Objective To explore the effectiveness of computer-aided technology in the treatment of primary elbow osteoarthritis combined with stiffness under arthroscopy. Methods The clinical data of 32 patients with primary elbow osteoarthritis combined with stiffness between June 2018 and December 2020 were retrospectively analyzed. There were 22 males and 10 females with an average age of 53.4 years (range, 31-71 years). X-ray film and three-dimensional CT examinations showed osteophytes of varying degrees in the elbow joint. Loose bodies existed in 16 cases, and there were 7 cases combined with ulnar nerve entrapment syndrome. The median symptom duration was 2.5 years (range, 3 months to 22.5 years). The location of bone impingement from 0° extension to 140° flexion of the elbow joint was simulated by computer-aided technology before operation and a three-dimensional printed model was used to visualize the amount and scope of impinging osteophytes removal from the anterior and posterior elbow joint to accurately guide the operation. Meanwhile, the effect of elbow joint release and impinging osteophytes removal was examined visually under arthroscopy. The visual analogue scale (VAS) score, Mayo elbow performance score (MEPS), and elbow range of motion (extension, flexion, extension and flexion) were compared between before and after operation to evaluate elbow function. Results The mean operation time was 108 minutes (range, 50-160 minutes). All 32 patients were followed up 9-18 months with an average of 12.5 months. There was no other complication such as infection, nervous system injury, joint cavity effusion, and heterotopic ossification, except 2 cases with postoperative joint contracture at 3 weeks after operation due to the failure to persist in regular functional exercises. Loose bodies of elbow and impinging osteophytes were removed completely for all patients, and functional recovery was satisfactory. At last follow-up, VAS score, MEPS score, extension, flexion, flexion and extension range of motion significantly improved when compared with preoperative ones (P<0.05). Conclusion Arthroscopic treatment of primary elbow osteoarthritis combined with stiffness using computer-aided technology can significantly reduce pain, achieve satisfactory functional recovery and reliable effectiveness.
More and more relevant research results show that anatomical segmentectomy has the same effect as traditional lobectomy in the surgical treatment of early-stage non-small cell lung cancer (diameter<2.0 cm). Segmentectomy is more difficult than lobotomy. Nowadays, with the promotion of personalization medicine and precision medicine, three-dimensional technique has been widely applied in the medical field. It has advantages such as preoperative simulation, intraoperative positioning, intraoperative navigation, clinical teaching and so on. It plays a key role in the discovery of local anatomical variation of pulmonary segment. This paper reviewed the clinical application of three-dimensional technique and briefly described the clinical application value of this technique in segmentectomy.
Objective To assess the clinical value of preoperative localization coupled with computed tomography (CT) three-dimensional reconstruction in pulmonary nodule-centered uniportal thoracoscopic combined subsegmental/segmental resection. Methods The clinical data of 30 patients of combined subsegmental/segmental resection in our hospital from December 2019 to October 2021 were retrospectively collected. There were 19 males and 11 females with the mean age of 56.4 (32.0-71.0) years. The pulmonary nodules were located by CT-guided injection of glue before operation. The three-dimensional reconstruction image and operation planning were carried out by Mimics 21.0 software. ResultsThe operations were all successfully performed, and there was no conversion to open thoracotomy or lobectomy. The mean tumor diameter was 11.6±3.5 mm, the mean distance between the nodule and the visceral pleura was 13.6±5.6 mm, the mean width of the actual cutting edge was 25.0±6.5 mm, the mean operation time was 110.2±23.8 min, the mean number of lymph node dissection stations was 6.5±2.4, the mean amount of intraoperative bleeding was 50.8±20.3 mL, the mean retention time of thoracic catheter was 3.2±1.1 d, and the mean postoperative hospital stay was 4.5±1.7 d. There was 1 patient of subcutaneous emphysema, 1 patient of atrial fibrillation and 1 patient of blood in sputum. Conclusion Preoperative CT-guided injection of medical glue combined with CT three-dimensional reconstruction of pulmonary bronchus and blood vessels is safe and feasible in pulmonary nodule-centered uniportal thoracoscopic combined subsegmental/segmental resection, which ensures the surgical margin and reserves lung tissues.
In this article, we introduce the principle, describe the utilization and discuss the future development of three-dimensional printing technology for manufacturing artificial organs.
ObjectiveTo review the research progress of digital occlusion setup in orthognathic surgery. Methods The literature related to digital occlusion setup in orthognathic surgery in recent years was consulted, and the imaging basis, methods, clinical applications as well as existing problems were reviewed. Results Digital occlusion setup in orthognathic surgery includes manual, semi-automatics, and fully automatic methods. The manual method mainly relies on visual cues for operation, which is difficult to ensure the best occlusion set up, though relatively flexible. The semi-automatic method utilizes the computer software for partial occlusion set up and adjustment, but the occlusion result is still largely depended by manual operation. The fully automatic method completely depends on the operation of computer software, and targeted algorithms for different occlusion reconstruction situations are needed. Conclusion The preliminary research results have confirmed the accuracy and reliability of digital occlusion setup in orthognathic surgery, but there are still some limitations. Further research is needed in terms of postoperative outcomes, doctor and patient acceptance, planning time and cost-effectiveness.
Tricalcium phosphate (TCP) is one of the most widely used bioceramics for constructing bone tissue engineering scaffold. The three-dimensional (3D) printed TCP scaffold has precise and controllable pore structure, while with the limitation of insufficient mechanical properties. In this study, we investigated the effect of sintering temperature on the mechanical properties of 3D-printed TCP scaffolds in detail, due to the important role of the sintering process on the mechanical properties of bioceramic scaffolds. The morphology, mass and volume shrinkage, porosity, mechanical properties and degradation property of the scaffold was studied. The results showed that the scaffold sintered at 1 150℃ had the maximum volume shrinkage, the minimum porosity and optimal mechanical strength, with the compressive strength of (6.52 ± 0.84) MPa and the compressive modulus of (100.08 ± 18.6) MPa, which could meet the requirements of human cancellous bone. In addition, the 1 150℃ sintered scaffold degraded most slowly in the acidic environment compared to the scaffolds sintered at the other temperatures, demonstrating its optimal mechanical stability over long-term implantation. The scaffold can support bone mesenchymal stem cells (BMSCs) adherence and rapid proliferation and has good biocompatibility. In summary, this paper optimizes the sintering process of 3D printed TCP scaffold and improves its mechanical properties, which lays a foundation for its application as a load-bearing bone.
ObjectiveTo explore the application value of multidisciplinary collaborative team (MDT) model in retroperitoneal tumors involving large vessels.MethodsThree cases of retroperitoneal tumors involving great vessels admitted to Xiang’an Hospital of Xiamen University in 2019 were retrospectively analyzed. With the support of 3D visual reconstruction and virtual reality (VR) technology, we performed MDT discussion and three cases received treatment of surgery, intervention, and targeted therapy.ResultsCase 1 was discussed by MDT and concluded that, based on CT examination, 3D reconstruction, and VR virtual image results, the tumor on the right side was determined to be completely resectable. The left tumor was judged to be unresectable, and the proposed treatment plan was right metastatic tumor resection + left metastatic tumor radiofrequency ablation. After surgery case 1 had been followed up for 6 months. The symptoms of diarrhea were significantly improved. CT reexamination showed that liver lesions and left retroperitoneal lesions were the same size and the condition was stable. After discussion by MDT, radiofrequency ablation around the tumor was proposed for case 2. This case was followed up for 3 months after surgery, and CT reexamination showed no new lesion in retroperitoneum. After MDT discussion, we concluded that arteriovenous fistula of case 3 had no indications for surgery, and proposed interventional combined with targeted therapy. After treatment, the tumor was found to be smaller after reexamination in 8 months than before treatment, and the efficacy was evaluated as partial remission. The follow-up was continued.ConclusionThe future development trend of retroperitoneal tumor therapy involving great vessels is to evaluate each patient’s condition under the MDT mode by using 3D visual reconstruction and VR technology, and to formulate the individualized treatment plan of operation combined with other treatments.
Based on the CT data and the structure characteristics of the femoral fractures during different healing stages, medical FE models of fractured femur treated with locking compression plate (LCP)were built.Under the physiological load of a standard body weight (70 kg) and the constraint condition,the stress distributions of LCP and fractured femur during healing were calculated by means of three-dimensional finite element analysis (3D-FEA).The results showed that the stress distribution in the LCP and the fractured femur was similar,during the initial stage which there was no newly formed bone or soft tissue in fracture site.The maximum von Mises stress (371.23,272.76 MPa) in the fractured femur was much higher than that in natural femur,and the intensive stress was concentrated mainly in the proximal area of the fractured femur.With the growth of bony callus bone in fracture site,the intensity of stress in proximal femur decreased.Contrasted to the two cases mentioned above,the value of the maximum von Mises stress (68.17 MPa) in bony callus bone stage decreased significantly,and was lower than the safe strength of natural bone.Therefore,appropriate training which is benefitial for the growth to new bone could be arranged for the better rehabilitation.
ObjectiveTo introduce the application of mixed reality technique to the preoperative and intraoperative pulmonary nodules surgery.MethodsOne 49-year female patient with multiple nodules in both lobes of the lung who finally underwent uniportal thoracoscopic resection of superior segment of left lower lobe and wedge resection of left upper lobe was taken as an example. The Mimics medical image post-processing software was used to reconstruct the patient's lung image based on the DICOM data of the patient's chest CT image before the surgery. The three-dimensional reconstructed image data was imported into the HoloLens glasses, and the preoperative discussions were conducted with the assistance of mixed reality technology to formulate the surgical methods, and the preoperative conversation with the patients was also conducted. At the same time, mixed reality technology was used to guide the surgery in real time.ResultsMixed reality technology can clearly pre-show the important anatomical structures of blood vessels, trachea, lesions and their positional relationship. With the help of mixed reality technology, the operation went smoothly. The total operation time was 49 min, the precise dorsal resection time was 27 min, and the intraoperative blood loss was about 39 mL. The patient recovered well and was discharged from hospital smoothly after surgery.ConclusionMixed reality technology has certain application value before and during the surgery for pulmonary nodules. The continuous maturity of this technology and its further application in clinics will not only bring a new direction to the development of thoracic surgery, but also provide a wide prospect.
Objective To study the hook of hamate bone by anatomy and iconography methods in order to provide information for the cl inical treatment of injuries to the hook of hamate bone and the deep branch of ulnar nerve. Methods Fifty-two upper l imb specimens of adult corpses contributed voluntarily were collected, including 40 antisepticized old specimens and 12 fresh ones. The hook of hamate bone and its adjacent structure were observed. Twentyfour upper l imbs selected randomly from specimens of corpses and 24 upper l imbs from 12 healthy adults were investigated by computed tomography (CT) three-dimensional reconstruction, and then related data were measured. The measurement results of24 specimens were analyzed statistically. Results The hook of hamate bone is an important component of ulnar carpal canal and carpal canal, and the deep branch of ulnar nerve is located closely in the inner front of the hook of hamate bone. The flexor tendons of the forth and the l ittle fingers are in the innermost side, closely l ie next to the outside of the hook of hamate bone. The hamate bone located between the capitate bone and the three-cornered bone with wedge-shaped. The medial-, lateral-, and front-sides are all facies articularis. The hook of hamate bone has an approximate shape of a flat plate. The position migrated from the body of the hamate bone, the middle of the hook and the enlargement of the top of the hook were given the names of “the basis of the hook”, “the waist of the hook”, and “the coronal of the hook”, respectively. The short path of the basement are all longer than the short path of the waist. The long path of the top of the hook is the maximum length diameter of the hook of hamate bone, and is longer than the long path of the basement and the long path of the waist. The iconography shape and trait of the hook of hamate bone is similar to the anatomy result. There were no statistically significant differences (P gt; 0.05) between two methods in the seven parameters as follows: the long path of the basement of the hook, the short path of the basement of the hook, the long path of the waist of thehook, the short path of the waist of the hook, the long path of the top of the hook, the height of the hook, of hamate bone, and the distance between the top and the waist of the hook. Conclusion The hook of hamate bone can be divided into three parts: the coronal part, the waist part, and the basal part; fracture of the hamate bone can be divided into fracture of the body, fracture of the hook, and fracture of the body and the hook. Facture of the hook of hamate bone or fracture unnion can easily result in injure of the deep branch of ulnar nerve and the flexor tendons of the forth and the l ittle fingers. The measurement results of CT threedimensional reconstruction can be used as reference value directly in cl inical treatments.