Background Accurate and precise preoperative planning can provide information instrumental for performing less invasive articular fracture surgery. The purpose of this study was to determine that computer-assisted pre...Background Accurate and precise preoperative planning can provide information instrumental for performing less invasive articular fracture surgery. The purpose of this study was to determine that computer-assisted preoperative planning （CAPP） has the potential to improve efficiency and time in the operating room. Methods Sixty-four patients with proximal humeral fractures were treated using locking plates by minimally invasive plate osteosynthesis （MIPO） with CAPP. The time needed for virtual segmentation, reduction, and fixation of the fracture fragments were recorded. Intra and interobserver reliabilities were analyzed using the intraclass correlation coefficient. The clinical function was analyzed using Constant Score and radiology. Results The mean total time required for CAPP of two-part, three-part, and four-part proximal humeral fractures were （13.63±1.38） minutes, （23.14±2.18） minutes, and （39.61±3.01） minutes, respectively. The intra and interobserver reliabilities for all variables were high, ranging from 0.785 to 0.992. The mean operation time was （50.1±6.7） minutes. Fifty- two patients were followed up with an average time of 34.2 months. The mean Constant Score of the injury side was （82.5 ± 9.9）. Three of the fifty-two patients had four complications. Conclusion The application of CAPP was efficient and reliable, and provided excellent clinical and radiographic outcomes for the treatment of proximal humerus fractures by MIPO.展开更多
Objective:Staghorn calculi present a particular and challenging entity of stone morphology.Treatment is associated with lower stone-free rates and higher complication rates compared to non-staghorn stones.In this revi...Objective:Staghorn calculi present a particular and challenging entity of stone morphology.Treatment is associated with lower stone-free rates and higher complication rates compared to non-staghorn stones.In this review we looked for the most relevant data on preoperative imaging and access planning to help decision making for percutaneous surgery with this complex condition.Methods:We conducted a PubMed search of publications in the past 2 decades that include relevant information on the planning for management of staghorn stones.Non-contrast computerized tomography(NCCT)is indeed the standard imaging tool for percutaneous nephrolithotomy(PCNL);additional tools such as three-dimensional computed tomography(CT)reconstruction of the staghorn calculus may help plan access in complex cases.Ultrasound guided percutaneous access may be considered for staghorn stones when planning upper pole access in kidney malposition or complex intrarenal anatomy or with complex body habitus.Wideband doppler ultrasound and real-time virtual sonography can assist.New technologies to improve kidney access such as Uro Dyna-CT or electromagnetic sensor have been reported,but have not shown utilization in staghorn cases.Staghorn morphometry-based prediction algorithms may predict the number of tract(s)and stage(s)for PCNL monotherapy.Lower pole access can be equally effective as upper pole when planning for staghorn and complex stones,with significantly less complications rate;Stone-Tract length-Obstruction-Number of involved calyces-Essence of stone density(STONE)nephrolithometry seems to be the best system to predict outcomes of PCNL in staghorn cases.There is a growing trend of endoscopic combined intrarenal surgery(ECIRS)in concordance with PCNL to treat larger stones.Conservative management of staghorn calculi is an undesired option,but can be an alternative for a carefully selected group of high-risk patients.Conclusion:Staghorn stones may lead to deterioration of renal function and life-threatening urosepsis.This entity should be managed aggressively with planning ahead for surgery using the different tools available as the cornerstone for a successful outcome.展开更多
Since the advent of liver resection as a treatment option for benign and malignant liver diseases, liver resections have continued to become safer with most centers reporting low morbidity and mortality. Gradual impro...Since the advent of liver resection as a treatment option for benign and malignant liver diseases, liver resections have continued to become safer with most centers reporting low morbidity and mortality. Gradual improvements in outcomes over the last decade have largely been due to improvement in surgical techniques including the more routine use of laparoscopy and advances in perioperative care.展开更多
To correct a lower limb deformity, orthopedic surgeons must have an exact understanding of the deformity. In general, preoperative planning is carried out using anterior-posterior (AP) and lateral radiographs. However...To correct a lower limb deformity, orthopedic surgeons must have an exact understanding of the deformity. In general, preoperative planning is carried out using anterior-posterior (AP) and lateral radiographs. However, for severe cases with a combination of angular and rotational deformities of the lower limb, obtaining true AP and lateral radiographs is difficult and accurate calculation of the rotational deformity from radiographs is impossible. In this report, we propose to focus on preoperative assessment using three-dimensional (3D) reconstruction images of computed tomography (CT) scans for severe lower limb deformity in a patient with bilateral fibular hemimelia type II according to the Achterman- Kalamchi classification. She underwent bifocal deformity corrections of the bilateral tibiae using Taylor spatial frames in combination with the Ilizarov external fixator. Complete bony union was achieved, without angular deformity or limb length discrepancy.展开更多
BACKGROUND Most complex renal stones are managed primarily with percutaneous nephrolithotomy(PCNL).However,PCNL is still a great challenge for surgeons because of poor comprehension on complex adjacent structures.Nove...BACKGROUND Most complex renal stones are managed primarily with percutaneous nephrolithotomy(PCNL).However,PCNL is still a great challenge for surgeons because of poor comprehension on complex adjacent structures.Novel techniques are required to assist in planning and navigation.AIM To apply and evaluate the Hisense computer-assisted surgery(CAS)system in PCNL.METHODS A total of 60 patients with complex renal stones were included.Thirty patients in the CAS group had three-dimensional(3 D)virtual models constructed with the CAS system.The model assisted in planning and navigating in the CAS system.Thirty patients in the control group planned and navigated as standard PCNL,without the application of the CAS system.Success rate of one attempt,operation time,initial stone-free rate,decrease in hemoglobin,and complications were collected and analyzed.RESULTS There were no statistically significant differences in the baseline characteristics or planning characteristics.The success rate of one puncturing attempt(90%vs 67%,P=0.028)and the initial stone-free rate(87%vs 63%,P=0.037)were significantly higher in the CAS group.However,there were no statistically significant differences in the operation time(89.20±29.60 min vs 92.33±33.08 min,P=0.859)or in the decrease in hemoglobin(11.07±8.32 g/L vs 9.03±11.72 g/L,P=0.300)between the CAS group and the control group.No statistically significant differences in the incidence of complications(Clavien-Dindo grade≥2)were found.CONCLUSION Compared with standard PCNL,CAS-assisted PCNL had advantages in terms of the puncturing success rate and stone-free rate.The Hisense CAS System was recommended to assist in preoperative planning and intraoperative navigation for an intuitive,precise and convenient PCNL.展开更多
Background：Old pelvis fractures are among the most challenging fractures to treat because of their complex anatomy,difficult-to-access surgical sites,and the relatively low incidence of such cases.Proper evaluation a...Background：Old pelvis fractures are among the most challenging fractures to treat because of their complex anatomy,difficult-to-access surgical sites,and the relatively low incidence of such cases.Proper evaluation and surgical planning are necessary to achieve the pelvic ring symmetry and stable fixation of the fracture.The goal of this study was to assess the use of three-dimensional （3D） printing techniques for surgical management of old pelvic fractures.Methods：First,16 dried human cadaveric pelvises were used to confirm the anatomical accuracy of the 3D models printed based on radiographic data.Next,nine clinical cases between January 2009 and April 2013 were used to evaluate the surgical reconstruction based on the 3D printed models.The pelvic injuries were all type C,and the average time from injury to reconstruction was 11 weeks （range：8-17 weeks）.The workflow consisted of.：（1） Printing patient-specific bone models based on preoperative computed tomography （CT） scans,（2） virtual fracture reduction using the printed 3D anatomic template,（3） virtual fracture fixation using Kirschner wires,and （4） preoperatively measuring the osteotomy and implant position relative to landmarks using the virtually defined deformation.These models aided communication between surgical team members during the procedure.This technique was validated by comparing the preoperative planning to the intraoperative procedure.Results：The accuracy of the 3D printed models was within specification.Production of a model from standard CT DICOM data took 7 hours （range：6-9 hours）.Preoperative planning using the 3D printed models was feasible in all cases.Good correlation was found between the preoperative planning and postoperative follow-up X-ray in all nine cases.The patients were followed for 3-29 months （median：5 months）.The fracture healing time was 9-17 weeks （mean：l0 weeks）.No delayed incision healing,wound infection,or nonunions occurred.The results were excellent in two cases,good in five,and poor in two based on the Majeed score.Conclusions：The 3D printing planning technique for pelvic surgery was successfully integrated into a clinical workflow to improve patient-specific preoperative planning by providing a visual and haptic model of the injury and allowing patient-specific adaptation of each osteosynthesis implant to the virtually reduced pelvis.展开更多
The purpose of this study was to investigate the prediction of mechanical error using DICOM-RT plan parameters for volumetric modulated arc therapy (VMAT). We created plans for gantry rotation arcs of 360° and 18...The purpose of this study was to investigate the prediction of mechanical error using DICOM-RT plan parameters for volumetric modulated arc therapy (VMAT). We created plans for gantry rotation arcs of 360° and 180° (full-arc and half-arc VMAT) for six maxillary sinus cancer cases using a Monaco treatment planning system, and delivered the doses with a linear accelerator. We calculated DICOM-RT plan parameters, including gantry, multileaf collimator (MLC) positions and Monitor Units (MU). We compared plans with regard to gantry angle per MU (degrees/MU) and MLC travel per MU (mm/MU) for each segment. Calculated gantry angle/MLC position speeds and errors were evaluated by comparison with the log file. On average, the half-arc VMAT plan resulted in 47% and 35% fewer degrees/MU and mm/MU than the full-arc VMAT plan, respectively. The root mean square (r.m.s.) gantry and MLC speeds showed a linear relationship with calculated degrees/MU and mm/MU, with coefficients of determination (R2) of 0.86 and 0.72, respectively. The r.m.s. gantry angle and MLC position errors showed a linear relationship with calculated degrees/MU and mm/MU with R2 of 0.63 and 0.76, respectively. Deviations from plan parameters were related to mechanical error for VMAT, and provided quantitative information without the need for VMAT delivery. These parameters can be used in the selection of treatment planning.展开更多
文摘Background Accurate and precise preoperative planning can provide information instrumental for performing less invasive articular fracture surgery. The purpose of this study was to determine that computer-assisted preoperative planning （CAPP） has the potential to improve efficiency and time in the operating room. Methods Sixty-four patients with proximal humeral fractures were treated using locking plates by minimally invasive plate osteosynthesis （MIPO） with CAPP. The time needed for virtual segmentation, reduction, and fixation of the fracture fragments were recorded. Intra and interobserver reliabilities were analyzed using the intraclass correlation coefficient. The clinical function was analyzed using Constant Score and radiology. Results The mean total time required for CAPP of two-part, three-part, and four-part proximal humeral fractures were （13.63±1.38） minutes, （23.14±2.18） minutes, and （39.61±3.01） minutes, respectively. The intra and interobserver reliabilities for all variables were high, ranging from 0.785 to 0.992. The mean operation time was （50.1±6.7） minutes. Fifty- two patients were followed up with an average time of 34.2 months. The mean Constant Score of the injury side was （82.5 ± 9.9）. Three of the fifty-two patients had four complications. Conclusion The application of CAPP was efficient and reliable, and provided excellent clinical and radiographic outcomes for the treatment of proximal humerus fractures by MIPO.
文摘Objective:Staghorn calculi present a particular and challenging entity of stone morphology.Treatment is associated with lower stone-free rates and higher complication rates compared to non-staghorn stones.In this review we looked for the most relevant data on preoperative imaging and access planning to help decision making for percutaneous surgery with this complex condition.Methods:We conducted a PubMed search of publications in the past 2 decades that include relevant information on the planning for management of staghorn stones.Non-contrast computerized tomography(NCCT)is indeed the standard imaging tool for percutaneous nephrolithotomy(PCNL);additional tools such as three-dimensional computed tomography(CT)reconstruction of the staghorn calculus may help plan access in complex cases.Ultrasound guided percutaneous access may be considered for staghorn stones when planning upper pole access in kidney malposition or complex intrarenal anatomy or with complex body habitus.Wideband doppler ultrasound and real-time virtual sonography can assist.New technologies to improve kidney access such as Uro Dyna-CT or electromagnetic sensor have been reported,but have not shown utilization in staghorn cases.Staghorn morphometry-based prediction algorithms may predict the number of tract(s)and stage(s)for PCNL monotherapy.Lower pole access can be equally effective as upper pole when planning for staghorn and complex stones,with significantly less complications rate;Stone-Tract length-Obstruction-Number of involved calyces-Essence of stone density(STONE)nephrolithometry seems to be the best system to predict outcomes of PCNL in staghorn cases.There is a growing trend of endoscopic combined intrarenal surgery(ECIRS)in concordance with PCNL to treat larger stones.Conservative management of staghorn calculi is an undesired option,but can be an alternative for a carefully selected group of high-risk patients.Conclusion:Staghorn stones may lead to deterioration of renal function and life-threatening urosepsis.This entity should be managed aggressively with planning ahead for surgery using the different tools available as the cornerstone for a successful outcome.
文摘Since the advent of liver resection as a treatment option for benign and malignant liver diseases, liver resections have continued to become safer with most centers reporting low morbidity and mortality. Gradual improvements in outcomes over the last decade have largely been due to improvement in surgical techniques including the more routine use of laparoscopy and advances in perioperative care.
文摘To correct a lower limb deformity, orthopedic surgeons must have an exact understanding of the deformity. In general, preoperative planning is carried out using anterior-posterior (AP) and lateral radiographs. However, for severe cases with a combination of angular and rotational deformities of the lower limb, obtaining true AP and lateral radiographs is difficult and accurate calculation of the rotational deformity from radiographs is impossible. In this report, we propose to focus on preoperative assessment using three-dimensional (3D) reconstruction images of computed tomography (CT) scans for severe lower limb deformity in a patient with bilateral fibular hemimelia type II according to the Achterman- Kalamchi classification. She underwent bifocal deformity corrections of the bilateral tibiae using Taylor spatial frames in combination with the Ilizarov external fixator. Complete bony union was achieved, without angular deformity or limb length discrepancy.
基金Supported by the Science and Technology Program in Chinese Medicine of Shandong Province,No.2020M074。
文摘BACKGROUND Most complex renal stones are managed primarily with percutaneous nephrolithotomy(PCNL).However,PCNL is still a great challenge for surgeons because of poor comprehension on complex adjacent structures.Novel techniques are required to assist in planning and navigation.AIM To apply and evaluate the Hisense computer-assisted surgery(CAS)system in PCNL.METHODS A total of 60 patients with complex renal stones were included.Thirty patients in the CAS group had three-dimensional(3 D)virtual models constructed with the CAS system.The model assisted in planning and navigating in the CAS system.Thirty patients in the control group planned and navigated as standard PCNL,without the application of the CAS system.Success rate of one attempt,operation time,initial stone-free rate,decrease in hemoglobin,and complications were collected and analyzed.RESULTS There were no statistically significant differences in the baseline characteristics or planning characteristics.The success rate of one puncturing attempt(90%vs 67%,P=0.028)and the initial stone-free rate(87%vs 63%,P=0.037)were significantly higher in the CAS group.However,there were no statistically significant differences in the operation time(89.20±29.60 min vs 92.33±33.08 min,P=0.859)or in the decrease in hemoglobin(11.07±8.32 g/L vs 9.03±11.72 g/L,P=0.300)between the CAS group and the control group.No statistically significant differences in the incidence of complications(Clavien-Dindo grade≥2)were found.CONCLUSION Compared with standard PCNL,CAS-assisted PCNL had advantages in terms of the puncturing success rate and stone-free rate.The Hisense CAS System was recommended to assist in preoperative planning and intraoperative navigation for an intuitive,precise and convenient PCNL.
基金This study was supported by grants from the National Natural Science Foundation of China，the Beijing Municipal Committee of Science and Technology
文摘Background：Old pelvis fractures are among the most challenging fractures to treat because of their complex anatomy,difficult-to-access surgical sites,and the relatively low incidence of such cases.Proper evaluation and surgical planning are necessary to achieve the pelvic ring symmetry and stable fixation of the fracture.The goal of this study was to assess the use of three-dimensional （3D） printing techniques for surgical management of old pelvic fractures.Methods：First,16 dried human cadaveric pelvises were used to confirm the anatomical accuracy of the 3D models printed based on radiographic data.Next,nine clinical cases between January 2009 and April 2013 were used to evaluate the surgical reconstruction based on the 3D printed models.The pelvic injuries were all type C,and the average time from injury to reconstruction was 11 weeks （range：8-17 weeks）.The workflow consisted of.：（1） Printing patient-specific bone models based on preoperative computed tomography （CT） scans,（2） virtual fracture reduction using the printed 3D anatomic template,（3） virtual fracture fixation using Kirschner wires,and （4） preoperatively measuring the osteotomy and implant position relative to landmarks using the virtually defined deformation.These models aided communication between surgical team members during the procedure.This technique was validated by comparing the preoperative planning to the intraoperative procedure.Results：The accuracy of the 3D printed models was within specification.Production of a model from standard CT DICOM data took 7 hours （range：6-9 hours）.Preoperative planning using the 3D printed models was feasible in all cases.Good correlation was found between the preoperative planning and postoperative follow-up X-ray in all nine cases.The patients were followed for 3-29 months （median：5 months）.The fracture healing time was 9-17 weeks （mean：l0 weeks）.No delayed incision healing,wound infection,or nonunions occurred.The results were excellent in two cases,good in five,and poor in two based on the Majeed score.Conclusions：The 3D printing planning technique for pelvic surgery was successfully integrated into a clinical workflow to improve patient-specific preoperative planning by providing a visual and haptic model of the injury and allowing patient-specific adaptation of each osteosynthesis implant to the virtually reduced pelvis.
文摘The purpose of this study was to investigate the prediction of mechanical error using DICOM-RT plan parameters for volumetric modulated arc therapy (VMAT). We created plans for gantry rotation arcs of 360° and 180° (full-arc and half-arc VMAT) for six maxillary sinus cancer cases using a Monaco treatment planning system, and delivered the doses with a linear accelerator. We calculated DICOM-RT plan parameters, including gantry, multileaf collimator (MLC) positions and Monitor Units (MU). We compared plans with regard to gantry angle per MU (degrees/MU) and MLC travel per MU (mm/MU) for each segment. Calculated gantry angle/MLC position speeds and errors were evaluated by comparison with the log file. On average, the half-arc VMAT plan resulted in 47% and 35% fewer degrees/MU and mm/MU than the full-arc VMAT plan, respectively. The root mean square (r.m.s.) gantry and MLC speeds showed a linear relationship with calculated degrees/MU and mm/MU, with coefficients of determination (R2) of 0.86 and 0.72, respectively. The r.m.s. gantry angle and MLC position errors showed a linear relationship with calculated degrees/MU and mm/MU with R2 of 0.63 and 0.76, respectively. Deviations from plan parameters were related to mechanical error for VMAT, and provided quantitative information without the need for VMAT delivery. These parameters can be used in the selection of treatment planning.
