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1.
Atlas Oral Maxillofac Surg Clin North Am ; 28(2): 111-118, 2020 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-32741508

RESUMEN

Temporomandibular joint ankyloses are a fusion of the mandibular condyle to the base of skull. Surgical advances have stemmed from innovation in computer planning, guidance, and intraoperative navigation, allowing surgeons to restore form and function with greater precision, predictability, and safety. Preoperative computer virtual surgical planning used the computed tomography scan data to render a 3-dimensional image that can be used for surgical simulations and fabrication of intraoperative aids. Temporomandibular joint reconstruction should be considered as a predictable option in the management of temporomandibular joint ankylosis. Intraoperative navigation allows for continuous real-time 3-dimensional positioning of instruments.


Asunto(s)
Anquilosis , Cirugía Asistida por Computador , Trastornos de la Articulación Temporomandibular , Humanos , Cóndilo Mandibular , Articulación Temporomandibular
2.
Medicine (Baltimore) ; 99(28): e21064, 2020 Jul 10.
Artículo en Inglés | MEDLINE | ID: mdl-32664123

RESUMEN

BACKGROUND: Computer navigation technology is gradually applied to the placement of pedicle screws, but its security and effectiveness still lack of high-quality evidence-based medical evidence. In this study, we will perform a systematic review of previously published randomized controlled trials to investigate the accuracy and effectiveness of computer navigation vsersus fluoroscopy guidance for pedicle screw placement. METHODS: All study protocols adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed (MEDLINE), The excerpta medica database, Web of Science (science and social science citation index), The Cochrane Library (Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials (CENTRAL), Cochrane Methodology Register), China National Knowledge Infrastructure, Chinese Science and Technology Periodical Database, WanFang, Chinese Biomedical Literature Database will be searched for relevant articles up to 18 April, 2020. We will include randomized controlled trials of computer navigation and fluoroscopy guidance for pedicle screw placement. The Cochrane Handbook (v6) will be used for assessment of study bias and reliability, and a meta-analysis will be performed using STATA 16.0. The main outcome will be the proportion of accurate implanted screws. Additional outcomes including: overall complication rate, radiation dosage, length of surgery, length of stay, estimated blood loss. RESULTS: The quality of the assessments will be assessed through Grading of Recommendations Assessment, Development, and Evaluation. Data will be disseminated through publications in peer-reviewed journals. CONCLUSION: We will evaluate the accuracy and other perioperative parameters between computer navigation and fluoroscopy guidance for pedicle screw placement. TRIAL REGISTRATION NUMBER: PROSPERO 2020 CRD42020172087.


Asunto(s)
Fluoroscopía/métodos , Tornillos Pediculares , Proyectos de Investigación , Fusión Vertebral/métodos , Cirugía Asistida por Computador/métodos , Pérdida de Sangre Quirúrgica , Humanos , Tiempo de Internación , Complicaciones Posoperatorias/epidemiología , Estudios Prospectivos , Ensayos Clínicos Controlados Aleatorios como Asunto , Reproducibilidad de los Resultados
3.
Shanghai Kou Qiang Yi Xue ; 29(1): 65-68, 2020 Feb.
Artículo en Chino | MEDLINE | ID: mdl-32524124

RESUMEN

PURPOSE: It was aimed to apply computer virtual design and digital surgical templates to simulate postoperative position of tooth and guide the accuracy of socket preparation during tooth autotransplantation. METHODS: The study enrolled 10 patients who underwent tooth autotransplant surgery. Cone-bean CT (CBCT) data were imported into Proplan CMF 3.0 software. The donor tooth was transferred to the recipient site according to the occlusion and space situation. A digital template was designed to guide socket preparation. Computer-aided rapid prototyping (RP) technique was used to print the surgical template and tooth model. RESULTS: With computer virtual design and digital template, it was possible to accurately guide socket preparation in recipient site. The six-month follow-up results showed the periodontal space in the radiographs was continuous and intact. There was no mobility in all cases and the probing depth of the tooth was <4 mm. The related data showed a favorable survival and success rates of the donor teeth. CONCLUSIONS: Computer virtual design can successfully simulate postoperative position in tooth autotransplantation while simplifying the surgical procedure, and enhance the accuracy of socket preparation.


Asunto(s)
Cirugía Asistida por Computador , Diente , Diseño Asistido por Computadora , Tomografía Computarizada de Haz Cónico , Humanos , Impresión Tridimensional , Alveolo Dental , Trasplante Autólogo
4.
Zhonghua Wai Ke Za Zhi ; 58(6): 425-429, 2020 Jun 01.
Artículo en Chino | MEDLINE | ID: mdl-32498480

RESUMEN

High tibial osteotomy(HTO) is an effective method for the treatment of knee osteoarthritis by transferring the weight bearing line to the lateral tibial plateau, which can significantly reduce the pressure and cartilage lesion of medial knee compartment.However, under- and over-correction of weight bearing line can lead to early postoperative failure.It is necessary to define the standard of axis correction, make correct preoperative plan, ensure the accuracy of operation and consider the risk factors of under- and over-correction of axis.With the advent of the era of intelligent medicine, the application of patient-specific instrumentation technology based on three dimention printing and navigation technology will help to achieve the precise control of axial alignment in high tibial osteotomy.


Asunto(s)
Osteoartritis de la Rodilla/cirugía , Osteotomía/métodos , Osteotomía/tendencias , Tibia/cirugía , Desviación Ósea/etiología , Desviación Ósea/prevención & control , Humanos , Articulación de la Rodilla/cirugía , Extremidad Inferior/cirugía , Osteotomía/efectos adversos , Cirugía Asistida por Computador
5.
Zhonghua Wai Ke Za Zhi ; 58(6): 457-463, 2020 Jun 01.
Artículo en Chino | MEDLINE | ID: mdl-32498486

RESUMEN

Objective: To examine the clinical effects of the treatment of knee osteoarthritis patients with kinematic alignment technique of total knee replacement (KA-TKA) assisted by patient-specific instrumentation (PSI). Methods: The clinical data of 14 patients with knee osteoarthritis treated with unilateral KA-TKA assisted by PSI at Department of Orthopaedic Surgery, Beijing Chaoyang Hospital Affiliated to Capital Medical University from May 2018 to August 2019 were analyzed retrospectively. There were 6 males and 8 females, aged 66.6 years (range: 56 to 79 years), 9 left knees and 5 right knees. The operation time, soft tissue release and extra varus or valgus osteotomy were recorded. The data of osteotomy blocks were measured and compared with the corresponding position of the prostheses. The hip knee ankle angle (HKA), the mechanical distal femoral lateral angle (mLDFA) and the proximal tibial medial angle (MPTA) were measured before and 3 months after the operation. The knee joint functional score (KS-F) , knee joint clinical score (KS-C) and the Western Ontario McMaster (WOMAC) Osteoarthritis Index were recorded and compared by paired t test or Wilcoxon non-parametric test. Results: The operation time was (81.8±16.9) minutes (range: 60 to 115 minutes), 2 cases were manually increased varus osteotomy by 2 mm and 1 patient received lateral retinaculum release. There was no extra medial or lateral soft tissue release. Intraoperative measurement of the resection showed that the femoral side mismatch was within 2 mm. The medial and lateral condyle, the medial and lateral posterior condyles were relatively overcut by 0.50 mm, 0.21 mm, 0.93 mm, and 0.71 mm, respectively. The tibial side mismatch was within 1.5 mm, the medial and lateral plateau were relatively undercut by 0.43 mm and 0.32 mm. HKA was corrected from (8.8±5.6) ° to (1.6±4.3) ° (t=20.723, P=0.000) .KS-C improved from 28.21±13.47 preoperative to 78.07±8.01 postoperative (t=-16.570, P=0.000); KS-F improved from 41.00±15.25 preoperative to 84.93±10.85 postoperative (t=-14.675, P=0.000).WOMAC Osteoarthritis Index decreased from 53.5 (25.75) (M(Q(R))) preoperative to 5.5 (5.25) postoperative (Z=-3.297, P=0.001) .No statistically significant difference was found in mLDFA and MPTA before and after surgery. No significant patellofemoral complication was recorded during follow-up time. Conclusions: PSI assisted TKA resection has high accuracy. KA-TKA aims to restore the native anatomy of the knee joint, only corrects the malalignment of lower extremities caused by articular cartilage wear, with less interference to soft tissues, easy to obtain satisfactory knee joint laxity and has a promising early clinical effect.


Asunto(s)
Artroplastia de Reemplazo de Rodilla/instrumentación , Artroplastia de Reemplazo de Rodilla/métodos , Osteoartritis de la Rodilla/cirugía , Anciano , Fenómenos Biomecánicos , Desviación Ósea/etiología , Desviación Ósea/prevención & control , Femenino , Humanos , Articulación de la Rodilla/fisiopatología , Articulación de la Rodilla/cirugía , Masculino , Persona de Mediana Edad , Osteoartritis de la Rodilla/fisiopatología , Modelación Específica para el Paciente , Estudios Retrospectivos , Cirugía Asistida por Computador
6.
Orthopade ; 49(7): 597-603, 2020 Jul.
Artículo en Alemán | MEDLINE | ID: mdl-32542426

RESUMEN

BACKGROUND: Compared with the current gold standard of knee endoprosthetics, the concept of kinematic alignment is more responsive to the individual anatomy of the patient as it enables the three-dimensional restoration of individual axes, joint lines and capsule tension. One point of criticism is the lack of intraoperative control over individual bone resections with conventional instrumentation. However, with the help of CT-based individual 3D-printed cutting blocks, a precise preoperative plan can be transferred to the operating room. The aim of this article is to explain the operative technique of patient-specific instrumentation (PSI)-protected kinematic alignment. METHODS: The procedure is based on a preoperative 3D model of the bony anatomy of the patient, with the aid of which the planning of the operation, with the positioning and size of the implant, as well as the necessary bone resections, are carried out. With this information about anatomy and resection levels the individual cutting blocks are produced, aided by a 3D printer. Intraoperative control is achieved by measuring the resection by means of a gage and comparison with the digital 3D design. DISCUSSION: With the aid of the 3D-printed PSI cutting blocks the preoperative plan of kinematic alignment can be implemented in a precise manner. It is a simple tool and does not require any great expense. Compared with the conventional instrumentation, the operating time is shortened. However, because of the purely CT-based design, no information about the state of the soft tissue is obtained.


Asunto(s)
Artroplastia de Reemplazo de Rodilla , Prótesis de la Rodilla , Cirugía Asistida por Computador , Fenómenos Biomecánicos , Humanos , Articulación de la Rodilla
7.
Bone Joint J ; 102-B(6): 772-778, 2020 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-32475249

RESUMEN

AIMS: For paediatric and adolescent patients with growth potential, preservation of the physiological joint by transepiphyseal resection (TER) of the femur confers definite advantages over arthroplasty procedures. We hypothesized that the extent of the tumour and changes in its extent after neoadjuvant chemotherapy are essential factors in the selection of this procedure, and can be assessed with MRI. The oncological and functional outcomes of the procedure were reviewed to confirm its safety and efficacy. METHODS: We retrospectively reviewed 16 patients (seven male and nine female, mean age 12.2 years (7 to 16)) with osteosarcoma of the knee who had been treated by TER. We evaluated the MRI scans before and after neoadjuvant chemotherapy for all patients to assess the extent of the disease and the response to treatment. RESULTS: The mean follow-up period was 64.3 months (25 to 148) after surgery and no patients were lost to follow-up. On MRI evaluation, 13 tumours were near but not in contact with the physes and three tumours were partially in contact with the physes before neoadjuvant chemotherapy. Bone oedema in the epiphysis was observed in eight patients. After neoadjuvant chemotherapy, bone oedema in the epiphysis disappeared in all patients. In total, 11 tumours were not in contact and five tumours were in partial contact with the physes. The postoperative pathological margin was negative in all patients. At the last follow-up, 12 patients were continuously disease-free and three had no evidence of disease. One patient died due to the disease. Functionally, the patients with retained allograft or recycled autograft had a mean knee range of flexion of 126° (90° to 150°). The mean Musculoskeletal Tumor Society functional score was 27.6 (23 to 30). CONCLUSION: TER is an effective limb-salvage technique for treating malignant metaphyseal bone tumours in paediatric and young osteosarcoma patients with open physes when a good response to chemotherapy and no progression of the tumour to the epiphysis have been confirmed by MRI. Cite this article: Bone Joint J 2020;102-B(6):772-778.


Asunto(s)
Neoplasias Óseas/diagnóstico por imagen , Neoplasias Óseas/cirugía , Imagen por Resonancia Magnética , Osteosarcoma/diagnóstico por imagen , Osteosarcoma/cirugía , Adolescente , Niño , Epífisis/cirugía , Femenino , Humanos , Masculino , Procedimientos Ortopédicos/métodos , Estudios Retrospectivos , Cirugía Asistida por Computador
8.
Bone Joint J ; 102-B(6_Supple_A): 49-58, 2020 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-32475289

RESUMEN

AIMS: The aims of this study were to determine the effect of osteophyte excision on deformity correction and soft tissue gap balance in varus knees undergoing computer-assisted total knee arthroplasty (TKA). METHODS: A total of 492 consecutive, cemented, cruciate-substituting TKAs performed for varus osteoarthritis were studied. After exposure and excision of both cruciates and menisci, it was noted from operative records the corrective interventions performed in each case. Knees in which no releases after the initial exposure, those which had only osteophyte excision, and those in which further interventions were performed were identified. From recorded navigation data, coronal and sagittal limb alignment, knee flexion range, and medial and lateral gap distances in maximum knee extension and 90° knee flexion with maximal varus and valgus stresses, were established, initially after exposure and excision of both cruciate ligaments, and then also at trialling. Knees were defined as 'aligned' if the hip-knee-ankle axis was between 177° and 180°, (0° to 3° varus) and 'balanced' if medial and lateral gaps in extension and at 90° flexion were within 2 mm of each other. RESULTS: Of 50 knees (10%) with no soft tissue releases (other than cruciate ligaments), 90% were aligned, 81% were balanced, and 73% were aligned and balanced. In 288 knees (59%) only osteophyte excision was performed by subperiosteally releasing the deep medial collateral ligament. Of these, 98% were aligned, 80% were balanced, and 79% were aligned and balanced. In 154 knees (31%), additional procedures were performed (reduction osteotomy, posterior capsular release, and semimembranosus release). Of these, 89% were aligned, 68% were balanced, and 66% were aligned and balanced. The superficial medial collateral ligament was not released in any case. CONCLUSION: Two-thirds of all knees could be aligned and balanced with release of the cruciate ligaments alone and excision of osteophytes. Excision of osteophytes can be a useful step towards achieving deformity correction and gap balance without having to resort to soft tissue release in varus knees while maintaining classical coronal and sagittal alignment of components. Cite this article: Bone Joint J 2020;102-B(6 Supple A):49-58.


Asunto(s)
Artroplastia de Reemplazo de Rodilla/métodos , Genu Varum/cirugía , Osteoartritis de la Rodilla/cirugía , Osteofito/cirugía , Rango del Movimiento Articular , Cirugía Asistida por Computador , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Osteoartritis de la Rodilla/complicaciones , Osteofito/complicaciones , Estudios Prospectivos
9.
Medicine (Baltimore) ; 99(20): e20017, 2020 May.
Artículo en Inglés | MEDLINE | ID: mdl-32443303

RESUMEN

BACKGROUND: Recently, controversy still exists regarding the clinical effects of measured resection or gap-balancing technique in total knee arthroplasty (TKA). The objective of this retrospective study was to compare the clinical outcomes of conventional measured resection technique and computer-assisted gap-balancing technique in TKA. METHODS: Strengthening the Reporting of Observational studies in Epidemiology checklist. Patients underwent primary TKA by a single surgeon between 2014 and 2016 were reviewed. This study was approved by the institutional review board in our hospital and was registered in the Research Registry. Outcome measures included surgical time, intraoperative complications, patient satisfaction, Oxford Knee Score, range of motion, postoperative complications, and revision. RESULTS: This study had limited inclusion and exclusion criteria and a well-controlled intervention. CONCLUSION: We were able to directly compare the outcomes of measured resection versus gap-balancing techniques and might reveal a better technique in TKA. TRIAL REGISTRATION: This study protocol was registered in Research Registry (researchregistry5441).


Asunto(s)
Artroplastia de Reemplazo de Rodilla/métodos , Artroplastia de Reemplazo de Rodilla/efectos adversos , Artroplastia de Reemplazo de Rodilla/instrumentación , Artroplastia de Reemplazo de Rodilla/estadística & datos numéricos , Humanos , Prótesis de la Rodilla/estadística & datos numéricos , Complicaciones Posoperatorias/etiología , Estudios Retrospectivos , Cirugía Asistida por Computador
10.
Surg Technol Int ; 36: 63-69, 2020 May 28.
Artículo en Inglés | MEDLINE | ID: mdl-32372404

RESUMEN

INTRODUCTION: Acetabular cup malposition is very common in total hip arthroplasty (THA) and is significantly associated with many serious postoperative complications, such as dislocation, wear and loosening, and decreased range of motion. To improve the accuracy of intraoperative assessment, we recently developed an innovative sensor-based navigation system (Force-PRO device) using an inertial measurement unit and a 3D-printed liner for acetabular cup measurement, and aimed to evaluate its reliability and correlate its accuracy with that of a computer-assisted navigation system (CANS). DESIGN: Method-comparison study between the Force-PRO device and a standard CANS in a 1:1 pelvic bone model. METHODS: The test-retest reliability of both the Force-PRO device and CANS, and agreement between the Force-PRO device and CANS, for the measurement of acetabular inclination and anteversion angles, were examined using 40 random acetabular cup positions. Statistical analysis was performed by using limits of agreement and intraclass correlation coefficient (ICC). RESULTS: The mean differences in the inclination angle and anteversion angle in test-retest of the Force-PRO device were -0.43°±1.03° and -0.40°±0.78°, respectively. The mean differences in the inclination angle and anteversion angle between the Force-PRO device and CANS were 0.70°±0.94° and -0.10°±0.44°, respectively. Excellent reliability in the inclination and anteversion angles of the Force-PRO device and excellent agreement between the Force-PRO device and CANS were demonstrated, with ICC values of 0.994 and 0.997, and 0.993 and 0.999, respectively. CONCLUSION: The Force-PRO device showed excellent reliability equivalent to CANS with excellent agreement in acetabular cup position measurement comparable to that with CANS. Future clinical studies will be needed to evaluate the efficacy of this device.


Asunto(s)
Artroplastia de Reemplazo de Cadera , Prótesis de Cadera , Acetábulo , Humanos , Complicaciones Posoperatorias , Reproducibilidad de los Resultados , Cirugía Asistida por Computador
12.
Radiol Clin North Am ; 58(4): 733-751, 2020 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-32471541

RESUMEN

Preoperative assessment with computed tomography (CT) is critical before transcatheter interventions for structural heart disease. CT provides information for device selection, device sizing, and vascular access approach. The interpreting radiologist must have knowledge of appropriate CT protocols, how and where to obtain the important measurements, and know additional imaging characteristics that are important to describe for optimal support of the interventionalist. CT is the modality of choice for pre-operative evaluation in patients undergoing transcatheter aortic valve replacement and left atrial appendage occlusion, and is also useful before transcatheter mitral valve replacement, which is an ongoing area of research.


Asunto(s)
Enfermedades de las Válvulas Cardíacas/diagnóstico por imagen , Enfermedades de las Válvulas Cardíacas/cirugía , Implantación de Prótesis de Válvulas Cardíacas/métodos , Cuidados Preoperatorios , Tomografía Computarizada por Rayos X , Aorta/diagnóstico por imagen , Aorta/cirugía , Humanos , Válvula Mitral/diagnóstico por imagen , Válvula Mitral/cirugía , Planificación de Atención al Paciente , Cuidados Preoperatorios/métodos , Cirugía Asistida por Computador , Reemplazo de la Válvula Aórtica Transcatéter/métodos
13.
Clin Oral Implants Res ; 31(8): 737-746, 2020 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-32459868

RESUMEN

OBJECTIVES: The objective of this in vitro study was to assess the accuracy of fully guided implant placement following virtual implant planning based on MRI. MATERIAL AND METHODS: Sixteen human cadaver hemimandibles with single missing teeth (n = 3), partially edentulous (n = 6) and edentulous situations (n = 7) were imaged using MRI. MRI and optical scans obtained with an intraoral scanner, were imported into an implant planning software. Virtual prosthetic and implant planning were performed regarding hard- and soft-tissue anatomy. Drill guides were manufactured, and fully guided implant placement was performed. Buccal and lingual bone and implant nerve distance were measured by three examiners in preoperative MRI and postoperative CBCT. The implant position was assessed using a software for deviation of implant positions displayed in CBCT and optical scans, respectively. RESULTS: MRI displayed relevant structures for implant planning such as cortical and cancellous bone, inferior alveolar nerve and neighboring teeth. Implant planning, CAD/CAM of drill guides and guided implant placement were performed. Deviations between planned and actual implant positions in postoperative CBCT and optical scans were 1.34 mm (SD 0.84 mm) and 1.03 mm (SD 0.46 mm) at implant shoulder; 1.41 mm (SD 0.88 mm) and 1.28 mm (SD 0.52 mm) at implant apex, and 4.84° (SD 3.18°) and 4.21° (SD 2.01°). Measurements in preoperative MRI and postoperative CBCT confirmed the compliance with minimum distances of implants to anatomical structures. CONCLUSIONS: Relevant anatomical structures for imaging diagnostics in implant dentistry are displayed with MRI. The accuracy of MRI-based fully guided implant placement in vitro is comparable to the workflow using CBCT.


Asunto(s)
Implantes Dentales , Cirugía Asistida por Computador , Diseño Asistido por Computadora , Tomografía Computarizada de Haz Cónico , Implantación Dental Endoósea , Humanos , Imagenología Tridimensional , Imagen por Resonancia Magnética , Mandíbula , Planificación de Atención al Paciente
14.
PLoS One ; 15(4): e0231440, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32287298

RESUMEN

BACKGROUND AND PURPOSE: There is limited standardization of acquisition and processing methods in diffusion tractography for pre-surgical planning, leading to a range of approaches. In this study, a number of representative acquisition variants and post processing methods are considered, to assess their importance when implementing a clinical tractography program. METHODS: Diffusion MRI was undertaken in ten healthy volunteers, using protocols typical of clinical and research scanning: a 32-direction diffusion acquisition with and without peripheral gating, and a non-gated 64 diffusion direction acquisition. All datasets were post-processed using diffusion tensor reconstruction with streamline tractography, and with constrained spherical deconvolution (CSD) with both streamline and probabilistic tractography, to delineate the cortico-spinal tract (CST) and optic radiation (OR). The accuracy of tractography results was assessed against a histological atlas using a novel probabilistic Dice overlap technique, together with direct comparison to tract volumes and distance of Meyer's loop to temporal pole (ML-TP) from dissections studies. Three clinical case studies of patients with space occupying lesions were also investigated. RESULTS: Tracts produced by CSD with probabilistic tractography provided the greatest overlap with the histological atlas (overlap scores of 44% and 52% for the CST and OR, respectively) and best matched tract volume and ML-TP distance from dissection studies. The acquisition protocols investigated had limited impact on the accuracy of the tractography. In all patients, the CSD based probabilistic tractography created tracts with greatest anatomical plausibility, although in one case anatomically plausible pathways could not be reconstructed without reducing the probabilistic threshold, leading to an increase in false positive tracts. CONCLUSIONS: Advanced post processing techniques such as CSD with probabilistic tractography are vital for pre-surgical planning. However, overall accuracy relative to dissection studies remains limited.


Asunto(s)
Procesamiento de Imagen Asistido por Computador/métodos , Cirugía Asistida por Computador/métodos , Adolescente , Adulto , Imagen de Difusión por Resonancia Magnética , Femenino , Ganglioglioma/diagnóstico por imagen , Ganglioglioma/cirugía , Humanos , Masculino , Persona de Mediana Edad , Oligodendroglioma/diagnóstico por imagen , Oligodendroglioma/cirugía , Adulto Joven
15.
Ann R Coll Surg Engl ; 102(6): e126-e129, 2020 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-32233649

RESUMEN

A 14-year-old boy underwent surgery for symptomatic malunion of the clavicle. This complication, which is uncommon in adults and adolescents, occurred after a displaced midshaft clavicle fracture that had been treated conservatively. Surgery may be considered if functional impairment, pain, weakness, fatigability and neurological symptoms persist in the presence of significant clavicular deformity. Our case was unusual because the patient had a symptomatic malunion and lost range of movement of his shoulder despite a minor degree of clavicular shortening. We adopted an approach used in lower limb deformity correction but not described for the clavicle in which corrective osteotomy was planned and practised using a three-dimensional printed model of the malunited clavicle. A three-dimensional printed model of the mirror image of the opposite clavicle served as a template of normal. Three-dimensional models were printed from the computed tomography data. The patient's symptoms resolved and he recovered full range of movement and shoulder function following the corrective osteotomy.


Asunto(s)
Clavícula/lesiones , Fracturas Mal Unidas/cirugía , Osteotomía/métodos , Impresión Tridimensional , Cirugía Asistida por Computador/métodos , Adolescente , Clavícula/diagnóstico por imagen , Clavícula/cirugía , Fracturas Mal Unidas/fisiopatología , Humanos , Masculino , Modelos Anatómicos , Rango del Movimiento Articular , Articulación del Hombro/fisiopatología , Tomografía Computarizada por Rayos X , Resultado del Tratamiento
16.
Surg Technol Int ; 36: 323-330, 2020 May 28.
Artículo en Inglés | MEDLINE | ID: mdl-32294224

RESUMEN

Manual total knee arthroplasty (TKA) has successfully treated end-stage knee osteoarthritis for several years. However, recent technological advancements have enabled surgeons to perform TKA with more accuracy and precision. Aligning the femoral and tibial components perpendicular to the mechanical axes of the femur and tibia is a fundamental principle for restoring knee kinematics and soft-tissue balance. Computer-assisted robotic TKA has proven its ability to fine tune lower leg alignment, component position, and soft-tissue balancing. Furthermore, robotic-assisted TKA (RATKA) offers the additional benefit of improving soft-tissue protection compared to manual techniques. Numerous systems have been developed in the advancement of technology in computer processing, and the number of robotic surgical systems is increasing as well. The three main categories of navigation systems can be classified as: image-based console navigation, imageless console navigation, and accelerometer-based handheld navigation systems. The purpose of this review was to describe emerging technologies for TKA. Specifically, we outline the available literature pertaining to each system with regards to their: (1) accuracy and precision of component alignment; (2) soft-tissue protection; (3) postoperative outcomes; and (4) other reported outcomes such as costs.


Asunto(s)
Artroplastia de Reemplazo de Rodilla , Cirugía Asistida por Computador , Fémur , Humanos , Articulación de la Rodilla , Osteoartritis de la Rodilla , Tibia
17.
Acta Cir Bras ; 35(2): e202000206, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32348403

RESUMEN

Purpose To present new endoscopic robotic devices in the context of minimally invasive procedures with high precision and automation. Methods Review of the literature by December 2018 on robotic endoscopy. Results We present the studies and investments for robotic implementation and flexible endoscopy evolution. We divided them into forceps manipulation platforms, active endoscopy and endoscopic capsule. They try to improve forceps handling and stability and to promote active movement. Conclusion The implementation and propagation of robotic models depend on doing what the endoscopist is unable to. The new devices are moving forward in this direction.


Asunto(s)
Endoscopía/métodos , Procedimientos Quirúrgicos Robotizados/métodos , Animales , Endoscopios/clasificación , Resección Endoscópica de la Mucosa/instrumentación , Resección Endoscópica de la Mucosa/métodos , Diseño de Equipo , Humanos , Procedimientos Quirúrgicos Mínimamente Invasivos/instrumentación , Modelos Animales , Procedimientos Quirúrgicos Robotizados/instrumentación , Cirugía Asistida por Computador/instrumentación , Instrumentos Quirúrgicos
19.
J Prosthodont ; 29(5): 409-414, 2020 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-32237001

RESUMEN

PURPOSE: Image registration of the optical intraoral scan to computed tomography image is essential for computer-guided implant surgery. The remaining teeth, which are considered to be congruent structures observed in the scan and radiographic images, are used to perform the image registration. The purpose of this study was to evaluate the effects of the distribution of matching fiducial points on the accuracy of the image registration. MATERIALS AND METHODS: A partially edentulous model with three anterior remaining teeth was prepared. Two mini dental implants were inserted in the posterior edentulous areas on both sides, and computed tomography and surface scan data were obtained. Three groups were set according to the distribution of the image matching points used: localized distribution, unilateral distribution, and bilateral distribution. Fifteen graduate students performed the registration process in each group using the same image matching method. The accuracy of image registration was evaluated by measuring the geometric discrepancies between the radiographic and registered scan images in the anterior, middle, and posterior regions. One-way and two-way analysis of variance with the Tukey HSD post hoc test were used for statistical analysis (α = 0.05) RESULTS: In general, the registration discrepancy was lowest in the bilateral distribution group, followed by the unilateral distribution and localized distribution groups (p< 0.001). In the regional analysis, the registration error tended to increase as the measurement region moved farther from the matching points. The distribution of the matching points and measurement regions had a statistical interaction in the accuracy of image registration. CONCLUSION: The accuracy of image registration of the surface scan to the computed tomography is affected by the matching point distribution that can be improved by placing artificial markers in the edentulous areas.


Asunto(s)
Implantes Dentales , Boca Edéntula , Cirugía Asistida por Computador , Marcadores Fiduciales , Humanos , Procesamiento de Imagen Asistido por Computador , Imagenología Tridimensional , Tomografía Computarizada por Rayos X
20.
Expert Rev Med Devices ; 17(6): 579-590, 2020 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-32342705

RESUMEN

INTRODUCTION: As the medical field is moving toward personalized and tailored approaches, we entered the era of precision surgery for the management of genitourinary cancers1. This is facilitated by the implementation of new technologies, among which robotic surgery stands out for the significant impact in the surgical field over the last two decades. AREAS COVERED: This article reviews the latest evidence on robotic surgery for the treatment of urologic cancers, including prostate, kidney, bladder, testis, and penile cancer. Functional and oncologic outcomes, new surgical techniques, new imaging modalities, and new robotic platforms are discussed. EXPERT OPINION: Robotic surgery had a growing role in the management of genitourinary cancers over the past 10 years. Despite a lack of high-quality evidence comparing the effectiveness of robotic to open surgery, the robotic approach allowed a larger adoption of a minimally invasive surgical approach, translating into lower surgical morbidity and shorter hospital stay. New robotic platforms might allow to explore novel surgical approaches, and new technologies might facilitate surgical navigation and intraoperative identification of anatomical structures, allowing a more tailored and precise surgery. It is an exciting time for robotic surgery, and upcoming technological advances will offer better outcomes to urologic cancer patients.


Asunto(s)
Procedimientos Quirúrgicos Robotizados/métodos , Procedimientos Quirúrgicos Robotizados/tendencias , Neoplasias Urológicas/cirugía , Humanos , Imagenología Tridimensional , Procedimientos Quirúrgicos Mínimamente Invasivos , Cirugía Asistida por Computador , Resultado del Tratamiento
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