Intraoperative cone-beam CT for image-guided tibial plateau fracture reduction
Intraoperative cone-beam CT for image-guided tibial plateau fracture reduction
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DOI：
10.1080/10929080701526872
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发表时间：
2007-07-01
影响因子：
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通讯作者：
Jaffray, D. A.
中科院分区：
文献类型：
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作者：
Khoury, A.;Siewerdsen, J. H.;Jaffray, D. A.
目的：在我们的实验室中，与Siemens Medical Solutions合作修改了移动的等中心C形臂，以包括提供多模式荧光透视和锥形束CT（CBCT）成像的大面积平板探测器。该技术是现有术中成像的重要进步（例如，Iso-C-3D），提供上级图像质量、更大的视野、更高的空间分辨率和软组织可见性。本研究的目的是评估该系统的性能和图像质量在胫骨平台（TP）fracture reconstruction.Methods：三TP骨折在新鲜冷冻尸体膝关节通过联合轴向加载和侧向冲击模拟。通过外侧入路对骨折进行复位，并通过X线透视进行评估。然后使用CBCT评估重建。如有必要，使用CBCT图像进行指导，对剩余移位骨碎片进行进一步复位和定位。从投影速度、剂量和过滤技术等方面评估CBCT图像质量。结果：CBCT成像提供了关节细节的精致可视化、微妙的碎片检测和定位以及复位和植入物放置的确认。在荧光镜图像显示成功的初始复位后，CBCT成像显示了对线不良和移位的碎片区域。CBCT有助于碎片定位和改善解剖复位。CBCT图像噪声随着剂量的减少而逐渐增加，但投影增加导致的图像差异不大。高分辨率重建提供了更好的平台depressions.Conclusion划定：这项研究表明，术中CBCT在TP骨折固定的2D透视和ISO-C-3D的明显优势。CBCT成像在骨折类型诊断、骨折碎片定位和术中解剖复位的3D确认方面具有优势。
Objectives: A mobile isocentric C-arm was modified in our laboratory in collaboration with Siemens Medical Solutions to include a large-area flat-panel detector providing multi-mode fluoroscopy and cone-beam CT (CBCT) imaging. This technology is an important advance over existing intraoperative imaging (e.g., Iso-C-3D), offering superior image quality, increased field of view, higher spatial resolution, and soft-tissue visibility. The aim of this study was to assess the system's performance and image quality in tibial plateau (TP) fracture reconstruction.Methods: Three TP fractures were simulated in fresh-frozen cadaveric knees through combined axial loading and lateral impact. The fractures were reduced through a lateral approach and assessed by fluoroscopy. The reconstruction was then assessed using CBCT. If necessary, further reduction and localization of remaining displaced bone fragments was performed using CBCT images for guidance. CBCT image quality was assessed with respect to projection speed, dose and filtering technique.Results: CBCT imaging provided exquisite visualization of articular details, subtle fragment detection and localization, and confirmation of reduction and implant placement. After fluoroscopic images indicated successful initial reduction, CBCT imaging revealed areas of malalignment and displaced fragments. CBCT facilitated fragment localization and improved anatomic reduction. CBCT image noise increased gradually with reduced dose, but little difference in images resulted from increased projections. High-resolution reconstruction provided better delineation of plateau depressions.Conclusion: This study demonstrated a clear advantage of intraoperative CBCT over 2D fluoroscopy and ISO-C-3D in TP fracture fixation. CBCT imaging provided benefits in fracture type diagnosis, localization of fracture fragments, and intraoperative 3D confirmation of anatomic reduction.