C-arm影像導引系統應用於股骨幹骨折骨髓內釘遠端鎖定之臨床實作

吳鴻康(Hung-Kang Wu)

指導教授 ： 曾清秀

國立中央大學/工學院/生物醫學工程研究所/碩士(2014年)

摘要

股骨幹骨折是骨科常見的疾病，常因高能量的傷害如車禍，重物打擊所引起，主要的治療方式是以骨髓內釘來固定骨頭，但遠端鎖定式骨釘的置入常是手術者棘手的問題，傳統手術需要照射多次X光(C-arm)，病人及醫療團隊都會被迫接受大量輻射, 本實驗希望經由電腦導引系統實施遠端鎖定式骨釘的手術置入，以期能更準確的打入內置物，並縮短時間及減少移動式X光機( C-arm )的照射。
本實驗最後一共收集了12個病人，6位病人使用電腦導引手術，6位使用傳統手術，同一組醫療人員隨機使用電腦導引系統及傳統手術方式紀錄並比較其手術時間及C型臂之X光照射次數，實驗組手術時間47±14.17分鐘，C-arm照射次數為4.83±0.56次，對照組手術時間為45±21.67分鐘 , C-arm照射次數為40.67±27.22次。
電腦導引與傳統手術比起來， 有明顯差異的還是在X光的照射次數上， 在手術時間上相對而言並無明顯差異， 在電腦導引所花的時間稍微多一點， 但可以發現時間似乎隨著使用的增加而減少。

關鍵字

手術導引 ； 骨髓內釘 ； 遠端固定 ； C-arm影像

並列摘要

Femoral shaft fractures are common orthopedic diseases , caused by high energy often as heavy combat damage or a car accident. The main treatment is to fix the bone by intramedullary nail , but the nail’s distal locking screw insertion pass through the bone to distal locking hole is often thorny issues by surgeon. Traditional surgery requires several X-ray irradiation (C-arm), patients and the medical teamwork will be forced to accept large amounts of radiation. We hope to insert the distal locking screws smoothly via computer navigative surgery systems, in order to more accurately insertion by distal locking screws , shorten of the operative time and reduce irradiation by the times of the X ray.
We collected a total of 12 patients , 6 patients using computer navigation surgery, 6 using traditional surgery , the same group of medical staff using a random study to compare computer navigation systems and traditional surgery. This study record and compare their operation time and the C-arm X-ray irradiation times , the experimental group’s operation time was 47 ± 14.17 minutes, C-arm irradiation times of 4.83 ± 0.56 times, the control group’s operative time was 45 ± 21.67 minutes, C-arm irradiation times of 40.67 ± 27.22 times.
Computer navigation surgery compared with traditional C-arm surgery, there are still significant differences in the number of X-ray irradiation. There was no significant difference in operative time. The computer navigation spend a little more time , but seems to decrease with increasing use .

並列關鍵字

surgical navigation ； intramedullary nail ； distal locking screw ； C-arm image

參考文獻

[14] 丁予安、黃立，人體試驗國內外相關法規之探討，台灣醫界，2010年，第53卷第3期，頁54-55.紐倫堡法則請參http://ohsr.od.nih.gov/guidelines/nuremberg.html

[3] C. Krettek, B. Konemann, T. Miclau, et al, "A mechanical distal aiming device for distal locking in femoral nails," Clin Orthop Relat Res, pp. 267-275, 1999.

[4] Z. Gugala, A. Nana, and R.W. Lindsey, "Tibial intramedullary nail distal interlocking screw placement: comparison of the free-hand versus distally-based targeting device techniques," Injury， vol. 32 Suppl 4, pp. Sd21-25, 2001.

[5] T. Karachalios, G. Babis, J. Tsarouchas, et al., "The clinical performance of a small diameter tibial nailing system with a mechanical distal aiming device," Injury, vol。 31, pp. 451-459, 2000。

[7] M. Hoffmann, M. Schroder, W. Lehmann, et al., "Next generation distal locking for intramedullary nails using an electromagnetic X-ray-radiation-free real-time navigation system," J Trauma Acute Care Surg, vol. 73, pp. 243-248, 2012.