Relationship between thoracic and lumbar vertebral posterior wall morphology and bone cement leakage into the spinal canal during the percutaneous kyphoplasty / 中国组织工程研究

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).

Effect of Head Extension Angle to Glottis Exposure : A Simulation Evaluation Based on CT Reconstruction Images of Upper Airway / 医学研究杂志

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.

Clinical application of transplantation of autologous fat with stromal vascular fraction for breast augmentation / 中华医学美学美容杂志

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.

Application of three-dimensional CT reconstruction in correction of mandibular angle hypertrophy with milling technique through intraoral incision / 中华医学美学美容杂志

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.

Evaluation of the effects of mandible rehabilitation by using the three-dimensional CT / 实用口腔医学杂志

Objective:To evaluate the contour and functional restoration in segmental defects of mandibles with three-dimensional CT(3D-CT) reconstrction.Methods: Twenty-four patients(16 males,8 females) underwent mandibular reconstruction by using nonvascularized bone grafts.In 24 patients,nonvascularized grafts from the iliac crests(n=11),the ribs(n=10),and the autogenous mandibular bones(AMB)(n=3)were used.`The length of segmental bone grafts ranged from 6 to 20 cm,with an average of 9.8 cm,for the defects with 5 to 20 cm.Both contour and functional effects with reconstructed mandible were determined and analysed via 3D-CT.Results: All free bone grafts were successfully healed.Among them,17 patients showed better soft tissue contour.Only 14 patients were satisfied for skeletal contour.All patients could wear a conventional denture after reconstruction.Conclusion:Facial contour can be achieved via mandibular reconstruction with iliac,rib and AMB.3D-CT can provide anatomy position for the surgical planning.It is an important mean to compensate inadequate of general X-ray and convention CT.Meanwhile it can be used for estimating the reconstruction effects while follow-up.

Three-dimensional CT Imaging in the Evaluation of Craniosynostosis

Technical advances in computer image analysis have made possible three-dimensional(3D) surface Informations of anatomic structures from contiguous axial CT slices. We have recently utilized this 3D CT reconstruction with spiral CT scanner in 6 consecutive patients with primary or secondary craniosynostosis to assess the presence and extent of synostosis, associated calvarial deformity and to facilitate surgical planning of the craniectomy site. High resolution 3-mm contiguous CT sections were obtained and 3D shaded-surface reconstruction image generated after reformation at 2-mm interval. In each case 3D CT demonstrated the exact extent of synostosis, and in 3 cases it was confirmed by surgical inspection. 3D CT images facilitated surgical planning by precisely localizing the proper site for craniectomy. Three-dimensional CT with shaded-surface display may be a useful adjunct to imaging and surgical planning in the patients with craniosynostosis, as well as a useful follow-up imaging study during observation or after surgery.