ABSTRACT
@#With the aging of the population and the increase in the number of edentulous patients, implant-supported fixed restorations have become more prevalent in clinical treatment. It is necessary to assess the patient's remaining bone and occlusal situation correctly; the upper jaw usually needs 6 to 8 implants, whereas the lower jaw needs 4 to 6 implants. Patients with severe alveolar bone atrophy can adopt the "all-on-4/6" treatment plan, short implants, and zygomatic and pterygomaxillary implants to avoid complex bone grafting and remain cautious when the surgical procedures require more surgical experience. According to the repair methods, the superstructure can be divided into one-piece repair and segmental repair. One-piece repair has a lower implant number, flexible location, and reasonable stress distribution but a high maintenance cost. Sectional repair easily achieves passive placement, convenient cleaning, and maintenance in the late stages, but implants need quantity and high requirements for alveolar bone. However, the requirements for alveolar bone and implant number are high. Mutually protected occlusion with minimal or no cantilever on provisional prosthesis is recommended.
ABSTRACT
BACKGROUND: Pilon fractures are mainly vertical compression violence involving the tibia distal articular surface fracture, especially the high-energy damage Pilon fracture. Pilion fracture is characterized by obvious fracture displacement, different levels of compression, crushing at stem epiphyseal end, unstable height, primary articular cartilage injury and uneven joint surface. Because it is difficult to treat, and holds various complications and high morbidity, it becomes a challenge in the field of orthopedics. Good preoperative planning and design can reduce the occurrence of complications and obtain good clinical treatment outcomes. OBJECTIVE: To explore the clinical effect of three-dimensional printing technology combined with virtual surgery design in the treatment of complex Pilon fractures. METHODS: Eighty-eight patients with complex Pilon fracture at Yulin Orthopedics Hospital of Chinese and Western Medicine from August 2017 to November 2018 were selected and divided into two groups (three-dimensional printing group, n=38; control group, n=50). The three-dimensional printing group was treated with three-dimensional printing technology combined with virtual surgery design, and the control group was treated with conventional surgery. The operation time, blood loss, incision length, one-time successful placement rate, postoperative ankle function recovery and healing were recorded. RESULTS AND CONCLUSION: (1) The three-dimensional printing group was superior to the control group in terms of operation time, blood loss, incision length, one-time successful placement rate, reduction satisfaction (Burwell-Charnley fracture reduction radiology evaluation), functional recovery degree (Mazur ankle joint score) after 12-month follow-up and wound healing (P < 0.05). (2) To conclude, compared with conventional surgery, three-dimensional printing combined with virtual surgery design for treating complex Pilon fractures can shorten the operation time, reduce surgical trauma and blood loss, and achieve satisfactory fracture reduction and functional recovery.
ABSTRACT
@#Objective To explore the surgical design and efficacy of novel modified Nuss procedure for pectus excavatum (PE). Methods We retrospectively analyzed the clinical data of 903 patients with PE who were treated by the new kind of steel bar and the novel modified Nuss procedure. There were 716 males and 187 females at mean age of 2-45 (12.1±6.8) years. Preoperative chest CT scans Haller index (HI) was 3.1-15.2 (4.6±1.3), with 38 patients of mild PE (HI<3.2), 302 patients of moderate PE (HI 3.2-3.5), 521 patients of severe PE (HI 3.6-6.0), and 42 patients of extremely severe PE (HI>6.0). The operative time, operative blood loss, hospital stay time as well as postoperative complications were reviewed and analyzed. Results All of the 903 patients successfully completed the surgery. The mean operative time was 20-45 (25.2±2.6) min for primary PE and that for special type of PE (including recurring PE, PE patients after heart disease operation and those corrected by 2 bars) was 48-150 (63.5±28.1) min. Blood loss was less than 10 mL for primary PE and 15-50 (23.5±5.5) mL for special type of PE. Postoperative hospital stay was 3-15 (4.5±1.6) d. A total of 845 patients (93.6%) required 1 steel bar insertion, 58 patients (6.4%) required 2 steel bars. Postoperative evaluation of the surgery outcomes revealed the following: excellent in 805 patients, good in 84 patients, fair in 14 patients and poor in 0. The good quality rate was 98.4%. Conclusion Novel modified Nuss procedure can simplify and optimize the surgical design with good short and mid-term effects.