Bone connection with robot is an important topic in the research of robot assisted fracture reduction surgery.With the method to achieve bone-robot connection in current robots,requirements on reliability and low trau...Bone connection with robot is an important topic in the research of robot assisted fracture reduction surgery.With the method to achieve bone-robot connection in current robots,requirements on reliability and low trauma can not be satisfied at the same time.In this paper,the design,manufacturing,and experiments of a novel Bone Connection Robotic Hand(BCRH)with variable stiffness capability are carried out through the bionics research on human hand and the principle of particle jamming.BCRH’s variable stiffness characteristic is a special connection between“hard connection”and“soft connection”,which is different from the existing researches.It maximizes the reliability of bone-robot connection while minimizes trauma,meets the axial load requirement in clinical practice,and effectively shortens the operating time to less than 40 s(for mode 1)or 2 min(for mode 2).Meanwhile,a theoretical analysis of bone-robot connection failure based on particle jamming is carried out to provide references for the research in this paper and other related studies.展开更多
The Fracture Reduction Robot(FRR)is a crucial component of robot-assisted fracture correction technology.However,long-term clinical experiments have identified significant challenges with the forward kinematics of the...The Fracture Reduction Robot(FRR)is a crucial component of robot-assisted fracture correction technology.However,long-term clinical experiments have identified significant challenges with the forward kinematics of the parallel FRR,notably slow computation speeds and low precision.To address these issues,this paper proposes a hybrid algorithm that integrates the Newton method with a genetic algorithm.This approach harnesses the rapid computation and high precision of the Newton method alongside the strong global convergence capabilities of the genetic algorithm.To comprehensively evaluate the performance of the proposed algorithm,comparisons are made against the analytical method and the Additional Sensor Algorithm(ASA)using identical computational examples.Additionally,iterative comparisons of iteration counts and precision are conducted between traditional numerical methods and the Newton-Genetic algorithm.Experimental results show that the Newton-Genetic algorithm achieves a balance between computation speed and precision,with an accuracy reaching the 10^(-4) mm order of magnitude,effectively meeting the clinical requirements for fracture reduction robots in medical correction.展开更多
The accuracy of a fracture reduction robot(FRR)is critical for ensuring the safety of surgery.Improving the repositioning accuracy of a FRR,reducing the error,and realizing a safer and more stable folding motion is cr...The accuracy of a fracture reduction robot(FRR)is critical for ensuring the safety of surgery.Improving the repositioning accuracy of a FRR,reducing the error,and realizing a safer and more stable folding motion is critical.To achieve this,a sparrow search algorithm(SSA)based on the Levy flight operator was proposed in this study for self-tuning the robot controller parameters.An inverse kinematic analysis of the FRR was also performed.The robot dynamics model was established using Simulink,and the inverse dynamics controller for the fracture reduction mechanism was designed using the computed torque control method.Both simulation and physical experiments were also performed.The actual motion trajectory of the actuator drive rod and its error with a desired trajectory was obtained through simulation.An optimized Levy-sparrow search algorithm(Levy-SSA)crack reduction robot controller demonstrated an overall reduction of two orders of magnitude in the reduction error,with an average error reduction of 98.74%compared with the traditional unoptimized controller.The Levy-SSA increased the convergence of the crack reduction robot control system to the optimal solution,improved the accuracy of the motion trajectory,and exhibited important implications for robot controller optimization.展开更多
The success of robot-assisted pelvic fracture reduction surgery heavily relies on the accuracy of 3D/3D feature-based registration.This process involves extracting anatomical feature points from pre-operative 3D image...The success of robot-assisted pelvic fracture reduction surgery heavily relies on the accuracy of 3D/3D feature-based registration.This process involves extracting anatomical feature points from pre-operative 3D images which can be challenging because of the complex and variable structure of the pelvis.PointMLP_RegNet,a modified PointMLP,was introduced to address this issue.It retains the feature extraction module of PointMLP but replaces the classification layer with a regression layer to predict the coordinates of feature points instead of conducting regular classification.A flowchart for an automatic feature points extraction method was presented,and a series of experiments was conducted on a clinical pelvic dataset to confirm the accuracy and effectiveness of the method.PointMLP_RegNet extracted feature points more accurately,with 8 out of 10 points showing less than 4 mm errors and the remaining two less than 5 mm.Compared to PointNettt and PointNet,it exhibited higher accuracy,robustness and space efficiency.The proposed method will improve the accuracy of anatomical feature points extraction,enhance intra-operative registration precision and facilitate the widespread clinical application of robot-assisted pelvic fracture reduction.展开更多
Radial head and neck fractures represent up to 14%of all pediatric elbow fractures and can be a difficult challenge in the pediatric patient.In up to 39%of proximal radius fractures,there is a concomitant fracture,whi...Radial head and neck fractures represent up to 14%of all pediatric elbow fractures and can be a difficult challenge in the pediatric patient.In up to 39%of proximal radius fractures,there is a concomitant fracture,which can easily be overlooked on the initial standard radiographs.The treatment options for proximal radius fractures in children range from non-surgical treatment,such as immobilization alone and closed reduction followed by immobilization,to more invasive options,including closed reduction with percutaneous pinning and open reduction with internal fixation.The choice of treatment depends on the degree of angulation and displacement of the fracture and the age of the patient;an angulation of less than 30 degrees and translation of less than 50%is generally accepted,whereas a higher degree of displacement is considered an indication for surgical intervention.Fractures with limited displacement and non-surgical treatment generally result in superior outcomes in terms of patient-reported outcome measures,range of motion and complications compared to severely displaced fractures requiring surgical intervention.With proper management,good to excellent results are achieved in most cases,and long-term sequelae are rare.However,severe complications do occur,including radio-ulnar synostosis,osteonecrosis,rotational impairment,and premature physeal closure with a malformation of the radial head as a result,especially after more invasive procedures.Adequate follow-up is therefore warranted.展开更多
BACKGROUND Assessment of the vascular status following limb fracture in children is important to evaluate the risk of compartment syndrome,which is an emergency condition.AIM To establish a simple and efficient gradin...BACKGROUND Assessment of the vascular status following limb fracture in children is important to evaluate the risk of compartment syndrome,which is an emergency condition.AIM To establish a simple and efficient grading scale of limb perfusion in children undergoing surgery for limb fracture.METHODS This retrospective study included pediatric patients with a limb fracture and postoperative plaster fixation who were admitted at The Department of Pediatric Orthopedics of Xinhua Hospital between February 2017 and August 2017.The outcome was poor limb perfusion,which is defined as the postoperative use of mannitol.The children were divided into two groups:The normal perfusion group and the poor perfusion group.Key risk factors have been selected by univariable analyses to establish the Grading Scale for Vascular Status.RESULTS A total of 161 patients were included in the study:85 in the normal perfusion group and 76 in the poor perfusion group.There were no significant differences in age,sex,body mass index,ethnicity,cause of fracture,fixation,or site of fracture between the two groups.After surgery,the skin temperature(P=0.048)and skin color(P<0.001)of the affected limb were significantly different between the two groups.The relative risk and 95%confidence interval for skin temperature of the affected limb,skin color,and range of motion of the affected limb are 2.18(1.84-2.59),2.89(2.28-3.66),and 2.16(1.83-2.56),respectively.The grading scale was established based on those three factors(score range:0-3 points).Forty-one patients(32.5%)with score 0 had poor limb perfusion;all patients with scores 1(n=32)and 2(n=3)had poor limb perfusion(both 100%).CONCLUSION In children undergoing surgery for limb fracture,a higher Grading Scale for Vascular Status score is associated with a higher occurrence of poor limb perfusion.A prospective study is required for validation.展开更多
Long-bone fractures are common complaints in orthopedic surgery.In recent years,significant progress has been made in robot-assisted fracture-reduction techniques.As a key medical device for diverse fracture morpholog...Long-bone fractures are common complaints in orthopedic surgery.In recent years,significant progress has been made in robot-assisted fracture-reduction techniques.As a key medical device for diverse fracture morphologies and sites,the design of the reduction robot has a profound impact on the reduction outcomes.However,existing reduction robots have practical limitations and cannot simultaneously satisfy clinical requirements in terms of workspace,force/torque,and structural stiffness.To overcome these problems,we first analyze the potential placement areas and performance requirements of reduction robots according to clinical application scenarios.Subsequently,a 3UPS/S-3P hybrid configuration with decoupled rotational and translational degrees of freedom(DOFs)is proposed,and a kinematic model is derived to achieve the motion characteristics of the remote center of motion(RCM).Furthermore,the structural design of a hybrid reduction robot with an integrated distal clamp and proximal fixator was completed,and a mechanical prototype was constructed.The results of the performance evaluations and static analysis demonstrate that the proposed reduction robot has acceptable workspace,force,and torque performance and excellent structural stiffness.Two clinical case simulations further demonstrated the clinical feasibility of the robot.Finally,preliminary experiments on bone models demonstrated the potential effectiveness of the proposed reduction robot in lower-limb fracture reduction.展开更多
BACKGROUND Pedicled abdominal flaps are a widely used surgical technique for forearm reconstruction in patients with soft tissue defects.However,some drawbacks include restricted flap size,partial flap loss,and donor-...BACKGROUND Pedicled abdominal flaps are a widely used surgical technique for forearm reconstruction in patients with soft tissue defects.However,some drawbacks include restricted flap size,partial flap loss,and donor-site morbidity.To address these concerns,we present a case of a pedicled abdominal flap using the deep inferior epigastric artery perforators(DIEP)for forearm reconstruction in a patient with a large soft tissue defect.CASE SUMMARY A 46-year-old male patient was admitted to our hospital with forearm injury caused by a pressing machine.A 15 cm×10 cm soft tissue defect with complete rupture of the ulnar side structures of the forearm was found.One week after orthopedic management of the neurovascular injury and fractures using the first stage of Masquelet technique,the patient was referred to the plastic and recon-structive surgery department for wound coverage.Surgical debridement and negative-pressure wound therapy revealed a 20 cm×15 cm soft tissue defect.A pedicle abdominal flap with the DIEP was used to cover the defect.Three weeks later,the flap was detached from the abdomen,and the abdominal defect was directly closed.Subsequently,the second stage of Masquelet technique was performed at the fracture site at week 10.Finally,all donor and recipient sites healed without complications,such as flap dehiscence,infection,hematoma,or necrosis.Fracture site osteosynthesis was achieved without complications.CONCLUSION Pedicled abdominal flap using the DIEP provides a reliable option for forearm reconstruction in patients with large soft tissue defects.展开更多
During the robot-assisted pelvic fracture reduction,the needle-tissue interactive deformation characteristic is not clear,which affects the accuracy of robotic surgery.In this paper,a layered rig-id-flexible coupling ...During the robot-assisted pelvic fracture reduction,the needle-tissue interactive deformation characteristic is not clear,which affects the accuracy of robotic surgery.In this paper,a layered rig-id-flexible coupling model is proposed,and the needle-tissue interactive deformation under the load-ing is analyzed by the Rayleigh-Ritz method,in accordance with the principle of minimum potential energy.The pelvic musculoskeletal tissue is reversely reconstructed,and the structure of the bone is segmented into cancellous bone and cortical bone.The Mooney-Rivlin five-parameter hyperelastic model is used to simulate muscle,and the Ogden hyperelastic model is used to simulate adipose tis-sue.Finite element simulation is performed by loading different magnitudes of forces.The accuracy of the rigid-flexible coupling model is 0.432 mm,which indicates the correctness of the needle-tis-sue interactive deformation theory analysis.展开更多
Purpose： To describe an indirect reduction technique during minimally invasive percutaneous plate osteosynthesis （MIPPO） of tibial shaft fractures with the use of a distraction support. Methods： Between March 2011...Purpose： To describe an indirect reduction technique during minimally invasive percutaneous plate osteosynthesis （MIPPO） of tibial shaft fractures with the use of a distraction support. Methods： Between March 2011 and October 2014, 52 patients with a mean age of 48 years （16-72 years） sustaining tibial shaft fractures were included. All the patients underwent MIPPO for the fractures using a distraction support prior to insertion of the plate. Fracture angular deformity was assessed by goniometer measurement on preoperative and postoperative images. Results： Preoperative radiographs revealed a mean of 7.6°（1.2°-28°） angulation in coronal plane and a mean of 6.8°（0.5°-19°） angulation in sagittal plane. Postoperative anteroposterior and lateral radio graphs showed a mean of 0.8°（0°-4.0°） and 0.6°00-3.6°） of varusvalgus and apex anterior/posterior angulation, respectively. No intraoperative or postoperative complications were noted. Conclusions： This study suggests that the distraction support during MIPPO of tibial shaft fractures is an effective and safe method with no associated complications.展开更多
Pelvic fracture is among the most complicated fractures in traumatic orthopedics,with high mortality and morbidity rates.The main difficulty associated with the reduction surgery is significant muscle resistance.It th...Pelvic fracture is among the most complicated fractures in traumatic orthopedics,with high mortality and morbidity rates.The main difficulty associated with the reduction surgery is significant muscle resistance.It then becomes necessary to decrease the reduction force against this strong muscle resistance,for improving surgical safety.Here,we propose a novel traction method for decreasing the reduction force during pelvic reduction,and investigate the performance of the elastic traction method on decreasing the reduction force using experimental tests and simulation-based analyses.From the experimental results,the reduction force decreased by 59.2%when 10 kg of elastic traction was applied.We also establish a musculoskeletal model of the pelvic fracture reduction,for analyzing the muscle resistance and the optimal traction force applied in reduction surgeries.The elastic traction method can counteract the muscle resistance increase in the non-traction direction owing to its flexibility.We conclude that the optimal traction force applied should be in the 10–15 kg range,and recommend adopting a dynamic traction strategy rather than continuous traction in clinical settings.Elastic traction is very promising for various surgeries that require traction,including pelvic reduction.It significantly reduces force,which can significantly reduce the physical exertion of the operating surgeon,the possibility of additional injuries to the operated patient,and promotes robot-assisted reduction surgeries.展开更多
Purpose： Tibial fracture is the most common long bone fracture. Distal third tibial fractures are chal- lenging though open reduction and plating can result in anatomical reduction and rigid fixation. This paper aime...Purpose： Tibial fracture is the most common long bone fracture. Distal third tibial fractures are chal- lenging though open reduction and plating can result in anatomical reduction and rigid fixation. This paper aimed to evaluate and compare the results of medial and lateral locking compression plates for distal third tibial fractures. Methods： This prospective clinical study involved 36 patients with distal tibial fractures admitted in Department of Orthopaedics, Sawai Mansingh Medical College ＆ Affiliated Hospital, Jaipur, India, from June 2011 to May 2012, including 29 closed fractures and 7 open fractures at the mean age of 38.9 years. Thirty-six patients were divided equally into two groups based on treatment method, including medial plating group （18 patients） and lateral plating group （18 patients）. They were followed up for at least 5 months after discharge. The functional outcomes were evaluated using Tenny and Wiss clinical assess- ment criteria. Results： Malunion was found in 3 cases of medial plating group and in 1 case of lateral plating group. In the medial plating group, there were 5 cases of superficial infections, 1 deep infection, 1 nonunion and 3 wound dehiscence. In the lateral plating group, there was 1 case of superficial infections, 1 deep infection and 1 nonunion, in the lateral plating group, 4 patients reported feeling the plates and screws but none of them asked to remove the hardware. In the medial plating group, 9 patients reported symptomatic hardware problems and 7 asked to remove the hardware. The number of cases graded as excellent/good/ fair was 1/8/7 in the medial plating group and 3/7/7 in the lateral plating group respectively. In the medial plating group, the final range of motion was 17.2° in ankle dorsiflexion and 30.7° in ankle plantar flexion. In the lateral plating group, the final range of motion was 19° in ankle dorsiflexion and 34.2° in ankle plantar flexion. Conclusion： Lateral plating of distal tibia is safe and feasible, which can provide biological fixation and prevent the soft tissue complications associated with medial plating.展开更多
Purpose The management of irreducible,sagittally unstable peritrochanteric fractures presents a significant challenge due to the inability to achieve closed reduction using conventional techniques.This study introduce...Purpose The management of irreducible,sagittally unstable peritrochanteric fractures presents a significant challenge due to the inability to achieve closed reduction using conventional techniques.This study introduces a novel minimally invasive technique leveraging the mechanical advantage principle with long,angled hemostatic clamps.Methods A retrospective review was performed on 16 patients who sustained sagittally unstable peritrochanteric fractures and underwent a percutaneous hemostatic clamp leverage reduction procedure.Inclusion criteria:(1)Preoperative confirmation of fracture type as peritrochanteric fracture;(2)Intraoperative imaging confirms the presence of sagittal plane displacement at the fracture site;(3)Age>18 years.Exclusion criteria:(1)Open fractures,pathological fractures,and diabetes;(2)Long-term use of corticosteroids;(3)Patients with local skin or systemic conditions not suitable for surgery.Regular follow-ups at intervals of 6–8 weeks continued until evidence of bone consolidation was apparent in radiographic assessments.Evaluation of the alignment quality considered factors such as the re-establishment of the neck-shaft angle,the integrity of all cortical bone edges,and the rectification of any translational displacement,while the assessment of hip functionality was performed using the Harris scoring system.Statistical analysis of the relevant data was performed using SPSS 25.0 software.Results The average age of these 16 patients was 56.8 years(ranging from 25 to 81 years),consisting of 8 males and 8 females.According to the AO/OTA fracture classification,the cohort included 13 cases of type 31A,2 cases of type 32A,and 1 case of type 32C.The time from hospital admission to the day of surgery ranged from 3 to 11 days,with an average of 5.1 days.Closed reduction was successfully implemented in all 10 instances,negating the necessity for transition to open reduction procedures.The mean operative duration was 105.8 min(range 80–180 min).Satisfactory results of the quality of reduction were determined by comparison with the normal side.The average Harris hip score was 94.1(range 87–99),and the fracture healing time was 4.2 months(3–6 months).Implant failure and malunion were not observed.Conclusions This study provides an alternative,minimally invasive technique for reducing sagittally unstable,irreducible peritrochanteric fractures.This technique holds the potential to manage complex fractures with the same efficacy as is typically reserved for simple and easily reducible fractures.展开更多
基金This research was supported by the National Natural Science Foundation of China(Grant Nos.51975070,62003060 and 52075051)the National Key Research and Development Program of China(Grant No.2020YFB1313000).
文摘Bone connection with robot is an important topic in the research of robot assisted fracture reduction surgery.With the method to achieve bone-robot connection in current robots,requirements on reliability and low trauma can not be satisfied at the same time.In this paper,the design,manufacturing,and experiments of a novel Bone Connection Robotic Hand(BCRH)with variable stiffness capability are carried out through the bionics research on human hand and the principle of particle jamming.BCRH’s variable stiffness characteristic is a special connection between“hard connection”and“soft connection”,which is different from the existing researches.It maximizes the reliability of bone-robot connection while minimizes trauma,meets the axial load requirement in clinical practice,and effectively shortens the operating time to less than 40 s(for mode 1)or 2 min(for mode 2).Meanwhile,a theoretical analysis of bone-robot connection failure based on particle jamming is carried out to provide references for the research in this paper and other related studies.
基金supported by the National Natural Science Foundation of China(52005120)the interdisciplinary Teamof Intelligent Elderly Care and Rehabilitation in the“Double first-class”Construction of Beijing University of Posts and Telecommunications in 2023(2023SYLTD04)+1 种基金the BUPT innovation andentrepreneurship support program(2024-YC-T038)the BUPT Excellent Ph.D.Students Foundation(CX2023315).
文摘The Fracture Reduction Robot(FRR)is a crucial component of robot-assisted fracture correction technology.However,long-term clinical experiments have identified significant challenges with the forward kinematics of the parallel FRR,notably slow computation speeds and low precision.To address these issues,this paper proposes a hybrid algorithm that integrates the Newton method with a genetic algorithm.This approach harnesses the rapid computation and high precision of the Newton method alongside the strong global convergence capabilities of the genetic algorithm.To comprehensively evaluate the performance of the proposed algorithm,comparisons are made against the analytical method and the Additional Sensor Algorithm(ASA)using identical computational examples.Additionally,iterative comparisons of iteration counts and precision are conducted between traditional numerical methods and the Newton-Genetic algorithm.Experimental results show that the Newton-Genetic algorithm achieves a balance between computation speed and precision,with an accuracy reaching the 10^(-4) mm order of magnitude,effectively meeting the clinical requirements for fracture reduction robots in medical correction.
基金supported by the Natural Science Foundation of Guangdong Province(2022A1515010487)Shenzhen Science and Technology Innovation Program(JCYJ20210324103800001)Shenzhen Science and Technology Innovation Program(JCYJ20220530112609022).
文摘The accuracy of a fracture reduction robot(FRR)is critical for ensuring the safety of surgery.Improving the repositioning accuracy of a FRR,reducing the error,and realizing a safer and more stable folding motion is critical.To achieve this,a sparrow search algorithm(SSA)based on the Levy flight operator was proposed in this study for self-tuning the robot controller parameters.An inverse kinematic analysis of the FRR was also performed.The robot dynamics model was established using Simulink,and the inverse dynamics controller for the fracture reduction mechanism was designed using the computed torque control method.Both simulation and physical experiments were also performed.The actual motion trajectory of the actuator drive rod and its error with a desired trajectory was obtained through simulation.An optimized Levy-sparrow search algorithm(Levy-SSA)crack reduction robot controller demonstrated an overall reduction of two orders of magnitude in the reduction error,with an average error reduction of 98.74%compared with the traditional unoptimized controller.The Levy-SSA increased the convergence of the crack reduction robot control system to the optimal solution,improved the accuracy of the motion trajectory,and exhibited important implications for robot controller optimization.
基金supported by the National Key Research and Development Program of China(Grant No.2020YFB1313800)the National Science Foundation of China(Grant No.NSFC62373259)+1 种基金the Natural Science Foundation of Top Talent of SZTU(Grant No.GDRC202303)the Education Promotion Foundation of Guangdong Province(Grant No.2022ZDJS115).
文摘The success of robot-assisted pelvic fracture reduction surgery heavily relies on the accuracy of 3D/3D feature-based registration.This process involves extracting anatomical feature points from pre-operative 3D images which can be challenging because of the complex and variable structure of the pelvis.PointMLP_RegNet,a modified PointMLP,was introduced to address this issue.It retains the feature extraction module of PointMLP but replaces the classification layer with a regression layer to predict the coordinates of feature points instead of conducting regular classification.A flowchart for an automatic feature points extraction method was presented,and a series of experiments was conducted on a clinical pelvic dataset to confirm the accuracy and effectiveness of the method.PointMLP_RegNet extracted feature points more accurately,with 8 out of 10 points showing less than 4 mm errors and the remaining two less than 5 mm.Compared to PointNettt and PointNet,it exhibited higher accuracy,robustness and space efficiency.The proposed method will improve the accuracy of anatomical feature points extraction,enhance intra-operative registration precision and facilitate the widespread clinical application of robot-assisted pelvic fracture reduction.
文摘Radial head and neck fractures represent up to 14%of all pediatric elbow fractures and can be a difficult challenge in the pediatric patient.In up to 39%of proximal radius fractures,there is a concomitant fracture,which can easily be overlooked on the initial standard radiographs.The treatment options for proximal radius fractures in children range from non-surgical treatment,such as immobilization alone and closed reduction followed by immobilization,to more invasive options,including closed reduction with percutaneous pinning and open reduction with internal fixation.The choice of treatment depends on the degree of angulation and displacement of the fracture and the age of the patient;an angulation of less than 30 degrees and translation of less than 50%is generally accepted,whereas a higher degree of displacement is considered an indication for surgical intervention.Fractures with limited displacement and non-surgical treatment generally result in superior outcomes in terms of patient-reported outcome measures,range of motion and complications compared to severely displaced fractures requiring surgical intervention.With proper management,good to excellent results are achieved in most cases,and long-term sequelae are rare.However,severe complications do occur,including radio-ulnar synostosis,osteonecrosis,rotational impairment,and premature physeal closure with a malformation of the radial head as a result,especially after more invasive procedures.Adequate follow-up is therefore warranted.
基金Supported by The Hospital-Funded Clinical Research of Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine,No.17CSY01.
文摘BACKGROUND Assessment of the vascular status following limb fracture in children is important to evaluate the risk of compartment syndrome,which is an emergency condition.AIM To establish a simple and efficient grading scale of limb perfusion in children undergoing surgery for limb fracture.METHODS This retrospective study included pediatric patients with a limb fracture and postoperative plaster fixation who were admitted at The Department of Pediatric Orthopedics of Xinhua Hospital between February 2017 and August 2017.The outcome was poor limb perfusion,which is defined as the postoperative use of mannitol.The children were divided into two groups:The normal perfusion group and the poor perfusion group.Key risk factors have been selected by univariable analyses to establish the Grading Scale for Vascular Status.RESULTS A total of 161 patients were included in the study:85 in the normal perfusion group and 76 in the poor perfusion group.There were no significant differences in age,sex,body mass index,ethnicity,cause of fracture,fixation,or site of fracture between the two groups.After surgery,the skin temperature(P=0.048)and skin color(P<0.001)of the affected limb were significantly different between the two groups.The relative risk and 95%confidence interval for skin temperature of the affected limb,skin color,and range of motion of the affected limb are 2.18(1.84-2.59),2.89(2.28-3.66),and 2.16(1.83-2.56),respectively.The grading scale was established based on those three factors(score range:0-3 points).Forty-one patients(32.5%)with score 0 had poor limb perfusion;all patients with scores 1(n=32)and 2(n=3)had poor limb perfusion(both 100%).CONCLUSION In children undergoing surgery for limb fracture,a higher Grading Scale for Vascular Status score is associated with a higher occurrence of poor limb perfusion.A prospective study is required for validation.
基金Supported by National Natural Science Foundation of China(Grant Nos.52405001,52175001,62373010,82472537)China Postdoctoral Science Foundation(Grant No.2024M760166)+2 种基金Postdoctoral Fellowship Program of CPSF(Grant No.GZC20230186)Shenzhen Municipal Science,Technology,and Innovation Commission(Grant No.SGDX20220530111005036)Beijing Natural Science Foundation(Grant Nos.3222002,3232004,L222061).
文摘Long-bone fractures are common complaints in orthopedic surgery.In recent years,significant progress has been made in robot-assisted fracture-reduction techniques.As a key medical device for diverse fracture morphologies and sites,the design of the reduction robot has a profound impact on the reduction outcomes.However,existing reduction robots have practical limitations and cannot simultaneously satisfy clinical requirements in terms of workspace,force/torque,and structural stiffness.To overcome these problems,we first analyze the potential placement areas and performance requirements of reduction robots according to clinical application scenarios.Subsequently,a 3UPS/S-3P hybrid configuration with decoupled rotational and translational degrees of freedom(DOFs)is proposed,and a kinematic model is derived to achieve the motion characteristics of the remote center of motion(RCM).Furthermore,the structural design of a hybrid reduction robot with an integrated distal clamp and proximal fixator was completed,and a mechanical prototype was constructed.The results of the performance evaluations and static analysis demonstrate that the proposed reduction robot has acceptable workspace,force,and torque performance and excellent structural stiffness.Two clinical case simulations further demonstrated the clinical feasibility of the robot.Finally,preliminary experiments on bone models demonstrated the potential effectiveness of the proposed reduction robot in lower-limb fracture reduction.
基金Supported by The Bio&Medical Technology Development Program of the National Research Foundation(NRF)funded by the Korean government(MSIT),No.RS-2023-00220408.
文摘BACKGROUND Pedicled abdominal flaps are a widely used surgical technique for forearm reconstruction in patients with soft tissue defects.However,some drawbacks include restricted flap size,partial flap loss,and donor-site morbidity.To address these concerns,we present a case of a pedicled abdominal flap using the deep inferior epigastric artery perforators(DIEP)for forearm reconstruction in a patient with a large soft tissue defect.CASE SUMMARY A 46-year-old male patient was admitted to our hospital with forearm injury caused by a pressing machine.A 15 cm×10 cm soft tissue defect with complete rupture of the ulnar side structures of the forearm was found.One week after orthopedic management of the neurovascular injury and fractures using the first stage of Masquelet technique,the patient was referred to the plastic and recon-structive surgery department for wound coverage.Surgical debridement and negative-pressure wound therapy revealed a 20 cm×15 cm soft tissue defect.A pedicle abdominal flap with the DIEP was used to cover the defect.Three weeks later,the flap was detached from the abdomen,and the abdominal defect was directly closed.Subsequently,the second stage of Masquelet technique was performed at the fracture site at week 10.Finally,all donor and recipient sites healed without complications,such as flap dehiscence,infection,hematoma,or necrosis.Fracture site osteosynthesis was achieved without complications.CONCLUSION Pedicled abdominal flap using the DIEP provides a reliable option for forearm reconstruction in patients with large soft tissue defects.
基金the National Key R&D Program of China(No.2020YFB1313803).
文摘During the robot-assisted pelvic fracture reduction,the needle-tissue interactive deformation characteristic is not clear,which affects the accuracy of robotic surgery.In this paper,a layered rig-id-flexible coupling model is proposed,and the needle-tissue interactive deformation under the load-ing is analyzed by the Rayleigh-Ritz method,in accordance with the principle of minimum potential energy.The pelvic musculoskeletal tissue is reversely reconstructed,and the structure of the bone is segmented into cancellous bone and cortical bone.The Mooney-Rivlin five-parameter hyperelastic model is used to simulate muscle,and the Ogden hyperelastic model is used to simulate adipose tis-sue.Finite element simulation is performed by loading different magnitudes of forces.The accuracy of the rigid-flexible coupling model is 0.432 mm,which indicates the correctness of the needle-tis-sue interactive deformation theory analysis.
文摘Purpose： To describe an indirect reduction technique during minimally invasive percutaneous plate osteosynthesis （MIPPO） of tibial shaft fractures with the use of a distraction support. Methods： Between March 2011 and October 2014, 52 patients with a mean age of 48 years （16-72 years） sustaining tibial shaft fractures were included. All the patients underwent MIPPO for the fractures using a distraction support prior to insertion of the plate. Fracture angular deformity was assessed by goniometer measurement on preoperative and postoperative images. Results： Preoperative radiographs revealed a mean of 7.6°（1.2°-28°） angulation in coronal plane and a mean of 6.8°（0.5°-19°） angulation in sagittal plane. Postoperative anteroposterior and lateral radio graphs showed a mean of 0.8°（0°-4.0°） and 0.6°00-3.6°） of varusvalgus and apex anterior/posterior angulation, respectively. No intraoperative or postoperative complications were noted. Conclusions： This study suggests that the distraction support during MIPPO of tibial shaft fractures is an effective and safe method with no associated complications.
基金This work was supported by Key research and development plan of the Ministry of science and technology of China[2019YFC0118002]National Natural Science Foundation(NSFC)Grant of China[61871019]+1 种基金Beijing science and technology project[Z18110001918024]Natural Science Foundation of Beijing[19L2011].
文摘Pelvic fracture is among the most complicated fractures in traumatic orthopedics,with high mortality and morbidity rates.The main difficulty associated with the reduction surgery is significant muscle resistance.It then becomes necessary to decrease the reduction force against this strong muscle resistance,for improving surgical safety.Here,we propose a novel traction method for decreasing the reduction force during pelvic reduction,and investigate the performance of the elastic traction method on decreasing the reduction force using experimental tests and simulation-based analyses.From the experimental results,the reduction force decreased by 59.2%when 10 kg of elastic traction was applied.We also establish a musculoskeletal model of the pelvic fracture reduction,for analyzing the muscle resistance and the optimal traction force applied in reduction surgeries.The elastic traction method can counteract the muscle resistance increase in the non-traction direction owing to its flexibility.We conclude that the optimal traction force applied should be in the 10–15 kg range,and recommend adopting a dynamic traction strategy rather than continuous traction in clinical settings.Elastic traction is very promising for various surgeries that require traction,including pelvic reduction.It significantly reduces force,which can significantly reduce the physical exertion of the operating surgeon,the possibility of additional injuries to the operated patient,and promotes robot-assisted reduction surgeries.
文摘Purpose： Tibial fracture is the most common long bone fracture. Distal third tibial fractures are chal- lenging though open reduction and plating can result in anatomical reduction and rigid fixation. This paper aimed to evaluate and compare the results of medial and lateral locking compression plates for distal third tibial fractures. Methods： This prospective clinical study involved 36 patients with distal tibial fractures admitted in Department of Orthopaedics, Sawai Mansingh Medical College ＆ Affiliated Hospital, Jaipur, India, from June 2011 to May 2012, including 29 closed fractures and 7 open fractures at the mean age of 38.9 years. Thirty-six patients were divided equally into two groups based on treatment method, including medial plating group （18 patients） and lateral plating group （18 patients）. They were followed up for at least 5 months after discharge. The functional outcomes were evaluated using Tenny and Wiss clinical assess- ment criteria. Results： Malunion was found in 3 cases of medial plating group and in 1 case of lateral plating group. In the medial plating group, there were 5 cases of superficial infections, 1 deep infection, 1 nonunion and 3 wound dehiscence. In the lateral plating group, there was 1 case of superficial infections, 1 deep infection and 1 nonunion, in the lateral plating group, 4 patients reported feeling the plates and screws but none of them asked to remove the hardware. In the medial plating group, 9 patients reported symptomatic hardware problems and 7 asked to remove the hardware. The number of cases graded as excellent/good/ fair was 1/8/7 in the medial plating group and 3/7/7 in the lateral plating group respectively. In the medial plating group, the final range of motion was 17.2° in ankle dorsiflexion and 30.7° in ankle plantar flexion. In the lateral plating group, the final range of motion was 19° in ankle dorsiflexion and 34.2° in ankle plantar flexion. Conclusion： Lateral plating of distal tibia is safe and feasible, which can provide biological fixation and prevent the soft tissue complications associated with medial plating.
基金Chongqing Medical Scientific Research Project(Joint project of Chongqing Health Commission and Science and Technology Bureau)2022MSXM096.
文摘Purpose The management of irreducible,sagittally unstable peritrochanteric fractures presents a significant challenge due to the inability to achieve closed reduction using conventional techniques.This study introduces a novel minimally invasive technique leveraging the mechanical advantage principle with long,angled hemostatic clamps.Methods A retrospective review was performed on 16 patients who sustained sagittally unstable peritrochanteric fractures and underwent a percutaneous hemostatic clamp leverage reduction procedure.Inclusion criteria:(1)Preoperative confirmation of fracture type as peritrochanteric fracture;(2)Intraoperative imaging confirms the presence of sagittal plane displacement at the fracture site;(3)Age>18 years.Exclusion criteria:(1)Open fractures,pathological fractures,and diabetes;(2)Long-term use of corticosteroids;(3)Patients with local skin or systemic conditions not suitable for surgery.Regular follow-ups at intervals of 6–8 weeks continued until evidence of bone consolidation was apparent in radiographic assessments.Evaluation of the alignment quality considered factors such as the re-establishment of the neck-shaft angle,the integrity of all cortical bone edges,and the rectification of any translational displacement,while the assessment of hip functionality was performed using the Harris scoring system.Statistical analysis of the relevant data was performed using SPSS 25.0 software.Results The average age of these 16 patients was 56.8 years(ranging from 25 to 81 years),consisting of 8 males and 8 females.According to the AO/OTA fracture classification,the cohort included 13 cases of type 31A,2 cases of type 32A,and 1 case of type 32C.The time from hospital admission to the day of surgery ranged from 3 to 11 days,with an average of 5.1 days.Closed reduction was successfully implemented in all 10 instances,negating the necessity for transition to open reduction procedures.The mean operative duration was 105.8 min(range 80–180 min).Satisfactory results of the quality of reduction were determined by comparison with the normal side.The average Harris hip score was 94.1(range 87–99),and the fracture healing time was 4.2 months(3–6 months).Implant failure and malunion were not observed.Conclusions This study provides an alternative,minimally invasive technique for reducing sagittally unstable,irreducible peritrochanteric fractures.This technique holds the potential to manage complex fractures with the same efficacy as is typically reserved for simple and easily reducible fractures.
