Percutaneous Sacroiliac Screw Placement: A Prospective Randomized Comparison of Robot-assisted Navigation Procedures with a Conventional Technique / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Sacroiliac (SI) screw fixation is a demanding technique, with a high rate of screw malposition due to the complex pelvic anatomy. TiRobot™ is an orthopedic surgery robot which can be used for SI screw fixation. This study aimed to evaluate the accuracy of robot-assisted placement of SI screws compared with a freehand technique.</p><p><b>METHODS</b>Thirty patients requiring posterior pelvic ring stabilization were randomized to receive freehand or robot-assisted SI screw fixation, between January 2016 and June 2016 at Beijing Jishuitan Hospital. Forty-five screws were placed at levels S1 and S2. In both methods, the primary end point screw position was assessed and classified using postoperative computed tomography. Fisher's exact probability test was used to analyze the screws' positions. Secondary end points, such as duration of trajectory planning, surgical time after reduction of the pelvis, insertion time for guide wire, number of guide wire attempts, and radiation exposure without pelvic reduction, were also assessed.</p><p><b>RESULTS</b>Twenty-three screws were placed in the robot-assisted group and 22 screws in the freehand group; no postoperative complications or revisions were reported. The excellent and good rate of screw placement was 100% in the robot-assisted group and 95% in the freehand group. The P value (0.009) showed the same superiority in screw distribution. The fluoroscopy time after pelvic reduction in the robot-assisted group was significantly shorter than that in the freehand group (median [Q1, Q3]: 6.0 [6.0, 9.0] s vs. median [Q1, Q3]: 36.0 [21.5, 48.0] s; χ2 = 13.590, respectively, P < 0.001); no difference in operation time after reduction of the pelvis was noted (χ2 = 1.990, P = 0.158). Time for guide wire insertion was significantly shorter for the robot-assisted group than that for the freehand group (median [Q1, Q3]: 2.0 [2.0, 2.7] min vs. median [Q1, Q3]: 19.0 [15.5, 45.0] min; χ2 = 20.952, respectively, P < 0.001). The number of guide wire attempts in the robot-assisted group was significantly less than that in the freehand group (median [Q1, Q3]: 1.0 [1.0,1.0] time vs. median [Q1, Q3]: 7.0 [1.0, 9.0] times; χ2 = 15.771, respectively, P < 0.001). The instrumented SI levels did not differ between both groups (from S1 to S2, χ2 = 4.760, P = 0.093).</p><p><b>CONCLUSIONS</b>Accuracy of the robot-assisted technique was superior to that of the freehand technique. Robot-assisted navigation is safe for unstable posterior pelvic ring stabilization, especially in S1, but also in S2. SI screw insertion with robot-assisted navigation is clinically feasible.</p>

Computer-assisted auto-frame navigation system for distal locking of tibial intramedullary nails: a preliminary report on clinical application / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To evaluate the clinical feasibility and effect of the computer-assisted auto-frame navigation system for distal locking of tibial intramedullary nails.</p><p><b>METHODS</b>The hardware components of the system included a PC computer with a monitor, auto mechanical stereotactical localization cubic frame, foot holder and localization operative apparatus. Special navigation software can be used for registration of X-ray fluoroscopic images and real-time controlling navigation of tools. Twenty-one cases of close tibial and fibular fractures were treated with closed intramedullary nailing, 6 of which involved in middle third, 12 in middle and lower third, 3 in lower third. C-arm alignment and registration time, fluoroscopic time and drilling time involved in the locking procedure were recorded. The size of unreamed or reamed tibial nails ranged from 8/300-11/330.</p><p><b>RESULTS</b>All distal holes except 1 were locked successfully. In 9 of 41 locked holes (21.95%), the drill bit touched the canal of locking hole without damage of the nail and clinical consequences. The fluoroscopy time per pair of screws was 2.23+/-0.31 s.</p><p><b>CONCLUSIONS</b>The computer-assisted auto-frame navigation system for distal locking is well designed, easy to operate and do not need additional instruments during the procedure. The developed system enables the physician to precisely navigate surgical instruments throughout the anatomy using just a few computer-calibrated radiographic images. The total time of X-ray exposure per procedure can be significantly reduced.</p>

Computer-assisted full planning system for long bone fracture treatment with intramedullary nailing:an experimental study / 中华创伤骨科杂志

Objective To evaluate the efficacy and clinical feasibility of the computer-assisted full plan- ning system for tibial fracture treatment with intramedullary nailing.Methods After analyzing the functional structure and operative procedures of the system,nine plastic tibia and 12 cadaver lower limbs were used for image mosaicing based on C-arm (PHILIPS BV Libra) fluoroscopic images in the operation room to assess the correctness of the mosaicing and planning algorithms.The plastic tibial model was used for analysis of the mosaicing precision.The cadaver tibial bone was used for reduction experiment with the reduction mechanism to analyze the operation feasi- bility.Results Only 7 to 10 [fluoroscopy time:(19.75?0.61)s] valid C-ann projection images were needed to produce a long bone panorama of the lower limb.The total time for image acquisition and mosaicing was within (4.17?0.86)minutes and the mosaicing precision in the plastic tibial model was (1.26?0.76)mm.The opera- tion of the reduction mechanism was very simple and could be controlled by a surgeon automatically or free of hand. An integrated reduction strategy could be produced for rough positioning in general and elaborate operations in de- tails.Conclusion The computer-assisted full planning system can be used for anatomical analysis based on the C-arm panorama,full surgical planning,virtual simulation,selection of proper intramedullary nails and fracture reduction in treatment of long bone fractures.

Design and experimental study of computer-assisted orthopaedic system for distal locking of intramedullary nails / 中华外科杂志

<p><b>OBJECTIVE</b>To test the safety and accuracy of the computer-assisted orthopaedic system for distal locking of intramedullary nails and apply it to internal fixation with intramedullary nails in the lower limb.</p><p><b>METHODS</b>According to the theory of mechanical arms stereotactic localization in computer-assisted orthopaedic surgery (CAOS), we design a CAOS system for distal locking of intramedullary nails. The system comprised 2 independent modules: computer-assisted imaging and registration workstation; mechanical stereotactic framework. Ten plastic tibia models, 20 plastic femur models (Synbone AG, Malans, Switzerland) and 6 human cadaver lower limbs were randomly divided into 2 groups undergoing internal fixation with intramedullary nails (Orthofix, Germany). The first group (CAOS group with 5 plastic tibia models, 10 plastic femur models, 6 human cadaver tibia, 6 human cadaver femur; each nail had 2 holes, and 2 distal locking screws were inserted in each bone, which gave a total number of 54 holes) used a computer-assisted orthopaedic system, the second group (CONTROL GROUP is the same as CAOS group) used Orthofix mechanical targeting device for distal locking. Comparison between 2 groups was made in radiation exposure time, operating time, percentage of correctly placed screws.</p><p><b>RESULTS</b>CAOS group: operating time was (4.44 +/- 2.99) min; radiation exposure time was (1.16 +/- 0.38) min; correctly placed screws rate was (100 +/- 0)%.</p><p><b>CONTROL GROUP</b>operating time was (10.42 +/- 4.18) min; radiation exposure time was (4.71 +/- 3.86) min; correctly placed screws rate was (94.44 +/- 0.36)%. Operating time and radiation exposure time in CAOS group were significantly shorter than those in control group (P < 0.05), no differences were found between 2 groups in relation to the percentage of correctly placed screws.</p><p><b>CONCLUSIONS</b>By using CAOS system for distal locking of intramedullary nails, the locking holes can be drilled accurately and safely. Radiation exposure significantly reduced.</p>

Studies on chemical constituents in bulbs of Bolbostemma paniculatum / 中国中药杂志

<p><b>OBJECTIVE</b>To investigate the chemical constituents of the bulbs of Bolbostemma panicultum.</p><p><b>METHOD</b>The compounds were isolated by column chromatography on silica gel, C18, Sephadex LH-20 separately and their structures were elucidated by chemical and spectroscopic technologies.</p><p><b>RESULT</b>Eight compounds were isolated and identified as maltol(I), emodin(II), cucurbitacin B(III), cucurbitacin E(IV), stigmasta-7, 22, 25-triene-3-ol(V), stigmasta-7, 22, 25-triene-3-nonadecanoic acid ester(VI), stigmasta-7, 22, 25-triene-3-O-beta-D-glucopyranoside(VII), stigmasta-7, 22, 25-triene-3-O-beta-D-(6'-palmitoyl) glucopyranoside(VIII).</p><p><b>CONCLUSION</b>I-VIII were obtained from this plant for the first time; VI and VIII are new compounds.</p>

Studies on the lignans from Patrinia scabra / 药学学报

<p><b>AIM</b>To study the lignans from Patrinia scabra Bunge.</p><p><b>METHODS</b>The constituents were separated and purified by column chromatography with silical gel, RP-silical gel and Sephadex LH-20. Their structures were identified on the basis of spectral data (IR, MS, 1HNMR, 13CNMR, HMQC and HMBC).</p><p><b>RESULTS AND CONCLUSION</b>A new lignan was obtained and its structure was elucidated as 4-[1-ethoxyl-1-(4-hydroxy-3-methoxy)benzyl]methyl- 2-(4-hydroxy-3-methoxy)benzyl-3-hydroxymethyl-tetrahydro-furan (2), along with three known lignans, lariciresinol (1), isolariciresinol (3) and nortracheloside (4).</p>