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Surgical Planning of Computer-Assisted Repositioning Osteotomies

Marmulla, Rüdiger M.D., D.M.D.; Niederdellmann, Herbert M.D., D.M.D.

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Abstract

Repositioning osteotomies are frequently used in orthopedic surgery and traumatology to correct malpositions. Computed tomography (CT), stereolithographic models, and x-rays are used in planning. However, the precision achieved in the planning phase is usually not translated to patients.

The Surgical Segment Navigator (SSN) is a navigation system that allows computer-assisted correction of malpositions. It consists of an infrared positioning device, two dynamic reference frames (DRF), an infrared pointer, and an infrared camera. All data are displayed numerically and graphically on the monitor of the SSN workstation.

The Laboratory Unit for Computer-Assisted Surgery (LUCAS) is used for planning surgery in the laboratory. LUCAS requires only a native CT scan. A preparatory operation to implant bone markers that will be visible in x-rays and a further planning CT scan showing the bone markers, which were necessary with previous systems, are not required for the LUCAS and SSN system. This significantly reduces the radiation exposure of the patient and the costs of surgical planning.

Measuring anatomical landmarks in the surgical site, which is time-consuming and reduces accuracy, is not required with the SSN system because the position of the infrared transmitters is known during surgical planning on the LUCAS workstation. This makes the surgical approach faster and much more precise. The surgical planning data are transferred to the surgical site using a data file and an individual surface pattern that fits the surface of the navigated bone segment. The data file is exported from the LUCAS-workstation to the SSN workstation. The planned spatial displacement of the infrared transmitters is saved in this file. The individual surface pattern carries the infrared transmitters. This pattern is the mechanical interface between infrared transmitters and navigated bone segment.

The individual surface pattern can be polymerized directly on a small stereolithographic model of the navigated bone segment. The surface pattern can also be generated as negative form from a CT data set using a computer-assisted design/manufacture system.

In summary, LUCAS and SSN allow for the computer-assisted correction of malpositions and positioning of artificial joints and implants. In principle, the systems can be used in all fields of surgery.

©1999American Society of Plastic Surgeons

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