ABSTRACT
During coronavirus disease 2019 epidemic, the treatment of severe trauma has been impacted. The Consensus on emergency surgery and infection prevention and control for severe trauma patients with 2019 novel corona virus pneumonia was published online on February 12, 2020, providing a strong guidance for the emergency treatment of severe trauma and the self-protection of medical staffs in the early stage of the epidemic. With the Joint Prevention and Control Mechanism of the State Council renaming "novel coronavirus pneumonia" to "novel coronavirus infection" and the infection being managed with measures against class B infectious diseases since January 8, 2023, the consensus published in 2020 is no longer applicable to the emergency treatment of severe trauma in the new stage of epidemic prevention and control. In this context, led by the Chinese Traumatology Association, Chinese Trauma Surgeon Association, Trauma Medicine Branch of Chinese International Exchange and Promotive Association for Medical and Health Care, and Editorial Board of Chinese Journal of Traumatology, the Chinese expert consensus on emergency surgery for severe trauma and infection prevention during coronavirus disease 2019 epidemic ( version 2023) is formulated to ensure the effectiveness and safety in the treatment of severe trauma in the new stage. Based on the policy of the Joint Prevention and Control Mechanism of the State Council and by using evidence-based medical evidence as well as Delphi expert consultation and voting, 16 recommendations are put forward from the four aspects of the related definitions, infection prevention, preoperative assessment and preparation, emergency operation and postoperative management, hoping to provide a reference for severe trauma care in the new stage of the epidemic prevention and control.
ABSTRACT
Objective To design a patient-specific distal femoral cutting guide for total knee arthroplasty using rapid prototyping and 3D printing technology and compare with conventional instrumentation.Methods A prospective self-control study was performed in 32 patients who underwent bilateral total knee arthroplasty between March 2015 and November 2015 in our department.The bilateral knee joints were randomly divided into patient-specific guide group and traditional surgery group.The patient-specific guide group obtained CT data of the lower extremities preoperatively.Patient-specific distal femoral cutting guides were designed and manufactured using rapid prototyping and 3D printing techniques.The traditional surgery group were performed using conventional instrumentation.The operation time of the two groups was recorded,and the amount of distal femoral osteotomy was measured.Postoperative alignments were measured including the angle of the lower limb mechanical axis angle (hipknee-ankle Angle,HKA),the mechanical lateral distal femoral angle (mLDFA),and the mechanical proximal tibial angle (mMPTA).In different follow-up points Hospital for Specific Surgery scores of the knee were recorded.Results In the coronal position,the postoperative mLDFA was 90.34°± 1.6° in the patient-specific guide group and 91.37°± 1.8° in the conventional surgery group.The difference between the two groups was statistically significant (t=-2.452,P=0.020).In the patient-specific guide group,the HKA angle was 0.36°±2.35°,and the conventional surgery group was 0.87°±1.85°.The difference between the two groups was statistically significant (t=-2.332,P=0.043).If preoperative mLDFA≤93°,there was no significant difference in postoperative mLDFA between the two groups (t=-1.409,P ＞ 0.05).If preoperative mLDFA ＞ 93°,there was a significant difference in postoperative mLDFA between the two groups (t=-4.145,P=0.004).In addition,the operation time of the patient-specific guide group was significantly shorter (t=-2.425,P ＜ 0.05),but the two groups did not have significant functional differences in the early postoperative period.Conclusion The 3D-printed patient-specific distal femoral cutting guide can significantly shorten the operation time and improve postoperative alignments.It is simple to operate.However,large sample sizes and long-term follow-up studies are still needed to verify their long-term effects.