第三节 应用前景
第三节 应用前景
从目前的技术发展水平来看,CT导航和X线透视导航是两种最主要的脊柱外科手术导航技术,但各自都存在一定的不足。CT导航可以提供三维图像,成像质量好,可进行术前规划,但术中需进行配准,延长了手术时间,医师选择合理的标志点需要大量的练习和实践,且无法及时反映术中变化。X线透视导航使用C形臂系统在术中摄像,应用方便,但只能得到二维导航图像,不能进行术前规划,且图像质量较差,基本上只在胸腰椎部位使用。后来出现的三维术中C形臂机是X线透视二维导航技术的延伸,虽然可实现术中三维导航,但导航图像质量与CT三维导航仍有差距,且价格更加昂贵。二、三维配准方法结合了两种导航系统的特点,较好地解决了上述存在的问题,但配准的步骤相对比较复杂,仍存在一定的计算误差,且在技术上仍未突破传统的导航技术,目前还没有完全进入实用化阶段。另外,基于X线透视的导航技术存在较多系统误差,包括C形臂影像增强器的图像畸变矫正误差、二维图像标定设备的安装误差、C形臂变形误差、X线透视图像成像误差、C形臂正侧位对准误差等,加之立体光学定位系统定位误差,以及示踪器的松动造成的定位偏移误差等。这些问题都需要在未来的研究中解决。
大量的临床实践已经表明,计算机辅助导航技术是提高手术成功率的有效手段和重要保障。但以目前导航技术的现状来看,还需要继续展开更加深入的研究,不断改进已有技术并改进导航方法,提高导航的精度和速度,使其有更大的实用性。
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