ObjectiveTo investigate and assess the value and efficiency of percutaneous transluminal angioplasty (PTA) for the treatment of infrapopliteal arteriosclerosis obliterans in diabetic patients. MethodsFifty-one diabetic patients with infrapopliteal arteriosclerosis obliterans undergoing PTA in our department from January 2010 to January 2013 were included in this study. Among them, 43 patients were followed up for 2 years. Based on the Fontaine stage, we analyzed their ankle-brachial index (ABI) before and after surgery. The curative effects were evaluated. ResultsThe PTA success rate and clinical symptoms remission rate in Fontaine stage Ⅱ, Ⅲ, and Ⅳ group was 96.2% (25/26), 83.3% (15/18), and 42.9% (3/7), respectively. The success rate for stage Ⅱ patients was significantly higher than that for stage Ⅲ and stage Ⅳ patients (P<0.05). ABI ranged from 0.60±0.11 before surgery to 0.86±0.09, 0.85±0.08, 0.84±0.07, and 0.83±0.08, 3, 6, 12, and 24 months after surgery respectively. Paired t-test showed the difference was statistically significant (P<0.01). There were 9 cases of recurrence during the follow-up. ConclusionPTA is a safe and effective method for diabetic patients with infrapopliteal arteriosclerosis obliterans, and it can improve the patients' clinical symptoms. We can obtain a satisfactory effect in a short term, but the evaluation of long-term effect needs further follow-up.
Objective To explore the feasibility and the effectiveness of the accurate placement of lumbar pedicle screws using three-dimensional (3D) printing navigational templates in Quadrant minimally invasive system. Methods The L1-5 spines of 12 adult cadavers were scanned using CT. The 3D models of the lumbar spines were established. The screw trajectory was designed to pass through the central axis of the pedicle by using Mimics software. The navigational template was designed and 3D-printed according to the bony surface where the soft tissues could be removed. The placed screws were scanned using CT to create the 3D model again after operation. The 3D models of the designed trajectory and the placed screws were registered to evaluate the placed screws coincidence rate. Between November 2014 and November 2015, 31 patients with lumbar instability accepted surgery assisted with 3D-printing navigation module under Quadrant minimally invasive system. There were 14 males and 17 females, aged from 42 to 60 years, with an average of 45.2 years. The disease duration was 6-13 months (mean, 8.8 months). Single segment was involved in 15 cases, two segments in 13 cases, and three segments in 3 cases. Preoperative visual analogue scale (VAS) was 7.59±1.04; Oswestry disability index (ODI) was 76.21±5.82; and the Japanese Orthopaedic Association (JOA) score was 9.21±1.64. Results A total of 120 screws were placed in 12 cadavers specimens. The coincidence rate of placed screw was 100%. A total of 162 screws were implanted in 31 patients. The operation time was 65-147 minutes (mean, 102.23 minutes); the intraoperative blood loss was 50-116 mL (mean, 78.20 mL); and the intraoperative radiation exposure time was 8-54 seconds (mean, 42 seconds). At 3-7 days after operation, CT showed that the coincidence rate of the placed screws was 98.15% (159/162). At 4 weeks after operation, VAS, ODI, and JOA score were 2.24±0.80, 29.17±2.50, and 23.43±1.14 respectively, showing significant differences when compared with preoperative ones (t=14.842,P=0.006;t=36.927,P=0.002;t=–36.031,P=0.001). Thirty-one patients were followed up 8-24 months (mean, 18.7 months). All incision healed by first intention, and no complication occurred. During the follow-up, X-ray film and CT showed that pedicle screw was accurately placed without loosening or breakage, and with good fusion of intervertebral bone graft. Conclusion 3D-printing navigational templates in Quadrant minimally invasive system can help lumbar surgery gain minimal invasion, less radiation, and accurate placement.