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Objective To evaluate the clinical value of transarterial catheterization C-arm CT perfusion scanning technique during prostatic artery embolization(PAE)for benign prostatic hyperplasia(BPH).Methods The clinical data of 46 patients with BPH received PAE were analyzed retrospectively.All patients underwent prostatic artery(PA)digital subtraction angiography(DSA)and C-arm CT perfusion scanning to identify PA and prevent non-target organ embolization.The final recognization of PA was consulted by three senior doctors.After C-arm CT confirmation,PA was embolized with 100-300 μm polyvinyl alcohol(PVA)particles or microspheres under fluoroscopy.The postoperative complications and 3-month clinical efficacy were observed.Results A total of 106 vessels were angioraphed in 46 patients,with 83 PA vessels and 23 non-PA vessels.PA was identified by DSA and C-arm CT with sensitivity of 81.9%(68/83)and 100%(83/83),respectively,which showed significance(χ2=22.3,P<0.01).Non-PA was identified by DSA and C-arm CT with specificity of 73.9%(17/23)and 100%(23/23),which showed significance(χ2=9.2,P=0.02).No serious complications were observed and 3-month clincial efficacy was 91.3%.Conclusion Transarterial catheterization C-arm CT perfusion scanning technique can accurately identify PA,reduce PA leakage and prevent non-target organ embolization.
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OBJECTIVE@#To compare the effectiveness of O-arm navigation and C-arm navigation for guiding percutaneous long sacroiliac screws in treatment of Denis type Ⅱ sacral fractures.@*METHODS@#A retrospective study was conducted on clinical data of the 46 patients with Denis type Ⅱ sacral fractures between April 2021 and October 2022. Among them, 19 patients underwent O-arm navigation assisted percutaneous long sacroiliac screw fixation (O-arm navigation group), and 27 patients underwent C-arm navigation assisted percutaneous long sacroiliac screw fixation (C-arm navigation group). There was no significant difference in gender, age, causes of injuries, Tile classification of pelvic fractures, combined injury, the interval from injury to operation between the two groups ( P>0.05). The intraoperative preparation time, the placement time of each screw, the fluoroscopy time of each screw during placement, screw position accuracy, the quality of fracture reduction, and fracture healing time were recorded and compared, postoperative complications were observed. Pelvic function was evaluated by Majeed score at last follow-up.@*RESULTS@#All operations were completed successfully, and all incisions healed by first intention. Compared to the C-arm navigation group, the O-arm navigation group had shorter intraoperative preparation time, placement time of each screw, and fluoroscopy time, with significant differences ( P<0.05). There was no significant difference in screw position accuracy and the quality of fracture reduction ( P>0.05). There was no nerve or vascular injury during screw placed in the two groups. All patients in both groups were followed up, with the follow-up time of 6-21 months (mean, 12.0 months). Imaging re-examination showed that both groups achieved bony healing, and there was no significant difference in fracture healing time between the two groups ( P>0.05). During follow-up, there was no postoperative complications, such as screw loosening and breaking or loss of fracture reduction. At last follow-up, there was no significant difference in pelvic function between the two groups ( P>0.05).@*CONCLUSION@#Compared with the C-arm navigation, the O-arm navigation assisted percutaneous long sacroiliac screws for the treatment of Denis typeⅡsacral fractures can significantly shorten the intraoperative preparation time, screw placement time, and fluoroscopy time, improve the accuracy of screw placement, and obtain clearer navigation images.
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Humans , Fracture Fixation, Internal/methods , Retrospective Studies , Imaging, Three-Dimensional , Bone Screws , Surgery, Computer-Assisted , Tomography, X-Ray Computed , Spinal Fractures/surgery , Fractures, Bone/surgery , Pelvic Bones/injuries , Postoperative Complications , Neck InjuriesABSTRACT
Objective:To investigate the safety and efficacy of C-arm CT laser-guided puncture combined with digital subtraction angiography (DSA)for percutaneous renal pelvic catheter drainage in the treatment of hydronephrosis caused by pelvic malignancy.Methods:A retrospective analysis was performed on the data of 56 patients with ureteral obstruction caused by pelvic malignancy admitted to the Affiliated Cancer Hospital of Zhengzhou University from February 2020 to August 2021, including 10 males and 46 females. The mean age of the patients was (54.0±10.1)years old. The causes were colorectal cancer (7 cases), bladder cancer (3 cases), cervical cancer (36 cases), endometrial cancer (3 cases), ovarian cancer (2 cases), pelvic metastasis of gastric cancer (4 cases) and pelvic sarcoma (1 case). There were 71 sides of renal pelvis dilation in 56 patients, with the degree of dilation ranging from 1.2cm to 5.0cm.The degree of hydronephrosis was mild on 36 sides, moderate on 27 sides, and severe on 8 sides. Preoperative blood urea nitrogen(9.90±6.22)mmol/L and creatinine (155.80±146.83)μmol/L.During the puncture and catheter drainage, the patient was placed in the prone position, the C-arm CT scan was used to plan the puncture path, and the laser positioning of the DSA flat panel detector was used to determine the skin puncture point. With local anesthesia, the puncture direction of the puncture needle was adjusted to make the skin puncture point, the tail of the puncture needle, and the laser fixation point present a state of "three-points in one-line" when the patient stopped breathing temporarily at the end of expiratory breath in a non-fluoroscopic state, so as to achieve the preset puncture angle. Subsequently, pyelocentesis was completed according to the planned puncture depth. After successful pyelocentesis, percutaneous external renal drainage tube insertion or ureteral stents were performed under DSA. The number of renal pelvis puncture, puncture time, radiation dose, deviation of external renal drainage tube insertion angle from puncture angle, as well as postoperative hemoglobin changes, renal function recovery and complications were recorded.Results:In this group, 56 cases of 71 sides of renal pelvis puncture and catheter drainage were successfully completed, and the success rate of the operation was 100.0% (71/71). The success rate of the first needle puncture was 97.2% (69/71). Those who failed the first needle puncture succeeded in the second puncture during the operation. The puncture time of renal pelvis was (1.9±1.8) min.The intraoperative radiation dose was (2.7±1.5) mSV. The external drainage tube of the renal pelvis was placed on 53 sides, and the external drainage tube was placed on 29 sides with the same angle as the preset angle, and 24 sides with a deviation within 3°.On the first day after operation, there was no significant difference in hemoglobin compared with that before operation, urea nitrogen (5.31±1.99) mmol/L and creatinine (62.25±16.72) μmol/L were re-examined after operation, and the differences were statistically significant compared with those before operation ( P=0.008, P=0.002). No serious surgery-related complications occurred in any patient. Conclusion:C-arm CT laser-guided puncture combined with DSA percutaneous renal pelvic catheter drainage could be safe and effective in the treatment of ureteral obstruction caused by pelvic malignancy.
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Objective:To explore the effect of mobile C-arm X-ray system in the surgical treatment of thoracolumbar spine fractures.Methods:The clinical data of 120 patients with thoracolumbar spine fractures admitted to People′s Hospital of Xinjiang Uygur Autonomous Region from July 2018 to July 2020 were retrospectively analyzed. According to different surgical methods, they were divided into control group and experimental group, with 60 cases in each group. The control group adopted the traditional posterior median approach lumbar fusion, and the experimental group adopted the percutaneous pedicle screw internal fixation guided by the C-arm system. The operation time, bleeding, operation cost, visual analog score (VAS) and activities of daily living (ADL) and complication rate were compared and analyzed between the two groups. Measurement data with normally distribution were expressed as mean±standard deviation( ± s), and the comparison between groups was performed by two independent samples t test. The comparison between groups of count data was performed by chi-square test. Results:The operation time, the blood loss, the cost, VAS, ADL score, the complication rate of the control group were (119.83 ± 10.96) min, (90.56±30.52) mL, (4.90±0.75) ten thousand yuan, (4.17±0.64) scores, (78.11±12.78) scores and 30%, while the experimental group were (103.50±13.76) min, (73.88±40.35) mL, (4.06 ± 0.97) ten thousand yuan, (2.40±0.49) scores, (86.00±8.86) scores and 5%, respectively, showing a significant difference between the two groups ( P<0.05). Conclusions:Application of mobile C-arm X-ray system in thoracolumbar spine minimally invasive surgery can reduce the probability of complications, improve the quality of life of patients, and accelerate the rehabilitation. It is valuable for popularization.
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Objective:To compare three fixed-field intensity-modulated radiotherapy (IMRT) plans for nasal cavity and paranasal sinus tumors, including the coplanar IMRT (C-IMRT) plan and the non-coplanar IMRT(NC-IMRT) plan which were based on a conventional C-arm LINAC (Trilogy), and the coplanar IMRT (H-IMRT) plan based on an O-ring LINAC (Halcyon).Methods:Based on the data of 10 patients in the Ningbo First Hospital from December 2018 to December 2021 with nasal cavity and paranasal sinus tumors who underwent postoperative radiotherapy, this study redesigned three IMRT plans with the same prescribed doses and optimization objectives. Then, this study compared the doses of target volumes and organ at risks(OARs), the validation pass rates, and the execution time of these plans. Friedman test was employed in this study, and multiple comparisons were further made in cases of different results.Results:The differences in the conformal index (CI) of PTV and PTV boost of the three plans were statistically significant ( χ2 = 7.51, 9.69, P < 0.05). The multiple comparisons showed that the median CI of the H-IMRT plan was higher than that of the NC-IMRT plan ( Z = 2.53, 2.68, P < 0.05). The differences in other parameters of target volumes were not statistically significant. Compared with the C-IMRT plan, the H-IMRT plan reduced the Dmax of bilateral lenses, bilateral corneas, ipsilateral optic nerve, and ipsilateral eyeball ( Z = 2.80, 2.80, 2.80, 2.80, 2.81, 2.09, P < 0.05). Compared with the C-IMRT plan, the NC-IMRT reduced the Dmax of bilateral lenses, corneas, and eyeballs and contralateral optic nerve ( Z = 2.80, 2.66, 2.80, 2.70, 2.29, 2.29, 2.65, P < 0.05) and reduced the Dmean of bilateral eyeballs ( Z = 2.80, 2.80, P < 0.05). Compared with the NC-IMRT plan, the H-IMRT plan reduced the Dmax of the ipsilateral lens and cornea ( Z = 2.50, 2.08, P < 0.05), but increased the Dmax of the contralateral optic nerve and the Dmean of bilateral eyeballs ( Z = 2.80, 2.80, 2.80, P < 0.05). The validation pass rate of the three plans met the institutional standards, and the differences were not statistically significant. Moreover, the H-IMRT plan had the shortest median execution time (172.00 s), followed by the C-IMRT plan (337.50 s), and the NC-IMRT plan (388.00 s). Conclusions:The verification pass rate of the three plans can achieve the requirements of treatment implementation. The three plans had similar dosimetric differences in target volumes. However, the H-IMRT and NC-IMRT plans can protect the normal tissues (especially optical organs) more effectively than the C-IMRT plan, which is conducive to reducing the toxicity after radiotherapy and provides space for local dose increase or the radiotherapy for the treatment of tumor recurrence. The execution efficiency of the three plans is in the order of H-IMRT > C-IMRT > NC-IMRT. It is necessary to select appropriate radiotherapy equipment and technology according to actual situations.
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Objective To compare the clinical effects of G-arm X-ray machine and C-arm X-ray machine in percutaneous kyphoplasty (PKP) for osteoporotic vertebral compression fracture (OVCF) of thoracolumbar spine.Methods The clinical data of ninety-five patients with thoracolumbar OVCF treated with PKP from May 2016 to August 2017 in Yanan University Affiliated Hospital were retrospectively analyzed.They were divided into two groups according to the different guiding fluoroscopy methods used during the operation.Forty-six cases in G arm group completed PKP under the guidance of G arm X-ray machine,Forty-nine cases in C arm group completed PKP under the guidance of C arm X-ray machine.The operation time,fluoroscopy times,cement leakage cases,the height of injured vertebral leading edge,Cobb angle of kyphosis,visual analogue score and Oswestry dysfunction index were recorded before and after operation,and the related indexes were analyzed and compared.Results Two groups of patients were successfully completed surgery,no complications of vascular and nerve injury.The operation time and fluoroscopy times in G arm group were less than those in C arm group (operation time:(29.6±4.5) min vs.(42.5±5.3) min,and fluoroscopy times in G arm group:(9.1±2.0) vs.(16.9±3.2));the difference was statistically significant (t =-12.747,12.870,P＜ 0.01).Postoperative height of injured vertebral leading edge(G arm group (22.3±5.3) mm),C arm group (22.4±5.1) mm),kyphosis Cobb angle (G arm group (9.2±3.8)°,C arm group (9.3±3.7) o),visual analogue score (G arm group (2.1±0.7)points,C arm group (2.2±0.9) points),Oswestry dysfunction index (G arm group (21.3±8.5) points,C arm group(21.5 ± 8.3)points),compared with preoperative(the hight of injured vertebral leading edge of G arm group (18.2 ±5.3) mm,C arm group (18.4±5.2) mm,Cobb angle of injured vertebra G arm group (15.7±4.4) °,C arm group (15.9±4.3) °,visual analogue score of G arm group (7.8± 1.2) points,C arm group (7.7± 1.1) points,Oswestry dysfunction index score of G arm group(41.2±8.3)points,C arm group (41.5±8.2) points),the difference was statistically significant (t =-3.709,-3.844,-7.582,-8.144,27.827,27.088,11.360,11.999,P＜0.01),but there was no significant difference between the two groups (P ＞0.05).Conclusion Using G-arm X-ray machine to assist PKP in the treatment of thoracolumbar spine OVCF can effectively shorten the operation time,reduce the intraoperative fluoroscopy time,and the clinical effect is satisfactory.
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Objective To explore the value of C-arm CT in transjugular intrahepatic portosystemic shunt (TIPS).Methods Between June 2015 and October 2017,a total of 16 patients with cirrhosis complicated by upper gastrointestinal bleeding or massive ascites due to portal hypertention in our center were retrospectively enrolled in the study.Abdominal enhanced CT was routinely performed before surgery.Postprocessing images of portal vein were used as a guidance of TIPS in real time after integrated with intraoperative c-arm CT images during selective operations.Results The success rate of C-arm CT-guided TIPS was 100％.Portal vein angiography showed the position basically consistent with CT matched images reference position.No obvious abdominal hemorrhage,injury of biliary tract and other complications occurred in all patients.The mean number of needle passes was 2.1 ±0.9 passes(range of 1.0-4.0 passes),the mean time of portal vein entry was 4.3 ± 1.9 min (range of 2.0-8.0 min),the mean fluoroscopy period was 22.6 ± 4.8 min (range of 17.0-32.0 min),DAP was (256.2± 96.7)mGy/cm2.Conclusion C-arm CT-guided TIPS is technically feasible and safe.
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OBJECTIVE@#To explore the application effect of operation bed and C-arm digital metrology adjustment in percutaneous vertebroplasty for osteoporotic thoracolumbar vertebral fractures.@*METHODS@#Ninty-four patients with osteoporotic thoracolumbar vertebral fractures admitted to our hospital from February 2015 to February 2017 were divided into control group and observation group according to random number table method, with 47 cases in each group. Control group adjusted C-arm and operating bed based on experience. For observation group surgical bed and C arm were measured and adjusted digitally and metrologically during percutaneous vertebroplasty. The operation time, times of fluoroscopy, hidden blood loss and bone cement volume were recorded in two groups. The clinical efficacy of two groups was observed by visual analogue score (VAS) and Oswestry Disability Index(ODI). Cobb angle and height of injured vertebrae before and after surgery were analyzed by imaging data.@*RESULTS@#The operation time, times of fluoroscopy, and hidden blood loss were significantly lower in observation group than in control group (0.05); VAS and ODI of observation group were significantly lower than that of the control group(<0.05); there was no significant difference in Cobb angle and height of injured vertebrae before and after operation between two groups. There were 3 cases of cement leakage, 1 case of urinary tract infection, 1 case of pulmonary infection, 2 cases of bedsore in observation group with complication rate was 14.89%(7/47); there were 8 cases of cement leakage, 2 cases of spinal nerve injury, 1 case of urinary tract infection, 3 cases of pulmonary infection, 2 cases of bedsore in control group with complication rate was 34.04% (16/47). The incidence of complications in observation group was significantly lower than that of control group (<0.05).@*CONCLUSIONS@#Operation bed and C-arm digital metrology adjustment can improve the surgical effect in percutaneous vertebroplasty for osteoporotic thoracolumbar vertebral fractures and promote rapid recovery.
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Humans , Bone Cements , Fractures, Compression , Osteoporotic Fractures , Retrospective Studies , Spinal Fractures , Treatment Outcome , VertebroplastyABSTRACT
Objective To explore the clinical application value of percutaneous kyphoplasty ( PKP ) under the guidance of G arm X ray machine in the treatment of osteoporotic vertebral compression fracture (OVCF). Methods The medical records of eighty-two patients (94 vertebral bodies) with OVCF treated with PKP were collected retrospectively. Thirty-nine cases ( 44 vertebral bodies ) were guided by G-arm X-ray machine to implement PKP,which were recorded as G-arm group. Forty-three cases (50 vertebral bodies) were guided by C-arm X-ray machine to carry out PKP,which were recorded as C-arm group. The operation time, intraoperative fluoroscopy times, bone cement leakage cases, preoperative and postoperative anterior height of injured vertebrae,Cobb angle of injured vertebrae,visual analogue scale scores and Oswestry disability index of the two groups were recorded. Results There was significant difference in operation time and intraoperative fluoroscopy times between the G-arm group and C-arm group (the operation time:(31. 6±5. 2) vs. (45. 8±6. 7) min,the intraoperative fluoroscopy times: (9. 5±2. 3) times vs. (18. 7±3. 5) times,t=-10. 64,-13. 91,P<0. 05) ,while there was no significant difference in the number of bone cement leakage ( P>0. 05) . Compared postoperative and preoperative anterior height of injured vertebrae, Cobb angle of injured vertebrae, visual analogue scale scores and Oswestry disability index scores of G-arm group and C-arm group respectively, the differences were significant ( t=-3. 41 vs. -3. 28, 6. 67 vs. 7. 66, 26. 63 vs. 25. 75 and 10. 41 vs. 11. 90, P<0. 05). There was no significant difference between the two groups (P>0. 05). Conclusion The treatment of OVCF with PKP guided by G-arm X-ray machine could significantly shorten operation time, reduce the intraoperative fluoroscopy times and the operative difficulty,and increase operation safety than PKP guided by traditional C-arm X-ray machine.
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On account of the problem that traditional C-arm X-ray apparatus cannot provide precise route guidance for minimally invasive surgeries, we designed and developed a laser positioning and navigation system based on C-arm X-ray apparatus, which can achieve precise positioning function and reduce the exposure of doctors and patients to radiation in minimally invasive surgeries under the linear guidance of a laser beam. Furthermore, this system can enhance the refinement level of surgical operation in minimally invasive surgeries.
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Humans , Cone-Beam Computed Tomography , Minimally Invasive Surgical Procedures , Radiography , Surgery, Computer-Assisted , Tomography, X-Ray Computed , X-RaysABSTRACT
Objective To explore the orthopedic application and significance of the design of GE OEC9900 L-arm.Methods The composition,performances,working flow and etc of OEC9900 L-arm were introduced,and the advantages of medium C-arm platform and L-arm were analyzed when used in orthopedics operation.Results OEC9900 L-arm facilitated the orthopedic surgeon to execute the operation with high operability and efficiency.Conclusion OEC9900 L-arm gains high practicability and feasibility,and thus can be used as the preferred choice for minimally invasive or routine operations.
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Objective To investigate the clinical characteristics of percutaneous gastrostomy guided by different imaging techniques,in an effort to inform selection of imaging guidance.Methods A retrospective analysis was conducted on the clinical data of 277 patients who underwent percutaneous gastrostomy at Affiliated Tumor Hospital of Zhengzhou University from January 2014 to December 2016.The patients were divided into three groups according to the imaging techniques used,i.e.group A guided by fluoroscopy of digital subtraction angiography (DSA),group B by C-arm computed tomography (CT),and group C by CT throughout the process.The technical success rate,complication rate,operation time and patient's radiation dose were compared among the three groups.Results There was no siguificant difference in technical success rate (93.8％vs.97.3％ vs.100％,x2=2.797,P=0.247) and complication rate (10.0％ vs.11.3％ vs.20.0％,x2=1.343,P=0.511) among the 3 groups,but the operation time [(25.57±5.99) min vs.(29.01±6.63) min vs.(45.47±8.98) min,x2 =27.977,P＜0.001] and patient's radiation [(27.30± 19.27) mGy vs.(145.07±106.08) mGy vs.(2 590.26±1 088.22) mGy,x2 =204.444,P＜0.001] dose were significantly different (x2=87.977,P＜0.001;x2=204.444,P＜0.001),with group A and B lower than group C (P＜ 0.001) and group A lower than group B (P≤0.001).Conclusions DSA fluoroscopic guidance should be the first choice for percutaneous gastrostomy,but before the operation,abdominal CT scan should be performed to exclude such situations as hypertrophy of left lobe of liver,and colon in front of the stomach.If the DSA machine is equipped with C-arm CT function,the surgery can also be directly guided by C-arm CT.Complete CT guidance can be used as a supplement in the case of failure by both DSA fluoroscopy and C-arm CT guidance.
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Objective To discuss the application of mobile C-arm CT scan in the operations for thoracolumbar burst fractures of type A3.Methods From January 2012 to December 2014,21 patients with single-segment thoracolumbar burst fracture (AO type A3) were treated.They were 15 males and 6 females,aged from 17 to 68 years (average,43.6 years).By the American Spinal Injury Association (ASIA) grading,one was grade A,2 were grade B,12 grade C,4 grade D and 2 grade E.Preoperative CT examination was conducted.Mobile C-arm CT scan was performed to evaluate reduction of the fragments after the fracture was reset by posterior pedicle screwing.Laminotomy for canal decompression or reduction of the fragments would be performed if it was indicated by the results of mobile C-arm CT scan.CT examination was conducted postoperatively to assess the fracture reduction and recovery of the canal calibre.Results All the patients were followed up for an average of 15.5 months (from 10 to 18 months).Their cobb angle,vertebral anterior margin compression rate,spinal occupancy rate,vertebral translocation rate and visual analogue score at postoperation and final follow-up were significantly improved compared with their preoperative values (P ＜ 0.05),but there were no significant differences between postoperation and final follow-up in all the above indexes (P ＞ 0.05).Postoperative ASIA grading showed that the spinal function was improved from grade B to grade C in one,from grade C to grade D in 4 cases,from grade C to grade E in 5 cases,and from grade D to grade E in 3 cases.Conclusion Since intraoperative C-arm CT scan can help decide whether laminectomy for canal decompression is conducted or not in the surgery of thoracolumbar burst fractures,it enhances the surgical safety and reliability.
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Objective To develop a laser positioning device for GE OEC850 and Wandong HMC-36 C-arm.Methods The device was composed of two cross-type laser tubes,timing circuit and power source.The optimal 30 cm projection point was determined with laser dual-crossed-line positioning method and considerations on the distance between the tube of GE OEC850 or Wandong HMC-36 C-arm and the image intensifier.Then the projection range was found around 30 cm to define the targeted area.Results The device eliminated the needs of multi times of projection due to improper positioning,decreased the exposure to medical personnel and patient during the operation,prolonged the service life of the tube and reduced the cost for hospital equipment.Conclusion The device behaves well in positioning and easy operation,and thus is worthy promoting clinically.
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Objective To discuss the application of mobile C-arm CT scan in the operations for thoracolumbar burst fractures of type A3.Methods From January 2012 to December 2014,21 patients with single-segment thoracolumbar burst fracture (AO type A3) were treated.They were 15 males and 6 females,aged from 17 to 68 years (average,43.6 years).By the American Spinal Injury Association (ASIA) grading,one was grade A,2 were grade B,12 grade C,4 grade D and 2 grade E.Preoperative CT examination was conducted.Mobile C-arm CT scan was performed to evaluate reduction of the fragments after the fracture was reset by posterior pedicle screwing.Laminotomy for canal decompression or reduction of the fragments would be performed if it was indicated by the results of mobile C-arm CT scan.CT examination was conducted postoperatively to assess the fracture reduction and recovery of the canal calibre.Results All the patients were followed up for an average of 15.5 months (from 10 to 18 months).Their cobb angle,vertebral anterior margin compression rate,spinal occupancy rate,vertebral translocation rate and visual analogue score at postoperation and final follow-up were significantly improved compared with their preoperative values (P ＜ 0.05),but there were no significant differences between postoperation and final follow-up in all the above indexes (P ＞ 0.05).Postoperative ASIA grading showed that the spinal function was improved from grade B to grade C in one,from grade C to grade D in 4 cases,from grade C to grade E in 5 cases,and from grade D to grade E in 3 cases.Conclusion Since intraoperative C-arm CT scan can help decide whether laminectomy for canal decompression is conducted or not in the surgery of thoracolumbar burst fractures,it enhances the surgical safety and reliability.
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Objective To develop a laser positioning device for GE OEC850 and Wandong HMC-36 C-arm.Methods The device was composed of two cross-type laser tubes,timing circuit and power source.The optimal 30 cm projection point was determined with laser dual-crossed-line positioning method and considerations on the distance between the tube of GE OEC850 or Wandong HMC-36 C-arm and the image intensifier.Then the projection range was found around 30 cm to define the targeted area.Results The device eliminated the needs of multi times of projection due to improper positioning,decreased the exposure to medical personnel and patient during the operation,prolonged the service life of the tube and reduced the cost for hospital equipment.Conclusion The device behaves well in positioning and easy operation,and thus is worthy promoting clinically.
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Objective To discuss the clinical application of C-arm CT in guiding Hook-wire localization of solitary pulmonary nodule (SPN) before video-assisted thoracoscopic surgery (VATS).Methods The clinical data of 51 patients with SPN (51 lesions in total),who received C-arm CT-guided Hook-wire localization before VATS during the period from January 2011 to December 2015 at authors' hospital,were retrospectively analyzed.The technical success rate,the time spent for localization,the incidence of complications,the rate of VATS conversion to thoracotomy,the average size of SPN,the distance between SPN and visceral pleura,and the pathological findings were documented.Results The technical success rate of preoperative C-arm CT-guided Hook-wire localization was 100％.The mean time spent for localization was 16 minutes.Asymptomatic pneumothorax occurred in 4 patients (7.8％) and asymptomatic hemorrhage in 11 patients (21.6％).Intraoperative dislodgement of the hook-wire was seen in one patient (2.0％).The average size of SPN was 10.7 mm.The mean distance between SPN and visceral pleura was 25.3 mm,and the puncturing depth (the length from skin to pulmonary nodule) was 66.7 mm.Pathological examination revealed that 60.8％ of the 51 SPNs were malignant.Conclusion Preoperative C-arm CT-guided Hook-wire localization of SPN before VATS is an accurate,safe and fast technique.This technique is an efficient means to guide the puncturing,and it has high application value in clinical practice.
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Objective To discuss the application of C-arm CT scan in performing precise prostatic arterial embolization (PAE).Methods The dominant artery of the prostate and its spatial relationship with the peripheral blood vessels were identified by intraoperative synchronous XperCT angiography,which was followed by the performance of precise PAE.Results Among 16 patients with benign prostatic hyperplasia,one patient had to give up the operation because abdominal aortic aneurysm was found by intraoperative angiography;2 patients received unilateral precise PAE as contralateral internal iliac artery was occluded;bilateral precise PAE was successfully accomplished in 13 patients.XperCT angiography was successfully performed for all the arteries that were treated with embolization.Based on the contrast agent staining of the prostate gland and the 3D reconstruction of peripheral arteries,the dominant artery of the prostate and its spatial relationship with the peripheral blood vessels were determined,and precise PAE was carried out.After PAE,no ectopic embolism-related complications occurred.One month after PAE,the remission rate of clinical symptoms was 100％.Conclusion Intraoperative C-arm CT scan can provide more accurate images which are very important for accurately identifying the prostate arteries and its relationship with the peripheral vessels,therefore,C-arm CT scan is an important technical support for the performance of precise PAE.
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Objective To evaluate the feasibility and safety of prostatic artery embolization (PAE)via transradial approach in treating prostatic hyperplasia.Methods The clinical data of 18 patients with prostatic hyperplasia,who received C-arm CT-guided PAE via left or right radial artery access,were retrospectively analyzed.The following indexes were recorded:arterial spasm and injury of upper limbs,incidence of puncture point bleeding,postoperative radial artery pulse and congestion,blood supply and nerve injury of fingers,the surgical success rate,incidence of perioperative cerebral vascular complications,operation time,radiation dose and clinical curative effect.Results Among the 18 patients,PAE via left radial artery access was employed in 14,and PAE via right radial artery access was performed in 4.Bilateral PAE was carried out in 16 patients,and only unilateral PAE was able to be successfully accomplished in 2 patients as the prostatic artery opening of the other side was tortuous with stenosis.After PAE,decreased radial pulse was observed in one patient and ultrasound examination revealed decreased blood flow.The operation time ranged from 96 min to 245 min.The radiation dose received by the patient varied from 2435 mGy to 4958 mGy with a mean of (3342±156) mGy,which was not significantly different from the radiation dose received by the patients who underwent PAE via femoral artery access during the same study period (P=0.1167).Conclusion In treating prostatic hyperplasia,PAE by using transradial approach is clinically safe and technically feasible.
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ANTECEDENTES Y OBJETIVO Las enfermedades coronarias susceptibles de ser atendidas en unidades asistenciales con soporte de hemodinamia (en específico angiógrafo) suponen una importante carga asistencial en los hospitales del Sistema Nacional de Salud. Debido a esto, en algunos centros se evalúa realizar este tipo de intervención con un Arco C, el cual es ajustado técnicamente para realizar esta labor. En este contexto el Departamento GES y Redes Integradas /DIGERA solicita esta síntesis de evidencia con el fin de evaluar el impacto del uso de Arco C en vez de Angiógrafo en intervenciones de hemodinamia. METODOLOGÍA Se formuló una estrategia de búsqueda para ser utilizada en 5 bases de datos con el objetivo de identificar revisiones sistemáticas que abordan la pregunta formulada. Al no encontrarse evidencia relevante, se procedió a buscar estudios primarios en PubMed y CENTRAL. Se utiliza metodología de la certeza de evidencia GRADE. Se excluyeron aquellos estudios en que las comparaciones en uno de los equipos fueron simuladas, o cuando la comparación se realizaba contra otros equipos médicos de imagenología. Consultando al solicitante, se decidió excluir todos los estudios que fueron realizados en otras áreas distintas a la hemodinamia y en donde la comparación incluía "Cone CT beam" para el Arco C. Además, al no encontrarse precisión diagnóstica, se incluyeron estudios que comparan la calidad de la imagen, dosis de radiación emitida, mortalidad y complicaciones en ambos dispositivos. RESULTADOS Se utilizan 2 estudios primarios, de los cuales se obtienen los siguientes resultados: -No es posible concluir si existen diferencias en la tasa de mortalidad perioperativa, re-intervención, eventos adversos, radiación emitida y calidad de imagen al realizar una Reparación de Aneurisma Aórtico Endovascular en un Arco C, en comparación a un Angiógrafo. La certeza en la evidencia es muy baja. -La dosis de radiación emitida por un angiógrafo sería mayor que la emitida por un Arco C al realizar un procedimiento de Catéter Central Insertado Periféricamente. -No se puede concluir si existen diferencias en la calidad de imagen obtenida con un angiógrafo y con un Arco C al realizar un PICC. La certeza en la evidencia es muy baja.