RESUMO
Knowledge about the distribution and dynamics of seasonal snow cover (SSC) is of high importance for climate studies, hydrology or hazards assessment. SSC varies considerably across the Hindu Kush Himalaya both in space and time. Previous studies focused on regional investigations or the influence of snow melt on the local hydrological system. Here, we present a systematic assessment of metrics to evaluate SSC dynamics for the entire HKH at regional and basin scale based on AVHRR GAC data at a 0.05° spatial and daily temporal resolution. Our findings are based on a unique four-decade satellite-based time series of snow cover information. We reveal strong variability of SSC at all time scales. We find significantly decreasing SSC trends in individual summer and winter months and a declining tendency from mid-spring to mid-fall, indicating a shift in seasonality. Thanks to this uniquely spatio-temporally resolved long-term data basis, we can particularly highlight the unique temporally variable character of seasonal snow cover and its cross-disciplinary importance for mountain ecosystems and downstream regions.
Assuntos
Ecossistema , Neve , Clima , Mudança Climática , Estações do AnoRESUMO
BACKGROUND: The orthopedic community is divided on the question of whether modern technologies in arthroplasty improve outcomes. Therefore, the aim of this initiative of the working group on intraoperative imaging and technology integration (Arbeitsgemeinschaft intraoperative Bildgebung und Technologieintegration, AGiTEC) is to initiate the collection of additional data for the scientific evaluation of modern technologies. QUESTION: To what extent are modern technologies currently used and which implementations are planned? Do the members of the German Society for Orthopedics and Trauma Surgery (DGOU) consider the acquisition of additional data for scientific assessment necessary? METHODS: Members of the DGOU were asked via an email survey about the distribution and projected introduction of modern technologies in arthroplasty. They were also asked whether sufficient data were collected for scientific evaluation and whether acquisition of additional data in studies or arthroplasty registries were considered necessary. RESULTS: Of the 7923 probands surveyed, 428 completed the questionnaire in full (5.4%). It was found that individual implants and navigation are currently the most frequently used (31% and 29%, respectively). The largest increases in the next 2 years are projected for virtual reality and robotics (+30% and +23%, respectively), 85% of respondents indicated that insufficient data were collected for scientific evaluation, and 89% each requested initiation of multicenter studies and inclusion of technologies in the arthroplasty registry. CONCLUSION: The results of this study should motivate the scientific community, industry, and those responsible for the arthroplasty registries to collect and analyze data for the scientific assessment of modern technologies.
Assuntos
Procedimentos Ortopédicos , Ortopedia , Artroplastia , Inquéritos e Questionários , TecnologiaRESUMO
Neurorehabilitation in patients suffering from motor deficits relies on relearning or re-adapting motor skills. Yet our understanding of motor learning is based mostly on results from one or two-dimensional experimental paradigms with highly confined movements. Since everyday movements are conducted in three-dimensional space, it is important to further our understanding about the effect that gravitational forces or perceptual anisotropy might or might not have on motor learning along all different dimensions relative to the body. Here we test how well existing concepts of motor learning generalize to movements in 3D. We ask how a subject's variability in movement planning and sensory perception influences motor adaptation along three different body axes. To extract variability and relate it to adaptation rate, we employed a novel hierarchical two-state space model using Bayesian modeling via Hamiltonian Monte Carlo procedures. Our results show that differences in adaptation rate occur between the coronal, sagittal and horizontal planes and can be explained by the Kalman gain, i.e., a statistically optimal solution integrating planning and sensory information weighted by the inverse of their variability. This indicates that optimal integration theory for error correction holds for 3D movements and explains adaptation rate variation between movements in different planes.
Assuntos
Adaptação Fisiológica , Desempenho Psicomotor , Teorema de Bayes , Humanos , Aprendizagem , MovimentoRESUMO
Aniridia is a condition characterized by defects or absence of the iris. Since the eyes are a central point of attention in the human face, these deformities are often covered with cosmetic implants. However, patients suffer from the static pupil diameter of these implants, resulting in high light sensitivity or inadequate night vision. Therefore, we present a functional iris implant based on dielectric elastomer actuators. These electric drives are characterized by a silent and continuous adaptation as well as a small construction volume and a low heat emission. Since they normally exhibit in-plane uniaxial motion, this displacement must be focused to operate similarly to the iris sphincter. Therefore, we investigated possible mechanical modifications of the setups to generate a directional motion. The results of the study are presented and discussed.Clinical Relevance- The proposed system design enables the functional treatment of aniridia and other accidental iris defects. In addition, the system serves as a basis for later developments of e.g. functional lenses that allow focus adjustment.
Assuntos
Aniridia , Iris , Aniridia/cirurgia , Humanos , Próteses e Implantes , Implantação de Prótese , Acuidade VisualRESUMO
Active urologic implants, such as bladder stimulators or artificial sphincters, are a widely-used approach for therapy of urinary incontinence. At present these devices are powered by primary batteries or conventional wireless power transferring techniques. As these methods are associated with several limitations, human body energy harvesting can be a promising alternative or complement for power supply. This paper introduces an approach to harvest energy from the urine flow inside the urethra with a mechatronic harvesting system based on a hubless flow turbine. Using a test bench approximating the flow conditions of the lower urinary tract, the feasibility of the harvesting principle is shown in-vitro.
Assuntos
Fontes de Energia Elétrica , Incontinência Urinária , Humanos , Próteses e Implantes , Bexiga UrináriaRESUMO
BACKGROUND: Immune checkpoint inhibitors (ICIs) have led to a paradigm change in the management of metastatic renal cell carcinoma (mRCC). Prospective trials have focused on ICI treatment in the first or second line. The aim of this analysis is to evaluate the benefit of ICI across different treatment lines. PATIENTS AND METHODS: This is a single-center retrospective study that included mRCC patients who received ICIs in various treatment lines. Objective response rates (ORR), progression-free survival (PFS) and overall survival (OS) were evaluated. RESULTS: Ninety-four patients were eligible for full evaluation. Patients were classified as International mRCC Database Consortium (IMDC) risk group categorization as good, intermediate and poor risk in 26.8%, 61.6% and 14.8% of cases, respectively. They were treated with ICI monotherapy, dual ICI therapy and ICI + tyrosine kinase inhibitor in 59%, 20% and 21% of cases, respectively. ORR, median PFS and OS for the entire cohort was 39.4%, 9.67 months [95% confidence interval (CI) 6.9-12.4 months] and 23.6 months (95% CI 13.3-33.9 months), respectively. The ORR by treatment line was 33% in first, 40.4% in the second, 35% in the third and 43.5% in the fourth line and beyond. Median PFS by treatment line was 8.6, 10.3, 7.9 and 7.23 months, respectively. The median OS was not reached in first-line treatment and was 26.2, 18.1 and 20.7 months in the second, third and fourth line and beyond, respectively. CONCLUSIONS: ICIs or ICI combinations are active in all treatment lines and should also be offered in heavily pretreated patients. Patient selection based on tumor and patient factors allows for maximal benefit from ICI-based therapies.
Assuntos
Carcinoma de Células Renais , Neoplasias Renais , Carcinoma de Células Renais/tratamento farmacológico , Humanos , Inibidores de Checkpoint Imunológico , Neoplasias Renais/tratamento farmacológico , Estudos Prospectivos , Estudos RetrospectivosRESUMO
BACKGROUND: Numerous processes are involved in the orthopedic and trauma surgery operating room (OR). Technical progress, particularly in the area of digitalization, is increasingly changing routine surgical procedures. OBJECTIVE: This article highlights the possibilities and also limitations regarding this matter. MATERIAL AND METHODS: Based on the current literature this article provides insights into innovations in the areas of digitalization of surgical devices, hybrid OR, machine-2-machine networking, management systems for perioperative efficiency improvement, 3D printing technology and robotics. RESULTS: The technical possibilities for the use of digital applications in the surgical environment are rapidly increasing. Close cooperation with industrial partners is important in this context. Technologies from the automotive, gaming and mobile phone industries are being adopted. CONCLUSION: Digital technology in the OR can improve treatment quality, patient and staff safety and cost efficiency; however, the networking of devices, implementation of innovations in existing structures and the sometimes high acquisition costs are still limiting factors.
Assuntos
Salas Cirúrgicas , Ortopedia , Robótica , Humanos , Impressão TridimensionalRESUMO
Tobacco-specific nitrosamines (TSNAs) have been of concern to the public health community for decades and their reduction through agricultural practices, plant breeding, and tobacco processing has also been a decades-long industry effort. Despite those efforts, TSNAs, though lower, continue to be constituents of concern in tobacco products. This paper examines the TSNA levels of dark air-cured, dark fire-cured, and burley tobaccos purchased in the United States by U.S. Smokeless Tobacco Company LLC (USSTC) and of nine finished USSTC moist smokeless tobacco products. TSNA values of the incoming purchased tobaccos and the finished products showed considerable variability. For the incoming tobaccos, the coefficient of variation was generally more than 100 % for each tobacco type and for each of the measured TSNAs. The relative TSNA variability of the finished tobacco products was also considerable, averaging approximately 25 %. It was also found that the measured values for the finished products averaged well above the proposed FDA NNN proposed product standard of 1.0 µg/g dry weight. Because of the large variability in NNN values, products would have to average well below FDA's proposed product standard to be consistently compliant.
RESUMO
Anatomic reconstruction of articular fractures is one of the critical factors in later achieving good functional outcome. Intraoperative 3D imaging has been shown to offer better evaluation and therefore can significantly improve the results. The purpose of this study was to assess the difference between intraoperative three-dimensional fluoroscopy (3D) and intraoperative computed tomography (iCT) imaging regarding fracture reduction, implant placement and articular impressions in a distal humeral fracture model. AO type 13-B2 fracture pattern were created in upper extremity cadaver specimens. Articular step-offs, intra-articular screw placement and intraarticular impressions of different degrees of severity were created. All specimens had imaging performed. For each articular pattern 3D fluoroscopy in standard (3Ds) and high quality (3Dh) were performed (Arcadis Orbic, Siemens, Germany) as well as an intraoperative CT scan (iCT, Airo, Brainlab, Germany). Three observers evaluated all imaging studies regarding subjective and objective parameters. iCT is more precise than 3D fluoroscopic imaging for detection of articular impressions. Articular step-offs and intraarticular screw placement are similar for iCT and 3D. Subjective imaging quality is the highest for iCT and lowest for 3Ds. Intraoperative CT may be particularly useful in assessing articular impressions and providing a good subjective image quality for the surgeon.
Assuntos
Fraturas Ósseas/diagnóstico por imagem , Imageamento Tridimensional/métodos , Tomografia Computadorizada por Raios X/métodos , Tomografia Computadorizada por Raios X/normas , Cadáver , HumanosRESUMO
INTRODUCTION: Stable pronator quadratus repair following volar plate fixation of distal radius fractures with complete plate coverage is difficult. MATERIALS AND METHODS: This study compares a modified pronator quadratus repair technique involving the brachioradialis muscle insertion (test group) with a conventional radial incision through the muscle without pronator quadratus repair (standard group). This prospective randomised study included 16 patients in the test group and 12 in the standard group; all were available for clinical, radiographic and ultrasound examination at a mean follow-up of 15 months. RESULTS: Pronator quadratus repair was feasible in all test group patients, and complete coverage of the distal plate was achieved in 11. No differences in functional outcome were observed between the groups. CONCLUSION: Pronator quadratus repair with a part of the brachioradialis muscle insertion is a reliable technique for coverage of a volar plate by slight distal transposition. In the repair of distal radius fractures, this may better protect the finger flexor tendons against irritation and/or rupture. That likelihood should now be studied.
Assuntos
Fixação Interna de Fraturas/métodos , Músculo Esquelético/transplante , Fraturas do Rádio/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Antebraço , Humanos , Masculino , Pessoa de Meia-Idade , Músculo Esquelético/cirurgia , Estudos Prospectivos , Adulto JovemRESUMO
PURPOSE: To evaluate the safety and efficacy of radiofrequency (RF) ablation of the basivertebral nerve (BVN) for the treatment of chronic low back pain (CLBP) in a Food and Drug Administration approved Investigational Device Exemption trial. The BVN has been shown to innervate endplate nociceptors which are thought to be a source of CLBP. METHODS: A total of 225 patients diagnosed with CLBP were randomized to either a sham (78 patients) or treatment (147 patients) intervention. The mean age within the study was 47 years (range 25-69) and the mean baseline ODI was 42. All patients had Type I or Type II Modic changes of the treated vertebral bodies. Patients were evaluated preoperatively, and at 2 weeks, 6 weeks and 3, 6 and 12 months postoperatively. The primary endpoint was the comparative change in ODI from baseline to 3 months. RESULTS: At 3 months, the average ODI in the treatment arm decreased 20.5 points, as compared to a 15.2 point decrease in the sham arm (p = 0.019, per-protocol population). A responder analysis based on ODI decrease ≥ 10 points showed that 75.6% of patients in the treatment arm as compared to 55.3% in the sham control arm exhibited a clinically meaningful improvement at 3 months. CONCLUSION: Patients treated with RF ablation of the BVN for CLBP exhibited significantly greater improvement in ODI at 3 months and a higher responder rate than sham treated controls. BVN ablation represents a potential minimally invasive treatment for the relief of chronic low back pain. These slides can be retrieved under Electronic Supplementary Material.
Assuntos
Ablação por Cateter/métodos , Dor Crônica/cirurgia , Dor Lombar/cirurgia , Coluna Vertebral , Adulto , Idoso , Dor Crônica/fisiopatologia , Método Duplo-Cego , Humanos , Dor Lombar/fisiopatologia , Pessoa de Meia-Idade , Medição da Dor , Estudos Prospectivos , Coluna Vertebral/inervação , Coluna Vertebral/fisiopatologia , Coluna Vertebral/cirurgia , Resultado do TratamentoRESUMO
PURPOSE: A new software application can be used without fixed reference markers or a registration process in wire placement. The aim was to compare placement of Kirschner wires (K-wires) into the proximal femur with the software application versus the conventional method without guiding. As study hypothesis, we assumed less placement attempts, shorter procedure time and shorter fluoroscopy time using the software. The same precision inside a proximal femur bone model using the software application was premised. METHODS: The software detects a K-wire within the 2D fluoroscopic image. By evaluating its direction and tip location, it superimposes a trajectory on the image, visualizing the intended direction of the K-wire. The K-wire was positioned in 20 artificial bones with the use of software by one surgeon; 20 bones served as conventional controls. A brass thumb tack was placed into the femoral head and its tip targeted with the wire. Number of placement attempts, duration of the procedure, duration of fluoroscopy time and distance to the target in a postoperative 3D scan were recorded. RESULTS: Compared with the conventional method, use of the application showed fewer attempts for optimal wire placement (p=0.026), shorter duration of surgery (p=0.004), shorter fluoroscopy time (p=0.024) and higher precision (p=0.018). Final wire position was achieved in the first attempt in 17 out of 20 cases with the software and in 9 out of 20 cases with the conventional method. CONCLUSIONS: The study hypothesis was confirmed. The new application optimised the process of K-wire placement in the proximal femur in an artificial bone model while also improving precision. Benefits lie especially in the reduction of placement attempts and reduction of fluoroscopy time under the aspect of radiation protection. The software runs on a conventional image intensifier and can therefore be easily integrated into the daily surgical routine.
Assuntos
Fraturas do Fêmur/diagnóstico por imagem , Fêmur/diagnóstico por imagem , Fixação Interna de Fraturas , Cirurgia Assistida por Computador/métodos , Órgãos Artificiais , Fios Ortopédicos , Osso e Ossos/diagnóstico por imagem , Osso e Ossos/cirurgia , Fraturas do Fêmur/cirurgia , Fêmur/anatomia & histologia , Fêmur/cirurgia , Fluoroscopia , Fixação Interna de Fraturas/métodos , Humanos , Modelos Anatômicos , Duração da Cirurgia , Reprodutibilidade dos Testes , SoftwareRESUMO
Accidents in which a person is run over are often associated with multiple serious injuries. Immediate bleeding control is crucial. Pressure and shear stress at the borders of subcutaneous tissue to the muscle fascia can cause hypoperfusion and the emergence of blood-filled cavities that are associated with a high risk of infection and necrosis, a so-called Morel-Lavallée lesion. Insufficient therapy can lead to local complications and furthermore to live-threatening sepsis.
Assuntos
Traumatismo Múltiplo/terapia , Ferimentos e Lesões/terapia , Acidentes de Trânsito , Adolescente , Desbridamento , Hemorragia/etiologia , Hemorragia/terapia , Humanos , Masculino , Traumatismo Múltiplo/etiologia , Traumatismo Múltiplo/cirurgia , Necrose , Manejo da Dor , Sepse/etiologia , Sepse/terapia , Síndrome , Ferimentos e Lesões/complicaçõesRESUMO
BACKGROUND: In the operative treatment of Dupuytren's disease, in certain cases proximal interphalangeal joint flexion contracture remains after fasciectomy due to shrinkage, shortening, and/or adhesion of the periarticular structures. OBJECTIVES: How can a residual flexion contracture of the proximal interphalangeal joint after partial fasciectomy in Dupuytren's disease be treated surgically and what follow-up results can be expected? METHODS: Description of anatomy, indication, surgical technique of arthrolysis of the proximal interphalangeal joint, postoperative treatment, and critical analysis of the results reported in the literature. RESULTS: Arthrolysis of the proximal interphalangeal joint is performed in up to six consecutive steps. An improvement of only about 50% compared to preoperative flexion contracture can be expected. CONCLUSIONS: Despite alleged unsatisfactory results arthrolysis of the proximal interphalangeal joint can be recommended in surgery of Dupuytren's disease. In certain cases, patient cooperation during lengthy postoperative treatment is necessary.
Assuntos
Contratura de Dupuytren/patologia , Contratura de Dupuytren/cirurgia , Fasciotomia/métodos , Articulações dos Dedos/patologia , Articulações dos Dedos/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Aderências Teciduais/cirurgia , Medicina Baseada em Evidências , Humanos , Aderências Teciduais/patologia , Resultado do TratamentoRESUMO
OBJECTIVE: Arthrodesis of the proximal interphalangeal joint of fingers in a functional and pain-free position. INDICATIONS: Primary and secondary osteoarthritis, traumatic joint destruction, posttraumatic malposition, instability, joint destruction due to infection, irreparable extensor and/or flexor tendon lesion, recurrent flexion deformity in Dupuytren's disease, arthritis (e. g., rheumatoid arthritis, psoriatic arthritis), failed resection arthroplasty, failed prosthesis, congenital disorder (e. g., camptodactyly). CONTRAINDICATIONS: Persistent joint infection. SURGICAL TECHNIQUE: Resection of the proximal phalanx head and the middle phalanx base, arthrodesis with figure-of-eight tension band wire in a functional position. POSTOPERATIVE MANAGEMENT: Plaster of Paris cast with arthrodesis position of the affected finger and intrinsic plus position of at least one adjacent finger for 2 weeks, custom-made finger splint for 4 weeks. RESULTS: A total of 15 of 16 patients with an arthrodesis of the proximal interphalangeal finger joint of the dominant hand by tension band wire were followed up after an average of 31 months. None was affected by the arthrodesis in everyday live. All patients were very satisfied with the result. Nine of 15 patients were free of pain both at rest and with activity. The average DASH score was 48 points. Grip strength averaged 29 kg, 7 % stronger than the contralateral hand.
Assuntos
Artrodese , Articulações dos Dedos , Artrodese/métodos , Artroplastia , Contratura de Dupuytren , Articulações dos Dedos/patologia , Articulações dos Dedos/cirurgia , Humanos , Resultado do TratamentoRESUMO
INTRODUCTION: Digital pyogenic flexor tenosynovitis requires fast, aggressive treatment. Although this infection occurs frequently, treatment consensus is lacking. MATERIALS AND METHODS: Between 2011 and 2015, 22 patients with acute pyogenic flexor tenosynovitis were treated with a single open debridement followed by irrigation; the incision was closed and a 10-day antibiotic course was administered. The average incision-to-suture time was 25 min, and the average hospital stay was 4 days. Recovery was uncomplicated for 20 patients, while two were reoperated, one due to germ resistance and the other due to necrotizing fasciitis. At an average of 30 month postoperatively, 21 of the 22 patients were available for follow-up. The affected finger was inspected, and sensibility, range of motion, and grip force were compared with the opposite side, and the DASH score was determined. Each patient documented pain in the affected finger at rest and during activity, and rated overall satisfaction with the treatment on a visual analogue scale. RESULTS: Almost all patients were free of pain at follow-up and very satisfied. Compared to the contralateral side, each of the affected fingers had the same range of motion and sensibility. Grip force was similar on both sides. The average DASH score was 35 points. CONCLUSION: A single open debridement with irrigation and primary wound closure followed by 10 days of antibiotic treatment resolved uncomplicated pyogenic flexor tenosynovitis. After 2 and a half years, the treatment yielded high patient satisfaction with neither functional nor subjective impairment of the affected finger.
Assuntos
Antibacterianos/uso terapêutico , Desbridamento , Dedos/cirurgia , Tenossinovite/cirurgia , Irrigação Terapêutica , Adolescente , Adulto , Idoso , Criança , Desbridamento/efeitos adversos , Fasciite Necrosante/cirurgia , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Complicações Pós-Operatórias , Amplitude de Movimento Articular , Reoperação , Infecção da Ferida Cirúrgica/cirurgia , Tenossinovite/tratamento farmacológico , Adulto JovemRESUMO
BACKGROUND: The results and immediate consequences of intraoperative three-dimensional (3D) imaging in the treatment of AO classification type C fractures of the distal radius, the tibial head and the tibial pilon were analyzed and compared with published results on general intraoperative revision rates following intraoperative 3D-imaging. METHODS: In this retrospective study 279 patients with AO type C fractures of the distal radius (n = 84), tibial head (n = 109) and tibial pilon (n = 86) who underwent intraoperative 3D-imaging were included. The findings of the 3D-imaging and the intraoperative revision rates were analyzed and compared with previously published results of our working group. RESULTS: In 70 out of 279 patients (25 %) an intraoperative revision was carried out following 3D-imaging. The revision rates were 15 % for fractures of the distal radius, 27 % for fractures of the tibial head and 32 % for fractures of the tibial pilon. The most common reason for immediate intraoperative revision was the necessity for improved repositioning due to a remaining step in the articular surface in 51 out of 279 patients (18%). CONCLUSION: Intraoperative revision rates following 3D-imaging increased with the severity of the injury pattern. Intraoperative 3D-imaging should be routinely used in the treatment of fractures of the tibial head, tibial pilon and even in comminuted distal radius fractures due to the high intraoperative revision rates found in the present study. Alternatively, a postoperative computed tomography (CT) control should be performed.
Assuntos
Fixação Interna de Fraturas/estatística & dados numéricos , Imageamento Tridimensional/estatística & dados numéricos , Fraturas do Rádio/cirurgia , Reoperação/estatística & dados numéricos , Cirurgia Assistida por Computador/estatística & dados numéricos , Fraturas da Tíbia/cirurgia , Feminino , Alemanha/epidemiologia , Humanos , Imageamento Tridimensional/métodos , Masculino , Pessoa de Meia-Idade , Segurança do Paciente , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/prevenção & controle , Prevalência , Fraturas do Rádio/diagnóstico por imagem , Fraturas do Rádio/epidemiologia , Reprodutibilidade dos Testes , Estudos Retrospectivos , Fatores de Risco , Sensibilidade e Especificidade , Cirurgia Assistida por Computador/métodos , Fraturas da Tíbia/diagnóstico por imagem , Fraturas da Tíbia/epidemiologia , Resultado do TratamentoRESUMO
BACKGROUND: De-novo scoliosis is most commonly associated with chronic back pain and in 70 % of cases with neurological symptoms of the lower extremities. In recent literature, the occurrence and severity of segmental lateral listhesis has been discussed as being an important prognostic factor of sagittal and frontal deformity progression. In general, operative interventions in patients with de-novo scoliosis are associated with a high rate of complications. Therefore, conservative treatment modalities are recommended at early stages of the disease. If conservative management fails and a sufficient reduction of the patient's symptoms cannot be achieved, depending on the symptoms, a selective decompression, short-segment fusion or long-instrumented reduction and fusion are indicated. Additionally to the patient's symptoms, specific imaging diagnostics are necessary to develop an adequate surgical treatment strategy. TREATMENT: Selective decompression without fusion is indicated in patients with a fixed deformity and primarily neurologic pain or deficits. In conditions of a focal pathology as cause of significant low back pain and/or neurologic symptoms at early stages of deformity, a short segment fusion is the treatment of choice. However, short-segment fusion as a less-invasive procedure must not be performed in biplanar unbalanced patients and/or advanced de-novo scoliosis. In advanced degenerative de-novo scoliosis a long-segment reposition and fusion following an alignment correction are needed. Standardized pre-operative planning and perioperative management are highly critical to the post-operative success. CONCLUSION: All operative treatment strategies in patients with de-novo scoliosis can be successful but they require sophisticated and individual surgical indication.
Assuntos
Degeneração do Disco Intervertebral/cirurgia , Dor Lombar/prevenção & controle , Vértebras Lombares/cirurgia , Escoliose/diagnóstico , Escoliose/cirurgia , Fusão Vertebral/métodos , Medicina Baseada em Evidências , Humanos , Degeneração do Disco Intervertebral/complicações , Degeneração do Disco Intervertebral/diagnóstico , Dor Lombar/diagnóstico , Dor Lombar/etiologia , Escoliose/complicações , Fusão Vertebral/instrumentação , Resultado do TratamentoRESUMO
BACKGROUND: Digital planning of implants is in most cases conducted prior to surgery. The virtual implant planning system (VIPS) is an application developed for mobile C-arms, which assists the virtual planning of screws close to the joint line during surgery for treatment of distal radius fractures with volar plate osteosynthesis. The aim of this prospective randomized study was to acquire initial clinical experiences and to compare the VIPS method with the conventional technique. METHOD: The study included 10 patients for primary testing and 30 patients with distal radius fractures of types A3, C1 and C2, divided in 2 groups. In the VIPS group, after placement of the plate and fracture reduction, a virtual 3D model of the plate was matched with the image of the plate from the fluoroscopic acquisition. Next, the length and position of the screws close to the joint line were planned on the virtual plate. The control group was treated with the same implant in the conventional way. Data were collected regarding screw replacement, fluoroscopy and operating room (OR) times. RESULTS: The VIPS group included six A3, one C1 and eight C2 fractures, while the control group consisted of six A3 and nine C2 fractures. Three screws were replaced in the VIPS group and two in the control group (p = 0.24). The mean intraoperative fluoroscopy time of the VIPS group amounted to 2.58 ± 1.38 min, whereas it was 2.12 ± 0.73 min in the control group (p = 0.26). The mean OR time in the VIPS group was 53.3 ± 34.5 minutes and 42.3 ± 8.8 min (p = 0.23) in the control group. CONCLUSION: The VIPS enables a precise positioning of screws close to joint line in the treatment of distal radius fractures; however, for routine use, further development of the system is necessary.