【导航微创距骨骨折螺钉接骨术】。

Unfallchirurgie (Heidelberg, Germany) Pub Date : 2025-01-01 Epub Date: 2024-12-17 DOI:10.1007/s00113-024-01513-2
Dominik M Haida, Thorsten Möhlig, Stefan Huber-Wagner
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引用次数: 0

摘要

手术目的:本手术的目的是使用螺钉固定术以导航和微创的方式保护多碎片和非移位距骨骨折(身体和颈部)免受继发性脱位。适应症:由于本病例患者年龄小,且有继发性脱位的风险,我们决定采用手术治疗。禁忌症:软组织肿胀,伤口感染和对骨合成材料过敏。手术技术:该视频可在线获得(英文),并详细展示了每个手术步骤。术前计算机断层扫描(CT)成像和螺钉规划。引用数组的附件。1)锥束CT (Cone beam CT, CBCT)扫描、图像融合与融合控制。微创皮肤切口的规划。皮肤切口,导航钻孔和插入K线。2)对K线进行CBCT扫描和位置检查,必要时进行微调。插入螺钉。3) CBCT扫描,随后检查螺钉位置,必要时重新拧紧螺钉。在机器人套件(Brainlab,慕尼黑,德国)使用以下元素进行:导航单元曲线导航系统,可移动机器人3D CBCT,“Loop-X”和墙壁监视器“BUZZ”。随访:术后X光片和CT控制种植体的位置。脚部部分负重,脚底接触10 kg,持续6周。主动和被动关节活动的物理治疗。依诺肝素钠预防血栓形成。大约1年后可选择移除种植体。证据:导航手术是常规的,到目前为止主要在脊柱区域。本文表明,在混合手术室中,导航肢体手术是可以成功进行的。
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[Navigated and minimally invasive screw osteosynthesis of a talus fracture].

Objective of surgery: The aim of this surgery is to safeguard the multifragmentary and nondisplaced talus fracture (body and neck) against secondary dislocation in a navigated and minimally invasive manner using screw osteosynthesis.

Indications: Due to the young age of the patient in the presented case and the risk of a possible secondary dislocation, the decision was made in favor of surgical treatment.

Contraindications: Soft tissue swelling, wound infections and allergies to the osteosynthesis material.

Surgical technique: The video is available online (in English) and shows the individual surgical steps in detail. Preoperative computed tomography (CT) imaging and screw planning. Attachment of the reference array. 1) Cone beam CT (CBCT) scan, image fusion and fusion control. Planning of the minimally invasive skin incisions. Skin incision, navigated drilling and insertion of the K‑wires. 2) CBCT scan and position check of the K‑wires, fine adjustment if necessary. Insertion of the screws. 3) CBCT scan with subsequent position check of the screws, retightening of the screws if necessary. Performed in the Robotic Suite (Brainlab, Munich, Germany) using the following elements: navigation unit curve navigation system, movable robotic 3D CBCT, "Loop-X" and wall monitor "BUZZ".

Follow-up: Postoperative X‑ray and CT to control the position of the implants. Partial weight-bearing of the foot with 10 kg sole contact for 6 weeks. Physiotherapy with active and passive joint mobilization. Thrombosis prophylaxis with enoxaparin sodium. Optional implant removal after approximately 1 year.

Evidence: Navigated operations are routine, so far mainly in the area of the spine. This article shows that navigated extremity surgery can be successfully performed in hybrid operating theaters.

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