计算机导航系统在股骨颈骨折经皮空心螺钉内固定中应用的实验研究

PERCUTANEOUS SCREW FIXATION FOR THE FRACTURES OF FEMORAL NECK WITH ASSISTED BY ISO-C^(2D) COMPUTER NAVIGATION SYSTEM: AN EXPERIMENTAL STUDY

目的:通过标本模拟手术实验,探讨计算机导航系统辅助股骨颈骨折经皮空心钉内固定的方法和价值。方法:使用计算机导航系统对15例股骨近端骨标本进行股骨颈空心钉置入的模拟手术,每例置入3枚空心钉,通过正、侧位X线片测量空心钉与颈干角、前倾角偏离角度;测量空心钉在股骨颈截面分散度来评价计算机导航系统的准确性,并与15例传统透视方法的测算结果比较;同时比较两种操作方法所需的钻孔次数。结果:采用计算机导航系统组空心钉在颈干角和前倾角的钉道偏离角度均小于传统透视组,螺钉在股骨颈截面分散度也明显优于传统组,差异均有统计学意义(P<0.05);在钻孔次数上,计算机导航系统组也明显少于传统透视组(P<0.05)。结论:计算机导航系统可以用于辅助股骨颈骨折经皮空心螺钉内固定操作,该方法具有提高空心钉准确性的优点,并且可明显减少钻孔次数。

Objective： To investigate the methods and application value of computer assisted orthopedic surgery system（CAOSS） in the percutaneous screw fixation for the fractures of femoral neck.Methods： Thirty femoral skeleton specimens were divided into two groups.Three cancellous screws were fixed in each of 15 fracture models with traditional standard fluoroscopy or Iso-C2D computer navigation system guidance randomly.The angle of screw deviation from cervicofemoral angle and femoral neck anteversion was accessed by calculating an index from the angles measured on the AP and lateral views of X-ray film,and the position of the screws was evaluated by direct measurement of the transverse section of femoral neck and assigned a score based on deviation from ideal screw position.The drilling attempts were documented.Results： Statistical analysis of the angle of screw deviation,screw spread within the femoral neck,and drilling attempts showed that the average screw deviation and screw spread were significantly better in the computer-assisted navigation group than in the conventional operation group（P0.05）.The drilling attempts in the navigation group were also lower.Conclusion： Computerized navigation can effectively assist the fixation of the cannulated screws in the treatment of femoral neck fractures,it improves the accuracy of cannulated screw placement and results in fewer drilling attempts.