ABSTRACT
Objective:To evaluate the early clinical outcomes of 5G remote telesupervised robot assisted total hip arthroplasty in the treatment of Kaschin-Beck disease with hip problems in Tibet through retrospective analysis of the hip surgery cohort.Methods:According to the operation procedure, 55 Kaschin-Beck disease patients (59 hips) undergoing total hip arthroplasty from November 2020 to November 2021 in the Karub District People's Hospital in Qamdo were divided into the conventional THA group (cTHA) and the 5G remote telesupervised robot assisted THA group (rTHA). Two of them underwent cTHA on both hips, while the other two patients underwent cTHA and rTHA separately of each hip, and the rest underwent single hip surgeries. In the cTHA group, there were 30 patients (32 hips), 16 males (17 hips) and 14 females (15 hips), aged 56.56±9.33 years (range, 36-76 years); In the rTHA group, there were 27 patients (27 hips), 10 males and 17 females, aged 55.41±10.90 years (range, 24 to 79 years). Before operation, Harris hip score was recorded and femoral offset (FO) and leg length difference (LLD) were measured via X-ray images. The operation time was collected during the hip surgery and an average network delay of 172.28±36.58 ms and a 1.08% data packet loss ratio is obtained during telesupervision. 24 hours post-operatively, the FO and LLD were both measured via the X-ray images, as well as the inclination and anteversion of the acetabular cup. The Harris scores were collected in the following up. The operation time, FO, LLD, inclination, anteversion and Harris score were compared between the two groups.Results:All cases in both groups were followed up for an average of 9.39±2.43 months (range, 6-19 months). There were no significant differences in pre-operative FO and LLD, preoperative Harris scores or average follow-up time between the two groups. The operation time in rTHA group was 126.41±12.78 min, which is significantly longer than the time 88.81±8.83 min in cTHA group ( t=13.31, P<0.001). After operation, the FO was significantly increased and the LLD was significantly decreased ( P<0.05). The postoperative LLD was 0.63±0.65 cm in the robot group and 1.15±0.71 cm in the conventional group, the difference was statistically significant ( t=2.88, P=0.006). However, there was no significant difference in the FO, inclination and anteversion between the two groups post-operatively ( P>0.05). The Harris scores of both groups were significantly improved compared with that before the operation. Additionally, the Harris score of the two groups was significantly higher than that before surgery, and the postoperative Harris score of the rTHA was 69.00±12.33 higher than that of the cTHA (62.31±11.87), with statistical significance ( t=2.12, P=0.039). The ratio of excellence of Harris score was 19% (5/27) in the rTHA and 9% (3/32) in the cTHA, with no significant difference between groups (χ 2=1.05, P=0.522). Conclusion:Compared to conventional surgery, 5G remote telesupervised robot assisted total hip arthroplasty has more advantages in improving the joint functions in the treatment of hip problems caused by Kashin-beck disease in Tibet Autonomous Region, and facilitates more accurate adjustment of lower limb length difference, even though it consumes more operation time.
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Objective:To analyze the correlation between electromagnetic perturbation index and intracranial pressure (ICP) in patients with acute ischemic stroke (AIS) after mechanical thrombectomy, and to explore their values in early warning of decompressive craniectomy (DC).Methods:Forty-three patients with AIS after mechanical thrombectomy admitted to our hospital from January 1, 2018 to December 31, 2019 were enrolled in our prospective cohort study. Electromagnetic perturbation index and invasive ICP were continually monitored for 1-5 d in all patients 24 h after mechanical thrombectomy. According to the mean ICP on the first d, all patients were divided into normal ICP group (ICP<15 mmHg), mild increased ICP group (15≤ICP≤22 mmHg) and moderate to severe increased ICP group (ICP>22 mmHg). According to the implementation of DC, these patients were divided into decompressive craniectomy group and non-decompressive craniectomy group. The differences in clinical data of patients in different ICP groups were compared. The correlation between electromagnetic perturbation index and ICP was analyzed by Pearson correlation method. Receiver operating characteristic (ROC) curve was drawn to analyze the diagnostic value of electromagnetic perturbation index in increased ICP (ICP>22 mmHg). Multivariate Logistic regression analysis was used to determine the independent influencing factors for DC after mechanical thrombectomy in AIS patients. ROC curve was used to evaluate the diagnostic values of electromagnetic perturbation index and ICP in DC implementation after mechanical thrombectomy in AIS patients.Results:(1) In these 43 patients, 8 had normal ICP, 13 had mild increased ICP, and 22 had moderate to severe increased ICP. There were significant differences in baseline Glasgow Coma Scale (GCS) scores, baseline National Institutes of Health Stroke Scale (NIHSS) scores, baseline Alberta stroke program early CT scale (ASPECTS) scores, percentage of patients accepted DC, and electromagnetic perturbation index among the 3 groups ( P<0.05). Correlation analysis showed that electromagnetic perturbation index was negatively correlated with ICP ( r=-0.699, P=0.000). ROC curve showed that the area under curve (AUC) of electromagnetic perturbation index in diagnosing ICP>22 mmHg was 0.850 ( 95%CI: 0.690-1.000, P=0.000), enjoying the optimal cutoff value of 126. (2) Among the 43 patients, 27 were in the decompressive craniectomy group and 16 were in the non-decompressive craniectomy group. Multivariable Logistic regression analysis showed that baseline NIHSS scores, baseline ASPECTS scores, electromagnetic perturbation index, and ICP were independent risk factors for DC implementation after mechanical thrombectomy in AIS patients ( P<0.05). ROC curve showed that the AUC of ICP in predicting DC implementation after mechanical thrombectomy was 0.851 ( 95%CI: 0.728-0.973, P=0.000), enjoying the optimal cutoff value of 18.5 mmHg; the AUC of electromagnetic perturbation index in predicting DC implementation after mechanical thrombectomy was 0.764 ( 95%CI: 0.609-0.919, P=0.004), enjoying the optimal cutoff value of 137.5. Conclusion:There is a good correlation between electromagnetic perturbation index and ICP, which can be used as reference indexes for early warning of DC after mechanical thrombectomy in AIS patients.
ABSTRACT
Based on optoacoustic effect, time-resolved optoacoustic technique effectively combines optical technology with acoustic technology and partly overcomes the biological tissue's scatter characteristics which might influence the results of measurement. Optoacoustic technique has the advantages of high sensitivity and high resolution and has been widely applied in biomedicine field. In this paper, the measuring principles, the key technique, application and future direction of this technique are synthetically reviewed to promote the research in theory and application in the future.