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  • 文章类型: Journal Article
    (1)简介:腹腔镜下盆腔肿瘤的方法是具有挑战性的,并受到次优的肿瘤可视化和解剖的阻碍,可能的肿瘤失败。立体定向导航提供实时图像指导,可以优化安全性,准确度,解剖具有挑战性的低骨盆肿瘤时的精确度。(2)方法:使用八个皮肤固定基准采集术前CT图像,并将其加载到导航系统中。患者跟踪器安装在床侧。进行患者-图像配对点配准,和仪器跟踪器安装在腹腔镜仪器上并校准仪器跟踪。在实时立体定向导航辅助下进行外科手术。(3)结果:3例患者行立体定向导航手术。基准配准误差良好至最佳(±1.9、±3.4和±3.4mm)。通过实时导航很容易识别和定位病变。手术很顺利。组织病理学检查发现1例直肠后神经鞘瘤,1例直肠腺癌盆腔外侧复发,和一个晚期肛管癌.无导航相关并发症,再入院,或术后死亡率观察。(4)结论:腹腔镜立体定向导航手术治疗复杂低位盆腔肿瘤是可行的,并能使肿瘤靶向性和保证切缘,影响肿瘤手术质量。需要进一步更广泛的系列来确认立体定向导航对具有挑战性的低骨盆肿瘤的影响。
    (1) Introduction: The laparoscopic approach to low pelvic tumors is challenging and hindered by suboptimal tumor visualization and dissection, with possible oncological failure. Stereotactic navigation provides real-time image guidance that may optimize safety, accuracy, and precision when dissecting challenging low pelvic tumors. (2) Methods: Preoperative CT images were acquired with eight skin-fixed fiducials and loaded into a navigation system. A patient tracker was mounted on the bed side. Patient-to-image paired point registration was performed, and an instrument tracker was mounted on a laparoscopic instrument and calibrated for instrument tracking. Surgical operations were performed with real-time stereotactic navigation assistance. (3) Results: Three patients underwent stereotactic navigation surgery. Fiducial registration errors were good to optimal (±1.9, ±3.4, and ±3.4 mm). Lesions were easily identified and targeted with real-time navigation. Surgeries were uneventful. Histopathology examinations identified one retro-rectal schwannoma, one lateral pelvic recurrence from rectal adenocarcinoma, and one advanced anal canal carcinoma. No navigation-related complications, readmissions, or postoperative mortalities were observed. (4) Conclusions: The application of laparoscopic stereotactic navigation surgery to complex low pelvic tumors is feasible and could impact oncological surgical quality by enabling tumor targeting and ensuring resection margins. Further wider series are needed to confirm stereotactic navigation\'s impact on challenging low pelvic tumors.
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  • 文章类型: Case Reports
    前庭神经鞘瘤是良性肿瘤,是桥小脑角最常见的肿瘤。这些病变的手术治疗涉及各种手术方法的考虑,这可能会对程序过程和患者预后产生深远的影响。因此,全面了解肿瘤的位置和周围解剖结构对于取得积极结果至关重要.我们介绍了一例47岁的女性前庭神经鞘瘤患者。一种新颖的混合现实(MR)系统用于将患者特定的3D模型注册到患者的头部,以进行手术计划和解剖可视化。
    一名47岁女性,有左侧听力损失史,耳鸣,和偶发的左侧面部刺痛。磁共振成像(MRI)显示左小脑桥脑角有3.3cm增强的病变,对肱桥脑和延髓有质量影响。手术切除通过乙状结肠后颅开颅术进行。
    在这项研究中,我们报道了增强现实(AR)可视化在前庭神经鞘瘤切除计划中的应用.该技术允许将患者的3D解剖模型有效且准确地配准到位于手术室中的头部上。该系统是手术计划的强大工具,因为它允许外科医生可视化关键解剖结构,他们躺在病人的头部。本病例证明了AR在复杂颅骨病变的手术计划中的价值和用途。
    UNASSIGNED: Vestibular schwannomas are benign tumors and are the most common tumor found in the cerebellopontine angle. Surgical management of these lesions involves consideration of various operative approaches, which can have profound effects on procedural course and patient outcomes. Therefore, a comprehensive understanding of the location of the tumor and surrounding anatomical structures is vital for a positive outcome. We present a case of a 47-year-old female patient with vestibular schwannoma. A novel mixed reality (MR) system was used to register patient-specific 3D models onto the patient\'s head for operative planning and anatomical visualization.
    UNASSIGNED: A 47-year-old female presented with a history of left-sided hearing loss, tinnitus, and episodic left facial tingling. Magnetic Resonance Imaging (MRI) demonstrated a 3.3 cm enhancing lesion in the left cerebellopontine angle at the with mass effect on the brachium pontis and medulla. Surgical resection was performed via retrosigmoid craniotomy.
    UNASSIGNED: In this study, we report the use of Augmented Reality (AR) visualization for planning of vestibular schwannoma resection. This technology allows for efficient and accurate registration of a patient\'s 3D anatomical model onto their head while positioned in the operating room. This system is a powerful tool for operative planning as it allows the surgeon to visualize critical anatomical structures where they lie on the patient\'s head. The present case demonstrates the value and use of AR for operative planning of complex cranial lesions.
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  • 文章类型: Journal Article
    背景与目的:青少年特发性脊柱侧凸(AIS)是一种普遍存在的三维脊柱疾患,具有多因素的发病机理,包括遗传学和环境因素。治疗选择包括非手术和手术治疗。手术干预在畸形矫正方面显示出积极的结果,疼痛缓解,和改善心脏和肺功能。手术并发症,包括过度失血和神经功能缺损,在2.27-12%的病例中报告。导航辅助技术,比如O形臂系统,一直是最近的焦点,精度更高。本研究旨在评估O形臂导航辅助下AIS患者一期后路器械融合的结果和并发症。材料和方法:这项回顾性研究评估了55例AIS患者(12-28岁),他们在2016年6月至2023年8月期间接受了由O-arm导航支持的一期后方器械矫正。我们检查了放射学手术结果(初始矫正率,校正率损失,最后一次随访纠正率)和并发症作为主要结果。患者的特点,术中失血,操作时间,融合水平的数量,并记录了螺杆密度。结果:73例患者中,55符合纳入标准。平均年龄16.67岁,以女性为主(78.2%)。手术结果显示出实质性的初始校正(58.88%)和在最后一次随访中持续的积极放射学影响(56.56%)。围手术期并发症,包括主要和次要,发生在18.18%的病例中。两名患者经历了严重的并发症。失血量(509.46mL)和手术时间(402.13min)与文献范围相当。趋势分析表明,在研究期间,手术时间和失血量有所改善。结论:O形臂导航辅助的一期后路器械对于AIS矫正手术证明是可靠的,实现显著和持续的积极放射学结果,更低的校正损失,减少术中失血,和没有植入物相关的并发症。尽管面临挑战,我们的研究证明了这种手术方法的有效性和成熟度.
    Background and Objectives: Adolescent idiopathic scoliosis (AIS) is a prevalent three-dimensional spinal disorder, with a multifactorial pathogenesis, including genetics and environmental aspects. Treatment options include non-surgical and surgical treatment. Surgical interventions demonstrate positive outcomes in terms of deformity correction, pain relief, and improvements of the cardiac and pulmonary function. Surgical complications, including excessive blood loss and neurologic deficits, are reported in 2.27-12% of cases. Navigation-assisted techniques, such as the O-arm system, have been a recent focus with enhanced precision. This study aims to evaluate the results and complications of one-stage posterior instrumentation fusion in AIS patients assisted by O-arm navigation. Materials and Methods: This retrospective study assesses 55 patients with AIS (12-28 years) who underwent one-stage posterior instrumentation correction supported by O-arm navigation from June 2016 to August 2023. We examined radiological surgical outcomes (initial correction rate, loss of correction rate, last follow-up correction rate) and complications as major outcomes. The characteristics of the patients, intraoperative blood loss, operation time, number of fusion levels, and screw density were documented. Results: Of 73 patients, 55 met the inclusion criteria. The average age was 16.67 years, with a predominance of females (78.2%). The surgical outcomes demonstrated substantial initial correction (58.88%) and sustained positive radiological impact at the last follow-up (56.56%). Perioperative complications, including major and minor, occurred in 18.18% of the cases. Two patients experienced a major complication. Blood loss (509.46 mL) and operation time (402.13 min) were comparable to the literature ranges. Trend analysis indicated improvements in operation time and blood loss over the study period. Conclusions: O-arm navigation-assisted one-stage posterior instrumentation proves reliable for AIS corrective surgery, achieving significant and sustained positive radiological outcomes, lower correction loss, reduced intraoperative blood loss, and absence of implant-related complications. Despite the challenges, our study demonstrates the efficacy and maturation of this surgical approach.
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  • 文章类型: Case Reports
    腰椎引流(LD)的放置可能是一个困难的过程,导致术后并发症,特别是在有持续性脑脊液渗漏或体型较大的患者中。本技术案例报告的目的是描述如何使用Medtronic的SureTrak导航系统进行导航LD放置。
    患者是一名18岁的病态肥胖男性,最初接受了枕骨下颅骨切除术伴硬脑膜成形术和C1椎板切除术治疗Chiari畸形。术后,他出现了假性脑膜膨出,并被带到手术室进行伤口修复,硬膜成形术修复,和LD放置。Medtronic的SureTrak导航系统用于伤口翻修前的LD放置。使用SureTrak导航在单次通过中实现了成功的LD放置。患者术后表现良好,术后第6天进行LD切除。患者出院时状况良好,没有脑脊液渗漏的迹象。
    使用SureTrak系统的导航是在体重指数高且持续存在脑脊液漏的患者中使用的合理选择。当病人已经在接受手术时,它可以帮助在一个单一的俯卧位置完成有效的低风险干预。
    UNASSIGNED: Lumbar drain (LD) placement can be a difficult procedure leading to postprocedure complications, particularly in patients with persistent cerebrospinal fluid leaks or a large body habitus. The objective of this technical case report is to describe the use of Medtronic\'s SureTrak Navigation system for navigated LD placement.
    UNASSIGNED: The patient was an 18-year-old morbidly obese male who initially underwent a suboccipital craniectomy with duraplasty and a C1 laminectomy for Chiari Malformation. Postoperatively, he developed a pseudomeningocele and was taken to the operating room for wound revision, duraplasty repair, and LD placement. Medtronic\'s SureTrak Navigation system was used for LD placement before wound revision. Successful LD placement was achieved in a single pass using the SureTrak Navigation. The patient did well postoperatively, and LD removal occurred on postoperative day 6. The patient was discharged in good condition without evidence of a cerebral spinal fluid leak.
    UNASSIGNED: Navigation using the SureTrak system is a reasonable option to use in patients with a high body mass index and a persistent cerebrospinal fluid leak. When the patient is already undergoing an operative procedure, it can aid in an efficient low-risk intervention completed in a single prone positioning.
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  • 文章类型: Case Reports
    未经证实:计算机断层扫描(CT)引导的浸润是治疗下背痛的主要方法。针头放置通常使用徒手方法进行,其中估计从计划针角度到实际针插入角度的平移。然而,在需要双斜进入路线(平面外)而不是平面内路线的情况下,徒手方法尤其具有挑战性。在这个系列中,我们报告了我们使用患者安装的Cube导航系统在腰椎疼痛治疗中指导针头放置复杂通路的经验。
    UNASSIGNED:我们回顾性分析了5例需要双斜入路进行CT引导下腰椎浸润疼痛治疗的患者。这些过程中的每一个都是使用立方体导航系统来提供导航指导。患者平均年龄为69±13岁(范围58-82岁;均为女性)。技术上的成功,程序时间,回顾性测定对照扫描的数量.
    未经评估:技术成功(即,定位和精度)在所有情况下都获得了。平均手术时间为15±7分钟(10-22分钟);平均进行2±1个CT对照扫描。在本研究中没有报告并发症或材料故障。
    UNASSIGNED:在这种初始情况下,使用Cube导航系统进行的双斜穿刺在腰椎的一系列复杂通道是准确的,并且该程序具有时间效率。在作者看来,立方体导航系统有可能改善复杂通道的针引导,特别是考虑到设备的易用性。
    UNASSIGNED: Computed tomography (CT)-guided infiltrations are a mainstay in the treatment of lower back pain. Needle placement is usually performed using the free-hand method, where the translation from the planned needle angle to the actual needle insertion angle is estimated. However, the free-hand method is especially challenging in cases where a double-oblique access route (out-of-plane) rather than an in-plane route is necessary. In this case series, we report our experience with the patient-mounted Cube Navigation System to guide needle placement for complex access routes in lumbar pain therapy.
    UNASSIGNED: We retrospectively analyzed the cases of five patients in whom a double-oblique access route was necessary for CT-guided lumbar infiltration pain treatment. Each of those procedures was done using the Cube Navigation System to provide navigational guidance. The mean patient age was 69 ± 13 years (range 58-82 years; all females). Technical success, procedure time, and number of control scans were determined retrospectively.
    UNASSIGNED: Technical success (i.e., positioning and accuracy) was obtained in all cases. Mean procedure time was 15 ± 7 min (10-22 min); on average, 2 ± 1 CT control scans were performed. There were no complications or material failures reported in the present study.
    UNASSIGNED: Double-oblique punctures with the Cube Navigation System in this initial case series of complex access routes at the lumbar spine were accurate and the procedure was time efficient. In the authors\' view, the Cube Navigation System has the potential to improve needle guidance for complex access routes, especially considering the ease of use of the device.
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  • 文章类型: Case Reports
    UNASSIGNED:单发肺结节是日常临床实践中的常见问题。目前,有导航系统与径向支气管超声和电磁导航获取活检。此外,快速现场评估可用于快速评估。这些小损伤,即使他们没有正电子发射断层扫描的任何临床重要信息,调查很重要。
    UNASSIGNED:射频和微波消融已被评估为局部治疗技术。这些技术可以用作不能进行手术的患者群体的治疗。目前,一个经过验证的操作系统用于通过支气管镜的工作通道进行内窥镜射频消融。
    UNASSIGNED:在我们的例子中,我们使用新系统进行长期随访的射频消融.
    UNASSIGNED: Single pulmonary nodules are a common issue in everyday clinical practice. Currently, there are navigation systems with radial-endobronchial ultrasound and electromagnetic navigation for obtaining biopsies. Moreover, rapid on-site evaluation can be used for a quick assessment. These small lesions, even when they do not have any clinically significant information with positron emission tomography, are important to investigate.
    UNASSIGNED: Radiofrequency and microwave ablation have been evaluated as local treatment techniques. These techniques can be used as therapy for a patient population that cannot be operated on. Currently, one verified operating system is used for endoscopic radiofrequency ablation through the working channel of a bronchoscope.
    UNASSIGNED: In our case, a new system was used to perform radiofrequency ablation with long-term follow-up.
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  • 文章类型: Case Reports
    带有外科技术说明的研究设计案例系列。目的本文报道保留肌肉的C0-C2临时固定治疗寰枕脱位(AOD)的经验和结果。方法AOD是一种罕见的高能创伤所致损伤,发生在不到1%的儿科创伤患者中。推荐的治疗方法是C0-C2融合,然而,将导致颅颈交界区(CCJ)的活动性显著丧失,特别是C1-C2旋转。另一种方法,具有保持C1-C2段移动性的能力,是一种暂时的固定,可以让韧带愈合,之后可以移除植入物以恢复CCJ关节的功能。通过对C2螺钉使用肌肉保护方法和导航,通过移除植入物后的运动恢复,可以实现CCJ的相对无创伤固定。结果我们介绍了2例采用临时固定治疗的AOD。一名12岁男孩卷入正面汽车碰撞,作为一个束缚的后座乘客,用C0-C2临时固定治疗10个月。移除植入物后11个月的随访包括临床评估,计算机断层扫描,磁共振成像(MRI),和屈伸X射线。他在随访时没有症状。CCJ在影像学上是稳定的,他的C1-C2旋转为45度。一名7岁的女孩下车时被车撞了。她接受了4个月的临时固定治疗,之后移除植入物。8年的随访包括临床评估和MRI轮换。她没有症状。CCJ的韧带看起来正常,她的C1-C2旋转为30度。结论C0-C2固定不融合可使小儿AOD的CCJ韧带愈合。通过在韧带愈合后移除植入物,在C1-C2段中的旋转可以被重新获得而没有随后的不稳定性。我们的两名患者对治疗的耐受性良好,随访时无症状。通过使用微创肌肉保存技术和导航,可以实现CCJ的临时固定,同时对软组织的损伤最小,从而在移除植入物后恢复几乎正常的功能。
    Study Design  Case series with surgical technical note. Objectives  This article reports experiences and results of muscle-preserving temporary C0-C2 fixation for the treatment of atlanto-occipital dislocation (AOD). Methods  AOD is a rare injury caused by high-energy trauma, occurring in less than 1% of pediatric trauma patients. Recommended treatment is C0-C2 fusion which, however, will result in significant loss of mobility in the craniocervical junction (CCJ), especially C1-C2 rotation. An alternative approach, with the ability of preserving mobility in the C1-C2 segment, is a temporary fixation that allows the ligaments to heal, after which the implants can be removed to regain function in the CCJ joints. By using a muscle-preserving approach and navigation for the C2 screws, a relatively atraumatic fixation of the CCJ can be achieved with motion recovery after implant removal. Results  We present two cases of AOD treated with temporary fixation. A 12-year-old boy involved in a frontal car collision, as a strapped back seat passenger, was treated with temporary C0-C2 fixation for 10 months. Follow-up at 11 months after implant removal included clinical evaluation, computed tomography, magnetic resonance imaging (MRI), and flexion-extension X-rays. He was free of symptoms at follow-up. The CCJ was radiographically stable and he had 45 degrees of C1-C2 rotation. A 7-year-old girl was hit by a car as she got off a bus. She was treated with temporary fixation for 4 months after which the implant was removed. Follow-up at 8 years included clinical evaluation and MRI in rotation. She was free of symptoms. The ligaments of the CCJ appeared normal and her C1-C2 rotation was 30 degrees. Conclusion  C0-C2 fixation without fusion allows the CCJ ligaments to heal in pediatric AOD. By removing the implants after ligament healing, rotation in the C1-C2 segment can be regained without subsequent instability. Both our patients tolerated the treatment well and were free of symptoms at follow-up. By using minimally invasive muscle-preserving technique and navigation, temporary fixation of the CCJ can be achieved with minimal damage to the soft tissues allowing recovery of almost normal function after implant removal.
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  • 文章类型: Journal Article
    背景:基于社区的健康案例管理者已被比作胶水,它将客户的动态需求与一系列脱节的健康和社会服务进行了比较。然而,由于角色定义不清,案例经理角色很难理解,令人困惑的术语,在新西兰能见度低。
    目的:本综述旨在绘制案件管理工作的图景,通过澄清工作来推进劳动力规划,角色,以及新西兰奥特罗阿(NZ)案例经理的关系。
    方法:我们的范围界定和映射审查包括同行评审的文章,灰色文献来源,以及来自15名病例经理的访谈数据。数据被迭代绘制,直到出现收敛模式并确定独特的角色。
    结果:发现了描述和评估新西兰(n=148)案例管理工作的丰富多样的文献,记录了至少38种不同的职称。进一步分析了18个不同的角色,并提供了足够的数据来探索研究问题。社会生态学地图突出了不同的专业间和部门间关系。
    结论:在这一领域有明显的创新和适应,特别是在过去的五年里。案件管理员也被称为健康导航员,在新西兰医疗保健中发挥着举足轻重但往往被低估的作用,通过他们的跨专业和部门间关系。他们的工作往往得不到认可,这阻碍了劳动力的发展和促进以人为本的综合医疗保健。
    Community-based case managers in health have been compared to glue which holds the dynamic needs of clients to a disjointed range of health and social services. However, case manager roles are difficult to understand due to poorly defined roles, confusing terminology, and low visibility in New Zealand.
    This review aims to map the landscape of case management work to advance workforce planning by clarifying the jobs, roles, and relationships of case managers in Aotearoa New Zealand (NZ).
    Our scoping and mapping review includes peer-reviewed articles, grey literature sources, and interview data from 15 case managers. Data was charted iteratively until convergent patterns emerged and distinctive roles identified.
    A rich and diverse body of literature describing and evaluating case management work in NZ (n = 148) is uncovered with at least 38 different job titles recorded. 18 distinctive roles are further analyzed with sufficient data to explore the research question. Social ecology maps highlight diverse interprofessional and intersectoral relationships.
    Significant innovation and adaptations are evident in this field, particularly in the last five years. Case managers also known as health navigators, play a pivotal but often undervalued role in NZ health care, through their interprofessional and intersectoral relationships. Their work is often unrecognised which impedes workforce development and the promotion of person-centered and integrated health care.
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  • 文章类型: Journal Article
    在本文中,我们提出了一个完整而有效的指导解决方案,四旋翼平台的导航和控制,以在绘制的葡萄园地形中完成3D覆盖飞行任务。首先,使用迭代结构化方向规划算法,使用地形的占用网格地图生成安全的引导覆盖路径。其次,从生成的路径中提取路点,并将其添加到轨迹的速度和加速度约束中。受约束的路点被馈送到线性二次调节器算法中,以便在满足指向和走廊约束的同时生成全局最小快照最佳轨迹。然后,当面对意想不到的障碍时,四旋翼倾向于使用改进的人工势场算法在本地实时重新规划其路径。最后,在特殊欧氏群SE(3)上开发了几何轨迹跟踪控制器。该控制器的目的是使用由惯性单元提供的矢量测量来跟踪所生成的轨迹,同时指向预定方向。通过多个仿真结果证明了该方法的性能。特别是,实现了安全的引导路径。满足航路点位置的无障碍最佳轨迹,指向的方向,和走廊的限制,使用优化的平台快照成功生成。此外,
    In this paper, we present a complete and efficient solution of guidance, navigation and control for a quadrotor platform to accomplish 3D coverage flight missions in mapped vineyard terrains. Firstly, an occupancy grid map of the terrain is used to generate a safe guiding coverage path using an Iterative Structured Orientation planning algorithm. Secondly, way-points are extracted from the generated path and added to them trajectory\'s velocities and accelerations constraints. The constrained way-points are fed into a Linear Quadratic Regulator algorithm so as to generate global minimum snap optimal trajectory while satisfying both the pointing and the corridor constraints. Then, when facing unexpected obstacles, the quadrotor tends to re-plan its path in real-time locally using an Improved Artificial Potential Field algorithm. Finally, a geometric trajectory tracking controller is developed on the Special Euclidean group SE(3). The aim of this controller is to track the generated trajectory while pointing towards predetermined direction using the vector measurements provided by the inertial unit. The performance of the proposed method is demonstrated through several simulation results. In particular, safe guiding paths are achieved. Obstacle-free optimal trajectories that satisfy the way-point position, the pointing direction, and the corridor constraints, are successfully generated with optimized platform snap. Besides, the implemented geometric controller can achieve higher trajectory tracking accuracy with an absolute value of the maximum error in the order of 10-3 m.
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  • 文章类型: Journal Article
    目的:微创经椎间孔腰椎椎间融合术(MIS-TLIF)是一种高度可重复的脊柱节段融合术。我们最近引入了“总导航”的概念,以改善工作流程并消除透视检查。结合增强现实(AR)的图像引导式手术可以进一步促进工作流程。在这项研究中,我们开发并评估了将AR集成到MISTLIF工作流程中的方案.
    方法:10例患者的病例系列是评估通过应用AR促进肾小管MIS-TLIF的方案的基础。使用专用软件在术前计算机断层扫描(CT)扫描上标记手术TLIF标志。该标记的CT扫描在术中与使用弹性图像融合的低剂量导航CT扫描融合,标记物转移到术中扫描.收集我们在此工作流程和手术结果方面的经验。
    结果:我们的AR方案在所有病例中均安全实施。TLIF标志可以在术前计划并转移到术中成像。在这10个案例中,1例另外进行了滑膜囊肿切除术,2例因中央狭窄而进行了骨减压。平均手术时间为160.6±31.9分钟。AR的实施使整个手术时间增加了1.72±0.37分钟。无并发症发生。
    结论:我们的研究结果支持使用AR进行总导航可能会进一步促进工作流程的想法,特别是在解剖结构更复杂的情况下,为了教学和培训的目的。需要做更多的工作来简化软件并使AR集成更加用户友好。
    OBJECTIVE: Minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) is a highly reproducible procedure for the fusion of spinal segments. We recently introduced the concept of \"total navigation\" to improve workflow and eliminate fluoroscopy. Imageguided surgery incorporating augmented reality (AR) may further facilitate workflow. In this study, we developed and evaluated a protocol to integrate AR into the workflow of MISTLIF.
    METHODS: A case series of 10 patients was the basis for the evaluation of a protocol to facilitate tubular MIS-TLIF by the application of AR. Surgical TLIF landmarks were marked on a preoperative computed tomography (CT)-scan using dedicated software. This marked CT scan was fused intraoperatively with the low-dose navigation CT scan using elastic image fusion, and the markers were transferred to the intraoperative scan. Our experience with this workflow and the surgical outcomes were collected.
    RESULTS: Our AR protocol was safely implemented in all cases. The TLIF landmarks could be preoperatively planned and transferred to the intraoperative imaging. Of the 10 cases, 1 case had additionally a synovial cyst resection and in 2 cases an additional bony decompression was performed due to central stenosis. The average procedure time was 160.6 ± 31.9 minutes. The AR implementation added 1.72 ± 0.37 minutes to the overall procedure time. No complications occurred.
    CONCLUSIONS: Our findings support the idea that total navigation with AR may further facilitate the workflow, especially in cases with more complex anatomy and for teaching and training purposes. More work is needed to simplify the software and make AR integration more user-friendly.
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