A hybrid CT-free navigation system for total hip arthroplasty.
A hybrid CT-free navigation system for total hip arthroplasty.
复制标题
用于全髋关节置换术的混合免 CT 导航系统。
DOI：
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发表时间：
2002
期刊：
影响因子：
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通讯作者：
L. Nolte
中科院分区：
文献类型：
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作者：
Guoyan Zheng;A. Marx;U. Langlotz;K. Widmer;M. Buttaro;L. Nolte
目的
设计和评价一种新型无CT图像引导手术导航系统，用于辅助全髋关节置换术（THA）中髋臼和股骨部件的放置。
材料和方法
本文中的方法是概念上基于我们以前的工作CT无杯放置。对于股骨部件放置，首先定义两个患者特定的参考坐标系：一个用于骨盆，基于所谓的骨盆前平面（APP）概念，另一个用于股骨，使用股骨头中心、后髁切线和股骨近端髓管轴线。一种混合方法用于相关标志采集，包括基于经皮点的数字化和使用多个配准荧光透视图像的双平面标志重建。在真实的时间内计算以下临床参数：髋臼杯倾斜度和前倾、股骨柄的前旋和内翻/外翻、偏侧以及完全THA的下肢长度变化。此外，通过将虚拟器械表示叠加到荧光透视图像上，外科医生可以看到器械操作，例如扩孔、打入和锉削。
结果
一项计算机辅助测量前扭转和内翻/外翻、下肢长度变化和股骨柄放置偏侧的实验室研究证明了申报导航系统的高精度。与基于CT的测量相比，前旋、内翻/外翻、下肢长度变化和偏侧的平均偏差分别为1.0度、0.6度、0.7 mm和1.7 mm，标准偏差分别为0.5度、0.5度、0.6 mm和0.7 mm。初步临床评价表明，THA可以受益于这种新开发的无CT混合系统。
结论
所提出的无CT混合系统有望提高THA手术的准确性和可靠性。
OBJECTIVE
To design and evaluate a novel CT-free image-guided surgical navigation system for assisting placement of both acetabular and femoral components in total hip arthroplasty (THA).
MATERIALS AND METHODS
The methodology in this paper is conceptually based on our previous work on CT-free cup placement. For femoral component placement, two patient-specific reference coordinate systems are first defined: One for the pelvis, based on the so-called anterior pelvic plane (APP) concept, and one for the femur, using the center of the femoral head, the posterior condylar tangential line, and the medullary canal axis of the proximal femur. A hybrid method is used for the associated landmark acquisition, which involves percutaneous point-based digitization and bi-planar landmark reconstruction using multiple registered fluoroscopy images. The following clinical parameters are computed in real time: cup inclination and anteversion, antetorsion and varus/valgus of the stem, lateralization, and change in leg length for complete THA. In addition, instrument actions such as reaming, impaction, and rasping are visualized for the surgeon by superimposing virtual instrument representations onto the fluoroscopic images.
RESULTS
A laboratory study of computer-assisted measurement of antetorsion and varus/valgus, change in leg length, and lateralization for femoral stem placement demonstrated the high precision of the proposed navigation system. Compared with CT-based measurement, mean deviations of 1.0 degrees, 0.6 degrees, 0.7 mm, and 1.7 mm were found for antetorsion, varus/valgus, change in leg length, and lateralization, respectively, with standard deviations of 0.5 degrees, 0.5 degrees, 0.6 mm, and 0.7 mm, respectively. A pilot clinical evaluation showed that THA could benefit from this newly developed CT-free hybrid system.
CONCLUSIONS
The proposed CT-free hybrid system promises to increase the accuracy and reliability of THA surgery.