking. We also explore the possibility of distal locking with an image bank of intramedullary nails and under navigation. Furthermore medical robots are being developed to further improve the precision of the procedure. Methods In our hospital, distal locking in 55 cases of femoral nailing and 36 cases of tibial nailing were performed under navigation. Another 13 cases of distal locking were performed with the image bank. Result The overall successful rate of distal locking was 97%. Conclusions Fluoronavigation in distal locking of intramedullary nailing of long bone fractures has achieved a high successful rate. Development of an image bank could further decrease the X-ray exposure suffered by the patient and operation theater staffs.
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Objective To explore the application of fluoro-navigation in close reduction and fixation of pelvi-acetabular fractures. Methods After imaging reconstruction from plan X-rays and CT tomographs, close reduction and fixation of pelvi-acetabular fractures were conducted under fluoro-navigation based on the indications. If the reduction was found satisfactory, surgical planning was discussed together with the patients. Results No complications occurred among patients with pelvi-acetabular dislocation. Apart from few cases postoperative CT scan showed satisfactory crew fixation. Conclusion The current experiences suggest that the fluoro-navigation is indicated for fixation of pelvi-acetabular fractures with close reduction.
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This article introduces the technique of cannulated hip screws fixation using fluoro-navigation. Fluoro-navigation system optimizes screw positioning and reduces radiation exposure during the internal fixation for intracapsular femoral neck fractures.
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Objective To illustrate the application of fluoronavigation in Gamma nailing—a common surgical procedure in treatment of intertrochanteric fracture of femur and to compare the newly designed Gamma-3 system for navigation with the Gamma-AP system. Methods 66 patients with intertrochanteric fractures underwent Gamma nailing (40 Gamma-AP and 26 Gamma-3) under fluoronavigation guidance. An observer recorded the different intra-operative parameters. Results The Gamma-3 group showed superior results of shorter operation time (averaging 32 minutes), smaller surgical wound size (5cm), less X-ray requirement during procedure (7 times) and at the same time better lag screw position (Tip-Apex-Distance 17.9 mm). Conclusions Fluoronavigation can facilitate gamma nailing as a minimally invasive surgery because of its accurate guidance to nail insertion and lag screw positioning, a smaller surgical wound and minimized X-ray exposure suffered by operation theater staff. The Gamma-3 system has shown better results than the Gamma-AP system because of its navigation-specific design.
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Objective To use 3D fluoro-images for reduction and fixation of articular and juxta-articular fractures. Methods Presurgical analysis was carried out based on standard plan X-rays and 3D fluoro-images. Stryker 3D Fluoro-navigation system was used for reduction and fixation of articular and juxta-articular fractures at the tibial plateau and distal tibia. Results A total of 11 tibial plateau fractures, 5 Pilon fractures and 1 femoral condyle fracture were treated. All the main fracture frangments were fixed via a small incision with canulated screws. Conclusion Navigation surgery based on the combined use of 3D fluoro-and CT-images is helpful in reducing the X-ray exposure in a minimally invasive surgery for articular fractures with acceptable accuracy.
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This paper introduces the applications of Computer Assisted Orthopaedic Surgery (CAOS), including pre-operative planner, surgical simulator, intra-operative navigation systems and medical robotics. Basic principals of surgical navigation are also discussed. In view of the high precision requirement for navigation assisted procedures, there exists a definite need for development of medical robotics to carry out these procedures. We have a brief review on the different robot systems and present the surgical navigation arm developed in the Chinese University of Hong Kong. The laboratory test results of navigation guided distal targeting of intramedullary nail with or without surgical navigation arm showed the better repeatability and precision when the robot arm was used. So far the surgical navigation arm has been successfully applied in clinical practice, including distal targeting of intramedullary nailing; percutaneous sacro-iliac screw and percutaneous trans-iliac screw in pelvic fractures and hip screw fixation for fracture of femoral neck. To conclude, medical robotics is an essential component of the future CAOS.