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Navigierte Anbohrung der Femurkopfnekrose

Experimentelle und klinische Ergebnisse

Navigated drilling for femoral head necrosis

Experimental and clinical results

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Zusammenfassung

Einleitung

In den frühen Stadien der Femurkopfnekrose kann eine lokale intraossäre Druckentlastung durch exakte Anbohrung der ischämischen Areale zu Schmerzreduktion und sogar Reperfusion führen. Mit Hilfe der Computer-Aided Surgery kann die Präzision dieser Anbohrung verbessert werden bei gleichzeitiger Reduktion der Strahlenbelastung von Patient und Operationsteam. Vorgestellt werden die experimentellen und klinischen Erfahrungen mit der fluoroskopischbasierten Anbohrung mit dem VectorVision®-Navigationssystem.

Material und Methoden

Bei insgesamt 70 Kunstknochen wurde eine Femurkopfnekrose simuliert. In 2 experimentellen Studien am reinen Knochenmodell und am Modell für Adipositas sowie in einer klinischen Studie an 10 Patienten mit Femurkopfnekrose wurden die Präzision sowie Dauer der Strahlenexposition und Prozedur mit Hilfe der VectorVision®-Navigation (BrainLAB, München) der konventionellen Anbohrung mit reiner fluoroskopischer Kontrolle gegenübergestellt.

Ergebnisse

Keines der Ziele wurde verfehlt. In beiden experimentellen Modellen konnte ein statistisch signifikanter Unterschied sowohl für die Präzision, die Anzahl der notwendigen Richtungskorrekturen als auch die Strahlenexpositionszeit gezeigt werden: Die in beiden Modellen gemittelte größte Distanz zum Mittelpunkt der Nekrose betrug 0,48 mm für die navigierten Anbohrungen und 1,06 mm für die konventionellen Anbohrungen, die nötigen Richtungskorrekturen gemittelt 0,175 bzw. 2,1 und die jeweils nötige Strahlenexposition unter 1 Sekunde bzw. 3,6 Sekunden. In der klinischen Anwendung sind die Reduktion der Strahlenexpositionszeit (unter 1 s. navigiert zu 56 s. konventionell) sowie der nötigen Bohrrichtungskorrekturen (0,2 navigiert zu 3,4 konventionell) ebenfalls signifikant.

Schlussfolgerung

Die fluoroskopischbasierte Anbohrung mit Hilfe des VectorVision®-Navigationssystems zeigt bei deutlich verbesserter Präzision eine enorme Reduktion der Strahlenbelastung gegenüber der konventionellen Anbohrung und kann für die klinische Routine empfohlen werden.

Abstract

Introduction

In the early stages of osteonecrosis of the femoral head, core decompression by exact drilling into the ischemic areas can reduce pain and achieve reperfusion. Using computer aided surgery, the precision of the drilling can be improved while simultaneously lowering radiation exposure time for both staff and patients. We describe the experimental and clinical results of drilling under the guidance of the fluoroscopically-based VectorVision navigation system (BrainLAB, Munich, Germany).

Materials and methods

A total of 70 sawbones were prepared mimicking an osteonecrosis of the femoral head. In two experimental models, bone only and obesity, as well as in a clinical setting involving ten patients with osteonecrosis of the femoral head, the precision and the duration of radiation exposure were compared between the VectorVision system and conventional drilling.

Results

No target was missed. For both models, there was a statistically significant difference in terms of the precision, the number of drilling corrections as well as the radiation exposure time. The average distance to the desired midpoint of the lesion of both models was 0.48 mm for navigated drilling and 1.06 mm for conventional drilling, the average drilling corrections were 0.175 and 2.1, and the radiation exposure time less than 1 s and 3.6 s, respectively. In the clinical setting, the reduction of radiation exposure (below 1 s for navigation compared to 56 s for the conventional technique) as well as of drilling corrections (0.2 compared to 3.4) was also significant.

Conclusions

Computer guided drilling using the fluoroscopically based VectorVision navigation system shows a clearly improved precision with a enormous simultaneous reduction in radiation exposure. It is therefore recommended for clinical routine.

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Danksagung

Die Autoren danken der Firma BrainLab (Heimstetten, Deutschland) für die Unterstützung mit dem Vector-Vision®-Navigationssystem.

Interessenkonflikt

Es besteht kein Interessenkonflikt. 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. Die Präsentation des Themas ist unabhängig und die Darstellung der Inhalte produktneutral.

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Authors and Affiliations

  1. Asklepios Klinik Bad Abbach, Orthopädische Klinik und Poliklinik der Universität Regensburg, Kaiser-Karl-V-Allee 3, 93077, Bad Abbach, Deutschland

    J. Beckmann, M. Tingart, L. Perlick, C. Lüring, J. Grifka & S. Anders

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  1. J. Beckmann
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  2. M. Tingart
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  3. L. Perlick
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  4. C. Lüring
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  5. J. Grifka
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  6. S. Anders
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Correspondence to J. Beckmann.

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Beckmann, J., Tingart, M., Perlick, L. et al. Navigierte Anbohrung der Femurkopfnekrose. Orthopäde 36, 458–465 (2007). https://doi.org/10.1007/s00132-007-1086-3

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  • DOI: https://doi.org/10.1007/s00132-007-1086-3

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