epiDRB - ein neues minimal-invasives Konzept für die Referenzierung im Rahmen der Computer-assistierten orthopädischen Chirurgie

Ohnsorge, J. A. K.; Weißkopf, M.; Siebert, C. H.

doi:10.1055/s-2005-836515

Cited by 10 publications

(7 citation statements)

References 11 publications

(34 reference statements)

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“…Other noninvasive fixation techniques are based on adhesive or epicutane fixation of reflective markers on the skin. 17 However, both techniques were limited by sterility problems, inaccuracy, patient inconvenience, and soft tissue motions. Consequently, no regular clinical application has been reported so far.…”

Section: Discussionmentioning

confidence: 99%

Experimental validation of noninvasive referencing in navigated procedures on long bones

Kendoff

Bogojević

Citak

et al. 2006

Journal Orthopaedic Research

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Navigation procedures in orthopedic surgery require fixation of reference markers to the anatomic region of interest. Inadequate fixation might lead to micromotion or loosening of the reference marker, consequently causing registration failures or errors in navigation. Osseous rigid fixation is usually achieved by minimally invasive Schanz screws or pins. The goal of this study was to evaluate a non invasive external fixation device, a headband so far used in cranial navigation, as an alternative invasive fixation technique to reference markers in the femur. A common navigation system with an adapted trauma software application was used to track the positions of the soft tissueattached headband relative to an invasive reference marker on the femur during manipulations of the thigh. Relative translative and rotational movements of the headband were measured during defined movements of the hip and knee and manipulations of the headband itself. The results revealed high translative and rotational movements, up to 6 mm and 38, respectively, due to minor manipulations of the affected lower extremity. Noninvasive soft tissue fixation with a headband does not allow rigid fixation for accurate navigated registration or operative procedures at the femur. Necessary intraoperative movements or manipulations would cause substantial registration failures. Invasive fixation techniques with screws or pins are still the method of choice. ß

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Section: Discussionmentioning

confidence: 99%

Experimental validation of noninvasive referencing in navigated procedures on long bones

Kendoff

Bogojević

Citak

et al. 2006

Journal Orthopaedic Research

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“…2). Die epiDRB [7] zur Referenzierung der Anatomie mit dem Röntgenbild wurde dorsal in der Mittellinie auf die Haut aufgesetzt und am Dornfortsatz des zu behandelnden und dem eines benachbarten Wirbelkörpers mittels Kirschnerdraht fixiert (Abb. 3).…”

Section: Methodeunclassified

“…Das Konzept der epiDRB sieht die Möglichkeit der multisegmentalen Navigation vor [7]. In der experimentellen Erprobung konnten daher mit denselben zwei Bildern ohne weiteres zwei bis drei Wirbelkörper instrumentiert werden.…”

Section: Methodeunclassified

“…Die schlüssige Verbindung der epiDRB mit den 2 mm starken Kirschner-Drähten wird durch Kompression in den entsprechend bemessenen Vorbohrungen der Längsstrebe mittels seitlicher Madenschrauben gewährleistet. Die Zuverlässigkeit der Referenzierung mittels epiDRB und insbesondere deren stabile Verankerung ist experimentell überprüft und sichergestellt [7].…”

Section: Methodeunclassified

“…Dennoch wurden bisher keine perkutanen Eingriffe an der Wirbelsäule navigiert, da die hierzu benötigte Dynamische Referenz-Basis (DRB) herkömm-licher Bauart eine invasive Fixierung mittels Schrauben oder Klemmen am mittels Mini-Inzision exponierten Dornfortsatz verlangte und somit der minimal-invasive Charakter des jeweiligen Eingriffs konterkariert wurde. Mit der neuartigen epiDRB [7] ist nunmehr eine strikt perkutane K-Draht-Fixierung und epikutane Abstützung bei niedrigem Schwerpunkt möglich und somit die Navigation auch eines perkutanen Eingriffs wie der vertebralen Zement-Augmentation sinnvoll. Die fluoroskopische Navigation ist bei der Pedikelschrauben-Insertion bereits ein weitgehend anerkanntes Verfahren [3, 4, 6, 8 -10] und kann dem Prinzip nach bei der Kyphoplastie, wie auch bei der Vertebroplastie angewendet werden.…”

Section: Zusammenfassungunclassified

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Minimal-invasive Computer-assistierte fluoroskopische Navigation der Kyphoplastie

Ohnsorge¹,

Siebert²,

Schkommodau³

et al. 2005

Z Orthop Ihre Grenzgeb

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In challenging cases of deteriorated anatomy and difficult radiomorphologic orientation, especially of the lower thoracic spine, the CAOS-procedure succeeds in finding the optimal pedicular approach to the vertebral body, helps to avoid collateral damage and minimises the overall risk of the procedure. High accuracy and reduced radiation exposure justify the clinical use of fluoroscopic navigation for transpedicular instrumentation.

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Experimental validation of a pinless femoral reference array for computer‐assisted hip arthroplasty

Renkawitz

Wegner

Gneiting

et al. 2009

Journal Orthopaedic Research

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The use of computer navigation systems during total hip arthroplasty requires the femoral fixation of a reflective dynamic reference base (DRB), which theoretically involves the risk of bony fracture, infection, and pin loosening. The first objective of this study was to evaluate the relative movements between a novel, noninvasive external femoral DRB system and the femur. Secondly, the maximum effects of these 3D movements on intraoperative, computer-assisted leg length and offset measures were evaluated. An imageless navigation system was used to track the positions of the soft tissue attached, pinless DRB relative to an invasive reference marker on the femur during a less-invasive, anterior surgical hip approach. Relative translatory movements up to 8.2 mm mediolaterally and up to 8.88 in rotation were measured. Using a measurement technique in which the calculation of leg length and offset changes is primarily based on a specific realignment of the leg, maximum differences of 1.3 mm for leg length and 1.2 mm for offset were found when comparing the pin-based and pinless methods. Thus, invasive fixation techniques with screws or pins are still the method of choice when standard measurement algorithms for intraoperative leg length and offset measures are used. Though direct translatory and rotational variations between the pinless array and the femoral bone were detected, the pinless array can be used to assess leg length and offset when used with a specific measurement technique that compensates for such variations. ß

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epiDRB - ein neues minimal-invasives Konzept für die Referenzierung im Rahmen der Computer-assistierten orthopädischen Chirurgie

Cited by 10 publications

References 11 publications

Experimental validation of noninvasive referencing in navigated procedures on long bones

Experimental validation of noninvasive referencing in navigated procedures on long bones

Minimal-invasive Computer-assistierte fluoroskopische Navigation der Kyphoplastie

Experimental validation of a pinless femoral reference array for computer‐assisted hip arthroplasty

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