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1.
Bone Joint J ; 102-B(3): 371-375, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32114817

RESUMO

With the identification of literature shortfalls on the techniques employed in intraoperative navigated (ION) spinal surgery, we outline a number of measures which have been synthesised into a coherent operative technique. These include positioning, dissection, management of the reference frame, the grip, the angle of attack, the drill, the template, the pedicle screw, the wire, and navigated intrathecal analgesia. Optimizing techniques to improve accuracy allow an overall reduction of the repetition of the surgical steps with its associated productivity benefits including time, cost, radiation, and safety. Cite this article: Bone Joint J 2020;102-B(3):371-375.


Assuntos
Fluoroscopia/métodos , Escoliose/cirurgia , Fusão Vertebral/métodos , Cirurgia Assistida por Computador/métodos , Tomografia Computadorizada por Raios X/métodos , Humanos , Parafusos Pediculares , Escoliose/diagnóstico
2.
Bone Joint J ; 102-B(3): 365-370, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32114820

RESUMO

AIMS: Patient-specific instrumentation has been shown to increase a surgeon's precision and accuracy in placing the glenoid component in shoulder arthroplasty. There is, however, little available information about the use of patient-specific planning (PSP) tools for this operation. It is not known how these tools alter the decision-making patterns of shoulder surgeons. The aim of this study was to investigate whether PSP, when compared with the use of plain radiographs or select static CT images, influences the understanding of glenoid pathology and surgical planning. METHODS: A case-based survey presented surgeons with a patient's history, physical examination, and, sequentially, radiographs, select static CT images, and PSP with a 3D imaging program. For each imaging modality, the surgeons were asked to identify the Walch classification of the glenoid and to propose the surgical treatment. The participating surgeons were grouped according to the annual volume of shoulder arthroplasties that they undertook, and responses were compared with the recommendations of two experts. RESULTS: A total of 59 surgeons completed the survey. For all surgeons, the use of the PSP significantly increased agreement with the experts in glenoid classification (x2 = 8.54; p = 0.014) and surgical planning (x2 = 37.91; p < 0.001). The additional information provided by the PSP also showed a significantly higher impact on surgical decision-making for surgeons who undertake fewer than ten shoulder arthroplasties annually (p = 0.017). CONCLUSIONS: The information provided by PSP has the greatest impact on the surgical decision-making of low volume surgeons (those who perform fewer than ten shoulder arthroplasties annually), and PSP brings all surgeons in to closer agreement with the recommendations of experts for glenoid classification and surgical planning. Cite this article: Bone Joint J 2020;102-B(3):365-370.


Assuntos
Artroplastia do Ombro/métodos , Tomada de Decisões , Imagem Tridimensional , Osteoartrite/cirurgia , Articulação do Ombro/cirurgia , Cirurgia Assistida por Computador/métodos , Tomografia Computadorizada por Raios X/métodos , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Osteoartrite/diagnóstico , Articulação do Ombro/diagnóstico por imagem
5.
Med Sci Monit ; 26: e922925, 2020 Mar 05.
Artigo em Inglês | MEDLINE | ID: mdl-32134048

RESUMO

BACKGROUND Anatomical reconstruction using a semitendinosus tendon autograft is one of the most widely-used techniques for chronic lateral ankle instability (CLAI), and it can result in good biomechanical recovery for patients. The purpose of this study was to investigate the outcome of a novel individualized three-dimensional printed guide template for lateral ankle ligament reconstruction compared with the traditional surgical methods. MATERIAL AND METHODS We retrospectively studied 34 patients with CLAI who required lateral ankle ligament reconstruction. Patients were randomly divided into 2 cohorts: the template group (18 patients) and the conventional group (16 patients). The average operation duration and number of radiation exposures were compared between the 2 cohorts. The displacement of anterior talar and talar tilt angle were recorded at the last follow-up, and Karlsson-Peterson score and American Orthopedic Foot and Ankle Society Score (AOFAS) were also compared. RESULTS All patients had satisfactory ankle stability at the last follow-up. The average operation duration was 51.9±3.6 min and the average number of radiation exposures was 1.34±0.6 in the template group, and the average operation duration was 72.4±12.6 min and the average number of radiation exposures was 6.58±1.7 in the conventional group. Difference between the 2 cohorts was statistically significant. However, in AOFAS (95.2±2.5 vs. 94.9±2.2; P>0.01.) and Karlsson Score (94.7±3.6 vs. 93.8±4.1; P>0.01.), no significant differences were found between the 2 cohorts. CONCLUSIONS Both the template technique and the conventional method provided satisfactory outcomes for CLAI patients. However, the shorter operation duration and low number of radiation exposures in the template cohort suggest it is the better alternative for treatment of CLAI.


Assuntos
Instabilidade Articular/cirurgia , Ligamentos Laterais do Tornozelo/cirurgia , Impressão Tridimensional , Tendões/transplante , Adolescente , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Procedimentos Cirúrgicos Reconstrutivos , Estudos Retrospectivos , Cirurgia Assistida por Computador , Transplante Autólogo , Adulto Jovem
8.
J Prosthodont ; 29(3): 272-276, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32020699

RESUMO

This technique report describes a fully digital workflow in which two surgical guides (i.e. one for alveolar bone reduction and the other for implant placement) are magnetically connected to ensure stability during full-arch implant surgery following guided bone reduction. Digital prosthesis design as well as virtual bone reduction and implant planning are developed from the superimposition of facial, intraoral and CBCT scans. With this technique, different surgical guides and interim poly(methylmethacrylate) (PMMA) fixed prosthesis are precisely connected with magnets after being digitally designed and 3D-printed. As a result, such magnetic connection allows for satisfactory stability of the implant surgical guide, as well as of the interim fixed PMMA fixed prosthesis during capture of screw-retained abutments.


Assuntos
Implantes Dentários , Cirurgia Assistida por Computador , Processo Alveolar , Projeto Auxiliado por Computador , Implantação Dentária Endo-Óssea , Prótese Dentária Fixada por Implante , Impressão Tridimensional , Fluxo de Trabalho
9.
J Biol Regul Homeost Agents ; 34(1 Suppl. 1): 79-87, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32064839

RESUMO

Replacing missing teeth in the aesthetic area is a clinical challenge which must be solved by a multidisciplinary approach in order to obtain an esthetic and functional implant-prosthetic rehabilitation. First therapeutic choice should be the less invasive option, in accordance with patients' expectations. The present clinical case presents the rehabilitation of the upper incisor group using a full-digital workflow to reduce operative time, costs and patient discomfort. The use of computer-guided-surgery and 3D technologies, as intraoral scanners or cone-beam-computed-tomography, allows the clinician to visualize all patient's information when planning the rehabilitation in order to obtain a more predictable and a less invasive surgery.


Assuntos
Tomografia Computadorizada de Feixe Cônico , Estética Dentária , Cirurgia Assistida por Computador , Fluxo de Trabalho , Humanos , Incisivo , Duração da Cirurgia
10.
J Biol Regul Homeost Agents ; 34(1 Suppl. 1): 161-164, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32064851

RESUMO

INTRODUCTION: CBCT combined to intra-oral scansion are the means to build an endodontic surgical guide to perform an easier and safer access to the apex in endodontic micro-surgery. . METHODS: A 38-year-old woman presented chronic apical periodontitis, which involved the three roots of 16 that was treated by endodontic therapy several years ago elsewhere. The palatine channel was retreated, the mesio- and disto- buccal roots were instead treated with apicoectomy. A surgical template was printed by a 3D printer to obtain greater precision in the surgical access. CONCLUSIONS: Endodontic microsurgery has evolved over the years. New tools have been introduced to improve therapy, even if the basic principles have not changed. In fact, according to the literature, it is necessary to cut at least 3 mm of root to be sure of eliminating the anatomical variations and the accessory channels. Several Authors have devoted themselves to creating an endodontic surgical template, some in vitro and others in vivo. The present paper introduces a new method that allows a more conservative osteotomy and greater precision the surgical access. Further investigation are needed to test and improve the effectiveness of the treatment but this technique seems very promising because it is less invasive for the patient and simplifies the work for the dentist who can perform micro-surgery in an easier and faster way.


Assuntos
Apicectomia , Periodontite/cirurgia , Impressão Tridimensional , Cirurgia Assistida por Computador , Adulto , Endodontia/métodos , Feminino , Humanos , Microcirurgia , Raiz Dentária
11.
Instr Course Lect ; 69: 183-208, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32017728

RESUMO

Total joint arthroplasty (TJA) is one of the most performed and successful surgeries in the United States for advanced degenerative and inflammatory arthritis with most patients reporting excellent outcomes. However, a large number of patients are still dissatisfied following TJA. To improve outcomes, new technologies such as patient-specific instrumentation and custom implants; smart implant trials; radiologic, computer, and portable accelerometer-based navigation systems; and robotics have been developed. Their overall goals are to avoid the drawbacks of conventional arthroplasty surgery, to simplify the procedures, to improve the accuracy of surgical techniques, to improve outcomes, and to decrease costs. This chapter provides an overview of the current technologies and their applications in TJA.


Assuntos
Artroplastia , Cirurgia Assistida por Computador , Humanos
12.
Instr Course Lect ; 69: 583-594, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32017753

RESUMO

The glenoid is considered a weak link in total shoulder arthroplasty because failure on the glenoid side is one of the most common reasons for revision of total shoulder arthroplasty. Glenoid wear is commonly seen in glenohumeral arthritis and compromises glenoid bone stock and also alters the native version and inclination of the glenoid. It is critical to recognize glenoid wear and correct it intraoperatively to avoid component malposition, which can negatively affect the survivorship of the glenoid implant. The end point of correction for the glenoid wear in shoulder arthroplasty is controversial, but anatomic glenoid component positioning is likely to improve long-term survivorship of the total shoulder arthroplasty. Preoperative three-dimensional (3-D) computer planning software, based on CT, is commercially available. It allows the surgeon to plan implant type (anatomic versus reverse), size, and position on the glenoid, and also allows for templating deformity correction using bone graft and/or augments. Guidance technology in the form of computer-assisted surgery (CAS) and patient-specific instrumentation (PSI) allows the surgeon to execute the preoperative plan during surgery with a greater degree of accuracy and precision and has shown superiority to standard instrumentation. However, the proposed benefits of this technology including improved glenoid survivorship, reduced revision arthroplasty rate and cost-effectiveness have not yet been demonstrated clinically. In this review, we present the current evidence regarding PSI and CAS in managing glenoid deformity in total shoulder arthroplasty.


Assuntos
Artroplastia do Ombro , Cavidade Glenoide , Articulação do Ombro , Cirurgia Assistida por Computador , Artroplastia , Humanos , Imagem Tridimensional
14.
Medicine (Baltimore) ; 99(3): e18875, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32011513

RESUMO

RATIONALE: In surgery of the lower jaw, the application of computer-assisted navigation is complicated and challenging due to the mobile nature of the mandible. In this study, we presented a computer-assisted navigation surgery for removal of the foreign body in the lower jaw with a mandible reference frame, basing on the strategy that the mandible is independent as an entity. PATIENT CONCERNS: A 41-year-old male patient, identified as having a broken fissure bur that displaced into the mandibular lingual soft tissue, was referred to our department. The fissure bur broke accidentally and then displaced into the soft tissue when the patient underwent extraction of the left mandibular impacted third molar. DIAGNOSIS: A metallic foreign body in the left lower jaw, confirmed by orthopantomography. INTERVENTIONS: A computer-assisted navigation surgery with a customized mandible reference frame. OUTCOMES: The broken bur was removed successfully. Satisfactory wound healing and mouth opening was achieved, without postoperative complications. LESSONS: Surgeons should be alert to the presence of broken bur in the lower jaw and avoid its displacement into deep facial space, and computer-assisted navigation with a mandible reference frame is recommended for removal of the foreign body in the lower jaw.


Assuntos
Corpos Estranhos/cirurgia , Mandíbula/cirurgia , Cirurgia Assistida por Computador , Adulto , Corpos Estranhos/diagnóstico por imagem , Humanos , Masculino , Mandíbula/diagnóstico por imagem , Radiografia Panorâmica
15.
Hua Xi Kou Qiang Yi Xue Za Zhi ; 38(1): 95-100, 2020 Feb 01.
Artigo em Chinês | MEDLINE | ID: mdl-32037774

RESUMO

Dental implants have become the main choice for patients to fill in their missing teeth. A precise placement is the basis for a functional and aesthetic restoration. A digital surgical guide is a carrier that transfers the preoperative plan of dental implants to the actual surgery. This paper provides some references that can help clinicians improve the accuracy of implant surgery by stating the development, classification, advantages and disadvantages, and factors that affect the accuracy of digital guides.


Assuntos
Implantes Dentários , Cirurgia Assistida por Computador , Projeto Auxiliado por Computador , Implantação Dentária Endo-Óssea , Estética Dentária , Humanos , Imagem Tridimensional , Planejamento de Assistência ao Paciente
16.
Hua Xi Kou Qiang Yi Xue Za Zhi ; 38(1): 108-113, 2020 Feb 01.
Artigo em Chinês | MEDLINE | ID: mdl-32037777

RESUMO

Identifying the ideal implantation site is important for the long-term stability and effectiveness of follow-up restorations. Implant surgical guide and navigation are used to determine the implantation site in clinic and improve the precision of implantation. However, due to difficulties in digital methods, such as multiple procedures, high cost, and actual accuracy of more than 1 mm, many physicians still prefer to operate with free hand. In preoperative, intraoperative, and postoperative procedures, time-saving and practical methods for implant site evaluation are lacking. In many cases, oral physicians found that the position deviates only by cone beam CT, which was costly to modify the position. In this article, we presented a precise implantation insertion technology that is guided by a measurable technique throughout the implantation application for all implant systems. This method was guided by a dynamic control measuring ruler, which functions together with the measuring and intraoperative locating rulers. The 3D space of the operative area was measured by a measuring ruler prior to operation, and the implant plan and quantitative guidance design were conducted according to the measured and cone beam CT data. The whole implantation process was guided by the dynamic control measuring ruler, and measuring verification results were also considered. This method can realize the quantification of the entire preoperative space analysis, intraoperative precise implantation guidance, and postoperative site measurement and evaluation. This practical technique also helps to adjust the position, improve the implantation accuracy and is suitable in generalizing dental implantation.


Assuntos
Implantes Dentários , Cirurgia Assistida por Computador , Projeto Auxiliado por Computador , Tomografia Computadorizada de Feixe Cônico , Implantação Dentária Endo-Óssea , Imagem Tridimensional , Planejamento de Assistência ao Paciente
17.
J Craniomaxillofac Surg ; 48(2): 132-140, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31955991

RESUMO

The aim of the study was to assess if there is a time difference (operative time, ischemia time, planning time and hospitalization) between computer-assisted surgery (CAS) and conventional planning in cranio-maxillofacial surgery. An electronic search was performed in June 2018. Studies comparing time difference between CAS and traditional planning were included. 28 publications were included, with 536 patients in the CAS group and 784 in the control group. 18 studies reported on mandibular/maxillary reconstruction and a meta-analysis was conducted on 15 of these studies. This meta-analysis was undertaken to demonstrate the difference between the groups regarding operative time, ischemia time and hospitalization for mandibular/maxillary reconstruction and showed a decreased operative time for the CAS group with a mean difference of -84.61 min, 95% confidence interval [-106.77, -62,45], p < 0.001. Ischemia time was also decreased, with a mean difference of -36.14 min, 95% confidence interval [-50.57, -21.71], p < 0.001. This systematic review and meta-analysis suggests that CAS is shortening the operative time and ischemia time for mandibular/maxillary reconstruction. It also leads to a reduction in hospitalization. Additionally, CAS seems to shorten the preoperative planning time for orthognathic surgery.


Assuntos
Procedimentos Cirúrgicos Reconstrutivos , Cirurgia Assistida por Computador , Humanos , Maxila
18.
Compend Contin Educ Dent ; 41(1): 26-30; quiz 31, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31895579

RESUMO

Dental implants arguably have become the preferred treatment modality for replacing missing teeth. The success of implants, however, depends on the precision of the implant placement to effectively support prosthetic restorations. With the evolution of static surgical guides, implant dentistry science has taken enormous strides toward ensuring accurate placement of dental implant fixtures, yet emerging digital protocols show the potential for dynamic real-time clinical support to the operator. Robotic-assisted dental surgery (RADS) is a novel form of dynamic surgical guidance that, in addition to visual navigation, offers haptic guidance for implant treatment planning, osteotomy preparation, and implant placement. This article discusses RADS and includes a case study that, to the authors' knowledge, is the first report of a robotic-assisted dental procedure with quantitative accuracy analysis for prosthetically driven planning and immediate placement of a single-tooth replacement.


Assuntos
Implantes Dentários , Procedimentos Cirúrgicos Robóticos , Cirurgia Assistida por Computador , Implantação Dentária Endo-Óssea , Planejamento de Assistência ao Paciente
19.
BMC Surg ; 20(1): 4, 2020 Jan 06.
Artigo em Inglês | MEDLINE | ID: mdl-31907042

RESUMO

BACKGROUND: To evaluate the efficacy of a sensitive, real-time tool for identification and protection for parathyroid glands during thyroidectomy. METHODS: Near-infrared (NIR) auto-fluorescence was measured intraoperatively from 20 patients undergoing thyroidectomy. Spectra were measured from suspicious parathyroid glands and surrounding neck tissues during the operation with a NIR fluorescence system. Fast frozen sections were performed on the suspicious parathyroid glands. Accuracy was evaluated by comparison with histology and NIR identification. Data were attracted for Fisher's linear discriminant analysis. RESULTS: The auto-fluorescence intensity of parathyroid was significantly higher than that of thyroid, fat and lymph node. The peak intensity of auto-fluorescence from parathyroid was 5.55 times of that from thyroid at the corresponding wave number. Of the 20 patients, the parathyroid was accurately detected and identified in 19 patients by NIR system, compared with their histologic results. One suspicious parathyroid did not exhibit typical spectra, and was proved to be fat tissue by histology. The NIR auto-fluorescence method had a 100% sensitivity of parathyroid glands identification and a high accuracy of 95%. The positive predictive value was 95%. The parathyroid gland have specific auto-fluorescence spectrum and can be separated from the other three samples through the Fisher's linear discriminant analysis. CONCLUSIONS: NIR auto-fluorescence spectroscopy can accurately identify normal parathyroid gland during thyroidectomy. The Fisher's linear discriminant analysis demonstrated the specificity of the NIR auto-fluorescence of parathyroid tissue and its efficacy in parathyroid discrimination.


Assuntos
Glândulas Paratireoides/diagnóstico por imagem , Espectrometria de Fluorescência/métodos , Espectroscopia de Luz Próxima ao Infravermelho/métodos , Cirurgia Assistida por Computador/métodos , Glândula Tireoide/cirurgia , Neoplasias da Glândula Tireoide/cirurgia , Tireoidectomia/métodos , Adulto , Idoso , Análise Discriminante , Feminino , Humanos , Período Intraoperatório , Masculino , Pessoa de Meia-Idade , Curva ROC , Neoplasias da Glândula Tireoide/diagnóstico
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