Clinical analysis of adult spontaneous cerebrospinal fluid rhinorrhea / 临床耳鼻咽喉头颈外科杂志

OBJECTIVES@#To discuss the clinical characteristics, diagnosis and treatment of adult spontaneous cerebrospinal fluid rhinorrhea (CSFR).@*METHODS@#A retrospective study was conducted on 18 patients of CSFR. Nasal secretion was collected for biochemical analysis. Imaging examination was done for identification of the bony defect in skull base.@*RESULTS@#In all cases, the glucose concentration of nasal secretion were more than 1.7 mmol/L, and the β-2 transferrin detected by immunoelectrophoresis technique were positive. Twelve cases were found to have bony defect in skull base. For the rest 6 cases without bony defect, MRI findings of 6 cases showed sinusoidal effusion with similar signals to cerebrospinal fluid, thus predicting the location of the leak. Conservative treatment was successful in one case, and the other 17 patients underwent endoscopic sinus surgery with computer assisted navigation system (CANS). The results of all cases underwent surgery were successful by one time. No recurrence occured during the follow-up time (11 to 24 months).@*CONCLUSIONS@#The incidence of adult CSFR is low, hence it is easily to be missed and misdiagnosed. The majority of CSFR patients are middle-aged and elderly obese women, often combined with hypertension, diabetes, moderate and severe osteoporosis due to no daily exercise habits. Correct medical history collection, reasonable preoperative examination and accurate preoperative localization of bony defect are essential for surgical repairment. CANS used during operation can enable surgeons to locate the site of leakage accurately and shorten the operation time.

Application of a computer-assisted navigation system (CANS) in the treatment of complicated orbital fractures / 中华医学美学美容杂志

Objective To evaluate the effectiveness of computer-assisted navigation system on open reduction as treatment for complicated orbital fractures.Methods The computed tomography (CT) data for 6 patients with complicated orbital fractures were obtained before surgery and imported into the surgical planning software.After 3-dimensional (3D) construction and segmentation,data from the unaffected side were used to guide the reduction data,and surgical simulation was performed.All patients underwent open reduction under the guidance of the navigation system.The segments were then reduced to the predetermined places.CT measurements were used to evaluate navigation accuracy and bone symmetry.Results A fairly accurate match between the intraoperative anatomy and the computed tomography images was achieved through registration,with a systematic error of 1 mm difference.With guidance of the navigation system,open reduction of fractures was performed in all cases.The reduction was checked by postoperative computed tomography scans,with a good match with preoperative planning noted.The maximal deviation between the reduction and preoperative planning was less than 2 mm.The postoperative facial appearance of the patients was clearly improved.Conclusions Navigation-guided open reduction of complicated orbital fractures can be regarded as a valuable treatment option for this potentially complicated procedure.

Comparison of Radiologic Measurements of Total Knee Replacement using Computer-assisted Navigation System and Conventional System in Varus Deformity of the Knee / 대한정형외과학회잡지

PURPOSE: To compare the radiologic measurements of the mechanical axis and the implant position of Total Knee Arthroplasty (TKA) using a computer-assisted navigation system with those using conventional TKA in varus deformity. MATERIALS AND METHODS: From January 2004 to January 2005, 49 TKAs using a CT-free navigation system (Vector Vision(R), BrainLab, Heirnstetten, Germany) (Group I) and 24 TKAs using the conventional technique (Group II) were performed on patients who had a preoperative varus deformity>10degrees. The patients were also subdivided into two groups, patients with a varus deformity 20degrees (group B). The PFC Sigma implants were used in both groups. The mechanical axis and implant position were measured by 2 observers according to the reontgenographic evaluation system of the American Knee Society. RESULTS: There was no significant difference in alpha, beta, delta angle and mechanical axis between group I and II. There was a significant difference in the gamma angle between group I and II (p20degrees tended to have more postoperative varus mechanical alignment than those with a preoperative varus deformity between 10degrees and 20degrees after TKA. More careful attention during the registration of the femoral mechanical axis should be paid in patients with a larger varus deformity in TKA using a computer-assisted navigation system. On the other hand, a reasonable mechanical valgus angle should be considered in femoral bone cutting for a varus deformity of the distal femur in conventional TKA. In addition, inadequate positioning of intramedullary rod should be recognized in conventional TKA.

Comparative Analysis of Image-free Navigation System-Assisted TKA and Conventional TKA

PURPOSE: To compare the roentgenographic results between Image-free navigation system-assisted total knee arthroplasty (TKA) using the OrthoPilot(R) and conventional TKA. MATERIALS AND METHODS: Of 120 primary TKA that operated by one surgeon, 60 cases were operated with a Image-free navigation system (OrthoPilot(R) 4.0, Aesculap, Tuttlingen, Germany) (group A) and 60 cases were operated with conventional method (manual alignment system) (group B). The alignment of the lower extremity and the position of the components were determined on postoperative long-leg standing anteroposterior radiogram and lateral radiogram. RESULTS: Mechanical axis was significantly more accurate in group A than group B(95% compared with 80%). The coronal inclination of femoral component to mechanical axis (theta) was significantly more accurate in group A than group B(96.7% compared with 80%). There were no significant differences between two groups in the sagittal inclination of femoral component(gamma), the coronal inclination of tibial component (beta) and the sagittal inclination of tibial component(delta). In all five measurements being excellently implanted, a significantly higher number was in group A(60% compared with 40%). CONCLUSION: Image-free navigation system-assisted TKA using the OrthoPilot(R) led to significantly increased precision of restoration of the alignment of the lower extremity and the position of the components compared with the conventional method. Potential benefits in long-term outcome and functional improvement require further investigation.

Intraoperative versus Postoperative Measurement in Total Knee Arthroplasty using Computer-Assisted Orthopaedic Surgery (CAOS): Accuracy of CAOS / 대한정형외과학회잡지

PURPOSE: The purpose of this research was to compare the intra-operative and post-operative measured angle in total knee arthroplasty (TKA) and to evaluate the postoperative improvement in the mechanical axis. MATERIALS AND METHODS: Forty TKAs were performed using CAOS between February and May 2004. We measured the mechanical axis in the preoperative orthograms. After inserting the implant, we measured the femoral component angle (FCA), tibial component angle (TCA) and tibial component slope (TCS) using the verification tool in CAOS, on the post-operative orthogram and X-ray of the lateral tibial view, 2 observers measured the FCA, TCA, TCS and mechanical axis. RESULTS: The mean FCA, TCA and TCS using the verification tool in CAOS, were valgus 0.03+/-0.85degrees, valgus 0.49+/-1.02degrees, nd 4.26+/-1.64degrees. The mean FCA, TCA and TCS by observer 1 were valgus 0.67+/-1.24degrees, varus 0.54+/-1.54degrees, and 4.57+/-1.74degrees and those by observer 2 were valgus 0.48+/-1.17degrees, varus 0.52+/-1.44degrees, and 4.24+/-2.83degrees. There was a positive correlation between the measured angle by respective observers and the angle measured by the CAOS (p<0.05). The mechanical axis by observers 1 and 2 improved from varus 13.96degrees to valgus 0.04degrees and from varus 14.12degrees to valgus 0.08degrees respectively. CONCLUSION: CAOS affords the possibility of precisely placing the femoral and tibial components. The angles measured by the respective observers and in the CAOS were significantly correlated.

Pedicle Screw Placement under the Guidance of Computer-Assisted Navigation System / 中国微创外科杂志

Objective To investigate the clinical value of computer-assisted navigation system (CANS) in pedicle screw placement. Methods From August 2002 to June 2006, we carried out 66 cases of pedicle screw placement under the guidance of CANS; 66 cases of traditional pedicle screw placement were set as a control. Results The mean operation time of CANS group was significantly shorter [(142.3?5.3) min vs (173.4?7.1) min; t=-28.301, P=0.000] and the blood loss was significantly fewer [(798.3?10.9)ml vs (912.2?14.3) ml; t=-51.463, P=0.000] than those in the control. X-ray and CT scan respectively showed that the placement of pedicle screw in CANS group was significantly more accurate than that in the control. (?2=29.424, P=0.000; ?2=36.829, P=0.000). Conclusion Pedicle screw placement under the guidance of CANS is more accurate, safe, and micro-invasive than traditional operation.