Complicações odontológicas em indivíduos com insuficiência renal crônica: estudo retrospectivo / Guided surgery: accuracy of milled and printed guides using the same digital surgical planning

Introdução e objetivo: A tecnologia digital tem desempenhado um papel cada vez mais importante na Odontologia há vários anos. Nos últimos anos, com a introdução da tomografia computadorizada (TC), da impressão tridimensional (3D), dos desenhos auxiliados por computador (CAD) e dos modelos feitas através destes desenhos (CAM), trouxeram uma grande evolução para os conceitos de tratamento na área da implantodontia. O objetivo deste estudo foi avaliar a acurácia de guias do tipo fresado e impresso a partir de um único planejamento virtual. Materiais e métodos: Foram selecionadas como amostras, dez manequins pré-fabricados com dentes ausentes com a finalidade de colocação de implantes. Estes manequins foram submetidos a tomografias computadorizadas de feixe cônico e a escaneamentos digitais através de um escâner intra oral, estas imagens foram sobrepostas em um software especifico de planejamentos digitais e assim gerados dois tipos de guias através de um mesmo planejamento digital. Guias impressos (grupo1) e guias fresados (grupo 2) foram confeccionados através de uma impressora tridimensional e uma fresadora respectivamente. Em cada manequim foram colocados dois implantes em regiões de dente 24 e dente 25, cada região com um guia diferente. Após a colocação dos implantes estes manequins foram submetidos a novas tomografias computadorizadas de feixe cônico onde foram adquiridas nova imagens, que foram sobrepostas com as imagens do planejamento inicial a fim de mensurar a fidelidade pós cirúrgica. Resultados: Foram avaliados desvios angulares e lineares, para os desvios angulares medianos, foi observada uma diferença significativa entre os grupos (p=0,033), com valores medianos de 3,78° (min-max: 1,32-8,75) para o guia impresso e 5,66° (3,06- 6,64) para o guia fresado, para desvios lineares do ápice, o resultado não demonstrou diferença significativa entre os grupos (p=0.423), com valores medianos de 0,73 (minmax: 0,53-1,82) para o guia impresso e 1,10 (0,26-2,47) para guia fresado. Conclusão: Houve diferenças significativas na acurácia da posição do implante apenas em relação ao desvio angular mediano, um dos fatores que pode ter contribuído é a extensão da extremidade livre que havia no guia cirúrgico fresado. Guias fresados utilizados em extremidade livre de dois dentes mostraram resultados semelhantes a extremidade menor (um dente), possibilitando a sua utilização dentro dos parâmetros clínicos aceitáveis e indicando futuros estudos de analises de tamanhos de extensão de extremidades.

Protocolo Abreviado Guiado Digital: Técnicas de Marcadores Tisulares, Silicona de Registro y CBCT con Sonrisa / Digitally Guided Abbreviated Protocol: Tissue Marker Techniques, Recording Silicone and CBCT with Smile

Establecer un protocolo de cirugía guiada estática con técnicas referenciales para ser realizado de manera predecible, repetible y simple, en todos los tipos de casos. El protocolo abreviado guiado digital para cirugía guiada estática para implantes se centra en diseñar computacionalmente una guía quirúrgica que se apoye en el tejido remanente del paciente, siendo un protocolo digital versátil para la cirugía y rehabilitación implanto protésica, basada en registros clínicos, principalmente la línea de la sonrisa y la captación de ésta en tomografía de haz cónico (CBCT), además de establecer dimensión vertical oclusal (DVO). Logrando así, planificación de implantes hasta la inserción inmediata de la prótesis temporal. Se ejemplifica el trabajo con 2 casos clínicos. Se establece un protocolo con la intención de que pueda ser realizado en pacientes desdentados parciales (Técnica de Registro Silicona) o totales (Técnica de Marcadores Tisulares en prótesis), definiendo un flujo de trabajo tridimensional, digital y optimizado, con un consecuente ahorro de tiempo clínico. Como principio del protocolo de cirugía guiada es lograr el objetivo quirúrgico - protésico deseado con alta precisión. La cirugía y rehabilitación de implantes de manera convencional es altamente dependiente del operador por lo que la alternativa de cirugía guiada de manera estática es una herramienta más para mejorar el pronóstico del paciente. Se establece un protocolo digital simple y efectivo, de cirugía guiada, para la rehabilitación implanto protésica basada en la línea de la sonrisa, tomografía de haz cónico (CBCT), dimensión vertical oclusal (DVO). Protocolo predecible y que optimiza los tiempos clínicos, logrando una rehabilitación protésica inmediata acorde e individualizada para cada paciente.

Establish a static guided surgery protocol with referential techniques to be performed in a predictable, repeatable and simple way, in all types of cases. The abbreviated digital guided protocol for static guided surgery for implants focuses on computationally designing a surgical guide that rests on the patient's remaining tissue, being a versatile digital protocol for prosthetic implant surgery and rehabilitation, based on clinical records, mainly the line of the smile and its uptake in cone beam tomography (CBCT), in addition to establishing occlusal vertical dimension (OVD). Thus achieving implant planning until the immediate insertion of the temporary prosthesis. The work is exemplified with 2 clinical cases. A protocol is established with the intention that it can be carried out in partially edentulous patients (Silicone Registration Technique) or total (Tissue Marker Technique in prostheses), defining a three-dimensional, digital and optimized workflow, with a consequent saving of time. clinical. As a principle of the guided surgery protocol, it is to achieve the desired surgical-prosthetic objective with high precision. Conventional implant surgery and rehabilitation is highly dependent on the operator, so the alternative of statically guided surgery is one more tool to improve the patient's prognosis. A simple and effective digital protocol for guided surgery is established for prosthetic implant rehabilitation based on the smile line, cone beam tomography (CBCT), and occlusal vertical dimension (OVD). Predictable protocol that optimizes clinical times, achieving an immediate and individualized prosthetic rehabilitation for each patient.

¿Existen discrepancias entre la planificación preoperatoria y la evaluación intraoperatoria realizada por el cirujano en la artroplastia total de rodilla con asistencia robótica? / Are there discrepancies between preoperative planning and intraoperative evaluation by the surgeon in robotically assisted total knee arthroplasty?

Introducción: Existe poca evidencia respecto de la concordancia entre el plan preoperatorio mediante artroplastia total de rodilla asistida por robot y el plan posterior al balance protésico realizado por el cirujano. El objetivo de este trabajo es evaluar el grado de concordancia entre la planificación preoperatoria de la artroplastia total de rodilla con asistencia robótica semiactiva (Mako) y la planificación efectuada por el traumatólogo durante la cirugía. Materiales y métodos: estudio retrospectivo y descriptivo de prótesis primarias instaladas entre octubre de 2018 y junio de 2019 con planificación preoperatoria realizada por el software MAKOplasty®. Se excluyeron las prótesis no colocadas por el sistema robótico o con información clínica incompleta. Esto se comparó con la planificación intraoperatoria del traumatólogo. Variables analizadas: alineación coronal y sagital, rotación y tamaño de los componentes e inserto. Los datos se analizaron con el softwareSTATA v.16.0. Se realizó un análisis descriptivo univariante cualitativo, con un intervalo de confianza del 95%. Resultados: se incluyeron cincuenta y una rodillas operadas de cuarenta y nueve pacientes, el 69% fueron mujeres. El nivel de concordancia para el componente femoral fue: axial 86.3% (IC = 73.7 - 94.2), coronal 88.2% (IC = 76.1 - 95.5), sagital 88.2% (IC = 76.1 - 95.5). Componente tibial: axial 98% (IC = 89.5 ­ 99.9), coronal 96.1% (IC = 86.5 ­ 99.5), sagital 96.1% (IC = 86.5 ­ 99.5). Tamaño del componente: fémur 94.1% (IC = 83.7 ­ 98.7), tibia 84.3% (IC = 71.4 ­ 92.9), inserto 27.4% (IC = 15.8 ­ 41.7). Conclusión: la planificación preoperatoria mediante el uso de la asistencia robótica semiactiva de Mako presenta un buen nivel de concordancia con la planificada intraoperatoriamente, a excepción del tamaño del inserto. El traumatólogo es determinante en la modificación del plan preoperatorio. Nivel de Evidencia: III

Introduction: There is little evidence regarding the concordance between the preoperative plan using robotic-assisted total knee arthroplasty and that after the prosthetic balance by the surgeon. Our aim is to evaluate the level of agreement between the preoperative planning of total knee arthroplasty with semiactive robotic assistance (Mako) and the planning made by the orthopedic surgeon during the surgery. Materials and methods: descriptive study of prostheses installed between October 2018 and June 2019 with preoperative planning performed by the MAKOplasty® software. This was compared with intraoperative planning by the Orthopedic Surgeon. Variables analyzed: coronal and sagittal alignment, rotation and size of the components and insert. The data was analyzed with the STATA v.16.0 software. A qualitative univariate descriptive analysis was performed, with a 95% confidence interval. Results: fifty-one operated knees from forty-nine patients were included, 69% were women. The level of agreement was: Femoral component: axial 86.3% [CI = 73.7 - 94.2], coronal 88.2% [CI = 76.1 - 95.5], sagittal 88.2% [CI = 76.1 - 95.5]. Tibial component: axial 98% [CI = 89.5 - 99.9], coronal 96.1% [CI = 86.5 - 99.5], sagittal 96.1% [CI = 86.5 - 99.5]. Component size: femur 94.1% [CI = 83.7 - 98.7], tibia 84.3% [CI = 71.4 - 92.9], insert 27.4% [CI = 15.8 - 41.7]. Conclusion: preoperative planning through the use of Mako semiactive robotic assistance presents a good level of agreement with that planned intraoperatively, with the exception of the insert size. The orthopedic surgeon is decisive in modifying the preoperative plan. Level of Evidence: III

Current application and limitations of augmented reality in the stomatology / 中华口腔医学杂志

Computer-assisted technology are gradually integrated into dental education and clinical treatment. As a cutting-edge technology in computer-aided medicine, augmented reality can not only be used as an aid to dental education by presenting three-dimensional scenes for teaching demonstration and experimental skills training, but also can superimpose virtual image information of patients onto real lesion areas for real-time feedback and intraoperative navigation. This review explores the current applications and limitations of augmented reality in dentistry to provide a reference for future research.

Current application and prospect of accurate navigation technology in orthopaedic trauma / 中华外科杂志

In the past decades,a dramatic development of navigation technology in orthopaedic surgery has been witnessed. By assisting the localization of surgical region,verification of target bony structure,preoperative planning of fixation,intraoperative identification of planned entry point and direction of instruments or even automated insertion of implants,its ability and potential to reduce operation time,intraoperative radiation,surgical trauma,and improve accuracy has been proved. However,in contrast to the widespread use of navigation technology in arthroplasty,orthopaedic tumor,and spine surgery,its application in orthopaedic trauma is relatively less. In this manuscript,the main purpose is to introduce the technical principles of navigation devices,outline the current clinical application of navigation systems in orthopaedic trauma,analyze the current challenges confronting its further application in clinical practice and its prospect in the future.

O-arm real-time guidance in cervical pedicle screw fixation / 中国骨伤

OBJECTIVE@#To explore the technical aspects of the accuracy of cervical pedicle screw placement with O-arm guidance.@*METHODS@#The clinical data of 21 patients who underwent cervical pedicle screw fixation by O-arm real-time guidance from December 2015 to January 2020 were analyzed retrospectively. There were 15 males and 6 females, aged from 29 to 76 years old with an average of (45.3±11.5) years. The postoperative CT scan was utilized to evaluate the placement of the pedicle screw and classified according to the Gertzbein and Robbins classification.@*RESULTS@#A total of 132 pedicle screws were implanted in 21 patients, 116 at C3-C6 and 16 at C1 and C2. According to Gertzbein & Robbins classification, the overall breach rates were found to be 11.36% (15/132) with 73.33% (11 screws) Grade B, 26.67% (4 screws) Grade C, and no Grade D or E screw breaches. There were no pedicle screw placement related complications at final follow-up.@*CONCLUSION@#The application of O-arm real-time guidance technology can make cervical pedicle screw placement reliable. High accuracy and better intra-operative control can increase surgeon's confidence in using cervical pedicle instrumentation. Considering the high-risk nature of anatomical area around cervical pedicle and the possibility of catastrophic complications, the spine surgeon should have sufficient surgical skills, experience, ensures stringent verification of the system, and never relies solely on the navigation system.

Application of a new point contact pedicle navigation template as an auxiliary screw implant in scoliosis correction surgery / 中国修复重建外科杂志

OBJECTIVE@#To explore the effectiveness of a new point contact pedicle navigation template (referred to as "new navigation template" for simplicity) in assisting screw implantation in scoliosis correction surgery.@*METHODS@#Twenty-five patients with scoliosis, who met the selection criteria between February 2020 and February 2023, were selected as the trial group. During the scoliosis correction surgery, the three-dimensional printed new navigation template was used to assist in screw implantation. Fifty patients who had undergone screw implantation with traditional free-hand implantation technique between February 2019 and February 2023 were matched according to the inclusion and exclusion criteria as the control group. There was no significant difference between the two groups ( P>0.05) in terms of gender, age, disease duration, Cobb angle on the coronal plane of the main curve, Cobb angle at the Bending position of the main curve, the position of the apical vertebrae of the main curve, and the number of vertebrae with the pedicle diameter lower than 50%/75% of the national average, and the number of patients whose apical vertebrae rotation exceeded 40°. The number of fused vertebrae, the number of pedicle screws, the time of pedicle screw implantation, implant bleeding, fluoroscopy frequency, and manual diversion frequency were compared between the two groups. The occurrence of implant complications was observed. Based on the X-ray films at 2 weeks after operation, the pedicle screw grading was recorded, the accuracy of the implant and the main curvature correction rate were calculated.@*RESULTS@#Both groups successfully completed the surgeries. Among them, the trial group implanted 267 screws and fused 177 vertebrae; the control group implanted 523 screws and fused 358 vertebrae. There was no significant difference between the two groups ( P>0.05) in terms of the number of fused vertebrae, the number of pedicle screws, the pedicle screw grading and accuracy, and the main curvature correction rate. However, the time of pedicle screw implantation, implant bleeding, fluoroscopy frequency, and manual diversion frequency were significantly lower in trial group than in control group ( P<0.05). There was no complications related to screws implantation during or after operation in the two groups.@*CONCLUSION@#The new navigation template is suitable for all kinds of deformed vertebral lamina and articular process, which not only improves the accuracy of screw implantation, but also reduces the difficulty of operation, shortens the operation time, and reduces intraoperative bleeding.

Multiresolution discrete optimization registration method of ultrasound and magnetic resonance images based on key points / 生物医学工程学杂志

The registration of preoperative magnetic resonance (MR) images and intraoperative ultrasound (US) images is very important in the planning of brain tumor surgery and during surgery. Considering that the two-modality images have different intensity range and resolution, and the US images are degraded by lots of speckle noises, a self-similarity context (SSC) descriptor based on local neighborhood information was adopted to define the similarity measure. The ultrasound images were considered as the reference, the corners were extracted as the key points using three-dimensional differential operators, and the dense displacement sampling discrete optimization algorithm was adopted for registration. The whole registration process was divided into two stages including the affine registration and the elastic registration. In the affine registration stage, the image was decomposed using multi-resolution scheme, and in the elastic registration stage, the displacement vectors of key points were regularized using the minimum convolution and mean field reasoning strategies. The registration experiment was performed on the preoperative MR images and intraoperative US images of 22 patients. The overall error after affine registration was (1.57 ± 0.30) mm, and the average computation time of each pair of images was only 1.36 s; while the overall error after elastic registration was further reduced to (1.40 ± 0.28) mm, and the average registration time was 1.53 s. The experimental results show that the proposed method has prominent registration accuracy and high computational efficiency.

Accuracy of selective laser sintered computer guided stents versus digital light processing stents in immediate implant placement in esthetic zone: a randomized controlled trial / Precisão de stents sinterizados por laser seletivo guiados por computador versus stents de processamento de luz digital na colocação imediata de implantes em região estética: um ensaio randomizado

Objective: To compare accuracy of selective laser sintered computer guided stents versus digital light processing stents in immediate implant placement in esthetic zone. Material and Methods: The patients were selected according to the eligibility criterias. The selected patients were randomly allocated to either digital light processing stents (test group) or selective laser sintered computer guided stents (control group). Proper examination and diagnostic records were done for each patient followed by triple scan protocol with cone beam computer tomography (CBCT). Planning and construction of tooth supported computer guided surgical stent was done by either digital light processing technique for test group or selective laser sintering for control group. Twenty implants were inserted following computer guided implant placement protocol. After post-operative CBCT pre and post images were merged using blue sky bio software. Linear and angular deviations between planned implant and actual implant positions were measured. Results: Tests were considered statistically significant if the p- value was less than 0.05. Difference in means were calculated for the analysis of continuous variables with corresponding 95% confidence intervals. There was no statistical difference between selective laser sintering and digital light processing groups in all measured terms. Conclusion : Within the limitations of this study, both techniques can be used for immediate implant placement with clinically satisfactory results decreasing the positional errors associated with immediate implant placement. (AU)

Objetivo: Comparar a acurácia de stents sinterizados por laser seletivo guiados por computador versus stents de processamento de luz digital na colocação imediata de implantes em região estética. Material e Métodos: Os pacientes foram selecionados de acordo com os critérios de elegibilidade. Os pacientes selecionados foram distribuídos aleatoriamente nos seguintes grupos: stents de processamento de luz digital (grupo experimental) ou stents sinterizados por laser seletivo guiados por computador (grupo controle). Os registros dos exames adequados e diagnósticos foram realizados para cada paciente seguido por um protocolo de varredura tripla com tomografia computadorizada de feixe cônico (TCFC).O planejamento e a construção do Stent cirúrgico guiado por computador com suporte dentário foram feitos pela técnica de processamento de luz digital para o grupo experimental ou sinterização a laser seletivo para o grupo controle. Vinte implantes foram inseridos seguindo o protocolo de colocação de implante guiado por computador. Após a TCFC pós-operatória, as imagens pré e pós foram mescladas usando o software blue sky bio. Foram medidos os desvios lineares e angulares entre o implante planejado e as posições reais do implante. Resultados: Os testes foram considerados estatisticamente significativos se o valor de p fosse menor que 0,05. A diferença nas médias foi calculada para a análise das variáveis contínuas com intervalos de confiança de 95%. Não houve diferença estatística entre os grupos de sinterização a laser seletivo e processamento digital de luz em todos as variáveis mensuradas. Conclusão: Dentro das limitações deste estudo, ambas as técnicas podem ser utilizadas para colocação imediata de implantes com resultados clinicamente satisfatórios diminuindo os erros posicionais associados colocação imediata de implantes. (AU)

Planejamento virtual em cirurgia ortognática: relato de caso / Virtual planning for orthognathic surgery: case report / Planificación virtual en cirugía ortognática: reporte de caso

Introdução: A correção das deformidades dentofaciais depende do bom diagnóstico, da precisão do planejamento e da correta execução da técnica cirúrgica. Buscando maior precisão, o planejamento virtual para cirurgia ortognática tem sido uma ferramenta amplamente aplicada pela cirurgia bucomaxilofacial. Este trabalho demonstra, por meio de caso clínico, os benefícios adquiridos pelo planejamento virtual, no que diz respeito a quantificação do movimento, avaliação da predição dos tecidos moles e osteotomias, assim como discorre sobre os cuidados e passos necessários para um correto planejamento. Relato do caso: Paciente de perfil classe II, submetida ao protocolo de planejamento virtual com aquisição de imagens tomográficas, escaneamento intraoral e utilização de software digital para avaliação diagnóstica, planejamento e impressão dos guias cirúrgicos. A mesma foi acompanhada durante 3 meses de pós operatório, apresentando boa precisão e previsibilidade nos movimentos cirúrgicos realizados. Discussão: Ao se realizar uma avaliação clínica acurada, somada a aquisição de imagens tridimensionais, a partir das tomografias de face, escaneamentos intraorais e o manejo da tecnologia CAD/CAM, é possível se alcançar maior precisão no planejamento e predictibilidade cirúrgica, bem como realizar um melhor diagnóstico das deformidades transversas. Contudo, deve-se levar em consideração a necessidade de conhecimento teórico-prático para a correta execução dos passos para o planejamento virtual. Considerações finais: Dado o exposto, foi possível observar precisão no resultado obtido e compatibilidade entre os movimentos planejados e executados. Assim como, demonstrou se aspectos relativos a cada um dos passos para o protocolo virtual, expondo-se suas particularidades e diferenças em relação ao planejamento convencional... (AU)

Introducción: La corrección de las deformidades dentofaciales depende de un buen diagnóstico, de la precisión de la planificación y la correcta ejecución de la técnica quirúrgica . Buscando mayor precisión, la planificación virtual para cirugía ortognática ha sido una herramienta aplicada ampliamente por la cirugia bucomaxilofacial. Este trabajo demuestra, por medio de un caso clínico, los beneficios obtenidos por la planificación virtual, en lo que respecta a la cuantificación del movimiento, evaluación de la predicción de los tejidos blandos y de las osteotomia, así enfatizando los cuidados y pasos necesarios para una correcta planificación. Relato de caso: Paciente con perfil clase II, utilizando protocolo de planificación virtual con adquisición de imágenes tomográficas, escaneamento intra-oral y uso de software digital para evaluación diagnóstica, planificación e impresión 3D de los guías quirúrgicos. La paciente tuvo seguimiento pos operatorio por tres meses, corroborando la precisión y previsibilidad de los movimientos quirúrgicos planificados y ejecutados. Discusión: Al realizarse una evaluación clínica acurada, sumando una adquisición de imágenes tridimensionales, a partir de la tomografía facial, escaneamento intra-oral y el manejo de tecnologia CAD/CAM, es posible alcanzar mayor precisión en la planificación y previsibilidad quirúrgica, así como un diagnóstico más acurado de las alteraciones transversas. Con todo, se debe considerar la necesidad de conocimiento teórico práctico para la correcta elaboración de un proyecto de planificación quirúrgica virtual. Consideraciones finales: Por lo expuesto, se observó precisión en el resultado obtenido considerando los movimientos planificados y ejecutados. Así como se describió aspectos relativos a cada uno de los pasos del protocolo virtual utilizado, exponiendo sus particularidades y diferencias en relación a la planificación quirúrgica convencional... (AU)

Introduction: The correction of dentofacial deformities depends directly on a good diagnosis, the precision of the surgical planning and the correct execution of the technique. Seeking greater precision, virtual planning for orthognathic surgery has been a tool widely applied in oral and maxillofacial surgery. This work demonstrates, through a case report, the benefits acquired by virtual planning, regarding the quantification of movement, evaluation of the prediction of soft tissues and osteotomies, as well as discusses the accuracy and steps necessary for a correct planning. Case report: Class II facial profile patient, submitted to the virtual planning protocol with acquisition of tomographic images, intraoral scanning and use of digital software for diagnostic evaluation, planning and printing of surgical guides. She was followed up for 3 months after the operation, showing good precision and predictability in the surgical movements performed. Discussion: When performing an accurate clinical evaluation, added up to the acquisition of three-dimensional images, from face tomography, intra-oral scans and the management of CAD/CAM technology, it is possible to achieve greater precision in surgical planning and predictability, as well as accomplish a better diagnosis of transverse deformities. However, one must take into account the need for theoretical practical knowledge for the correct execution of the steps for virtual planning. Final considerations: Given the above, it was possible to observe precision in the result obtained and compatibility between the planned and executed movements. As well, aspects related to each of the steps for the virtual protocol were demonstrated, exposing their particularities and differences in relation to conventional planning... (AU)

Cirurgia guiada: acurácia de guias fresados e impressos utilizando um mesmo planejamento cirúrgico digital / Guided surgery: accuracy of milled and printed guides using the same digital surgical planning

Introdução e objetivo: A tecnologia digital tem desempenhado um papel cada vez mais importante na Odontologia há vários anos. Nos últimos anos, com a introdução da tomografia computadorizada (TC), da impressão tridimensional (3D), dos desenhos auxiliados por computador (CAD) e dos modelos feitas através destes desenhos (CAM), trouxeram uma grande evolução para os conceitos de tratamento na área da implantodontia. O objetivo deste estudo foi avaliar a acurácia de guias do tipo fresado e impresso a partir de um único planejamento virtual. Materiais e métodos: Foram selecionadas como amostras, dez manequins pré-fabricados com dentes ausentes com a finalidade de colocação de implantes. Estes manequins foram submetidos a tomografias computadorizadas de feixe cônico e a escaneamentos digitais através de um escâner intra oral, estas imagens foram sobrepostas em um software especifico de planejamentos digitais e assim gerados dois tipos de guias através de um mesmo planejamento digital. Guias impressos (grupo1) e guias fresados (grupo 2) foram confeccionados através de uma impressora tridimensional e uma fresadora respectivamente. Em cada manequim foram colocados dois implantes em regiões de dente 24 e dente 25, cada região com um guia diferente. Após a colocação dos implantes estes manequins foram submetidos a novas tomografias computadorizadas de feixe cônico onde foram adquiridas nova imagens, que foram sobrepostas com as imagens do planejamento inicial a fim de mensurar a fidelidade pós cirúrgica. Resultados: Foram avaliados desvios angulares e lineares, para os desvios angulares medianos, foi observada uma diferença significativa entre os grupos (p=0,033), com valores medianos de 3,78° (min-max: 1,32-8,75) para o guia impresso e 5,66° (3,06- 6,64) para o guia fresado, para desvios lineares do ápice, o resultado não demonstrou diferença significativa entre os grupos (p=0.423), com valores medianos de 0,73 (minmax: 0,53-1,82) para o guia impresso e 1,10 (0,26-2,47) para guia fresado. Conclusão: Houve diferenças significativas na acurácia da posição do implante apenas em relação ao desvio angular mediano, um dos fatores que pode ter contribuído é a extensão da extremidade livre que havia no guia cirúrgico fresado. Guias fresados utilizados em extremidade livre de dois dentes mostraram resultados semelhantes a extremidade menor (um dente), possibilitando a sua utilização dentro dos parâmetros clínicos aceitáveis e indicando futuros estudos de analises de tamanhos de extensão de extremidades.

Extending the Indications of 5-Aminolevulinic Acid for Fluorescence-Guided Surgery for Different Central Nervous System Tumors: A Series of 255 Cases in Latin America

Introduction Fluorescence guidance with 5-aminolevulinic acid (5-ALA) is a safe and reliable tool in total gross resection of intracranial tumors, especially malignant gliomas and cases of metastasis. In the present retrospective study, we have analyzed 5-ALA-induced fluorescence findings in different central nervous system (CNS) lesions to expand the indications of its use in differential diagnoses. Objectives To describe the indications and results of 5-ALA fluorescence in a series of 255 cases. Methods In 255 consecutive cases, we recorded age, gender, intraoperative 5-ALA fluorescence tumor response, and 5-ALA postresection status, as well the complications related to the method. Postresection was classified as '5-ALA free' or '5-ALA residual'. The diagnosis of histopathological tumor was established according to the current classification of the World Health Organization (WHO). Results There were 195 (76.4%) 5-ALA positive cases, 124 (63.5%) of whom underwent the '5-ALA free' resection. The findings in the positive cases were: 135 gliomas of all grades; 19 meningiomas; 4 hemangioblastomas; 1 solitary fibrous tumor; 27 metastases; 2 diffuse large B cell lymphomas; 2 cases of radionecrosis; 1 inflammatory disease; 2 cases of gliosis; 1 cysticercosis; and 1 immunoglobulin G4-related disease.

Long Term Outcomes of Computer-Navigated Lateral Opening Wedge Distal Femoral Osteotomy for Lateral Compartment Knee Arthrosis / Resultados a longo prazo de osteotomia varizante femoral distal (OVFD) com cunha de abertura lateral para artrose do compartimento lateral do joelho utilizando navegação computadorizada

Abstract Objective The primary aim of the present study was to evaluate the long-term outcomes including survivorship of computer navigated distal femoral lateral opening wedge osteotomy (DFLOWO). The secondary aim was to identify the potential factors that may influence its survivorship. Methods A retrospective analysis of prospectively collected data for patients with lateral compartment arthritis who underwent navigated DFLOWO from December 2006 to November 2012 was performed. The International Knee Documentation Committee (IKDC) and Knee Injury and Osteoarthritis Outcome Score (KOOS) scores were analyzed for outcome measures. Conversion to arthroplasty during the follow-up was the end point. Results A total of 19 DFLOWOs were performed in 17 patients with a mean age of 46.6 ± 6.5 years formed the study cohort. The coronal alignment was corrected from a mean of 7.1° (2-11°) valgus to a mean of 2.1° (0.5°-3°) varus. The IKDC scores improved from mean of 39 preoperatively to 53 at the mean long-term follow-up of 9.1 years. The mean KOOS scores at the long-term follow-up were pain 71, symptoms 56, activities of daily living 82, sports and recreation 59, quality of life 43. Survivorship of the DFLOWO was 78.9% at a follow-up of 9.1 years. Presence of ≥ grade 2 according to the International Cartilage Repair Society (ICRS) cartilage degeneration in the medial compartment of the knee and >7° preoperative valgus deformity were strongly correlated with conversion to total knee arthroplasty (TKA) at the long-term follow-up (r= 0.66). ConclusionsComputer navigated DFLOWO has satisfactory clinical outcomes and 79% survivorship in long-term follow-up. Presence of more than ICRS ≥ grade 2 degenerative changes in the medial compartment of knee with > 7° preoperative valgus deformity negatively affects the survivorship of DFLOWO in the long-term follow-up.

Resumo Objetivo O objetivo principal do presente estudo foi avaliar os resultados a longo prazo, incluindo a sobrevivência em Osteotomia Varizante Femoral Distal com Cunha de Abertura Lateral (OVFD-CAL) utilizando navegação computadorizada. O objetivo principal do presente estudo foi avaliar os resultados a longo prazo, incluindo a sobrevivência. Métodos Foi realizada uma análise retrospectiva dos dados coletados prospectivamente de pacientes com artrite do compartimento lateral submetidos a OVFD-CAL por navegação de dezembro de 2006 a novembro de 2012. As pontuações International Knee Documentation Committee (IKDC, na sigla em inglês) e Knee Injury and Osteoarthritis Outcome Score (KOOS, na sigla em inglês) foram analisadas para medição de resultados. Conversão para artroplastia durante o acompanhamento foi o ponto final. Resultados Um total de 19 OVFD-CAL foram realizados em 17 pacientes com média de idade de 46,6 ± 6,5 anos formaram a coorte do estudo. O alinhamento coronal foi corrigido a partir de uma média de 7,1° (2-11°) de valgo para uma média de 2,1° (0,5°-3°) de varo. As pontuações do IKDC melhoraram de uma média pré-operatória de 39 para 53 no acompanhamento de médio de longo prazo de 9,1 anos. Os escores do KOOS no acompanhamento a longo prazo foram: dor 71, sintomas 56, atividades da vida diária 82, esportes e recreação 59, qualidade de vida 43. A sobrevivência do OVFD-CAL foi de 78,9% em um acompanhamento de 9,1 anos. Presença de degeneração da cartilagem segundo a Sociedade Internacional de Reparação de Cartilagem (International Cartilage Repair Society [ICRS, na sigla em inglês])≥ grau 2 no compartimento medial do joelho e deformidade pré-operatória em valgo > 7° fortemente correlacionado com a conversão para artroplastia total do joelho (ATJ) no acompanhamento a longo prazo (r - 0,66). ConclusõesA OVFD-CAL por navegação computadorizada apresentou resultados clínicos satisfatórios e sobrevida de 79% no acompanhamento a longo prazo. Presença de alterações degenerativas ICRS ≥ grau 2 no compartimento medial do joelho com > 7° de deformidade pré-operatória em valgo afeta negativamente a sobrevivência da OVFD-CAL no acompanhamento de longo prazo.

Comparación entre cirugía asistida por navegación y cirugía convencional en el reemplazo total de rodilla / Comparison between computer navigation-assisted surgery and conventional surgery in total knee replacement

Introducción: El reemplazo total de rodilla es el tratamiento de elección en los estadios finales de la patología degenerativa articular; su duración depende, en gran medida, de la alineación, el posicionamiento y la estabilidad de la articulación. El objetivo de este estudio fue comparar el eje mecánico del miembro inferior medido por telemetría, después de un reemplazo total de rodilla asistido por navegación o con técnicas convencionales, realizado por el mismo cirujano y con la misma prótesis. Se evaluó también el grado de satisfacción de los pacientes sometidos a este procedimiento y su posible variación entre estas dos técnicas. Materiales y métodos: Estudio retrospectivo, comparativo, observacional, descriptivo de 200 pacientes sometidos a un reemplazo total de rodilla, divididos en dos grupos: grupo A (100 pacientes) con prótesis Columbus® colocada con el sistema de navegación OrthoPilot® y grupo B (100 pacientes), con la misma prótesis colocada con técnica convencional. Se realizaron tele-metrías posoperatorias para determinar y comparar el resultado en ambos grupos. También se comparó el grado de satisfacción con el procedimiento y el índice de masa corporal y su posible relación con los resultados. Resultados: Se obtuvieron mejores resultados en los reemplazos totales de cadera asistidos por navegación, con diferencias estadísticamente significativas tanto en la obtención del eje mecánico posoperatorio como en el grado de satisfacción con el procedimiento. Conclusión: Los reemplazos totales de rodilla primarios guiados por un sistema de navegación fueron más precisos para lograr la alineación final del miembro en un eje mecánico de 0°± 3°. Nivel de Evidencia: III

Introduction: Total knee replacement (TKR) is the treatment of choice in the final stages of degenerative joint disease, and its survival depends largely on the alignment, positioning, and stability of the joint. This research aims to compare the mechanical axis of the lower limb measured by telemetry, after a computer navigation-assisted TKR vs. conventional techniques, performed by the same surgeon and using the same prosthesis. Secondly, to evaluate the degree of satisfaction of the patients submitted to this procedure and its possible variation between these two techniques. materials and methods: Retrospective, comparative, observational, descriptive study of 200 patients undergoing TKR, divided into two groups: Group A (100 patients), with Columbus® prostheses placed with the OrthoPilot®navigation system; and Group B (100 patients), with the same prosthesis placed with the conventional technique. Postoperative telemetry was performed on all patients to determine and compare the results in both groups. Secondly, the degree of satisfaction with the procedure and body mass index (BMI)­and its possible relationship with the results­were compared. Results: Computer navigation-assisted TKR obtained better outcomes with statistically significant differences both in the postoperative mechanical axis and in the degree of satisfaction with the procedure. Conclusion: Computer navigation-assisted primary TKRs were shown in our study to be more accurate in achieving final limb alignment on a 0° ± 3° limb mechanical axis. Level of Evidence: III

An in vitro model study of computer-guided endodontic microsurgery / 中华口腔医学杂志

Objective: To assess and compare the accuracies and operating time of endodontic microsurgery performed by operators with different levels of experience in endodontics using computer-guided techniques including dynamic and static navigations in a surgical simulation model. Methods: Six pairs of three dimensional (3D)-printed models of upper and lower jaws were set up on dental manikins. A total of 120 teeth (10 teeth each jaw) were included in the models. Microsurgeries of osteotomy and root-resection were performed on the models by two operators with different experience, namely novices and experts, under of free hand (FH)(n=20), dynamic navigation (DN)(n=20), and static navigation (SN)(n=20) conditions, respectively. The duration of each operation was recorded. Cone-beam CT was taken for 3D-printed models before and after the operation. The path of preoperative surgery planning was simulated. The linear deviations at the entry and the end point and the angular deviation of the access path between the simulated and the actual operation were compared by the software. Results: Significant difference of the entry deviation was observed between the novices and the experts in the FH group [(1.44±0.49) and (1.02±0.58) mm] (q=4.67, P=0.020). There were no significant differences between the novices and the experts in the end point and angular deviations (P>0.05). For the novices, the entry deviations in both DN and SN groups [(0.76±0.32) and (0.66±0.20) mm] were significantly lower than those in FH group (q=7.58, P<0.001; q=8.66, P<0.001). The angular deviations in the abovementioned two groups (5.0°±3.5°, 3.9°±2.1°) were significantly lower than that in FH group (10.9°±6.1°) (q=7.38, P<0.001; q=8.70, P<0.001). For the experts, significant differences were found only in the angular deviations among DN, SN and FH groups (3.6°±1.9°, 3.2°±1.7° and 8.2°±3.9°) (q=5.74, P=0.001; q=6.29, P<0.001). The operation durations were significantly shortened for both the novices [(4.80±2.15), (1.09±0.48) min] (q=14.60, P<0.001; q=20.10, P<0.001) and the experts [(3.40±1.96),(1.02±0.34) min] (q=5.86, P<0.001; q=9.37, P<0.001) by using DN and SN techniques. Regarding the differences between tooth types, in FH group, the operating time on the anterior teeth was significantly shorter than that on the posterior teeth (q=8.14, P<0.001; q=5.20, P=0.007), while in DN and SN groups, there were no significant differences in the operating time between two tooth types (P>0.05). No significant differences were discovered in the accuracies on the anterior and posterior teeth among three techniques or between two kinds of operators (P>0.05). Conclusions: Dynamic and static navigation techniques could assist the clinicians, especially the novices, to improve the accuracies and shorten the operating time of osteotomy and root resection microsurgeries.

Evaluation on Surgical Robotic Pose Repeatability Based on Laser Tracking Measurement / 中国医疗器械杂志

To provide accurate information for registration and safety evaluation of surgical robot, the pose repeatability measurement method was proposed. According to the terminal instrument of the master-slave surgical robot (such as high-frequency electric knife, ultrasonic knife), a suitable target ball fixture was designed. The node data at 10%, 50% and 100% rated speed were measured respectively. Through data analysis, the pose repeatability property of the tested samples at different speeds was obtained. It has high applicability and repeatability, and can meet the requirements of data traceability and registration testing.

Intraoperative assisted O-arm navigation imaging for unstable pelvic fractures in INFIX / 中国骨伤

OBJECTIVE@#To investigate the effect of internal external fixator assisted O-arm navigation imaging in the treatment of unstable pelvic fractures.@*METHODS@#From May 2019 to November 2019, 15 patients with unstable pelvic fractures were treated by intraoperative O-arm navigation imaging using INFIX technology. There were 6 males and 9 females. The age ranged from 24 to 66 years old. The course of disease ranged from 2 to 14 days. According to Tile classification, there were 1 case of B1 type, 8 cases of B2 type, 3 cases of C1 type, and 3 cases of C2 type. According to Young-Burgess classification, there were 8 cases of LC, 1 case of APC, 4 cases of VS, 2 cases of CM. Preoperative routine pelvic anteroposterior film, entrance position, exit position and pelvic CT three-dimensional reconstruction were performed. Intraoperative O-arm navigation system three-dimensional reconstruction and triplane scanning imaging were used to evaluate the effect of intraoperative reduction. The anterior pelvic ring was fixed with internal external fixator, and the posterior ring was fixed with sacroiliac screw, plate screw or lumbar iliac screw. The operation time, intraoperative bleeding and nail placement were observed and recorded. The quality of fracture reduction was evaluated by Matta standard, and the postoperative function was evaluated by Majeed function score.@*RESULTS@#Wound healing was good in all patients without vascular, nerve and local irritation complications. All the 15 patients were followed up for 10 to 16 months. The fracture reduction was evaluated according to the Matta scoring standard, 9 cases were excellent results, 5 cases were good, and 1 case was medium. The Majeed functional score was 0 to 95 points.@*CONCLUSION@#The built-in external fixator assisted O-arm navigation imaging system in the treatment of unstable pelvic fractures. The reduction effect is evaluated in advance, the operation time is shortened, and the accuracy of internal fixation is improved. The operation is simple, safe and less bleeding. The operation is in line with the principles of minimally invasive medical treatment and precision medical treatment in orthopedics, which is conducive to the recovery of patients' postoperative function and rapid recovery.

Accuracy and safety of robot assisted pedicle screw placement / 中国骨伤

OBJECTIVE@#To investigate the accuracy and safety of pedicle screw placement assisted by orthopedic robot and C-arm fluoroscopy.@*METHODS@#The clinical data of 36 patients with spinal diseases underwent surgical treatment from January 2019 to August 2020 was retrospectively analyzed. Among them, 18 cases were implanted pedicle screws assisted by orthopaedic robot(observation group), including 12 males and 6 females, aged from 16 to 61 years with an average of (38.44±3.60) years;there were 1 case of adolescent scoliosis, 1 case of spinal tuberculosis, 7 cases of lumbar spondylolisthesis, 4 cases of thoracic fracture and 5 cases of lumbar fracture. Another 18 cases were implanted pedicle screws assisted by C-arm fluoroscopy(control group), including 10 males and 8 females, aged from 18 to 58 years with an average of (43.22±2.53) years;there were 1 case of adolescent scoliosis, 6 cases of lumbar spondylolisthesis, 6 cases of thoracic fracture and 5 cases of lumbar fracture. The intraoperative fluoroscopy times, nail placement time and postoperative complications were recorded in two groups. CT scan was performed after operation. The Gertzbein-Robbins standard was used to evaluate the accuracy of pedicle screw placement which was calculated.@*RESULTS@#The number of intraoperative fluoroscopy in observation group was(6.89±0.20) times, which was significantly higher than that in control group(14.00±0.18)times(P<0.05). The placement time of each screw in observation group was(2.56±0.12) min, which was significantly different from that in control group(4.22±0.17) min (P<0.05). One case of incision infection occurred in control group after operation, and recovered after active dressing change. During the follow-up period, no serious complications such as screw loosening and fracture occurred in two groups, and there was no significant difference in complications between two groups(P>0.05). A total of 107 screws were placed in observation group, including 101 screws in class A, 4 in class B, 2 in class C, 0 in class D and 0 in class E, the accuracy rate of pedicle screw placement=[(number of screws in class A+B) / the number of all screws placed in the group] ×100%=98.1%(105/107); and a total of 104 screws were placed in control group, including 90 screws in class A, 4 in class B, 5 in class C, 5 in class D and 0 in class E, the accuracy rate of pedicle screw implantation=[(number of screws in class A+B/the number of all screws placed in the group]×100%=90.3% (94/104); there was significant difference between two groups (P<0.05).@*CONCLUSION@#Orthopaedic robot assisted pedicle screw placement has the advantages of less fluoroscopy times, shorter screw placement time and higher accuracy, which can further improve the surgical safety and has a broad application prospect in the orthopaedic.

Application of mixed reality technology in the field of hepatobiliary surgery / 中华外科杂志

Mixed reality is a new three-dimensional presentation technology that combines the virtual digital world with the real world, which has been initially applied in the field of hepatobiliary surgery. Compared with virtual reality, augmented reality and three-dimensional visualization technology, mixed reality technology has unique advantages in preoperative evaluation and formulation of surgical plan, real-time accurate navigation during operation and three-dimensional virtual teaching. And it is a new generation of auxiliary tool for precision hepatobiliary surgery. This paper describes the application and research progress of mixed reality technology in the field of hepatobiliary surgery, and discusses its application potential and current limitations.

How to change from traditional surgery to intelligent navigation surgery? / 中华外科杂志

After more than 20 years of multidisciplinary integration of medical science and technology,as well as research and practice in innovative diagnosis and treatment,digital medicine 4.0 has made a profound and important impact on the development of traditional surgery. To combine traditional surgery with digital medicine 4.0 technology is the direction of surgery development in the future.New technologies represented by digital intelligent navigation surgery have been deeply explored and widely applied in the diagnosis and treatment of many surgical diseases. With the innovative development and application of artificial intelligence,Big Data and mixed reality technology,the surgery will develop in ways similar to aerospace automatic and intelligent navigation,leading to the advent of digital medicine 5.0.