Particulate bone plays a crucial role in various oral and maxillofacial surgical procedures,including reconstruction,implantation,and craniofacial surgery.Autologous bone and deproteinized bovine bone xenografts are t...Particulate bone plays a crucial role in various oral and maxillofacial surgical procedures,including reconstruction,implantation,and craniofacial surgery.Autologous bone and deproteinized bovine bone xenografts are the two primary resources used for such procedures,with the former demonstrating superior cost-effectiveness and reduced comorbidity rates,particularly in cases involving donor zones.However,a significant challenge lies in acquiring uniformly sized autologous particulate bone specimens,with existing tools often yielding coarse particles at a high cost.Consequently,commercial bone xenograft solutions are frequently favored despite lower standards.This technical note introduces a novel technique for swiftly,safely,and efficiently obtaining autologous particulate bone specimens.The procedure involves the use of a motor handpiece fitted with a micro drill and surgical spoon to collect the bone particles.The continuous irrigation with saline maintains a clear surgical field during the milling process.The collected bone particles are then transferred to a metal capsule for further use.This technique offers a promising solution to the challenge of inconsistent particle size associated with harvesting using traditional methods,providing surgeons with a reliable and efficient method of obtaining autologous particulate bone samples.展开更多
Introduction: While autograft bone is the gold standard for multilevel posterolateral lumbar fusion, bone substitutes and graft extenders such as allograft bone, ceramics and demineralized bone matrix (DBM) have been ...Introduction: While autograft bone is the gold standard for multilevel posterolateral lumbar fusion, bone substitutes and graft extenders such as allograft bone, ceramics and demineralized bone matrix (DBM) have been used to avoid the morbidity and insufficient quantity associated with harvesting autologous bone. The primary objective of this retrospective study was to determine whether, in patients with increased risk of operative nonunion related to multilevel fusion, adding DBM fibers to mineralized bone allograft resulted in better fusion than using allograft alone. The secondary objectives were to evaluate how adding DBM fibers affects functional disability, low back pain, intraoperative blood loss and the nonunion rate. Methods: This retrospective study involved a chart review of consecutive patients who underwent multilevel lumbar spinal fusion and were operated on by a single surgeon. The patients were divided into two groups: 14 patients received mineralized bone allograft (control group) and 14 patients received a combination of mineralized bone allograft and DBM (experimental group). Patients were reviewed at a mean of 16.4 ± 2.2 months after surgery at which point CT scans were analyzed to determine whether fusion had occurred;Oswestry disability index (ODI) and pain were also evaluated. Results: A mean of 5 levels [min 2, max 13] were fused in these patients. Posterolateral fusion as defined by the Lenke classification was not significantly different between groups. The experimental DBM group had a significantly better composite fusion score than the control group (P Discussion: Adding DBM fibers to allograft bone during multilevel posterolateral spinal fusion was safe and produced better composite fusion than using allograft only as an autograft extender.展开更多
Like any organ in children, the ear has particular anatomical features that are well shown in imaging. The petrous bone computed tomography (CT) is a valuable tool for diagnosing ear pathologies and evaluating surgica...Like any organ in children, the ear has particular anatomical features that are well shown in imaging. The petrous bone computed tomography (CT) is a valuable tool for diagnosing ear pathologies and evaluating surgical possibilities. In children, the ear has the peculiarity of having the morphology and size of adults, and the only difference resides in the components of the middle and inner ear related to the growth of the temporal bone and the state of ossification which are progressive with age. Some aspects of growth can simulate pathology and must be known. The pneumatisation of the temporal bone occurs gradually after birth and in several outbreaks until adulthood. The external auditory canal, the internal auditory meatus and the petromastoid canal progressively reach the adult aspect because of the growth of the petrous bone. This work aims to highlight the particularities of the petrous bone CT in pediatrics, since it has become widely used in the exploration of malformations, trauma, infectious complications of the ear and in the assessment of deafness.展开更多
BACKGROUND: Fascia iliaca compartment nerve block(FICNB) has been an established technique for postoperative analgesia after surgery for femoral bone fracture. FICNB is technically easy, effective for postoperative pa...BACKGROUND: Fascia iliaca compartment nerve block(FICNB) has been an established technique for postoperative analgesia after surgery for femoral bone fracture. FICNB is technically easy, effective for postoperative pain control after operation for femoral bone fracture and decreases the complications induced by systemic analgesic drugs. The severity of postoperative pain is affected by genetics, cultural and social factors across the world. In this study we assessed the efficacy of fascia iliaca compartment nerve block when it is used as part of multimodal analgesia after surgery for femoral bone fracture.METHODS: An institution-based case control study was conducted from September, 2013 to May, 2014. All patients who had been operated on under spinal anesthesia for femoral bone fracture were included. The patients divided into a FICNB group(n=20) and a control group(n=20). The FICNB group was given 30 mL of 0.25% bupivacaine at the end of the operation. Postoperative pain was assessed within the f irst 24 hours, i.e. at 15 minutes, 2 hours, 6 hours, 12 hours and 24 hours using 100 mm visual analogue scale(VAS), total analgesic consumption, and the time for the f irst analgesic request.RESULTS: VAS pain scores were reduced within the f irst 24 hours after operation in the FICNB group compared wtih the control group. VAS scores at 2 hours were taken as median values(IQR) 0.00(0.00) vs.18.00(30.00), P=0.001; at 6 hours 0.00(0.00) vs. 34.00(20.75), P=0.000; at 24 hours 12.50(10.00) vs. 31.50(20.75), P=0.004; and at 12 hours(17.80±12.45) vs.(29.95±12.40), P=0.004, respectively. The total analgesic consumption of diclofenac at 12 and 24 hours was reduced in the FICNB group, and the time for the fi rst analgesic request was signifi cantly prolonged(417.50 vs. 139.25 minutes, P=0.000).CONCLUSIONS: A single injection for FICNB could lead to postoperative pain relief, reduction of total analgesic consumption and prolonged time for the fi rst analgesic request in the FICNB group after surgery for femoral bone fracture. We recommend FICNB for analgesia after surgery for femoral bone fracture and for patients with femoral bone fracture at the emergency department.展开更多
BACKGROUND Tranexamic acid(TXA)has been used as an anti-fibrinolytic drug for over half a century and has received much attention in recent decades.AIM To evaluate the efficacy of topical vs intravenous TXA in reducin...BACKGROUND Tranexamic acid(TXA)has been used as an anti-fibrinolytic drug for over half a century and has received much attention in recent decades.AIM To evaluate the efficacy of topical vs intravenous TXA in reducing blood loss and promoting wound healing in bone surgery.METHODS From the electronic resources,PubMed,Cochrane Library,Embase,ISI,and Scopus were used to perform a literature search over the last 10 years between 2010 and 2020.EndNote™X8 was used for managing the electronic resource.Searches were performed with mesh terms.The data were retracted blindly by two independent reviewers.Random effects were used to deal with potential heterogeneity and I2 showed heterogeneity.Chi-square(I2)tests were used to quantify the extent of heterogeneity(P<0.01 was considered statistically significant).The efficacy of topical TXA in reducing blood loss and promoting wound healing in bone surgery was compared with intravenous TXA and placebo.RESULTS According to the research design,1360 potentially important research abstracts and titles were discovered in our electronic searches,and 18 papers remained in agreement with our inclusion criteria.It was found that TXA reduced 277.51 mL of blood loss compared to placebo,and there was no significant difference between topical TXA and IV TXA in reducing blood loss in bone surgery.Our analyses also showed that TXA significantly reduced blood transfusion compared to placebo and there was no significant difference between topical TXA and IV TXA.CONCLUSION The use of both topical and intravenous TXA are equally effective in reducing blood loss in bone surgery,which might be beneficial for wound healing after surgery.展开更多
BACKGROUND Enhanced recovery after surgery(ERAS)was introduced in China in 2007.Over time,the scope of ERAS has expanded from abdominal surgery to orthopedics,urology and other fields.Continuous development and resear...BACKGROUND Enhanced recovery after surgery(ERAS)was introduced in China in 2007.Over time,the scope of ERAS has expanded from abdominal surgery to orthopedics,urology and other fields.Continuous development and research has contributed to progress of ERAS in China.In 2019,to promote the application of ERAS in bone tumor surgery,we formed the“Consensus of Experts on Perioperative Management of Accelerated Rehabilitation in Major Surgery of Bone Tumors in China”.AIM To evaluate the effect of enhanced recovery after bone tumor surgery in perioperative management in China.METHODS One hundred and seven patients who underwent bone tumor surgery at the Second Affiliated Hospital of Xi’an Jiaotong University between May 2019 and April 2021 were randomized into a study group(53 cases)and a control group(54 cases).The study group adopted the ERAS protocol and the control group adopted conventional care.Main outcome measures included postoperative length of stay(LOS),postoperative complications,mortality,and 30-d readmission rates.Secondary outcomes included postoperative visual analog scale(VAS)score of pain,number of blood transfusions,drainage volume in 24 h after operation,patient satisfaction 30 d after discharge,VAS score at 30 d after discharge,and daily standing walking time.RESULTS There were no significant differences in the baseline data,clinical features and surgical site between the two groups.The LOS in the study group with the ERAS protocol was 7.72±3.34 d compared with 10.28±4.27 d in the control group who followed conventional care.The incidence of postoperative nausea and vomiting(PONV)in the study group was 19%and 37%in the control group.The VAS scores of pain on postoperative day 1(POD1)and POD3 in the study group were 4.79±2.34 and 2.79±1.53 compared with 5.28±3.27 and 3.98±2.27 in the control group.The drainage volume in 24 h after the operation was 124.36±23.43 mL in the study group and 167.43±30.87 mL in the control group.The number of blood transfusions in the study group was also lower.The patient satisfaction rate was higher in the study group than in the control group.CONCLUSION The ERAS protocol in the perioperative period of bone tumor surgery can decrease LOS,PONV,and postoperative pain,blood transfusion and 24-h drainage,improve patient satisfaction and accelerate recovery.展开更多
The cortical bone trajectory(CBT) is a novel technique in lumbar fixation and fusion.The unique caudocephalad and medial-lateral screw trajectories endow it with excellent screw purchase for vertebral fixation via a m...The cortical bone trajectory(CBT) is a novel technique in lumbar fixation and fusion.The unique caudocephalad and medial-lateral screw trajectories endow it with excellent screw purchase for vertebral fixation via a minimally invasive method.The combined use of CBT screws with transforaminal or posterior lumbar interbody fusion can treat a variety of lumbar diseases,including spondylolisthesis or stenosis,and can also be used as a remedy for revision surgery when the pedicle screw fails.CBT has obvious advantages in terms of surgical trauma,postoperative recovery,prevention and treatment of adjacent vertebral disease,and the surgical treatment of obese and osteoporosis patients.However,the concept of CBT internal fixation technology appeared relatively recently;consequently,there are few relevant clinical studies,and the long-term clinical efficacy and related complications have not been reported.Therefore,large sample and prospective studies are needed to further reveal the long-term complications and fusion rate.As a supplement to the traditional pedicle trajectory fixation technique,the CBT technique is a good choice for the treatment of lumbar diseases with accurate screw placement and strict indications and is thus deserving of clinical recommendation.展开更多
Cancer patients with bone metastases in their extremities may require surgical intervention to prevent deterioration in their quality of life due to a pathological fracture or severe bone pain. However, curative surgi...Cancer patients with bone metastases in their extremities may require surgical intervention to prevent deterioration in their quality of life due to a pathological fracture or severe bone pain. However, curative surgical interventions sometimes have severe complications due to the status of the original cancers. To avoid the decreased quality of life caused by bone metastasis, minimally invasive surgery that avoids additional surgical morbidity is required. We have established two therapeutic treatments for bone metastasis, a photodynamic acridine orange treatment (AOT) and an electronic magnetic hyperthermia treatment (EMHT). The present study investigated the clinical outcomes of combination therapy with EMHT and AOT for patients with bone metastases in their extremities. Methods: The study included 6 patients with 7 bone cancer metastasis locations. For bone metastases, all patients received intraregional tumor excision supported by AOT, in which photodynamic and radiodynamic therapy kills tumor cells during surgery with minimal damage to normal tissues. After the curettage, bone reconstruction was performed by using magnetic materials with calcium phosphate cement. EMHT was repeatedly performed after surgery. In EMHT, tumor cells are killed with an electric magnetic field generator, and bony union is promoted by electronic stimulation. Results: The mean duration of follow-up was 14 months. During the follow-up period, only one patient experienced a local recurrence, and this recurrence occurred 14 months after surgery. Bony union occurred in 4 of 5 cases (80%), and the pain score was significantly reduced after surgery. Conclusions: In the present study, AOT reduced the invasiveness of surgery. EMHT reduced the tumor growth without major complications and promoted bone formation after surgery. Our clinical results confirmed that EMHT and AOT combination therapy for bone metastasis can preserve limb function without local recurrence or bone absorption.展开更多
Purpose: Bone marrow transplantation (BMT) and pre-treatment conditioning increases the risk of developing pediatric cataracts. We present the outcome of cataract surgery in children who have had BMT. Methods: We cond...Purpose: Bone marrow transplantation (BMT) and pre-treatment conditioning increases the risk of developing pediatric cataracts. We present the outcome of cataract surgery in children who have had BMT. Methods: We conducted a retrospective chart study with 15 BMT patients (28 eyes) who underwent cataract extraction between 2002 and 2012. Outcome measures include change in best corrected visual acuity (BCVA) and complications. Results: 7 (47%) patients had acute lymphoid leukemia, 3 (20%) had acute myeloid leukemia, 2 (13%) had myelodysplastic syndrome, 1 (7%) had Fanconi anemia, 1 (7%) had juvenile myelomonocytic leukemia, and 1 (7%) had adrenoleukodystrophy. Patients received BMT at a mean age of 3.9 ± 1.6 years. 12 (80%) patients received total body irradiation (TBI) and 3 of these 12 received cranial irradiation in addition to TBI;one (7%) received only cranial irradiation. Total body irradiation included head and eye exposure. Mean age of cataract surgery was 9.1 ± 2.3 years;mean follow-up was 55.9 ± 45.1 months. All cataracts were of posterior subcapsular subtype. Mean BCVA improved from 0.7 ± 0.4 logMAR to 0.3 ± 0.5 logMAR (p Conclusions: Children with history of BMT have a predisposition of developing posterior subcapsular cataracts and have a high rate of visually significant PCO if the posterior capsule is left intact at the time of cataract surgery.展开更多
An automatic markerless knee tracking and registration algorithm has been proposed in the literature to avoid the marker insertion required by conventional computer-assisted knee surgery,resulting in a shorter and les...An automatic markerless knee tracking and registration algorithm has been proposed in the literature to avoid the marker insertion required by conventional computer-assisted knee surgery,resulting in a shorter and less invasive surgical workflow.However,such an algorithm considers intact femur geometry only.The bone surface modification is inevitable due to intra-operative intervention.The mismatched correspondences will degrade the reliability of registered target pose.To solve this problem,this work proposed a supervised deep neural network to automatically restore the surface of processed bone.The network was trained on a synthetic dataset that consists of real depth captures of a model leg and simulated realistic femur cutting.According to the evaluation on both synthetic data and real-time captures,the registration quality can be effectively improved by surface reconstruction.The improvement in tracking accuracy is only evident over test data,indicating the need for future enhancement of the dataset and network.展开更多
[Basckground]This case report presented a methodology for immediate implantation in the esthetic zone with a facial bone defect along with flap surgery,guided bone regeneration,and non-submerged healing.[Case presenta...[Basckground]This case report presented a methodology for immediate implantation in the esthetic zone with a facial bone defect along with flap surgery,guided bone regeneration,and non-submerged healing.[Case presentation]A 27-year-old female patient was complaining of the aesthetic complication that was caused via metallic staining of the neck of ceramic crowns in the maxillary right anterior region for one year.She has experienced immediate implantation along with flap surgery,guided bone regeneration(GBR),and non-submerged healing.The torque of the implant reached to the 35 N·cm to confirm primary stability.Six months after surgery,the healing abutment and the implant were fixed,the gingiva was healthy in the surgical area,and the nearby teeth and the opposite teeth were normal.[Results]The results of cone-beam computer tomography(CBCT)revealed that bone defects were filled with the newly formed bone.At the same time,the final impressions accomplished,and an all-ceramic crown was fit-placed.As a whole,the patient satisfaction rate was high.[Conclusions]Immediate implant placement with flap surgery,GBR,and non-submerged healing with a facial bone wall defect in the esthetic zone is an achievable process.展开更多
Craniomaxillofacial surgery is difficult due to the complexity of the regional anatomy. Computer-assisted surgery is a promising tool aiming to improve the safety and precision of such surgery. A computer-assisted sur...Craniomaxillofacial surgery is difficult due to the complexity of the regional anatomy. Computer-assisted surgery is a promising tool aiming to improve the safety and precision of such surgery. A computer-assisted surgical navigation approach for reconstruction of mandibular defects using a patient-specific titanium mesh tray and particulate cancellous bone and marrow (PCBM) harvested from bilateral anterior ilia is proposed. This case report involves a large multicystic ameloblastoma affecting the right mandible of a 31-year-old male patient. Following detailed clinical examination, radiological interpretation, and histopathological diagnosis, computer-assisted surgical simulation with a virtual 3-dimensional (3-D) model was designed using surgical planning software based on the pre-operative computed tomography data. Long-span segmental resection of the mandible was planned, and the defect was analyzed for reconstruction using a patient-specific reconstruction titanium mesh tray mediated with computer-aided design and manufacturing (CAD/CAM) techniques. During the actual surgery, the ultrasonic bone cutting instrument in the surgeon’s hand was connected to the navigation system to touch an anatomical position on the patient. Therefore, osteotomies were performed finely and smoothly according to the navigation images of the cutting bone line by sequentially moving the instrument. Finally, a CAD/CAM-mediated titanium mesh tray condensed by PCBM was adapted to the remaining mandibular fragments. Six months postoperatively, the patient had a good mandibular configuration and facial contour. Integration of different technologies, such as software planning and 3-D surgical simulation, combined with intraoperative navigation and CAD/CAM techniques, provides safe and precise mandibular reconstruction surgery.展开更多
Because of its simplicity,reliability,and replicability,the Masquelet induced membrane technique(IMT)has become one of the preferred methods for critical bone defect reconstruction in extremities.Although it is now us...Because of its simplicity,reliability,and replicability,the Masquelet induced membrane technique(IMT)has become one of the preferred methods for critical bone defect reconstruction in extremities.Although it is now used worldwide,few studies have been published about IMT in military practice.Bone reconstruction is particularly challenging in this context of care due to extensive soft-tissue injury,early wound infection,and even delayed management in austere conditions.Based on our clinical expertise,recent research,and a literature analysis,this narrative review provides an overview of the IMT application to combat-related bone defects.It presents technical specificities and future developments aiming to optimize IMT outcomes,including for the management of massive multi-tissue defects or bone reconstruction performed in the field with limited resources.展开更多
Introduction: Iliac particulate cancellous bone and marrow (PCBM) is commonly used as a high-quality reconstruction material;however, PCBM cannot be extracted in sufficient amounts to meet demand. To determine the app...Introduction: Iliac particulate cancellous bone and marrow (PCBM) is commonly used as a high-quality reconstruction material;however, PCBM cannot be extracted in sufficient amounts to meet demand. To determine the appropriate amount of iliac PCBM to be collected, we used digital technology to measure the volume required for jaw reconstruction before surgery. Clinical Case: The patient, a 23-year-old man, underwent surgery for a calcifying odontogenic cyst. A maxillary cyst occupied the left anterior-premolar region (tooth 21 - 25) and the deciduous canine remained;a permanent canine was included in the cyst. We planned to preserve the teeth except for the impacted canine, completely excise the maxillary cyst, and preserve the alveolar ridge morphology. Preoperative digital imaging was used to determine the amount of alveolar ridge reconstruction required and accordingly determine the amount of iliac cancellous bone to be harvested. We used a titanium mesh tray and grafts of iliac particulate cancellous bone and marrow to reconstruct the alveolar ridge. The amount of iliac cancellous bone that needed to be collected was clarified and the supply amount could be collected in just the right amount;thus, the cortical bone of the iliac inner plate could be preserved. The alveolar bone morphology was reconstructed to allow the placement of dental implants as per the preoperative digital surgery. Three years after the operation, no sign of recurrence has been observed. Conclusion: Minimally invasive surgery was performed by clarifying the amount of iliac cancellous bone graft that needs to be harvested, which improved the accuracy of surgery.展开更多
BACKGROUND The use of advanced platelet-rich fibrin(A-PRF)membranes for guided bone and tissue regeneration in through-and-through defects after endodontic surgery was explored in three cases.CASE SUMMARY Herein,three...BACKGROUND The use of advanced platelet-rich fibrin(A-PRF)membranes for guided bone and tissue regeneration in through-and-through defects after endodontic surgery was explored in three cases.CASE SUMMARY Herein,three patients presented to the endodontic clinic suffering from apical periodontitis,associated with large bone resorption and related to previously endodontically treated teeth.Periapical surgery was indicated in these cases and the osteotomy site was covered by A-PRF membrane.Cone-beam computed tomography(CBCT)was used to assess the cases before and after the surgery.CONCLUSION Four months post-surgery,the recall CBCT scan showed complete obliteration of the osteotomy with newly formed bone.A-PRF membrane showed promising results and was an advantageous addition to surgical endodontic treatment.展开更多
The drilling process in orthopedic surgery can sometimes lead to an undesired increase in temperature,which can cause serious damage to bones and soft tissues.This overheating is typically identified as a temperature ...The drilling process in orthopedic surgery can sometimes lead to an undesired increase in temperature,which can cause serious damage to bones and soft tissues.This overheating is typically identified as a temperature above 47℃,known as the critical limit,and can result in the condition known as osteonecrosis.This study aims to develop a new control system,using a proportional-integral-derivative(PID)controller,to prevent overheating and the resulting osteonecrosis.The bone temperature is constantly measured using a thermocouple and,when it reaches the critical temperature of 47℃,the cooling device is activated by the PID-controlled system.This new control system makes the drill machine with cooling device more user-friendly and allows surgeons to set a desired temperature level manually.展开更多
文摘Particulate bone plays a crucial role in various oral and maxillofacial surgical procedures,including reconstruction,implantation,and craniofacial surgery.Autologous bone and deproteinized bovine bone xenografts are the two primary resources used for such procedures,with the former demonstrating superior cost-effectiveness and reduced comorbidity rates,particularly in cases involving donor zones.However,a significant challenge lies in acquiring uniformly sized autologous particulate bone specimens,with existing tools often yielding coarse particles at a high cost.Consequently,commercial bone xenograft solutions are frequently favored despite lower standards.This technical note introduces a novel technique for swiftly,safely,and efficiently obtaining autologous particulate bone specimens.The procedure involves the use of a motor handpiece fitted with a micro drill and surgical spoon to collect the bone particles.The continuous irrigation with saline maintains a clear surgical field during the milling process.The collected bone particles are then transferred to a metal capsule for further use.This technique offers a promising solution to the challenge of inconsistent particle size associated with harvesting using traditional methods,providing surgeons with a reliable and efficient method of obtaining autologous particulate bone samples.
文摘Introduction: While autograft bone is the gold standard for multilevel posterolateral lumbar fusion, bone substitutes and graft extenders such as allograft bone, ceramics and demineralized bone matrix (DBM) have been used to avoid the morbidity and insufficient quantity associated with harvesting autologous bone. The primary objective of this retrospective study was to determine whether, in patients with increased risk of operative nonunion related to multilevel fusion, adding DBM fibers to mineralized bone allograft resulted in better fusion than using allograft alone. The secondary objectives were to evaluate how adding DBM fibers affects functional disability, low back pain, intraoperative blood loss and the nonunion rate. Methods: This retrospective study involved a chart review of consecutive patients who underwent multilevel lumbar spinal fusion and were operated on by a single surgeon. The patients were divided into two groups: 14 patients received mineralized bone allograft (control group) and 14 patients received a combination of mineralized bone allograft and DBM (experimental group). Patients were reviewed at a mean of 16.4 ± 2.2 months after surgery at which point CT scans were analyzed to determine whether fusion had occurred;Oswestry disability index (ODI) and pain were also evaluated. Results: A mean of 5 levels [min 2, max 13] were fused in these patients. Posterolateral fusion as defined by the Lenke classification was not significantly different between groups. The experimental DBM group had a significantly better composite fusion score than the control group (P Discussion: Adding DBM fibers to allograft bone during multilevel posterolateral spinal fusion was safe and produced better composite fusion than using allograft only as an autograft extender.
文摘Like any organ in children, the ear has particular anatomical features that are well shown in imaging. The petrous bone computed tomography (CT) is a valuable tool for diagnosing ear pathologies and evaluating surgical possibilities. In children, the ear has the peculiarity of having the morphology and size of adults, and the only difference resides in the components of the middle and inner ear related to the growth of the temporal bone and the state of ossification which are progressive with age. Some aspects of growth can simulate pathology and must be known. The pneumatisation of the temporal bone occurs gradually after birth and in several outbreaks until adulthood. The external auditory canal, the internal auditory meatus and the petromastoid canal progressively reach the adult aspect because of the growth of the petrous bone. This work aims to highlight the particularities of the petrous bone CT in pediatrics, since it has become widely used in the exploration of malformations, trauma, infectious complications of the ear and in the assessment of deafness.
文摘BACKGROUND: Fascia iliaca compartment nerve block(FICNB) has been an established technique for postoperative analgesia after surgery for femoral bone fracture. FICNB is technically easy, effective for postoperative pain control after operation for femoral bone fracture and decreases the complications induced by systemic analgesic drugs. The severity of postoperative pain is affected by genetics, cultural and social factors across the world. In this study we assessed the efficacy of fascia iliaca compartment nerve block when it is used as part of multimodal analgesia after surgery for femoral bone fracture.METHODS: An institution-based case control study was conducted from September, 2013 to May, 2014. All patients who had been operated on under spinal anesthesia for femoral bone fracture were included. The patients divided into a FICNB group(n=20) and a control group(n=20). The FICNB group was given 30 mL of 0.25% bupivacaine at the end of the operation. Postoperative pain was assessed within the f irst 24 hours, i.e. at 15 minutes, 2 hours, 6 hours, 12 hours and 24 hours using 100 mm visual analogue scale(VAS), total analgesic consumption, and the time for the f irst analgesic request.RESULTS: VAS pain scores were reduced within the f irst 24 hours after operation in the FICNB group compared wtih the control group. VAS scores at 2 hours were taken as median values(IQR) 0.00(0.00) vs.18.00(30.00), P=0.001; at 6 hours 0.00(0.00) vs. 34.00(20.75), P=0.000; at 24 hours 12.50(10.00) vs. 31.50(20.75), P=0.004; and at 12 hours(17.80±12.45) vs.(29.95±12.40), P=0.004, respectively. The total analgesic consumption of diclofenac at 12 and 24 hours was reduced in the FICNB group, and the time for the fi rst analgesic request was signifi cantly prolonged(417.50 vs. 139.25 minutes, P=0.000).CONCLUSIONS: A single injection for FICNB could lead to postoperative pain relief, reduction of total analgesic consumption and prolonged time for the fi rst analgesic request in the FICNB group after surgery for femoral bone fracture. We recommend FICNB for analgesia after surgery for femoral bone fracture and for patients with femoral bone fracture at the emergency department.
文摘BACKGROUND Tranexamic acid(TXA)has been used as an anti-fibrinolytic drug for over half a century and has received much attention in recent decades.AIM To evaluate the efficacy of topical vs intravenous TXA in reducing blood loss and promoting wound healing in bone surgery.METHODS From the electronic resources,PubMed,Cochrane Library,Embase,ISI,and Scopus were used to perform a literature search over the last 10 years between 2010 and 2020.EndNote™X8 was used for managing the electronic resource.Searches were performed with mesh terms.The data were retracted blindly by two independent reviewers.Random effects were used to deal with potential heterogeneity and I2 showed heterogeneity.Chi-square(I2)tests were used to quantify the extent of heterogeneity(P<0.01 was considered statistically significant).The efficacy of topical TXA in reducing blood loss and promoting wound healing in bone surgery was compared with intravenous TXA and placebo.RESULTS According to the research design,1360 potentially important research abstracts and titles were discovered in our electronic searches,and 18 papers remained in agreement with our inclusion criteria.It was found that TXA reduced 277.51 mL of blood loss compared to placebo,and there was no significant difference between topical TXA and IV TXA in reducing blood loss in bone surgery.Our analyses also showed that TXA significantly reduced blood transfusion compared to placebo and there was no significant difference between topical TXA and IV TXA.CONCLUSION The use of both topical and intravenous TXA are equally effective in reducing blood loss in bone surgery,which might be beneficial for wound healing after surgery.
文摘BACKGROUND Enhanced recovery after surgery(ERAS)was introduced in China in 2007.Over time,the scope of ERAS has expanded from abdominal surgery to orthopedics,urology and other fields.Continuous development and research has contributed to progress of ERAS in China.In 2019,to promote the application of ERAS in bone tumor surgery,we formed the“Consensus of Experts on Perioperative Management of Accelerated Rehabilitation in Major Surgery of Bone Tumors in China”.AIM To evaluate the effect of enhanced recovery after bone tumor surgery in perioperative management in China.METHODS One hundred and seven patients who underwent bone tumor surgery at the Second Affiliated Hospital of Xi’an Jiaotong University between May 2019 and April 2021 were randomized into a study group(53 cases)and a control group(54 cases).The study group adopted the ERAS protocol and the control group adopted conventional care.Main outcome measures included postoperative length of stay(LOS),postoperative complications,mortality,and 30-d readmission rates.Secondary outcomes included postoperative visual analog scale(VAS)score of pain,number of blood transfusions,drainage volume in 24 h after operation,patient satisfaction 30 d after discharge,VAS score at 30 d after discharge,and daily standing walking time.RESULTS There were no significant differences in the baseline data,clinical features and surgical site between the two groups.The LOS in the study group with the ERAS protocol was 7.72±3.34 d compared with 10.28±4.27 d in the control group who followed conventional care.The incidence of postoperative nausea and vomiting(PONV)in the study group was 19%and 37%in the control group.The VAS scores of pain on postoperative day 1(POD1)and POD3 in the study group were 4.79±2.34 and 2.79±1.53 compared with 5.28±3.27 and 3.98±2.27 in the control group.The drainage volume in 24 h after the operation was 124.36±23.43 mL in the study group and 167.43±30.87 mL in the control group.The number of blood transfusions in the study group was also lower.The patient satisfaction rate was higher in the study group than in the control group.CONCLUSION The ERAS protocol in the perioperative period of bone tumor surgery can decrease LOS,PONV,and postoperative pain,blood transfusion and 24-h drainage,improve patient satisfaction and accelerate recovery.
基金Supported by The Joint Project of Chongqing Health Commission and Science and Technology Bureau,No.2022QNXM066The Top-notch Young Talent Project of Chongqing Traditional Chinese Medicine Hospital,No. CQSZYY2020008。
文摘The cortical bone trajectory(CBT) is a novel technique in lumbar fixation and fusion.The unique caudocephalad and medial-lateral screw trajectories endow it with excellent screw purchase for vertebral fixation via a minimally invasive method.The combined use of CBT screws with transforaminal or posterior lumbar interbody fusion can treat a variety of lumbar diseases,including spondylolisthesis or stenosis,and can also be used as a remedy for revision surgery when the pedicle screw fails.CBT has obvious advantages in terms of surgical trauma,postoperative recovery,prevention and treatment of adjacent vertebral disease,and the surgical treatment of obese and osteoporosis patients.However,the concept of CBT internal fixation technology appeared relatively recently;consequently,there are few relevant clinical studies,and the long-term clinical efficacy and related complications have not been reported.Therefore,large sample and prospective studies are needed to further reveal the long-term complications and fusion rate.As a supplement to the traditional pedicle trajectory fixation technique,the CBT technique is a good choice for the treatment of lumbar diseases with accurate screw placement and strict indications and is thus deserving of clinical recommendation.
文摘Cancer patients with bone metastases in their extremities may require surgical intervention to prevent deterioration in their quality of life due to a pathological fracture or severe bone pain. However, curative surgical interventions sometimes have severe complications due to the status of the original cancers. To avoid the decreased quality of life caused by bone metastasis, minimally invasive surgery that avoids additional surgical morbidity is required. We have established two therapeutic treatments for bone metastasis, a photodynamic acridine orange treatment (AOT) and an electronic magnetic hyperthermia treatment (EMHT). The present study investigated the clinical outcomes of combination therapy with EMHT and AOT for patients with bone metastases in their extremities. Methods: The study included 6 patients with 7 bone cancer metastasis locations. For bone metastases, all patients received intraregional tumor excision supported by AOT, in which photodynamic and radiodynamic therapy kills tumor cells during surgery with minimal damage to normal tissues. After the curettage, bone reconstruction was performed by using magnetic materials with calcium phosphate cement. EMHT was repeatedly performed after surgery. In EMHT, tumor cells are killed with an electric magnetic field generator, and bony union is promoted by electronic stimulation. Results: The mean duration of follow-up was 14 months. During the follow-up period, only one patient experienced a local recurrence, and this recurrence occurred 14 months after surgery. Bony union occurred in 4 of 5 cases (80%), and the pain score was significantly reduced after surgery. Conclusions: In the present study, AOT reduced the invasiveness of surgery. EMHT reduced the tumor growth without major complications and promoted bone formation after surgery. Our clinical results confirmed that EMHT and AOT combination therapy for bone metastasis can preserve limb function without local recurrence or bone absorption.
文摘Purpose: Bone marrow transplantation (BMT) and pre-treatment conditioning increases the risk of developing pediatric cataracts. We present the outcome of cataract surgery in children who have had BMT. Methods: We conducted a retrospective chart study with 15 BMT patients (28 eyes) who underwent cataract extraction between 2002 and 2012. Outcome measures include change in best corrected visual acuity (BCVA) and complications. Results: 7 (47%) patients had acute lymphoid leukemia, 3 (20%) had acute myeloid leukemia, 2 (13%) had myelodysplastic syndrome, 1 (7%) had Fanconi anemia, 1 (7%) had juvenile myelomonocytic leukemia, and 1 (7%) had adrenoleukodystrophy. Patients received BMT at a mean age of 3.9 ± 1.6 years. 12 (80%) patients received total body irradiation (TBI) and 3 of these 12 received cranial irradiation in addition to TBI;one (7%) received only cranial irradiation. Total body irradiation included head and eye exposure. Mean age of cataract surgery was 9.1 ± 2.3 years;mean follow-up was 55.9 ± 45.1 months. All cataracts were of posterior subcapsular subtype. Mean BCVA improved from 0.7 ± 0.4 logMAR to 0.3 ± 0.5 logMAR (p Conclusions: Children with history of BMT have a predisposition of developing posterior subcapsular cataracts and have a high rate of visually significant PCO if the posterior capsule is left intact at the time of cataract surgery.
文摘An automatic markerless knee tracking and registration algorithm has been proposed in the literature to avoid the marker insertion required by conventional computer-assisted knee surgery,resulting in a shorter and less invasive surgical workflow.However,such an algorithm considers intact femur geometry only.The bone surface modification is inevitable due to intra-operative intervention.The mismatched correspondences will degrade the reliability of registered target pose.To solve this problem,this work proposed a supervised deep neural network to automatically restore the surface of processed bone.The network was trained on a synthetic dataset that consists of real depth captures of a model leg and simulated realistic femur cutting.According to the evaluation on both synthetic data and real-time captures,the registration quality can be effectively improved by surface reconstruction.The improvement in tracking accuracy is only evident over test data,indicating the need for future enhancement of the dataset and network.
文摘[Basckground]This case report presented a methodology for immediate implantation in the esthetic zone with a facial bone defect along with flap surgery,guided bone regeneration,and non-submerged healing.[Case presentation]A 27-year-old female patient was complaining of the aesthetic complication that was caused via metallic staining of the neck of ceramic crowns in the maxillary right anterior region for one year.She has experienced immediate implantation along with flap surgery,guided bone regeneration(GBR),and non-submerged healing.The torque of the implant reached to the 35 N·cm to confirm primary stability.Six months after surgery,the healing abutment and the implant were fixed,the gingiva was healthy in the surgical area,and the nearby teeth and the opposite teeth were normal.[Results]The results of cone-beam computer tomography(CBCT)revealed that bone defects were filled with the newly formed bone.At the same time,the final impressions accomplished,and an all-ceramic crown was fit-placed.As a whole,the patient satisfaction rate was high.[Conclusions]Immediate implant placement with flap surgery,GBR,and non-submerged healing with a facial bone wall defect in the esthetic zone is an achievable process.
文摘Craniomaxillofacial surgery is difficult due to the complexity of the regional anatomy. Computer-assisted surgery is a promising tool aiming to improve the safety and precision of such surgery. A computer-assisted surgical navigation approach for reconstruction of mandibular defects using a patient-specific titanium mesh tray and particulate cancellous bone and marrow (PCBM) harvested from bilateral anterior ilia is proposed. This case report involves a large multicystic ameloblastoma affecting the right mandible of a 31-year-old male patient. Following detailed clinical examination, radiological interpretation, and histopathological diagnosis, computer-assisted surgical simulation with a virtual 3-dimensional (3-D) model was designed using surgical planning software based on the pre-operative computed tomography data. Long-span segmental resection of the mandible was planned, and the defect was analyzed for reconstruction using a patient-specific reconstruction titanium mesh tray mediated with computer-aided design and manufacturing (CAD/CAM) techniques. During the actual surgery, the ultrasonic bone cutting instrument in the surgeon’s hand was connected to the navigation system to touch an anatomical position on the patient. Therefore, osteotomies were performed finely and smoothly according to the navigation images of the cutting bone line by sequentially moving the instrument. Finally, a CAD/CAM-mediated titanium mesh tray condensed by PCBM was adapted to the remaining mandibular fragments. Six months postoperatively, the patient had a good mandibular configuration and facial contour. Integration of different technologies, such as software planning and 3-D surgical simulation, combined with intraoperative navigation and CAD/CAM techniques, provides safe and precise mandibular reconstruction surgery.
文摘Because of its simplicity,reliability,and replicability,the Masquelet induced membrane technique(IMT)has become one of the preferred methods for critical bone defect reconstruction in extremities.Although it is now used worldwide,few studies have been published about IMT in military practice.Bone reconstruction is particularly challenging in this context of care due to extensive soft-tissue injury,early wound infection,and even delayed management in austere conditions.Based on our clinical expertise,recent research,and a literature analysis,this narrative review provides an overview of the IMT application to combat-related bone defects.It presents technical specificities and future developments aiming to optimize IMT outcomes,including for the management of massive multi-tissue defects or bone reconstruction performed in the field with limited resources.
文摘Introduction: Iliac particulate cancellous bone and marrow (PCBM) is commonly used as a high-quality reconstruction material;however, PCBM cannot be extracted in sufficient amounts to meet demand. To determine the appropriate amount of iliac PCBM to be collected, we used digital technology to measure the volume required for jaw reconstruction before surgery. Clinical Case: The patient, a 23-year-old man, underwent surgery for a calcifying odontogenic cyst. A maxillary cyst occupied the left anterior-premolar region (tooth 21 - 25) and the deciduous canine remained;a permanent canine was included in the cyst. We planned to preserve the teeth except for the impacted canine, completely excise the maxillary cyst, and preserve the alveolar ridge morphology. Preoperative digital imaging was used to determine the amount of alveolar ridge reconstruction required and accordingly determine the amount of iliac cancellous bone to be harvested. We used a titanium mesh tray and grafts of iliac particulate cancellous bone and marrow to reconstruct the alveolar ridge. The amount of iliac cancellous bone that needed to be collected was clarified and the supply amount could be collected in just the right amount;thus, the cortical bone of the iliac inner plate could be preserved. The alveolar bone morphology was reconstructed to allow the placement of dental implants as per the preoperative digital surgery. Three years after the operation, no sign of recurrence has been observed. Conclusion: Minimally invasive surgery was performed by clarifying the amount of iliac cancellous bone graft that needs to be harvested, which improved the accuracy of surgery.
基金Supported by the Princess Nourah Bint Abdulrahman University Researchers Supporting Project,No.PNURSP2023R363.
文摘BACKGROUND The use of advanced platelet-rich fibrin(A-PRF)membranes for guided bone and tissue regeneration in through-and-through defects after endodontic surgery was explored in three cases.CASE SUMMARY Herein,three patients presented to the endodontic clinic suffering from apical periodontitis,associated with large bone resorption and related to previously endodontically treated teeth.Periapical surgery was indicated in these cases and the osteotomy site was covered by A-PRF membrane.Cone-beam computed tomography(CBCT)was used to assess the cases before and after the surgery.CONCLUSION Four months post-surgery,the recall CBCT scan showed complete obliteration of the osteotomy with newly formed bone.A-PRF membrane showed promising results and was an advantageous addition to surgical endodontic treatment.
基金supported by the Department of Scientific Research Project Unit at Kocaeli University under the project number of 2012/44.
文摘The drilling process in orthopedic surgery can sometimes lead to an undesired increase in temperature,which can cause serious damage to bones and soft tissues.This overheating is typically identified as a temperature above 47℃,known as the critical limit,and can result in the condition known as osteonecrosis.This study aims to develop a new control system,using a proportional-integral-derivative(PID)controller,to prevent overheating and the resulting osteonecrosis.The bone temperature is constantly measured using a thermocouple and,when it reaches the critical temperature of 47℃,the cooling device is activated by the PID-controlled system.This new control system makes the drill machine with cooling device more user-friendly and allows surgeons to set a desired temperature level manually.