Comparison of 3D C-arm fluoroscopy and 3D image-guided navigation for minimally invasive pelvic surgery

PurposeThis study aims to compare the efficacy and accuracy of percutaneous screw fixation using three-dimensional $$(\hbox {ISO-C}^\mathrm{3D})$$(ISO-C3D) navigation and conventional C-arm fluoroscopy in pelvic fracture surgery.MethodsThis was a retrospective study of 81 patients with pelvic fractures treated using percutaneous screw fixation between June 2005 and January 2011. All pelvic fractures were treated with closed reduction, small open reduction, or medium open reduction. Intraoperative radiation exposure, fixation, surgical outcome, and functional recovery were compared based on the fluoroscopy navigation method used during screw fixation. Radiographic follow-up was assessed at 1, 3, 6, and 9 months postoperatively, and a CT scan was completed at 9 months postoperatively.ResultsA total of 130 cannulated screws were placed. Average screw fixation time and fluoroscopy exposure time in $$\hbox {ISO-C}^\mathrm{3D}$$ISO-C3D group were lower than the C-arm fluoroscopy group ($$4.0\,\pm \,0.7\,\hbox {min};\, 34.2\,\pm \,2.2\,\hbox {s}$$4.0±0.7min;34.2±2.2s vs $$19.4\,\pm \,0.8\,\hbox {min};\, 57.8\,\pm \,4.9\,\hbox {s}$$19.4±0.8min;57.8±4.9s) $$(P<0.001)$$(P<0.001). Seventy-four of the 81 patients made a full recovery. Successful outcome was confirmed with radiological imaging and postoperative follow-up at 6–24 months. No delayed union or nonunion was detected. No significant difference in functional recovery at 6 months postoperative was found due to the fluoroscopy imaging technique.ConclusionsPercutaneous screw fixation using the $$\hbox {ISO-C}^\mathrm{3D}$$ISO-C3D navigational system minimizes the fluoroscope exposure and screw insertion time, while improving screw insertion accuracy. Moreover, the $$\hbox {ISO-C}^\mathrm{3D}$$ISO-C3D navigational system provided a reliable method for fluoroscopy imaging in pelvic fractures.

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