CAJ | 학술논문

目的探讨基于术前CT扫描的术中实时三维导航技术应用于经皮骶髂关节螺钉置入术的可行性. 方法术前沿着5具正常骨盆标本髂骨翼各置入1枚钛钉后行CT扫描.将扫描数据导入SuperImage软件完成骨盆的三维重建.将三维模型导入导航软件中,获得钛钉标识点在三维虚拟空间的坐标,并规划骶髂关节螺钉置入的安全路径.术中通过导航探针,获取钛钉的实际空间坐标,并与虚拟标识点进行配准；通过导航系统实时跟踪术中骨盆及手术器械的空间位置.在实时三维导航下按照虚拟规划的安全路径,在5具骨盆标本上各完成1枚经皮骶髂关节螺钉的置入,并记录手术操作时间.术后行骨盆CT扫描及三维重建,观察螺钉的位置,并与术前规划结果进行对比. 结果在5具正常骨盆标本上按照术前虚拟规划的路径各顺利置入1枚骶髂关节螺钉.术后CT扫描显示5枚螺钉位置均满意,与术前虚拟规划结果基本一致.手术操作时间为19～ 23 min,平均21.6 min. 结论术中实时三维导航技术充分利用术前虚拟规划信息,术中螺钉置入精度高,且无需X线透视,操作流程简单、快捷,在经皮骶髂关节螺钉固定术中具有良好的可行性.
목적 탐토기우술전CT소묘적술중실시삼유도항기술응용우경피저가관절라정치입술적가행성. 방법 술전연착5구정상골분표본가골익각치입1매태정후행CT소묘.장소묘수거도입SuperImage연건완성골분적삼유중건.장삼유모형도입도항연건중,획득태정표식점재삼유허의공간적좌표,병규화저가관절라정치입적안전로경.술중통과도항탐침,획취태정적실제공간좌표,병여허의표식점진행배준；통과도항계통실시근종술중골분급수술기계적공간위치.재실시삼유도항하안조허의규화적안전로경,재5구골분표본상각완성1매경피저가관절라정적치입,병기록수술조작시간.술후행골분CT소묘급삼유중건,관찰라정적위치,병여술전규화결과진행대비. 결과 재5구정상골분표본상안조술전허의규화적로경각순리치입1매저가관절라정.술후CT소묘현시5매라정위치균만의,여술전허의규화결과기본일치.수술조작시간위19～ 23 min,평균21.6 min. 결론 술중실시삼유도항기술충분이용술전허의규화신식,술중라정치입정도고,차무수X선투시,조작류정간단、쾌첩,재경피저가관절라정고정술중구유량호적가행성.
Objective To study the feasibility of using real-time three-dimensional (3D) navigation based on preoperative CT scans in percutaneous insertion of sacroiliac joint screws.Methods CT scanning was performed in 5 cadaveric specimens of normal pelvis into which 5 titanium screws were inserted as markers along the iliac wings.The CT scan data were imported to the SuperImage software for 3D reconstruction of the pelvic models.The 3D models were transferred to the navigation software to determine safe approaches for placement of sacroiliac joint screws on the basis of coordinates of the titanium screw markers in the virtual 3D space.Coordinates of the titanium screws in real space were obtained by the navigation probe before they were matched to the markers in the 3D model to complete the registration.Next the system real-time tracked the positions of surgical instruments and the cadaveric pelvis.Under the real-time 3D navigation,percutaneous implantation of one sacroiliac joint screw was completed in each of the 5 pelvic specimens in accordance with the safe approaches planned preoperation.Operative time was record.CT scans of the pelvis were obtained postoperatively for 3D reconstruction.Positions of the screws in postoperative 3D models were observed and compared with those in the preoperative models.Results In each of the 5 cadaveric specimens of normal pelvis,one sacroiliac screw was successfully inserted along safe approach planned preoperatively.Postoperative CT scanning showed that the placement of 5 screws was highly accurate and consistent with the preoperative virtual planning.The operative time ranged from 19 to 23 minutes,averaging 21.6 minutes.Conclusions Since 3D real-time navigation can make a good use of preoperative virtual planning,screws can be placed accurately,simply and quickly in the operation without X-ray fluoroscopy.It is feasible to use 3D real-time navigation on the basis of preoperative CT scans in the percutaneous fixation with sacroiliac joint screws.