Purpose： To describe our clinical experience with a system named SureShorTM Distal Targeting （Smith ＆ Nephew, Memphis, USA） based on magnetic field presence and discuss our suggestions on this technique. Methods：...Purpose： To describe our clinical experience with a system named SureShorTM Distal Targeting （Smith ＆ Nephew, Memphis, USA） based on magnetic field presence and discuss our suggestions on this technique. Methods： We analysed prospectively 47 patients affected by humeral, tibial or femoral fractures, treated in our institution during a 3-year period of time （August 2010 to September 2013）. We considered the following parameters： the time to set up, the time to position a single screw, the effectiveness of the system （drilling ad screwing）, the irradiation exposure time during distal locking procedure and surgical complications. Results： A total number of 96 screws were inserted. The mean preparation time of the device was 5.1 min _＋ 2 min （range 3 10 min）. The mean time for single screw targeting was 5.8 min ± 2.3 min （range 4-18 min）. No major complications occurred. Only a few locking procedures were needed to be practiced in order to obtain the required expertise with this targeting device. Conclusion： According to our results, this device is reliable and valid whenever the correct technique is followed. It is also user friendly, exposes to lower radiation and needs less surgical time compared to relative data from the literature. However, the surgeon should always be aware of how to use the free hand technique in case of malfunctioning of the system.展开更多
Objective： To evaluate the accuracy of computer-assisted pedicle screw installation and its clinical benefit as compared with conventional pedicle screw installation techniques. Methods： Total 176 thoracic pedicle s...Objective： To evaluate the accuracy of computer-assisted pedicle screw installation and its clinical benefit as compared with conventional pedicle screw installation techniques. Methods： Total 176 thoracic pedicle screws placed in 42 thoracic fracture patients were involved in the study randomly, 20 patients under conventional fluoroscopic control （84 screws） and 22 patients had screw insertion under three dimensional （3D） computer-assisted navigation （92 screws）. The 2 groups were compared for accuracy of screw placement, time for screw insertion by postoperative thincut CT scans and statistical analysis by χ^2 test. The cortical perforations were then graded by 2-mm increments： Grade Ⅰ （good, no cortical perforation）, Grade Ⅱ （screw outside the pedicle 〈2 mm）, Grade Ⅲ （screw outside the pedicle 〉2 mm）. Results： In computer assisted group, 88 （95.65%） were Grade Ⅰ （good）, 4 （4.35%） were Grade Ⅱ （〈2mm）, no Grade Ⅲ （〉2 mm） violations. In conventional group, there were 14 cortical violations （16.67%）, 70 （83.33%） were Grade Ⅰ （good）, Ⅱ （13.1%） were Grade Ⅱ （〈2 mm）, and 3 （3,57%） were Grade Ⅲ （〉2 mm） violations （P〈0.001）. The number （19.57%） of upper thoracic pedicle screws （ T1-T4 ） inserted under 3D computer-assisted navigation was significantly higher than that （3.57%） by conventional fluoroscopic control （P〈0.001）. Average screw insertion time in conventional group was （4.56 ±1.03） min and （2.54 ± 0.63） min in computer assisted group （P〈0.001）. In the conventional group, one patient had pleura injury and one had a minor dura violation. Conclusions： This study provides further evidence that 3D computer-assisted navigation placement ofpedicle screws can increase accuracy, reduce surgical time, and be performed safely and effectively at all levels of the thoracic spine, particularly upper thoracic spine.展开更多
文摘Purpose： To describe our clinical experience with a system named SureShorTM Distal Targeting （Smith ＆ Nephew, Memphis, USA） based on magnetic field presence and discuss our suggestions on this technique. Methods： We analysed prospectively 47 patients affected by humeral, tibial or femoral fractures, treated in our institution during a 3-year period of time （August 2010 to September 2013）. We considered the following parameters： the time to set up, the time to position a single screw, the effectiveness of the system （drilling ad screwing）, the irradiation exposure time during distal locking procedure and surgical complications. Results： A total number of 96 screws were inserted. The mean preparation time of the device was 5.1 min _＋ 2 min （range 3 10 min）. The mean time for single screw targeting was 5.8 min ± 2.3 min （range 4-18 min）. No major complications occurred. Only a few locking procedures were needed to be practiced in order to obtain the required expertise with this targeting device. Conclusion： According to our results, this device is reliable and valid whenever the correct technique is followed. It is also user friendly, exposes to lower radiation and needs less surgical time compared to relative data from the literature. However, the surgeon should always be aware of how to use the free hand technique in case of malfunctioning of the system.
基金This study was supported by National Natural Science Foundationof China （No. 30772209）.
文摘Objective： To evaluate the accuracy of computer-assisted pedicle screw installation and its clinical benefit as compared with conventional pedicle screw installation techniques. Methods： Total 176 thoracic pedicle screws placed in 42 thoracic fracture patients were involved in the study randomly, 20 patients under conventional fluoroscopic control （84 screws） and 22 patients had screw insertion under three dimensional （3D） computer-assisted navigation （92 screws）. The 2 groups were compared for accuracy of screw placement, time for screw insertion by postoperative thincut CT scans and statistical analysis by χ^2 test. The cortical perforations were then graded by 2-mm increments： Grade Ⅰ （good, no cortical perforation）, Grade Ⅱ （screw outside the pedicle 〈2 mm）, Grade Ⅲ （screw outside the pedicle 〉2 mm）. Results： In computer assisted group, 88 （95.65%） were Grade Ⅰ （good）, 4 （4.35%） were Grade Ⅱ （〈2mm）, no Grade Ⅲ （〉2 mm） violations. In conventional group, there were 14 cortical violations （16.67%）, 70 （83.33%） were Grade Ⅰ （good）, Ⅱ （13.1%） were Grade Ⅱ （〈2 mm）, and 3 （3,57%） were Grade Ⅲ （〉2 mm） violations （P〈0.001）. The number （19.57%） of upper thoracic pedicle screws （ T1-T4 ） inserted under 3D computer-assisted navigation was significantly higher than that （3.57%） by conventional fluoroscopic control （P〈0.001）. Average screw insertion time in conventional group was （4.56 ±1.03） min and （2.54 ± 0.63） min in computer assisted group （P〈0.001）. In the conventional group, one patient had pleura injury and one had a minor dura violation. Conclusions： This study provides further evidence that 3D computer-assisted navigation placement ofpedicle screws can increase accuracy, reduce surgical time, and be performed safely and effectively at all levels of the thoracic spine, particularly upper thoracic spine.
