Elektromagnetisches Tracking bei der minimalinvasiven Versorgung von Sakrumfrakturen mit perkutanen Iliosakralschrauben
Janssen, Maximilian; Schmitz-Rode, Thomas (Thesis advisor); Kuhl, Christiane (Thesis advisor)
Dissertation / PhD Thesis
Dissertation, Rheinisch-Westfälische Technische Hochschule Aachen, 2021
"Electromagnetic real - time navigation in the treatment of sacral fractures with percutaneous iliosacral screw fixation" (by Maximilian Janssen) Abstract Background: The dissertation refers to the progressive development of studies that try to combine radiological methods with modern computer - assisted navigation systems in different medical situations. Some notable authors have already emphasized the diverse possibilities within electromagnetic real - time navigation and paved the way for further scientifically examination of these technologies. Methods: The minimally invasive treatment of double - sided sacral fractures (Denis I and II) with percutaneous iliosacral screws was studied. In this connection four basically different techniques were applied to anthropomorphic pelvic models with custom - made holders: the real - time electromagnetic navigation (EMT - group), the optical navigation with preoperatively CT - data (OCT - group), the optical navigation with intraoperatively 3D - data (O3D - group) and the conventional 2D - fluoroscopic standard without any navigational aspects. Results: Each group included 40 screws. Therefore, a total of 160 screws were placed and analyzed. The EMT - group showed significantly (p< 0,05) less screw malposition than the Fluoro - group and the OCT - group. However, the results of the O3D - group and the EMT - group were comparable. Analyzing the time of screw placement same results stood out, because here too, the O3D - group and the EMT - group proved to be significantly (p<0,05) faster than the comparison groups. Furthermore, the EMT - group showed a hundred percent reduction of additive, intraoperatively radiation exposure and absolutely no clinically relevant wire perforation, which means significantly (p<0,001) better results in both aspects compared to every other experimental group. Conclusion: Regarding the specific indication the real - time electromagnetic navigation turned out to be a safe and feasible procedure serving significantly higher precision and speed than the present standard. Optical navigation with intraoperatively 3D - data is able to obtain comparable results. The real - time electromagnetic navigation is capable of reducing the additive, intraoperatively radiation exposure to zero and, moreover, goes without the serious disadvantages of optical navigation in general (i.e. the interference - prone line of sight between patient and camera for example). Interestingly, in this experiment the optical navigation with preoperatively CT - data featured no additional benefit. Advanced studies on electromagnetic navigation, particularly on its clinical practicability, as well as a critical discussion on the expansion of its previous indications seem more than reasonable and over all pretty seminal.