Summary： Preoperative planning of corrective osteotomy with traditional radiography has limitations in regards to determining the ideal osteotomy location and orientation in three-dimensional femoral de- formities. T...Summary： Preoperative planning of corrective osteotomy with traditional radiography has limitations in regards to determining the ideal osteotomy location and orientation in three-dimensional femoral de- formities. Though a successful operation can be planned preoperatively, intraoperative contingencies might adhere to the procedural plan in the performance of operation. To efficiently perform a planned procedure, proposed is a design to implement three-dimensional reconstruction photography, based on computer-tomography （CT） scan. A custom-made guide was designed to navigate the osteotomy as planned, and additionally, a personalized intramedullary nail was used for fixation after osteotomy. Three-dimensional （3D） photography of deformed femur was established based on the CT dataset and transferred into 3D photography processing software for further planning. Osteotomy planes were de- signed and adjusted at deformity sites to correct the 3D deformities. The methodology of a custom-made osteotomy guide was introduced in femoral corrective osteotomy, for the first time, to navigate the op- eration as planned. After the virtual osteotomy and reduction of bone segments, the parameters of a custom-made intramedullary nail were measured for manufacturing. Findings Virtual operation in computer shows complete correction of the 3D deformity. The osteotomy guide, obtained by rapid-prototyping techniques, navigates mimicking surgery on rapid-prototyping model of the involved femur as planned. Internal fixation was achieved using the custom-made intramedullary nail. Interpreta- tion three-dimensional visualization introduces an advantage in preoperative planning for corrective os- teotomy of 3D femoral deformity, and the custom-made osteotomy guide is crucial to realize such a de- liberate plan during the actual procedures. The internal fixator, such as an intramedullary nail, can be modified or personalized for fixation in unique cases.展开更多
AIM:To evaluate the efficacy of custom-made soft keratoconus(KC)lenses on corneal aberrations and photic phenomena in two different optical zones in patients with KC.METHODS:Sixty eyes of 42 patients with KC were exam...AIM:To evaluate the efficacy of custom-made soft keratoconus(KC)lenses on corneal aberrations and photic phenomena in two different optical zones in patients with KC.METHODS:Sixty eyes of 42 patients with KC were examined at baseline and after fitting HydroCone(Toris K)soft silicone hydrogel lenses.Best spectacle-corrected visual acuity(BSCVA)and contact lens-corrected visual acuity(CLCVA)were recorded.Lower-and higher-order corneal aberrations(LOAs and HOAs)were measured with and without Toris K lenses and compared in central 4.5 mm and 7 mm zones.Mesopic pupil diameter and subjective photic phenomena were also assessed.RESULTS:Mean CLCVA was significantly improved compared to BSCVA(P<0.0001).Corneal curvature and refractive measurements were found to be significantly reduced by the use of Toris K lenses,except for posterior corneal curvature values.In the 4.5 mm central optical zone,all wavefront aberrations decreased significantly after lens fitting(P<0.0001).In contrast,in the 7 mm(peripheral)optical zone,values for HOAs,spherical and residual aberrations,and optical path differences were increased,while LOAs,trefoil,and quadrifoil coefficients were decreased.The rate of photic phenomena was significantly higher in participants with a pupil size>6.00 mm(85.7%).CONCLUSION:Toris K lenses provide good visual results and a significant reduction in central corneal aberrations in patients with KC but could cause an increase in peripheral aberrations.This practical and nonsurgical approach appears to be an effective method for the visual management of KC.展开更多
Irregular craniofacial bone defects caused by craniofacial fractures always result in craniofacial bone and contour asymmetry and should therefore be reconstructed.Polyetheretherketone(PEEK)is an ideal substitute for ...Irregular craniofacial bone defects caused by craniofacial fractures always result in craniofacial bone and contour asymmetry and should therefore be reconstructed.Polyetheretherketone(PEEK)is an ideal substitute for autologous bone grafts and has been widely used in craniofacial bone defect reconstruction.The precise design of custom-made PEEK implants is particularly important to optimise reconstruction.Herein,the workflow and principles for the design and manufacture of PEEK implants are summarised,and a protocol for the precise design of an irregular craniofacial bone defect PEEK implant is presented.According to the method and principles,the design flow was efficient and could be standardised,and design errors could be avoided as much as possible.展开更多
Large oro-antral communication, associated with total maxillectomy, may lead speech and/or swallowing dysfunction. These surgical defects are packed with obuturator or prosthesis following surgery;however, achieving r...Large oro-antral communication, associated with total maxillectomy, may lead speech and/or swallowing dysfunction. These surgical defects are packed with obuturator or prosthesis following surgery;however, achieving retention and stability is dependent on anatomical conditions. A 68-year-old Japanese female with large oro-antral communication arising because of bilateral total maxillectomy was referred for evaluating application of obturator. The temporary obturator was constructed as underlying 3 mm thick and covereing 1.5 - 2 mm thick ethylene vinyl acetate sheet (EVA). These two sheets formed the flexible hollow bulb portion, which aided retention and stability by engaging the undercut portion of the surgical defect. For the patients who have difficulty anatomical features for conventional prosthesis, this type of temporary obturator made with EVA sheets could be an effective solution in the early postoperative period.展开更多
Introduction: Cranioplasty is the surgical repair of a bony defect or deformity in the skull that is caused after cranial surgery or trauma. It carries cosmetic and protective benefits. Many types of materials are all...Introduction: Cranioplasty is the surgical repair of a bony defect or deformity in the skull that is caused after cranial surgery or trauma. It carries cosmetic and protective benefits. Many types of materials are allowed. The subject of this study is to compare the outcome of two different manufacturing processes in reconstruction of calvarial skull defects by using 3D custom-made cranioprostheses versus hand-made bone cement implants. Patient and Methods: This is a prospective comparative study conducted on 20 patients of calvarial skull defects of different etiologies, sites and sizes, admitted in the neurosurgical departments of Cairo and Fayoum Universities in the period from August 2017 to February 2018. Patients are divided into two study groups: (group 1) 10 patients operated upon by 3D custom-made implant;(group 2) operated upon by hand-made bone cement implant. Statistical Analysis Used: Mann-Whitney test and Chi-square test. Results: Craniotomy using 3D custom-made implants gives better results than using bone cement in the functional restoration of skull shape and cranial protection with shorter operative time and less rate of postoperative complications. There is no statistically significant difference between the two study groups regarding cosmetic outcome. Conclusion: 3D custom-made implant is recommended for large and complex skull defects. Further and large studies might be needed.展开更多
BACKGROUND Two-stage revision is the most common treatment for chronic periprosthetic joint infection of the hip,involving a resection arthroplasty with or without placement of an antibiotic-loaded spacer,followed by ...BACKGROUND Two-stage revision is the most common treatment for chronic periprosthetic joint infection of the hip,involving a resection arthroplasty with or without placement of an antibiotic-loaded spacer,followed by antibiotic therapy before reimplantation.AIM To compare the outcomes and complications of two consecutive treatment protocols for two-stage revision arthroplasty of the infected hip:One using Girdlestone with an antibiotic holiday,the other using custom-made articulating spacers(CUMARS)without an antibiotic holiday.METHODS In this retrospective study,two consecutive cohorts were compared.Group A(2017-2020)underwent two-stage revision with a Girdlestone and an antibiotic holiday before reimplantation,while Group B(2020-2023)received CUMARS whenever possible,and no antibiotic holiday,or a Girdlestone if indicated.The primary outcome was successful infection eradication after one year.Secondary outcomes included surgical duration,length of hospital stay,weight-bearing allowance,discharge destination,and complications.RESULTS A total of 98 patients were included:39 patients in Group A and 59 patients in Group B.Successful infection eradication after one year was achieved in 69%of Group A and 83%of Group B(P=0.164).Patients in Group B were more frequently allowed to bear weight(64%vs 18%,P<0.001),had a shorter in-hospital stay(9 vs 16 days,P<0.001),and were more often discharged home after the first surgery(48%vs 24%,P=0.048).No significant differences were found in(mechanical)complications.CONCLUSION A protocol including CUMARS is a safe and effective treatment,offering faster recovery,shorter length of hospital stay,and enabling more patients to return home during the interval.This reduces strain on patients and the healthcare system,potentially saving costs,without compromising infection control or increasing(mechanical)complications.展开更多
Background:Computed tomography(CT)and magnetic resonance imaging(MRI)data can be fused to identify the tumor boundaries.This enables surgeons to set close but tumor-free surgical margins and excise the tumor more prec...Background:Computed tomography(CT)and magnetic resonance imaging(MRI)data can be fused to identify the tumor boundaries.This enables surgeons to set close but tumor-free surgical margins and excise the tumor more precisely.This study aimed to report our experience in performing computer navigation-aided joint-preserving resection and custom-made endoprosthesis reconstruction to treat bone sarcoma in the diaphysis and metaphysis of the femur and tibia.Methods:Between September 2008 and December 2015,24 patients with bone sarcomas underwent surgical resection and joint-sparing reconstruction under image-guided computer navigation.The cohort comprised 16 males and eight females with a median age of 19.5 years(range:12-48 years).The tumor location was the femoral diaphysis in three patients,distal femur in 19,and proximal tibia in two.The tumors were osteosarcoma(n=15),chondrosarcoma(n=3),Ewing sarcoma(n=3),and other sarcomas(n=3).We created a pre-operative plan for each patient using navigation system software and performed navigation-aided resection before reconstructing the defect with a custom-made prosthesis with extracortical plate fixation.Results:Pathological examination verified that all resected specimens had appropriate surgical margins.The median distance from the tumor resection margin to the joint was 30 mm(range:13-80 mm).The median follow-up duration was 62.5 months(range:24-134 months).Of the 24 patients,21 remain disease free,one is alive with disease,and two died of the disease.One patient developed local recurrence.Complications requiring additional surgical procedures occurred in six patients,including one with wound hematoma,one with delayed wound healing,one with superficial infection,one with deep infection,and two with mechanical failure of the prosthesis.The mean Musculoskeletal Tumor Society score at the final follow-up was 91%(range:80%-100%).The 5-and 10-year implant survival rates were 91.3%and 79.9%,respectively.Conclusions:Computer navigation-aided joint-preserving resection and custom-made endoprosthesis reconstruction with extracortical plate fixation is a reliable surgical treatment option for bone sarcoma in the diaphysis and metaphysis of the femur and tibia.展开更多
Aim:Cranioplasty implants are used primarily in cases of surgical cranial decompression following pathological elevations of intracranial pressure.Available bone substitutes include porous hydroxyapatite(HA)and polyme...Aim:Cranioplasty implants are used primarily in cases of surgical cranial decompression following pathological elevations of intracranial pressure.Available bone substitutes include porous hydroxyapatite(HA)and polymethylmethacrylate.Whichever material is used,however,prosthetic cranial implants are susceptible to intra-and postsurgical complications and even failure.The aim of this study was to investigate such occurrences in HA cranioplasty implants,seeking not only to determine the likely causes(whether correlated or not with the device itself)but also,where possible,to suggest countermeasures.Methods:We analyzed information regarding failures or complications reported in postmarketing surveillance and clinical studies of patients treated worldwide with custom-made HA cranial implants(Custom Bone Service Fin-Ceramica Faenza,Italy)in the period 1997-2013.Results:The two most common complications were implant fractures(84 cases,2.9%of the total fitted)and infections(51 cases,1.77%).Conclusion:Although cranioplasties are superficial and not difficult types of surgery,and use of custom-made implants are often considered the“easy”option from a surgical perspective,these procedures are nonetheless plagued by potential pitfalls.If performed well they yield more than satisfactory results from the points of view of both the patient and surgeon,but lack of appropriate care can open the door to numerous potential sources of failure,which can compromise-even irreparably-the ability to heal.展开更多
基金supported by grants from the National Natural Science Foundation of China (No. 81141022)the General Hospital of Chinese Liberation Army (No. 10KMM09)
文摘Summary： Preoperative planning of corrective osteotomy with traditional radiography has limitations in regards to determining the ideal osteotomy location and orientation in three-dimensional femoral de- formities. Though a successful operation can be planned preoperatively, intraoperative contingencies might adhere to the procedural plan in the performance of operation. To efficiently perform a planned procedure, proposed is a design to implement three-dimensional reconstruction photography, based on computer-tomography （CT） scan. A custom-made guide was designed to navigate the osteotomy as planned, and additionally, a personalized intramedullary nail was used for fixation after osteotomy. Three-dimensional （3D） photography of deformed femur was established based on the CT dataset and transferred into 3D photography processing software for further planning. Osteotomy planes were de- signed and adjusted at deformity sites to correct the 3D deformities. The methodology of a custom-made osteotomy guide was introduced in femoral corrective osteotomy, for the first time, to navigate the op- eration as planned. After the virtual osteotomy and reduction of bone segments, the parameters of a custom-made intramedullary nail were measured for manufacturing. Findings Virtual operation in computer shows complete correction of the 3D deformity. The osteotomy guide, obtained by rapid-prototyping techniques, navigates mimicking surgery on rapid-prototyping model of the involved femur as planned. Internal fixation was achieved using the custom-made intramedullary nail. Interpreta- tion three-dimensional visualization introduces an advantage in preoperative planning for corrective os- teotomy of 3D femoral deformity, and the custom-made osteotomy guide is crucial to realize such a de- liberate plan during the actual procedures. The internal fixator, such as an intramedullary nail, can be modified or personalized for fixation in unique cases.
文摘AIM:To evaluate the efficacy of custom-made soft keratoconus(KC)lenses on corneal aberrations and photic phenomena in two different optical zones in patients with KC.METHODS:Sixty eyes of 42 patients with KC were examined at baseline and after fitting HydroCone(Toris K)soft silicone hydrogel lenses.Best spectacle-corrected visual acuity(BSCVA)and contact lens-corrected visual acuity(CLCVA)were recorded.Lower-and higher-order corneal aberrations(LOAs and HOAs)were measured with and without Toris K lenses and compared in central 4.5 mm and 7 mm zones.Mesopic pupil diameter and subjective photic phenomena were also assessed.RESULTS:Mean CLCVA was significantly improved compared to BSCVA(P<0.0001).Corneal curvature and refractive measurements were found to be significantly reduced by the use of Toris K lenses,except for posterior corneal curvature values.In the 4.5 mm central optical zone,all wavefront aberrations decreased significantly after lens fitting(P<0.0001).In contrast,in the 7 mm(peripheral)optical zone,values for HOAs,spherical and residual aberrations,and optical path differences were increased,while LOAs,trefoil,and quadrifoil coefficients were decreased.The rate of photic phenomena was significantly higher in participants with a pupil size>6.00 mm(85.7%).CONCLUSION:Toris K lenses provide good visual results and a significant reduction in central corneal aberrations in patients with KC but could cause an increase in peripheral aberrations.This practical and nonsurgical approach appears to be an effective method for the visual management of KC.
基金the Program of Shanghai Municipal Commission of Health and Family Planning(No.20194Y0033)。
文摘Irregular craniofacial bone defects caused by craniofacial fractures always result in craniofacial bone and contour asymmetry and should therefore be reconstructed.Polyetheretherketone(PEEK)is an ideal substitute for autologous bone grafts and has been widely used in craniofacial bone defect reconstruction.The precise design of custom-made PEEK implants is particularly important to optimise reconstruction.Herein,the workflow and principles for the design and manufacture of PEEK implants are summarised,and a protocol for the precise design of an irregular craniofacial bone defect PEEK implant is presented.According to the method and principles,the design flow was efficient and could be standardised,and design errors could be avoided as much as possible.
文摘Large oro-antral communication, associated with total maxillectomy, may lead speech and/or swallowing dysfunction. These surgical defects are packed with obuturator or prosthesis following surgery;however, achieving retention and stability is dependent on anatomical conditions. A 68-year-old Japanese female with large oro-antral communication arising because of bilateral total maxillectomy was referred for evaluating application of obturator. The temporary obturator was constructed as underlying 3 mm thick and covereing 1.5 - 2 mm thick ethylene vinyl acetate sheet (EVA). These two sheets formed the flexible hollow bulb portion, which aided retention and stability by engaging the undercut portion of the surgical defect. For the patients who have difficulty anatomical features for conventional prosthesis, this type of temporary obturator made with EVA sheets could be an effective solution in the early postoperative period.
文摘Introduction: Cranioplasty is the surgical repair of a bony defect or deformity in the skull that is caused after cranial surgery or trauma. It carries cosmetic and protective benefits. Many types of materials are allowed. The subject of this study is to compare the outcome of two different manufacturing processes in reconstruction of calvarial skull defects by using 3D custom-made cranioprostheses versus hand-made bone cement implants. Patient and Methods: This is a prospective comparative study conducted on 20 patients of calvarial skull defects of different etiologies, sites and sizes, admitted in the neurosurgical departments of Cairo and Fayoum Universities in the period from August 2017 to February 2018. Patients are divided into two study groups: (group 1) 10 patients operated upon by 3D custom-made implant;(group 2) operated upon by hand-made bone cement implant. Statistical Analysis Used: Mann-Whitney test and Chi-square test. Results: Craniotomy using 3D custom-made implants gives better results than using bone cement in the functional restoration of skull shape and cranial protection with shorter operative time and less rate of postoperative complications. There is no statistically significant difference between the two study groups regarding cosmetic outcome. Conclusion: 3D custom-made implant is recommended for large and complex skull defects. Further and large studies might be needed.
文摘BACKGROUND Two-stage revision is the most common treatment for chronic periprosthetic joint infection of the hip,involving a resection arthroplasty with or without placement of an antibiotic-loaded spacer,followed by antibiotic therapy before reimplantation.AIM To compare the outcomes and complications of two consecutive treatment protocols for two-stage revision arthroplasty of the infected hip:One using Girdlestone with an antibiotic holiday,the other using custom-made articulating spacers(CUMARS)without an antibiotic holiday.METHODS In this retrospective study,two consecutive cohorts were compared.Group A(2017-2020)underwent two-stage revision with a Girdlestone and an antibiotic holiday before reimplantation,while Group B(2020-2023)received CUMARS whenever possible,and no antibiotic holiday,or a Girdlestone if indicated.The primary outcome was successful infection eradication after one year.Secondary outcomes included surgical duration,length of hospital stay,weight-bearing allowance,discharge destination,and complications.RESULTS A total of 98 patients were included:39 patients in Group A and 59 patients in Group B.Successful infection eradication after one year was achieved in 69%of Group A and 83%of Group B(P=0.164).Patients in Group B were more frequently allowed to bear weight(64%vs 18%,P<0.001),had a shorter in-hospital stay(9 vs 16 days,P<0.001),and were more often discharged home after the first surgery(48%vs 24%,P=0.048).No significant differences were found in(mechanical)complications.CONCLUSION A protocol including CUMARS is a safe and effective treatment,offering faster recovery,shorter length of hospital stay,and enabling more patients to return home during the interval.This reduces strain on patients and the healthcare system,potentially saving costs,without compromising infection control or increasing(mechanical)complications.
文摘Background:Computed tomography(CT)and magnetic resonance imaging(MRI)data can be fused to identify the tumor boundaries.This enables surgeons to set close but tumor-free surgical margins and excise the tumor more precisely.This study aimed to report our experience in performing computer navigation-aided joint-preserving resection and custom-made endoprosthesis reconstruction to treat bone sarcoma in the diaphysis and metaphysis of the femur and tibia.Methods:Between September 2008 and December 2015,24 patients with bone sarcomas underwent surgical resection and joint-sparing reconstruction under image-guided computer navigation.The cohort comprised 16 males and eight females with a median age of 19.5 years(range:12-48 years).The tumor location was the femoral diaphysis in three patients,distal femur in 19,and proximal tibia in two.The tumors were osteosarcoma(n=15),chondrosarcoma(n=3),Ewing sarcoma(n=3),and other sarcomas(n=3).We created a pre-operative plan for each patient using navigation system software and performed navigation-aided resection before reconstructing the defect with a custom-made prosthesis with extracortical plate fixation.Results:Pathological examination verified that all resected specimens had appropriate surgical margins.The median distance from the tumor resection margin to the joint was 30 mm(range:13-80 mm).The median follow-up duration was 62.5 months(range:24-134 months).Of the 24 patients,21 remain disease free,one is alive with disease,and two died of the disease.One patient developed local recurrence.Complications requiring additional surgical procedures occurred in six patients,including one with wound hematoma,one with delayed wound healing,one with superficial infection,one with deep infection,and two with mechanical failure of the prosthesis.The mean Musculoskeletal Tumor Society score at the final follow-up was 91%(range:80%-100%).The 5-and 10-year implant survival rates were 91.3%and 79.9%,respectively.Conclusions:Computer navigation-aided joint-preserving resection and custom-made endoprosthesis reconstruction with extracortical plate fixation is a reliable surgical treatment option for bone sarcoma in the diaphysis and metaphysis of the femur and tibia.
文摘Aim:Cranioplasty implants are used primarily in cases of surgical cranial decompression following pathological elevations of intracranial pressure.Available bone substitutes include porous hydroxyapatite(HA)and polymethylmethacrylate.Whichever material is used,however,prosthetic cranial implants are susceptible to intra-and postsurgical complications and even failure.The aim of this study was to investigate such occurrences in HA cranioplasty implants,seeking not only to determine the likely causes(whether correlated or not with the device itself)but also,where possible,to suggest countermeasures.Methods:We analyzed information regarding failures or complications reported in postmarketing surveillance and clinical studies of patients treated worldwide with custom-made HA cranial implants(Custom Bone Service Fin-Ceramica Faenza,Italy)in the period 1997-2013.Results:The two most common complications were implant fractures(84 cases,2.9%of the total fitted)and infections(51 cases,1.77%).Conclusion:Although cranioplasties are superficial and not difficult types of surgery,and use of custom-made implants are often considered the“easy”option from a surgical perspective,these procedures are nonetheless plagued by potential pitfalls.If performed well they yield more than satisfactory results from the points of view of both the patient and surgeon,but lack of appropriate care can open the door to numerous potential sources of failure,which can compromise-even irreparably-the ability to heal.
