Navigation with fused pre-operative CT/MRI and intra-operative 3D fluoroscopy - Introduction to a new navigation technique and the clinical applications

摘要

Introduction: Intra-operative 3D fluoroscopy has been applied in various fields of computer aided orthopaedic surgery (CAOS) including spine, trauma, tumor and arthroplasty. In the Department of Orthopaedics and Traumatology, Prince of Wales Hospital, Hong Kong SAR we have used Siemens ISO-C 3D with Stryker Leibinger Navigation in orthopaedic trauma surgery in 35 cases. The advantage of this technique being it could provide better delineation of the fracture pattern and bony structure than 2D fluoroscopy and more convenient and less traumatic than using pre-operative CT with pre-implanted fiducial markers. However, there were limitations including lower resolution images of the intra-operative 3D fluoroscopy images compared to conventional CT and also smaller working volume (12cm3 )- limited by the C-arm. This has limited the application of intra-operative 3D fluoroscopy in pelvic-acetabular fracture fixation as the working volume does not cover all the concerned bony structure. Also there is much inferior soft tissue information compared with MRI.