ABSTRACT
BACKGROUND: Clinical repair of critical-sized bone defects (CBDs) in the tibial diaphysis presents numerous challenges, including inadequate soft tissue coverage, limited blood supply, high load-bearing demands, and potential deformities. This study aimed to investigate the clinical feasibility and efficacy of employing 3D-printed prostheses for repairing CBDs exceeding 10 cm in the tibial diaphysis. METHODS: This retrospective study included 14 patients (11 males and 3 females) with an average age of 46.0 years. The etiologies of CBDs comprised chronic osteomyelitis (10 cases) and aseptic non-union (4 cases), with an average defect length of 16.9 cm. All patients underwent a two-stage surgical approach: (1) debridement, osteotomy, and cement spacer implantation; and (2) insertion of 3D-printed prostheses. The interval between the two stages ranged from 8 to 12 weeks, during which the 3D-printed prostheses and induced membranes were meticulously prepared. Subsequent to surgery, patients engaged in weight-bearing and functional exercises under specialized supervision. Follow-up assessments, including gross observation, imaging examinations, and administration of the Lower Extremity Functional Scale (LEFS), were conducted at 3, 6, and 12 months postoperatively, followed by annual evaluations thereafter. RESULTS: The mean postoperative follow-up duration was 28.4 months, with an average waiting period between prosthesis implantation and weight-bearing of 10.4 days. At the latest follow-up, all patients demonstrated autonomous ambulation without assistance, and their LEFS scores exhibited a significant improvement compared to preoperative values (30.7 vs. 53.1, P < 0.001). Imaging assessments revealed progressive bone regeneration at the defect site, with new bone formation extending along the prosthesis. Complications included interlocking screw breakage in two patients, interlocking screw loosening in one patient, and nail breakage in another. CONCLUSIONS: Utilization of 3D-printed prostheses facilitates prompt restoration of CBDs in the tibial diaphysis, enabling early initiation of weight-bearing activities and recovery of ambulatory function. This efficacious surgical approach holds promise for practical application.
Subject(s)
Diaphyses , Osteomyelitis , Printing, Three-Dimensional , Tibia , Humans , Male , Female , Middle Aged , Osteomyelitis/surgery , Osteomyelitis/diagnostic imaging , Retrospective Studies , Adult , Tibia/surgery , Tibia/diagnostic imaging , Diaphyses/surgery , Diaphyses/diagnostic imaging , Fractures, Ununited/surgery , Fractures, Ununited/diagnostic imaging , Plastic Surgery Procedures/methods , Plastic Surgery Procedures/instrumentation , Aged , Follow-Up Studies , Prosthesis Design , Prostheses and Implants , Osteotomy/methods , Weight-Bearing , Feasibility StudiesABSTRACT
BACKGROUND: The treatment of infected bone defects remains a clinical challenge. With the development of three-dimensional printing technology, three-dimensional printed implants have been used for defect reconstruction. The aim of this study was to investigate the clinical outcomes of three-dimensional printed porous prosthesis in the treatment of femoral defects caused by osteomyelitis. METHODS: Eleven patients with femoral bone defects following osteomyelitis who were treated with 3D-printed porous prosthesis at our institution between May 2017 and July 2021, were included. Eight patients were diagnosed with critical-sized defects, and the other three patients were diagnosed with shape-structural defects. A two-stage procedure was performed for all patients, and the infection was eradicated and bone defects were occupied by polymethylmethacrylate spacer during the first stage. The 3D-printed prosthesis was designed and used for the reconstruction of femoral defects in the second stage. Position of the reconstructed prostheses and bone growth were measured using radiography. The union rate, complications, and functional outcomes at the final follow-up were assessed. RESULTS: The mean length of the bone defect was 14.0 cm, union was achieved in 10 (91%) patients. All patients showed good functional performance at the most recent follow-up. In the critical-sized defect group, one patient developed a deep infection that required additional procedures. Two patients had prosthetic dislocations. Radiography demonstrated good osseous integration of the implant-bone interface in 10 patients. CONCLUSION: The 3D printed prostheses enable rapid anatomical and mechanically stable reconstruction of extreme femur bone defects, effectively shortens treatment time, and achieves satisfactory clinical outcomes.
Subject(s)
Femur , Osteomyelitis , Printing, Three-Dimensional , Prosthesis Design , Titanium , Humans , Osteomyelitis/surgery , Osteomyelitis/etiology , Osteomyelitis/diagnostic imaging , Male , Female , Femur/surgery , Femur/diagnostic imaging , Middle Aged , Adult , Porosity , Treatment Outcome , Prosthesis Implantation/instrumentation , Prosthesis Implantation/methods , Prosthesis Implantation/adverse effects , Retrospective Studies , Aged , Young Adult , Plastic Surgery Procedures/methods , Plastic Surgery Procedures/instrumentationABSTRACT
OBJECTIVE: To determine the diagnostic and therapeutic value of contrast-enhanced ultrasound-guided endoscopic retrograde appendicitis treatment (ERAT) in patients with uncomplicated appendicitis. METHODS: A retrospective analysis was performed on clinical and ultrasound data collected from 105 pediatric patients with uncomplicated appendicitis between January 2020 and December 2023. The ultrasound findings before and after treatment, as well as postoperative follow-up and recurrence rates, were summarized and analyzed. RESULTS: Successful intubation was achieved in 96 patients (91.4%). The conventional ultrasound appendix visualization rate was 39.6% (38/105), while the appendix visualization rate after contrast-enhanced ultrasound-guidance was 75% (72/105). Contrast-enhanced ultrasound revealed various appendiceal morphologic changes in 89 patients, such as twisting, tortuosity, stiffness, rough inner wall, dilated diameter, and narrowing of the lumen. Additionally, local filling defects, which indicated the presence of fecal stones or debris deposition, were noted in 68 patients. No leakage of the contrast agent occurred. Post-treatment evaluation showed improvement in appendiceal diameter, lumen, and filling defects (P < .01). The follow-up rate was 82 of 89 patients (92.1%), all of whom recovered well without a recurrence. The recurrence rate was 7.9% (7/89). Among the patients with recurrences, five patients resolved after medical treatment and two patients recovered after surgical treatment. CONCLUSION: Contrast-enhanced ultrasound-guided ERAT for uncomplicated appendicitis is safe and effective. Specifically, the appendix is increased, which facilitates an evaluation of therapeutic effectiveness. ERAT serves as a valuable supplementary modality to determine the need for surgical treatment of acute appendicitis, which is of significant clinical value.
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Using the generalized multiparticle Mie-solution method, this study examines the optical properties of chain-like particles under different atmospheric conditions and various arrangements. The structural composition of aerosols exhibits a more pronounced impact on their extinction and absorption cross sections when the incident wavelength is below 600 nm, whereas significant changes are observed in backscattering cross sections for incident wavelengths above 600 nm. As the orientation angle between the incident wave and particle chain increases, the extinction cross sections and absorption cross sections exhibit varying degrees of decline. Furthermore, marine atmospheric aerosol chains demonstrate similar extinction cross sections to those of polluted atmospheric aerosols, and their absorption cross sections closely resemble those of clean atmospheric aerosols. In addition, for a particle chain of fixed length, the greater the disparity in particle sizes within the chain, the larger the difference between the backscattering cross section and that of the chains with equal particle sizes. This research provides theoretical support for assessing the climate effects of aerosols and inverting aerosol properties by LiDAR data.
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Background: Applying 3D printed prostheses to repair diaphyseal defects of lower limbs has been clinically conducted in orthopedics. However, there is still no unified reference standard for which the prosthesis design and fixation mode are more conducive to appropriate biomechanical conduction. Methods: We built five different types of prosthesis designs and fixation modes, from Mode I to Mode V. Finite element analysis (FEA) was used to study and compare the mechanical environments of overall bone-prosthesis structure, and the maximum stress concentration were recorded. Additionally, by comparing the maximum von Mises stress of bone, intramedullary (IM) nail, screw, and prosthesis with their intrinsic yield strength, the risk of fixation failure was further clarified. Results: In the modes in which the prosthesis was fixed by an interlocking IM nail (Mode I and Mode IV), the stress mainly concentrated at the distal bone-prosthesis interface and the middle-distal region of nail. When a prosthesis with integrally printed IM nail and lateral wings was implanted (Mode II), the stress mainly concentrated at the bone-prosthesis junctional region. For cases with partially lateral defects, the prosthesis with integrally printed wings mainly played a role in reconstructing the structural integrity of bone, but had a weak role in sharing the stress conduction (Mode V). The maximum von Mises stress of both the proximal and distal tibia appeared in Mode III, which were 18.5 and 47.1â MPa. The maximum peak stress shared by the prosthesis, screws and IM nails appeared in Mode II, III and I, which were 51.8, 87.2, and 101.8â MPa, respectively. These peak stresses were all lower than the yield strength of the materials themselves. Thus, the bending and breakage of both bone and implants were unlikely to happen. Conclusion: For the application of 3D printed prostheses to repair diaphyseal defects, different fixation modes will lead to the change of biomechanical environment. Interlocking IM nail fixation is beneficial to uniform stress conduction, and conducive to new bone regeneration in the view of biomechanical point. All five modes we established have reliable biomechanical safety.
ABSTRACT
The repair of critical diaphyseal defects of lower weight-bearing limbs is an intractable problem in clinical practice. From December 2017, we prospectively applied 3D printed porous Ti6Al4V scaffolds to reconstruct this kind of bone defect. All patients experienced a two-stage surgical process, including thorough debridement and scaffold implantation. With an average follow-up of 23.0 months, ten patients with 11 parts of bone defects were enrolled in this study. The case series included three females and seven males, their defect reasons included seven parts of osteomyelitis and four parts of aseptic nonunion. The bone defects located at femur (five parts) and tibia (six parts), with an average defect distance of 12.2 cm. Serial postoperative radiologic follow-ups displayed a continuous process of new bone growing and remodeling around the scaffold. One patient suffered tibial varus deformity, and he underwent a revision surgery. The other nine patients achieved scaffold stability. No scaffold breakage occurred. In conclusion, the implantation of 3D printed Ti6Al4V scaffold was feasible and effective to reconstruct critical bone defects of lower limbs without additional bone grafting. Graphical abstract.
Subject(s)
Bone Transplantation , Tissue Scaffolds , Alloys , Female , Humans , Lower Extremity , Male , Porosity , Printing, Three-Dimensional , Prospective Studies , TitaniumABSTRACT
Background: Nonunion of the humeral shaft can turn into bone defects. There is no consensus on the optimal treatment of humeral shaft nonunion with bone defects. Herein, we presented a single case of a patient with a 9.5 cm humerus shaft bone defect treated with a 3D printed Ti6Al4V microporous prosthesis after internal fixation failure of a middle-inferior humerus fracture. Case Description: A 53-year-old female who injured her left upper limb by falling was diagnosed with a fracture of the left humeral shaft. The fracture was treated with open reduction and internal fixation. Nine months postoperatively, radiography examination indicated humeral nonunion with a 9.5 cm segmental bone defect. A 3D printing technology was then used to design and fabricate a customized microporous prosthesis with an intramedullary nail and lateral plates. A two-stage surgical strategy was performed, including radical debridement, temporary fixation for the induced membrane formation, and the implantation of the prosthesis. At 18 months of follow-up, encouraging clinical outcomes were observed. The prosthesis remained stable in the original implantation area and callus formation was found at the contact end of the prosthesis and bone stump. The upper limb functions returned to normal with a satisfactory functional score. Also, no complications were found. Conclusions: Reconstruction with a 3D printed microporous prosthesis might be used as an alternative for the repair of large segmental bone defects of limbs.
ABSTRACT
Critical metaphyseal bone defects caused by nonunion and osteomyelitis are intractable to repair in clinical practice owing to the rigorous demanding of structure and performance. Compared with traditional treatment methods, 3D printing of customized porous titanium alloy prostheses offer feasible and safe opportunities in repairing such bone defects. Yet, so far, no standard guidelines for optimal 3D printed prostheses design and fixation mode have been proposed to further promote prosthesis stability as well as ensure the continuous growth of new bone. In this study, we used a finite element analysis (FEA) to explore the biomechanical distribution and observed new bone regeneration in clinical practice after implanting 3D printed prostheses for repairing metaphyseal bone defects. The results reflected that different fixation modes could result in diverse prosthesis mechanical conductions. If an intramedullary (IM) nail was applied, the stress mainly conducted equally along the nail instead of bone and prosthesis structure. While the stress would transfer more to the lateral bone and prosthesis's body when the printed wing and screws are selected to accomplish fixation. All these fixation modes could guarantee the initial and long-term stability of the implanted prosthesis, but new bone regenerated with varying degrees under special biomechanical environments. The fixation mode of IM nail was more conducive to new bone regeneration and remodeling, which conformed to the Wolff's law. Nevertheless, when the prosthesis was fixed by screws alone, no dense new callus could be observed. This fixation mode was optional for defects extremely close to the articular surface. In conclusion, our innovative study could provide valuable references for the fixation mode selection of 3D printed prosthesis to repair metaphyseal bone defect.
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We investigate, both theoretically and numerically, the equivalence relationship between the positive and negative refraction index dielectric materials in electrostatic invisibility cloak. We have derived an analytical formula that enables fast calculate the corresponding positive dielectric constant from the negative refraction index material. The numerical results show that the negative refraction index material can be replaced by the positive refractive index materials in the static field cloak. This offers some new viewpoints for designing new sensing systems and devices in physics, colloid science, and engineering applications.
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Based on the Rayleigh approximation, this paper presents the electromagnetic scattering properties of the small partially charged isotropic sphere and those of a similar anisotropic sphere and then discusses the effect of surface charges on particles' optical properties. The numerical simulation results show that the surface charges on a charged particle can enhance the scattering of the incident waves, and the effect on an anisotropic charged sphere is much greater than that on an isotropic charged particle. Therefore it is necessary to consider the medium property (isotropic or anisotropic) and electric effects of dust particles in the remote sensing of sandstorms.
Subject(s)
Algorithms , Dust/analysis , Environmental Monitoring/methods , Models, Theoretical , Nephelometry and Turbidimetry/methods , Refractometry/methods , Computer Simulation , Light , Scattering, Radiation , Static ElectricityABSTRACT
We calculate the light scattering properties of the partially charged dust particles with the Mie theory for electromagnetic waves with different frequencies, and the attenuation coefficients of an electromagnetic wave propagating in a sandstorm are also calculated. The results show that the electric charges distributed on the sand surface have a significant effect on the attenuation of the electromagnetic wave, especially for a frequency lower than 40 GHz, and attenuation coefficients increase with the magnitude of charges carried by the dust particles (expressed by the charge-to-mass ratio in this paper). For the higher frequency electromagnetic wave, such as visible light, the effect of charges carried by sand particles on its attenuation is very little, which can be ignored.