Objectives: This pre-clinical feasibility study evaluates the accuracy of a novel augmented reality-based (AR-based) guidance technology using head-mounted displays (HMDs) for the placement of patient-specific instruments (PSIs)—also referred to as surgical guides—and osteotomy performance in pelvic tumour resections. The goal is to improve PSI placement accuracy and osteotomy execution while assessing user perception and workflow efficiency.Methods: The study was conducted on ten 3D-printed pelvic phantoms derived from CT scans of cadaveric specimens. Custom PSIs were designed and printed to guide osteotomies at the supraacetabular, symphysial, and ischial regions. An AR application was developed for the HoloLens 2 HMD to display PSI location and cutting planes. The workflow included manual supraacetabular PSI placement, AR-guided placement of the other PSIs and osteotomy execution. Postoperative CT scans were analysed to measure angular and distance errors in PSI placement and osteotomies. Task times and user feedback were also recorded.Results: The mean angular deviation for PSI placement was 2.20°, with a mean distance error of 1.19 mm (95% CI: 0.86 to 1.52 mm). Osteotomies showed an overall mean angular deviation of 3.73° compared to planned cuts, all within the predefined threshold of less than 5°. AR-assisted guidance added less than two minutes per procedure. User feedback highlighted the intuitive interface and high usability, especially for visualising cutting planes.Conclusions: Integrating AR through HMDs is a feasible and accurate method for enhancing PSI placement and osteotomy performance in pelvic tumour resections. The system provides reliable guidance even in cases of PSI failure and adds minimal time to the surgical workflow while significantly improving accuracy. Further validation in cadaveric models is needed to ensure its clinical applicability.
目的：这项临床前可行性研究评估了一种基于增强现实（AR）的头戴式显示器（HMD）导航技术，在骨盆肿瘤切除术中用于放置患者特异性器械（PSI，亦称手术导板）及执行截骨操作的准确性。研究旨在提升PSI放置精度与截骨操作质量，同时评估用户感知及工作流程效率。 方法：研究基于十例源自尸体标本CT扫描数据的三维打印骨盆模型展开。设计并打印了定制化PSI，用于引导髋臼上方、耻骨联合及坐骨区域的截骨操作。针对HoloLens 2头戴式显示器开发了AR应用程序，以可视化PSI定位及截骨平面。工作流程包括手动放置髋臼上方PSI，AR引导下放置其余PSI并执行截骨。通过术后CT扫描分析PSI放置及截骨的角度偏差与距离误差，同时记录操作时间与用户反馈。 结果：PSI放置的平均角度偏差为2.20°，平均距离误差为1.19毫米（95%置信区间：0.86至1.52毫米）。截骨操作与预设截骨平面相比，整体平均角度偏差为3.73°，均低于预设的5°阈值。AR辅助导航使单次手术增加耗时不足两分钟。用户反馈强调该系统界面直观、可用性高，尤其在截骨平面可视化方面表现突出。 结论：通过头戴式显示器整合增强现实技术，是提升骨盆肿瘤切除术中PSI放置与截骨操作精度可行且准确的方法。该系统即使在PSI失效情况下仍能提供可靠导航，在显著提升准确性的同时仅对手术流程增加极短耗时。未来需通过尸体模型进一步验证以确保其临床适用性。
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