Computer-Assisted Planning and Navigation for Corrective Distal Radius Osteotomy, Based on Pre- and Intraoperative Imaging
Computer-Assisted Planning and Navigation for Corrective Distal Radius Osteotomy, Based on Pre- and Intraoperative Imaging
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DOI：
10.1109/tbme.2010.2084576
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发表时间：
2011-01-01
影响因子：
4.6
通讯作者：
Streekstra, G. J.
中科院分区：
文献类型：
--
作者：
Dobbe, J. G. G.;Strackee, S. D.;Streekstra, G. J.
桡骨远端骨折后的畸形愈合是非常常见的，如果有症状，则采用所谓的矫正截骨术进行治疗。在传统的桡骨远端截骨术中，在骨折部位切割桡骨，并在截骨间隙中插入楔形物以校正桡骨远端姿势。标准程序使用两张正交X线片来估计两个倾角和插入截骨间隙的楔形物的尺寸。然而，3-D空间中的最佳校正需要恢复三个角度和三个位移。本文介绍了一种新的技术，使用术前规划的基础上3-D图像。术中3D成像也可用于在桡骨近端和远端插入骨针后和截骨前使用标记工具。定位工具的开发，以纠正桡骨远端姿势在六个自由度导航销。该方法准确（d（err）< 1.2 mm，phi（err）< 0.9度，mTRE = 1.7 mm），重现性高（SEd < 1.0 mm，SE phi = 1.4度，SEm TRE = 0.7 mm），并允许术中评价最终结果。小切口的针放置和截骨术使该方法微创。
Malunion after a distal radius fracture is very common and if symptomatic, is treated with a so-called corrective osteotomy. In a traditional distal radius osteotomy, the radius is cut at the fracture site and a wedge is inserted in the osteotomy gap to correct the distal radius pose. The standard procedure uses two orthogonal radiographs to estimate the two inclination angles and the dimensions of the wedge to be inserted into the osteotomy gap. However, optimal correction in 3-Dspace requires restoring three angles and three displacements. This paper introduces a new technique that uses preoperative planning based on 3-D images. Intraoperative 3-D imaging is also used after inserting pins with marker tools in the proximal and distal part of the radius and before the osteotomy. Positioning tools are developed to correct the distal radius pose in six degrees of freedom by navigating the pins. The method is accurate (d(err) < 1.2 mm, phi(err) < 0.9 degrees, mTRE = 1.7 mm), highly reproducible (SEd < 1.0 mm, SE phi = 1.4 degrees, SEm TRE = 0.7 mm), and allows intraoperative evaluation of the end result. Small incisions for pin placement and for the osteotomy render the method minimally invasive.