Objectives:Pelvic fracture urethral injuries(PFUI)result from traumatic disruption of the urethra.A significant proportion of cases are complex rendering their management challenging.We described management strategies...Objectives:Pelvic fracture urethral injuries(PFUI)result from traumatic disruption of the urethra.A significant proportion of cases are complex rendering their management challenging.We described management strategies for eight different complex PFUI scenarios.Methods:Our centre is a tertiary referral centre for complex PFUI cases.We maintain a prospective database(1995e2016),which we retrospectively analysed.All patients with PFUI managed at our institute were included.Results:Over two decades 1062 cases of PFUI were managed at our institute(521 primary and 541 redo cases).Most redo cases were referred to us from other centres.Redo cases had up to five prior attempts at urethroplasty.We managed complex cases,which included bulbar ischemia,young boys and girls with PFUI,PFUI with double block,concomitant PFUI and iatrogenic anterior urethral strictures.Bulbar ischemia merits substitution urethroplasty,most commonly,using pedicled preputial tube.PFUI in young girls is usually associated with urethrovaginal fistula.Young boys with PFUI commonly have a long gap necessitating trans-abdominal approach.Our success rate with individualised management is 85.60%in primary cases,79.13%in redo cases and 82.40%in cases of bulbar ischemia.Conclusion:The definition of complex PFUI is ever expanding.The best chance of success is at the first attempt.Anastomotic urethroplasty for PFUI should be performed in experienced hands at high volume centres.展开更多
Three-dimensional printed Ti-6Al-4V hemipelvic prosthesis has become a current popular method for pelvic defect reconstruction.This paper presents a novel biomimetic hemipelvic prosthesis design that utilises patient-...Three-dimensional printed Ti-6Al-4V hemipelvic prosthesis has become a current popular method for pelvic defect reconstruction.This paper presents a novel biomimetic hemipelvic prosthesis design that utilises patient-specific anatomical data in conjunction with the Voronoi diagram algorithm.Unlike traditional design methods that rely on fixed,homogeneous unit cell,the Voronoi diagram enables to create imitation of trabecular structure(ITS).The proposed approach was conducted for six patients.The entire contour of the customised prosthesis matched well with the residual bone.The porosity and pore size of the ITS were evaluated.The distribution of the pore size ranged from 500 to 1400μm.Porosity calculations indicated the average porosity was 63.13±0.30%.Cubic ITS samples were fabricated for micrograph and mechanical analysis.Scanning electron microscopy images of the ITS samples exhibited rough surface morphology without obvious defects.The Young’s modulus and compressive strength were 1.68±0.05 GPa and 174±8 MPa,respectively.Post-operative X-rays confirmed proper matching of the customised prostheses with the bone defect.Tomosynthesis-Shimadzu metal artifact reduction technology images indicated close contact between the implant and host bone,alongside favourable bone density and absence of resorption or osteolysis around the implant.At the last follow-up,the average Musculoskeletal Tumour Society score was 23.2(range,21-26).By leveraging additive manufacturing and Voronoi diagram algorithm,customised implants tailored to individual patient anatomy can be fabricated,offering wide distribution of the pore size,reasonable mechanical properties,favourable osseointegration,and satisfactory function.展开更多
文摘Objectives:Pelvic fracture urethral injuries(PFUI)result from traumatic disruption of the urethra.A significant proportion of cases are complex rendering their management challenging.We described management strategies for eight different complex PFUI scenarios.Methods:Our centre is a tertiary referral centre for complex PFUI cases.We maintain a prospective database(1995e2016),which we retrospectively analysed.All patients with PFUI managed at our institute were included.Results:Over two decades 1062 cases of PFUI were managed at our institute(521 primary and 541 redo cases).Most redo cases were referred to us from other centres.Redo cases had up to five prior attempts at urethroplasty.We managed complex cases,which included bulbar ischemia,young boys and girls with PFUI,PFUI with double block,concomitant PFUI and iatrogenic anterior urethral strictures.Bulbar ischemia merits substitution urethroplasty,most commonly,using pedicled preputial tube.PFUI in young girls is usually associated with urethrovaginal fistula.Young boys with PFUI commonly have a long gap necessitating trans-abdominal approach.Our success rate with individualised management is 85.60%in primary cases,79.13%in redo cases and 82.40%in cases of bulbar ischemia.Conclusion:The definition of complex PFUI is ever expanding.The best chance of success is at the first attempt.Anastomotic urethroplasty for PFUI should be performed in experienced hands at high volume centres.
基金supported by Qingdao Research Institutes of Sichuan University,Research of Biomedical Materials and 3D Printing Related Products(No.20GZ30301).
文摘Three-dimensional printed Ti-6Al-4V hemipelvic prosthesis has become a current popular method for pelvic defect reconstruction.This paper presents a novel biomimetic hemipelvic prosthesis design that utilises patient-specific anatomical data in conjunction with the Voronoi diagram algorithm.Unlike traditional design methods that rely on fixed,homogeneous unit cell,the Voronoi diagram enables to create imitation of trabecular structure(ITS).The proposed approach was conducted for six patients.The entire contour of the customised prosthesis matched well with the residual bone.The porosity and pore size of the ITS were evaluated.The distribution of the pore size ranged from 500 to 1400μm.Porosity calculations indicated the average porosity was 63.13±0.30%.Cubic ITS samples were fabricated for micrograph and mechanical analysis.Scanning electron microscopy images of the ITS samples exhibited rough surface morphology without obvious defects.The Young’s modulus and compressive strength were 1.68±0.05 GPa and 174±8 MPa,respectively.Post-operative X-rays confirmed proper matching of the customised prostheses with the bone defect.Tomosynthesis-Shimadzu metal artifact reduction technology images indicated close contact between the implant and host bone,alongside favourable bone density and absence of resorption or osteolysis around the implant.At the last follow-up,the average Musculoskeletal Tumour Society score was 23.2(range,21-26).By leveraging additive manufacturing and Voronoi diagram algorithm,customised implants tailored to individual patient anatomy can be fabricated,offering wide distribution of the pore size,reasonable mechanical properties,favourable osseointegration,and satisfactory function.
