ObjectiveTo introduce the application of Photoshop CS16.0 (PS) software in preoperative osteotomy design of ankylosing spondylitis kyphosis (ASK), and to investigate applied values of the preoperative design. MethodsBetween March 2009 and March 2013, 21 cases of ASK were treated through preoperative osteotomy design by using PS software. There were 16 males and 5 females, aged from 23 to 50 years (mean, 34.2 years). The deformity included thoracolumbar kyphosis in 14 cases, thoracic kyphosis in 2 cases, and lumbar kyphosis in 5 cases. The ultimate osteotomy angle of preoperative plans and the location and extent of osteotomy were determined by the osteotomy design, which guided operation procedures of the surgeon. The actual osteotomy angle was obtained by measuring Cobb angle of osteotomy segment before and after operation. The sagittal parameters of spine and pelvis including global kyphosis (GK), lumbar lordosis (LL), sagittal vertical axis (SVA), pelvic incidence (PI), pelvic tilt (PT), and chin brow-vertical angle (CBVA) were measured at preoperation, at 1 week after operation, and last follow-up. The clinical outcomes were assessed by simplified Chinese Scoliosis Research Society-22 (SRS-22) questionnaire and Oswestry disability index (ODI). ResultsNo complications occurred in the other cases except 1 case of dural tear during operation and 1 case of nerve injury after operation, and primary healing of incision was obtained. All patients were followed up 14 to 45 months (mean, 26.3 months). The SRS-22 and ODI scores at 1 week after operation and last follow-up were significantly improved when compared with preoperative scores (P<0.05), but no significant difference was found between at 1 week and last follow-up (P>0.05). The preoperative planned osteotomy angle and the postoperative actual osteotomy angle were (34.2±10.5)° and (33.7±9.7)° respectively, showing no significant difference (t=0.84, P=0.42). The CBVA, GK, SVA, PT, and LL were significantly improved when compared with the preoperative values (P<0.05), but no significant difference was found between at 1 week and last follow-up (P>0.05). At last follow-up, no failures of internal fixation was found, and bony fusion was obtained. ConclusionThe preoperative osteotomy design by using PS software can precisely recover the spinal sagittal balance and horizontal angle of view, so it can effectively avoid excessive correction and insufficient correction of the deformity and obtain good effectiveness in treating ASK.
Objective To prepare cationic Vancomycin hydrochloride multivesicular liposome (MVL) and to inspect its quality. Methods Cationic Vancomycin hydrochloride MVLs were prepared by double emulsion method, and the storing solution of Vancomycin was prepared. The analysis method of Vancomycin in vitro was established; the specificity, precision, and resorption rate were estimated. Reverse phase high performance liquid chromatography (RP-HPLC) was used to determine the concentration of Vancomycin, encapsulation efficiency, and release characteristics in vitro. The formulation and pharmaceutical process were optimized by single factor experiments and orthogonal experimental design with the factor of encapsulation efficiency as the criteria. The liposome morphology was observed by optical microscopy and transmission electron microscopy. The particle size and Zeta potential were determined by Malvern instrument. The stability was analyzed by dynamic analysis. Results An RP-HPLC method was established for the assay of Vancomycin. The analysis method was precise, simple, and reliable for the quality control of Vancomycin. Vancomycin hydrochloride MVLs were round and well-distributed. The average particle size and the encapsulation efficiency were 3.3 μm and 24.9%, respectively. Zeta potential was 24.53 mV, and 90.5% of Vancomycin hydrochloride was released after 264 hours in normal saline under 37℃. Cationic Vancomycin MVLs were stored for 1 month at 4 ℃, which mantained good stability. Conclusion Cationic Vancomycin hydrochloride MVLs have good appearance, high encapsulation efficiency, good stability, and significant sustained release properties.
【Abstract】 Objective To evaluate the feasibility and effectiveness of reconstruction of mandibular bone defects using three-dimensional skull model and individualized titanium prosthetics from computer assisted design. Methods Between July 2002 and November 2009, 9 patients with mandibular defects accepted restorative operation using individualized bone prosthetics. Among 9 cases, 4 were male and 5 were female, aged 19-55 years. The causes of mandibulectomy were benign lesions in 8 patients and carcinoma of gingival in 1 patient. Mandibular defects exceeded midline in 2 cases, involved condylar in 4 cases, and was limited in one side without involvement of temporo-mandibular joint in 3 cases. The range of bone defects was 9.0 cm × 2.5 cm-17.0 cm × 2.5 cm. The preoperative spiral CT scan was performed and three-diamensional skull model was obtained. Titanium prosthetics of mandibular defects were designed and fabricated through multi-step procedure of reverse engineering and rapid prototyping. Titanium prosthetics were used for one-stage repair of mandibular bone defects, then two-stage implant denture was performed after 6 months. Results The individualized titanium prosthetics were inserted smoothly with one-stage operative time of 10-23 minutes. All the cases achieved incision healing by first intention and the oblique mandibular movement was corrected. They all got satisfactory face, had satisfactory contour and good occlusion. In two-stage operation, no loosening of the implants was observed and the abutments were in good position with corresponding teeth which were designed ideally before operation. All cases got satisfactory results after 1-9 years of follow-up. At last follow-up, X-ray examinations showed no loosening of implants with symmetry contour. Conclusion Computer assisted design and three-dimensional skull model techniques could accomplish the design and manufacture of individualized prosthetic for the repair of mandibular bone defects.
Objective To investigate the value of computer-aided design (CAD) in defining the resection boundary, reconstructing the pelvis and hip in patients with pelvis tumors. Methods Between November 2006 and April 2009, 5 cases of pelvis tumors were treated surgically using CAD technology. There were 3 males and 2 females with an average age of 36.4 years (range, 24-62 years). The cause was osteosarcoma, giant cell tumor of bone, and angiosarcoma in 1 case, respectively,and chondrosarcoma in 2 cases. According to the Enneking system for staging benign and mal ignant musculoskeletal tumors, regions I, I + II, III, IV, and I + IV is in 1 case, respectively. According to the principle of reverse engineering, 5 patients with pelvis tumors were checked with lamellar CT/MRI scanning, whose two-dimensional data were obtained in disease area. The three-dimensional reconstruction of pelvic anatomical model, precise resection boundary of tumor, individual surgical template, individual prosthesis, and surgical simulation were precisely made by computer with CAD software. Based on the proposal of CAD, the bone tumor was resected accurately, and allograft il ium with internal fixation instrument or allogeneic il ium with personal ized prosthetic replacement were used to reconstruct the bone defect after tumor was resected. Results The operation was successfully performed in 5 cases. The average operation time was 7.9 hours, and the average blood loss was 3 125 mL. Hemorrhage and cerebrospinal fluid leakage occurred in 1 case, respectively, and were cured after debridement. Five patients were followed up from 24 to 50 months (mean, 34.5 months). All patients began non-weight bearing walk with double crutches at 4-6 weeks after operation, and began walk at 3-6 months after operation. Local recurrence developed in 2 patients at 18 months after operation, and resection and radiotherapy were performed. According to International Society of Limb Salvage criteria for curative effectiveness of bone tumor l imb salvage, the results were excellent in 2 and good in 3. Conclusion The individual surgical template, individual prosthesis, and surgical simulation by CAD ensure the precision and rel iabil ity of pelvis tumors resection. The CAD technology promotes pelvis tumor resection and the reconstruction of pelvis to individual treatment stage, and good curative effectiveness can be obtained.
Objective?To introduce a new method of flap design and to investigate the feasibility of the clinical application.?Methods?Between April 2006 and November 2009, 89 patients with skin and soft tissue defects were treated. There were 47 males and 42 females with an average age of 36 years (range, 16-67 years). The injuries were caused by machine crush (38 cases), electric saw (16 cases), electricity (8 cases), traffic accident (18 cases), rolling machine (3 cases), and crash of heavy object (6 cases). The locations were forearm in 4 cases, palm in 23 cases, finger in 41 cases, lower leg in 7 cases, and dorsum of foot in 14 cases. All the cases complicated by exposure of tendons or bones. The time from injury to hospitalization was 30 minutes to 5 days (mean, 3 hours). The areas of skin and soft tissue defect ranged from 2.0 cm × 1.5 cm to 26.0 cm × 18.0cm. The wounds were repaired with the pedicle flaps in 72 cases and the free flaps in 17 cases. All the flaps were designed with eight-point-location method. A trapezoid was made in the raw surface and the four vertexes of the trapezoid were on the edge of the raw surface. The exterior points of the heights of arciforms were made on the edge of the raw surface too. The eight points were the labelling points. The top width, the bottom width, the height of the trapezoid, and the heights of the arciforms could be measured. The above numerus were expanded 5%-10%. The expanded numerus were the corresponding numerus of the skin flap. The size of flaps ranged from 2.2 cm × 1.7 cm to 28.5 cm × 19.5cm. The donor sites were closed directly in 17 cases, and repaired with skin grafts in 72 cases.?Results?All the flaps were successfully dissected according to flap design. When the flaps were transplanted to the wounds, tension of the flaps was appropriate. All the flaps and skin grafts survived. The wounds and incisions at donor sites healed by first intention. Eighty-nine patients were followed up 6 to 26 months (mean, 20 months). The texture, appearance, flexibility, and function of the flaps were satisfactory, and no complication occurred. The sensory restoration of the pedicle flaps were graded as S3-S4.?Conclusion?It is an ideal and simple method to design flap using eight-point-location method. The flaps are precise in the figure and area.
Objective To summarize and analyze the operation-correlated compl ications of total knee arthroplasty (TKA)with posterior stabil ized prosthesis (PS). Methods From October 2000 to October 2007, 707 cases (816 knees) underwent TKA. All the TKA knees were divided equally into former and latter groups according to the operation time (408 knees for each group). In the former group (October 2000 to January 2005, n=350), there were 63 males (84 knees) and 287 females (324 knees), aging (63.5 ± 7.8) years. A total of 198 left knees affected and 210 right knees affected; 292 single kneesaffected and 58 both knees affected. There were 304 knees of osteoarthritis, 84 knees of rheumatoid arthritis and 20 knees of other disease. The disease course was (9.3 ± 5.6) years. The knee range of motion (ROM) was (97.2 ± 8.7)°, the HSS score was 47.4 ± 12.2. In the latter group (January 2005 to October 2007, n=357), there were 77 males (92 knees) and 280 females (316 knees), aging (62.7 ± 6.3) years. A total of 221 left knees affected and 187 right knees affected; 306 single knees affected and 51 both knees affected. There were 278 knees of osteoarthritis, 109 knees of rheumatoid arthritis and 21 knees of other disease. The disease course was (8.6 ± 5.1) years. The knee ROM was (101.1 ± 10.3)°, the HSS score was 49.3 ± 11.2. We modified the method of lateral patellar retinaculum release and used a new femoral rotational al ignment technique in the latter group. The intraoperative and postoperative compl ications were divided into mild, moderate and severe. The HSS score, ROM and compl ications of the knee were compared and analyzed statistically during the follow-up. Results The former group was followed up 5.3 years (1 to7 years), compl ications occurred in 278 knees (68.1%), including mild in 136 knees (33.3%), moderate in 135 knees (33.1%) and severe in 7 knees (1.7%). The latter group was followed up 2.1 years (0.5 to 3.5 years), compl ications occurred in 159 knees (39.0%), including mild in 111 knees (27.2%), moderate in 47 knees (11.5%) and severe in 1 knee (0.2%), and there was significant difference between them (P lt; 0.001). There was significant difference in increased ROM between the former group (6.0 ± 3.7)° and the latter group (14.4 ± 4.2)° after operation (P lt; 0.05). There was significant difference in increased HSS score between the former group (36.9 ± 3.7)and the latter group (44.0 ± 4.2) after operation (P lt; 0.05). Conclusion The TKA is a complex operation with innumerable potential compl ications. To accumulate operative experience and improve surgical skills are the key points to reduce the operation-correlated compl ications.
Objective To summarize the clinical outcome of the Ribbed anatomic cementless total hip arthroplasty (THA) in the treatment of hip-joint disease. Methods From January 2001 to June 2005, 34 patients(38 hips) with hip-joint disease were treated with Ribbed anatomic cementless THA. Their ages ranged from 29 to 55 years with an average age of 42.7 years.The disease course was from 3 to 18 years. Among these cases, there were 7 cases (7 hips) of femoral neck fracture, 5 cases(5 hips) of traumatic arthritis after fracture of acetabulum, 15 cases(16 hips) of necrosis of the femoral head and 7 cases(10 hips) of ankylosing spondylitis. Four patients were operated on both hip joints. The average Harris hip score was 38.6(25-57) before operation. Results Twenty-one patients(23 hips) were followed up 861 months with an average of 35 months. The Harris hip score was 76-98 after operation with an average of 92.3, showing significant difference when compared with that before operation(Plt;0.05). The excellent and good result was achieved in 93.5 % of patients. Radiographs showed no prosthetic osteolysis and no evidence of loosening. Pain in the thigh occurred in 4 patients,and it can be relieved by using nonsteroid antiinflammatory drug. Conclusion Ribbed anatomic cementless THA has good clinical and radiographic results in treating patients with hip-joint disease.
Objective To improve the fitness and initial fixation strength between the hip and bone and to optimize the shape of the prosthetic implants. Methods The cross-section of hip canal was automatically extracted by Image processing. By using taper curve fit,hypocurve predigesting and the curve of shape center fit, the parameters of long-short diameter and the curve of shape center were got to design the hip shape.CAD was adopted to analyze and evaluate the configuration of bone and shape of hip.The “peg-in-hole” was employed to optimize the shape of implant by the visual test of “Drawingout” in computer. Results 23.2% hip-bone average matching rate and 0.033% bone damage rate were presented by CAD analysis. The implant extraction path were validated visually and quantitatively by measuring the maximum amount of overlap in the path configuration. Conclusion The valuable method for prothsetic hip design was presented by the way of image processing,graphics design and optimizingdesign in this study.
Objective To investigate the closing method of wound after removalof the traditional pedicled abdominal flap. Methods Accordingto the design,the pedicled abdominal flaps were cut and lifted, and then the incision were extended from both sides on base of the flap to anterior superior iliac spine, respectively. After separating on superficial fascia, two flaps were obtained. The wound of donor site was closed completely by these two pedicled flaps. Twelvepatients with skin defects on hands or forearms were treated using the reformedmethod of traditional pedicled abdominal flap. Results All of the 12 reformed pedicled abdominal flaps survived, and only one had local necrosis on the distalpart of the abdominal flap, about 1.5 cm ×2.0 cm. Conclusion This new designcould provide a good method to close the abdominal wound after removal of pedicled abdominal flap.
Objective To design a new custom-made artificial semi-knee joint based on rapid prototyping(RP) technique and to explore a method to solve necroses of allocartilage in hemi-joint allotransplantation. Methods Based on the extracted 3D contour image of the articular cartilage of femoral condyle, the custom-made artificial semi-knee joint was designed with Surfacer 9.0 image processingsoftware. The artificial semi-knee joint design used the femoral condylar 3D contour of the patient as the outer face and the subchondral bone 3D contour of allograft bone as inner face. One dado for medullary nailand two for special designing cages which were used to fix the cartilage into the allograft were added on the inner face. After being converted into RP data format, the computerassisted design was imported into the LPS600 rapid prototyping machine, and the prototype was achieved. Furthermore, the prototype could be modified by hand according to the design. Then the RP model was used as a positive mould to build up a silica gel negativemould, and the negative mould was sent to the factory to manufacture Ti-6Al-4V alloy articular cartilage through ordinary mould-melted founding process. Finally, the whole metal cartilage was completed after melting two special cages on it andpolishing it. Results A new custom-made artificial semi-knee joint was made ad used to treat a 14-year old patient. The custom-made artificial semi-knee joint and the subchondral bone were a perfect match. The operative result was satisfactory. The patient could walk 5 weeks after operation. The bone healing of the auto-bone and allo-bone was achieved 6 months later. A follow-up period lasting 1 yearshowed that the knee joint played a good function. Conclusion The artificial semi-knee joint is a good match for the allograft boneand a good idea to solve necroses of allocartilage in hemijoint allotransplantation.