Orthopaedic surgery has a “laser eye”: fluoroscopic navigation technology

  As medical standards continue to improve and the demand for safety and effectiveness of surgery increases, computer-aided technology has become a major development in orthopedics today. Orthopaedic navigation technology, today, is involved in spine surgery, joint surgery, trauma surgery, bone oncology and orthopaedic surgery. Among them, fluoroscopic navigation technology is especially applicable to traumatology orthopedics. The current level of navigation-assisted surgery in our orthopaedic trauma three departments is already in the leading position in China.  Applying positioning system to orthopedic surgery In orthopedic surgery, it has always been the dream and challenge for trauma orthopedic surgeons to avoid intricate nerves and blood vessels and to fix and repair fractures accurately with minimal surgical damage. Computer-assisted orthopedic surgery is a new technology that uses the high-speed processing and control capabilities of computers for digital medical images to provide technical support to orthopedic surgeons through a virtual surgical environment to make the surgery more minimally invasive, safer and more accurate. Because this is a technology based on intraoperative images and the application of corresponding positioning means, the surgical site and intraoperative surgical instruments are tracked, displayed, positioned and guided in real time, and the working principle is just like the navigation for aircraft and ships in aviation and navigation. Computer-aided orthopedic surgery is a surgical system with computer image processing workstations and image tracking equipment as the core. The basic function of this system is to informally process the images provided by medical imaging equipment and display and locate the real human muscle and bone anatomical structures in combination with a stereoscopic positioning system to perform surgery with the help of a computer.  In recent years, with the continuous development of computer-assisted orthopedic surgery (CAOS) technology and equipment, more and more orthopedic surgeons have started to apply CAOS in their clinical work and as the main technology and means to carry out minimally invasive trauma orthopedic surgery. Since CAOS integrates computer, medical image processing, precision instrument manufacturing and medical robot technology, it is the crystallization of multidisciplinary wisdom, which makes it have technical advantages in many aspects that are incomparable to traditional orthopedic surgery, and greatly promotes the development of orthopedic surgery to the goal of minimally invasive and intelligent surgery in the true sense. In recent years, a few large hospitals in China have carried out this technology in neurosurgery and orthopaedics one after another. Just like the development process of every new technology, orthopaedic trauma navigation technology is still in its initial stage, and many problems still exist in practice. In addition to the continuous development and improvement of hardware and software technology specific to trauma orthopaedic navigation, the training of orthopaedic surgeons engaged in navigation surgery and the establishment of orthopaedic navigation technology standards in our Asian population are also the most urgent tasks for orthopaedic surgeons.  Fluoroscopic navigation makes orthopedic surgery safer Fluoroscopic navigation techniques are more commonly used for pelvic fracture surgery. Due to the unique anatomy of the pelvis and the complex anatomical relationships of the adjacent organs, as well as the high surgical demands, there are many shortcomings in the traditional surgical approach. Since the introduction of navigation technology, we can achieve multi-angle, real-time monitoring of the operation to maximize the avoidance of dangerous areas and significantly improve the accuracy rate. Usually the operation can be completed in a short time and is minimally invasive, with a fairly small incision, so it greatly reduces the amount of bleeding for the patient. At the same time, since fluoroscopy cannot be avoided in orthopedic surgery, which is a considerable concern for patients and medical staff, the use of navigation technology allows for multi-view observation and virtual surgery procedures, so repeated fluoroscopy is not required, greatly reducing X-ray fluoroscopy time and saving medical resources.  For patients with multiple fractures, navigation technology also has the advantage of reducing the risks associated with surgery by eliminating the need for excessive changes in the surgical position during the procedure. For patients with intramedullary and hollow nailing of the tibia and femur, fluoroscopic navigation technology can guide the placement of the internal fixation, just as a missile positioning system in the military can accurately target the missile, thereby increasing the one-time success rate of the surgery and reducing the damage to the patient. In addition, the use of fluoroscopic navigation technology in knee osteotomy and orthopedic surgery for knee osteoarthritis also has its advantages, as it can measure the force line of the affected limb intraoperatively and directly obtain the necessary objective index data, just like a navigator in flight, which can adjust the course at any time and guide the operation, further improving the accuracy and practical value of osteotomy and orthopedic surgery.  The real-time monitoring function of fluoroscopic navigation technology reduces the amount of X-ray exposure to the patient and surgeon, improves the precision, accuracy and safety of the surgery, shortens the operation time and reduces the trauma. In addition, the fluoroscopic navigation system will play an important role in surgical training and evaluation in a virtual surgical environment. This technology will not only provide opportunities for young surgeons to practice surgery, but will also allow for the design of testing systems for the objective evaluation of surgical qualifications.