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取对侧大隐静脉移植桥接治疗腘动脉外膜囊肿一例

虚拟现实技术联合电磁导航手术机器人辅助治疗复杂骨盆骨折一例

EFFECTIVENESS OF REPAIRING OR RECONSTRUCTING DEFECTS OF FOREFOOT

ObjectiveTo evaluate the effectiveness of repairing or reconstructing defects of the forefoot. MethodsBetween February 2006 and February 2013, 57 patients with defects of the forefoot were treated. There were 41 males and 16 females with an average age of 38.9 years (range, 19-68 years). The disease causes included motor vehicles crush injury in 28 cases, crashing injury in 17 cases, and machine extrusion injury in 12 cases. The left side was involved in 25 cases and the right side in 32 cases, with a mean disease duration of 4.7 hours (range, 0.5-75.0 hours). Defect located at the 1st metatarsus in 9 cases, at the 5th metatarsus in 8 cases, at the 1st and the 2nd metatarsus in 16 cases, at the 4th and 5th metatarsus in 11 cases, at multiple metatarsus and the forefoot in 13 cases. The bone defect ranged from 2.5 cm×1.9 cm×1.4 cm to 13.3 cm×11.2 cm×2.7 cm. The soft tissue defect ranged from 12.4 cm×6.3 cm to 27.2 cm×18.7 cm. The iliac bone or vascularized iliac bone or vascularized fibula bone was used to rebuild the arch of the foot, and free flap was used to repair defects of the forefoot. The donor site was sutured directly or covered with skin graft. ResultsVenous crisis and partial necrosis occurred in 3 and 2 flaps respectively, which healed after symptomatic treatment. The other flaps and grafted skins survived, and wounds healed primarily. Fifty-one cases were followed up 1.5-2.5 years (mean, 2.1 years). The appearance was excellent and the feeling of the flap recovered at different levels. The two-point discrimination was 8.4-19.8 mm (mean, 13.7 mm) at 1.5 years after operation. According to upper extremity functional evaluation standard by hand surgery branch of Chinese Medical Association, sensation recovered to S2 in 6 cases, to S3 in 18 cases, and to S4 in 27 cases. The patients began to walk with weight loading at 2-6 months after operation (mean, 3.9 months). The bone healing time was 3-6 months (mean, 4.2 months). Based on American Orthopaedic Foot and Ankle Society (AOFAS) standards, the results were excellent in 19 cases, good in 24 cases, fair in 7 case, and poor in 1 case, and the excellent and good rate was 84.3%. ConclusionIt is a good solution to treat defects of the forefoot to use iliac bone or vascularized iliac bone or vascularized fibula bone for rebuilding the arch of the foot and use free flap for repairing defect.

增强现实技术联合 3-D 打印技术行半椎体置换治疗椎体肿瘤一例

目的 总结增强现实（augmented reality，AR）技术联合 3-D 打印技术行半椎体置换治疗椎旁巨大神经鞘膜瘤 1 例经验。 方法 2017 年 3 月收治 1 例 66 岁男性椎旁巨大神经鞘膜瘤患者。术前 CT 增强扫描显示，脊柱腰骶部右侧旁盆腔内见一 8.9 cm×7.8 cm×7.6 cm 大小的不均匀明显强化肿块。利用 Mimics 软件处理 CT 扫描数据，模拟手术切除肿瘤，设计 L5、S1 椎体模型，并 3-D 打印钛合金椎体。术中术者佩戴导入了术前重建 AR 影像的 Hololens 眼镜，彻底切除肿瘤后，植入打印钛合金椎体。 结果 患者手术顺利完成，手术时间 245 min，术中出血量约 1 200 mL。术后病理检查结果示：（腹膜后脊柱旁）神经鞘瘤。术后 6 个月随访，患者疼痛视觉模拟评分（VAS）由术前 5 分降至 2 分；X 线片及 CT 复查示钛金属椎体呈部分骨性融合，位置良好，无断裂、脱出，椎体无塌陷。 结论 应用 AR 技术辅助肿瘤切除，联合 3-D 打印假体置换治疗椎旁巨大肿瘤可行。