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CT guidance assisted by electromagnetic navigation system for percutaneous fixation by internal cemented screws (FICS).

电磁导航系统辅助下的CT引导下经皮内固定骨水泥螺钉 (FICS)。

  • 影响因子:4.08
  • DOI:10.1007/s00330-019-06408-0
  • 作者列表:"Moulin B","Tselikas L","De Baere T","Varin F","Abed A","Debays L","Bardoulat C","Hakime A","Teriitehau C","Deschamps F","Gravel G
  • 发表时间:2020-02-01
Abstract

PURPOSE:To evaluate electromagnetic navigation system (ENS) for percutaneous fixation by internal cemented screw (FICS) under CT guidance. BACKGROUND:FICS is a recently developed modality that consists in inserting screws, under imaging guidance, into bone through a minimal skin incision. FICS recently showed good efficacy for the palliation or prevention of pathologic fractures of the pelvic ring and femoral neck. MATERIALS AND METHODS:In this single-center retrospective study, we reviewed all consecutive cancer patients treated with percutaneous FICS under ENS-assisted CT guidance for the prevention or palliation of pelvic or femoral neck fractures. The primary endpoint was technical success. Secondary endpoints were screw placement accuracy (defined by proximal deviation p, distal deviation d, and angle deviation θ), radiation dose exposure, number of CT acquisitions, duration of procedures, and complications. RESULTS:Mean duration of FICS procedures was 111 ± 51 min. Mean post-procedure hospitalization length was 2.1 days. Technical success was achieved in 48 cases (96%) with a total of 76 screws inserted. Mean distance p, mean distance d, and mean angle θ were respectively 8.0 ± 4.5 mm, 7.5 ± 4.4 mm, and 5.4 ± 2°. Angle θ accuracy was higher for screws with a craniocaudal angulation of less than 20° (4.4° vs 6.4°, p = 0.02). The mean number of CT acquisitions during procedures was 6.4 ± 3.0. The mean dose length product was 1524 ± 953 mGy cm and the mean dose area product was 12 ± 8 Gy cm2. Five complications occurred in 4 patients. CONCLUSION:CT guidance assisted by ENS is an effective approach for percutaneous FICS. KEY POINTS:• ENS-assisted CT enables screw insertion in the pelvic ring and femoral neck, with a wide range of trajectories, even when a significant craniocaudal angulation is required. • ENS-assisted CT can be used as an alternative to CBCT guidance for percutaneous fixation by internal cemented screw. • ENS-assisted CT provides high technical success rate with excellent placement accuracy.

摘要

目的: 评价电磁导航系统 (ENS) 在CT引导下经皮骨水泥螺钉 (FICS) 内固定的应用价值。 背景: FICS是最近发展起来的一种方式,包括在成像引导下,通过最小的皮肤切口将螺钉插入骨中。近年来,FICS在缓解或预防骨盆环和股骨颈病理性骨折方面显示出良好的疗效。 材料和方法: 在这项单中心回顾性研究中,我们回顾了所有在ENS辅助CT引导下经皮FICS治疗预防或缓解骨盆或股骨颈骨折的连续癌症患者。主要终点是技术成功。次要终点是螺钉置入准确性 (由近端偏差p、远端偏差d和角度偏差 θ 定义) 、辐射剂量暴露、CT采集次数、手术持续时间和并发症。 结果: FICS手术平均持续时间为 111 ± 51 min。平均术后住院时间为 2.1 天。技术成功 48 例 (96%),共置入螺钉 76 枚。平均距离p、平均距离d和平均角度 θ 分别为 8.0 ± 4.5毫米 ° 、 7.5 ± 4.4毫米 ° 和 5.4 ± 2 °。角度 θ 准确度较高,颅外角度小于 20 ° 的螺钉 (4.4 ° vs 6.4 °,p = 0.02)。术中CT采集的平均次数为 6.4 ± 3.0。平均剂量长度乘积为 1524 ± 953 mGy · cm,平均剂量面积乘积为 12 ± 8 Gy · cm 2。4 例患者发生 5 例并发症。 结论: ENS辅助下CT引导是经皮穿刺FICS的有效方法。 要点: • ENS辅助CT可在骨盆环和股骨颈中进行螺钉置入,轨迹范围广泛,即使需要显著的颅audal成角。•ENS辅助CT可作为CBCT引导下经皮骨水泥螺钉内固定的替代。•ENS辅助CT提供了很高的技术成功率,具有优异的放置精度。

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影响因子:1.41
发表时间:2020-03-01
DOI:10.1177/1078155219842277
作者列表:["Gyori DJ","Bullington SM","Crawford BS","Vernon VP"]

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