CAJ | 학술논문

目的确定标准的术中透视图像,作为计算机辅助影像导航经皮螺钉内固定治疗髋臼前、后柱骨折的注册图像.方法选取干燥尸体骨盆4具、模型骨盆4具作为骨折模型.直视徒手将2.5 mm导针置入髋臼前、后柱(双侧);双侧前柱导针分别采用逆行及顺行置入,后柱导针采用逆行植入;目视确认导针位置满意后,将骨盆固定于影像导航手术模拟操作模块,应用C形臂x线透视机,针对髋臼结构的前、后、外、内4个虚拟平面的垂直方向进行多角度连续动态透视,选择并确认能够清楚显示导针与前后柱、髋臼关节面的透视影像,作为导航手术的注册图像,记录此时c形臂x线透视机与骨盆、手术床的相对空间位置.依此注册图像,在导航手术系统辅助下,应用6.5 mm的钛中空螺钉进行髋臼前、后柱螺钉置入.每个骨折模型,每侧进行1次操作,共16次.目测螺钉位置、分别记录为获取标准注册图像C形臂摆放时间、透视时间、手术操作时间(导航系统建立,软件界面操作及螺钉植入操作的总时间).结果所有螺钉置入位置满意,未进关节;前柱螺钉置入需要闭孔斜位(Judet-Letoumel斜位)、闭孔人口位、闭孔斜出口位、骨盆正位像;后柱螺钉置入需要髂骨斜位、闭孔斜位、骨盆入口位、闭孔斜出口位像;为获取前柱、后柱标准注册图像摆放C形臂X线透视机的时间平均分别为9.5、7.3 min,前柱、后柱每枚螺钉置入术中透视时间平均分别为2.9、1.7 S,前柱、后柱每枚螺钉置人操作时间平均分别为11.7、9.2 min.结论导航注册图像不同与传统的Judet-Letoumel影像,如何正确获取标准的术中透视注册图像,是确保安全、准确实施影像导航辅助经皮螺钉内固定手术的关键.
목적 학정표준적술중투시도상,작위계산궤보조영상도항경피라정내고정치료관구전、후주골절적주책도상.방법 선취간조시체골분4구、모형골분4구작위골절모형.직시도수장2.5 mm도침치입관구전、후주(쌍측);쌍측전주도침분별채용역행급순행치입,후주도침채용역행식입;목시학인도침위치만의후,장골분고정우영상도항수술모의조작모괴,응용C형비x선투시궤,침대관구결구적전、후、외、내4개허의평면적수직방향진행다각도련속동태투시,선택병학인능구청초현시도침여전후주、관구관절면적투시영상,작위도항수술적주책도상,기록차시c형비x선투시궤여골분、수술상적상대공간위치.의차주책도상,재도항수술계통보조하,응용6.5 mm적태중공라정진행관구전、후주라정치입.매개골절모형,매측진행1차조작,공16차.목측라정위치、분별기록위획취표준주책도상C형비파방시간、투시시간、수술조작시간(도항계통건립,연건계면조작급라정식입조작적총시간).결과 소유라정치입위치만의,미진관절;전주라정치입수요폐공사위(Judet-Letoumel사위)、폐공인구위、폐공사출구위、골분정위상;후주라정치입수요가골사위、폐공사위、골분입구위、폐공사출구위상;위획취전주、후주표준주책도상파방C형비X선투시궤적시간평균분별위9.5、7.3 min,전주、후주매매라정치입술중투시시간평균분별위2.9、1.7 S,전주、후주매매라정치인조작시간평균분별위11.7、9.2 min.결론 도항주책도상불동여전통적Judet-Letoumel영상,여하정학획취표준적술중투시주책도상,시학보안전、준학실시영상도항보조경피라정내고정수술적관건.
Objective To establish a new imaging protocol to acquire the most appropriate fluoro-images for fluoro-navigated percutaneous fixation of acetabular fracture and to evaluate the safety and effieiency of the procedures.Methods Guide needles were inserted into the bilateral anterior and posterior columns of the acetabula of 4 dry human cadaver pelvic skeletons and 4 plastic pelvic models.Then the pelvis skeletons were fixed to imaging guided surgery mimic operation modules.Dynamic fluoroscopy Was conducted with C-arm X-ray machine vertically on the 4 virtual planes of the acetabulum,inner,outer,anterior,and posterior from multiple angles.The fluoroscopic images clearly showing the guide needles,anterior and posterior columns,and acetabulum were selected as registration images,and the relative space positions between the C-arm X-ray fluoroscope and pelvis and operation table.Guided by the navigation system.totally 16 titanium hollow screws were inserted into bilateral anterior and posterior columns of acetabula of the 4 pelvis skeletons.The screw positions were estimated by visual method.The time needed to position the C-arm so as to obtain the standard registration image,time needed for fluoroscopy,and operation time,including establishment of navigation system,software interface operation,and screw insertion,were recorded.Results All the screws were inserted to the satisfying positions:placed within the desired bony corridor of the column and none of then were inserted into the joint.While inserting the screw into the anterior column fluoroscopy should be conducted with obturated oblique view.obturated inlet view,obturated oblique outlet view,or pelvic AP view.While inserting the screw into the posterior column fluoroscopy should be conducted with iliac-oblique view,obturated oblique view,pelvic inlet view,or obturated oblique outlet view.The total surgical time required for screw insertion was 11.7 min for anterior column,and Was 9.2 min for posterior column.9.5 and 7.3 minutes were needed to position the C-arm X-ray machine so as to obtain the images of the anterior and posterior columns respectively.2.9 and 1.7 seconds were needed for the actual fluoroscopy during insertion of the screws into the anterior and posterior columns respectively.Conclusion The standard registered fluoro-images are different from the conventional standard Judet-Letournel oblique views.How to get appmpriate fluoro-images is the key point for fluoro-navigated percutancous fixation of acetabular fractures.