Surgical technique of lateral unicompartmental knee arthroplasty and discussion of the maximum correction value in the treatment of knee valgus deformity / 中国修复重建外科杂志

OBJECTIVE@#To investigate the surgical technique and the short-term effectivenss of lateral unicompartmental knee arthroplasty (LUKA) through lateral approach in the treatment of valgus knee and to calculate the maximum value of the theoretical correction of knee valgus deformity.@*METHODS@#A retrospective analysis was performed on 16 patients (20 knees) who underwent LUKA and met the selection criteria between April 2021 and July 2022. There were 2 males and 14 females, aged 57-85 years (mean, 71.5 years). The disease duration ranged from 1 to 18 years, with an average of 11.9 years. Knee valgus was staged according to Ranawat classification, there were 6 knees of type Ⅰ, 13 knees of type Ⅱ, and 1 knee of type Ⅲ. All patients were assigned the expected correction value of genu valgus deformity by preoperative planning, including the correction value of lateral approach, intra-articular correction value, and residual knee valgus deformity value. The actual postoperative corrected values of the above indicators were recorded and the theoretical maximum correctable knee valgus deformity values were extrapolated. The operation time, intraoperative blood loss, incision length, hospital stay, hip-knee-ankle angle (HKA), mechanical lateral distal femoral angle (mLDFA), mechanical medial proximal tibia angle (mMPTA), joint line convergence angle (JLCA), posterior tibial slope (PTS), range of motion (ROM), Hospital for Special Surgery (HSS) score, and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score were also recorded for effectiveness evaluation.@*RESULTS@#The patients' incision length averaged 13.83 cm, operation time averaged 85.8 minutes, intraoperative blood loss averaged 74.9 mL, and hospital stay averaged 6.7 days. None of the patients suffered any significant intraoperative neurological or vascular injuries. All patients were followed up 10-27 months, with a mean of 17.9 months. One patient with bilateral knee valgus deformities had intra-articular infection in the left knee at 1 month after operation and the remaining patients had no complication such as prosthesis loosening, dislocation, and infection. The ROM, HSS score, and WOMAC score of knee joint significantly improved at each time point after operation when compared to those before operation, and the indicators further improved with time after operation, the differences were all significant ( P<0.05). Imaging measurement showed that HKA, mLDFA, JLCA, and PTS significantly improved at 3 days after operation ( P<0.05) except for mMPTA ( P>0.05). Postoperative evaluation of the knee valgus deformity correction values showed that the actual intra-articular correction values ranged from 0.54° to 10.97°, with a mean of 3.84°. The postoperative residual knee valgus deformity values ranged from 0.42° to 5.30°, with a mean of 3.59°. The actual correction values of lateral approach ranged from 0.21° to 12.73°, with a mean of 4.26°.@*CONCLUSION@#LUKA through lateral approach for knee valgus deformity can achieve good early effectiveness. Preoperative planning can help surgeons rationally allocate the correction value of knee valgus deformity, provide corresponding treatment strategies, and the maximum theoretical correction value of knee valgus deformity can reach 25°.

Aplicación de modelos 3D en cirugía hepática / Implementation of three-dimensional printed models in hepatic surgery

RESUMEN La impresión de modelos tridimensionales (M3D) implica obtener una estructura sólida y formada a partir de un modelo digital. Para la reconstrucción 3D se utilizó tomografía computarizada contrastada, realizándose impresión de modelos sobre la base de las principales estructuras anatómicas hepáticas. Se utilizaron M3D en dos pacientes con indicación quirúrgica, una mujer con trombocitopenia familiar y metástasis hepática de adenocarcinoma rectal, sin respuesta a quimioterapia, y un hombre con hepatopatía infecciosa crónica y diagnóstico de carcinoma hepatocelular. La aplicación de M3D resultó de gran utilidad, pues permitió un mejor entendimiento de la relación espacial de las estructuras anatómicas en ambos casos. En nuestra experiencia, la aplicación de M3D fue muy útil para planificar la cirugía y dar una aproximación más certera de los reparos anatómicos. El modelo se obtuvo en 7 días y costó 380 dólares, un valor elevado para nuestro medio.

ABSTRACT Three-dimensional (3D) printing is the construction of a solid structure from a digital model. 3D reconstruction was performed using contrast-enhanced computed tomography scan, and 3D-printed models were built based on the main anatomic structures of the liver. 3D-printed models were used in two patients with indication of surgery; one woman with inherited thrombocytopenia and liver metastases from colorectal adenocarcinoma with no response to chemotherapy, and one man with chronic liver infection and hepatocellular carcinoma. The implementation of 3D printing technology was very useful, as it facilitated the understanding of the spatial relationships among the anatomical structures in both cases. In our experience, the use of 3D-printed models was very useful for preoperative planning and for understanding the anatomic landmarks. The model was built in 7 days, with a cost of 380 dollars which is elevated in our environment.

Tratamiento de deformidad severa de la columna vertebral con modelos de impresión 3D / Treatment of severe spinal deformity with 3D printing models

Resumen: Introducción: La escoliosis es una deformidad compleja que afecta los tres planos del eje de la columna vertebral. La asociación entre patología neuromuscular y la alineación vertebral fue descrita inicialmente en 1960. La patología neuromuscular es progresiva y resulta en anormalidades posturales. Las metas quirúrgicas en pacientes con deformidad neuromuscular engloban la corrección anatómica para la sedestación y deambulación, así como mejoría funcional. El estándar de oro de tratamiento es por vía posterior con tornillos transpediculares. La técnica de «manos libres¼ ahorra tiempo quirúrgico, disminuye la radiación al reducir el uso de fluoroscopía. El advenimiento de la tecnología de impresión 3D permite estudio preciso del área anatómica y detalle de la deformidad en sus tres planos. Este modelo puede ser esterilizado para guía transoperatoria. Paciente femenino de 13 años de edad que desarrolla escoliosis neuromuscular toracolumbar secundario a parálisis cerebral infantil (PCI) espástica, con instrumentación previa T11-L3 de la cual desarrolla curva severa proximal. Finalizada la segmentación del modelo tridimensional se detectó violación pedicular mayor a 2 mm hacia canal medular bilateral en los pedículos de L1 y L2 de instrumentación previa, displasia pedicular y se observaron las características morfológicas de los pedículos. La planeación tridimensional y el uso de guías quirúrgicas representan una herramienta para la planeación quirúrgica, sobre todo en casos severos y con displasia pedicular. Ayuda como guía quirúrgica para la colocación de tornillos transpediculares a manos libres con posible reducción de radiación y tiempo anestésico.

Abstract: Introduction: Scoliosis is a complex deformity that affects all three planes of the axis of the spine. The association between neuromuscular pathology and vertebral alignment was initially described in 1960. Neuromuscular pathology is progressive and results in postural abnormalities. Surgical goals in patients with neuromuscular deformity include anatomical correction for sedation and ambulation, as well as functional improvement. The gold standard of treatment is by posterior approach with transpedicular screws. The «hands-free¼ technique saves surgical time, decreases radiation by reducing the use of fluoroscopy. The advent of 3D printing technology allows precise study of the anatomical area and detail of the deformity in its three planes. This model can be sterilized for transoperative guidance. A 13-year-old female patient who develops thoracolumbar neuromuscular scoliosis secondary to spastic cerebral palsy (CP), with previous instrumentation T11-L3 of which he develops severe proximal curve. After the segmentation of the three-dimensional model, pedicle violation greater than 2 mm towards bilateral medullary canal was detected in the pedicles of L1 and L2 of previous instrumentation, pedicle dysplasia and the morphological characteristics of the pedicles were observed. Three-dimensional planning and the use of surgical guides represent a tool for surgical planning, especially in severe cases and with pedicle dysplasia. It helps as a surgical guide for the placement of hands-free transpedicular screws with possible reduction of radiation and anesthetic time.

Three-Dimensional Printing in Minimally Invasive Cardiac Surgery: Optimizing Surgical Planning and Education with Life-Like Models

Abstract Over recent years, the surgical community has demonstrated a growing interest in imaging advancements that enable more detailed and accurate preoperative diagnoses. Alongside with traditional imaging methods, three-dimensional (3-D) printing emerged as an attractive tool to complement pathology assessment and surgical planning. Minimally invasive cardiac surgery, with its wide range of challenging procedures and innovative techniques, represents an ideal territory for testing its precision, efficacy, and clinical impact. This review summarizes the available literature on 3-D printing usefulness in minimally invasive cardiac surgery, illustrated with images from a selected surgical case. As data collected demonstrates, life-like models may be a valuable adjunct tool in surgical learning, preoperative planning, and simulation, potentially adding safety to the procedure and contributing to better outcomes.

Application of 3D printing mirror models and segmentation models in preoperative planning for patellar fractures / 中华创伤骨科杂志

Objective:To explore the application of 3D printing mirror models and segmentation models in preoperative planning for patellar fractures.Methods:Retrospectively analyzed were the data of 46 patellar fractures which had been treated at Department of Orthopedics, Liyang City People's Hospital from January 2016 to August 2020 using 3D printing mirror models and segmentation models in preoperative planning. There were 26 males and 20 females, aged from 19 to 79 years (average, 51.5 years). All the fractures belonged to AO type C. According to the design requirements of a solid model, the patients with DICOM CT data of bilateral lower extremities were assigned into the mirror model group (24 cases) while those with DICOM CT data of only a unilateral lower extremity into the segmentation model group (22 cases). In the mirror model group, CT scans of bilateral knee joints and the proximal tibia exceeding 15 cm were required, while in the segmentation model group, CT scans of only the affected knee joint were required. The original DICOM data were extracted and imported into software Mimics 19.0. In the mirror model group, after the "three-level long-short axis control" method was used to judge the symmetry, the original fracture model and the mirror model were created and printed respectively. During the operation, the fracture line drawn by the mirror model was used to find the fracture fragments with a similar shape which were to be assembled and fixated. The fracture fragments in the segmentation model group were divided into independent entities, converted into STL files and printed separately before the bone fragments were assembled and fixated in sequence. X-ray films were taken after operation. Recorded were the simulated operation time, visual analog scale (VAS) of the knee joint at one month after operation, and B?stman scores at one and 6 months after operation.Results:All patients were followed up for 6 to 24 months (mean, 13.6 months). In preoperative planning, only the mirror model was suitable for patients with comminuted fracture with compression and impaction, both models were suitable for fractures without impaction, compression or impaction, and the segmentation model was suitable for patients with bilateral fractures at the same site, poliomyelitis, one limb missing, and previous fracture. In the mirror model group in which the patients were controlled bilaterally using the "three-level long-short axis control" method, there was no significant difference among the 6 sets of data at 3 levels on both sides ( P>0.05). For the segmentation model group and the mirror model group, the time for preoperative simulated operation averaged 11.2 min and 9.2 min respectively, the VAS score at one month after operation was both lower than 3 points, and the B?stman scores at one and 6 months after operation were both larger than 20 points. Conclusions:The mirror image model of the unaffected patella can be used as the fracture recovery model for the affected side, but the symmetry needs to be verified in advance in case of severe degeneration. Both the 3D printed mirror model and the 3D segmentation model are suitable for preoperative planning for patellar fractures as they are complementary. Patients in both groups can obtain good joint function after treatment.

Aplicações da tomografia computadorizada de feixe cônico na cirurgia de dentes inclusos / Applications of cone beam tomography in the surgery of included teeth

It is necessary to use criteria based on the scientific literature, in order to obtain correct indications for cone beam computed tomography (CBCT). Therefore, the objective of this work is to analyze, through a bibilographic review, the applications of CBCT in oral surgery, mainly addressing surgery for included / impacted teeth. A bibliographic survey was performed in the PubMed database, selecting the keywords impacted teeth AND preoperative planning AND cone beam computed tomography. Twelve studies related to the topic were analyzed, some related to the use of CBCT and conventional radiographs in surgeries of included teeth, seeking to evaluate the influence of CBCT on the diagnosis and planning of cases and on the incidence of postoperative complications such as sensorineural disorders. It has been observed that CBCT is a good indication for surgery of included / impacted teeth when one wants to obtain a precise location of the dental element within the bone structure and its relationship with the adjacent structures, resulting in a better diagnosis and planning of cases, bringing more security and predictability during procedures... (AU)

É necessária a utilização de critérios baseados na literatura científica, para se obter indicações corretas da tomografia computadorizada de feixe cônico (TCFC). Sendo assim, o objetivo deste trabalho é analisar, por meio de revisão bibilográfica, as aplicações da TCFC em cirurgia oral, abordando principalmente a cirurgia de dentes inclusos/impactados. Realizou-se um levantamento bibliográfico no banco de dados PubMed, selecionado os descritores impacted teeth AND preoperative planning AND cone beam computed tomography. Foram analisados 9 estudos relacionados ao tema, alguns relacionaram o uso da TCFC e de radiografias convencionais nas cirurgias de dentes inclusos buscando avaliar a influência da TCFC no diagnóstico e planejamento dos casos e na incidência de complicações pós operatórias como distúrbios neurossensoriais. Foi observado que a TCFC é uma boa indicação na cirurgia de dentes inclusos/impactados quando se quer obter uma localização precisa do elemento dental dentro da estrutura óssea e sua relação com as estruturas adjacentes, resultando em um melhor diagnóstico e planejamento dos casos, trazendo mais segurança e previsibilidade durante os procedimentos... (AU)

Discectomía Endoscópica Lumbar Percutánea: presentación de 110 casos intervenidos en Argentina y revisión de la técnica quirúrgica / Percutaneous Lumbar Endoscopic Discectomy: presentation of 110 operated cases in Argentina and review of the surgical technique

Introducción: La Discectomía Endoscópica Lumbar Percutánea (DELP) es una técnica mínimamente invasiva que se usa en distintos países desde finales de los ochenta para el tratamiento de las Hernias Discales. Objetivo: El propósito del presente artículo es presentar los resultados de la evolución clínica de 110 pacientes operados de distintas hernias discales lumbares por técnica endoscópica percutánea, con seis meses de seguimiento. Asimismo, describir la técnica realizada y los aspectos más relevantes del planning preoperatorio, entre ellos el punto de ingreso percutáneo. Materiales y Métodos: En un grupo de 110 pacientes y 141 discos operados entre abril de 2016 y octubre de 2019, se recogieron datos como la edad, el sexo, la clínica, las imágenes de RMN y el planning del ingreso (Skin Entry Point) con target en el fragmento discal herniado. Se realizó en todos los casos una fragmentectomía dirigida, y luego se complementó con técnica In-Out. Se registró, como dato principal, la diferencia en los puntajes de Oswestry (ODI) pre y postquirúrgico a los 6 meses del procedimiento. También se constató la duración de la operación, el tiempo de hospitalización, y la necesidad de reintervención. Todos los pacientes se operaron despiertos, recibiendo anestesia peridural y sedación. Resultados: Se operaron 110 pacientes y 141 hernias discales. El promedio de reducción en ODI a los 6 meses fue 47,5 puntos (SD=5,7), representando un porcentaje medio de reducción de 85% (SD=9,5). Desde el punto de vista técnico se logró promediar la distancia de línea media al ingreso o Skin Entry Point, según el nivel operado y el abordaje elegido. Conclusión: a la luz de los resultados en nuestra serie de 110 pacientes con hernias discales lumbares, operados despiertos por endoscopía percutánea, se obtuvieron mejorías en el dolor promedio del 85% a seis meses. La técnica endoscópica puede ser considerada como un procedimiento efectivo para pacientes con hernias foraminales, extraforaminales y centrales en los niveles L3L4, L4L5 y L5S1.

Introduction: Introduction: PELD is a minimally invasive technique that has been used in different countries since the late 1980s for the treatment of Herniated Discs. Objective: to describe the surgical method from the Approach point of view and PELD results in a series of 110 patients. Materials and Methods: In a group of 110 patients who together had 141 discs operated on between April 2016 and October 2019, data were collected on patients age and gender, clinical presentation, MRI abnormalities and Skin Entry Point (SEP) with target in the herniated disc fragment. A focused fragmentectomy was performed in all cases, and then it was complemented with an In-Out technique. The main result was the difference in the pre and postoperative Oswestry Disability Index (ODI) scores 6 months after the procedure. The operation duration, the lenght of hospitalization, and the need for reoperation were also recorded. All patients underwent surgery awake, receiving epidural anesthesia and sedation. Results: Respecting the SEP of the endoscope according to the MRI planning focused in the herniated fragment, the evolution of the patients was very favorable. The average reduction in ODI at 6 months was 47.5 points (SD = 5.7), representing an average percentage reduction of 85% (SD = 9.5). The average surgery time was 58 minutes, and the hospitalization time 8.5 hours. Conclusions: In our series of surgical patients with lumbar disc herniations, PELD with focused fragmentectomy in awake patients proved to be a technique with very good results, especially with prior planning of the SEP to achieve effective root decompression

Application of 3D printing technology in preoperative planning of scapular fracture / 中国组织工程研究

BACKGROUND: The current internal fixation surgery for scapula fractures is limited by the complex anatomical structure of scapula, which is often difficult to operate, with much bleeding and time-consuming. OBJECTIVE: To observe the clinical efficacy of the application of 3D printing technology in scapula fracture surgery. METHODS: The clinical data of 28 cases (aged 34-70 years) with scapula fractures in the Second Affiliated Hospital of Nanjing Medical University from January 2016 to December 2018 were analyzed retrospectively. Among them, 14 cases were treated after routine preparation (control group). Another 14 patients underwent 64-slice thin-slice CT scanning and 3D reconstruction. The fracture model was printed with 3D printing technology. The surgical approach was designed and the internal fixation was customized before the operation (3D printing group). The operation time, intraoperative blood loss and intraoperative X-ray frequency of the two groups were recorded. Imaging data were followed up six weeks after the operation. The treatment effects were evaluated according to the Hardegger shoulder joint function assessment standard. All patients signed the informed consent. This study was approved by the Hospital Ethics Committee. RESULTS AND CONCLUSION: (1) All the 28 operations were successfully completed. The operation time, intraoperative blood loss and X-ray frequency of the 3D printing group were all less than those of the control group (P < 0.05). (2) The excellent and good rate of the 3D printing group was higher than that of the control group (P < 0.05). (3) The operative approach and internal fixation used in the 3D printing group were consistent with the preoperative design. The application of 3D printing technology in the surgical treatment of scapula fractures can help surgeons better understand the characteristics of scapula fractures and make surgical plans, reduce the difficulty of surgery, obtain more accurate reduction, reduce the duration of surgery, intraoperative bleeding and intraoperative X-ray fluoroscopy, and improve the surgical efficacy.

Systematic evaluation and meta-analysis of total hip arthroplasty with three-dimensional printing model in preoperative planning / 中国组织工程研究

BACKGROUND: Three-dimensional (3D) printing-assisted total hip arthroplasty plays an important role in preoperative planning, intraoperative guidance and positioning, and production of individualized implants. It has important clinical significance for the treatment of hip joint diseases. OBJECTIVE: To evaluate the clinical efficacy of preoperative planning using 3D printed models to assist total hip arthroplasty by systematic evaluation and meta-analysis. METHODS: PubMed, Embase, Cochrane Libray, CNKI, Wanfang databases were retrieved electronically for the articles published before December 2019. The keywords were “hip arthroplasty, hip replacement, THA, 3D printing, three dimensional printing” in Chinese and English, respectively. The clinical controlled trials of 3D printed models versus non-3D printed models to assist total hip arthroplasty in the treatment of hip joint diseases were enrolled. The literature was screened according to the inclusion and exclusion criteria; data were extracted; and the quality of the included studies was evaluated using the Cochrane 5.1.0 bias risk assessment tool, followed by data analysis using RevMan 5.3 software. RESULTS AND CONCLUSION: (1) Fourteen controlled studies were included, involving 601 participants, including 279 cases in the 3D group and 322 cases in the traditional surgery group. (2) Meta-analysis results showed that during the first hip arthroplasty, the operation time in the 3D group was shorter than that in the traditional surgery group [SMD=-0.89, 95%CI (-1.15, -0.64), P 0.05]. During revision surgery, the operation time in the 3D group was shorter than that in the traditional surgery group [SMD=-1.39, 95% CI (-1.92, -0.86), P < 0.05], and Harris score was higher than that in the traditional surgery group [SMD=1.51, 95%CI (-0.05, 2.96), P < 0.05]. The intraoperative blood loss and postoperative drainage volume in the 3D group were less than those in the traditional surgery group [SMD=-1.90, 95%CI (-2.82, -0.99), P < 0.05; SMD=-2.87, 95%CI (-3.36, -2.37), P < 0.05]. The anteversion angle and abduction angle in the 3D group were closer to the preoperative design angle compared with the traditional surgery group [SMD=-1.24, 95%CI (-1.57, -0.91), P < 0.05; SMD=-1.71, 95%CI (-2.96, -0.45), P < 0.05]. (3) These results show that compared with traditional total hip arthroplasty, 3D printing assisted total hip arthroplasty can significantly shorten the operation time, reduce the amount of intraoperative blood loss and postoperative drainage, improve the accuracy of total hip arthroplasty, and can better relieve pain, and improve the quality of life. However, due to the low quality of the included literature, high-quality large-sample, multi-center randomized controlled trials are still needed to confirm the clinical efficacy.

Application value of multimodal image fusion technology in the diagnosis and treatment of intrahepatic cholangiocarcinoma / 中华消化外科杂志

Objective To explore the application value of multimodal image fusion technology in the diagnosis and treatment of intrahepatic cholangiocarcinoma (ICC).Methods The retrospective descriptive study was conducted.The clinicopathological data of 11 patients with ICC who were admitted to Zhujiang Hospital of Southern Medical University between January and September 2018 were collected.There were 5 males and 6 females,aged (55 ± 12)years,with a range from 30 to 74 years.The data of contrast-enhanced computed tomography (CT) and magnetic resonance imaging (MRI) with gadoxetate disodium (Gd-EOB-DTPA) of the upper abdomen were respectively collected,and three-dimensional(3D) model of liver was constructed based on CT-MRI fusion images.The preoperative evaluation and surgical planning were carried out based on the different modal imaging examination technologies.The indocyanine green (ICG) molecular fluorescence imaging system and augmented reality navigation system were used to guide hepatectomy.Observation indicators:(1) preoperative evaluation;(2) intraoperative situations;(3) comparison between surgical planning based on the different model imaging technologies and actual surgical method;(4) follow-up.Follow-up using outpatient examination and telephone interview was performed to detect postoperative complications up to November 2018.Measurement data with normal distribution were represented as Mean ± SD,measurement data with skewed distribution were represented as M (range).Count data were described as absolute number or percentage and comparisons were analyzed using the paired chi-square test.Results (1) Preoperative evaluation:the proportions of grade 3 and above branch vessels of the portal vein and hepatic vein system and tumor margin by enhanced CT examination and enhanced MRI examination were respectively 11/11,4/11 and 5/11,11/11,with statistically significant differences in above indicators (x2 =4.16,5.14,P＜0.05).The enhanced CT showed 11 liver cancer lesions and enhanced MRI showed 13 lesions (including 2 lesions not demonstrated by enhanced CT,with a maximum diameter ≤ 10 mm).The 3D model of liver based on CT-MRI fusion image:location,number,infiltrating range (tumor boundary),intrahepatic vascular distribution,variation and its spatial relationship with lesions could be stereoscopically,intuitively and comprehensively displayed.(2) Intraoperative situations:of 11 patients,11 lesions were explored with naked eyes;13 lesions were detected by ICG molecular fluorescence imaging system,including 2 lesions showing low uptake lesions in liver and gallbladder specific period by preoperative MRI examinations and intrahepatic metastasis cancer by pathologic examination.Of 11 patients,6 had naked-eye ischemia boundaries around related vessels of hepatic portal ligation;10 with anatomical hepatectomy had hepatic segments or hemihepatic boundary by ICG molecular fluorescence imaging system,including 2 using positive staining and 8 using anti-staining.Among 11 patients,3 (1 combined with local resection of hepatic segment Ⅷ metastases),2,2,1,1,1 and 1 underwent respectively left hepatectomy,left lateral lobectomy of liver,right hepatectomy,extended right hepatectomy,right lobectomy of liver,resection of partial hepatic segment Ⅷ and mesohepatectomy.Seven of 11 patients received regional lymph node dissection and 4 received simple lymph node biopsy.Of 11 patients,1 diagnosed as with bile leakage of liver section underwent suture and ligation treatment with 4-0 Prolene;10 didn't occurred bile leakage.The surgical margin of 11 patients was negative.The operation time,volume of intraoperative blood loss and duration of hospital stay were (240± 118)minutes,(275±249)mL and (13 ± 8) days,respectively.There was no blood transfusion in the perioperative period.(3) Comparison between surgical planning based on the different model imaging technologies and actual surgical method:surgical planning of 3D model based on CT,MRI and CT-MRI fusion image in 6,9 and 11 patients was respectively consistent with actual surgical method.(4) Follow-up:11 patients were followed up for 2-10 months,with a median time of 6 months.Three patients had postoperative complications,2 of which were found in Clavien-Dindo Ⅰ and Ⅱ,including 1 with pleural effusion + peritoneal effusion and 1 with pleural effusion,they were improved after conservative treatment;1 with complication of Clavien-Dindo Ⅲ (postoperative intra-abdominal bleeding) was improved by selective arterial embolization using percutaneous femoral artery puncture.There was no postoperative bile leakage,hepatic failure and death.Conclusion Multimodal image fusion technique is helpful to optimize the preoperative surgical planning,which can assist the recognition of important vessels and real-time navigation of hepatectomy during operation,and improve the safety of operation.

Value of virtual reality technology in preoperative planning of transtrochanteric curved varus osteotomy for avascular necrosis of femoral head in adults / 中国修复重建外科杂志

Objective: To research the value of virtual reality (VR) technology in the preoperative planning of transtrochanteric curved varus osteotomy for avascular necrosis of the femoral head (ANFH) in adults. Methods: Between June 2018 and November 2018, 7 patients (11 hips) with ANFH, who were treated with transtrochanteric curved varus osteotomy, were enrolled in the study. There were 4 males (7 hips) and 3 females (4 hips) with an average age of 31.9 years (range, 14-46 years). Among them, 3 patients were unilateral ANFH and 4 patients were bilateral ANFH. There was 1 patient (1 hip) of traumatic ANFH, 2 patients (4 hips) of alcohol-induced ANFH, 2 patients (3 hips) of hormonal ANFH, and 2 patients (3 hips) of idiopathic ANFH. All hips were Association Research Circulation Osseous (ARCO) stage Ⅲ. There were 5 hips for Japanese Investigation Committee (JIC) type C1 and 6 hips for type C2. There were 5 hips for China-Japan Friendship Hospital (CJFH) type L1,1 for type L2, and 5 for type L3. The disease duration ranged from 5 to 12 months (mean, 8 months). Preoperative Harris score was 53.91±7.66. The neck-shaft angle ranged from 128 to 143° (mean, 133.9°). VR technology was adopted for the preoperative planning. CT data were imported into the software to construct the morphology of necrotic area, and the transrtrochanteric varus osteotomy was simulated. The varus angle was designed according to the integrity rate of femoral head. The planned varus angle was 6 to 16° (mean, 9.7°). The transtrochanteric curved varus osteotomy was performed according to the preoperative planning, and the varus angle and loading area were confirmed under fluoroscopy. If the planned varus angle was too small, it would continue to increase under the fluoroscopy until a satisfactory varus angle. Postoperative changes of the neck-shaft angle were calculated and compared with the preoperative planned varus angle (error). The hip function was assessed by using the Harris score. Results: All incisions healed by first intention. All patients were followed up 6-11 months with an average of 8 months. The X-ray film at 2 days after operation showed that the neck-shaft angle was 112-135° (mean, 123.4°). The difference of the neck-shaft angle between pre- and post-operation was 6-16° (mean, 11.0°). Among them, the difference of the neck-shaft angle was consistent with planned varus angle in 5 hips, while the error of the remaining 6 hips was 1-4°. There was 1 patient (1 hip) of osteotomy nonunion at 4 months after operation, 1 patient (1 hip) of proximal femur fracture at 2 months after operation. The rest 5 patients (9 hips) obtained union at the osteotomy. At last follow-up, the Harris score was 82.18±16.35, showing significant difference when compared with preoperative score ( t=-5.195, P=0.000). Conclusion: VR technology is a brand-new preoperative planning method for transtrochanteric curved varus osteotomy in treating ANFH.

Clinical applicaton of three-dimensional visualization technology in hepatectomy of complex hepatocellular carcinoma / 中华肝胆外科杂志

Objective@#To study the clinical application of three-dimensional (3D) visualization technology in liver resection of complicated liver cancer.@*Methods@#A retrospective analysis of 28 patients with complicated liver cancer treated from June 2017 to June 2018 in the Department of Hepatobiliary Surgery, the Affiliated Tumor Hospital of Guangxi Medical University. There were 26 males and 2 females, aged (46±10) years old. A treatment plan on how to perform liver resection for these patients was developed under the guidance of 3D visualization technology. The actual surgical procedures, operation time, intraoperative blood loss, and postoperative complications were documented. The virtual resected liver volume was compared with the actual resected liver volume. The virtual surgical resection margin was also compared with the actual surgical resection margin.@*Results@#All the 28 patients with complicated liver cancer completed the 3D visualization analysis with the location, shape and quantity of tumor being clearly shown. Of the 27 patients who underwent liver resection, 13 underwent anatomical hepatectomy, and 14 underwent non-anatomical hepatectomy. The operation time ranged from 145 to 350 min (median 240 min). The intraoperative blood loss ranged from 100 to 1 500 ml (median 300 ml). The incisional wound healed slowly in 4 patients, pleural effusion developed in 8 patients, and ascites in 2 patients. There were no significant differences in the virtual resected liver volume compared with the actual resected liver volume (P>0.05). There was an excellent positive correlation between the patient's virtual resected liver volume and the actual resected liver volume (r=0.986, P<0.05). There was no significant difference between the virtual surgical resection margin and the actual surgical resection margin (P>0.05). There was an excellent positive correlation between virtual surgical resection margin and the actual surgical resection margin (r=0.983, P<0.05).@*Conclusion@#Three-dimensional visualization technology accurately assessed the liver status, optimized surgical procedures, and played an important role in liver resection of complex liver cancer.

Clinical applicaton of three-dimensional visualization technology in hepatectomy of complex hepatocellular carcinoma / 中华肝胆外科杂志

Objective To study the clinical application of three-dimensional (3D) visualization technology in liver resection of complicated liver cancer.Methods A retrospective analysis of 28 patients with complicated liver cancer treated from June 2017 to June 2018 in the Department of Hepatobiliary Surgery,the Affiliated Tumor Hospital of Guangxi Medical University.There were 26 males and 2 females,aged (46± 10) years old.A treatment plan on how to perform liver resection for these patients was developed under the guidance of 3D visualization technology.The actual surgical procedures,operation time,intraoperative blood loss,and postoperative complications were documented.The virtual resected liver volume was compared with the actual resected liver volume.The virtual surgical resection margin was also compared with the actual surgical resection margin.Results All the 28 patients with complicated liver cancer completed the 3D visualization analysis with the location,shape and quantity of tumor being clearly shown.Of the 27patients who underwent liver resection,13 underwent anatomical hepatectomy,and 14 underwent nonanatomical hepatectomy.The operation time ranged from 145 to 350 min (median 240 min).The intraoperative blood loss ranged from 100 to 1 500 ml (median 300 ml).The incisional wound healed slowly in 4 patients,pleural effusion developed in 8 patients,and ascites in 2 patients.There were no significant differences in the virtual resected liver volume compared with the actual resected liver volume (P ＞ 0.05).There was an excellent positive correlation between the patient's virtual resected liver volume and the actual resected liver volume (r =0.986,P ＜ 0.05).There was no significant difference between the virtual surgical resection margin and the actual surgical resection margin (P ＞ 0.05).There was an excellent positive correlation between virtual surgical resection margin and the actual surgical resection margin (r =0.983,P ＜ 0.05).Conclusion Three-dimensional visualization technology accurately assessed the liver status,optimized surgical procedures,and played an important role in liver resection of complex liver cancer.

Utility of Cardiac CT for Preoperative Evaluation of Mitral Regurgitation: Morphological Evaluation of Mitral Valve and Prediction of Valve Replacement

OBJECTIVE: We aimed to investigate the diagnostic accuracy of cardiac computed tomography (CT) for the detection of mitral valve (MV) prolapse in mitral regurgitation (MR) with surgical findings as the standard reference, and to assess the predictability of MV replacement based on morphologic CT findings. MATERIALS AND METHODS: A total of 156 patients who had undergone preoperative cardiac CT and subsequently received MV surgery due to severe MR were retrospectively enrolled. Non-repairable MV was defined when at least one of the following conditions was met: 1) anterior leaflet prolapse, 2) bi-leaflet prolapse, or 3) valve morphology (leaflet thickening, calcification, or mitral annular calcification [MAC]). Diagnostic performance of CT for the detection of the prolapsed segment was assessed with surgical findings as the standard reference. Logistic regression analysis was performed to evaluate the value of CT findings to predict actual valve replacement. RESULTS: During surgery, MV prolapse was identified in 72.1%. The sensitivity, specificity, and diagnostic accuracy for the detection of MV prolapse were 99.1%, 81.4%, and 94.2%, respectively, per patient. One-hundred eighteen patients (75.6%) underwent MV repair and the remaining 38 patients received MV replacement. Bi-leaflet prolapse and valve morphology were independent predictors of valve replacement after adjusting for clinical variables (adjusted odds ratio, [OR] 8.63 for bi-leaflet prolapse; OR, 4.14 for leaflet thickening; and OR, 5.37 for leaflet calcium score > 5.6; p < 0.05). CONCLUSION: Cardiac CT can have high diagnostic performance for detecting the prolapsed segment of the MV and predictability of valve replacement before surgery. Bi-leaflet prolapse and valve morphology, such as leaflet thickening, or calcification or MAC, are the most important predictors of valve replacement.

Preliminary application of 3D printing technique in resection and reconstruction of mandibular ameloblastoma / 医疗卫生装备

Objective To investigate the primary application of 3D printing technique in vascularized fibula resection and grafting for mandible ameloblastoma. Methods The data of 3 cases of unilateral mandibular ameloblastoma were retrospectively collected.The thin slice CT scan of mandible was performed before operation.The scanned original data were imported into mimics 17.0 software for 3D reconstruction.Mirror image of the healthy side mandible was generated by the mirror image tool of the software.Preoperative planning,designing transplantation of vascularized fibula bone,pre-bending and pre-shaping titanium plate,surgical simulation were done by the mirror model.Results All operations were performed successfully,and were in agreement with the preoperative planning.The facial appearance and mandible function were both satisfactory.Conclusion 3D printing technology assisting mandibular ameloblastoma resection and bone graft reconstruction is able to optimize preoperative planning,provide individualized treatment and achieve postoperative satisfaction.

Razonamiento quirúrgico en inestabilidad crónica posterolateral de rodilla / Surgical rationale in chronic posterolateral knee injury

Los pacientes con mal alineamiento en varo pueden ser difíciles de tratar cuando tienen una lesión crónica de la esquina posterolateral (EPL), resultando en doble o triple varo y subsecuentemente varus thrust durante la marcha. Una osteotomía tibial alta es un procedimiento útil y necesario particularmente en el estadío crónico. Este artículo revisa los fundamentos de la planificación preoperatoria en una lesión crónica de la EPL.

Patients with varus malalignment can be difficult to manage when they have a chronic injury to the posterolateral corner (PLC), resulting in double or triple varus and subsequent varus thrust during gait. A high tibial osteotomy is a useful and necessary procedure particularly in the chronic setting. This article reviews the basics of preoperative planning in a chronic injury of the PLC.

Cirugía asistida por computador en tumores óseos: principios generales / Computer assisted surgery in bone tumours: general principles

La mayoría de los tumores óseos primarios pueden ser tratados mediante una resección amplia —muchas veces asociada a terapias adyuvantes— sin comprometer la sobrevida del paciente. La posibilidad de una resección conservadora depende de la localización y tamaño del tumor y de las partes blandas circundantes. Una cuidadosa evaluación de estudios imagenológicos permite al cirujano elaborar un plan quirúrgico que permita una resección con márgenes adecuados, al mismo tiempo que conservar la mayor cantidad de tejido sano, de modo de obtener una extremidad funcional. A veces, la ejecución quirúrgica de lo planeado se hace muy difícil, y la precisión de esta puede resultar afectada. La cirugía guiada por computador se ha constituido en una herramienta útil en estas situaciones. Está basada en la creación de un plan virtual en 3 dimensiones mediante el procesamiento de imágenes de tomografía computada (TC) y resonancia nuclear magnética (RNM). Este plan puede ser reproducido en el escenario quirúrgico mediante la correspondencia entre este escenario virtual y la anatomía real del paciente. Esta tecnología puede permitir una mayor precisión en la ejecución de osteotomías en zonas difíciles como la pelvis, minimizando la resección innecesaria de tejido sano, pero manteniendo un margen oncológico adecuado. Describiremos los principios y el razonamiento que fundamentan el uso de la cirugía guiada por computador en la cirugía de tumores óseos, la cual se ha constituido en una herramienta útil para el manejo de situaciones clínicas específicas...

The majority of primary bone tumours can be effectively treated with wide resection —frequently associated with adjuvant therapy— without compromising the outcome of the patient. The feasibility of limb-sparing surgery in a particular scenario is dependent on the location and size of the tumour, as well as the involvement of the host bone and surrounding soft tissues. Careful evaluation of imaging studies allows the surgeon to plan the resection with adequate margins, while preserving as much normal tissues as possible, in order to achieve a functional limb. At times, the surgical execution of what was planned as resection becomes very difficult, and precision may be less than optimal. Computer-guided surgery has become a useful tool in these situations. It is based on the creation of a three-dimensional virtual plan by means of image processing from computed tomography (CT) and magnetic resonance (MRI) of the clinical situation. This plan is reproduced in the surgical field by means of the interaction between this virtual scenario and the actual anatomy of the patient. This technology could allow better precision in the execution of osteotomies in difficult areas, such as the pelvis, minimising unnecessary resection of normal tissue, while maintaining wide margins. A description is presented of the principles and rationale of computer-guided surgery for bone tumours, which has become a useful tool for the management of selected clinical situations...

Evaluation of Soft Tissue Profile Change Following Bi-maxillary Surgery in Dento-skeletal Class III by Photogrammetric Analysis .

3D analysis allows for simulation of orthognathic surgery and prediction of aesthetic and functional outcomes. Our study aims to find common and repeatable parameters on the behaviour of soft tissues following bone movement by pre- and post-treatment by photogrammetric analysis. Three representative patients who underwent bimaxillary surgery of advancement/retrusion of the jaws for correction of class III dento-skeletal malformation were presented. By overlapping pre-operative and post-operative 3D photos we obtained colour and millimetric maps that allowed the objective appreciation of facial soft tissues modification in all planes of the space after orthognathic surgery. The study disclosed interesting insight into the soft tissue behaviour following orthognathic surgery and highlighted the possibility to draw reliable dissipation curves of facial skin after orthognathic surgery. This study also provided the base for future development of 3D images analysis (3D VTO) to plan and predict aesthetic outcomes of patients with dento-skeletal malformation.

Clinical Value of Visualized Prediction of Corrective Osteotomy of Ankylosing Spondylitis

STUDY DESIGN: Retrospective study. OBJECTIVES: To evaluate the clinical value of preoperative planning via computer simulation by comparing preoperative and postoperative measurements of a patient with ankylosing spondylitis. SUMMARY OF LITERATURE REVIEW: Ankylosing spondylitis is a disorder that results in a spinal deformity because chronic inflammation at the ligament attachment sites triggers ossification; it causes round fixed kyphosis. This causes limitations in not only everyday life but also social interaction because it is impossible for patients to face forward. Therefore, surgical correction is necessary. MATERIALS AND METHODS: We analyzed 38 patients (41 instances) who underwent correctional osteotomy between June 2007 and March 2014 to treat kyphosis caused by ankylosing spondylitis. We chose the appropriate operation site on the basis of preoperative simulations of osteotomy and the site for pre- and postoperative radiological evaluations conducted from the lateral view in a standing position. For the clinical evaluation, Bath Ankylosing Spondylitis Function Index (BASFI), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Hospital Anxiety and Depression Survey (HADS), and Health Locus of Control Form C Questionnaire (HLC-C) were used. RESULTS: The mean sagittal vertical axis (SVA) was improved from 123.4 mm to 66.1 mm, the mean thoracic kyphosis angle (TKA) changed from 42.2degrees to 40.1degrees, and the mean lumbar lordosis angle (LLA) improved from 16.0degrees to 28.5degrees. The correlation coefficients between the preoperative predictive value and the postoperative radiographic measurement were 0.43, 0.93, and 0.87, which were all statistically significant. CONCLUSIONS: By comparing the preoperative measurement with the postoperative radiologic score, we found that the two were correlated and that the clinical assessment improved on the basis of the visualization. Therefore, preoperative simulation of patients with ankylosing spondylitis along with a kyphotic deformity is thought to be clinically effective.

Application of 3D-printing technology in preoperative planning and doctor-patient consultation of percutaneous nephrolithotomy / 中华泌尿外科杂志

Objective To discuss the applications of 3D-printing technology in percutaneous nephrolithotomy (PCNL) and its function in preoperative consultation.Methods Fifteen patients of renal calculus in Tongji Hospital from April to June 2015 were selected in the present study.The preoperative CT scan of renal was processed by three-dimensional radiological software,the renal tissue and perirenal fat were deleted but the 12th rib was left with the renal calculi by the software,and the final models were made by photosensitive resin.Virtual operation based on the 3D-printed model of renal calculi and preoperative data were made preoperatively and compared with actual operation.The efficacy of the models in preoperative planning was evaluated.Operators were asked to fill the questionnaire after operation in order to investigate the efficacy of the renal calculi printed by 3D-printing technology in PCNL.By using the models in consultation before operation,the patients and their family members were asked to fill questionnaires and the efficacy of the models in doctor-patient communication was also evaluated.Results The 15 3D-printed models of renal calculi were set up well and all the operations were successful.The models clearly reflected the size and shape of the renal calculi and the position of the renal calculi and the 12th rib.The virtual puncture point and the renal calyx of puncture were basically corresponded to the actual operation,the puncture depth of virtual operations was (5.7 ± 0.6) cm,while the puncture depth of actual operations was (6.2 ± 0.7) cm,and there was no significant difference (P =2.04).The average evaluation score of the models given by operators was 7.5 ± 0.5,and the average score of the doctor-patient conversation before operation given by the patients or their family members was 8.7 ± 0.8.Conclusions The renal calculi models printed by 3D-printing technology can clearly reflect the size and shape of renal calculi,and the models also play a very important role in preoperative planning and operative process.Meanwhile,the models could be useful in the doctor-patient consultation.