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INTRODUCTION: This study aimed to investigate the accuracy of cup position and assess the changes in pelvic tilt during primary total hip arthroplasty (THA) in the lateral decubitus position using a new computed tomography (CT)-based navigation system with augmented reality (AR) technology. MATERIALS AND METHODS: There were 37 cementless THAs performed using a CT-based navigation system with AR technology in the lateral decubitus position and 63 cementless THAs performed using manual implant techniques in the lateral decubitus position in this retrospective study. Postoperative cup radiographic inclination and anteversion were measured using postoperative CT, and the proportion of hips within Lewinnek's safe zone was analyzed and compared between the two groups. The mean absolute values of navigation error were assessed. Intraoperative pelvic tilt angles were also recorded using navigation system. RESULTS: The percentage of cups inside Lewinnek's safe zone was 100% in the navigation group and 35% in the control group (p < 0.001). The mean absolute values of navigation error in inclination and anteversion were 2.9° ± 2.1° and 3.3° ± 2.4°, respectively. The mean abduction angle of the pelvis was 5.1° ± 4.8° after placing the patients in the lateral decubitus position and 4.1° ± 6.0° after cup placement. The mean posterior tilt angle was 6.8° ± 5.1° after placing the patients in the lateral decubitus position and 9.3° ± 5.9° after cup placement. The mean internal rotation angle was 14.8° ± 7.4° after cup placement. There were no correlations between the navigation error in inclination or anteversion and the absolute values of changes of the pelvic tilt angle at any phase. CONCLUSIONS: Although progressive pelvic motion occurred in THA in the lateral decubitus position, especially during cup placement, the CT-based navigation system with AR technology improved cup placement accuracy.
Subject(s)
Arthroplasty, Replacement, Hip , Patient Positioning , Tomography, X-Ray Computed , Humans , Arthroplasty, Replacement, Hip/methods , Arthroplasty, Replacement, Hip/instrumentation , Female , Male , Tomography, X-Ray Computed/methods , Retrospective Studies , Middle Aged , Aged , Patient Positioning/methods , Hip Prosthesis , Augmented Reality , Surgical Navigation Systems , Surgery, Computer-Assisted/methods , Pelvis/diagnostic imaging , Pelvic Bones/diagnostic imaging , Pelvic Bones/surgeryABSTRACT
Objective:To investigate the clinical value of augmented reality (AR) technology combined with Doppler ultrasound in repairing soft tissue defects around ankle with posterior tibial artery perforator flap.Methods:From June, 2017 to June, 2020, 13 patients with soft tissue defects around ankle were repaired with the posterior tibial artery perforator flap sized 3.0 cm×7.0 cm-5.0 cm×10.0 cm. Preoperative CTA scan was performed to obtain the 3-dimensional image of the blood supply of the donor site. The origin and direction of blood supply, length of pedicle, diameter and the location of perforator were determined. An image fusion software based on Android mobile phone was used from the body surface to realize the navigation by AR, and to mark the locations of the points where blood vessels ran and passed by. At the same time, Doppler ultrasound was employed to confirm the navigation. The optimal puncture fulcrum was used as the flap rotation point in design of the flap. After the flap had been designed, the flap was harvested and the defect was repaired. Outpatient clinic follow-up was performed to evaluate the survival of flap and the function of ankle.Results:All 13 flaps survied without vascular issues. After 6-16 (average 10) months follow-up, all flaps survived. The flaps appeared soft with good blood supply. The colour of the repaired sites were basically the same as normal skin. According to American Orthopedic Foot and Ankle Society (AOFAS) , the ankle function was excellent in 9 patients and good in 4 patients. There was no obvious scar formation on the donor sites.Conclusion:The application of AR technology combined with Doppler ultrasound in the surgical planning of posterior tibial artery perforator flap has advantages in easy to operate in clinical practice. It can reduce the risk of surgery, and has significance in clinical practice.
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Objective@#To investigate the application value of augmented reality (AR) technology in pancreatoduodenectomy (PD).@*Methods@#The retrospective and descriptive study was conducted. The clinicopathological data of 3 male patients who underwent PD in Tsinghua University Affiliated Beijing Tsinghua Changgung Hospital from June 2018 to February 2019 were collected. The 3 patients were aged from 52 to 63 years, with a median age of 57 years. Digital imaging and communication standard format data of enhanced computed tomography (CT) scan were collected, the three-dimensional (3D) images of abdominal arteries, portal vein, descending duodenum, pancreatic body and tail, pancreatic head, common bile duct, and pancreatic duct were reconstructed. The results were imported into the AR software. Optical tracking based on two-dimensional codes and manual interactive rigid registration were adopted for intraoperative navigation. Observation indicators: (1) surgical and postoperative conditions; (2) postoperative pathological examination; (3) follow-up. Follow-up using outpatient examination or telephone interview was conducted to detect survival of patients and tumor metastasis and recurrence up to June 2019. The measurement data with skewed distribution were expressed as M (range). Count data were expressed as absolute numbers.@*Results@#(1) Surgical and postoperative conditions: all the 3 patients underwent PD with AR technology as intraoperative navigation successfully. The operation time, volume of intraoperative blood loss, and duration of postoperative hospital stay were 6 hours (range, 5-8 hours), 700 mL (range, 300-900 mL), 11 days (range, 9-12 days). There was no perioperative death or complication occured. After surgery, the patients who underwent PD combined with superior mesenteric vein (SMV) resection and reconstruction had patent SMV on the enhanced computed tomography examination. (2) Postoperative pathological examination: results of pathological examination showed 1 case of intraductal papillary mucinous neoplasm (IPMN) of the pancreas with invasive adenocarcinoma (neoplasm invading SMV), 1 case of insulinoma, and 1 case of periampullary neuroendocrine carcinoma, respectively. (3) Follow-up: 3 patients were followed up for 4-12 months, with a median follow-up time of 6 months. During the follow-up, the patient with IPMN of the pancreas and invasive adenocarcinoma had liver metastasis at 3 months after surgery, and received chemotherapy at other hospital. After 4 cycles of chemotherapy, the metastatic nodule shrank, and the patient was still in follow-up up to deadline of follow-up. Other 2 patients had no recurrence or metastasis.@*Conclusion@#AR technique assisted PD is safe and feasible, which is helpful to indentify vascular branches and tracks.
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Objective To investigate the application value of augmented reality (AR) technology in pancreatoduodenectomy (PD).Methods The retrospective and descriptive study was conducted.The clinicopathological data of 3 male patients who underwent PD in Tsinghua University Affiliated Beijing Tsinghua Changgung Hospital from June 2018 to February 2019 were collected.The 3 patients were aged from 52 to 63 years,with a median age of 57 years.Digital imaging and communication standard format data of enhanced computed tomography (CT) scan were collected,the three-dimensional (3D) images of abdominal arteries,portal vein,descending duodenum,pancreatic body and tail,pancreatic head,common bile duct,and pancreatic duct were reconstructed.The results were imported into the AR software.Optical tracking based on two-dimensional codes and manual interactive rigid registration were adopted for intraoperative navigation.Observation indicators:(1) surgical and postoperative conditions;(2) postoperative pathological examination;(3) follow-up.Follow-up using outpatient examination or telephone interview was conducted to detect survival of patients and tumor metastasis and recurrence up to June 2019.The measurement data with skewed distribution were expressed as M (range).Count data were expressed as absolute numbers.Results (1) Surgical and postoperative conditions:all the 3 patients underwent PD with AR technology as intraoperative navigation successfully.The operation time,volume of intraoperative blood loss,and duration of postoperative hospital stay were 6 hours (range,5-8 hours),700 mL (range,300-900 mL),11 days (range,9-12 days).There was no perioperative death or complication occured.After surgery,the patients who underwent PD combined with superior mesenteric vein (SMV) resection and reconstruction had patent SMV on the enhanced computed tomography examination.(2) Postoperative pathological examination:results of pathological examination showed 1 case of intraductal papillary mueinous neoplasm (IPMN) of the pancreas with invasive adenocarcinoma (neoplasm invading SMV),1 case of insulinoma,and 1 case of periampullary neuroendocrine carcinoma,respectively.(3) Follow-up:3 patients were followed up for 4-12 months,with a median follow-up time of 6 months.During the follow-up,the patient with IPMN of the pancreas and invasive adenocarcinoma had liver metastasis at 3 months after surgery,and received chemotherapy at other hospital.After 4 cycles of chemotherapy,the metastatic nodule shrank,and the patient was still in follow-up up to deadline of follow-up.Other 2 patients had no recurrence or metastasis.Conclusion AR technique assisted PD is safe and feasible,which is helpful to indentify vascular branches and tracks.
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To explore the value of CTA combined augmented reality(AR) navigation in tongue re-construction with free anterolateral thigh perforator (ALTP) flaps. Methods From December, 2016 to December, 2018, 9 cases of tongue cancer patients were treated with lingual reconstruction with the free ALTP flap. The domi-nant perforator was selected according to CTA before operation. The origin, course, locations at the level passing through the fascia lata of the perforators and digital flaps were located and marked under the guidance of AR naviga-tion technology. The flaps area were 6 cm×8 cm-8 cm×12 cm, and the donor sites were closed directly. The effect of the AR navigation was explored intraoperatively.The function of reconstructed tongue and donor site were followed-up 3 to 6 months postoperatively. Results All navigation-positioned perforators were confirmed by AR preoperatively. Intraoperative exploration showed that the perforators were accurately located. All flaps survived, and no vascular cri-sis occurred. The donor sites healed primarily with linear scars. The tongue was plump, and the function of voice and swallowing were favorable. Conclusion CTA combined AR navigation has the advantages of accurate location, easy to use and low cost in tongue reconstruction with free ALTP flaps.It is a worthy method to be popularized.
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Augmented reality technology has great clinical application potential in functional rehabilitation of human hand. The princi-ple, structure and difficulties of augmented reality technology application in functional rehabilitation of human hand were analyzed. 8 typi-cal systems were introduced and discussed, based on which the advantages and disadvantages of these systems were compared. Finally, the relevant developing tendency and prospect in future was predicated.
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@# Augmented reality technology has great clinical application potential in functional rehabilitation of human hand. The principle,structure and difficulties of augmented reality technology application in functional rehabilitation of human hand were analyzed. 8 typical systems were introduced and discussed, based on which the advantages and disadvantages of these systems were compared. Finally, the relevant developing tendency and prospect in future was predicated.
