Comput. Aided Surg. - Navigated versus conventional transfixation of AC joint injuries: feasibility and accuracy.

Tópicos

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Resumo

JECTIVE: Transfixation of the acromioclavicular (AC) joint is a well-established technique for treating Rockwood IV to VI lesions. However, several complications, including pin breakage or pin migration due to incorrect placement, have been reported in the literature. A cadaveric study was performed to investigate whether the use of 3D navigation might improve the accuracy of AC joint transfixation.METHODS: Seventeen transfixations of the AC joint (8 non-navigated, 9 navigated) were performed minimally invasively in cadaveric shoulders. For the navigated procedures, a 3D C-arm (Ziehm Vision FD Vario 3D) and a navigation system (BrainLab VectorVision) were used. Reference markers were attached to the spina scapulae, then a 3D scan was performed and the data transferred to the navigation system. Two Kirschner wires (K-wires) were placed either freehand under fluoroscopic control (in the non-navigated group) or with the use of a navigated drill guide. Radiological analysis was performed with OsiriX software, measuring the distance of the K-wires from the center of the AC joint. For statistical analysis, Student's t-test was performed, with the significance level being set to p<0.05.RESULTS: The maximum distance of the K-wires from the center of the AC joint was 5.4?1.1mm for the freehand non-navigated group and 3.1?1.6mm for the navigated group (p=0.0054). The minimum distance of the K-wires from the AC joint center was 3.0?0.6mm for the freehand group and 1.6?0.6mm for the navigated group (p=0.0002). The radiation time was significant lower for the freehand group (41.25?20.4 seconds versus 79.5?13.3 seconds for the navigated group, p=0.004). There was no statistical difference between the groups with respect to the time required for surgery (11.25?3.6min for the freehand group and 12.6?4.6min for the navigated group; p=0.475). In the freehand group, the AC joint was penetrated by both K-wires in 87.5% of the procedures, compared to 100% in the navigated group. Both K-wires were placed completely intraosseously in the clavicula in 50% of the procedures in the freehand group, compared to 88% in the navigated group.CONCLUSION: Three-dimensional navigation may improve the accuracy of AC joint transfixation techniques. However, the radiation time is increased when using the navigated procedure, while the overall operation time remains comparable. Nevertheless, a 3D C-arm with a variable isocentric design is recommended for the acquisition of the shoulder scans.

Resumo Limpo

jectiv transfix acromioclavicular ac joint wellestablish techniqu treat rockwood iv vi lesion howev sever complic includ pin breakag pin migrat due incorrect placement report literatur cadaver studi perform investig whether use d navig might improv accuraci ac joint transfixationmethod seventeen transfix ac joint nonnavig navig perform minim invas cadaver shoulder navig procedur d carm ziehm vision fd vario d navig system brainlab vectorvis use refer marker attach spina scapula d scan perform data transfer navig system two kirschner wire kwire place either freehand fluoroscop control nonnavig group use navig drill guid radiolog analysi perform osirix softwar measur distanc kwire center ac joint statist analysi student ttest perform signific level set presult maximum distanc kwire center ac joint mm freehand nonnavig group mm navig group p minimum distanc kwire ac joint center mm freehand group mm navig group p radiat time signific lower freehand group second versus second navig group p statist differ group respect time requir surgeri min freehand group min navig group p freehand group ac joint penetr kwire procedur compar navig group kwire place complet intraoss clavicula procedur freehand group compar navig groupconclus threedimension navig may improv accuraci ac joint transfix techniqu howev radiat time increas use navig procedur overal oper time remain compar nevertheless d carm variabl isocentr design recommend acquisit shoulder scan

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