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Objective:To compare the clinical value of CTA and CDU in perforator flap of peroneal artery.Methods:From February 2013 to October 2016, 47 patients who suffered with soft tissue defects and were hospitalised in the Department of Orthopaedics, the 920th Hospital of Joint Logistic Support Force of Chinese PLA were retrospectively reviewed and evaluated. All the defects were reconstructed by the perforator flap of peroneal artery. All patients received preoperative CTA and CDU scans before surgery. Appropriate perforator vessels were selected and the locating points in body surface and external diameters of the perforator vessels were recorded and compared with intraoperative findings. SPSS 22.0 statistical software was used for data analysis. P<0.05 was considered statistically significant. Results:The intraoperative coincidence rate of the proposed perforator vessels was 97.87% for CDU and 95.74% for CTA, with no significant difference between the 2 groups( P>0.05). It was found that the preoperative CTA and CDU measurements were consistent with the actual intraoperative measurements, and there was no significant difference between the 2 groups( P>0.05). For CTA combined with CDU, an intraoperative coincidence rate was 100% in the location of peroneal perforating vessels. All flaps were followed-up for 1 to 18(mean 13.5) months. All the flaps survived well with good texture and appearance without complication. Conclusion:CDU and CTA are reliable and useful in preoperative vascular evaluation of peroneal perforator flap, and both can be used in a complementary or combined manner.
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Objective:To explore the morphology and vessel distribution of the scapholunate interosseous ligament and anatomical basis for the clinical reconstruction of scapholunate interosseous ligament.Methods:From October, 2018 to December, 2018, 12 fresh wrist joint specimens were perfused with gelatin-lead oxide solution from ulnar or radial artery and scanned under micro-CT. The morphology of scapholunate interosseous ligament in neutral position and the distribution of nutrient vessels in the ligament were observed on reconstructed 3D images by Mimics. The width, length and thickness of palmar, dorsal and proximal ligaments were measured. The anatomical parameters at the entrance of nutrient vessels in the scapholunate interosseous ligament were taken and their relationship with the blood supply to the scapholunate was analyzed.Results:①For scapholunate interosseous ligament, it was found that the average length of the proximal sub-region was the longest, the length of palmar and dorsal sides was similar to each other and the widest and thinnest was in palmar side, while the thickness and width of dorsal and proximal were similar. ②There was no nutrient vessel in the proximal part of the scapholunate interosseous ligament. But there were abundant nutrient vessels in the palmar and dorsal scapholunate interosseous ligament, and there was no significant difference in blood supply to palmar and dorsal scapholunate interosseous ligament ( P>0.05). ③The palmar and dorsal medial nutrient vessels that supply to the scapholunate interosseous ligament enter the scapholunate from the attachment of ligament of scapholunate interosseous joint. Conclusion:The palmar side of the scapholunate interosseous ligament is wider and thinner than that of the other subareas, which makes it more vulnerable to injury from an anatomical point of view. There is abundant blood supply to the palmar and dorsal subareas of the scapholunate interosseous ligament and the supplying vessels anastomose inside the scapholunate bone. There is no distribution of blood vessel at the proximal part of scapholunate interosseous ligament, hence is difficult to heal. An injury of palmar and dorsal ligaments may affect the blood supply of scapholunate.
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Objective To evaluate the accuracy and feasibility of S2 alar-iliac screwing assisted by an individualized navigation template in clinic.Methods Five patients underwent S2 alar-iliac screwing from March 2015 to July 2017.They were 2 men and 3 women,aged from 41 to 61 years (average,54.8 years).After their preoperative CT scan data of the pelvis were used for 3D reconstruction,their individualized navigation templates were designed,3D printed and used to assist the implantation of S2 alar-iliac screws.After operation,their postoperative CT data were reviewed and reconstructed using software Mimics.The caudal angulation on the sagittal plane (sagittal angle,SA),lateral angulation on the transverse plane (transverse angle,TA),horizontal distance to the median sacral crest (horizontal distance,HD),and vertical distance to the first posterior sacral foramen's inferior margin (vertical distance,VD) of the screws were measured and compared with the corresponding values in the preoperative design.Results In the 5 patients,altogether 10 S2 alar-iliac screws were implanted through the sacroiliac joint without piercing the iliac bone cortex.There were no significant differences between the preoperative design and postoperative measurements in terms of SA (32.22°±5.57° versus 31.95°±5.78°),TA (42.59°±4.55° versus 42.21°± 5.29°),HD (5.04 ± 0.40 mm versus 5.00 ± 0.41 mm) orVD (19.58 ± 1.49 mm versus 19.54±1.12 mm) (P ＞ 0.05).Conclusion In the adult pelvic fixation,the S2 alar-iliac screwing can be assisted by an individualized navigation template to achieve high accuracy in implantation.
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Objective To investigate the efficacy and accuracy of 3D printing individualized navigation templates used in shoulder hemi-arthroplasty (HA).Methods We collected 9 adult cadaveric specimens of 18 shoulders with no obvious deformities or defects.After CT scanning was conducted on bilateral shoulders,the raw CT data in DICOM format were imported into software Mimics 10.01 and Imageware 12.0 to reconstruct 3D shoulder models.The retroversion angles and heights of bilateral humeral heads were measured to design individualized navigational templates using software Geomagic Studio 12.0.Rapid prototyping (RP) technique was used to manufacture the individualized navigation templates which were then used to assist shoulder HA in cadaveric specimens.CT scanning was performed postoperatively to measure the retroversion angle and height of the prosthesis implanted for comparison with the preoperative measurements.Results Before shoulder replacement in the 9 cadaveric specimens,respectively,the heights of left and right humeral heads averaged 300.0 ± 11.6 mm and 300.0 ± 11.4 mm,and the retroversion angles 15.6°±4.9° and 15.9°± 4.9°.After the replacement,the heights of left and right humeral heads averaged 300.0 ± 11.3 mm and 300.0 ± 11.7 mm,respectively,and the retroversion angles 15.7° ± 4.9° and 15.8° ± 5.2°,respectively.There were no significant differences between the left and right sides in the pre-or post-operative heights or retroversion angles of the humeral head (P ＞ 0.05).There were no significant differences either between preand post-operation in the heights or retroversion angles of the left and right humeral heads (P ＞ 0.05).The mean errors for the preoperative and postoperative heights and retroversion angles of the humeral heads were 1.44 ± 0.96 mm and 0.25° ± 0.15°,respectively.Conclusion Individualized navigation templates 3D printed can be used to assist effective and accurate shoulder HA because they are designed and manufactured according to accurate measurements of retroversion angles and heights of the humeral heads which are acquired by computer preoperatively.
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Objective To characterize the spinal motion of 6 degrees of freedom (6DOF) under the fulcrum bending in Lenke type 1 adolescent idiopathic scoliosis (AIS) patients using 3D image volume fusion technique.Methods Ten volunteers with Lenke type 1 AIS were examined by the Gemstone Spectral Imaging to obtain their T1-S1 vertebral morphological data in the supine position and fulcrum bending position.With the computer software,images of 2 different positions were fused with the 3D image to obtain in vivo kinematics data of each vertebral body in the target area.Results In the apical vertebrae (AV) region,the main range of motion in the fulcrum bending position ranged from-2.57°± 0.95° to-1.37°± 0.65°,showing significant differences between segments (P ＜ 0.05);along the vertical axis the coupling rotation ranged from-2.71° ± 0.48° to-1.27° ± 0.49°;along the coronal axis,the coupling flexion and extension ranged from 0.19° ± 0.85° to 1.51° ± 0.42°.In the upper end vertebrae (UEV) area,the main ROM ranged from-2.20° ± 1.13° to-1.91° ± 0.76°,showing no significant differences between the 3 segments (P ＞ 0.05);along the vertical axis,coupling rotation ranged from 0.18°±0.47° to 1.35°±0.52°;along the coronal axis,coupling flexion and extension ranged from 1.62° ± 0.41° to 2.07° ± 0.37°.In the lower end vertebrae (LEV) region,the main movement ranged from-0.79°± 0.63° to 0.73°± 1.09°,showing significant differences between the 3 segments (P ＜ 0.05);along the vertical axis,the coupling rotation ranged from-1.62°± 1.05° to-0.60°± 0.60°;along the coronal axis,the coupling flexion extension ranged from -1.41° ± 0.87° to-0.75° ± 0.66°.Conclusionts In the fulcrum bending position,Lenke type 1 AIS shows a unique motion and coupling mechanism in the spine.The coupling rotational movement in the UEV region is at the same side as the lateral flexion movement.The coupling rotational motion in the AV and LEV regions is opposite the lateral flexion movement.
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Objective To investigate the effectiveness of digital technology in repairing wounds of the lower leg and foot with perforator pedicled propeller flaps.Methods Eighteen patients with wounds of the lower leg and foot were returned to the hospital for review and evaluated retrospectively.The wounds were repaired by using the perforator pedicled propeller flaps from January,2013 to February,2014.There were 11 males and 7 females,with an average age of 27 years (range,6-48 years).Including 6 cases of injuries caused by the spokes and the Achilles heel of soft tissue defects.Five cases of infection after internal fixation of calcaneal fractures induced skin necrosis,2 cases of dorsal skin defects caused by heavy injured,5 cases of foot and ankle soft tissue defects caused by car accidents.All wounds were associated with exposure of tendon.The wounds area were ranged from 2.5 cm×5.0 cmn to 4.0 cm× 15.0 cm.The course of disease was from 3 hour to 35 days.Computed tomography angiography (CTA) was performed preoperatively,the appropriate perforator was selected and the CTA data were imported into the Mimics 15.0 software for the location of the perforator vessel and the design of the propeller flap,and simulate flap cut and transfer.The flap was obtained according to preoperative plan during operation.The flap size ranged from 4.0 cm×7.0 cm to 5.0 cm ×20.5 cm.These flaps included terminal branch of the peroneal artery perforator in 14 cases,posterior tibia artery perforator in 4 cases.All patients were followed up at regular intervals.Results The reconstruction of Mimics 15.0 software could confirm the perforator vessels origin,vascular distribution,diameter,and the cutting length.The rotation direction of the flap could be simulated preoperatively,which was consistent with the actual observation intraoperative.The donor sites were sutured directly.One case suffered from vascular crisis in 1 day was cured by the removal of part of the suture,massage and bloodletting.All cases were followed-up for 1 month to 16 months,and all flaps survived well and pediele were smooth with a satisfied appearance.The patient were extremely satisfied with the results for repair.Conclusion The preoperative individualization design of the perforator pedicled propeller flaps can be realized through CTA combined with Mimics 15.0 software.It can reduce the risk of operation.