Creation of a microsurgical neuroanatomy laboratory and virtual operating room: a preliminary study.

OBJECTIVE: A comprehensive understanding of microsurgical neuroanatomy, familiarity with the operating room environment, patient positioning in relation to the surgery, and knowledge of surgical approaches is crucial in neurosurgical education. However, challenges such as limited patient exposure, heightened patient safety concerns, a decreased availability of surgical cases during training, and difficulties in accessing cadavers and laboratories have adversely impacted this education. Three-dimensional (3D) models and augmented reality (AR) applications can be utilized to depict the cortical and white matter anatomy of the brain, create virtual models of patient surgical positions, and simulate the operating room and neuroanatomy laboratory environment. Herein, the authors, who used a single application, aimed to demonstrate the creation of 3D models of anatomical cadaver dissections, surgical approaches, patient surgical positions, and operating room and laboratory designs as alternative educational materials for neurosurgical training. METHODS: A 3D modeling application (Scaniverse) was employed to generate 3D models of cadaveric brain specimens and surgical approaches using photogrammetry. It was also used to create virtual representations of the operating room and laboratory environment, as well as the surgical positions of patients, by utilizing light detection and ranging (LiDAR) sensor technology for accurate spatial mapping. These virtual models were then presented in AR for educational purposes. RESULTS: Virtual representations in three dimensions were created to depict cadaver specimens, surgical approaches, patient surgical positions, and the operating room and laboratory environment. These models offer the flexibility of rotation and movement in various planes for improved visualization and understanding. The operating room and laboratory environment were rendered in three dimensions to create a simulation that could be navigated using AR and mixed reality technology. Realistic cadaveric models with intricate details were showcased on internet-based platforms and AR platforms for enhanced visualization and learning. CONCLUSIONS: The utilization of this cost-effective, straightforward, and readily available approach to generate 3D models has the potential to enhance neuroanatomical and neurosurgical education. These digital models can be easily stored and shared via the internet, making them accessible to neurosurgeons worldwide for educational purposes.

Processed electroencephalography: impact of patient age and surgical position on intraoperative processed electroencephalogram monitoring of burst-suppression.

We previously reported that processed EEG underestimated the amount of burst suppression compared to off-line visual analysis. We performed a follow-up study to evaluate the reasons for the discordance. Forty-five patients were monitored intraoperatively with processed EEG. A computer algorithm was used to convert the SedLine® (machine)-generated burst suppression ratio into a raw duration of burst suppression. The reference standard was a precise off-line measurement by two neurologists. We measured other potential variables that may affect machine accuracy such as age, surgery position, and EEG artifacts. Overall, the median duration of bust suppression for all study subjects was 15.4 min (Inter-quartile Range [IQR] = 1.0-20.1) for the machine vs. 16.1 min (IQR = 0.3-19.7) for the neurologists' assessment; the 95% limits of agreement fall within - 4.86 to 5.04 s for individual 30-s epochs. EEG artifacts did not affect the concordance between the two methods. For patients in prone surgical position, the machine estimates had significantly lower overall sensitivity (0.86 vs. 0.97; p = 0.038) and significantly wider limits of agreement ([- 4.24, 3.82] seconds vs. [- 1.36, 1.13] seconds, p = 0.001) than patients in supine position. Machine readings for younger patients (age < 65 years) had higher sensitivity (0.96 vs 0.92; p = 0.021) and specificity (0.99 vs 0.88; p = 0.007) for older patients. The duration of burst suppression estimated by the machine generally had good agreement compared with neurologists' estimation using a more precise off-line measurement. Factors that affected the concordance included patient age and position during surgery, but not EEG artifacts.

Lateral position: a friendly surgical position for intramedullary nailing of tibial shaft fractures via infrapatellar approach.

BACKGROUND: The conventional infrapatellar approach to intramedullary nailing of tibial fractures adopts the supine high-flexion knee position. However, this has disadvantages including difficulty in obtaining the proximal tibial anteroposterior view during intraoperative fluoroscopy, prolonged duration of fluoroscopy. Accordingly, the present study investigated the utility of the lateral position in the infrapatellar approach to intramedullary nailing of tibial shaft fractures. METHODS: The present study was a retrospective analysis of 112 patients who sustained closed tibial shaft fractures and treated with intramedullary nailing via the infrapatellar approach. Patients were divided into two groups according to surgical position: lateral or supine. The demographic and clinical data were collected and analyzed. RESULTS: There were 54 patients in the lateral and 58 in the supine position groups. The duration of surgery and fluoroscopy was shorter in the lateral group than the supine group (p < 0.05). Blood loss during surgery was lower in the lateral compared with supine position group (p < 0.05). The malunion rate was lower in the lateral position group as compared with the supine position group (p < 0.05); moreover, fewer surgical assistants were needed than in the supine group (p < 0.05). There were no significant differences in fracture healing time, other complications between the two groups (p > 0.05). CONCLUSIONS: The lateral position was a more convenient choice for intramedullary nailing of tibial shaft fractures via infrapatellar approach.

Application of a Self-Made Equipment for Patient Positioning during Percutaneous Nephroscopy in the Oblique-Supine Position.

BACKGROUND: The oblique-supine position for percutaneous nephrolithotomy (PCNL) has advantages, but the position fixation methods are inadequate. This study aimed to analyze the PCNL outcomes using a patented self-made frame for oblique-supine position. METHODS: This was a prospective study of patients scheduled to undergo PCNL at 2 hospitals in China between November 2009 and December 2016. The patients underwent PCNL in the oblique-supine position using the self-made position frame (n = 94). Operative time, stone clearance rate, intraoperative average systolic pressure, intraoperative average heart rate, intraoperative average airway pressure, intraoperative average intrapelvic pressure, and complications were observed. RESULTS: The patients were 45.3 ± 19.7 years old and 71% were male. Stones were of the size 2.5 ± 1.1 cm. The operative time was 95.6 min and the stone clearance rate was 81.9%. Intraoperative systolic blood pressure was 15.13 ± 1.68 kPa. Intraoperative airway pressure was 15.5 ± 2.3 cm H2O. Postoperative fever was observed in 3.2% of the patients. None had organ injury. Postoperative stay was 4.8 ± 0.6 days. The nephrostomy tube was routinely removed on the 5th day after surgery and the patients were discharged on the following day. CONCLUSION: The self-made surgical position frame met the position requirements for the oblique-supine PCNL operation. This surgical position frame deserves clinical application and promotion.

Predictive detection areas for identifying additional MRI-detected breast lesions on second-look ultrasonography.

PURPOSE: Identifying an additional MRI-detected breast lesion on second-look ultrasonography (US) is technically challenging because of lesion displacement with the patient's position change. The aim of this study is to help identify MRI-detected lesions on second-look US by developing a probing area, called "the predictive detection area" (PDA), and by assessing the PDA. METHODS: We measured the nipple-to-lesion distances (NLDs) for 16 breast lesions on prone- and supine-position MRI sets and calculated the difference and angle between the two NLD vectors, representing the lesion displacement. The minimum and maximum differences and angles were chosen to form the PDA. Another 22 breast lesions, detected in the prone MRI, were identified on US by probing the PDA to evaluate the probability of existence. RESULTS: The width between the minimum and maximum differences in two NLDs and the angle to form the PDA for the upper-inner, upper-outer, and lower-outer quadrants were 23.0 mm and 95.0°, 29.0 mm and 41.0°, and 18.0 mm and 17.0°, respectively. The respective probabilities of existence were 100, 80, and 100%. CONCLUSIONS: The PDA had a high probability of existence and was acceptably accurate; therefore, the PDA in a second-look US has the potential to help operators to quickly identify additional MRI-detected lesions.

Effect of different surgical positions on the cerebral venous drainage: a pilot study using healthy volunteers.

Excessive neck flexion and rotation in certain surgical positions may cause kinking of the internal jugular vein that obstructs cerebral venous blood flow and results in elevated intracranial pressure. The objective of this study was to measure internal jugular vein flow and identify potential impediments to venous flow in supine, prone, and park bench positions using non-anaesthetised volunteers. Twenty-seven volunteers were recruited. Venous flow rate was derived from ultrasound measurements of the vessel cross-sectional area and flow velocity. Change from supine to prone position produced a significant increase in both jugular vein cross-sectional areas without affecting venous flows. In the right park bench position, the right internal jugular vein cross-sectional area decreased from 1.2 to 0.9 cm(2) (p = 0.027) without substantive changes in mean venous flow rate (p = 0.91) when compared with supine. In summary, the internal jugular vein flow was not compromised by either prone or park bench positions in non-anaesthetised volunteers, and careful positioning may prevent kinking of the jugular vein. Further studies in anaesthetised and ventilated patients are needed to validate these results for clinical practice.

The Accuracy of a Mechanical Cup Alignment Guide in Total Hip Arthroplasty (THA) Through Direct Anterior and Posterior Approaches Measured with CT-Based Navigation.

The purpose of this study was to compare the accuracy of a mechanical cup alignment guide using CT-based navigation between a direct anterior approach (DAA) in both supine and lateral positions and a posterior approach (PA) in the lateral position. A trial cup was placed with a mechanical guide that aimed at 47° of radiographic inclination and 14° of anteversion. The average cup inclination and anteversion were measured using CT-based navigation. The average radiographic anteversion in the DAA supine and lateral group was larger, and that in the PA group was smaller than the target angle. In conclusion, there are no differences in the accuracy or precision of cup angles among the DAA supine, DAA lateral position, and PA groups using a mechanical guide.

Intrarenal pressure detection during flexible ureteroscopy with fiber optic pressure sensor system in porcine model.

To validate the feasibility of a fiber-optic pressure sensor-based pressure measurement device for monitoring intrarenal pressure and to analyze the effects of ureteral acess sheath (UAS) type, surgical location, perfusion flow rate, and measurement location on intrarenal pressure (IRP). The measurement deviations and response times to transient pressure changes were compared between a fiber-optic pressure sensing device and a urodynamic device IRP in an in vitro porcine kidney and in a water tank. Finally, pressure measurements were performed in anesthetized female pigs using fiber-optic pressure sensing device with different UAS, different perfusion flow rates, and different surgical positions at different renal calyces and ureteropelvic junctions (UPJ). According to our operation, the result is fiber optic pressure sensing devices are highly accurate and sensitive. Under the same conditions, IRP varied among different renal calyces and UPJ (P < 0.05). IRP was lowest at 50 ml/min and highest at 150 ml/min (P < 0.05). Surgical position had a significant effect on IRP (P < 0.05). 12/14 Fr UAS had a lower IRP than 11/13 Fr UAS. Therefore fiber optic pressure sensing devices are more advantageous for IRP measurements. In ureteroscopy, the type of ureteral sheath, the surgical position, the perfusion flow rate, and the location of the measurement all affect the intrarenal pressure value.

Correlation between surgical position and neck pain in patients undergoing thyroidectomy: a prospective observational study.

BACKGROUND: Thyroid diseases are one of the most common health problems worldwide. Although they represent a necessary step in order to perform thyroidectomy, hyperextension of the neck can potentially increase postoperative pain. The aim of this study is to determine a correlation between the degree of neck hyperextension on the operative table and the postoperative pain in patients undergoing open thyroidectomy. METHODS: Patients were prospectively enrolled from the cohort of patients operated at the Endocrine Surgery Unit of the University Hospital of Pisa, between May and July 2021. Both of patients who underwent total thyroidectomy or hemi-thyroidectomy were recruited. The following data were analysed in order to find a correlation with postoperative pain at 24 h: age, gender, type of surgery, BMI, operative time, and degree of neck extension. RESULTS: Overall, 195 patients were enrolled. A direct, statistically significant correlation emerged between the degree of neck hyperextension and the postoperative pain 24 h after surgery, regardless of the pain of the surgical wound (p < 0.001; beta 0.270). CONCLUSIONS: A direct correlation emerges between neck tilt angle and postoperative neck pain. Moreover, total thyroidectomy (TT) predisposes more to postoperative neck pain, considering the type of surgery.

Effect of Neck Rotation With Flexion on Ultrasonographic Optic Nerve Sheath Diameter in Patients Undergoing Elective Craniotomy.

Background Extreme neck positioning to facilitate craniotomy can result in impaired venous drainage from the brain and a subsequent rise in increased intracranial pressure (ICP). The effects of varied neck positioning intraoperatively on ultrasonographic optic nerve sheath diameter (USG-ONSD) are still unexplored. This study aims to quantify the angle of neck rotation and flexion that can cause a significant increase in USG-ONSD in patients undergoing elective craniotomy. Methods A total of 100 patients were recruited in this non-randomized study and equally divided into two groups. In one group, patients with neck rotation ≤30 degrees and in another group, patients with neck rotation >30 degrees with varying degrees of neck flexion were included. The average of three USG-ONSD measurements in both eyes was obtained and compared in both groups at baseline, after positioning, and at the end of the surgery after making the neck neutral. Results The results of 100 recruited patients were analyzed. All the patients had neck flexion in the range of 40° to 45°, whereas the neck rotation ranged from 10° to 45°. The USG-ONSD of both eyes changed significantly from baseline to post-positioning time point in patients with neck rotation >30° (right eye p=0.038, left eye p=0.04) when compared to neck rotation ≤30°. There was no significant change in USG-ONSD from baseline to the postoperative time point after making the neck neutral (right eye p=0.245, left eye p=0.850) in both groups. Conclusions This study demonstrates that USG-ONSD, a surrogate measure of ICP, increased significantly after neck flexion with rotation >30° in neurosurgical patients. However, USG-ONSD becomes comparable to baseline after putting the patient's neck in a neutral position after surgery.

[Back-forward bending CT in simulated surgical position to evaluate the remaining real angle and flexibility of thoracolumbar kyphosis secondary to old osteoporotic vertebral compression fracture].

Objective: To introduce a scout view scanning technique of back-forward bending CT (BFB-CT) in simulated surgical position for evaluating the remaining real angle and flexibility of thoracolumbar kyphosis secondary to old osteoporotic vertebral compression fracture. Methods: A total of 28 patients with thoracolumbar kyphosis secondary to old osteoporotic vertebral compression fracture who met the selection criteria between June 2018 and December 2021 were included in the study. There were 6 males and 22 females with an average age of 69.5 years (range, 56-92 years). The injured vertebra were located at T 10-L 2, including 11 cases of single thoracic fracture, 11 cases of single lumbar fracture, and 6 cases of multiple thoracolumbar fractures. The disease duration ranged from 3 weeks to 36 months, with a median of 5 months. All patients received examinations of BFB-CT and standing lateral full-spine X-ray (SLFSX). The thoracic kyphosis (TK), thoracolumbar kyphosis (TLK), local kyphosis of injured vertebra (LKIV), lumbar lordosis (LL), and the sagittal vertical axis (SVA) were measured. Referring to the calculation method of scoliosis flexibility, the kyphosis flexibility of thoracic, thoracolumbar, and injured vertebra were calculated respectively. The sagittal parameters measured by the two methods were compared, and the correlation of the parameters measured by the two methods was analyzed by Pearson correlation. Results: Except LL ( P>0.05), TK, TLK, LKIV, and SVA measured by BFB-CT were significantly lower than those measured by SLFSX ( P<0.05). The flexibilities of thoracic, thoracolumbar, and injured vertebra were 34.1%±18.8%, 36.2%±13.8%, and 39.3%±18.6%, respectively. Correlation analysis showed that the sagittal parameters measured by the two methods were positively correlated ( P<0.001), and the correlation coefficients of TK, TLK, LKIV, and SVA were 0.900, 0.730, 0.700, and 0.680, respectively. Conclusion: Thoracolumbar kyphosis secondary to old osteoporotic vertebral compression fracture shows an excellent flexibility and BFB-CT in simulated surgical position can obtain the remaining real angle which need to be corrected surgically.

Surgical Position of Lateral-Tilted Supine is Suitable for Proximal Humeral Fracture Operations in Geriatric Patients.

Objective: To report a new surgical position of lateral-tilted supine (LTS) for geriatric proximal humeral fracture operations. Methods: Between January 2016 and December 2020, we adopted the LTS position for operations in 65 geriatric patients with proximal humeral fractures. Results: Sixty-five patients including 25 males and 40 females aged 80.3 ± 8.5 years. The LTS position could be used for almost all proximal humeral fracture surgeries, such as ORIF with plate, suture anchor, and other fixation in 4 patients, open reduction and internal fixation (ORIF) with multiLoc nailing in 48, and shoulder hemiarthroplasty (SHA) in 13. Surgical position setting times were 11.47 ± 2.14 min. The systolic blood pressure changes before and after positioning were 15.07 ± 8.72 mmHg. All of the C-arm X-ray directions, including the cephalic side, contralateral side, and ipsilateral side, can be used in the LTS position surgeries. No surgical complications or no surgical position-related complications were found in these 65 cases. Conclusion: The surgical position of LTS is suitable for geriatric proximal humeral fracture operations.

The effects of different surgical positions (semi-sitting and lateral position) on the surgical outcomes of large vestibular schwannoma: study protocol for a randomized controlled trial.

BACKGROUND: There is an ongoing discussion about the advantages and disadvantages of different surgical positions (semi-sitting and lateral position) for vestibular schwannoma surgery. Each position has its advantages, disadvantages, challenges, and risk profiles. The objectives of this study are to compare the effects of different surgical positions (semi-sitting and lateral position) on the outcomes of large vestibular schwannoma, primarily including effectiveness and safety. METHODS: In this single-centre, open, randomized controlled trial, we will recruit a total of 116 participants according to the inclusion and exclusion criteria who will be randomized to an experimental group or control group. Patients will undergo operations in semi-sitting and lateral positions. The primary endpoint will be the percentage of gross total resection. The secondary endpoints will include the facial nerve function, hearing preservation, surgical position placement time, time of operation (skin-to-skin surgical time), hospital stay, total hospitalization fee, and complications. The follow-up period will be at least 12 months, during which time patients will be evaluated both clinically and radiologically. DISCUSSION: This issue is still debated after 30 years since the first large comparative study was published in 1989, so the study will be useful. Therefore, more high-quality studies are required to compare clinical outcomes, complications, and other factors associated with these two positions. TRIAL REGISTRATION: Chinese Clinical Trial Registry ChiCTR1900027550 . Registered on 17 November 2019.

A novel view of computed tomography images similar to the visual field of otologic surgeons.

OBJECTIVES: In preparation for endoscopic sinus surgery (ESS), the most important computed tomography (CT) image for otolaryngologists is the coronal plane image because it has a viewpoint similar to that of the surgical visual field. Contrastingly, otologic surgeons refer to axial and coronal plane images before ear surgery and must imagine the anatomical structure of the temporal bone by reconstructing three-dimensional (3D) images in their minds. We propose a "surgical position view (SPV) image," a novel viewpoint of CT images that enables otologic surgeons to see a perspective similar to the surgical visual field. METHOD: Sagittal plane CT images of the temporal bone were created from axial plane images with multi-planar reconstruction (MPR). Then, the SPV image was obtained by rotating it 90° to the supine position. The entire process can be performed anywhere in the hospital within 1 minute using the electronic medical record computer's image viewer. RESULTS: SPV images show anatomical structures of the temporal bone, external ear canal, mastoid cavity, sigmoid vein, facial nerve, ossicles, and cochlea, in a similar view to the actual ear surgery. Soft tissue such as cholesteatoma is depicted in the same concentration as the normal CT image. CONCLUSION: The SPV image enables an otologic surgeon to see the temporal bone CT image from the actual ear surgery viewpoint simply and quickly. It helps to visualize the 3D anatomical structure of the temporal bone and can be useful for ear surgery planning. LEVEL OF EVIDENCE: 5.

Initial multi-centre clinical experience with prone transpsoas lateral interbody fusion: Feasibility, perioperative outcomes, and lessons learned.

BACKGROUND: Lateral interbody fusion (LIF) is traditionally performed with the patient in lateral decubitus, requiring repositioning to prone for adjunctive posterior procedures, or modifying traditional posterior techniques to be done while positioned lateral. The benefits of lateral anterior column access may be achievable with the patient prone, allowing for concomitant posterior techniques in a more familiar single-position setting. METHODS: Prone transpsoas (PTP) access was outlined and vetted by a group of LIF-experienced spine surgeons. Early clinical experience included prospectively capturing procedural details and perioperative outcomes across a multi-centre cohort of clinicians to assess feasibility and to identify efficiencies and/or challenges. RESULTS: Perioperative data was prospectively collected from 120 consecutive cases (176 levels) from 22 surgeons. Lateral exposure was achieved in an average 18 min/level, guided by triggered EMG; and retraction time averaged 25 min/level, with continued plexus monitoring via saphenous SSEP. Fixation was via percutaneous pedicle screws (65%), open pedicle screws (24%), other (11%). No re-positioning was required. Concomitant procedures facilitated by prone position included direct decompression (37%), treatment at L5-S1 (18%), posterior instrumentation revision (7%), and osteotomy/bony releases (9%). PTP procedure time, blood loss, and length of stay were consistent with established LIF experience. Challenges included patient movement with lateral instrument forces, retractor sag, stability of access relative to the patient, and surgeon ergonomics of the working channel. These challenges were overcome later in the experience through development of a specialized positioner and retractor system specific to this approach and a prescribed workflow developed by consensus of the surgeons. CONCLUSION: Initial multi-centre clinical experience suggests that PTP is not only feasible but creates efficiencies by allowing for single-position surgery maximizing both anterior and posterior column access and corrective techniques, with perioperative outcomes consistent with lateral decubitus experience. Learnings included the need for development of procedure-specific technologies and technique refinement.

Application of a modified surgical position in anterior approach for total cervical artificial disc replacement.

BACKGROUND: Total cervical artificial disc replacement (TDR) has been considered a safe and effective alternative surgical treatment for cervical spondylosis and degenerative disc disease that have failed to improve with conservative methods. Positioning the surgical patient is a critical part of the procedure. Appropriate patient positioning is crucial not only for the safety of the patient but also for optimizing surgical exposure, ensuring adequate and safe anesthesia, and allowing the surgeon to operate comfortably during lengthy procedures. The surgical posture is the traditional position used in anterior cervical approach; in general, patients are in a supine position with a pad under their shoulders and a ring-shaped pillow under their head. AIM: To investigate the clinical outcomes of the use of a modified surgical position versus the traditional surgical position in anterior approach for TDR. METHODS: In the modified position group, the patients had a soft pillow under their neck, and their jaw and both shoulders were fixed with wide tape. The analyzed data included intraoperative blood loss, position setting time, total operation time, and perioperative blood pressure and heart rate. RESULTS: Blood pressure and heart rate were not significantly different before and after body positioning in both groups (P > 0.05). Compared with the traditional position group, the modified position group showed a statistically significantly longer position setting time (P < 0.05). However, the total operation time and intraoperative blood loss were significantly reduced in the modified position group compared with the traditional position group (P < 0.05). CONCLUSION: The clinical outcomes indicated that total operation time and intraoperative blood loss were relatively lower in the modified position group than in the traditional position group, thus reducing the risks of surgery while increasing the position setting time. The modified surgical position is a safe and effective method to be used in anterior approach for TDR surgery.

Back-forward bending CT in simulated surgical position to evaluate the remaining real angle and flexibility of thoracolumbar kyphosis secondary to old osteoporotic vertebral compression fracture / 中国修复重建外科杂志

OBJECTIVE@#To introduce a scout view scanning technique of back-forward bending CT (BFB-CT) in simulated surgical position for evaluating the remaining real angle and flexibility of thoracolumbar kyphosis secondary to old osteoporotic vertebral compression fracture.@*METHODS@#A total of 28 patients with thoracolumbar kyphosis secondary to old osteoporotic vertebral compression fracture who met the selection criteria between June 2018 and December 2021 were included in the study. There were 6 males and 22 females with an average age of 69.5 years (range, 56-92 years). The injured vertebra were located at T 10-L 2, including 11 cases of single thoracic fracture, 11 cases of single lumbar fracture, and 6 cases of multiple thoracolumbar fractures. The disease duration ranged from 3 weeks to 36 months, with a median of 5 months. All patients received examinations of BFB-CT and standing lateral full-spine X-ray (SLFSX). The thoracic kyphosis (TK), thoracolumbar kyphosis (TLK), local kyphosis of injured vertebra (LKIV), lumbar lordosis (LL), and the sagittal vertical axis (SVA) were measured. Referring to the calculation method of scoliosis flexibility, the kyphosis flexibility of thoracic, thoracolumbar, and injured vertebra were calculated respectively. The sagittal parameters measured by the two methods were compared, and the correlation of the parameters measured by the two methods was analyzed by Pearson correlation.@*RESULTS@#Except LL ( P>0.05), TK, TLK, LKIV, and SVA measured by BFB-CT were significantly lower than those measured by SLFSX ( P<0.05). The flexibilities of thoracic, thoracolumbar, and injured vertebra were 34.1%±18.8%, 36.2%±13.8%, and 39.3%±18.6%, respectively. Correlation analysis showed that the sagittal parameters measured by the two methods were positively correlated ( P<0.001), and the correlation coefficients of TK, TLK, LKIV, and SVA were 0.900, 0.730, 0.700, and 0.680, respectively.@*CONCLUSION@#Thoracolumbar kyphosis secondary to old osteoporotic vertebral compression fracture shows an excellent flexibility and BFB-CT in simulated surgical position can obtain the remaining real angle which need to be corrected surgically.

Preoperative practice of surgical position reduces postoperative pain and discomfort in patients receiving kidney surgeries: a nonrandomized pilot study.

OBJECTIVE: Prolonged maintenance of surgical position often results in postoperative pain and discomfort in patients. The present study aimed to investigate the effect of preoperative practice of surgical position on postoperative pain and general comfort in patients receiving kidney surgeries. METHODS: For this nonrandomized pilot study, 74 patients receiving kidney surgeries were selected using the probability sampling method. Patients from ward 1 were assigned to the practice group (n=35), and those from ward 2 were assigned to the control group (n=39). The practice group were instructed to practice the surgical position for 3 days prior to the surgery. Postoperative pain and comfort were surveyed using two questionnaires for 3 days, respectively. The postoperative pain scores were compared using the Student's t-test. RESULTS: The two groups did not differ significantly in wound pain on postoperative days 1-3 (P > 0.05). However, the practice group showed significantly reduced low back pain and contralateral shoulder pain than the control group for 3 postoperative days (P < 0.05). The physical domain score was significantly higher in the practice group than in the control group (P < 0.01). CONCLUSION: Preoperative practice of surgical position can effectively reduce postoperative low back pain and contralateral shoulder pain in patients receiving kidney surgeries and improve the physical comfort.

Dynamic virtual simulation of the occurrence and severity of edge loading in hip replacements associated with variation in the rotational and translational surgical position.

Variation in the surgical positioning of total hip replacement can result in edge loading of the femoral head on the rim of the acetabular cup. Previous work has reported the effect of edge loading on the wear of hip replacement bearings with a fixed level of dynamic biomechanical hip separation. Variations in both rotational and translational surgical positioning of the hip joint replacement combine to influence both the biomechanics and the tribology including the severity of edge loading, the amount of dynamic separation, the force acting on the rim of the cup and the resultant wear and torque acting on the cup. In this study, a virtual model of a hip joint simulator has been developed to predict the effect of variations in some surgical positioning (inclination and medial-lateral offset) on the level of dynamic separation and the contact force of the head acting on the rim as a measure of severity of edge loading. The level of dynamic separation and force acting on the rim increased with increased translational mismatch between the centres of the femoral head and the acetabular cup from 0 to 4 mm and with increased cup inclination angle from 45° to 65°. The virtual model closely replicated the dynamics of the experimental hip simulator previously reported, which showed similar dynamic biomechanical trends, with the highest level of separation being found with a mismatch of 4 mm between the centres of the femoral head and acetabular cup and 65° cup inclination angle.

Application of panning axial turnover in placement of surgical positions before thoracic surgery / 中国实用护理杂志

Objective To evaluate the application of panning axial turnover in placement of surgical positions before thoracic surgery. Methods From June 2017 to September 2017, altogether 140 patients who underwent thoracic surgery were enrolled in and randomly divided into two groups: the observation group and the control group. The control group was treated with traditional turnover method, while the observation group were treated with axial turnover. Results No significant changes were found in blood pressure, heart rate and respiratory rate (P>0.05) after turning over. There was no significant difference between the observation group and the control group about turn over time, (7.06 ± 0.78)s vs. (7.01±0.81)s (P>0.05). The subjective evaluation results of the medical staff in the observation group were significantly better than those of the control group (Z=-7.111, P<0.01) and the shift rate of double-lumen endotracheal tube in the observation group was 3.7% (2/54), which was significantly lower than 21.6% (11/51) of the control group (χ2=6.158, P<0.05). Conclusions The panning axial turnover properly guided the turn-over work with the principle of human body mechanics, which was more labor-saving and requires less operators. Besides, the panning axial turnover effectively reduced the double- lumen tracheal intubation shift rate. It′s worthy of clinical promotion.