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Navigation an der Brust- und Lendenwirbelsäule mit dem 3D-Bildwandler

Intraoperative three-dimensional navigation for pedicle screw placement

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Zusammenfassung

Das SIREMOBIL Iso-C3D (Siemens AG, Medical Solutions, Erlangen) erlaubt die intraoperative dreidimensionale Erfassung knöcherner Strukturen. Es wird ein hochauflösender 3D-Datenkubus mit einer Kantenlänge von 12 cm erzeugt. Die Daten können in ein Navigationssystem importiert werden, ohne die Notwendigkeit einer Registrierung des Datensatzes durch den Chirurgen. In der vorliegenden prospektiven Studie wird die Genauigkeit der Iso-C3D-Navigation bei der Platzierung von thorakalen und lumbalen Pedikelschrauben untersucht. Bei 61 Patienten mit 73 Frakturen wurden insgesamt 302 Pedikelschrauben platziert. Bei 5 Schrauben wurde in einem postoperativen Kontroll-CT eine inkorrekte Schraubenlage (≥2 mm) nachgewiesen. Dies entspricht einer Fehlplatzierungsrate von 1,7%. Durchleuchtungszeit bei der Iso-C3D-Navigation lag bei 1,28 (±0,56) min bei einer Gesamtoperationsdauer von 103,26 (±23,3) min. Neurologische Komplikationen wurden postoperativ nicht beobachtet. Die Iso-C3D-Navigation stellt ein sehr präzises Verfahren zur Platzierung von Pedikelschrauben dar.

Abstract

The mobile SIREMOBIL Iso-C3D C-arm (Siemens, Erlangen, Germany) is the first device permitting intraoperative, three-dimensional representation of bone structures. A high-resolution, isotropic 3D data cube in the isocenter with sides of approximately 12 cm is calculated simultaneously. The SIREMOBIL Iso-C3D is linked to the navigation system. This makes it possible to transfer the generated 3D data directly to the linked navigation system without the need for surgeon-dependent registration. In this prospective clinical trial, we evaluated the accuracy of pedicle screw placement using this device. In 61 patients, a total of 302 pedicle screws were placed. Only in five cases (1.7%) were misplacements of ≥2 mm shown in postoperative control CT. The average fluoroscopy time was 1.28±0.56 min, and the average operative duration was 103.26±23.3 min. There were no postoperative neurological complications in any of the 30 patients. From these data, we conclude that Iso-C3D navigation is a very accurate method for the placement of pedicle screws.

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Der korrespondierende Autor versichert, dass keine Verbindungen mit einer Firma, deren Produkt in dem Artikel genannt ist, oder einer Firma, die ein Konkurrenzprodukt vertreibt, bestehen.

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  1. Berufsgenossenschaftliche Unfallklinik Ludwigshafen, Klinik für Unfall- und Wiederherstellungschirurgie an der Universität Heidelberg

    P. A. Grützner, K. Wendl, J. von Recum & A. Wentzensen

  2. M.E. Müller Research Center for Orthopaedic Surgery, Institute for Surgical Technology and Biomechanics, Universität Bern, Schweiz

    T. Beutler & L.-P. Nolte

  3. Berufsgenossenschaftliche Unfallklinik Ludwigshafen, Klinik für Unfall- und Wiederherstellungschirurgie an der Universität Heidelberg, Ludwig-Guttmann-Straße 13, 67071 , Ludwigshafen

    P. A. Grützner

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  1. P. A. Grützner
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  2. T. Beutler
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  3. K. Wendl
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  4. J. von Recum
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  5. A. Wentzensen
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  6. L.-P. Nolte
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Grützner, P.A., Beutler, T., Wendl, K. et al. Navigation an der Brust- und Lendenwirbelsäule mit dem 3D-Bildwandler. Chirurg 75, 967–975 (2004). https://doi.org/10.1007/s00104-004-0944-3

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