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OBJECTIVE@#To introduce an arthroscopic "inlay" Bristow procedure based on the Mortise-Tenon joint structure concept using suture button fixation, and to evaluate its clinical and radiology results postoperatively with a minimal 3-year follow-up.@*METHODS@#A total of 56 patients who received arthroscopic "inlay" Bristow procedure with suture button fixation between June 2015 to June 2016 were eventually enrolled in this study. Radiological assessment on the 3D CT scan was performed preoperatively, immediately after operation, and postoperatively at the end of 3 months, 6 months and the final follow-up. Complications postoperatively were also recorded.@*RESULTS@#A total of 56 patients were finally included in this study. The mean follow-up time was (36.1±3.7) months. Coracoid grafts (middle point) were positioned at about 4 o'clock (123.8°±12.3°) in the En-face view. In the axial view, 95% (53/56) of the grafts positioning were measured as flush, 5% (3/56) as medial. Bone union rate was 96.4% at the final follow-up. At the end of 3 months, 6 months, and the final follow-up, the length of the coracoid graft was 96.9%±4.9%, 91.9%±6.2%, and 91.6%±6.6% of the immediate postoperative length, respectively. Compared with the immediate postoperative length, the length measured at the end of 3 months shortened not significantly (t=2.12, P > 0.05). The coracoid graft shortened more pronouncedly 6 months postoperatively (t=4.98, P < 0.05) and then remained almost constant over time (t=-0.75, P > 0.05), with all grafted coracoid graft retaining more than 90% of their initial length by the 3-year follow-up. And new bone formation at the junction between the coracoid graft and glenoid neck in the axial view were obviously noted in 25 cases. The quantitative evaluation showed that the glenoid area in En-face view was significantly increased at the final follow-up than that immediately after surgery [(9.72±1.22) cm2 vs. (9.42±1.11) cm2]. No degenerative changes were noted on CT images in all the patients at the final follow-up.@*CONCLUSION@#This study reported a series of "inlay" Bristow procedure with suture button fixation for recurrent shoulder dislocation, providing satisfactory union rate and excellent graft positioning. And using suture button fixation instead of screw can reduce osteolysis and complications related to hardware implantation. Moreover, the bone remodeling between the coracoid process and glenoid could be beneficial to restoring the anterior stability of shoulder joint in a long term follow-up.
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Humans , Arthroscopy , Joint Instability , Radiology , Shoulder Dislocation , Shoulder Joint , SuturesABSTRACT
BACKGROUND: Percutaneous kyphoplasty (PKP) is an effective method for treating osteoporotic vertebral compression fracture. Although satisfactory clinical outcomes can be achieved, bone cement leakage is still one of the main complications of PKP. Based on previous studies, there are many high risk factors for bone cement leakage into the spinal canal; however, less attention to the posterior wall morphology of different vertebral bodies may be an important reason for bone cement leakage into spinal canal. OBJECTIVE: To investigate the effect of thoracic and lumbar vertebral posterior wall morphology in the patients with osteoporotic vertebral compression fracture on bone cement leakage into the spinal canal during the PKP. METHODS: The clinical data of osteoporotic vertebral compression fracture patients with PKP were selected. There were 98 osteoporotic vertebral compression fracture patients with CT scan and three-dimensional reconstruction image data from T6 to L5. The three-dimensional reconstruction of CT and multiplanar reconstruction were used to measure the depth of the concave vertebral posterior wall (OC) and the corresponding middle-sagittal diameter of the vertebra (PC) of the non-fractured vertebral body, the ratio of OC to PC was calculated. All subjects were divided into thoracic group (T6-T12) and lumbar group (L1-L5) based on the location of measured vertebral, and the differences of the OC between groups were compared. 357 patients (548 vertebrae) with osteoporotic vertebral compression fracture without CT three-dimensional reconstruction underwent PKP within the same period. They were also divided into thoracic vertebra and lumbar vertebra groups. The degree of bone cement leakage into the spinal canal was compared between thoracic and lumbar vertebra groups. RESULTS AND CONCLUSION: (1)The morphological parameters of posterior vertebral wall in 98 patients showed that the depth of the concave vertebral posterior wall gradually (OC) deepened from T6toT12, with an average of 4.6 mm. The depth became gradually shallow from L1 to L5, with an average of 0.6 mm. The ratio of the depth of the concave vertebral posterior wall to the corresponding middle-sagittal diameter of the vertebra was approximately 16% (1/6) from T6toT12. The average value of ratios from Li to U was 3%. The ratios in lumbar vertebra were significantly decreased compared with thoracic vertebra (16%, 1/6). (2) Results form 357 patients who underwent PKP at the same time showed that the rate of bone cement leakage into spinal canal was 10.2% (31/304) in the thoracic vertebra group during the PKP, and the rate of lumbar vertebra group was 3.7% (9/244). In the thoracic group, the average maximal sagittal diameter of the bone cement intruded spinal canal was (3.1 ±0.2) mm, the average maximal area of the bone cement intruded spinal canal was (30.8±0.3) mm2, and the spinal canal encroachment rate was (22.5±0.2)%. In the lumbar group, the average maximal sagittal diameter of the bone cement intruded spinal canal was (1.4±0.1) mm, the average maximal area of the bone cement intruded spinal canal was (14.9±0.2) mm2, and the spinal canal encroachment rate was (11,4±0.3)%. There was significant difference between thoracic and lumbar groups (P<0.05). (3) The above results imply that due to the presence of OC structure in the middle and lower thoracic vertebra, it is possible to reduce the occurrence of bone cement leakage into spinal canal through avoiding bone cement distribution over the posterior 1/6 (16%) of vertebral body in PKP. The effect of the difference between thoracic and lumbar vertebral posterior wall morphology in osteoporotic vertebral compression fracture patients on bone cement leakage into the spinal canal during the PKP may be one of the reasons why the rate of bone cement leakage into spinal canal in thoracic vertebra significantly higher than that in lumbar vertebra. The study protocol was approved by the Ethics Committee of the Affiliated Hospital of Southwest Medical University (approval No. K2018008).
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BACKGROUND: Personalized positioning guide plate based on three-dimensional CT data can improve the accuracy of posterior-stabilized prosthesis joint replacement, but bone structure reconstruction based on three-dimensional CT scan data ignores the thickness of distal femoral articular cartilage, which will affect the use of personalized osteotomy guide plate and the clinical effect of total knee arthroplasty. OBJECTIVE: To investigate the safety, accuracy and early clinical efficacy of three-dimensional printed screw positioning guide based on MRI and three-dimensional CT assisted medial pivot-total knee arthroplasty in the treatment of osteoarthritis. METHODS: A total of 110 patients with knee osteoarthritis admitted to Department of Orthopedics, Nanjing Hospital Affiliated to Nanjing Medical University from February 2018 to April 2019 were selected. All patients received medial pivot-total knee arthroplasty, and were randomly assigned to two groups. The 58 patients in the experimental group completed knee osteotomy with the assistance of personalized osteotomy guide plate based on MRI and three-dimensional CT. The 52 patients in the control group completed knee osteotomy with the traditional intramedullary and extramedullary positioning methods. The operation time and intraoperative blood loss of the two groups were recorded. Postoperative follow-up was conducted to review the X-ray films. KSS score of knee function and the visual analogue scale score were evaluated. RESULTS AND CONCLUSION: (1) 110 patients were followed up for 6-10 months without serious postoperative complications. (2) The operation time and intraoperative blood loss in the experimental group were less than those in the control group (P 0. 05). (5) The results showed that the personalized osteotomy guide plate assisted internal axial knee prosthesis replacement based on MRI and three-dimensional CT could effectively improve the accuracy of prosthesis placement and shorten the operation time. The method was safe and feasible, and the early clinical effect was satisfactory.
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Objective: To measure and anlyze the morphological indexes of talus of the Chinese population with three-dimensional measurement method and to provide the accurate data of morphological parameters of talus, and to pvovide basis for designing the talar prostheses. Methods: Forty male and 40 female volunteers applied for this study and 4 of them were excluded. At last, 76 volunteers of 39 males and 37 females were included. The ankle joints of 76 subjects were scanned by CT and the CT images were reconstructed to three-dimensional model with Mimics software. A total of 13 indexes were measured including talar length, breadth, height, and volume, length, breadth, and radian of medial and lateral malleolus articular surfaces, anterior, middle, and posterior breadth of trochlea; among 13 indexes, 9 indexes were measured through Mimics software, and the other 4 indexes were measured through Magics software. Results: All the indexes of the subjects were normally distributed. There were no significant differences in the morphological indexes between left and right talus in either males or females (P> 0.05). The talar length, breadth, and height in the males were (60.85 ± 2. 82), (42.96 ± 2.59), and 33.76 ± 1.73) mm, respectively, and in the females they were (54. 41± 2. 49), (39.76 ± 1.78), and (29. 72 ± 1. 20) mm, respectively. Most of the indexes were larger in the males than the females (P0.05). Conclusion: CT measurement method to measure the morphological indexes of talus is more convenient and fast, its measurement error is small, and its erpeatability is high Left and right sides of talus show strong degree of symmetry, thus the morphological indexes of the contralateral talus can be adopted as a reference for designing talus prosthesis.
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OBJECTIVE: To explore the feasibility and value of using three-dimensional CT reconstruction to evaluate the inferior mesenteric artery(IMA) classification and its characteristics in rectal cancer patients.METHODS: The clinical data of 108 rectal cancer patients admitted in Department of General Surgery, Daping Hospital of Army Military Medical University from January 2017 to November 2018 were analyzed retrospectively. The IMA images obtained by three-dimensional CT reconstruction before the operation were reviewed,the IMA was typed according to the different characteristics of IMA branches, and compared and analyzed the differences and characteristics of each IMA type. The length of IMA and the distance from the root of IMA to the bifurcation of the abdominal aorta were measured,and their associations with clinical features were analyzed.RESULTS: Of the 108 cases,60 were male and 48 were female. The IMA was classified into four types, of which 53(49.1%)were type Ⅰ,24(22.2%)were type Ⅱ,18(16.7%)were type Ⅲ,and 13(12%)were type Ⅳ. Univariate ANOVA showed that there were no statistically significant differences in age,BMI,LIMA,DIMA,number of positive lymph nodes,intraoperative blood loss and postoperative hospital stay among the patients with different IMA types(P>0.05). However,there was a statistically significant difference in IMA length between type II and type I or type Ⅲ(P=0.022 and 0.011,respectively). The average IMA length(LIMA)was(5.7±2.0)cm,and the average distance(DIMA)between the root of IMA and the bifurcation of the abdominal aorta was(6.3±2.3)cm.CONCLUSION: Three-dimensional CT angiography can be used before radical resection of rectal cancer to obtain the types of IMA branches and their pathways,so as to provide guidance for the treatment of IMA and preservation LCA in radical resection of rectal cancer.
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Objective To investigate the clinical effect of precise percutaneous radiofrequency ablation of semilunar ganglion through fo -ramen ovale under the three-dimensional CT for the treatment of trigeminal neuralgia .Methods A total of 80 patients with primary trigeminal neuralgia in our hospital from August 2013 to December 2015 were selected,and they were randomly divided into two groups with 40 cases in each group .The control group was implemented blind detective radiofrequency ablation ,while the observation group was carried out under the three-dimensional CT positioning radiofrequency ablation .All the patients were followed up for 3 months after treatment .Compared the overall clinical results , and recorded the time of targeting the trigeminal nerve and the complications within 1 week after treatment between the two groups.The pain condition at different time points (before treatment,1 week and 3 months after treatment) between the two groups were com-pared.Results The positioning time of observation group was shorter than that of the control group ,the difference was significant (P<0.05). The VAS score of the observation group 1 week and 3 months after surgery was lower than the control group ,the difference was significant (P<0.05).The ratio of masticatory muscle weakness ,hypoacusis,facial swelling and congestion and corneal anesthesia of the observation group within 1 week postoperatively were lower than those of the control group ,the difference was significant (P<0.05).The effective rate of the observation group was higher than that of the control group ,the difference was significant (P<0.05).Conclusion Percutaneous radiofre-quency ablation of semilunar ganglion through foramen ovale under the three -dimensional CT for the treatment of trigeminal neuralgia has the advantages of more accurate positioning of the foramen ovale ,shorter operation time , and less complications ,which can relieve the pain of pa-tients and improve the overall clinical effect .
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Objective To explore the use of three-dimensional computed tomography angiography (3D CTA) in the diagnosis of cervical spondylosis with vertebral artery involvement.Methods The study group included 45 patients treated for cervical spondylosis with vertebral artery involvement,from January 2014 to July 2015;42 healthy volunteers were selected as the control group.3D CTA data of all research subjects were evaluated.Results The findings in the experimental group included 3 patients with normal vertebral artery,8 with unilateral narrowed lumen,2 with aberrant route,3 with vascular sclerosis,8 with local lumen stenosis,3 with left side compression,4 with right side compression,and 5 with vessel tortuosity.The right vertebral artery transverse diameter and radius,the left vertebral artery transverse diameter and radius,and 3D images of the left vertebral artery diameter,right transverse diameter,right radius,and left transverse process inner diameter showed statistically significant differences between the two groups (P ＜ 0.05).Conclusion 3D CTA can be used for accurate diagnosis of cervical spondylosis with vertebral artery involvement and can clearly display the diameter of the vertebral artery and the transverse diameter of the vertebral artery.
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Objective To investigate the effect of head extension angle to glottis exposure by using three-dimensional CT reconstruction sagittal plane images of upper airway.Methods There were 80 patients,aged 7-78 years old,who had been scanned by helical CT in the head and neck.Reconstructed images were obtained by AW4.4 workstation and the following parameter was measured:angle α(A0 group),the angle created by the upper central incisor and root of epiglottis(angular vertex) and midpoint of glottis.Reconstructed images were printed according to the actual size of human body in a ratio of 1∶ 1,then the images were cut off from the upper central incisor to root of epiglottis by a section of arcs.Increasing the degree of angle α by clockwise to hypothetically increase the angle of head extension.The glottis was exposed by using a paper-made laryngoscope(Macintosh) model,and the success rate of glottis exposure was recorded when the degree of angle α was respectively increased 10°(A10 group),20°(A20 group),and 30°(A30 group).Results Compared with A0 group,the success rate of glottis exposure increased significantly in A10 group,A20 group and A30 group.The success rate of glottis exposure in A20 group and A30 group was significantly higher than A10 group.Compared with A20 group,the success rate of glottis exposure obviously increased in A30 group.Conclusion Based on CT reconstruction images of upper airway,we can analog study the effect of head extension angle to glottis exposure.
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Objective To observe the temporomandibular joint spaces changes after the plastic surgery of combined zygoma with mandibular angel.Methods We randomly selected 59 patients with prominent zygoma and mandibular angle,screening periodontal disease,TMJ pain and partial jaw.Bilateral zygomatic arch coarctation,jaw edge of the mandibular angle ostectomy and the mandibular body outer panel split were used.All patients accepted CT scan and three-dimensional reconstruction before operation,10 days after operation and 6 months after operation,and then image analysis softwares were used to measure the line distance of corresponding angle (0°,60°,120°,and 180°)at the TMJ sagittal plane.The 0° (EE 'pitch) and 60° (AA'pitch) represented for pre-space,the 60° and 120° (PP'pitch) was upper-space,the 120° and 180° (SS'pitch) was posterior-space.Results 0° and 60° had the same change trend,which slightly increased at 10 days after operation.The difference before operation and 10 days,6 months after operation were not statistically significant (P ＞ 0.05);120° and 180° had the same change trend,which increased at 10 days after operation.The difference between before operation and 10 days after operation was statistically significant (P ＜ 0.05),but the difference between before operation and 6 months after operation was not statistically significant (P＞ 0.05).Conclusions In the short term after plastic surgery of zygoma combined with mandibular angel,the TMJ upper and posterior spaces are changed,and the interspace reduced.This may indicate that the TMJ has compensatory ability,and short-term changes can return to normal.
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Objective To explore the clinical effect of transplantation of autologous fat with stromal vascular fraction for breast augmentation.Methods From September 2012 to March 2014,15 people accepted breast augmentation by transplanting autologous fat with SVF under local anaesthesia.Three-dimensional computer tomography reconstruction (3D-CT reconstruction) was applied preoperatively and postoperatively,the data of the thickness of breast's subcutaneous tissue was compared to observe the breast contour improvement.Results Autologous fat was injected 2 times in 3 cases,and the rest were 1 time.6 months after operation,13 cases were satisfied with the results,and 2 cases were quite satisfied.3D-CT reconstruction was performed before operation and 6 months after operation;statistics showed that before operation the thickness of breast subcutaneous tissue of the right side was (11±4) mm,the left side was (11±6) mm;6 months after operation the right side was (14±3) mm,the left side was (16±3) mm (P＞0.05).The breast was soft,no major complication such as nodules,cysts or calcification were seen.Conclusions The transplantation of SVF with autologous fat is a safe,effective procedure for breast augmentation.3D-CT reconstruction can show more details of breast structures,which is a more effective method to guide and evaluate the lipotrans plantation.
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Objective To explore the therapeutic methods and effects of orbital blow-out fractures.Methods Thirty-three cases (36 eyes) of orbital pure blow-out fracture were treated by surgery from January 2007 to July 2013.The features of orbital fractures were determined with three-dimensional computed tomography scans.The area of fractures was exposed through sub-ciliary incision,the herniated orbital contents were released and reduced to the orbital cavity.The fractured orbital walls were repaired precisely with autologous bone or Medpor.Results After 6 to 12 months followup,there were no serious complications such as infection of bone graft,exposure of implants in all 33 cases,and all the cases got satisfactory appearance of eyelids and orbit,of which the diplopia disappeared and eyeball movement function recovered normally.The protrution of eyeball in 29 cases were symmetrical,but 4 cases presented mild enophthalmos at affected side.Conclusions The orbital volume enlarges and orbital content herniating into paranasal sinuses is caused by orbital blow-out fracture.Implanting autogenous grafts and Medpor to restore orbital volume are proved to be effective.Early CT examination is an effective method for the diagnosis.In order to avoid complications,the orbital blow-out fracture should be subjected to surgical treatment as soon as possible.
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Objective To observe the surgical results of milling technique in treating mandibular angle hypertrophy through an intraoral approach and the effect of three-dimensional computer tomography (3D-CT) reconstruction.Methods Milling-technique was used to treat mandibular angle hypertrophy of 43 patients through intraoral approach under local anaesthesia.3D-CT was applied preoperatively and postoperatively,the data of mandibular angle and masseter muscle thickness were compared preoperatively and postoperatively.The facial contour improvement was also observed.Results Of 43 cases,33 cases were followed-up for 4 to 24 months after operation.The majority of patients were satisfied with the aesthetic results,changes of anterior and lateral view of basifacial part were obvious,the curve of the mandibular angle was smooth and the shape was natural; no major complications such as facial nerve injury or malfracture were seen.Conclusions Milling-technique is a safe,effective and simple method for mandibular angle reduction,and 3D-CT reconstruction has a positive effect preoperatively and postoperatively.
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Objective To compare the position,volume and matching index (MI) of esophagus between quiet end-inspiration and end-expiration in three dimensional CT (3D-CT) assisted with active breathing control (ABC) and the corresponding phases in four dimensional CT (4D-CT).Methods Eleven patients with peripheral lung cancer underwent 4D-CT simulation scan and 3D-CT simulation scans in end-inspiratory hold (CTEIH) and end-expiratory hold (CTEEH) in succession.The 0％ phase was defined as end-inspiratory phase (CT0),while the 50％ phase was defined as end-expiratory phase (CT50).The proximal,mid-,and distal thoracic esophagus were delineated separately on CT0,CT50,CTEIH and CTEEH images.The position,volume and MI of each segment esophagus between CT0 and CTEIH,CT50 and CTEEH were compared.Results In the left-right (x) direction,the position differences in the proximal,mid-,and distal thoracic esophagus between CT0and CTEIH were (-0.02 ±0.16)cm,(0.06 ± 0.26)cm and (0.10 ± 0.33) cm respectively,and in the anterior-posterior (y) direction,the position differences were (0.04 ±0.24)cm,(0.04 ±0.12) cm and (0.08 ±0.15) cm respectively,and the position differences in the same direction were not statistically significant.In the x direction,the position differences of the proximal,mid-,or distal thoracic esophagus between CT50 and CTEEH were (-0.02 ±0.24) cm,(0.12 ± 0.37) cm and (0.26 ± 0.33) cm respectively,and in the y direction,the position differences were (0.03 ±0.21)cm,(0.04 ±0.17)cm and (0.14 ±0.18)cm respectively,and the position differences in x and y directions of proximal and mid-thoracic esophagus between CT50 and CTEEH were not statistically significant,while the position differences in x and y directions of distal thoracic esophagus between CT50and CTEEH were both statistically significant (t =0.025,0.024,P ＜ 0.05).The volumes of the proximal,mid-and distal thoracic esophagus were all larger in CT0and CT50 than those in CTEIHand CTEEH,but without statistical differences.The MIs of the volumes of the proximal,mid-and distal thoracic esophagus between CT0 and CTEIH were (0.50 ± 0.17),(0.50 ± 0.19) and (0.56 ± 0.08),respectively,and those between CT50and CTEEH were (0.50 ±0.16),(0.47 ±0.14) and (0.51 ±0.15),respectively.The MI of each segment esophagus between CT0and CTEIHwas larger than that between CT50 and CTEEH,but without statistical differences.Conclusions The influence of breathing modes on the centroid positions of the proximal,mid-thoracic normal esophagus were not significant and there were spatial mismatches for any segment esophagus between 3D-CT assisted with ABC and 4D-CT.
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Objecttve To compare the positional and volumetric differences of planning target volumes(PTVs)based on axial three-dimensional CT(3D-CT)and four-dimensional CT(4D-CT)for the primary tumor of non-small cell lung cancer(NSCLC).Methods Sixteen NSCLC patients with lesions located in the upper lobe and 12 patients with lesions in middle and lower lobes,totally 28 patients, initially underwent three-dimensional CT scans followed by 4D-CT scans of the thorax under normal free breathing.PTVvector was defined on gross tumor volume (GTV) contoured on 3D-CT and its motion vector. The clinical target volumes(CTVs)were created by adding 7 mm to GTVs,then, internal target volume (ITVs)were produced by enlarging CTVs isotropically based on the individually measured amount of motion in the 4D-CT,lastly,PTVs were created by adding 3 mm setup margin to ITVs. PTV4D was defined on the fusion of CTVs on all phases of the 4D data.The CTV wag generated by adding7 mm to the GTV on each phase.then,PIVs were produced by fusing CTVs on 10 phases and adding 3 mm setup margin.The position of the target center,the volume of target and the degree of inclusion(DI)were compared reciprocally between the PTVvector and the PTV 4D The difference of the position,volume and degree of inclusion of the targets between PTVvecter and PTV4D were compared,and the relevance between the relative characters of the targets and the three-dimensional vector was analyzed based on the groups of the patients. Results The median of the 3 D motion vector for the lesions in the upper lobe was 2.8 mm, significantly lower than that for the lesions in the middle and lower lobe ( 7.0 mm, z = - 3. 485, P < 0. 05 ). In the upper lobe group there was only significant spatial difference between the PTVvector and PTV4D targets in the center coordinate at the x axe (z = -2. 010, P < 0. 05 ), while in the middle and lower lobes there was only significant spatial difference between the PTVvector and PTV4D targets in the center coordinates at the z axe (z = -2. 136,P <0.05). The median of ratio of PTV4D and PTVvector, of the upper lobe group was 0. 75, significantly higher than that of the middle and lower lobes group (0. 52, z = - 2. 949, P < 0. 05 ).A significant correlation was found for the motion vector and the ratio of PTV and PTV4D in both groups ( r = - 0. 638, - 0. 850, P < 0. 05 ). For all patients, the median of D[ of PTV4D in PTVvector was 66. 39% ,while the median of DI of PTVvector, in PTV4D was 99. 55% , both showed a positive significant correlation with the motion vector (r = -0. 814,0. 613 ,P < 0. 05). Conclusions PTV4D defined based on 4D-CT simulation images is obviously less than PTV defined based on 3D-CT simulation images. The ratio and DI of both targets are related with the three-dimensional motion vector of the tumor.
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Objective To compare the three-dimensional eephalometric and three-dimensional CT measurements of adult zygomatic complex among a Sanjiang population.Methods 120 female natives of Sanjiang region from Chinese Han between 19 to 23 years of age (mean 21.4 years),were randomly selected from students of Jiamusi University.Three-dimensional cephalometric and CT measurements of the face and skull were taken,with reference to zygomatic size measurement by Prof.Qi Zuo-liang,for the comparative study, which included the upper,mid and lower facial width followed by the length,width and angle of malar process,and width of the facial bone.Statistical analysis was done with the obtained measurements.Results Three-dimensional CT analysis showed facial width ratio of 0.83 and 0.79 and skeletal facial profile width ratio of 0.81 and 0.77,respectively,when compared with three-dimensional cephalometric analysis that showed facial width ratio of 0.84 and 0.77.Both values showed no statistical significance (P>0.05).Conclusion Three-dimensional CT measurement as the same to three-dimensional cephalometric can be used in the diagnosis of prominent malar complex.
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Objective: To simulate the surgical approaches for intracranial aneurysms using three-dimensional CT angiography (3D-CTA) ,so as to assess the value of 3D-CTA in the microneurosurgery for ruptured intracranial aneurysms. Methods1 Totally 134 patients with spontaneous subarachnoid hemorrhage caused by ruptured intracranial aneurysm were confirmed by operation. All the patients were examined by CTA before operation and surgical simulation was conducted. Some patients were examined by the pre-operative DSA (digital subtract angiography). The findings of pre-operation CTA,DSA and intra-operative findings were compared and the clinical value of cerebral 3D-CTA was analyzed. Results1 3D-CTA discovered 162 aneurysms out of a total of 163 in 134 patients. The sensitivity and specificity of 3D-CTA for diagnosis of ruptured intracranial aneurysm were 99. 4% and ioo% , respectively. Moreover, pre-operation examination with 3D-CTA clearly displayed the location,size, and shape of aneurysms, the axis direction of the aneurysmatic summits and the width of aneurysmatic neck. Furthermore,the spatial relations between the parent aneurysm artery, the aneurysm, the periphery vessel and bony structures were also demonstrated. These findings were in accordance with the intra-operative findings. There was no rupture during exploration. The Glasgow outcome score was 5 in 85 patients,4 in 22,3 in 17,2 in 6,and 1 in 4. Conclusion1 The conventional pre-operative 3D-CTA examination can simulate surgery for patients with ruptured intracranial aneurysms, and it can help to design the operative approach and improve the successful rate of operation.
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PURPOSE: We wanted to evaluate the clinical results of the Latarjet procedure for treating anterior shoulder instability combined with a glenoid bone defect. MATERIALS AND METHODS: Between Oct. 2006 and May. 2007, fourteen patients underwent a Latarjet operation to treat their anterior shoulder instability combined with a glenoid bone defect. The mean follow-up period was 15 months (range: 12 to 19 months), and the average age at the time of surgery was 29.9-years-old (range: 19 to 44 years). There were 13 males and 1 female. Eight patients exhibited involvement of the right shoulder. The dominant arm was involved in 8 patients. Six patients had undergone a previous arthroscopic Bankart repair before their Latarjet operation and 2 patients had a history of seizure. RESULTS: The average Rowe score improved from 51.8 to 80.2 with 9 excellent, 4 good, and 1 fair results. The average Korean shoulder score for instability improved from 61.6 to 82.1 postoperatively. The active forward flexion and external rotation at the side of the involved shoulder was an average of 8degrees and 16degrees less than that of the uninvolved shoulder. The muscle strength of the involved shoulder measured 78.7% in forward flexion and 82.5% in external rotation, as compared with that of the uninvolved shoulder. There was 1 case of dislocation, 1 transient subluxation, 2 fibrotic unions, 1 resorption of the transferred coracoid process, 1 intraoperative broken bone, 1 transient musculocutaneous nerve injury and 1 case of stiffness. CONCLUSION: The Latarjet procedure for treating anterior shoulder instability combined with a significant glenoid defect effectively restores function and stability through extending the articular arc at the expense of external rotation. We should be cautious to avoid or detect complications when performing coracoid transfer.
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Female , Humans , Male , Arm , Joint Dislocations , Follow-Up Studies , Fractures, Bone , Muscle Strength , Musculocutaneous Nerve , ShoulderABSTRACT
BACKGROUND: When surgeons plan mandible ortho surgery for patients with skeletal class III facial asymmetry, they must be consider the exact method of surgery for correction of the facial asymmetry. Three-dimensional (3D) CT imaging is efficient in depicting specific structures in the craniofacial area. It reproduces actual measurements by minimizing errors from patient movement and allows for image magnification. Due to the rapid development of digital image technology and the expansion of treatment range, rapid progress has been made in the study of three-dimensional facial skeleton analysis. The purpose of this study was to conduct 3D CT image comparisons of mandible changes after mandibular surgery in facial asymmetry patients. MATERIALS & METHODS: This study included 7 patients who underwent 3D CT before and after correction of facial asymmetry in the oral and maxillofacial surgery department of Yeungnam University Hospital between August 2002 and November 2005. Patients included 2 males and 5 females, with ages ranging from 16 years to 30 years (average 21.4 years). Frontal CT images were obtained before and after surgery, and changes in mandible angle and length were measured. RESULTS: When we compared the measurements obtained before and after mandibular surgery in facial asymmetry patients, correction of facial asymmetry was identified on the "after" images. The mean difference between the right and left mandibular angles before mandibular surgery was 7degrees, whereas after mandibular surgery it was 1.5degrees. The right and left mandibular length ratios subtracted from 1 was 0.114 before mandibular surgery, while it was 0.036 after mandibular surgery. The differences were analyzed using the nonparametric test and the Wilcoxon signed ranks test (p<0.05). CONCLUSION: The system that has been developed produces an accurate three-dimensional representation of the skull, upon which individualized surgery of the skull and jaws is easily performed. The system also permits accurate measurement and monitoring of postsurgical changes to the face and jaws through reproducible and noninvasive means.
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Female , Humans , Male , Facial Asymmetry , Jaw , Mandible , Skeleton , Skull , Surgery, OralABSTRACT
Pseudoaneurysm arising from the superficial temporal artery (STA) is a rare and potentially critical cause of palpable mass. Most pseudoaneurysms form as a result of blunt trauma and present as painless, pulsatile mass that may be associated with pathologic finding and enlarged size. We report a rare case of pseudoaneurysm arising from STA caused by blunt injury and diagnosed by 3-dimensional computed tomography (CT) angiography.
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Aneurysm, False , Angiography , Temporal Arteries , Wounds, NonpenetratingABSTRACT
PURPOSE: In maxillofacial surgery, proper preoperative diagnosis is very important in achieving good postoperative results. Although conventional CT scans are useful for visual representations of fractures, they cannot provide direct guidance for reconstructing facial bone fractures. However, the recent technology of multislice scanning has brought many clinical benefits to CT images. Direct correlations can be made between preoperative imaging data and operative planning. The aim of the current study is to evaluate the differences between conventional CT and multidetective three-dimensional CT(3D MDCT) measurements in craniofacial deformities. METHODS: From January 2005 to November 2005, MDCT scans of 41 patients were evaluated by comparing them with conventional CT scans. The 3D MDCT images were assessed and reviewed by using a simple scoring system. RESULTS: The 3D MDCT scans offered easy interpretation, facilitated surgical planning, and clarified postoperative results in malar complex fractures, mandibular fractures, and extensive maxillofacial fractures and cranioplasty. However, 3D MDCT images were not superior to conventional CT scans in the diagnosis of blowout fractures. CONCLUSION: In spite of its limitations, the 3D MDCT provided additional and more comprehensive information than the conventional CT for preoperative assessment of craniofacial deformities. Therefore, the 3D MDCT can be a useful tool for diagnosis and systematic treatment planning in craniofacial skeletal deformities.