Int J Comput Assist Radiol Surg - Image guidance can support scaphoid K-wire insertion: an experimental study and initial clinical experience.

Tópicos

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Resumo

RPOSE: In the treatment of small bone fractures, such as the scaphoid bone, conventional navigation is limited by its dependence on fixed reference arrays. We introduce a new technique based on reference markers in surgical instruments. If visible on a standard fluoroscopic image, static trajectories are overlaid in this image to guide implant insertions. Fixed markers are not required. The purpose of this study was to identify the possible advantages of the new guidance technique.METHODS: For this study, 20 artificial hand specimens were randomized into two groups and blinded with polyurethane foam: 10 were treated conventionally and 10 were image guided. We used a clip containing radiopaque markers, which was detected by the system's workstation. A static trajectory was displayed consecutively in the fluoroscopic image to serve as an aiming device. Secondly, we included 3 patients with fractures of the scaphoid bone to test the integrability of this novel method in a clinical setting.RESULTS: In the experimental setup, trajectory guidance reduced the duration of surgery and radiation exposure. Furthermore, it reduced the perforation rate. Accuracy was not improved by the new technique. For clinical cases, the system was integrated into the accommodated surgical workflow and rated as very helpful by users.CONCLUSION: The system helped reduce the misplacement rate and the emission of radiation. The main limitations were that trajectories were not displayed in real time and could only be shown in a single fluoroscopic image. However, the system is simple and can be easily integrated into the surgical workflow.

Resumo Limpo

rpose treatment small bone fractur scaphoid bone convent navig limit depend fix refer array introduc new techniqu base refer marker surgic instrument visibl standard fluoroscop imag static trajectori overlaid imag guid implant insert fix marker requir purpos studi identifi possibl advantag new guidanc techniquemethod studi artifici hand specimen random two group blind polyurethan foam treat convent imag guid use clip contain radiopaqu marker detect system workstat static trajectori display consecut fluoroscop imag serv aim devic second includ patient fractur scaphoid bone test integr novel method clinic settingresult experiment setup trajectori guidanc reduc durat surgeri radiat exposur furthermor reduc perfor rate accuraci improv new techniqu clinic case system integr accommod surgic workflow rate help usersconclus system help reduc misplac rate emiss radiat main limit trajectori display real time shown singl fluoroscop imag howev system simpl can easili integr surgic workflow

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