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ABSTRACT: To investigate a new targeting mechanical arm for CT-based navigated percutaneous fixation of pelvic fractures, and to evaluate the safety and efficiency of the procedures.
Using CT-based 3D navigation software combined with targeting mechanical arm, percutaneous insertion of pelvic models (3 dry human cadaver pelvic skeletons and 5 plastic Sybone pelvic models) were performed, 8 pelvic models allowed percutaneous cannulated screw insertion of both S-I joint (2 S-I screws placement for each side, total 32 screws in this experiment) and both superior ramus (1 ramus medullary screw placement for each side, total 16 screws in this experiment). Percutaneous insertion of pelvic models (4 dry human cadaver pelvic skeletons and 4 plastic Sybone pelvic models, 1 S-I screws and 1 ramus medullary scre placement for each side, 32 screws in this experiment) were performed using fluoro-navigation system (Stryker, USA). Time necessary for every screw insertion were recorded. Accuracy of screw placement was assessed using C-arm imaging and direct eyes inspecting. The time and accuracy of the two methods were compared.
The time required for the CT-based 3D navigation procedure (3.6 ± 1.2) min was significantly less than using the targeting mechanical arm compared to drilling freehand with navigation (9.1 ± 0.8) min (t = 2.50, P < 0.01). There was no significant difference in accuracy between the two methods.
CT-based 3D navigation software combined with targeting mechanical arm should be potential to apply percutaneous sacroiliac screwing for pelvic fractures with more accurate and more reliable.
Zhonghua wai ke za zhi [Chinese journal of surgery] 06/2012; 50(6):555-9.
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ABSTRACT: Computer-assisted procedures have recently been introduced for navigated femoral neck screw placement. Currently there is little information available regarding accuracy and efficiency of the different navigated procedures. The aim of this study was to compare two fluoroscopic navigation tracking technologies, a novel bi-planar robot navigation and standardized optoelectronic navigation, versus standard freehand fluoroscopic insertion in a Synbone hip model.
Eighteen fixed Synbone hip models were divided into 3 groups. C-arm navigated cannulated screws (AO-ASIF, diameter 7.3 mm) were inserted using freehand targeting (control group). A novel bi-planar robot system (TINAV, GD2000) and an optoelectronic system (Stryker OTS Navigation System) were used for the navigated procedures (robot group and optoelectronic group). Accuracy was measured using radiographic evaluation including the measurement of screw parallelism and decentralization, and joint penetration. To evaluate the efficiency, the number of guidewire passes, operative time and fluoroscopic images taken were noted.
The two computer-assisted systems provided significantly improved accuracy compared to the freehand technique. Each of the parameters, including guidewire passes and number of fluoroscopy images, was significantly lower when using the computer-assisted systems than for freehand-unguided insertion (P <0.05), but operative time was significantly shorter when using freehand-unguided insertion than for the computer-assisted systems (P <0.05). Accuracy, operative time and number of fluoroscopy images taken were similar among the two navigated groups (P >0.05), but guidewire passes in the robot group were significantly less than in the optoelectronic group (P <0.05).
Both bi-planar robot navigation and optoelectronic navigation were similarly accurate and have the potential to improve accuracy and reduce radiation for freehand fluoroscopic targeting for insertion of cannulated screws in femoral neck fractures. Guidewire passes in the robot group were significantly less than in the optoelectronic group. However, both navigated procedures were associated with time-consuming registration and high rates of failed matching procedures.
Chinese medical journal 12/2011; 124(23):3906-11. · 0.86 Impact Factor
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ABSTRACT: To develop a traction reductor for the reduction of lower limb fractures during the minimally invasive surgery and explore its safety and efficacy.
From February 2007 to March 2009, closed or limited open reduction plus percutaneous plate and screw internal-fixation were conducted in 34 patients with fracture of distal femur and tibia metaphysic, among which there were 3 distal femoral fractures (2 33-B, 1 33-C), 14 proximal tibial fractures (9 41-A, 3 41-B, 2 41-C) and 17 distal tibial fractures (9 43-A, 5 43-B, 3 43-C, 2 Gustilo I a), according to the Association for Osteosynthesis-Orthopaedic Trauma Association (AO-OTA) classification. Besides, closed reduction plus interlocking intramedullary nailing on tibial shaft fracture were applied in 36 patients (7 42-A, 21 42-B, 8 42-C, 2 Gustilo I a). All the 70 patients, with an average age of 37.6 years (range: 17 to 63 years) and average time before surgery of 4.7 d (range: 0.7 to 12.0 d), underwent reduction by self-designed traction reductor for lower limb fracture in the surgery. The reduction duration and C-arm fluoroscopy time were recorded. Recovery of the force line of affected limbs after surgery was determined by whether the line from anterior superior iliac spine to the interdigit between the first and second toe-web passed the patella center. And the distance from bilateral anterior superior iliac spine to medial malleolus tip as well as the difference between lower limbs were recorded to determine the recovery of length after surgery. Meanwhile, the varus-valgus and anteroposterior angulations after reduction were measured by AP and lateral X-ray.
The reduction duration was 12.7 min (range: 7 to 31 min); X-ray fluoroscopy time, 1.3 min (range: 0.4 to 3.0 min); length difference between both lower limbs (6.5 ± 1.1) mm; and axial alignment difference (7.0 ± 1.8) mm. The X-ray result showed that varus-valgus angle was (2.75 ± 0.16)°; and anteroposterior angulation (5.13 ± 0.51)°.
The traction reductor for lower limb fracture could achieve satisfying fracture reduction in the minimally invasive surgery of distal femur, tibia metaphysic and tibial shaft fracture.
Zhonghua wai ke za zhi [Chinese journal of surgery] 09/2010; 48(18):1425-9.
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ABSTRACT: To establish a new imaging protocol to acquire the most appropriate fluoro-images for fluoro-navigated percutaneous fixation of acetabular fracture and to evaluate the safety and efficiency of the procedures.
Guide needles were inserted into the bilateral anterior and posterior columns of the acetabula of 4 dry human cadaver pelvic skeletons and 4 plastic pelvic models. Then the pelvis skeletons were fixed to imaging guided surgery mimic operation modules. Dynamic fluoroscopy was conducted with C-arm X-ray machine vertically on the 4 virtual planes of the acetabulum, inner, outer, anterior, and posterior from multiple angles. The fluoroscopic images clearly showing the guide needles, anterior and posterior columns, and acetabulum were selected as registration images, and the relative space positions between the C-arm X-ray fluoroscope and pelvis and operation table. Guided by the navigation system, totally 16 titanium hollow screws were inserted into bilateral anterior and posterior columns of acetabula of the 4 pelvis skeletons. The screw positions were estimated by visual method. The time needed to position the C-arm so as to obtain the standard registration image, time needed for fluoroscopy, and operation time, including establishment of navigation system, software interface operation, and screw insertion, were recorded.
All the screws were inserted to the satisfying positions: placed within the desired bony corridor of the column and none of then were inserted into the joint. While inserting the screw into the anterior column fluoroscopy should be conducted with obturated oblique view, obturated inlet view, obturated oblique outlet view, or pelvic AP view. While inserting the screw into the posterior column fluoroscopy should be conducted with iliac-oblique view, obturated oblique view, pelvic inlet view, or obturated oblique outlet view. The total surgical time required for screw insertion was 11.7 min for anterior column, and was 9.2 min for posterior column. 9.5 and 7.3 minutes were needed to position the C-arm X-ray machine so as to obtain the images of the anterior and posterior columns respectively. 2.9 and 1.7 seconds were needed for the actual fluoroscopy during insertion of the screws into the anterior and posterior columns respectively.
The standard registered fluoro-images are different from the conventional standard Judet-Letournel oblique views. How to get appropriate fluoro-images is the key point for fluoro-navigated percutaneous fixation of acetabular fractures.
Zhonghua yi xue za zhi 08/2008; 88(27):1900-4.
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ABSTRACT: To evaluate the precision in location and clinical flexibility of the newly designed full-length planning module of orthopedic robot system in treatment of fractures of long bone.
Nine plastic tibia models were selected for the image mosaicing. The full length of each tibia model was measured on the constructed panorama and compared with the real model length to record the length deviation and conduct the precision analysis. Fracture of tibia and fibula with shortening and angulation deformity was caused on a cadaver specimen with two lower limbs. Full-length planning was carried out on the entire tibial panorama with the fracture. After the reduction distance was determined quantitatively, automatic close traction procedure was carried out with the tibial reduction frame to analyze the precision and effectiveness of this module. At the same time, the relative length variation between the two bone fragments was monitored utilizing video camera to ensure the safety of the reduction operation. Image mosaicing, surgical planning, and bone traction were performed on a clinical case of tibial fracture to validate the clinical feasibility of the module.
An entire tibial panorama could be constructed from 7 - 10 C-arm images collected during the operation. 1.5 min was needed for image collection. The average mosaicing and planning time was 3 min. The mosaicing error was less than 1.5 mm. The average time for the traction frame installation and traction operation was 4 min. Traction resulted in accurate reposition of the fracture ends meeting the requirement of surgery in both the cadaver specimen and the clinical case.
The newly designed full-length planning module of orthopedic robot system is easy to use and provides effective and accurate traction result in long bone fracture therapy. This module can not only achieve the minimally invasive surgery, but also dramatically decrease the radiation damage to the medical staff.
Zhonghua yi xue za zhi 12/2007; 87(43):3038-42.
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ABSTRACT: To investigate the effects of medical robot-assisted surgical navigation system based on fluoroscopic images in distal locking of femoral intramedullary nails.
Using a robot-assisted computer-guided system designed based on modularization and minimization that permitted C-arm alignment assistance and real-time navigation control, provided constant feedback without the need for radiologic updates, thus avoiding constant X-ray exposure. The C-arm was used to collect the orthotopic and lateral X-ray images into the computer so as to calculate the locations of the target points. Nails were locked into 5 plastic femurs (Swiss Sybone, 35 holes), 2 dry human femoral specimens (12 holes), and one leg of fresh human cadaver (6 holes). Radiographs were taken to confirm that screws were positioned correctly, and fluoroscopic time associated with the locking procedure was recorded.
All distal holes were locked successfully. In 6 (11.1%) of the 53 holes the drill bit touched the canal of the locking hole, albeit with no damage to the nail. The fluoroscopy time of per screw was 1.83 +/- 0.31 seconds.
The medical robot-assisted surgical navigation system enables the physicians to precisely navigate surgical instruments throughout the procedure using just a few computer-calibrated radiographic images. The total radiation time per procedure can be significantly reduced because additional X-ray exposure is not required for tool navigation. The idea of a robot-assisted surgical navigation system is practicable.
Zhonghua yi xue za zhi 04/2006; 86(9):614-8.
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Man-yi Wang,
Jun-qiang Wang,
Wen-yong Liu,
Lei Hu,
Li Zhou,
Yu Wang,
Chun-peng Zhao, Yong-gang Su,
Ying-ze Zhang,
Zhao-hui Song,
Tian-miao Wang
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ABSTRACT: To investigate the feasibility and accuracy of the software computer-assisted robot orthopaedic trauma surgery planning system (CAOTS).
The software CAOTS was developed and used on 85 cases of stereotactic operation, 24 model bones, 21 cadaveric extremity bones, and 40 patients. 307 groups of directional targets in these cases were randomly sampled. The distribution of error sources for evaluating system performance was embodied using Monte-Carlo method in order to derive the theoretic guarantees for further optimizing and enhancing the system performance, then the software SPSS 2.0 was used to analyze the errors.
The statistical area of deviation number was 0.0408 +/- 0.4578 mm, corresponding to the result by Monte-Carlo method. Punching succeeded at the first run for all 307 cases without wrong locking and other clinical complications.
Accurate and reliable, CAOTS improves the intra-operative navigation techniques and facilitates the orthopedists to perform operation.
Zhonghua yi xue za zhi 04/2006; 86(9):609-13.
