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Objective:To investigate the feasibility and therapeutic effect of total knee arthroplasty (TKA) with cruciate-retaining (CR) prosthesis by using FEM-X1 femoral extramedullary positioning instrument based on the theory of restricted kinematic alignment (rKA).Methods:Thirty five cases who underwent total knee arthroplasty in Nanjing Drum Tower Hospital from November 2019 to December 2020 were retrospectively analyzed, including 7 males and 28 females with an average age of 71± 8 years (ranging from 55 to 85 years) Following the guidance of rKA alignment, the FEM-X1 femoral extramedullary positioning instrument was used for TKA with CR prosthesis. Before the operation, the full-length lower limb radiographs of both anteroposterior and lateral views were taken in a standing position for preoperative assessment of lateral distal femoral angle (LDFA), the medial proximal tibial angle (MPTA) and hip-knee-ankle angle (HKA). According to the principle of rKA alignment, the target LDFA, MPTA and HKA were calculated. The proximal end of tibia and distal end of femur were cut using extramedullary positioning instrument respectively. The posterior femoral condyle was cut according to the tibial plateau and mediolateral soft tissue tension. The prosthesis was installed after osteotomy. The release of collateral ligaments, PCL function, release of PCL, patellofemoral trajectory, release of patellofemoral support band, the amount of blood loss and time of operation were recorded. Postoperative LDFA, MPTA, HKA, and posterior slope angle of tibial prosthesis were measured on X-ray images. The Knee Society Score (KSS) was used for functional evaluation.Results:Thirty five cases of TKA with CR prosthesis following rKA alignment were successfully completed. The operation time was 100 (90, 110) min, and the blood loss was 100 (100, 200) ml. 30 of them were followed up for 12.5±0.7 months (ranging from 12 to 14 months). The pre-operative and post-operative LDFA were 1.0°(-2.0°, 4.0°), 0°(-2.0°, 2.0°), MPTA were -4.0°(-5.0°, -1.0°), -2.0°(-3.0°, -1.0°), HKA were -3.0°(-3.0°, -1.0°), -2.0°(-3.0°, -1.0°). There was no significant difference between the three angles before and after operation ( Z=-0.89, P=0.372; Z=1.87, P=0.061; Z=1.03, P=0.302). The average posterior tibial slope was 5°(3°, 7°). At the follow-up of one year, the KSS clinical score was 94(92, 97) and functional score was 80(70, 90) in 30 cases. During the operation, PCL was released in 1 case because of excessive tension; and lateral retinacular release was performed in 1 case because of poor patellofemoral track. Conclusion:ITKA with CR prosthesis by using the extramedullary positioning instrument on the theory of rKA alignment showed a good clinical outcome at a short follow up.
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Objective:To investigate the clinical efficacy of proximal femoral nail anti-rotation (PFNA) assisted by the "3-2-1" surface positioning method in the treatment of femoral subtrochanteric fractures.Methods:A total of 97 patients with subtrochanteric fractures admitted to the Second Hospital of Fuzhou from January 2015 to December 2020 were retrospectively analyzed. They were divided into two groups according to whether the "3-2-1" surface positioning method (3 longitudinal axes, 2 preset incisions, and 1 auxiliary incision) was used. There were 44 patients in the surface positioning group, including 25 males and 19 females, aged 61.59±18.43 years (range, 22-90 years). According to the Seinsheimer classification, there were 13 cases of type II, 11 cases of type III, 6 cases of type IV, and 14 cases of type V. The mechanism of injury was low energy injury in 26 cases and high energy injury in 18 cases. There were 53 patients in the traditional positioning group, including 30 males and 20 females, aged 56.38±17.24 years (range, 24-90 years). According to the Seinsheimer classification, there were 9 cases of type II, 22 cases of type III, 9 cases of type IV, and 13 cases of type V. According to the mechanism of injury, there were 30 cases of low energy injury and 23 cases of high energy injury. The length of incision, operation time, and blood loss were recorded. At 1, 3, 6, and 12 months after operation, the anteroposterior and lateral X-ray films of the hip were taken to evaluate the imaging indicators (neck-shaft angle, anteroposterior and lateral displacement, and angulation), fracture healing, and complications (infection, malunion, loosening and breakage of the internal fixation, and periprosthetic fracture). The Harris hip score and EuroQol five dimensions questionnaire (EQ-5D) were evaluated.Results:All patients successfully completed the operation and were followed up for 15.12±1.54 months (range, 12-18 months). The operation time, incision length, dominant blood loss and hidden blood loss in the surface positioning group were 1.78(1.50, 2.00) h, 8(8, 9) cm, 300(200, 400) ml and 843(629, 1 130) ml, respectively, which were less than 2.10(1.69, 2.38) h, 10(9, 12) cm, 400(300, 500) ml and 1 030(954, 1 266) ml in the traditional positioning group, and the difference was statistically significant ( P<0.05). The neck-shaft angle in the surface positioning group was 135.54°±2.83°, which was larger than 132.33°±3.37° in the traditional positioning group, and the difference was statistically significant ( t=5.02, P<0.001). The anterolateral and lateral displacement and lateral image angle in the surface positioning group were 4.70±1.60 cm, 4.52±1.71 cm and 9.36°±2.94°, respectively, which were lower than 6.14±2.57 cm, 5.98±2.70 cm and 11.46°±4.68° in the traditional positioning group, and the difference was statistically significant ( P<0.05). One year after operation, the Harris hip score and EQ-5D score of the surface positioning group were 92(84, 99) points and 0.90(0.73, 1.00) points, respectively, which were higher than 88(74, 96) points and 0.81(0.72, 0.94) points of the traditional positioning group ( P<0.05). Conclusion:The "3-2-1" surface positioning method assisted PFNA internal fixation in the treatment of femoral subtrochanteric fracture can improve the quality of reduction, reduce intraoperative blood loss, and improve hip function and quality of life.
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OBJECTIVE@#To evaluate the accuracy of trephine bur drilling at different depths guided by dynamic navigation system in 3D printing in vitro model.@*METHODS@#A model at the depth of 5 mm, 10 mm, and 15 mm from the outer surface of which hemispherical cavities was reserved and the 3D printing technology was used to make the standardized model with Veroclear resin. The cone beam CT (CBCT) was taken and the data were imported into the dynamic navigation software (DCARER, China) to establish navigation path programming. Under the guidance of dynamic navigation, a trephine bur with a diameter of 4.5 mm was used to complete the access operation. At each depth, 10 approaches were completed. The postoperative model CBCT was taken. The approach trajectory under navigation was reconstructed and compared with the designed path. The two-dimensional distance deviation, depth deviation, three-dimensional distance deviation, and angle deviation between the actually prepared path and the designed path were calculated.@*RESULTS@#At the depth of 5 mm, the two-dimensional distance deviation between the end position of the prepared path and the designed path was (0.37±0.06) mm, the depth deviation was (0.06±0.05) mm, the three-dimensional distance deviation was (0.38±0.07) mm, and the angle deviation was 2.46°±0.54°; At the depth of 10 mm, the four deviations between the end position of prepared path and the designed path were (0.44±0.05) mm, (0.16±0.06) mm, (0.47±0.05) mm, and 2.45°±1.21°, respectively; At the depth of 15 mm, the four deviations were (0.52±0.14) mm, (0.16±0.07) mm, (0.55±0.15) mm, and 3.25°±1.22°, respectively. With the increase of entry depth, the three-dimensional and depth accuracy of dynamic navigation system decreased (P < 0.01), and the positioning angle deviation had no relation with the entry depth (P>0.01).@*CONCLUSION@#Dynamic navigation technology can achieve high positioning accuracy in the depth range of 15 mm, but its deviation increases with the increase of entry depth.
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China , Cone-Beam Computed Tomography , Printing, Three-Dimensional , Surgery, Computer-AssistedABSTRACT
Objective To determine the location of PQ-LRP protein in Microsporum canis using the enhanced green fluorescent protein(EGFP)as a marker.Methods The total RNA was extracted from Microsporum canis,and reversely transcribed into cDNA.The PQ-LRP gene was amplified by PCR using the above cDNA as the template.The fusion gene of PQ-LRP gene and EGFP gene was linked to the plasmid pCAMBIA 1300.Microsporum canis was subjected to Agrobacterium tumefaciens-mediated transformation,in order to achieve the integrated expression of the fusion gene LRP-EGFP in Microsporum canis under the regulation by the fungal universal promoter Ptrpc and terminator Ttrpc.Laser-scanning confocal microscopy was conducted to determine the cellular localization of the fusion protein.Results The expression vector pCAMBIA-LRP-EGFP was successfully constructed,and the fusion gene LRP-EGFP was expressed integratedly in Microsporum canis.Laser-scanning confocal microscopy showed that fluorescence signals of LRP-EGFP were concentrated on the cell membrane of Microsporum canis,giving a granular or cluster-like appearance.Conclusion The infusion gene LRP-EGFP can be successfully expressed in Microsporum canis,and PQ-LRP protein is located on the cell membrane of Microsporum canis.
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In ultrasound/computed tomography (CT) fusion images, ultrasound allows visualization of the target in real time. CT provides a navigation for ultrasound scanning and improves the overview in areas of limited visualization with ultrasound. This study was performed to investigate the feasibility of ultrasound/CT fusion based on an electromagnetic tracking technique using external fiducial markers for canine ocular and periocular regions. In 7 Beagle dogs, contrast-enhanced CT images of the head were obtained with placing external fiducial markers over the frontal region and both sides of the forepaws of the dog. Ultrasonography was performed under a magnetic field by installing a position sensor in the linear probe, without changing the dog's position. The positions of the external fiducial markers were adjusted and matched, based on the CT images. The execution time of co-registration and the distance between the regions of interest and the co-registration points, the frontal bone, cornea, retina, and optic nerve, were estimated. Approximately 60% of external fiducial markers were properly recognized in all dogs. After adjustment, all external fiducial markers were precisely matched. The co-registration execution time was less than 1 min. The distances between the regions of interest and co-registration points were less than 3 mm in all dogs. The electromagnetic tracking technique using external fiducial markers was a simple and applicable method for fusion imaging of a canine head using real-time ultrasonography and CT. This technique can be useful for interventional procedures of retrobulbar and periorbital lesions.
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Animals , Dogs , Cornea , Fiducial Markers , Frontal Bone , Head , Magnetic Fields , Magnets , Methods , Optic Nerve , Retina , Tomography, X-Ray Computed , UltrasonographyABSTRACT
Objective To investigate the utilization rate of gold fiducial markers and reasons for abandonment of gold fiducial markers in the CyberKnife VSI System, and to provide reference data for implantation of gold fiducial markers and radiotherapy planning. Methods From March to August,2017,a total of 47 patients had gold fiducial markers implanted or pasted. In those patients, 42 patients had gold fiducial markers implanted,including 32 receiving computed tomography(CT)-guided 3D-printing coplanar template assisted implantation, 1 receiving CT-guided 3D-printing non-coplanar template assisted implantation,1 receiving CT-guided implantation,and 8 receiving ultrasound-guided implantation. A total of 44 patients received the CyberKnife treatment, including 2 patients who failed to use gold fiducial markers and were treated with spine tracking instead and 3 patients missing the treatment for other reasons. The numbers of utilized and abandoned gold fiducial markers were recorded for calculation of the utilization and abandonment rates. The reasons for abandonment of gold fiducial markers were analyzed and classified. Results A total of 134 gold fiducial markers were implanted into or pasted to the 44 patients.In all the gold fiducial markers, 111 were utilized and 23 abandoned, yielding a utilization rate of 82.8% and an abandonment rate of 17.2%.The reasons for abandonment of gold fiducial markers included large rigidity error(26.1%), unqualified implanted fold fiducial markers(17.4%), displacement of gold fiducial markers(26.1%), and others(30.4%). Conclusions Compared with the CT-guided or ultrasound-guided implantation of gold fiducial markers, the CT-guided 3D-printing coplanar or non-coplanar template assisted implantation of gold fiducial markers requires only two puncture needles for each implantation and implants two gold fiducial markers by a single needle,which reduces the number of puncture needles,risk of puncture-induced injury,and incidence of complications after implantation. Not all the gold fiducial markers implanted by a variety of ways will be utilized. Some gold fiducial markers will be abandoned for different reasons,which should be taken into account during implantation of gold fiducial markers.
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Objective To analyze the qualified rate of the fiducial markers during 3D-printing co-planar template assisted CT-guided implantation in stereotactic body radiation therapy by CyberKnife,and to explore the cause of the unavailable markers in order to provide the reference for the fiducial implantation,treatment planning and radiotherapy delivery.Methods From March to December 2017,a total of 52 cases were planned to stereotactic body radiation therapy(SBRT) using CyberKnife by fiducial tracking,and the fiducial markers were implanted based on CT-guided 3D-printing co-planar template,including 22 in lung,12 in liver,5 in mediastinal lymph node,8 in retroperitoneal lymph node,3 in pancreas,each in celiac and pelvic lymph nodes,respectively.Except 7 cases not fit for CyberKnife treatment,45 cases finished the treatment of CyberKnife,but there were 3 cases changed to spine tracking due to unqualified fiducial markers.The number of fiducial markers used and the qualified rate of fiducial markers were analyzed,and the cause of unqualified fiducial markers was studied.Results A total of 131 fiducial markers were impanted into 42 cases who finally received the treatment of CyberKnife by fiducial tracking,including 85 fiducial markers qualified (64.89％) and 46 fiducial markers unqualified (35.11％).The main causes of the unqualified fiducial markers varied,including outrange of rigidity error(26.08％),fiducial markers unavailable(41.31％),and other (32.61％).Conclusions The 3D-printing co-planar template assisted CT-guided implantation could reduce the number of puncture needles used,help to decrease the risk of puncture and trauma and the incidence of complications after the fiducial markers implantation.However,the fiducial markers implanted by this way would be abandoned by a variety of causes and should be taken into account before the fiducial markers implantation.
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Objective@#To evaluate the efficacy and safety of the application of dye-tattooing under ultrasound guidance in preoperative localization of neck recurrences from thyroid cancer.@*Methods@#Between October 2014 to September 2016, 25 patients with 34 lesions were enrolled. There were 22 cases of papillary thyroid carcinoma and three cases of medullary thyroid carcinoma, all of which could not be detected by computed tomography. Surgeons located the recurrent lesions using dye-tattooing under ultrasound guidance along with radiologist three days before the operation.@*Results@#All lesions were successfully located (100%), 32 of which were located directly and two of which were located indirectly. Postoperative pathological examination confirmed 25 metastases of papillary thyroid carcinoma, two metastases of medullary thyroid carcinoma, and seven cases of false positives. The accuracy of ultrasound diagnosis was 79.4%. After 15 months of follow-up, neither tumor residual nor recurrences was detected according to imaging tests.@*Conclusions@#Dye-tattooing under ultrasound guidance represents a reliable and safe method for localization of neck recurrences from thyroid cancer. The cooperation between experienced surgeons and radiologists will be crucial to successful location.
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Objective To investigate the outcome of a new designed extramedullary femoral osteotomy module and to compare with conventional intramedullary system in clinical study.Methods The extramedullary femoral osteotomy module was designed with the extramedullary alignment rod connecting with the T type rod at right angle,and it had a 5°-7° adjustable valgus design.The positioning module fixation screw was parallel with the epicondylar axis.The coronal plane of the distal femur bone cut was orientated by the extramedullary alignment rod pointing to the inguinal midpoint,and the sagittal plane was orientated by the extramedullary alignment rod keeping parallel with the distal femoral medullary cavity.The terminal distal femoral bone cut was conducted with suitable osteotomy after the orientation.Sixty patients who underwent unilateral total knee arthroplasty (TKA) from October 2015 to March 2016 were randomly divided into intramedullary and extramedullary group for prospective controlled study.Blood loss,drainage and the incidence of deep vein thrombosis (DVT) were evaluated at one week postoperatively.Knee valgus angle and femoral prosthesis flexion angle were analyzed at two weeks postoperatively.Moreover,the extramedullary femoral osteotomy module was used in 273 patients (78 males and 195 females) with an average age of 68.7 (range,57-82 years old) who underwent unilateral TKA from April 2016 to January 2017.Blood loss,operation duration and lower limb ultrasonography preoperatively and at one week postoperatively were recorded.Knee valgus angle and femoral prosthesis flexion angle were measured at 2 weeks postoperatively.Range of knee motion and Hospital for Special Surgery (HSS) knee score at six weeks postoperatively were also reported.Results In the randomized controlled trial,blood loss and drainage in extramedullary group was less than that in intramedullary group (t=-3.330,P=0.004).There was no significant difference in the incidence of DVT at 1 week postoperatively (x2=2.269,P=0.132) and the knee valgus angle and femoral prosthesis flexion angle at 2 weeks postoperatively within the two groups.In the clinical application,operation time was 60.13± 13.69 min,and blood loss and drainage was 109.11±70.73 ml.There were four cases of popliteal vein thrombosis,nine cases of posterior tibial vein thrombosis,and seventeen cases of muscular venous thrombosis at one week postoperatively.The incidence rate of DVT was 11.0％.There was no symptomatic pulmonary embolism at three months postoperatively.Knee valgus angle was 7.34°±0.69°,and 211 knees accounting for 77.3％ were in the range of ±3° error.Femoral prosthesis flexion angle was 6.43°±1.59°,and 273 knees were all in the range of ±10° error.Range of knee motion improved from 54.52±5.96 preoperative to 86.20±4.92 at six weeks postoperative.HSS knee score improved from 100.88°±7.51° preoperative to 110.42°±7.08° at six weeks postoperative.Conclusion The new designed extramedullary femoral osteotomy module used in distal femoral osteotomy during TKA can significantly reduce the risk of bleeding and the incidence rate of DVT postoperatively.Furthermore,patients can obtain as excellent prosthesis position and limb alignment as conventional intramedullary system.
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Objective To evaluate the accuracy and feasibility of primary total knee arthroplasty (TKA) assisted by the self-made extramedullary osteotomy template on distal femur alignment.Methods We retrospectively analyzed the clinical data of 40 patients with osteoarthritis or rheumatoid undergoing primary TKA from September 2015 to March 2016.All patients were divided into two groups,extramedullary group and intramedullary group.Extramedullary group had 20 patients (4 males and 16 females) aged 65.1±6.9 years (range 51-75).Intramedullary group had 20 patients (3 males and 17 females) aged 65.7±7.9 years (range 48-75).The blood loss volume,drainage in operation,postoperative range of motion (ROM) at 1 week and 2 weeks,deviation between the ideal value and preoperative hip-knee-ankle (HKA) angle,coronal and sagittal angle of the femoral prosthesis were compared within the two groups.Results The age,gender,body mass index,deviation between the ideal value and preoperative HKA angle,Hospital for Special Surgery (HSS) scoring system,ROM of knee were not significantly different between the two groups.The operation time was 97.4± 14.0 min in extramedullary group and 111.7±9.9 min in intramedullary group (P ＜ 0.05).The blood loss was 71.8± 14.0 ml in extramedullary group and 111.7± 10.0 ml in intramedullary group (P ＜ 0.05),while the drainage volume was 167.0±74.5 ml in extramedullary group and 243.2±91.6 ml in intramedullary group (P＜ 0.05).The postoperative mean deviation of the HKA angle in extramedullary group (2.37°±0.73°) was smaller than that in intramedullary group (3.26°±1.42°).Furthermore,the coronal alignment of the femoral prosthesis in extramedullary group (89.70°±1.91°) was larger than that in intramedullary group (87.69°±2.39°).The sagittal alignment of the femoral prosthesis in extramedullary group (90.03°±2.62°) was also significantly larger than that in intramedullary group (88.07°±2.43°,P ＜ 0.05).The postoperative ROM of knee at 1 and 2 week in the extramedullary group were 101.75°±7.48° and 114.00°±7.88° respectively,while those in the intramedullary group were 101.25°±8.41° and 114.25°±8.78°.There was no statistically different between the two groups.There was no intraoperative and postoperative early complications reported in the two groups.Conclusion Although the primary TKA assisted by the selfmade extramedullary osteotomy template on distal femur alignment can shorten operation time,decrease the blood loss and increase the accuracy of coronal and sagittal alignment,the HSS score and ROM of knee are similar as intramedullary method.
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Technological advances have rapidly expanded the therapeutic potential of endoscopic ultrasound (EUS). Innovations in stent technology; directed adjunctive therapy for pancreatic tumors, including radiofrequency ablation and fiducial marker placement; advanced imaging modalities, including needle-based confocal laser endomicroscopy; and new echoendoscopes, such as the forward-viewing linear echoendoscope, are emerging as safe and effective tools and devices for providing a broad range of treatments and therapies previously not thought possible. In this review, we summarize and discuss the new echoendoscopes, accessories, and stents for interventional EUS and highlight the recent literature on technical and therapeutic efficacy. The therapeutic role and indications for EUS are rapidly evolving well beyond its current limits as new EUS-specific designed tools are designed, and ultimately, should help achieve the goal of improving patient outcomes.
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Humans , Catheter Ablation , Endosonography , Fiducial Markers , Microscopy , Stents , UltrasonographyABSTRACT
Objective To investigate the outcome of a new designed extramedullary femoral alignment system and to compare with conventional intramedullary system in clinical results.Methods Twenty consecutive patients (3 males and 17females with an average age of 70.1 (range,52-82 years old) with osteoarthritis (OA) or rheumatoid arthritis (RA) who were treated with the extramedullary method between January 2015 to August 2015 and 20 consecutive patients (5 males and 15 females with an average age of 65.9 (range,52-87 years old) with OA or RA treated with conventional intramedullary method between April 2015 to September 2015 were studied.In extramedullary group,CT scan was used to evaluate the relation between the hip (femoral head) center and anterior superior iliac spine preoperatively.During the total knee arthroplasty,the hip joint center was defined according to the anterior superior iliac spine (ASIS).Knee joint center was defined as the center of the line connecting medial and lateral epicondyle.The terminal femoral bone cut plane was defined as the line between femoral and knee center.In intramedullary group,the traditional intramedullary method was adopted.The coronal and sagittal alignment,blood loss and drainage at one week postoperatively and the range of motion at one week,6 weeks and 3 months were evaluated.Results There was no significant difference in age,hip-knee-ankle (HKA) angle,the Hospital for Special Surgery (HSS) Knee Score,BMI,operation time within the two groups.Blood loss and drainage in extramedullary group (121 ±64 ml and 181±149 ml) was significantly less than that in intramedullary group (177±47 ml and 292±156 ml).There was no significant difference in coronal alignment of the femoral prosthesis within the two groups (89.8°±2.1° v.s.89.8°±2.2°,P＞0.05).However,the two groups had significant difference in sagittal alignment (-0.8°±2.2° v.s.2.5°±2.1 °,P＜0.05).The alignment of extramedullary group had much more tendency in flexion degree.No difference was found in range of motion at 1 week,6 weeks and 3 months postoperatively (103.8°±7.8° v.s.102.5°±7.2°,108.5°±8.0° v.s.108.3°±7.4°,117.0°±7.1° v.s.114.5°±8.1°,P＞0.05).Conclusion The present designed extramedullary system is practical in total knee arthroplasty and has more accuracy in sagittal plane.The patients treated with extramedullary system have less blood loss and drainage and have similar range of motion in early stage after operation when compared with the intramedullary method.
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BACKGROUND/AIMS: Stereotactic body radiation therapy (SBRT) for gastrointestinal malignancies requires the placement of fiducials to guide treatment delivery. This study aimed to determine the safety and technical feasibility of endoscopic ultrasonography (EUS)-guided fiducial placement for SBRT. METHODS: From November 2010 to August 2012, 32 consecutive patients who were scheduled to receive SBRT for pancreatic and hepatic malignancies were referred for EUS-guided fiducial placement. Primary outcome measurements included technical success, the fiducial migration rate, and procedural complications. RESULTS: All 32 patients had successful fiducial placement under EUS guidance. The mean number of fiducials placed per patient was 2.94+/-0.24 (range, 2 to 3 seeds). Spontaneous fiducial migration was noted in one patient (3.1%). Of the 32 patients with fiducials placed, 29 patients (90.6%) successfully underwent SBRT. One patient (3.1%) developed mild pancreatitis, requiring a 2-day prolonged hospitalization after fiducial placement. Five patients (15.6%) underwent same-session, EUS-guided fine needle aspiration for histologic confirmation at the time of fiducial placement, without any procedure-related complication. CONCLUSIONS: EUS-guided fiducial placement is a safe and technically feasible technique for preparing patients with both pancreatic and hepatic malignancies for SBRT. The fiducial markers facilitate safe and accurate targeting of the tumor during SBRT.