用两次透视实现精准股骨截骨导航,减少辐射与手术创伤。
Electromagnetic Navigation for Femoral Osteotomy Using High-Accuracy X-ray-to-CT Registration

- 通过两次透视完成术中影像配准,结合电磁追踪实现实时导航。
- 误差仅3.05度,显著优于手动操作的6.32度,且无超5度临床阈值偏差。
- 精度媲美个性化器械,但无需额外切开或增加辐射,适合骨科手术室。
矫正性股骨截骨术中精确执行术前规划仍具挑战。现有技术受限于精度波动、侵入性强及辐射暴露,手工操作和患者特异性器械(PSI)分别需超过30次和超过6次透视。本文提出一种集成电磁追踪(EMT)导航系统,最小化手术切开和术中透视次数。系统结合基于CT的术前规划与一次术中C臂校准,仅需初始化时两幅透视图像即可实现高精度X射线到CT配准,从而实现锯片与骨段相对于术前计划的实时、无透视电磁导航,适用于单平面和双平面截骨。在18个合成股骨的可行性研究中,EMT导航总角度误差为(3.05±0.75)°,显著低于手工操作的(6.32±2.36)°(p=0.031),且所有案例均未超过5°临床阈值;而手工操作有4例超出阈值(共6次试验)。系统在总角度误差(p≤0.02)和总位移误差(p=0.048)上与PSI统计等效(±2°,±2mm),用户问卷评分无显著差异。该系统仅用两次透视即实现术前计划转移,精度匹配PSI,且无额外手术暴露,推动后续尸体及临床验证。
原文摘要 · Abstract (English)
Accurate execution of preoperative plans in corrective femoral osteotomies remains challenging. Current techniques are limited by variable accuracy, invasiveness, and radiation exposure, with free-hand methods and patient-specific instrumentation (PSI) often requiring >30 and >6 fluoroscopic images, respectively. We present an integrated, electromagnetic tracking (EMT)-based navigation system for femoral osteotomies that minimizes dissection and intraoperative fluoroscopy. The system couples CT-based preoperative planning with one-time intraoperative C-arm calibration and accurate X-ray-to-CT registration from two fluoroscopic images acquired at initialization. This enables real-time, fluoroscopy-free EMT navigation of the saw blade and bone fragments relative to the preoperative plan, and is compatible with uniplanar and biplanar osteotomies. In a feasibility study using 18 synthetic femora, EMT guidance significantly outperformed free-hand execution in total angular error ($(3.05 \pm 0.75)^\circ$ vs.\ $(6.32 \pm 2.36)^\circ$, $p=0.031$), assuming the same minimal surgical exposure for both. No EMT-guided trials exceeded the >5° clinical threshold, whereas free-hand produced 4 outliers of 6 trials. The system achieved statistical equivalence ($\pm 2^\circ$, $\pm 2,\text{mm}$) to PSI for total angular ($p \le 0.02$) and total translational ($p=0.048$) errors, with no significant differences in user questionnaire scores. By transferring preoperative plans using only two fluoroscopic images while matching PSI accuracy without additional surgical exposure, the proposed system motivates subsequent cadaveric and clinical validation.
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