| Objective: Apply computer-assisted navigation thermoplastic elastomerfilm localization system to conduct simulated surgery with internal fixation ofcannulated screws in non-displaced femoral neck fractures, and compare withclinical cases with manual operation monitored by X-ray perspective intraditional surgery methods. By assessing accuracy of inserting the cannulatedscrew guide pins in this system, compare the parallelism and dispersity ofspace distribution of screws in these two methods, as well as the duration forcompletion of embedding operation of cannulated screws, and then assess theaccuracy, stability and feasibility of the system, so as to provide a newminimally invasive positioning method to conduct clinical internal fixationsurgery treatment for femoral neck fractures.Methods: This research adopted computer-assisted navigationthermoplastic elastomer film localization system to conduct simulated surgeryof fixating cannulated screws in non-displaced femoral neck fractures with12cases of femoral neck samples as experimental group.12randomly selectedclinical cases of femoral neck fractures were treated under manual operationof X-ray perspective monitoring by using traditional methods as the controlgroup. Conducted grouping and numbering of12cases of femoral necksamples in6normal adult antiseptic corpses in the experiment group tosimulate the fixation surgery inside non-displaced femoral neck fractures.Used computer-assisted navigation thermoplastic elastomer film localizationsystem to locate the fixed cannulated screws of femoral neck. Inserted3cannulated screws in each sample, totaling36screws. For the12clinical casesof femoral neck fractures randomly selected in the control group, their fracturetypes were all GardenI and GardenII. Adopted manual operation under X-ray perspective monitoring in regular surgery method to conduct internal fixationof cannulated screws. Through measurement, calculated the starting point ofplanned spike and practical spike, the space coordinate of virtual ending pointand the error range of their spatial distance, and assessed the accuracy ofcomputer-assisted navigation thermoplastic elastomer film localization systemto complete the surgery; calculated depth of parallelism of two sets ofcannulated screws at coronal plane and transverse plane along the long axis offemoral neck, and compared the parallelism of two cannulated screws in thetwo surgery methods; calculated the ratio of the area of triangle formed bycannulated screws at CT section of virtual line of femoral neck fracture in thefemoral neck section, and compared the dispersity of cannulated screws in thetwo surgery methods; meanwhile, the operating time and frequency ofintraoperative fluoroscopy in insertion operation for femoral neck fracturewere compared between the two surgery methods.Results: All cannulated screws in experiment group were successfullyinserted in the first time, and the guide pins weren't adjusted repeatedly.Conducted visual inspection of all guide pins and screws displayed inpositioning image, which were all inside femoral neck without penetratingbone cortex. Guide pins were properly distributed with good parallelism. FromCT scanning, one femoral neck sample's cannulated screws at the back upperside penetrated bone cortex, and others remained inside the bone cortex offemoral neck. Error range in spatial distance of planned spike in experimentgroup and practical starting point of spike is0.46mm～3.56mm, error range inspatial distance of virtual ending point is0.89mm～4.78mm, distance mean ofspatial error of spike is2.25±0.99mm. After statistical analysis of parallelismparameters of cannulated screws in the two surgery methods, the resultsshowed that the parallelism error range of cannulated screws of two sets ofvertical CT reconstruction levels in experiment group is0°～3°, while theparallelism error range of hollow screws in traditional surgery method is2°～7°. So the parallelism of cannulated screws in experiment group ismuch better than that of traditional surgery method (P＜0.01), and its stability is also much better than that of traditional surgery method (P＜0.01). The areapercentage mean between triangle formed by cannulated screws at CT sectionof virtual facture line of femoral neck in experiment group and section of thefemoral neck is42.07±8.15%, while the area percentage mean in traditionalsurgery method is33.71±9.68%, thus dispersity of cannulated screws inexperiment group is better than that in traditional surgery method (P＜0.05).For the operating time needed to complete insertion operation with cannulatedscrews during the surgery, the average time in experiment group is67.41±16.72min, while the average time in traditional surgery group is47.53±10.41min, and difference of these two has statistical significance (P＜0.05). For the frequency of intraoperative fluoroscopy, experiment group onlyneeds two times of CT scanning under computer-assisted navigationthermoplastic elastomer film localization system, while control group needs43.23±8.74perspective to complete insertion under traditional surgerymethod.Conclusion: Computer-assisted navigation thermoplastic elastomer filmlocalization system can provide precise spatial orientation and stable routefor non-displaced femoral neck fractures fixation. Error range of spatialdistance of inserted cannulated screws in this system is0.46mm～4.78mm,and its accuracy can totally satisfy the application standard in clinical internalfixation surgery. For parallelism between cannulated screws, distribution ofspace position of screws and stability of surgery operations, this system ismuch better than traditional surgery method. Meanwhile, it greatly reducesnumber of perspectives during surgery and duration of medical workersexposed to X-ray. Although there is obvious statistical difference on theoperating time for the cannulated screws insertion in these two methods,butcomputer-assisted navigation thermoplastic elastomer film localizationsystem can effectively assist the fixation of the cannulated screws in thetreatment of non-displaced femoral neck fractures,and can provide a newminimally invasive positioning method for internal fixation treatment offemoral neck fractures. |
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