Comparison of screw placement guided by O-arm navigation and ultrasound volume navigation in minimally invasive transforaminal lumbar interbody fusion / 中国修复重建外科杂志

OBJECTIVE@#To compare the effectiveness of O-arm navigation and ultrasound volume navigation (UVN) in guiding screw placement during minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) surgery.@*METHODS@#Sixty patients who underwent MIS-TLIF surgery for lumbar disc herniation between June 2022 and June 2023 and met the selection criteria were included in the study. They were randomly assigned to group A (screw placement guided by UVN during MIS-TLIF) or group B (screw placement guided by O-arm navigation during MIS-TLIF), with 30 cases in each group. There was no significant difference in baseline data, including gender, age, body mass index, and surgical segment, between the two groups ( P>0.05). Intraoperative data, including average single screw placement time, total radiation dose, and average single screw effective radiation dose, were recorded and calculated. Postoperatively, X-ray film and CT scans were performed at 10 days to evaluate screw placement accuracy and assess facet joint violation. Pearson correlation and Spearman correlation analyses were used to observe the relationship between the studied parameters (average single screw placement time and screw placement accuracy grading) and BMI.@*RESULTS@#The average single screw placement time in group B was significantly shorter than that in group A, and the total radiation dose of single segment and multi-segment and the average single screw effective radiation dose in group B were significantly higher than those in group A ( P<0.05). There was no significant difference in the total radiation dose between single segment and multiple segments in group B ( P>0.05), while the total radiation dose of multiple segments was significantly higher than that of single segment in group A ( P<0.05). No significant difference was found in the accuracy of screw implantation between the two groups ( P>0.05). In both groups, the grade 1 and grade 2 screws broke through the outer wall of the pedicle, and no screw broke through the inner wall of the pedicle. There was no significant difference in the rate of facet joint violation between the two groups ( P>0.05). In group A, both the average single screw placement time and screw placement accuracy grading were positively correlated with BMI ( r=0.677, P<0.001; r=0.222, P=0.012), while in group B, neither of them was correlated with BMI ( r=0.224, P=0.233; r=0.034, P=0.697).@*CONCLUSION@#UVN-guided screw placement in MIS-TLIF surgery demonstrates comparable efficiency, visualization, and accuracy to O-arm navigation, while significantly reducing radiation exposure. However, it may be influenced by factors such as obesity, which poses certain limitations.

Clinical application of percutaneous pedicle screw placement guided by ultrasound volume navigation combined with X-ray fluoroscopy: a prospective randomized controlled study / 中国修复重建外科杂志

OBJECTIVE@#To explore the feasibility and accuracy of ultrasound volume navigation (UVN) combined with X-ray fluoroscopy-guided percutaneous pedicle screw implantation through a prospective randomized controlled study.@*METHODS@#Patients with thoracic and lumbar vertebral fractures scheduled for percutaneous pedicle screw fixation between January 2022 and January 2023 were enrolled. Among them, 60 patients met the selection criteria and were included in the study. There were 28 males and 32 females, with an average age of 49.5 years (range, 29-60 years). The cause of injury included 20 cases of traffic accidents, 21 cases of falls, 17 cases of slips, and 2 cases of heavy object impact. The interval from injury to hospital admission ranged from 1 to 5 days (mean, 1.57 days). The fracture located at T 12 in 15 cases, L 1 in 20 cases, L 2 in 19 cases, and L 3 in 6 cases. The study used each patient as their own control, randomly guiding pedicle screw implantation using UVN combined with X-ray fluoroscopy on one side of the vertebral body and the adjacent segment (trial group), while the other side was implanted under X-ray fluoroscopy (control group). A total of 4 screws and 2 rods were implanted in each patient. The implantation time and fluoroscopy frequency during implantation of each screw, angle deviation and distance deviation between actual and preoperative planned trajectory by imaging examination, and the occurrence of zygapophysial joint invasion were recorded.@*RESULTS@#In terms of screw implantation time, fluoroscopy frequency, angle deviation, distance deviation, and incidence of zygapophysial joint invasion, the trial group showed superior results compared to the control group, and the differences were significant ( P<0.05).@*CONCLUSION@#UVN combined with X-ray fluoroscopy-guided percutaneous pedicle screw implantation can yreduce screw implantation time, adjust dynamically, reduce operational difficulty, and reduce radiation damage.

Real time ultrasound guided closed reduction of nasal bone fracture / 中国医学影像技术

Objective: To explore the clinical value of real-time ultrasound-guided closed reduction of nasal bone fracture. Methods: Sixty patients with clinically confirmed nasal bone fractures were randomly divided into experimental group and control group (each n=30). Both groups were treated with closed reduction of nasal bone fracture under general anesthesia. Patients in experimental group were treated with real-time ultrasound-guided closed reduction, while those in control group were treated with closed reduction of nasal bone fracture under traditional visual and palpation. After reduction, effect of reduction was evaluated with three-point method based on nasal CT scan. The second reduction rates, hospitalization time and post-operative CT scores were compared between the two groups. Results: The second reduction rate of fracture was 0 in the experimental group, whereas 13.33% (4/30) in control group (χ2=4.286, P=0.038).The hospitalization time of experimental group was 4 days, of control group was 5 days (Z=-5.024, P<0.001). The scoring of experimental group were 3 points and 2 points respectively in 19 cases and 11 cases, while of control group were 3 points in 11 cases, 2 points in 16 cases and 1 point in 3 cases. The reduction effect of experimental group was better than that of control group (χ2=6.059, P=0.048). Conclusion: Real-time ultrasound-guided closed reduction of nasal bone fracture is accurate and reliable, which can reduce the risk of second reduction of fracture and avoid X-ray radiation, also effectively shorten the hospitalization time of patients and improve the satisfaction of both doctors and patients.

Intra- and Inter-rater Reliability of Shear Wave Elastic Imaging Technique for Elastic Modulus Measurements of Muscle and Tendon / 中国康复理论与实践

@#Objective To explore the intra- and inter-rater reliability of shear wave elastography (SWE) for the patellar tendon and quadriceps femoris stiffness.Methods From October to November, 2017, the stiffness of the patellar tendon and quadriceps femoris of 20 healthy men was measured by SWE, and measured again five days later. The results were evaluated with interclass correlation coefficient (ICC).Results For patellar tendon, ICC=0.79 in intra-rater and inter-rater; for rectus femoris, ICC=0.71 in intra-rater and 0.73 in inter-rater; for vastus lateralis muscle, ICC=0.84 in intra-rater and 0.74 in inter-rater; for vastus medialis,ICC=0.95 in intra-rater and 0.94 in inter-rater.Conclusion It is a reliable and repeatable method to measure the stiffness of patellar tendon and quadriceps femoris by SWE.

Ultrasound-guided minimal invasive fixation for metacarpus and phalange fractures / 中国医学影像技术

Objective To explore value of high-frequency ultrasound-guided minimally invasive fixation treatment for metacarpus and phalange fractures.Methods Totally 26 patients of acute metacarpus and phalange fractures were selected and randomly divided into experimental group and control group (each n =13).The patients in experimental group underwent ultrasound-guided closed reduction,while in control group underwent C-arm X-ray fluoroscopy-guided reduction.Then the patients in two groups were followed up,and the curative effect of both methods were observed.Results The successful rate of closed reduction was 76.92％ (10/13) in experimental group,while was 84.62％ (11/13) in control group (x2=0,P=1.00).C-arm fluoroscopy was performed (0.62±1.19) times in experimental group,and (3.46±0.78) times in control group (t=-7.21,P＜0.01).The average healing time of fracture was (5.45±0.64) weeks in experimental group and (5.71±0.78) weeks in control group.The excellent and good rate of total active motion (TAM) was 84.62％ (11/13) in experimental group and 92.31％ (12/13) in control group,respectively.The average grip strength was (32.22±2.44) kg in experimental group,and (34.11±2.74) kg in control group (all P＞0.05).Conclusion High frequency ultrasound-guided minimally invasive fixation is reliable in treatment of metacarpal and phalangeal fractures,which can significantly reduce X-ray radiation.

Progresses of ultrasound-guided closed reduction and minimally invasive fixation of limb fractures / 中国医学影像技术

The treatment of limb fractures with closed reduction and minimally invasive fixation with C-arm or conventional X-ray guidance has been widely accepted and gradually developed due to less trauma and rapid healing.However,the radiation damage of X-ray can not be ignored.With the continuous progresses of ultrasound technology,the application of ultrasound in clinic is involved not only in the diagnosis of fractures,but also in the closed reduction and fixation of fractures.The research progresses of ultrasound-guided closed reduction and minimally invasive fixation of limb fractures were reviewed in this article.