【Abstract】 Objective To study the effectiveness of computer assisted pedicle screw insertion in osteoporotic spinalposterior fixation. Methods Between December 2009 and March 2011, 51 patients underwent pedicle screw fixation using the computer assisted navigation (navigation group), while 41 patients underwent the conventional technique (traditional group). All patients had osteoporosis under the dual-energy X-rays absorptiometry. There was no significant difference in age, gender, bone mineral density, involved segment, preoperative complications, and other general status between 2 groups (P gt; 0.05). The amount of blood loss, the operation time, the rate of the pedicle screw re-insertion, and the postoperative complication were observed. The state of the pedicle screw location was assessed by CT postoperatively with the Richter’s classification and the fusion state of the bone graft was observed using three-dimensional (3-D) CT scans during follow-up. Results A total of 250 screws were inserted in navigation group, and 239 were inserted successfully at first time while the other 11 screws (4.4%) were re-inserted. A total of 213 screws were inserted in traditional group, and 190 were successful at first time while 23 screws (10.8%) were re-inserted. There was significant difference in the rate of screws re-insertion between 2 groups (χ2=6.919, P=0.009). Both the amount of blood loss and the operation time in navigation group were significantly less than those in traditional group (P lt; 0.05). According to Richter’s classification for screw location, the results were excellent in 240 screws, good in 10 screws innavigation group; the results were excellent in 191 screws, good in 21 screws, and poor in 1 screw in traditional group. Significant difference was noticed in the screw position between 2 groups (χ2=7.566, P=0.023). The patients were followed up (7.8 ± 1.5) months in navigation group and (8.7 ± 1.5) months in traditional group. No loosening, extraction, and breakage of the pedicle screw occurred in navigation group, and all these patients had successful fusion within 6 months postoperatively. While in traditional group, successful fusion was shown in the other patients by 3-D CT, except the absorption of bone graft was found in only 1 patient at 6 months after operation. And then, after braking by adequate brace and enhancing the anti-osteoporotic therapy, the bone graft fused at 9 months postoperatively. Conclusion The computer assisted navigating pedicle screw insertion could effective reduce the deviation or re-insertion of the screws, insuring the maximum stabil ity of each screw, mean while it can reduce the exposure time and blood loss, avoiding complication. The computer assisted navigation would be a useful technique which made the pedicle screw fixation more safe and stable in patients with osteoporosis.
Objective To investigate the application value of intraoperative CT navigation in posterior thoracic pedicle screw placement for scoliosis patients. Methods Between October 2009 and December 2011, 46 patients with scoliosis were treated with thoracic pedicle screw placement under intraoperative CT navigation in 21 cases (group A) or under C-arm fluoroscopy in 25 cases (group B). There was no significant difference in age, gender, type of scoliosis, involved segment, and Cobb angle of main thoracic curve between 2 groups (P gt; 0.05). A total of 273 thoracic pedicle screws were placed in group A and 308 screws in group B. The pedicle screw position evaluated and classified by intraoperative CT images according to the Modi et al. method; and the accurate rate, the safe rate, and the potential risk rate of pedicle screws were calculated on the upper thoracic spine (T1-4), the middle thoracic spine (T5-8), the lower thoracic spine (T9-12), and the entire thoracic spine (T1-12). The accuracy and security of thoracic pedicle screw placement were compared between 2 groups. Results On the entire thoracic spine, the accurate rate of group A (93.4%) was significantly higher than that of group B (83.8%), the safe rate of group A (98.9%) was significantly higher than that of group B (92.5%), showing significant differences between 2 groups (P lt; 0.05). However, the potential risk rate of group B (7.5%) was significantly higher than that of group A (1.1%) (P lt; 0.05). On the upper, the middle, and the lower thoracic spines, there was no significant difference in the accurate rate, the safe rate, and the potential risk rate of pedicle screws between 2 groups (P gt; 0.05). According to CT evaluation results, the potential risk pedicle screws were revised or removed during operation. The patients of 2 groups had no neurological deficits through physical examination of nervous system at 3 days after operation. Conclusion Intraoperative CT navigation can improve the accuracy and security of posterior thoracic pedicle screw placement and it can ensure the safety of operation by finding and promptly removing or revising the potential risk pedicle screws.
Objective To evaluate the radiographic and postoperative function of computer navigation versus traditional methods for total knee arthroplasty through meta-analysis. Methods we searched the specialized trials registered in Cochrane muscle group, The Cochrane Library (CCTR), MEDLINE (1966 to 2009), EMbase (1980 to 2009), PubMed (1966 to 2009), NRR (http://www.update-software.com/National/), CCT (http://www.controlled-trials.com), and CBMdisc (1979 to July 2009), and we manually searched some Chinese orthoopaedics journals. Data were extracted and evaluated by two reviewers independently. Randomized controlled trials of computer navigation and traditional methods for total knee arthroplasty were included. The quality of the included trials was critically assessed. RevMan 4.2.8 software was used for data analysis. Results Eighteen RCTs of computer navigation and traditional methods for total knee arthroplasty were included. A total of 2 349 patients met the inclusion criteria for the review. The results showed that, computer navigation versus traditional methods for the total knee arthroplasty: a) about radiography: there was difference in the precise measurement of lower limbs mechanical axis (WMD= – 0.56, 95%CI – 0.74 to – 0.38, Plt;0.00001), but no obvious difference in measurement of the femoral frontal axis (WMD= – 0.29, 95%CI – 0.58 to 0.00, P=0.05), sagittal axis (WMD= – 1.64, 95%CI – 3.49 to 0.21, P=0.08) and angle of rotation (WMD= – 0.11, 95%CI – 0.87 to 0.66, P=0.79). Obvious difference was not found in the tibial frontal axis (WMD= – 0.31, 95%CI – 0.69 to 0.06, P=0.10), but found in the tibial sagittal axis (WMD= – 0.69, 95%CI – 1.10 to – 0.28, P=0.001). No difference was found in the tibiafemoral angle (WMD= 0.03, 95%CI – 0.78 to 0.84, P=0.95), patella tilt angle (WMD= – 1.45, 95%CI – 3.12 to 0.22, P=0.09) and patella angle of rotation (WMD= – 0.34, 95%CI – 0.71 to 0.02, P=0.06); b) there was obvious difference in operating time (WMD= 13.31, 95%CI 10.00 to 16.63, Plt;0.000 01), but no obvious difference in the complications (RR= 1.65, 95%CI 0.87 to 3.13, P=0.13) and the hemorrhage volume (WMD= – 74.81, 95%CI – 184.71 to 35.09, P=0.18); and c) about the evaluation of postoperative function: the follow-up in all studies was more than 6 months; there was no obvious difference in joint motion (WMD= – 2.17, 95%CI – 5.66 to 1.33, P=0.22), KSS scores (WMD= 6.28, 95%CI – 3.69 to 16.25, P=0.22), and OXFORD scores (WMD= – 0.31, 95%CI – 2.05 to 1.43, P=0.72). Conclusions Compared with traditional methods, computer navigation using for the total knee arthroplasty: a) is much accurate in measurement of the lower limbs mechanical axis and tibial sagittal axis, but is not superior in measurement of the femoral frontal axis, femoral sagittal axis, femoral angle of rotation, tibial frontal axis, tibiafemoral angle, patella tilt angle, and patella angle of rotation; b) may spend a longer operating time if not performed by proficient for it is a kind of new technique realm, but is similar in decreasing complications and hemorrhage volume; and c) is not obvious different in function evaluation after over 6 months follow-up which has to be further studied.
This paper presents a surgical optical navigation system with non-invasive, real-time, and positioning characteristics for open surgical procedure. The design was based on the principle of near-infrared fluorescence molecular imaging. The in vivo fluorescence excitation technology, multi-channel spectral camera technology and image fusion software technology were used. Visible and near-infrared light ring LED excitation source, multi-channel band pass filters, spectral camera 2 CCD optical sensor technology and computer systems were integrated, and, as a result, a new surgical optical navigation system was successfully developed. When the near-infrared fluorescence was injected, the system could display anatomical images of the tissue surface and near-infrared fluorescent functional images of surgical field simultaneously. The system can identify the lymphatic vessels, lymph node, tumor edge which doctor cannot find out with naked eye intra-operatively. Our research will guide effectively the surgeon to remove the tumor tissue to improve significantly the success rate of surgery. The technologies have obtained a national patent, with patent No. ZI.2011 1 0292374.1.
Objective To explore the value of electromagnetic navigation interlocking intramedullary nail in the treatment of femoral shaft fracture. Methods Between July 2012 and October 2013, 53 cases of femoral shaft fracture were treated. There were 40 males and 13 females, aged 16-52 years (mean, 38.3 years). The causes of injury were traffic accident in 28 cases, falling from height in 11 cases, falling in 7 cases, crush injury in 4 cases, and other in 3 cases. Of 53 cases, there were 3 cases of open fracture (Gustilo I degree) and 50 cases of closed fracture. Fracture was located in the proximal femur in 17 cases, middle femur in 29 cases, and distal femur in 7 cases. According to Winquist classification, 7 cases were rated as type I, 8 cases as typeⅡ, 22 cases as typeⅢ, and 16 cases as type IV; according to AO classification, 18 cases were rated as type 32-A, 28 cases as type 32-B, and 7 cases as type 32-C. The time from injury to operation was 3-11 days (mean, 5 days). Distal interlocking intramedullary nail was implanted using electromagnetic navigation. Results The distal locking nail operation with interlocking intramedullary nail was successfully completed under electromagnetic navigation; the one-time success rate of distal locking nail operation reached 100%; and the locking nail time was 5.0-9.5 minutes (mean, 7.0 minutes). Healing of incision by first intention was obtained after operation, and no complication of skin necrosis, infection, and sinus tract occurred. Fifty-three cases were all followed up 5-12 months (mean, 9 months). One case had hip pain and weaken middle gluteal muscle strength, and the symptoms disappeared after removing the nail. During the follow-up period, no broken nails, nail exit, infection, or re-fracture occurred. All fractures achieved clinical healing, and the healing time was 8-22 weeks (mean, 14.5 weeks). In 49 patients followed up 8 months, the Lysholm score was excellent in 44 cases, good in 4 cases, and acceptable in 1 case, with an excellent and good rate of 98%. Conclusion Electromagnetic navigation system is safe and reliable, with the advantages of high positioning accuracy, short operation time, and no radiation, the clinical application of the system for distal locking nail operation can obtain excellent short-term effectiveness.
ObjectiveTo investigate the application and technical essentials of computer-assisted navigation in the surgical management of periacetabular fractures and pelvic fractures. MethodsBetween May 2010 and May 2011, 39 patients with periacetabular or anterior and posterior pelvic ring fractures were treated by minimally invasive fixation under computer-assisted navigation and were followed up more than 2 years, and the clinical data were analyzed retrospectively. There were 21 males and 18 females, aged 15-64 years (mean, 36 years). Fractures were caused by traffic accident in 23 cases, crush injury in 6 cases, and falling from height in 10 cases. Of them, 6 cases had acetabular fractures; 6 cases had femoral neck fractures; 18 cases had dislocation of sacroiliac joint; and 15 cases had anterior pelvic ring injuries. All patients were treated with closed or limited open reduction and screw fixations assisted with navigation. ResultsEighty-nine screws were inserted during operation, including 8 in the acetabulum, 18 in the neck of the femur, 33 in the sacroiliac joint, and 30 in the symphysis pubis and pubic rami. The mean time of screw implanted was 20 minutes (range, 11-38 minutes), and the average blood loss volume was 20 mL (range, 10-50 mL). The postoperative pelvic X-ray and three dimensional CT scan showed good reduction of fractures and good position of the screws. No incision infection, neurovascular injury, or implant failure occurred. All patients were followed up 27-33 months with an average of 29.6 months. The patients could walk with full weight loading at 6-12 weeks after operation (mean, 8 weeks); at last follow-up, the patients could walk on the flat ground, stand with one leg, and squat down, and they recovered well enough to do their job and to live a normal life. ConclusionMinimally invasive fixation under computer-assisted navigation may be an excellent method to treat some specific types of periacetabular and anterior and posterior pelvic ring fractures because it has the advantages of less trauma and blood loss, lower complication incidence, and faster recovery.
ObjectiveTo evaluate the value of total knee arthroplasty (TKA) with computer navigation by comparing with conventional TKA. MethodsBetween May 2010 and December 2011, 45 patients underwent primary unilateral TKA, and the clinical data were retrospectively analyzed. Of 45 patients, 22 cases were treated with TKA with computer navigation (group A), 23 cases with the conventional TKA (group B). There was no significant difference in gender, age, body mass index, side, cause of disease, disease duration, preoperative range of motion (ROM) of the knee, and preoperative Hospital for Special Surgery (HSS) score between 2 groups (P > 0.05). The operation time, intraoperative blood loss, incidence of patellar retinacular release, complication, and drainage volume were compared. The prosthesis loosening, postoperative HSS score, and ROM of the knee were also compared. ResultsNo difference was found in the incidence of patellar retinacular release during TKA, and it was 13.6% (3/22) in group A and was 4.3% (1/23) in group B, showing no significant difference (χ2=1.198, P=0.346). The operation time of group A was significantly longer than that of group B (t=7.557, P=0.000). There was no significant difference in intraoperative blood loss during TKA between 2 groups (t=-0.295, P=0.769), while the drainage volume of group A was significantly less than that of group B (t=-2.419, P=0.020). Incomplete fracture during TKA and acute infection occurred at 8 days after TKA in 1 case of group A respectively, while no fracture or infection was found in group B, showing significant difference (Z=-0.509, P=0.000). The patients of 2 groups were followed up 27-46 months. No significant difference in valgus and varus of knee, and malalignment of the femoral and tibial prosthesis was found (P > 0.05). There was no significant difference in HSS score and ROM of the knee at last follow-up between 2 groups (P > 0.05). No prosthesis loosening was found in 2 groups. ConclusionTKA with computer navigation has similar results to conventional TKA in the mechanical alignment, but it obviously prolongs operation time. It may also increase the incidence of infection and tractor pin related fracture.
ObjectiveTo investigate the accuracy of the two-dimension computer-aided surgery navigation system in the lumbar pedicle screw fixation on recombinant CT section after operation. MethodsBetween February 2011 and April 2013, 218 patients undergoing lumbar spinal pedicle screw fixation were divided into 2 groups:two-dimension computer-aided surgery navigation system was used in 95 cases (the navigation group) and X-ray fluoroscopy assistant technology in 123 cases (the fluoroscopy assistant group). There was no significant difference in age, gender, and type of disease between 2 groups (P>0.05). The mean operating time, blood loss volume, and fluoroscopy times, and the one-time success rate of pedicle screw implant were observed. The sagittal screw angle (SSA), the relationship between the pedicle cortex and screw, the accuracy rate of pedicle screw, and the sagittal angle on both sides (SBA) were observed. ResultsA total of 504 screws were inserted in navigation group, 432 (85.7%) were inserted successfully at first time and 472 (85.7%) were inserted successfully at end time. A total of 656 screws were inserted in fluoroscopy assistant group, 474 (72.3%) were successfully inserted at first time, and 563 (85.8%) were inserted successfully at end time. There were significant differences in the one-time success rate and final success rate of pedicle screw implant between 2 groups (χ2=30.19, P=0.00; χ2=18.16, P=0.00). There was no significant difference in the mean operating time and the blood loss volume of pedicle screw implant between 2 groups (t=0.88, P=0.38; t=1.47, P=0.14); but the fluoroscopy times of pedicle screw implant in navigation group 0.7±0.3 were significantly less than that in fluoroscopy assistant group 1.5±1.0 (t=-8.09, P=0.00). The SSA and SBA in navigation group[(3.7±0.9)° and (1.7±0.8)°] were significantly less than those in fluoroscopy assistant group[(6.0±1.7)° and (3.5±1.6)°] (t=-26.92, P=0.00; t=-22.49, P=0.00). ConclusionThe sagittal screw angle and accuracy of pedicle screw implant can be significantly improved using the two-dimension computer-aided surgery navigation system in lumbar posterior fixation.
ObjectiveTo evaluate the value of computer assisted navigation system (CANS) in the reconstruction of mandibular defects. MethodsBetween April 2012 and September 2014, 8 patients with mandibular defects were included in this study. There were 5 males and 3 females with an age range of 22-50 years (mean, 34.5 years), including 4 cases of ameloblastoma, 3 cases of odontogenic keratocyst, and 1 case of condylar osteoma. According to the CRABS (condyle, ramus, angle, body, symphysis) classification criteria based on the location of mandibular defect, there were 1 case of right CRAB type, 1 case of left RABS type, 1 case of left CR type, 1 case of right RAB type, 1 case of left C type, 1 case of right RABS+left S type, and 2 cases of right AB type. With the biteplate fixing mandible, maxillofacial CT and the donor site CT scan were done. Computer assisted design was made by using Surgicase CMF5.0 software and BrainLab Iplan software, included delineating the osteotomy lines for resection, ascertaining the normal anatomic structures for defect reconstruction, and determining the reconstructive morphology. With guide plates and the guidance of BrainLab navigation system, an en bloc tumor resection and simultaneous defect reconstruction were performed under the precise localization of mandibular angle and condyle. Preoperative and postoperative CT images were superimposed in Geomagic studio12.0 software system, and both were compared by three-dimensional (3D) objects and 2D slices. The complications and signs of recurrence were observed. ResultsUnder the guidance of navigation, preoperative facial symmetry design, surgery simulation, and simultaneous navigation operation were performed successfully. The postoperative CT and postoperative 3D error analysis showed osteotomy lines and reconstruction contour had good matching with the preoperative planning. The error of important corresponding points (mandibular angle and external pole of condyle) in the reconstruction of mandibular defects were (1.83±0.19) mm and (1.61±0.24) mm. The patients were followed up 2-6 months (mean, 3.5 months). No complication was observed in the other patients except the patients undergoing rib transplantation who had mild limitation of mouth opening. Good facial symmetry was obtained, and no tumor recurrence was found. ConclusionCANS can effectively increase the surgical precision in the reconstruction of mandibular defects and reduce complications, and recover facial symmetry. It is regarded as a valuable technique in this potentially complicated procedure.
Objective To investigate the short-term effectiveness of percutaneous pedicle screw (PPS) guided with photoelectric navigation for thoracolumbar fractures. Methods Between May 2013 and June 2015, the clinical data of 39 patients with thoracolumbar fractures in accordance with the selection criteria were retrospectively analyzed. The patients were divided into photoelectric navigation PPS group (trial group, 20 cases) and C-arm X-ray guidance PPS group (control group, 19 cases). There was no significant difference in gender, age, injury cause, fracture vertebrae, AO classification, operation time after injury, visual analogue scale (VAS) score, and vertebral compression ratio (VCR) between 2 groups (P > 0.05). The operation time, bleeding amount, perspective times, VAS score, and one-time success rate (OSR) of screw placement were recorded; VCR and endplate-screw angle (ESA) were measured; and pedicle-screw relationship (PSR) was assessed by Ringel’s method in radiographic result. Results Differences in operation time and bleeding amount were not significant between 2 groups (P > 0.05); perspective times of control group was significantly more than t hat of trial group (t=-15.658, P=0.000). The OSR of trial group (95.60%, 87/91) was significantly better than that of control group (86.75%, 72/83) (χ2=4.323, P=0.038). The patients were followed up 6-11 months (mean, 7.6 months) in trial group, and 7-11 months (mean, 7.8 months) in control group. No neurovascular complications associated with screw insertion occurred. Difference was not significant in VAS score at 7 days and 6 months after operation between 2 groups (P > 0.05), but VAS scores at 7 days and 6 months were significantly improved when compared with preoperative score in 2 groups (P < 0.05), and significant difference in VAS score was shown between at 7 days and 6 months in 2 groups (P < 0.05). VCR of trial group and control group were significantly improved to 94.75%±5.10% and 92.40%±5.09% at 6 months after operation from preoperative 71.97%±5.66% and 73.50%±5.97% (t=11.865, P=0.000; t=11.359, P=0.000), but there was no significant difference between 2 groups (t=1.442, P=0.158). ESA of trial group and control group were (1.82±1.13)° and (3.36±2.43)° at 6 months after operation, showing significant difference (t=5.421, P=0.000). At 6 months after operation, according to PSR classification, 83 screws rated as grade I, 6 as grade II, and 2 as grade III, and excellent and good rate of screw replacement was 97.80% in trial group; 54 screws were rated as grade I, 19 as grade II, 7 as grade III, and 3 as grade IV, and excellent and good rate of screw replacement was 87.95% in control group; difference was significant between 2 groups (χ2=18.347, P=0.000). Conclusion Application of photoelectric navigation can guide screws placement by the two-dimensional multi pl ane dynamic image, has better accuracy of screws position in thoracolumbar fractures, reduces the introperative X-ray perspective times, maintains good reduction of vertebral body, and achieves satisfactory effectiveness.