Applications for 3D-navigation in trauma surgery using the SIREMOBIL Iso-C~(3D)

摘要

Objectives/Background/lntroduction: CT- and C-arm-based navigation resulted in advantages concerning the intraoperative handling and reduction of the X-ray exposition, in the literature a clinical increased precision has been reported. The lack of external SD-imaging based on preoperative CT-scans is the essential intraoperative matching; the disadvantages of the 2D-imaging using a C-arm are reductions in the interpretation of complex anatomical structures. Recently a new CAOS-tool has been introduced, the combination of navigation (SurgiGATE~(TM), Medivision) and intraoperative CT-imaging (SIREMOBIL Iso-C~(3D), Siemens). The goal of this non randomized retrospective and prospective study is to verify clinical applications for the intraoperative 3D-CT-navigation. Methods: The SIREMOBIL Iso-C~(3D) combined with navigation was installed in our department in December 2002, five patients were operated using the intraoperative 3D stereotaxy. In one patient an spinal fusion was performed, in one patient an arthrodesis of the lower ankle with navigated removal of the cartilage, in three patients fracture stabilization (radius n=l, tibia n=l, pelvis n=l) were done. All operations were performed by two surgeons, all data concerning chronology (time consummation), intraoperative performance and postoperative results are collected prospectively. Results: The intraoperative performance of the navigation of SIREMOBIL Iso-C~(3D) datasets was excellent in all applications, except at the pelvis because of a reduced field of view (12xl2cm) of the scan. The scan quality in all cases was close to the external CT-scans used for external CT-based navigation, using the system in fractures, slight reductions of the quality had to be accepted after reduction and placement of k-wires. Transferring the datasets showed problems in two patients, a new scan was necessary in both cases. An additional matching was not required in one patient. Postoperative verification of the implant position showed accurate placement of all screws. The intraoperative 3D-imaging technique allowed sufficient clinical control of the joint reconstruction in all applications because a complete visual examination of the joint is possible. Conclusions: The possibilities and first clinical experience with this innovative system for intraoperative 3D navigation of trauma applications are advantageous. In all patients with exception of excentric parts of the pelvis (e.g., Acetabulum) the 3D navigation showed a perfect intraoperative performance. The clinical benefit can be illustrated with examples.