Computerassistierte Zielbohrungen an der unteren Extremität Technik und Indikationen

Abstract

Computer assisted navigation-based surgery is a novel and interesting challenge for todays surgeons. One must however keep in mind, that the indications for these techniques (a) should be carefully considered, (b) used only if morbidity is not increased and (c) when previously problematic or inacurate surgical methods can be improved upon. This study reports that, using a non-invasive fixation method (FISCOFIX-Cast), lesions between the ankle- and knee-joints can be precisely localized, registered and treated. Due to the difficult access to lesions especially in the posterior areas of the talus, using conventional arthroscopic methods this procedure is very useful. Percutaneous retrograde drilling (cf. [6, 7, 9, 15, 20, 21]) spared the joint's cartilage in all cases. At the level of the knee joint we see the usefulness of this method for complex situations (cf. [12, 13]) requiring precise drilling.

Return to Sports After Surgical Treatment of Osteochondral Defects of the Talus: A Systematic Review of 2347 Cases

“…The aim of this technique is to revascularize the subchondral bone and subsequently to achieve the formation of new bone. 70 One study (a retrospective case series) was included in this treatment group, 72 including 15 patients all with primary defects and a mean follow-up of 12 months.…”

Computer-assistierte retrograde Anbohrung der Osteochondrosis dissecans tali mittels fluoroskopischer Navigation

“…Dies war bei keiner der navigierten Bohrungen der Fall. Durch Computer-assistierte fluoroskopische Navigation von Freihandbohrungen konnte am Talus mit einer Streubreite von 0,0 bis maximal 4,4 mm eine ähnlich hohe Genauigkeit erreicht werden, wie durch Rosenberger et al [16] unter Verwendung von CT und komplexen Fixierhilfen mit einem Bereich von 1,0 bis 3,5 mm. Die CT-basierte Navigation weist somit trotz der dem Bildgebungsverfahren immanenten höheren Auflösungsfähigkeit, keine effektiven Vorteile bei gleichwohl höherer Kosten, Zeit-und Strahlenbelastung auf.…”

“…Bei der Planung und Durchführung des hohe Präzision erfordernden Eingriffs kann CAOS (Computer Assisted Orthopaedic Surgery) wertvolle Dienste leisten. Rosenberger (2002) ermöglichte in einem stereotaktischen Ansatz die räumliche Zuordnung präoperativ gewonnener CT-Daten durch intraoperative Fixierung des Sprunggelenks in einem individuell angefertigten Stiefel aus Fiberglas [16]. Mit einer mechanischen Zielvorrichtung und unter zusätzlicher BV-Kontrolle konnten hierdurch 10 Zielbohrungen am Talus mit einer Abweichung von 1,0 bis 3,5 mm durchgeführt werden.…”

Initial Outcomes of 3-Dimensional Imaging-Based Computer-Assisted Retrograde Drilling of Talar Osteochondral Lesions

“…The use of CT-based computer-assisted retrograde drilling was introduced for appropriate cases. 2 , 7 , 32 , 33 The main problems that arise are due to the complex architecture of the foot, which has 28 bones and more than 30 joints. The foot tends not to remain in the same position during the preoperative CT and registration; thus, registration is more difficult to achieve in the foot than in other body regions, such as the spine or pelvis.…”

“…Rosenberger et al 7 , 32 , 33 have also described a CT-guided technique for computer-assisted retrograde drilling of osteochondral defects of the talus. For this technique, application of a fixation device to the ankle is necessary.…”