定位装置辅助下四肢深部金属异物的精准定位及取出

doi:10.13418/j.issn.1001-165x.2021.02.007

PDF(3718 KB)

中国临床解剖学杂志 ›› 2021, Vol. 39 ›› Issue (2) : 148-153. DOI: 10.13418/j.issn.1001-165x.2021.02.007

断层影像解剖

定位装置辅助下四肢深部金属异物的精准定位及取出

苏炜炜^{1, 2}，　何藻鹏^{1, 2}，　张国栋²，　李卫³，　许靖⁴
廖政文⁵，　谢普生¹，　林东鑫²，　黄文华^{1, 2}

作者信息 +

Accurate localization and removal of deeply imbedded metallic foreign bodies in human limbs assisted by positioning device

Su Weiwei^1,2, He Zaopeng^1,2, Zhang Guodong², Li Wei³, Xu Jing⁴, Liao Zhengwen⁵, Xie Pusheng¹, Lin Dongxin², Huang Wenhua^1,2

Author information +

文章历史 +

摘要

目的　探讨新型定位装置在四肢深部金属异物精准定位及取出术中的应用。方法　选取成人尸体防腐上、下肢标本10侧，置入φ2.0 mm金属球造模65例，分为实验组和对照组，前者为65例异物的实际定位结果，后者为理论上65例异物的定位结果。在定位装置辅助下定位，之后进行薄层CT扫描和三维重建，测量定位偏差距离（D1），统计不同精度等级的合格定位数，进行卡方检验，获得定位装置的定位精度，记录透视时间（T1）和异物取出时间（T2）。结果　65例金属异物全部实现精准定位并取出；T1=（46.06±18.44）s，T2=（177.10±65.87）s；该定位装置的定位精度为2.3 mm。结论　借助定位装置可实现四肢深部金属异物的精准定位及取出。

Abstract

Objective　To explore the application of the new positioning device on the accurate localization and removal surgery of deeply imbedded metallic foreign bodies.　Methods　Ten human limb specimens were used and 65 metal balls with a diameter of 2.0 mm were inserted. This experiment was divided into an experimental group, which was the actual locating result of the 65 cases of foreign bodies, and a control group, which was the theoretical optimal locating result of the 65 cases of foreign bodies. After localization with assistance of the locating device, a thin layer CT scan and 3D reconstruction were performed to measure the positioning deviation distance (D1). The qualified positioning numbers of different accuracy levels was counted. The chi square test was performed to obtain the positioning accuracy of the locating device and the fluoroscopy time (T1) and removal time of the foreign body (T2) were recorded.　Results　All 65 metallic foreign bodies were located and removed precisely, with mean T1: 46.06±18.44 seconds and T2: 177.10±65.87 seconds. The location accuracy of this device was 2.3mm.　Conclusions　With the aid of this positioning device, the precise localization and removal of deeply embedded metallic foreign bodies in human limbs can be achieved.

导出引用

苏炜炜, 何藻鹏, 张国栋, 李卫, 许靖, 廖政文, 谢普生, 林东鑫, 黄文华. 定位装置辅助下四肢深部金属异物的精准定位及取出[J]. 中国临床解剖学杂志. 2021, 39(2): 148-153 https://doi.org/10.13418/j.issn.1001-165x.2021.02.007

Su Weiwei, He Zaopeng, Zhang Guodong, Li Wei, Xu Jing, Liao Zhengwen, Xie Pusheng, Lin Dongxin, Huang Wenhua. Accurate localization and removal of deeply imbedded metallic foreign bodies in human limbs assisted by positioning device[J]. Chinese Journal of Clinical Anatomy. 2021, 39(2): 148-153 https://doi.org/10.13418/j.issn.1001-165x.2021.02.007

中图分类号： R608

参考文献

[1] Cima RR, Kollengode A, Garnatz J, et al. Incidence and characteristics of potential and actual retained foreign object events in surgical patients[J]. J Am Coll Surg, 2008, 207(1): 80-87. DOI:10.1016/j.jamcollsurg. 2007. 12.047.
[2] O'Brien L, Eyster KM, Hansen KA. Retained foreign body: “needle in a haystack”[J]. J Patient Saf, 2015, 11(4): 228-229. DOI: 10.1097/PTS.0000000000000078.
[3] Su YX, Nan GX. Using methylene blue as a marker to find and remove tiny metallic foreign bodies embedded in the soft tissues of children: a randomised controlled trial[J]. Int J Surg, 2016, 29: 43-48. DOI: 10.1016/j.ijsu.2016.03.018.
[4] Teltzrow T, Hallermann C, Müller S, et al. Foreign body-induced angiosarcoma 60 years after a shell splinter injury[J]. Mund Kiefer Gesichtschir, 2006, 10(6): 415-418. DOI: 10.1007/s10006-006-0026-4.
[5] Xing GF, Shi CW, Qian HX, et al. Novel methods of removing metallic foreign body from human soft tissue: a report of 7390 cases[J]. J Surg Res, 2013, 183(1): 337-340. DOI: 10.1016/j.jss.2012.12.018.
[6] He B, Xu C, Mao Y, et al. A novel navigation system to guide metallic foreign body extraction[J]. Int J Comput Assist Radiol Surg, 2016, 11(11): 2105-2110. DOI: 10.1007/s11548-016-1424-1.
[7] Lorenz KJ, Böckers A, Fassnacht U, et al. Implementation of a miniaturised navigation system in head and neck surgery for the detection and removal of foreign bodies[J]. Eur Arch Otorhinolaryngol, 2017, 274(1): 553-559. DOI: 10.1007/s00405-016-4212-1.
[8] Zhang GD, Yu ZX, Chen XH, et al. Accurate placement of cervical pedicle screws using 3D-printed navigational templates: an improved technique with continuous image registration[J]. Orthopade, 2018, 47(5): 428-436. DOI: 10.1007/s00132-017-3515-2.
[9] Yu ZX, Zhang GD, Chen XH, et al. Application of a novel 3D drill template for cervical pedicle screw tunnel design: a cadaveric study[J]. Eur Spine J, 2017, 26(9): 2348-2356. DOI: 10.1007/s00586-017-5118-3.
[10]Xu J, He ZP, Zhang GD, et al. An experimental study on the digital precision of internal fixation via the sinus tarsi approach for calcaneal fractures[J]. J Orthop Surg (Hong Kong), 2019, 27(1): 2309499019 834072. DOI: 10.1177/2309499019834072.
[11] Zhu QH, Chen Y, Zeng QL, et al. Percutaneous extraction of deeply-embedded radiopaque foreign bodies using a less-invasive technique under image guidance[J]. J Trauma Acute Care Surg, 2012, 72(1): 302-305. DOI: 10.1097/TA.0b013e31822c1c50.
[12]Tantray MD, Rather A, Manaan Q, et al. Role of ultrasound in detection of radiolucent foreign bodies in extremities[J]. Strategies Trauma Limb Reconstr, 2018, 13(2): 81-85. DOI: 10.1007/s11751-018-0308-z.
[13]Ma H, Jh K. Diagnostic X-rRay exposure and thyroid cancer risk: systematic review and meta-analysis[J]. Thyroid, 2018, 28(2): 220-228. DOI: 10.1089/thy.2017.0159.
[14] Hendee WR. History, current status, and trends of radiation protection standards[J]. Med Phys, 1993, 20(5): 1303-1314. DOI: 10.1118/1.597153.
[15]Marant Micallef C, Shield KD, Vignat J, et al. The risk of cancer attributable to diagnostic medical radiation: estimation for France in 2015[J]. Int J Cancer, 2019, 144(12): 2954-2963. DOI: 10.1002/ijc.32048.
[16]Lim H, Choi J, Kim JH, et al. Estimation of cancer incidence and mortality risks attributed to diagnostic medical radiation exposure in Korea, 2013[J]. J Korean Med Sci, 2018, 33(29): e211. DOI: 10.3346/jkms.2018.33.e211.
[17]Qian HX, Qin XJ, Xing GF, et al. Comparison of the efficacy and characteristics of metallic foreign body extraction by incision surgery and x-ray guided forceps after body-surface projection positioning: a STROBE-compliant article[J]. Medicine (Baltimore), 2018, 97(35): e12116. DOI: 10.1097/MD.0000000000012116.