Objective To improve the accuracy of the acetabular component placement using the nonimage based surgical navigation system. Methods Twenty-three patients (14 males, 9 females; age, 28-55 years;26 hips）with hip disease underwent the total hip arthroplasty (THA) using the nonimage based surgicalnavigation system from February 2004 to April 2006. Rheumatoid arthritis was found in 3 patients (3 hips), necrosis of the femoral head in 6 patients (6 hips), and osteoarthritis in 14 patients (16 hips). All the patients were randomly divided into the following 2 groups: the navigated group (11 patients, 13 hips), treated by THA using the nonimage based surgical navigation system; and the control group (12 patients, 13 hips), treated by the traditional THA. According to thedesign of the study, the acetabular component was placed in the best inclination angle (45°) and the anteversion angle (15°). The postoperative component position was examined. Results No fracture, dislocation, infection or injury to the sciatic nerve was found. In the navigated group, the inclination and the anteversion reached 15.4±1.4° and 45.5±1.3°, respectively. In the control group,the inclination and the anteversion were 13.9±7.6° and 43.7±6.4°, respectively. The inclination difference was considered statistically significant (Plt;0.01). All the patients were followed up for 10-40 months,averaged 26 months. In the navigated group, the postoperative average Harris hip score was 95 (range,85-110), with an excellent result in 11 hips and a good result in 2 hips. In the control group, the postoperative average Harris hip score was 92 (range,75-110), with an excellent result in 9 hips, a good result in 3 hips, and a fair result in 1 hip. The Harris hip score difference was considered statistically significant (Plt;0.05). There was a significantly better result obtained in the navigated group than in the control group. Conclusion The acetabular component can be implanted accurately by the nonimage based surgical navigation system, which can reduce the incidence of the loosening of the prostheses and has an important value in clinical practice.
Objective To investigate a modified robotized hydraulictensor for management of the ligament balance in the total knee arthroplasty. Methods The effect of the modified robotized hydraulic tensor on the mechanical behaviour of the ligament system balance in the total knee arthroplasty was analyzed andthe related information was obtained. Results The robotized hydraulic tensor acted as a tensorsensor system, which could assist the surgeon by providing thequantitative information to align the lower limb in extension, equalize the articular spaces in extension and flexion, balance the internal and external forces, and define the femoral component rotation, and by providing the information toplan the releasing of the soft tissues and the rotating of the femoral component. Conclusion The modified robotized hydraulic tensor can enable the surgeon to properly manage the ligament balance in the total knee arthroplasty.
【Abstract】 Objective To investigate the qual itative rotation al ignment of components in total knee arthroplastyand the accuracy and the effectiveness of Bone Morphing computer assisted system when qual itatively practicing. MethodsFrom November 2002 to June 2003, 21 patients with three compartments osteoarthritis(21 knees) were treated by primarytotal knee arthroplasty after the conservative medical treatment failed, with the assistance of a “Bone Morphing” CeravisionSystem, implanted posterior stabil ized total knee prosthesis. Twenty-one patients included 5 males (5 knees) and 16 females (16knees) with an average age of 72.4 years (64-79 years) . The locations were left knee in 10 cases and right knee in 11 cases. Thepatients suffered from knee pain and l imitation of movement from 2 to 10 years. There were 14 genu varum and 7 genu valgumpreoperatively. The relative preoperative, intraoperative and postoperative data from cl inical check-up, the X-ray films and theintraoperative components rotational al ignment real-time records in CD Rom were analyzed. Results All operative incisionshealed up by first intension. Twenty-one patients were followed up 12-16 months(mean 13.3 months). For the achievement ofproper lower l imb al ignment and normal frontal laxity of knee, rotational al ignment of femoral components was from internalrotation (IR)1° to external rotation (ER) 5°, tibial components from IR 0° to ER 5°. In patients with genu varum, the rotationalal ignment of the femoral components was ER 1°- ER 5°, of tibial components ER 2°- ER 5°. In patients with genu valgum, the rotationalal ignment of femoral components was IR 1°- ER 4°, of tibial components IR 0°-ER 4°. After 3 months of operation, themean flexion angle measured as range of motion (ROM) was 115°(105-130°), the frontal laxsity measured as 0.2-0.5 cm (mean0.27 cm) of internal laxity and 1.0-2.5 cm (mean 1.7 cm) for external laxity, there were no knee pain, paterllar instabil ity or dislocationand abnormal knee frontal laxity. Conclusion Using Bone Morphing computer-assisted system can optimise theindividual components rotation al ignment accurately.
ObjectiveTo observe the asynchrony patterns between left and right lungs in smokers and non-smokers,to assess the role of vibration response imaging(VRI) in the early detection and evaluation of smoking-related lung abnormalities. MethodsData were collected as follows:(1)past history and smoking history were collected;(2)exhaled CO test to confirm smoking status was performed;(3)VRI test was performed and the curve of Breath Energy Unit(BEU)was drawn,which is an energy versus time graph of the breath energy.The asynchrony between left and right lungs was derived from this graph;(4)pulmonary function test was performed.In the end,26 villagers with normal spirometry findings were included in the study.The subjects were divided into an ever-smoking group and a never-smoking group. ResultsThe BEU lung asynchrony was 2.0(3.0) frame in the never-smoking group,and 2.0(3.0) frame too in the ever-smoking group.Rank sum test showed that there was no significant difference(Z=-0.29,P=0.77) between the never-smokers and the ever-smokers in the lung asynchrony.Rank correlation analysis suggested that in the ever-smoking group,smoking index and BEU asynchrony had significant correlation(r=0.61,P=0.03).In the never-smoking group,the coefficient of passive smoking index and lung asynchrony was 0.52(P=0.07).The P value of the coefficient between passive smoking index and lung asynchrony was nearly 0.05,scatter between them could be seen a presence of a certain trend. ConclusionThe lung asynchrony in VRI has dose-effect relationship with ever-smokers' smoking level(smoking index).Thus,the lung abnormalities in VRI caused by the exposure to passive smoking is maybe the same as the abnormalities caused by direct smoking.
Objective To investigate effectiveness of applying the Bone Morphingbased image-free computer-assisted system for the ligament balancing managementin the total knee arthroplasty (TKA). Methods Between November 2002 and June 2003, twenty-one posterior stabilized total knee prostheses (Ceraver, France) were implanted in 21 patients using the Bone Morphing based image-free Ceravision system.This cohort included 5 men and 16 women with an average age of 72.4 years, two undergoing high tibial osteotomy and 1 undergoing distal femoral osteotomy before. The preoperative deviation was measured by the full-length AP X-rays. The knees were in varus deviation in 14 patients and in valgus deviation in 7 patients, with an average of 2.36°(varus 13°-valgus 13°). The frontal X-rays ofthe knee were assessed, the mean value of the varus force-stress test was 8.47°(varus 2°-varus 20°), and the mean value of the valgus forcestress test was 3.63°(varus 7°-valgus 12°). Results With the Ceravisionrecorded data, the intraoperative alignment was assessed, the mean lower limb axis was 3.33°(varus 12°-valgus 10°),and compared with the preoperative data, the difference was significant (Plt;0.05); the mean value of the varus force-stress test was 6.47°(varus 0°-varus 24°), the mean value of the valgus force-stress test was 4.32°(varus 8°- valgus 15°), and compared with the preoperative data, the difference was significant (Plt;0.05). The post-prosthetic alignment on Ceravision with a deviation of 0.175°(varus 2°- valgus 3°) was compared with the postoperative alignment by the full-length AP X-rays, with a deviation of 0.3°(varus 3.5°-valgus 1.5°), the difference wasn’t significant(Pgt;0.05).The clinical check-up performed 3 months after operation showed that the average range of movement (ROM) was 115°(105-130°), the mean frontal laxity was 0.27 mm(0.2-0.5 mm). The femoral and tibial components were implanted in the satisfactory 3 dimensional position without ligament imbalance in all the patients, andthere were no instability or patella complications.Conclusion Utilization of the Bone Morphing based image-free computer-assisted system can achieve an accurate component 3 dimensional alignment, optimal bone resection, optimal control of surgical decision in releasing the soft tissues, rotating the femoral component to gain an extension/flexion rectangular gap, and managing theligament balancing so as to achieve a satisfactory initial clinical outcome. This system can be routinely used in the TKA.
【Abstract】 Objective To introduce several navigation systems in anterior cruciate l igament reconstructionand to investigate the appl ication of navigation systems for the improvement in reconstruction of the anterior cruciatel igament. Methods The related l iterature was reviewed extensively, and the main current computer assisted surgery systems(OthoPilot system, Bone Morphing system, Fluoroscopic-based system, etc) for util ization in the anterior cruciate l igament reconstructionwere analyzed. Results The computer-assisted systems can enhance the accurate placement of tunnels. Accordingto the anatomical and isometric parameters, graft impingement on the intercondylar notch could be avoided, and individualideal implantation using 3D visual ization local isers was achieved. Conclusion It is possible that computer-assisted systemswill enable surgeons to better acquire the accuracy and rel iabil ity of the various operative techniques, to meet the demand ofsurgeon’s surgical optimisation and to improve the cl inical results.
Objective To evaluate the security and effectiveness of minimal invasive fixation with fluoroscopybased navigation in the management of pelvic fractures. Methods From April 2007 to June 2008, 22 patients with pelvic fractures were treated with percutaneous screw fixation under the guidance of a fluoroscopy-based navigation system after closed reduction. There were 13 males and 9 females, aged 21-65 years old. Fractures were caused by traffic accident in 17 cases, andfall ing from height in 5 cases. According to AO classification, there were 2 cases of A2.2 type, 2 cases of A2.3 type, 7 cases of B1.2 type, 3 cases of B2.2 type, 1 case of B3.3 type, 2 cases of C1.2 type, 3 cases of C1.3 type, and 2 cases of C2.3 type. The interval from injury to hospital ization was 4 hours to 3 days (mean 1.2 days). After 3-13 days of skeletal traction through tibial tubercle, the operation was performed. Results Totally 42 screws were inserted. The average time for operation was 20.4 minutes per screw. Forty-one screws were inserted correctly with a successful insertion rate of 97.6%, only 1 hollow screw was reinserted for deviation. No incision problem and implant failure occurred. All 22 patients were followed up 7 to 21 months with an average of 14.5 months. At last follow-up, fracture union was achieved in all patients with satisfactory screw fixation. According to Majeed functional scoring, the results were excellent in 18 cases and good in 4 cases, with an excellent and good rate of 100%. Conclusion The minimal invasive fixation with fluoroscopy-based navigation makes the surgery for the pelvic fracture more precise and time-saving, and improves cl inical results without an increasing rate of compl ications.
Objective To design a new custom-made artificial semi-knee joint based on rapid prototyping(RP) technique and to explore a method to solve necroses of allocartilage in hemi-joint allotransplantation. Methods Based on the extracted 3D contour image of the articular cartilage of femoral condyle, the custom-made artificial semi-knee joint was designed with Surfacer 9.0 image processingsoftware. The artificial semi-knee joint design used the femoral condylar 3D contour of the patient as the outer face and the subchondral bone 3D contour of allograft bone as inner face. One dado for medullary nailand two for special designing cages which were used to fix the cartilage into the allograft were added on the inner face. After being converted into RP data format, the computerassisted design was imported into the LPS600 rapid prototyping machine, and the prototype was achieved. Furthermore, the prototype could be modified by hand according to the design. Then the RP model was used as a positive mould to build up a silica gel negativemould, and the negative mould was sent to the factory to manufacture Ti-6Al-4V alloy articular cartilage through ordinary mould-melted founding process. Finally, the whole metal cartilage was completed after melting two special cages on it andpolishing it. Results A new custom-made artificial semi-knee joint was made ad used to treat a 14-year old patient. The custom-made artificial semi-knee joint and the subchondral bone were a perfect match. The operative result was satisfactory. The patient could walk 5 weeks after operation. The bone healing of the auto-bone and allo-bone was achieved 6 months later. A follow-up period lasting 1 yearshowed that the knee joint played a good function. Conclusion The artificial semi-knee joint is a good match for the allograft boneand a good idea to solve necroses of allocartilage in hemijoint allotransplantation.
Objective To investigate the significance of three dimensional (3D) visualization and virtual surgery system in liver transplantation surgery. Methods Two patients suffered from cholangiolithiasis were scanned by 64 slice helical-CT on livers and the data were collected. Man-made segmentation and true up on the image from the data were carried out. 3D moulds of the liver and the intrahepatic vessels were reconstructed by VTK software respectively. And then, the moulds were imported to the FreeForm Modeling System for modifying. At last, auxiliary partial orthotopic liver transplantation was simulated with the force-feedback equipment (PHANTOM). Results ①It had greatly verisimilar image for the reconstructed 3D liver moulds with artery, vein, portal vein and bile duct; By liver seeing through, it had high fidelity and b 3D effect for the intrahepatic artery, vein, portal vein and bile duct, and their spatial disposition and course and correlationship were shown clearly. ②In the virtual surgery system, the virtual scalpel could be manipulated on 3D liver mould with PHANTOM. The simulating effect was the same as the clinic operation for auxiliary partial orthotopic liver transplantation. Plane visualization of hepatic resection and intrahepatic vessel cutting was achieved by adjusting the transparency of the resection part. Life-like could be felt and power feeling could be touched during virtul operation. Conclusion ①The visualized liver mould reconstructed is 3D and verisimilar, and it is helpful to design reasonable scheme for liver transplantation. ②It not only can improve the surgical effect and decrease the surgical risk, but also can reduce the complications and enhance the communication between doctor and patient through designing surgical plan and demonstrating visualized operation before surgery. ③Visualized liver transplantation surgery is helpful for medical workers to train and study.
Objective To review the CT appearances and important differential diagnoses of various primary and secondary mesenteric neoplasms. Methods By describing the mesenteric anatiomy and major routes for the dissemination of metastatic mesenteric tumors, the article presents both the common and rare types of various primary and secondary mesenteric neoplasms, and addresses the characteristic CT appearances and important aspects of the differential diagnosis. Results CT study, especially the multislice spiral CT (MSCT), along with the clinical history and other related information, can nicely depict various mesenteric tumors and well differentiate them from infectious, inflammatory or vascular processes affecting the mesentery. Conclusion CT is the imaging method of choice for the evaluation of tumors of small bowel mesentery.