Phantom study of a fully automatic radioactive seed placement robot for the treatment of skull base tumours.

BACKGROUND: Interstitial brachytherapy is a form of intensive local irradiation that facilitates the effective protection of surrounding structures and the preservation of organ functions, resulting in a favourable therapeutic response. As surgical robots can perform needle placement with a high level of accuracy, our team developed a fully automatic radioactive seed placement robot, and this study aimed to evaluate the accuracy and feasibility of fully automatic radioactive seed placement for the treatment of tumours in the skull base. METHODS: A fully automatic radioactive seed placement robot was established, and 4 phantoms of skull base tumours were built for experimental validation. All the phantoms were subjected to computed tomography (CT) scans. Then, the CT data were imported into the Remebot software to design the preoperative seed placement plan. After the phantoms were fixed in place, navigation registration of the Remebot was carried out, and the automatic seed placement device was controlled to complete the needle insertion and particle placement operations. After all of the seeds were implanted in the 4 phantoms, postoperative image scanning was performed, and the results were verified via image fusion. RESULTS: A total of 120 seeds were implanted in 4 phantoms. The average error of seed placement was (2.51 ± 1.44) mm. CONCLUSION: This study presents an innovative, fully automated radioactive particle implantation system utilizing the Remebot device, which can successfully complete automated localization, needle insertion, and radioactive particle implantation procedures for skull base tumours. The phantom experiments showed the robotic system to be reliable, stable, efficient and safe. However, further research on the needle-soft tissue interaction and deformation mechanism of needle puncture is still needed.

Research progress on valgus impacted proximal humeral fractures / 中国修复重建外科杂志

OBJECTIVE@#To review the advancement made in the understanding of valgus impacted proximal humeral fracture (PHF).@*METHODS@#The domestic and foreign literature about the valgus impacted PHF was extensively reviewed and the definition, classification, pathological features, and treatment of valgus impacted PHFs were summarized.@*RESULTS@#PHF with a neck shaft angle ≥160° is recognized as a valgus impacted PHF characterized by the preservation of the medial epiphyseal region of the humeral head, which contributes to maintenance of the medial periosteum's integrity after fracture and reduces the occurrence of avascular necrosis. Therefore, the valgus impacted PHF has a better prognosis when compared to other complex PHFs. The Neer classification designates it as a three- or four-part fracture, while the AO/Association for the Study of Internal Fixation (AO/ASIF) categorizes it as type C (C1.1). In the management of the valgus impacted PHF, the selection between conservative and surgical approaches is contingent upon the patient's age and the extent of fracture displacement. While conservative treatment offers the advantage of being non-invasive, it is accompanied by limitations such as the inability to achieve anatomical reduction and the potential for multiple complications. Surgical treatment includes open reduction combined with steel wire or locking plate and/or non-absorbable suture, transosseous suture technology, and shoulder replacement. Surgeons must adopt personalized treatment strategies for each patient with a valgus impacted PHF. Minimally invasive surgery helps to preserve blood supply to the humeral head, mitigate the likelihood of avascular necrosis, and reduce postoperative complications of bone and soft tissue. For elderly patients with severe comminuted and displaced fractures, osteoporosis, and unsuitable internal fixation, shoulder joint replacement is the best treatment option.@*CONCLUSION@#Currently, there has been some advancement in the classification, vascular supply, and management of valgus impacted PHF. Nevertheless, further research is imperative to assess the clinical safety, biomechanical stability, and indication of minimally invasive technology.

Progress in research into the wedge effect during cephalomedullary nailing for intertrochanteric fractures / 中华创伤骨科杂志

Surgical intervention is the first choice treatment for intertrochanteric fractures that are common in clinical practice. Cephalomedullary nailing with two parts inserted respectively into the femoral medullary cavity and femoral head has been the mainstream protocols for the elderly patients with intertrochanteric fracture, but insertion of the cephalomedullary nail may likely lead to the outward displacement of the femoral shaft and the inversion and rotation of the head and neck bone mass, namely the so-called wedge effect. However, few reports have dealt with how to prevent the wedge effect and reduce the complications it may cause such as coxa vara deformity. The present review expounds and analyzes the concept, biomechanical mechanism, influencing factors, measurements, and prevention methods of the wedge effect, hoping to help the surgeons who try to avoid the wedge effect in surgical treatment.

Research progress in judgment criteria for reduction of femoral intertrochanteric fractures / 中华创伤骨科杂志

With accelerated aging process of the population, femoral intertrochanteric fractures have gradually become another major social health problem in China. Internal fixation is still the gold standard treatment for the fractures. Fracture reduction is the first step of the treatment and also the first element that affects the treatment efficacy. It is still controversial in clinical practice how to evaluate the quality of fracture reduction during internal fixation of the fractures. This article systematically expounds and analyzes the 7 systems of judging criteria for the reduction of intertrochanteric fractures from the aspects of fracture alignment, fracture apposition, difference in judgment criteria, and difference in imaging methods, in order to provide a reference for reaching consensus and improving curative effects.

The effect of bone morphogenetic protein-2 and osteoprotegerin in trans-sutural distraction osteogenesis / 华西口腔医学杂志

<p><b>OBJECTIVE</b>To determine if locally administered bone morphogenetic protein-2 (BMP-2) and osteoprotegerin (OPG) improved osteogenesis and new bone formation by trans-sutural distraction osteogenesis.</p><p><b>METHODS</b>Twenty four dogs were divided into three groups randomly and received new internal trans-sutural distraction osteogenesis treatment. Five days after operation, infusion apparatus with double-tube was inserted to submucosa near the distracted zone to deliver controlled release agent of recombinant human bone morphogenetic protein-2/poly (lactic-co-glycolic acid)/fibrin sealant (rhBMP-2/PLGA/FS) in group A and group C. Recombinant human osteoprotegerin/fibrin sealant (rhOPG/ FS) was injected three weeks later in group B and group C. Histology staining and bone histomorphometry were used to measure the changes of maxillary bone sutura after distraction for 1, 2, 4 and 6 weeks.</p><p><b>RESULTS</b>New bone formation observed in distracted zone showed a significant increase in group A and C. Transmission electron microscope showed the osteoblast and osteocyte were active with dilated rough endoplasmic reticulum and a large number of chondriosomes and Golgi complex. After distraction for 6 weeks, indexes of osteoblast of group A, B, and C were 38.5 +/- 7.7, 35.7 +/- 6.5, and 41.7 +/- 11.0, indexes of osteoclast (Ioc) were 5.9 +/- 1.0, 1.2 +/- 0.3, and 2.8 +/- 0.4, bone trabecula thicknesses were (38.36 +/- 13.28), (66.20 +/- 9.16), and (51.85 +/- 9.92) microm respectively. Increased bone density and decreased Ioc were found in group B and C.</p><p><b>CONCLUSION</b>The new elastic distractor is effective in inducing new bone formation. BMP-2 and OPG combination acts synergistically, and leads to significant enhancement of bone formation and remodeling.</p>

Relationship between malunion of distal radius fracture and functional recovery / 中国矫形外科杂志

Malunion is one of common complications after distal radius fractures.It is indicated that malunion plays an important role in fracture recovery in many studies.This article sums up the research data,from aspects of both biomechanical analysis and follows-up of clinical cases,of domestic and foreign scholars in recent years,and reviews the influences of malunion on wrist joint functional outcome.

Level of serum soluble CD44v6 in patients with oral and maxillofacial malignancy / 实用口腔医学杂志

0.05). Serum sCD44v6 levels in patients with OSCC decreased after treatment (P