EpiDRB - ein neues minimal-invasives Konzept für die Referenzierung im Rahmen der Computer-assistierten orthopädischen Chirurgie

Abstract

Optoelectronic navigation for computer-assisted orthopaedic surgery (CAOS) is based on a firm connection of bone with passive reflectors or active light-emitting diodes in a specific three-dimensional pattern. Even a so-called "minimally-invasive" dynamic reference base (DRB) requires fixation with screws or clamps via incision of the skin. Consequently an originally percutaneous intervention would unnecessarily be extended to an open procedure. Thus, computer-assisted navigation is rarely applied. Due to their tree-like design most DRB's interfere with the surgeon's actions and therefore are at permanent risk to be accidentally dislocated. Accordingly, the optic communication between the camera and the operative site may repeatedly be interrupted. The aim of the research was the development of a less bulky, more comfortable, stable and safely trackable device that can be fixed truly percutaneously. With engineering support of the industrial partner the radiolucent epiDRB was developed. It can be fixed with two or more pins and gains additional stability from its epicutaneous position. The intraoperative applicability and reliability was experimentally tested. Its low centre of gravity and its flat design allow the device to be located directly in the area of interest. Thanks to its epicutaneous position and its particular shape the epiDRB may perpetually be tracked by the navigation system without hindering the surgeon's actions. Hence, the risk of being displaced by accident is minimised and the line of sight remains unaffected. With the newly developed epiDRB computer-assisted navigation becomes easier and safer to handle even in punctures and other percutaneous procedures at the spine as much as at the extremities without an unproportionate amount of additional trauma. Due to the special design referencing of more than one vertebral body is possible at one time, thus decreasing radiation exposure and increasing efficiency.