Intra-articular opening wedge osteotomy for varus ankle arthritis with computer-assisted planning and patient-specific surgical guides: a retrospective case series.

BACKGROUND: Computer-assisted preoperative planning, combined with PSI has become an effective technique for treating complex limb deformities. The purpose of this study was to evaluate the efficacy and safety of the novel technique in corrective osteotomy for intra-articular varus ankle deformities associated with osteoarthritis and ankle instability. METHODS: Nineteen patients with intra-articular varus ankle arthritis were reviewed between April 2017 and June 2019, including ten men and nine women with a mean age of 58.3 ± 9.9 years (range, 38 to 76 years). All patients underwent intra-articular opening wedge osteotomy assisted by 3D virtual planning and PSI. Weight-bearing radiographs were used to assess the radiographic results, including TAS angle, TT angle, TMM angle, TC angle, TLS angle, opening-wedge angle, and wedge height. Functional outcomes were assessed by the AOFAS score, VAS score, and ROM of the ankle. RESULTS: The average follow-up time was 32.2 ± 9.0 months (range, 22 to 47 months). The average union time was 4.4 ± 0.9 months (range, 3.0 to 6.5 months). The TAS angle significantly changed from 84.1 ± 4.6° preoperatively to 87.7 ± 3.1° at the 1-year follow-up and 86.2 ± 2.6° at the latest follow-up. Similarly, the TT angle, TMM angle and TC angle changed significantly at the 1-year follow-up compared with the preoperative assessment and remained stable until the last follow-up. However, the TLS was not corrected significantly. The postoperative obtained opening-wedge angle, and wedge height showed no significant change with preoperative planning. The overall complication rate was 15.8%. The mean VAS score improved from 5.3 ± 0.6 to 2.7 ± 0.7. The mean AOFAS score improved from 56.2 ± 7.6 to 80.6 ± 4.6. However, the ROM showed no significant change. CONCLUSIONS: Accurate correction and satisfactory functional recovery were attained with computer-assisted planning and PSI in the corrective osteotomy of intra-articular varus ankle deformities.

A survey of 3D object detection algorithms for intelligent vehicles development.

With the rapid development of Artificial Intelligent algorithms on Computer Vision, 2D object detection has greatly succeeded and been applied in various industrial products. In the past several years, the accuracy of 2D object detection has been dramatically improved, even beyond the human eyes detection ability. However, there is still a limitation of 2D object detection for the applications of Intelligent Driving. A safe and reliable self-driving car needs to detect a 3D model of the around objects so that an intelligent driving car has a perception ability to real driving situations. This paper systematically surveys the development of 3D object detection methods applied to intelligent driving technology. This paper also analyzes the shortcomings of the existing 3D detection algorithms and the future development directions of 3D detection algorithms on intelligent driving.

Adjacent segment degeneration after intervertebral fusion surgery by means of cervical block vertebrae.

BACKGROUND: The prevalence of cervical block vertebrae is unknown. Furthermore, there is no consensus on the cause of adjacent segment degeneration (ASD) after cervical fusion. QUESTIONS/PURPOSES: (1) What is the incidence of cervical block vertebrae? Is there a gender difference? (2) Among cervical block vertebrae cases, is ASD related to age and segment? And what is the specific relationship? (3) What are the imaging findings and characteristics of this disease? PATIENTS AND METHODS: We retrospectively diagnosed cervical block vertebrae cases with bony fusions in any segments of the cervical spine without intervertebral fusion surgery of 33,762 patients reported from 2006 to 2011 in north China. Then the X-ray of the obtained cases were observed and counted. The primary outcome was incidence of ASD according to age and segment. The secondary outcome measures were C2-7 angle in fusion (single segment fusion of lower cervical vertebra) and control groups (randomly selected cases of non-fusion), Cobb's angle of fusion segments, and curvature of each lower cervical segment in the control group. RESULTS: A total of 218 cervical block vertebrae cases were found, with a incidence of 0.65%, and C2-3 represented the highest number of fusion segment cases. There were no significant differences in the incidence by sex. Varying degrees of degeneration in the adjacent segment was present in 112 cases (51.4%). The incidence of ASD increased with age, with the ASD growth rate reaching its peak at the age of 51-60 years (55.08%). Cervical curvature shows no significant difference between patients with cervical block vertebrae and normal individuals. The segmental curvature was lower in the fusion group than in the control group, with statistical significance achieved in fusion segments located in C4-5, C5-6, and C6-7, but not C3-4. CONCLUSIONS: Fusion segments located in C4-5, C5-6, and C6-7 are more prone to ASD than C3-4. The incidence of ASD in patients with vertebral fusion increases with age. LEVEL OF EVIDENCE: III.

The Efficacy of Liposomal Bupivacaine Using Periarticular Injection in Total Knee Arthroplasty: A Systematic Review and Meta-Analysis.

BACKGROUND: Total knee arthroplasty (TKA) is gradually emerging as the treatment of choice for end-stage osteoarthritis. In the past, the method of liposomal bupivacaine by periarticular injection (PAI) showed better effects on pain reduction and opioid consumption after surgery. However, some recent studies have reported that liposomal bupivacaine by PAI did not improve pain control and functional recovery in patients undergoing TKA. Therefore, this meta-analysis was conducted to determine whether liposomal bupivacaine provides better pain relief and functional recovery after TKA. METHODS: Web of Science, PubMed, Embase, and the Cochrane Library were comprehensively searched. Randomized controlled trials, controlled clinical trials, and cohort studies were included in our meta-analysis. Eleven studies that compared liposomal bupivacaine using the PAI technique with the conventional PAI method were included in our meta-analysis. The preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines and Cochrane Handbook were applied to assess the quality of the results published in all included studies to ensure that the results of our meta-analysis were reliable and veritable. RESULTS: Our pooled data analysis demonstrated that liposomal bupivacaine was as effective as the control group in terms of visual analog scale score at 24 hours (P = .46), 48 hours (P = .43), 72 hours (P = .21), total amount of opioid consumption (P = .25), range of motion (P = .28), length of hospital stay (P = .53), postoperative nausea (P = .34), and ambulation distance (P = .07). CONCLUSION: Compared with the conventional PAI method, liposomal bupivacaine shows similar pain control and functional recovery after TKA. Considering the cost for pain control, liposomal bupivacaine is not worthy of being recommended as a long-acting alternative analgesic agent using the PAI method.

Comparison of Less Invasive Stabilization System Plate and Retrograde Intramedullary Nail in the Fixation of Femoral Supracondylar Fractures in the Elderly: A Biomechanical Study.

OBJECTIVE: To compare the biomechanical stabilities of less invasive stabilization system (LISS) plate and retrograde intramedullary nail (IMN) for the comminuted femoral supracondylar fracture fractures in the elderly. METHODS: Sixteen pairs of embalmed cadaver femurs were obtained to simulate a comminuted supracondylar femur fracture (AO/OTA33-A3) gap model. All left-side specimens were fixed with LISS plate, and retrograde IMN were applied to the right-side specimens. All specimens were tested in torsional, axial and cyclic load mode on an Instron testing machine. RESULTS: The mean torsional stiffness for LISS plate group was 34.1% greater than retrograde IMN group (2.90 vs. 1.91 Nm/degree, P = 0.002), but the mean axial stiffness was greater for the retrograde IMN (199.16 vs. 303.93 N/mm, P < 0.001). The total deformation of LISS plate caused by cyclic axial loading was greater than retrograde IMN (4.17 vs. 3.57 mm, P = 0.014). Significantly less mean irreversible deformation was detected in LISS plate than in retrograde IMN (1.64 vs. 1.69 mm, P = 0.699). Failure loads of the constructs were significantly different between the two groups (LISS plate: 2941±128 N; retrograde IMN: 4022±176 N, P < 0.001). CONCLUSION: For comminuted femoral supracondylar fractures in the elderly, the tested instruments can both maintain sufficient biomechanical stabilities, but retrograde IMN is superior to LISS plate in deformation of fracture site.

Custom-made Prosthesis for Reconstruction after Radical Resection for Chondrosarcoma of Manubrium.

The clinical incidence of tumors in the manubrium is not high. Regardless of whether the tumor is primary or metastatic, the tumor should be completely removed as long as the patient is able to tolerate the surgery. This procedure can lead to sternal defects. Deciding on the method of defect reconstruction is a critical problem that clinicians face. In this , to reduce the limitations of the patient's upper body movement after surgery due to the inflexibility in the connections of the sternal prosthesis, we created a prosthesis using a computer-assisted design method and a 3-D technique, to completely preserve the agility of the sternum and maximize the patient's post-operational movement. The method used in the present study takes into consideration the individual's chest anatomy, sternum stress, and many other biological characteristics. Care is taken to measure the sternum size accurately, to provide personalized treatment, to accomplish precise results, and to reduce potential future damage. The patient's shoulder function was improved following the procedure.