Objective To discuss the measurement of bone tumor volume on the basis of three dimensional images segmentation technology. Methods Twenty patients with lacunar bone tumor from Tianjin Hospital and Tongji Hospital wer...Objective To discuss the measurement of bone tumor volume on the basis of three dimensional images segmentation technology. Methods Twenty patients with lacunar bone tumor from Tianjin Hospital and Tongji Hospital were included in the展开更多
BACKGROUND Percutaneous transhepatic biliary drainage(PTBD)is one of the primary clinical treatment options for patients with obstructive jaundice.In recent years,PTBD assisted by three-dimensional(3D)reconstruction t...BACKGROUND Percutaneous transhepatic biliary drainage(PTBD)is one of the primary clinical treatment options for patients with obstructive jaundice.In recent years,PTBD assisted by three-dimensional(3D)reconstruction technology has been widely implemented,but its advantages over traditional methods remains inconclusive.Thus,a discussion is warranted.AIM To explore the safety and efficacy of 3D reconstruction technology-assisted PTBD.METHODS We systematically searched the databases including the Cochrane Library,PubMed,EMBASE,Web of Science and China National Knowledge Infrastructure.The search period extended from the establishment of each database to November,2024.We screened the literature according to predefined inclusion and exclusion criteria,assessed the quality of the studies,and extracted data.Meta-analysis was performed using Revman 5.4.1 software.RESULTS A total of 15 studies were included,involving 1434 patients.The results of the meta-analysis showed that compared with the traditional group,the overall post-operative complications rate in the 3D reconstruction technology group was significantly lower[odds ratio=0.25;95%confidence interval(CI):0.17-0.36,P<0.00001].The overall puncture success rate in the 3D reconstruction group was better than those in the traditional group(odds ratio=3.61;95%CI:1.98-6.55,P<0.0001).However,there was no significant difference between the two groups in the reduction levels of postoperative total bilirubin(mean difference=-1.38;95%CI:-3.29 to 0.53,P=0.16).Subgroup analysis were conducted on the surgery time according to guidance stages of the 3D reconstruction,3D reconstruction imaging modalities,and types of studies.The results were stable,with no significant changes observed.CONCLUSION 3D reconstruction technology significantly improves the puncture success rate and safety of PTBD.However,it has no significant advantage in bile drainage effectiveness.Continued research is warranted to further explore its clinical value and optimize its application.展开更多
The traditional computed tomography(CT)reconstruction methods are noisy,low resolution,poor contrast,and generally not suitable to detect the smaller flaws.Besides,the filter design is also difficult.The CT characteri...The traditional computed tomography(CT)reconstruction methods are noisy,low resolution,poor contrast,and generally not suitable to detect the smaller flaws.Besides,the filter design is also difficult.The CT characteristics reconstruction technology was brought forward to improve in these aspects,which is defined to directly reconstruct the characteristics of the projection for the best requirements not the overall image quality.The two-dimension(2D)and three-dimension(3D)CT characteristics reconstruction algorithm were firstly introduced,then by detailed analysis,experimental results and comparsion of parameters calculated,its advantages in keeping better high-frequency feature,better noise immunity,short time-consuming and easier design are verified.展开更多
Nasal defects are facial defects caused by trauma,tumors,or congenital diseases that seriously damage a patient’s physical and mental health.Nasal defects,from skin defects to total nasal defects,require surgical rep...Nasal defects are facial defects caused by trauma,tumors,or congenital diseases that seriously damage a patient’s physical and mental health.Nasal defects,from skin defects to total nasal defects,require surgical repair and reconstruction to restore the appearance and function of the nose,which have always been challenges for rhinoplasty.The development of digital technology has increased the possibility of nasal reconstruction.Digital technology is involved in the preoperative,intraoperative,and postoperative stages of nasal construction and is of great significance in improving the effect of this surgery.This article reviews the application of major digital technologies,including three-dimensional(3D)imaging technology,computer-assisted surgical navigation,and 3D printing,in nasal reconstruction and discusses the shortcomings of the current application of digital technology.展开更多
BACKGROUND Recently,medical three-dimensional printing technology(3DPT)has demonstrated potential benefits for the treatment of cubitus varus deformity(CVD)by improving accuracy of the osteotomy through the use of an ...BACKGROUND Recently,medical three-dimensional printing technology(3DPT)has demonstrated potential benefits for the treatment of cubitus varus deformity(CVD)by improving accuracy of the osteotomy through the use of an osteotomy guide,with or without a patient-mated plate.Here,we present an interesting CVD case,involving a patient who was treated with corrective biplanar chevron osteotomy using an innovative customized osteotomy guide and a newly designed patient-matched monoblock crosslink plate created with 3DPT.CASE SUMMARY A 32-year-old female presented with a significant CVD from childhood injury.A computer simulation was processed using images from computerized tomography scans of both upper extremities.The biplanar chevron osteotomy was designed to create identical anatomy between the mirror image of the contralateral distal humerus and the osteotomized distal humerus.Next,the customized osteotomy guide and patient-matched monoblock crosslink plate were designed and printed.A simulation osteotomy was created for the real-sized bone model,and the operation was performed using the posterior paratricipital approach with k-wire positioning from the customized osteotomy guide as a predrilled hole for screw fixation to achieve immediate control of the reduction after osteotomy.Our method allowed for successful treatment of the CVD case,significantly improving the patient’s radiographic and clinical outcomes,with satisfactory result.CONCLUSION 3DPT-created patient-matched osteotomy guide and instrumentation provides accurate control during CVD correction.展开更多
Objective: To evaluate three-dimensional bronchial artery imaging charactersin central lung cancer and applied values with multi-slice spiral CT (MSCT) to provide theoreticalevidence on blood supply and intervention t...Objective: To evaluate three-dimensional bronchial artery imaging charactersin central lung cancer and applied values with multi-slice spiral CT (MSCT) to provide theoreticalevidence on blood supply and intervention therapy. Methods: Eighteen patients with central lungcancer underwent MSCT with real time helical thin-slice CT scanning. Three-dimensional bronchialartery reconstruction was done at the console work-station. The space anatomical characters ofbronchial artery were observed through different rotations. Results: For 6 cases, thethree-dimensional images of bronchial artery (33.33%) could exactly show the origins, the routes(lung inner segment and mediatism segment) and the diameters of bronchial arteries. Vision rate ofbronchial arteries was the highest in pulmonary artery stricture and truncation groups, and thevessels' diameter became larger apparently. These characters demonstrated blood supply of this kindof central lung cancer come from bronchial artery. Volume rendering images were the best ones amongthree-dimensional images. Conclusion: Three-dimensional imaging with MSCT in bronchial artery canreveal the anatomical characters of bronchial artery and provide theoretical evidence on bloodsupply and intervention therapy of central lung cancer.展开更多
BACKGROUND Percutaneous sclerotherapy can be used to successfully treat venous malformations(VMs)of the head,neck,and limbs.However,the standard curative effect of sclerotherapy has rarely been analyzed,and there is c...BACKGROUND Percutaneous sclerotherapy can be used to successfully treat venous malformations(VMs)of the head,neck,and limbs.However,the standard curative effect of sclerotherapy has rarely been analyzed,and there is currently no accurate statistical method to measure the volume of VMs after sclerotherapy.Here,we propose a novel threedimensional(3D)reconstruction method to evaluate this effect.OBJECTIVE To test the feasibility of 3D software(MIMICS 19.0)to evaluate the treatment effect of sclerotherapy.METHODS This retrospective study included patients with VMs on the head,neck,and limbs who were treated with ethanol sclerotherapy or foam sclerotherapy every 8 weeks.MIMICS 19.0 was used to calculate the performance of the lesion after treatment and measure the VM volumes before and after the treatment.The effect of the clinical treatment dose on the lesion was evaluated,and the treatment effect of each patient was recorded.The relationship between the number of treatments and the reduced volume of VMs was analyzed.RESULTS Based on the MIMICS-calculated regions of interest(ROI),we found that 1 mL of ethanol reduced the lesion by 473 mm3 and that one dosage of foam(1 mL of polidocanol and 4 mL air content)reduced the lesion by 2138 mm3,demonstrating that the foam sclerosing agent exhibited greater efficacy in this study.CONCLUSIONS The MIMICS 3D volume reconstruction method can effectively and safely evaluate the efficacy of sclerotherapy and provide a preoperative evaluation.This method is simple,accurate,and feasible.展开更多
Background The trochanter of the femur is a common site for bone tumors.However,locating the specificboundary of bone tumor infiltration and determining the surgical method can be challenging.The objective of thisstud...Background The trochanter of the femur is a common site for bone tumors.However,locating the specificboundary of bone tumor infiltration and determining the surgical method can be challenging.The objective of thisstudy was to review the diagnosis,treatment,and surgical outcomes of patients with tumors or tumor-like changesin the femoral trochanter after computer-assisted precise tumor resection and hip-preserving reconstruction ofthe trochanter.Methods From January 2005 to September 2020,11 patients with trochanteric tumors(aged:18–53 years;sixmales and five females)were treated in Guangzhou First People’s Hospital.The cases included aneurysmal bonecyst(n=1),giant cell tumor of bone(n=2),fibrous histiocytoma of bone(n=1),endochondroma(n=1),andfibrous dysplasia of bone(n=6).For patients with trochanteric tumors,computed tomography and magnetic resonance imaging scanning were performed before operation to obtain two-dimensional image data of the lesion.Athree-dimensional digital model of bilateral lower limbs was reconstructed by computer technology,the boundary of tumor growth was determined by computer simulation,the process of tumor resection and reconstructionwas simulated,and the personalized guide template was designed.During the operation,the personalized guideplate guided the precise resection of the tumor,and the allogeneic bone was trimmed to match the shape of thebone defect.Results All 11 patients underwent accurate resection of the tumor or tumor-like lesion and reconstruction ofthe hip.In eight cases,the lesion was confined to the trochanter,which was fixed with large segment allogeneicbone,autologous iliac bone,and proximal femoral anatomic plate.In three cases,allogeneic bone,autologousiliac bone,and femoral reconstruction nail were used to fix the tumor under the trochanter.Postoperative Xray examination showed that the repair and reconstruction of the bone defect was effective,and callus bridgingbetween the allogenic bone and autogenous bone was observed 6 months after operation.All patients recoveredtheir walking function 3–6 months after operation.The duration of the follow-up period ranged from 6 monthsto 6 years.A patient experienced recurrence of endochondroma;pathological examination revealed chondrocyticsarcoma.The remaining 10 patients were treated with segmental resection and reconstruction.The operationtime ranged 2.5–4.5 h(average:3.2 h).Intraoperative blood loss ranged from 300 to 500 ml(average:368 ml).The local recurrence rate was 9.1%,and the overall survival rate was 100%.The average Musculoskeletal TumorSociety score was 27(excellent and good for eight and three patients,respectively).Conclusions Three-dimensional computer skeleton modeling and simulation-assisted resection and reconstruction of femoral trochanteric tumor is a new surgical technique,which might markedly improve the surgical effect,shorten the surgical time,increase the overall survival rate of patients with tumors,reduce the local recurrencerate,assist in the digitization and programming of femoral trochanteric tumor surgery,and improve surgicalaccuracy.展开更多
Objective: We constructed 3D-model of ONFH in computer according to three-dimensional computerized tomography (3D-CT) data. We determined the location and volume of necrosis to investigate its clinical efficacy. Metho...Objective: We constructed 3D-model of ONFH in computer according to three-dimensional computerized tomography (3D-CT) data. We determined the location and volume of necrosis to investigate its clinical efficacy. Method: Totally 92 hips (59 cases) with ONFH (44 males, 15 females) were included, with mean age of 37.5 years (range from 26 to 58). Totally 20 cases (35 hips) were induced by corticosteroid (CTSs), 31 (49 hips) induced by alcohol, 4 (4 hips) induced by trauma and 4 (4 hips) idiopathic. All the hips were categorized into stage ARCO II. Finally diagnosed by MRI, all hips were scanned by CT to acquire data in DICOM format. The images were imported into software to extract 3D-shape of femoral heads, necrotic foci, their volumes and distribution in each quadrant. Deviation of volumes between digital image and biopsy specimen was analyzed by SAS9.1 package. Correlativity between collapse and volume of necrosis under specific pathogeneses was also analyzed. Among the cases necessitating total hip arthroplasty (THA) due to advancing to ARCO III, we randomly selected 8 of them to perform 3D-CT scanning thrice prior to surgical operation. Total femoral heads harvested were torn asunder. Cubic capacity of femoral heads and necrotic foci were hereby measured and compared with those acquired from digital models. Result: Through the digital model, necrotic foci were found mainly locating within the super lateral portion of femoral head, coinciding with those observed in biopsy specimen. Average volumetric ratio of digitally acquired necrosis focus/femoral head in 58 collapsed hips was 36.8%. The ratio of the 34 hips without collapse was 17.3%. In collapsed femoral heads, the distribution of necrosis focus was 23.4% in quadrant 1 (q1), 23.6% in q2, 12.1% in q3, 14.4% in q4, 9.0% in q5, 11.8% in q6, 1.6% in q7 and 3.9% in q8. In femoral heads without collapse, the distribution was 34.2% in q1, 29.6% in q2, 11.8% in q3, 11.3% in q4, 6.0% in q5, 6.0% in q6, 0.5% in q7 and 0.4% in q8. As for the average cubic capacities of femoral heads and necrotic foci, those acquired from the digital model and biopsy specimen had no significant difference in matched-pairs test (t = -1.49, P = 0.179 for femoral heads and t = -1.52, P = 0.172 for necrotic foci). There was significant difference (F = 2.720, P = 0.035 P was respectively 0.0001 and 0.0005). Decision tree model showed that 94.6% (53/56) hips would progress into collapse if the volumetric ratio of necrotic tissue was over 23.48%. Otherwise, if distribution in q2 was over 45.13%, 83.3% (5/6) hips would progress into collapse. No collapse (0/30) would occur if the distribution of necrotic tissue in q2 was under 45.13%. Conclusion: Digital 3D-model reconstructed from CT scanning can precisely incarnate spatial orientation of necrotic foci in femoral head. Multinomial logistic regression and decision-making tree shows that volumetric ratio of necrotic tissues plays an important role in anticipating collapse of femoral head.展开更多
文摘Objective To discuss the measurement of bone tumor volume on the basis of three dimensional images segmentation technology. Methods Twenty patients with lacunar bone tumor from Tianjin Hospital and Tongji Hospital were included in the
基金Supported by the Natural Science Foundation of Fujian Province,No.2022J011442.
文摘BACKGROUND Percutaneous transhepatic biliary drainage(PTBD)is one of the primary clinical treatment options for patients with obstructive jaundice.In recent years,PTBD assisted by three-dimensional(3D)reconstruction technology has been widely implemented,but its advantages over traditional methods remains inconclusive.Thus,a discussion is warranted.AIM To explore the safety and efficacy of 3D reconstruction technology-assisted PTBD.METHODS We systematically searched the databases including the Cochrane Library,PubMed,EMBASE,Web of Science and China National Knowledge Infrastructure.The search period extended from the establishment of each database to November,2024.We screened the literature according to predefined inclusion and exclusion criteria,assessed the quality of the studies,and extracted data.Meta-analysis was performed using Revman 5.4.1 software.RESULTS A total of 15 studies were included,involving 1434 patients.The results of the meta-analysis showed that compared with the traditional group,the overall post-operative complications rate in the 3D reconstruction technology group was significantly lower[odds ratio=0.25;95%confidence interval(CI):0.17-0.36,P<0.00001].The overall puncture success rate in the 3D reconstruction group was better than those in the traditional group(odds ratio=3.61;95%CI:1.98-6.55,P<0.0001).However,there was no significant difference between the two groups in the reduction levels of postoperative total bilirubin(mean difference=-1.38;95%CI:-3.29 to 0.53,P=0.16).Subgroup analysis were conducted on the surgery time according to guidance stages of the 3D reconstruction,3D reconstruction imaging modalities,and types of studies.The results were stable,with no significant changes observed.CONCLUSION 3D reconstruction technology significantly improves the puncture success rate and safety of PTBD.However,it has no significant advantage in bile drainage effectiveness.Continued research is warranted to further explore its clinical value and optimize its application.
基金National Natural Science Foundation of China(No.61471325)
文摘The traditional computed tomography(CT)reconstruction methods are noisy,low resolution,poor contrast,and generally not suitable to detect the smaller flaws.Besides,the filter design is also difficult.The CT characteristics reconstruction technology was brought forward to improve in these aspects,which is defined to directly reconstruct the characteristics of the projection for the best requirements not the overall image quality.The two-dimension(2D)and three-dimension(3D)CT characteristics reconstruction algorithm were firstly introduced,then by detailed analysis,experimental results and comparsion of parameters calculated,its advantages in keeping better high-frequency feature,better noise immunity,short time-consuming and easier design are verified.
基金supported by the Clinical Key Project of the Peking University Third Hospital(grant no.BYSYFY2021005).
文摘Nasal defects are facial defects caused by trauma,tumors,or congenital diseases that seriously damage a patient’s physical and mental health.Nasal defects,from skin defects to total nasal defects,require surgical repair and reconstruction to restore the appearance and function of the nose,which have always been challenges for rhinoplasty.The development of digital technology has increased the possibility of nasal reconstruction.Digital technology is involved in the preoperative,intraoperative,and postoperative stages of nasal construction and is of great significance in improving the effect of this surgery.This article reviews the application of major digital technologies,including three-dimensional(3D)imaging technology,computer-assisted surgical navigation,and 3D printing,in nasal reconstruction and discusses the shortcomings of the current application of digital technology.
文摘BACKGROUND Recently,medical three-dimensional printing technology(3DPT)has demonstrated potential benefits for the treatment of cubitus varus deformity(CVD)by improving accuracy of the osteotomy through the use of an osteotomy guide,with or without a patient-mated plate.Here,we present an interesting CVD case,involving a patient who was treated with corrective biplanar chevron osteotomy using an innovative customized osteotomy guide and a newly designed patient-matched monoblock crosslink plate created with 3DPT.CASE SUMMARY A 32-year-old female presented with a significant CVD from childhood injury.A computer simulation was processed using images from computerized tomography scans of both upper extremities.The biplanar chevron osteotomy was designed to create identical anatomy between the mirror image of the contralateral distal humerus and the osteotomized distal humerus.Next,the customized osteotomy guide and patient-matched monoblock crosslink plate were designed and printed.A simulation osteotomy was created for the real-sized bone model,and the operation was performed using the posterior paratricipital approach with k-wire positioning from the customized osteotomy guide as a predrilled hole for screw fixation to achieve immediate control of the reduction after osteotomy.Our method allowed for successful treatment of the CVD case,significantly improving the patient’s radiographic and clinical outcomes,with satisfactory result.CONCLUSION 3DPT-created patient-matched osteotomy guide and instrumentation provides accurate control during CVD correction.
文摘Objective: To evaluate three-dimensional bronchial artery imaging charactersin central lung cancer and applied values with multi-slice spiral CT (MSCT) to provide theoreticalevidence on blood supply and intervention therapy. Methods: Eighteen patients with central lungcancer underwent MSCT with real time helical thin-slice CT scanning. Three-dimensional bronchialartery reconstruction was done at the console work-station. The space anatomical characters ofbronchial artery were observed through different rotations. Results: For 6 cases, thethree-dimensional images of bronchial artery (33.33%) could exactly show the origins, the routes(lung inner segment and mediatism segment) and the diameters of bronchial arteries. Vision rate ofbronchial arteries was the highest in pulmonary artery stricture and truncation groups, and thevessels' diameter became larger apparently. These characters demonstrated blood supply of this kindof central lung cancer come from bronchial artery. Volume rendering images were the best ones amongthree-dimensional images. Conclusion: Three-dimensional imaging with MSCT in bronchial artery canreveal the anatomical characters of bronchial artery and provide theoretical evidence on bloodsupply and intervention therapy of central lung cancer.
文摘BACKGROUND Percutaneous sclerotherapy can be used to successfully treat venous malformations(VMs)of the head,neck,and limbs.However,the standard curative effect of sclerotherapy has rarely been analyzed,and there is currently no accurate statistical method to measure the volume of VMs after sclerotherapy.Here,we propose a novel threedimensional(3D)reconstruction method to evaluate this effect.OBJECTIVE To test the feasibility of 3D software(MIMICS 19.0)to evaluate the treatment effect of sclerotherapy.METHODS This retrospective study included patients with VMs on the head,neck,and limbs who were treated with ethanol sclerotherapy or foam sclerotherapy every 8 weeks.MIMICS 19.0 was used to calculate the performance of the lesion after treatment and measure the VM volumes before and after the treatment.The effect of the clinical treatment dose on the lesion was evaluated,and the treatment effect of each patient was recorded.The relationship between the number of treatments and the reduced volume of VMs was analyzed.RESULTS Based on the MIMICS-calculated regions of interest(ROI),we found that 1 mL of ethanol reduced the lesion by 473 mm3 and that one dosage of foam(1 mL of polidocanol and 4 mL air content)reduced the lesion by 2138 mm3,demonstrating that the foam sclerosing agent exhibited greater efficacy in this study.CONCLUSIONS The MIMICS 3D volume reconstruction method can effectively and safely evaluate the efficacy of sclerotherapy and provide a preoperative evaluation.This method is simple,accurate,and feasible.
文摘Background The trochanter of the femur is a common site for bone tumors.However,locating the specificboundary of bone tumor infiltration and determining the surgical method can be challenging.The objective of thisstudy was to review the diagnosis,treatment,and surgical outcomes of patients with tumors or tumor-like changesin the femoral trochanter after computer-assisted precise tumor resection and hip-preserving reconstruction ofthe trochanter.Methods From January 2005 to September 2020,11 patients with trochanteric tumors(aged:18–53 years;sixmales and five females)were treated in Guangzhou First People’s Hospital.The cases included aneurysmal bonecyst(n=1),giant cell tumor of bone(n=2),fibrous histiocytoma of bone(n=1),endochondroma(n=1),andfibrous dysplasia of bone(n=6).For patients with trochanteric tumors,computed tomography and magnetic resonance imaging scanning were performed before operation to obtain two-dimensional image data of the lesion.Athree-dimensional digital model of bilateral lower limbs was reconstructed by computer technology,the boundary of tumor growth was determined by computer simulation,the process of tumor resection and reconstructionwas simulated,and the personalized guide template was designed.During the operation,the personalized guideplate guided the precise resection of the tumor,and the allogeneic bone was trimmed to match the shape of thebone defect.Results All 11 patients underwent accurate resection of the tumor or tumor-like lesion and reconstruction ofthe hip.In eight cases,the lesion was confined to the trochanter,which was fixed with large segment allogeneicbone,autologous iliac bone,and proximal femoral anatomic plate.In three cases,allogeneic bone,autologousiliac bone,and femoral reconstruction nail were used to fix the tumor under the trochanter.Postoperative Xray examination showed that the repair and reconstruction of the bone defect was effective,and callus bridgingbetween the allogenic bone and autogenous bone was observed 6 months after operation.All patients recoveredtheir walking function 3–6 months after operation.The duration of the follow-up period ranged from 6 monthsto 6 years.A patient experienced recurrence of endochondroma;pathological examination revealed chondrocyticsarcoma.The remaining 10 patients were treated with segmental resection and reconstruction.The operationtime ranged 2.5–4.5 h(average:3.2 h).Intraoperative blood loss ranged from 300 to 500 ml(average:368 ml).The local recurrence rate was 9.1%,and the overall survival rate was 100%.The average Musculoskeletal TumorSociety score was 27(excellent and good for eight and three patients,respectively).Conclusions Three-dimensional computer skeleton modeling and simulation-assisted resection and reconstruction of femoral trochanteric tumor is a new surgical technique,which might markedly improve the surgical effect,shorten the surgical time,increase the overall survival rate of patients with tumors,reduce the local recurrencerate,assist in the digitization and programming of femoral trochanteric tumor surgery,and improve surgicalaccuracy.
文摘Objective: We constructed 3D-model of ONFH in computer according to three-dimensional computerized tomography (3D-CT) data. We determined the location and volume of necrosis to investigate its clinical efficacy. Method: Totally 92 hips (59 cases) with ONFH (44 males, 15 females) were included, with mean age of 37.5 years (range from 26 to 58). Totally 20 cases (35 hips) were induced by corticosteroid (CTSs), 31 (49 hips) induced by alcohol, 4 (4 hips) induced by trauma and 4 (4 hips) idiopathic. All the hips were categorized into stage ARCO II. Finally diagnosed by MRI, all hips were scanned by CT to acquire data in DICOM format. The images were imported into software to extract 3D-shape of femoral heads, necrotic foci, their volumes and distribution in each quadrant. Deviation of volumes between digital image and biopsy specimen was analyzed by SAS9.1 package. Correlativity between collapse and volume of necrosis under specific pathogeneses was also analyzed. Among the cases necessitating total hip arthroplasty (THA) due to advancing to ARCO III, we randomly selected 8 of them to perform 3D-CT scanning thrice prior to surgical operation. Total femoral heads harvested were torn asunder. Cubic capacity of femoral heads and necrotic foci were hereby measured and compared with those acquired from digital models. Result: Through the digital model, necrotic foci were found mainly locating within the super lateral portion of femoral head, coinciding with those observed in biopsy specimen. Average volumetric ratio of digitally acquired necrosis focus/femoral head in 58 collapsed hips was 36.8%. The ratio of the 34 hips without collapse was 17.3%. In collapsed femoral heads, the distribution of necrosis focus was 23.4% in quadrant 1 (q1), 23.6% in q2, 12.1% in q3, 14.4% in q4, 9.0% in q5, 11.8% in q6, 1.6% in q7 and 3.9% in q8. In femoral heads without collapse, the distribution was 34.2% in q1, 29.6% in q2, 11.8% in q3, 11.3% in q4, 6.0% in q5, 6.0% in q6, 0.5% in q7 and 0.4% in q8. As for the average cubic capacities of femoral heads and necrotic foci, those acquired from the digital model and biopsy specimen had no significant difference in matched-pairs test (t = -1.49, P = 0.179 for femoral heads and t = -1.52, P = 0.172 for necrotic foci). There was significant difference (F = 2.720, P = 0.035 P was respectively 0.0001 and 0.0005). Decision tree model showed that 94.6% (53/56) hips would progress into collapse if the volumetric ratio of necrotic tissue was over 23.48%. Otherwise, if distribution in q2 was over 45.13%, 83.3% (5/6) hips would progress into collapse. No collapse (0/30) would occur if the distribution of necrotic tissue in q2 was under 45.13%. Conclusion: Digital 3D-model reconstructed from CT scanning can precisely incarnate spatial orientation of necrotic foci in femoral head. Multinomial logistic regression and decision-making tree shows that volumetric ratio of necrotic tissues plays an important role in anticipating collapse of femoral head.
