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BACKGROUND:Preliminary experiments have performed three-dimensional (3D) reconstruction of proximal tibial fractures, digital steel plate design, the establishmentof the proximal tibia plate standard parts library and the operation simulation of 3D printing. OBJECTIVE:To explore feasibility and accuracy of standard parts library plates and screws in the proximal tibial fracture internal fixation navigation in digital design combined with 3D printing model on the basis of preliminary studies. METHODS:Dicom format images of continuous thin layer CT scanning were colected in 20 cases of proximal tibial fractures, and uploaded in Mimics software for 3D reconstruction and fracture reduction. Plate and screw selected from standard part library wereusedfor virtual fixation. Navigation module with screw channel was designed. 3D printing skeleton, bone plate, and navigation module were used for skeleton model and internal fixation. Screw and plate were placed by navigation. Navigation module card, nail and board position were observed. Postoperative appearance and CT scanning were utilized to assess outcomes. RESULTS AND CONCLUSION:After CT scanning and reconstructionin 20 skeleton models, in combination with appearance, the position of plate, screw insertion point, the direction, length and diameter of the screw were consistent with that in Mimics software. The navigation module and the corresponding proximal end of the tibia were closely bonded with good fitting degree. In the application, card slots and stability were good, and could perfectly guide plate and screw placement. These reuslts suggest that with the aid of navigation module, standard parts library plate internal fixation for proximal tibia fracture has high accuracy. On the basis of digital design and 3D printing, digital internal fixation technology of standard parts library plate is expected to achieve good implant navigation in the department of orthopedics.
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BACKGROUND:Cholecystokinin as an endogenous neuroprotective factor in the nervous system has garnered increasing attention. Findings from previous animal studies show that cholecystokinin can effectively promote the regeneration of the injured peripheral nerve. On this basis, further clinical trials wil be performed to observe whether local application of cholecystokinin at nerve anastomosis can promote peripheral nerve regeneration. METHODS/DESIGN:As a prospective randomized controled trial, this study wil enrol 100 patients with complete rupture of the peroneal nerve, who wil be randomly divided into two groups: after nerve suture and partial gelatin sponge infiltration at nerve anastomosis, the patients wil be treated with 8 nmol/kg cholecystokinin (treatment group) or saline (control group). At 6, 12, 24 weeks after treatment, common peroneal nerve conduction velocity and electromyography and nerve fiber morphology wil be detected; the clinical efficacy at the last folow-up wil be assessed; and al adverse events during the folow-up wil be recorded to assess the therapeutic efficacy and safety. DISCUSSION:In this study, cholecystokinin as an inducing agent for nerve growth factor synthesis wil be observed and studied, with a view to providing a new idea for seeking peripheral nerve therapy. ETHICAL APPROVAL: The study protocol was approved by the Medical Ethics Committee of the Affiliated Hospital of Putian University (approval No. 2014116). Written informed consent wil be obtained from patients before treatment.
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BACKGROUND:On CT reconstruction of three-dimensional (3D) model, fracture virtual reduction and internal fixation cannot be achieved, and reasonable operation scheme cannot be formulated. Digital design can fuly meet the needs of clinical orthopedics physicians. Standard parts database can provide the possibility to choose the ideal internal fixation. 3D printing makes the reasonable operation scheme accurate in clinical implementation. OBJECTIVE:To discuss the feasibility, accuracy and minimal invasion of internal fixation in treatment of the distal femoral fracture with digital design of standard parts database by 3D printing. METHODS: (1) Nine adult lower extremity specimens were selected to take continuously thin-layer CT scanning. After Dicom images were imported into the mimics software, the model was established. According to the AO classification, they were classified into A1-3, B1-3 and C1-3 types of distal femoral fracture by virtual design. Internal fixation with plate and screw formed standard parts database virtualy. It was printed out the pilot hole of the navigation module design by three-dimensional printing forming technique. Plate and screw were inserted assisted by the module. X-ray and CT scan were taken postoperatively to access the position. (2) 30 patients with distal femoral fracture were subjected to above fixation. The operation time, intraoperative blood loss and postoperative drainage were recorded. Imaging and curative effects were evaluated during folow-up. RESULTS AND CONCLUSION: (1) Nine samples underwent X-ray and CT scan. 3D reconstruction results revealed plate position, screw entry point, nail direction, length and diameter were consistent with presetting data in Mimics software. The navigation models were designed to fit the lateral bony structure of distal femur. There were good fitting degree, good card position and good stability when the navigation was applied. It could guide plant and screw implantation. (2) In 30 cases, the operation time was (104.63±26.12) minutes, intraoperative blood loss was (121.74±11.49) mL, and postoperative drainage volume was (30.29±6.38) mL. Al patients were folowed up. According to Schagzker criterion, the efficiency of 22 cases was excelent, 6 cases good and 2 cases average, and the excelent and good rate was 93%. The parameters of length, diameter, orientation and angle were consistent with that preoperatively. (3) Internal fixation formed by standard parts database assisted by 3D printing navigation model has advantages of high accuracy, short process, lessened blood loss, high safety, less complications, and precise fixation. Digital design of standard parts database via3D printing navigation module is expected to achieve implant navigation and application.
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BACKGROUND:In three-dimensional CT reconstruction model, fracture virtual reduction and internal fixation cannot be achieved, and reasonable operation scheme cannot be formulated. It cannot fuly meet the needs of clinical orthopedics physicians. OBJECTIVE:To explore the methods to perform three-dimensional reconstruction, reduction on proximal tibial fracture and to design digital plate using software. METHODS:Nine specimens of knee joint were built to be A1-3, B1-3 and C1-3 types of proximal tibial fracture according to the AO standard. Al specimens were treated with CT scan. Three-dimensional reconstruction and reduction on nine types of bone fracture models were performed in Mimics. The digital plates and screws were designed in Solidworks. Virtual internal fixation on the reduced three-dimensional models was performed. RESULTS AND CONCLUSION:Al bone fracture models received three-dimensional reconstruction and reduction, and the design for internal fixational plates and screws as wel as virtual internal fixation were accomplished. A3, B3 and C3 types were presented. These results suggest that the digital plates for proximal tibial fracture could be designed in Mimics and Solidworks with a personal computer. Our experience could be used in the real operation.
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BACKGROUND:Odontoid fracture is very common in cervical spine injuries, the special position of odontoid process, which is adjacent to important anatomic structure, makes screw placement difficult, and a slight discrepancy in position and orientation of the inserted screw leads to a decrease in intensity of internal fixation, even invalid internal fixation. Therefore, it is very necessary to develop an individualized treatment protocol by which screws can be precisely and safely placed and which is worthy of clinical popularization. OBJECTIVE:To study the navigation of Mimics software and three dimensional (3D)-printed module in anterior odontoid cannulated screw fixation and to investigate its feasibility and accuracy. METHODS:Sixteen human cadaveric cervical spines were scanned by a continuous thin-slice CT scanner. Original DICOM CT images were three-dimensional y reconstructed using Mimics software. The screw channel and support column were designed for C2 vertebra odontoid cannulated screw fixation for odontoid fracture. Segmentation of bone surface was performed. Navigation modules with screw channel were built using 3D printing technique. Navigation modules were used to aid screw placement. Screw fitting and placement were evaluated using X-ray and CT scan. RESULTS AND CONCLUSION:Total y 16 navigation modules were built and 22 screws were implanted. During and after screw placement, the cortical bone along screw channel and surrounding the vertebral body was not cracked. Postoperative X-ray and CT scans showed that some factors regarding screw placement such as entry point, orientation and depth of placement were consistent with those ideal factors simulated by Mimics software. The navigation modules were closely attached to the corresponding bony structure in front of the vertebral body, with a satisfactory gomphosis. Screw fitting and stability were good during application. These results verify that with the aid of navigation module, anterior odontoid cannulated screw fixation is reliable for treatment of odontoid fracture, which provides insights into the popularization of 3D printing-based digital navigation technique in orthopedic implantation.
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BACKGROUND:The important reason for failed back surgery syndrome is the postoperative epidural scar adhesions, therefore, exploring the methods of preventing postoperative lumbar epidural scar adhesions has always been a hot research in spine surgery field. OBJECTIVE:To investigate the effect of Shenshu point magnetic stimulation therapy on epidural scar adhesions in rat models of failed back surgery syndrome. METHODS:Sixty Sprague-Dawley rat models of failed back surgery syndrome were successfuly established using the method of laminectomy, and then divided into Shenshu magnetic therapy group and blank control group. Beginning from 1 week after modeling, rats in the Shenshu magnetic therapy group were subjected to bilateral Shenshu magnetic stimulation for 6 weeks, 5 days of treatment per week. Rats in the blank control group were not given any intervention. At 13 weeks after modeling, rats were harvested and the area ratio of epidural scars, range of adhesions and formation of colagen fibers were observed under light microscope. Fibroblasts were counted. Hydroxyproline content and transforming growth factor β1 expression in scar tissue were compared between these two groups.
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BACKGROUND:The limitation of the traditional intramedulary nailing relies on the personal experience of the doctor. Moreover, the enlargement of the bone marrow causes the destruction of the biological environment of the marrow cavity and affects the healing of bone. OBJECTIVE:To observe therapeutic effect of digital technology assisted intramedulary nail fixation for femoral shaft fracture. METHODS:A total of 80 patients with femoral shaft fracture, who were treated in the Department of Orthopedics, Affiliated Hospital of Putian University from January 2010 to January 2014, were enroled. Digital technology was used to assist treatment. Three-dimensional digital model of femoral shaft fracture was established before treatment. Virtual reduction was conducted in the three-dimensional digital fractures. The diameter of medulary cavity was measured. Appropriate specification of intramedulary nailing was selected according to the measurement data. Closed reduction and intramedulary nailing were performed according to operation scheme of digital technology. RESULTS AND CONCLUSION:The 80 patients were folowed up for 12 to 24 months. Fractures were completely healed. At 12 months after treatment, they were evaluated by clinical curative effect standard in department of orthopedics. There were excelent in 62 cases, good in 15 cases, and good in 3 cases, with the excelent and good rate of 96%. No complications occurred such as infection, fixator breakage or loosening. These results verify that digital technology assisted intramedulary nail fixation for femoral shaft fracture obtained positive therapeutic effects, could obviously shorten operation time, reduce surgical trauma, and diminish intraoperative X-ray emission to patients and health care workers.
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BACKGROUND:Previous studies have found that cholecystokinin octapeptide (CCK-8) can promote the regeneration after sciatic nerve injury in rats, but the exact mechanism remains unclear. OBJECTIVE:To screen effective indicators and analyze the mechanism of CCK-8 promoting sciatic nerve regeneration from the perspective of nerve growth factor and nerve regeneration microenvironment. METHODS:Healthy Sprague-Dawley rats, for the preparation of unilateral sciatic nerve transection injury model, were randomly divided into two groups. In the CCK-8 group, the animal model received intraperitoneal injection of CCK-8 (8 nmol/kg) for consecutive 7 days, while the control group was injected with equal volume of normal saline. The nerve growth factor expression, inducible nitric oxide synthase in the spinal cord, serum superoxide dismutase activity and malondialdehyde concentration, as wel as apoptotic cel s in spinal cord were al detected. RESULTS AND CONCLUSION:In the CCK-8 group, nerve growth factor expression was higher than that in the control group (P<0.01), while inducible nitric oxide synthase and the number of apoptotic cel s were lower (P<0.01), serum superoxide dismutase activity was higher but malondialdehyde concentrations was lower (P<0.01, 0.05). The mechanisms of CCK-8 promoting sciatic nerve regeneration include protecting neurons, anti-apoptosis, inhibiting inflammatory response, anti-NO and anti-oxidation, reducing malondialdehyde, and al eviating free radical damage, as wel as stimulating nerve growth factor expression and release.
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10.3969/j.issn.2095-4344.2013.26.024
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Objective To investigate the effect of total hip arthroplasty in treatment of patients with ankylosing spondylitis and bilateral hip bony ankylosis. Methods 43 patients with ankylosing spondylitis and bilateral hip bony ankylosis were randomly divided into observation group (23 cases) and control group (20 cases) in accordance with the principle of informed consent, individually treated by total hip arthroplasty and conservative treatment, the effect of two groups were compared and analyzed. Results In the observation group, the postoperative Harris hip score and the VAS pain score of patients were significantly better than the control group,the differences were all statistically significant between two groups( all P ＜ 0.05 ). Excellent rate of the two groups were 91.3% and 60.0% respectively, and the difference was statistically significant ( x2 = 4.328, P ＜ 0.05 ). Conclusion Total hip arthroplasty in treatment of patients with ankylosing spondylitis and bilateral hip bony ankylosis has better clinical effect, and could improve the quality of life of patients, so it was worthy of clinical application.