Fluoroscopy Frequency Research Articles

Percutaneous minimally invasive screwing assisted by 3D printing patient-specific external guide template for pelvic and acetabular fractures

Objective To evaluate the efficacy and safety of 3D printing patient-specific external guide template in assisting minimally invasive screwing for treatment of pelvic and acetabular fractures. Methods The clinical and follow-up data of 39 pelvic or acetabular fractures were retrospectively analyzed which had been treated from June 2016 to February 2018 at Department of Orthopaedics, Wuhan Union Hospital. The patients were divided into a template group and a freehand group. In the template group, there were 14 men and 7 women with an age of 46.3±18.2 years and 17 pelvic fractures and 4 acetabular fractures; in the freehand group, there were 12 men and 6 women with an age of 43.8±12.2 years and 14 pelvic fractures and 4 acetabular fractures. The 2 groups were compared in terms of operation time, fluoroscopic frequency, guide wire adjustments, fracture reduction, screw penetration rate, function evaluation and adverse events. Results All the 39 patients were followed up for 9 to 13 months (average, 11.6 months). A total of 42 screws were placed in the template group and 35 screws in the freehand group. The values of operation time (43.8±22.2 min), fluoroscopic frequency (29.6±10.7 times) and guide wire adjustments (1.8±1.2 times) in the external guide template group were all significantly lower than those in the freehand group (73.8±22.6 min, 54.6±16.5 times and 9.8±2.8 times, respectively) (P 0.05). One case in the freehand group experienced numbness after operation on unilateral dorsi pedis which disappeared at 3-month follow-up. Conclusion The 3D printing patient-specific external guide template can reduce fluoroscopic frequency, save operation time and improve accuracy of screw insertion, providing a new means for minimally invasive treatment of pelvis and acetabular fractures. Key words: Pelvis; Acetabulum; Fractures, bone; Surgical procedures, minimally invasive; 3D printing technology

Short-term outcomes of rod-shaped glass bone graft for treatment of tibial plateau fracture

Objective To analyze the short-term outcomes of rod-shaped glass bone graft for the treatment of tibial plateau fracture. Methods From January 2019 to February 2019, 4 patients with tibial plateau fracture underwent minimally invasive reduction and new glass bone graft at Trauma Emergency Center, The Third Hospital of Hebei Medical University. They were 2 men and 2 women, aged from 31 to 67 years (average, 42 years). The fractures happened at 3 left sides and one right side. According to Schanzker's classification, 3 cases were type Ⅱ and one case was type Ⅲ. According to Zhang's classification for tibial plateau fractures, they were all type Ⅰ. The reduction was carried out under general anesthesia by a Zhang's traction device and a self-made rod. A rod-shaped glass bone graft of appropriate size was implanted along the bone tunnel. The plate was implanted through small incisions after fluoroscopy results were satisfactory. Intraoperative arthroscopic examination was used to assess fracture displacement before wound closure. The operation time, incision length, fluoroscopic frequency for insertion of guide needle, intraoperative blood loss, and short-term postoperative complications were recorded for each patient. Results The operation time for the patients averaged 37.5 min, the total length of all incisions 7.0 cm, the fluoroscopy required for insertion of guide needle 8.8 times, and the intraoperative blood loss 40.0 ml. All incisions were healed by the first intention. Postoperative intermuscular thrombosis occurred in 2 cases. No postoperative infection or related complications happened. Conclusion Rod-shaped glass bone graft can lead to positive short-term outcomes for tibial plateau fractures, but a more reliable conclusion necessitates further clinical trials with a large sample size and long-term follow-up. Key words: Knee joint; Surgical procedures, minimally invasive; Bone graft; Tibial plateau fracture; Glass bone

Lumbopelvic Fixation Versus Novel Adjustable Plate for Sacral Fractures: A Retrospective Comparative Study

Purpose: The purpose of this study is to compare the therapeutic effects of the lumbopelvic technique and a novel adjustable plate for sacral fractures. Materials and Methods: Patients with unilateral sacral fractures fixed via the lumbopelvic technique or using a novel adjustable plate from June 2011 to June 2017 were recruited into this study and were divided into two groups: group A (lumbopelvic fixation) and group B (novel adjustable plate). Surgical time, intraoperative blood loss, frequency of intraoperative fluoroscopy, reduction quality, and related complications were reviewed. Fracture healing was assessed by the radiographs conducted at follow-up. Functional outcome was evaluated according to the Majeed score at the final follow-up. Results: The mean blood loss and frequency of intraoperative fluoroscopy in group B were reduced compared with group A (both P < 0.001). The mean surgical time was 122.22 ± 13.09 minutes in group A and 103.96 ± 24.80 minutes in group B (P = 0.007). All patients healed well in this study, and no difference in the fracture healing time was noted between the two groups (P = 0.685). Satisfactory rates of reduction quality and functional outcome did not differ (both P > 0.05) in this study. The complication rate was 22.22% (4/18) in group A and 4.16% (1/24) in group B (P = 0.191). Conclusion: For patients with unilateral sacral fractures, satisfactory radiographic appearance and functional outcome could be obtained by both the lumbopelvic technique and a novel adjustable plate. However, the novel adjustable plate represents a less invasive technique with lower radiograph exposure.

Hammering reverse guide wire technique for safe placement of anterior column retrograde in-tramedullary screw in pelvic and acetabular surgery

Objective To evaluate the efficacy and accuracy of hammering reverse guide wire technique for safe placement of anterior column retrograde intramedullary screw in pelvic and acetabular surgery. Methods From September 2015 to March 2018, 46 patients with pelvic or/and acetabular fracture involving the anterior column were treated with hammering reverse guide wire technique for safe placement of anterior column retrograde intramedullary screw at Department of Orthopaedics, Lishui Municipal Central Hospital. They were 28 men and 18 women, aged from 21 to 85 years (mean, 55.6 years). There were 34 pelvic ring fractures, 9 acetabular fractures and 3 combined pelvic ring and acetabular fractures. After the anterior lateral spine of pubic tuberosity was drilled by a guide pin and drill bit as the entry point, a reverse guide wire was knocked into the bone lightly by a hammer. For each retrograde intramedullary screwing into the acetabular anterior column, we recorded operation time, fluoroscopic frequency, and attempts to establish an acceptable screw pathway by the guide pin. The accuracy of screwing and the quality of fracture reduction were evaluated by imaging examination. For each patient, we recorded fracture union time and complications. Functional recovery of the pelvis and acetabulum was assessed by postoperative physical examination at the last follow-ups. Results The operation time of retrograde intramedullary screwing for the 46 patients averaged 28.9 minutes (from 16 to 55 minutes); the fluoroscopy frequency averaged 16.3 times (from 9 to 35 times); an acceptable screw pathway was established by the first attempt in 43 of the 46 patients (93.5%) and re-established after adjustment of the guide pin in the other 3. Forty patients were followed up for an average of 15.2 months(from 6 to 36 months). Postoperative CT scan and three-dimensional reconstruction showed that all the screws had been placed safely and accurately in the acetabular anterior column. Implant loosening and fracture displacement occurred in one case and lower limb thrombosis in another. No nail breakage, fracture nonunion, incision necrosis or infection, neurovascular injury or femoral head necrosis was observed. All fractures united after an average of 14.7 weeks (from 12 to 18 weeks). According to the Majeed scoring at the last follow-ups, the pelvic and acetabular function was evaluated as excellent in 29 cases, as good in 9, and as fair in 2, giving an excellent and good rate of 95.0%. Conclusion Hammering reverse guide wire technique is an effective method for safe placement of anterior column retrograde intramedullary screw in pelvic and acetabular surgery, because it can increase accuracy of screwing and reduce intraoperative radiation, operation time and incidence of complications though it is simple. Key words: Pelvis; Acetabulum; Fractures, bone; Surgical procedures, minimally invasive; Fracture fixation, internal

Can an unipedicular approach replace bipedicular percutaneous vertebroplasty for osteoporotic vertebral compression fracture?

To compare outcomes of unipedicular versus bipedicular approach for percutaneous vertebroplasty for the treatment of thoracolumbar acute osteoporotic vertebral compression fracture (AOVCF). From November 2014 to September 2015, 382 patients with AOVCF were randomly assigned to the unipedicular and bipedicular groups. Clinical outcomes and complications were compared. Both groups were comparable with respect to bone cement leakage and adjacent vertebral fractures (P> 0.05). Although the bipedicular approach was found to be superior in terms of reduction of kyphosis and loss of reduction, frequency of x-ray fluoroscopy, VAS and ODI scores, the volume of cement injected and operating time, the between-group differences were not statistically significant (P> 0.05). Nerve root stimulation was more frequent in the unipedicular group (P< 0.05). The clinical and radiological outcomes of both procedures were comparable. The unipedicular approach was associated with more nerve root stimulation.

Sacroiliac screw versus a minimally invasive adjustable plate for Zone II sacral fractures: a retrospective study

ObjectiveFracture line of the sacrum always involves the Zone II region because sacral foramina are anatomically and physiologically weak regions of the sacrum. The purpose of this study is to compare the therapeutic effects of a sacroiliac screw and a minimally invasive adjustable plate (MIAP) for Zone II sacral fractures. MethodsPatients with unilateral Zone II sacral fractures fixed with a unilateral sacroiliac screw or MIAP from August 2009 to January 2016 were recruited into this study and were divided into two groups: group A (sacroiliac screw) and group B (MIAP). Surgical time, blood loss, frequency of intraoperative fluoroscopy, and relative complications were reviewed. Radiographs and CT scans were routinely acquired to evaluate the fracture displacement and reduction quality. Fracture healing was evaluated in the radiographs at each follow-up. Functional outcome was assessed based upon the Majeed scoring system at the final follow-up. ResultsThirty-one patients in group A and thirty-nine patients in group B were included in this study. No significant differences in average surgical time (P = 0.221) or blood loss (P = 0.234) were noted between group A and group B. The mean frequency of intraoperative fluoroscopy was 15.74±2.98 in group A and 6.08±1.94 in group B (P = 0.000). All fractures healed well within four months in all patients, and the healing time exhibited no significant difference between the two groups (P = 0.579). Satisfactory rates of reduction quality and functional outcome were not statistically different between the two groups (P > 0.05). The complication rate was 16.13% (5/31) in group A and 5.13% (2/39) in group B (P = 0.222). ConclusionMIAP has a fixation effect and exhibits reduction potential for Zone II sacral fractures. Favourable radiographic and functional results could be obtained through the MIAP technique, which is easy to conduct without pre-contouring. Compared with the unilateral S1 sacroiliac screw technique, repeated projections and iatrogenic sacral injury can be avoided.

Comparison study of three fixation methods for the treatment of the fifth metacarpal neck fractures

Objective To compare the clinical efficacy of closed reduction Kirschner wire transverse fixation, open reduction Kirschner wire cross fixation and open reduction plate screw fixation in the treatment of the fifth metacarpal neck fractures. Methods From March 2010 to January 2017, 83 patients with fresh closed fifth metacarpal neck fractures were treated by closed reduction Kirschner wire transverse fixation (34 cases as group A), open reduction Kirschner wire cross fixation (22 cases as group B) and open reduction plate screw fixation (27 cases as group C). According to the operation time, the number of C-arm fluoroscopy, complications, joint function recovery, grip strength and patient satisfaction, the efficacy of the three surgical methods was evaluated comprehensively. Results All the 83 patients were follow-up for 7 to 33 months with an average of 16.5 months. All the fractures achieved anatomical reduction and bone healing. At the last follow-up, there were no significant differences in grip strength, fracture healing time, complications and C-arm fluoroscopy frequency among the three groups (P>0.05). The operative time between group A and group B, group A and group C were significantly different (P 0.05). According to the upper extremity function evaluation criteria issued by the Hand Surgery Society of the Chinese Medical Association, the results were rated as excellent in 27 cases, good in 4 cases and fair in 3 cases with the excellent and good rate being 91.2% for group A; the results were rated as excellent in 15 cases, good in 5 cases and fair in 2 cases with the excellent and good rate being 90.9% for group B; the results were rated as excellent in 16 cases, good in 7 cases and fair in 4 cases with the excellent and good rate being 85.2% for group C. Conclusion The application of closed reduction Kirschner wire transverse fixation in the treatment of fresh closed fifth metacarpal neck fractures has the advantages of easy operation, short operation time, stable fixation, little joint and tendon irritation and allowing early functional exercise. It has satisfactory efficacy and is worthy of clinical promotion. Key words: Metacarpal bones; Fractures,bone; Comparative study; Kirschner wire; Plate

The efficacy of using 3D printing models in the treatment of fractures: a randomised clinical trial

BackgroundThe aim of this study was to evaluate the efficacy of the use of three-dimensional (3D) printing models for preoperative planning in cases of complex fracture.MethodsIn total, 48 patients with AO type C fractures of the distal radius were enrolled in the study between January 2014 and January 2015. They were divided randomly into 3D model (n = 23) and routine treatment (n = 25) groups. A 3D digital model of each distal radius fracture in the former group was constructed. The model was exported to a 3D printer for construction of a full solid model. During each operation, the operative time, amount of blood loss, and frequency of intraoperative fluoroscopy were recorded, which were regarded as primary outcome measures. Patients were followed to evaluate surgical outcomes by Gartland–Werley scores, radiological evaluation, and range of motion of wrist, and these were regarded as the secondary outcome measures. In addition, we invited surgeons and patients to complete questionnaires.ResultsThe treatment of complex fractures using the 3D printing approach reduced the frequency of intraoperative fluoroscopy, blood loss volume, and operative time, but did not improve postoperative function compared with routine treatment. The patients wanted the doctor to use the 3D model to describe the condition and introduce the operative plan because it facilitated their understanding. The orthopaedic surgeons thought that the 3D model was useful for communication with patients, but were much less satisfied with its use in preoperative planning.ConclusionOur study revealed that 3D printing models effectively help the doctors plan and perform the operation and provide more effective communication between doctors and patients, but can not improve postoperative function compared with routine treatment.Trial RegistrationThis trial was registered at the Chinese Clinical Trial Registry on May 9, 2017 (ChiCTR-IRP-17011343, http://www.chictr.org.cn/showproj.aspx?proj=19264).

Percutaneous screw fixation assisted by an orthopedic robot for pelvic and acetabular fractures

Objective To analyze the effectiveness and safety of percutaneous screw fixation assisted by an orthopedic robot for treatment of pelvic and acetabular fractures. Methods Fifteen patients with fresh closed pelvic or acetabular fracture were hospitalized from September to December 2017 at Department of Orthopaedics, Foshan Hospital of Traditional Chinese Medicine. They were 10 men and 5 women, from 22 to 69 years of age (average, 65.2 years). There were 9 pelvic fractures (5 cases of Tile type B and 4 ones of Tile type C) and 6 acetabular fractures (3 anterior column fractures, 2 posterior column fractures and one transverse fracture). All patients underwent percutaneous transpedicular screw fixation with the assistance of an orthopaedic robot. Fluoroscopic frequency, number of guide needle adjustment and deviation between initial planning and the final screw position were recorded intraoperatively. Postoperative CT was performed to eval-uate screw positions and incidence of adverse events. Functional recovery in the patients was evaluated in regular follow-ups. Results A total of 26 screws were implanted in the operation. The fluoroscopic fre-quency ranged from 12 to 49 times, with a mean value of 17.3 times per screw; the number of needle ad-justment ranged from 0 to 2 times(mean, 0.3 times); the deviation of the actual path from its initial plan-ning ranged from 0.82 to 1.42 mm (mean, 1.06 mm). No surgery-related neurovascular injury occurred in any patient. Postoperative CT examination revealed that no screws cut out of cortical bone, yielding a 100% rate of excellent and good screw positions. Two patients were lost to the follow-up, and the re-maining 13 patients were followed up for 12 to 14 months (mean, 12.6 months). Their Majeed functional scores at the final follow-up averaged 88.6 points (from 68 to 96 points). No neurological symptoms were observed during follow-up. Conclusion Since percutaneous screw fixation assisted by an orthopaedic robot is accurate and safe and needs less fluoroscopic frequency, it will became a major minimally invasive surgical technique for pelvic and acetabular fractures. Key words: Pelvis; Acetabulum; Fractures, bone; Fracture fixation, internal; Robot

Transesophageal echocardiography-assisted transcatheter device closure of apical muscular ventricular septal defect.

Transesophageal echocardiography-assisted transcatheter device closure of apical muscular ventricular septal defect.

Clinical Application and Efficacy Analysis of 3D Navigation Module in the Treatment of Atlantoaxial Instability

Background: Posterior cervical atlantoaxial pedicle screw fixation is a very effective treatment for atlantoaxial instability (AAI). However, due to the complex anatomy of the cranial-cervical junction, the accuracy and safety of posterior atlantoaxial pedicle screw placement remains extremely challenging. Objective: To quantitatively evaluate the safety and accuracy of the 3D navigation module to assist the posterior atlantoaxial fixation. Methods: A total of 20 AAI patients were selected between June 2014 and September 2015. The Mimics v10.1 and 3-matic software were used. The 3D navigation module was designed as a double-sided positioning hole guide with a guide rod. All patients underwent posterior atlantoaxial posterior pedicle screw fixation with 3D navigation module. The actual entry point and screw trajectory were measured after operation, which were compared with the ideal entry point and screw trajectory. The Japanese Orthopaedic Association (JOA) score was measured before and after surgery to evaluate the neurological function improvement. The average operation time, blood loss, and frequency of intraoperative fluoroscopy were counted. Results: The posterior atlantoaxial pedicle screw fixation with a 3D navigation module was successfully performed in all patients. A total of 80 atlantoaxial pedicle screws were implanted in the 20 patients. Postoperative CT scan showed that two pedicle screws deviated from the medial aspect of the atlas pedicle cortex and entered the spinal canal approximately 1 mm, without causing neurological complications. There was no significant difference between the ideal and actual entry points or ideal and actual screw trajectories of the atlas and axis (P &gt; 0.05). The preoperative JOA score was 12.45 ± 1.15 and postoperative JOA score was 15.5 ± 0.89, with statistically significant difference (P &lt; 0.05). Conclusion: It was safe and effective to use the 3D navigation module to assist the posterior atlantoaxial pedicle insertion, with a high accuracy of pedicle screw placement. Keywords: atlantoaxial instability, pedicle screw, 3D navigation module, rapid prototyping

Clinical Application of Orthopedic Robot Navigation and Positioning System

To investigate the orthopedic robot navigation system fracture clinical application of the cannulated screw fixation in femoral neck. 40 patients were randomly divided into the robot operation group and the traditional operation group, namely 20 cases for each group. The frequency of fluoroscopy, the time of operation and the number of drill holes in the two groups were measured. The parallelism between the cannulated screws was measured. The deviation angle between the cannulated screws and femoral neck-shaft angle or anteversion angle was measured. The difference between the two groups was compared with the statistical methods. There were significant differences in the operation time, the frequency of fluoroscopy and the number of drill holes in the two groups (P <0.05). The difference of the parallelism and the deviation angle between the cannulated screws in the two groups were statistically significant (P <0.05). The operation time was short, the radiation in the operation was less, the mechanical distribution of the cannulated screws was better, the safety and accuracy of the operation were improved, when the orthopedic robot navigation and positioning system assisted the cannulated screw fixation in femoral neck fracture.

Treatment of unstable pelvic fractures with sacroiliac screwing assisted by 3D printing technique in combination with front ring nail-rod system

Objective To explore the clinical efficacy of 3D printing technique in assisting sacroiliac screwing in combination with front ring nail-rod system for treatment of unstable pelvic fractures. Methods From July 2015 to June 2017, 3D printing technique was used to assist the sacroiliac screwing in combination with front ring nail-rod system for 16 patients with unstable pelvic fracture at Orthopaedic Center, The Fourth People's Hospital of Zigong. They were 9 males and 7 females, aged from 19 to 60 years (average, 39.8 years). By the Tile classification, 5 cases were type B1, 6 type B2, 3 type B3 and 2 type C. Their operation duration, bleeding, fluoroscopy frequency, incision length, postoperative fracture reduction, success rate of sacroiliac screwing, accuracy of sacroiliac screwing, perioperative complications, weight-bearing exercise time, fracture healing time and the Majeed scores at the last follow-up were documented. Results All the 3D models and navigation templates were successfully designed and printed. Surgery succeeded in all the patients. Follow-ups ranged from 6 to 18 months, averaging 13.3 months. The bleeding ranged from 100 to 250 mL, averaging 162.4 mL; the operation duration ranged from 60 to 120 min, averaging 73.2 min; the intra-operative fluoroscopy frequency ranged from 13 to 31 times, averaging 17.4 times; the incision length ranged from 16 to 32 cm, averaging 21.1 cm. All the incisions healed by the first intention and all the fractures obtained osseous union after 90 to 120 d (average, 102.3 d). No significant complications like neurovascular injury or pulmonary embolism happened. The weight-bearing exercise time ranged from 25 to 40 d, averaging 31.5 d. According to the Matta imaging scores, the reduction was rated as excellent in 12 cases and good in 4. Altogether 28 screws were inserted with a success rate of 100%. Compared with the preoperative simulated screwing, the actual screwing angle deviated postoperatively by 0.12°±0.32°, the X axis by 0.36±1.24 mm, the Y axis by 0.36±1.24 mm and the Z axis by 0.22±1.26 mm, showing no statistically significant difference between the actual 3D deviations and the test value of 0 (P>0.05). Conclusion In the treatment of unstable pelvic fractures, 3D printing technique can be used in preoperative preparation of the connecting rod in the front ring nail-rod system to assist the sacroiliac screwing, significantly shortening the operation duration, reducing bleeding, ensuring safe and accurate screwing, and facilitating functional recovery. Key words: Pelvis; Fracture fixation, internal; Bone nails; 3D printing technique

Reduced Radiation Exposure and Puncture Time of Percutaneous Transpedicular Puncture with Real-Time Ultrasound Volume Navigation

The present study introduced ultrasound volume navigation (UVN) to reduce the radiation exposure and puncture time of percutaneous transpedicular puncture in percutaneous vertebroplasty (PVP) or percutaneous kyphoplasty (PKP). We retrospectively reviewed the medical records of patients with osteoporotic vertebral compression fracture who had undergone PVP or PKP guided by UVN or fluoroscopy from September 2017 to December2017. We enrolled 10 patients (6 women, 4 men) with 24 pedicles involved in the present study. Significant reductions in fluoroscopy frequency (2.58 vs. 17.42; P < 0.01), exposure time (2.36 vs. 15.69 seconds; P < 0.01), and puncture time (4.13 vs. 19.21 minutes; P < 0.01) for each pedicle were observed in the UVN group compared with the fluoroscopy group. Obvious correlations among fluoroscopy frequency, exposure time, and puncture time for each pedicle were observed (P < 0.01). The visual analog scale scores and Oswestry Disability Index were both significantly improved after the procedures. All patients achieved excellent or good clinical outcomes. No complications were observed in any patient. UVN could obviously reduce the radiation exposure and puncture time of percutaneous transpedicular puncture in PVP and PKP.

Controlled study on Gamma nail and proximal femoral locking plate for unstable intertrochanteric femoral fractures with broken lateral wall

The gamma nail and proximal femoral locking plate (PFLP) are both used for fractures. A controlled study was performed to determine the optimal implant. To assess and analyze the clinical effects of gamma nails and PFLPs for patients with unstable intertrochanteric femoral fractures, specifically with broken lateral walls. Thirty-six patients with unstable intertrochanteric femoral fractures and broken lateral walls were treated with gamma nails or PFLPs and retrospectively studied. The clinical data were compared. Duration of surgery and early full weight-bearing time were significantly longer in the PFLP group compared to the gamma nail group (P < 0.05). However, intraoperative fluoroscopy frequency and total blood loss in the PFLP group were significantly less than those in the gamma nail group (P < 0.05). No significant differences were found in hospitalized days, Parker Palmer mobility scores, Harris hip scores, and complications between the two groups. No difference in hip-functional recovery was found between the gamma nail group and the PFLP group, indicating that both the gamma nail and PFLP were effective for unstable intertrochanteric femoral fractures with a broken lateral wall. However, early weight bearing on the fractures was not encouraged in patients treated with PFLP.

Lateral decubitus intramedullary nailing for femoral subtrochanteric fractures

Objective To investigate the efficacy of lateral decubitus intramedullary nailing for treatment of subtrochanteric fractures of the femur. Methods From January 2012 to December 2015, 23 patients with simple femoral subtrochanteric fracture were treated at Department of Orthopedic Trauma, Changhai Hospital. They were 15 males and 8 females, aged from 19 to 77 years (average, 48.3 years). According to the Seinsheimer classification, there were 6 cases of type ⅡB, 8 cases of type ⅡC, 6 cases of type ⅢA, and 3 cases of type ⅢB. Their injuries were caused by traffic accident in 10 cases, falling from a height in 5 cases, and sprain in 8 cases. All patients were treated by closed reduction and anterograde intramedullary nailing at lateral decubitus. Their operative time, bleeding volume, fluoroscopic frequency, fracture healing time, functional recovery and complications were recorded and analyzed. Results Their operative time ranged from 55 to 80 min, averaging 65.7 min; their bleeding volumes ranged from 240 to 420 mL, averaging 304.3 mL; their fluoroscopic frequency ranged from 30 to 60 times, averaging 42.7 times. This cohort was followed up for 12 to28 months (average, 17.9 months). Their fracture healing time ranged from 4 to 10 months, averaging 5.5 months. Nonunion occurred in one patient but was cured by secondary operation. The HSS evaluation at the final follow-ups showed 17 excellent cases and 6 good ones, yielding an excellent to good rate of 100%. All the wounds healed by the first intention. No infection, deep vein thrombosis or implant failure was observed. Conclusion As lateral decubitus intramedullary nailing can achieve satisfactory clinical efficacy for subtrochanteric fractures of the femur, the body position of lateral decubitus may be a good alternative. Key words: Posture; Fracture fixation, intramedullary; Bone nail; Lateral decubitus; Subtrochanteric fracture

Robot-assisted percutaneous screw placement combined with pelvic internal fixator for minimally invasive treatment of unstable pelvic ring fractures.

PurposeThe purpose of this study was to investigate the safety and efficacy of the combination of robot‐assisted percutaneous screw placement and pelvic internal fixator (INFIX) for minimally invasive treatment of unstable anterior and posterior pelvic ring injuries.MethodsFrom September 2016 to June 2017, twenty‐four patients with unstable anterior and posterior pelvic ring injuries were treated with TiRobot‐assisted percutaneous sacroiliac cannulated screw fixation on the posterior pelvic ring combined with robot‐assisted pedicle screw placement in the anterior inferior iliac spine along with INFIX on the anterior pelvic ring. The results of the treatment, including surgery duration, fluoroscopy frequency, total drilling, amount of blood loss, fracture healing time, and postoperative functional outcomes were recorded and compared with another 21 similar patients who underwent conventional manual positioning surgery.ResultsThe TiRobot group incurred significantly shorter duration of surgery; less fluoroscopy frequency, intraoperative bleeding, and total drilling than in the conventional group (P < 0.05). Postoperative radiological follow‐up showed that all screws were in the safe area and no screw penetrated the cortex. All wounds healed by primary intention and no iatrogenic damage to the blood vessels, nerves, and organs occurred. Patients showed good tolerance to INFIX and reported no discomfort. The mean follow‐up duration was 5.4 months; the fractures were all healed, no loss of reduction occurred, and the mean Majeed score at the last follow‐up did not show any difference.ConclusionTiRobot‐assisted percutaneous screw placement combined with INFIX for the anterior and posterior pelvic ring injuries is accurate, safe, less invasive, and shows satisfactory efficacy, suggesting it is a better method for minimally invasive treatment of unstable pelvic ring fractures.

Comparative study of sacroiliac screw placement guided by three-dimensional printing template technology or X-ray fluoroscopy

Objective To compare the clinical effect of three-dimensional printing template technology with X-ray fluoroscopy in assisting surgery for sacroiliac screw placement. Methods A retrospective case-control study was conducted on 28 cases of sacroiliac complex injury from January 2015 to December 2016. The patients were divided into template group (13 cases) and fluoroscopy group (15 cases) according to whether the preoperative three-dimensional printing template was adopted. In template group, there were nine males and four females, with an average age of 46.7 years (range, 18-68 years). According to Tile typing, there were eight cases of type B (two type B1, three type B2, and three type B3) and five cases of type C (three type C1 and two type C2). In fluoroscopy group, there were 11 males and four females, with an average age of 47.1 years (range, 18-65 years). According to Tile typing, there were 10 cases of type B (three type B1, four type B2, and three type B3) and five cases of type C (three type C1 and two type C2). The screw numbers, time for single screw placement, and fluoroscopy frequency were recorded. The Matta criteria was used to evaluate fracture reduction quality, and Majeed score was used to evaluate pelvic fracture function at the last follow-up. Results All patients were followed up for 6-20 months [(10.4±0.6)months]. Fifteen screws were implanted in template group, and 17 in fluoroscopy group. The time for single screw placement was 25-38 minutes [(28±5.3)minutes] in template group and 45-70 minutes [(60.3±5.8)minutes] in fluoroscopy group (P 0.05). According to Majeed score at the last follow up, there were eight excellent cases, three good, two fair, with an excellent and good rate of 85% in template group; there were six excellent cases, six good, three fair, with an excellent and good rate of 80% in fluoroscopy group (P>0.05). Conclusions Compared with traditional surgery, three-dimensional printing template technology assisted surgery for sacroiliac screws placement presents advantages of less operation time and reduced fluoroscopy frequency. This technology improves the safety profile and should be further promoted in clinical applications. Key words: Pelvis; Sacroiliac Joint; Fracture fixation, internal; Three-dimensional printing, template

Comparative study on digital orthopedic three-dimensional visualization technology combined with image-based computer navigation and simple image-based computer navigation in percutaneous screw fixation for sacroiliac joint complex injury

Objective To compare the clinical effect of digital orthopedic three-dimensional visualization technology combined with image-based computer navigation and simple image-based computer navigation in percutaneous screw fixation for the treatment of sacroiliac joint complex injury. Methods A retrospective case-control analysis was conducted on 49 cases of sacroiliac complex injury from January 2015 to May 2017. There were 27 males and 22 females, with an average of 39.3 years old (range, 21-66 years). According to AO typing, there were 10 cases of type B1, 19 type B2, and 20 type C1. The duration from injury to operation ranged from 5 to 11 days (mean, 6.5 days). Based on the application of three-dimensiona digital programming, the 49 cases were assigned to Group A (n=24) which used Mimics computer assisted surgery software to simulate screw placement on the healthy side of sacroilic joint before operation and Group B (n=25) without the simulation programming. Screw placement time, intraoperative fluoroscopy frequency, and intraoperative bleeding were compared between two groups. Fracture reduction was evaluated by modified Matta standard score, and the function of hip joint by Majeed pelvic fracture function score at the last follow-up. Fracture healing and complications were observed. Results All patients were followed up for an average of 10.4 months (range, 6-24 months). The time of sacroiliac joint screw placement [(18.4±3.0)min] and the intraoperative fluoroscopy frequency [(12.9±3.8)times] in Group A were significantly less than those [(26.4±3.8) min, (19.4±1.5) times] in Group B (P 0.05). According to the modified Matta reduction standard, the good and excellent rate of Group A was 92% (22/24), and that of Group B was 92% (23/25). At the last follow up, the Majeed pelvic function score was 96% (23/24) in Group A and 92% (23/25) in Group B (P>0.05). Bone healing was seen in all patients 4 months after operation, and no complications such as wound infection, deep venous thrombosis, or screw loosening were observed. Conclusion The digital orthopedic three-dimensiona visualization technology in preoperative planning can reduce the time of sacroiliac screw placement and the intraoperative fluoroscopy frequency. It is an effective adjuvant technique for the percutaneous screw fixation under navigation in the treatment of sacroiliac joint. Key words: Sacroiliac joint; Imaging, three-dimensional; Surgery, computer-assisted; Bone nail

Volume Navigation with Fusion of RealTime Ultrasound and CT Images to Guide Posterolateral Transforaminal Puncture in Percutaneous Endoscopic Lumbar Discectomy

The use of percutaneous endoscopic lumbar discectomy (PELD) is increasing in the treatment of lumbar disc herniations (LDH). Nerve and vessel injury may happen during the establishment of the transforaminal working channel. Also, there is usually exposure to intraop radiation when the C-arm is used to help establish the location of the transforaminal working channel. To evaluate the accuracy and safety of the volume navigation technique for guiding transforaminal puncture in cadaver and clinical patient treatment. Cadaver experiment and comparative clinical research. Changhai Hospital, the Second Military Medical University. Volume navigation guided transforaminal puncture was performed in 15 cadavers. The registration error, time of overall puncture, ultrasound (US) observed distance between needle tip and target (DNT), and puncture error were recorded. Clinical research was performed in 63 patients who had undergone PELD. Comparative research was done between 2 groups: Those who had transforaminal puncture carried out under C-arm guidance (n = 30), and those patients whose transforaminal puncture was carried out under volume navigation guidance (n = 33). Puncture times and frequency of fluoroscopy were recorded. Both groups were evaluated with Oswestry Disability Index (ODI), and visual analog scale (VAS) before surgery at 1, 3, and 6 months, and 1 year post-surgery. In the cadaver experiment, mean registration error was 2.66 ± 1.10 mm; DNT 20.08 ± 1.32 mm; puncture error 2.91 ± 1.29 mm; overall time of puncture 22.10 ± 5.20 min. In the clinical patient research, puncture times and frequency of fluoroscopy were significantly lower in the volume navigation group compared with the C-arm group (P < 0.001). There were no significant differences between the 2 groups in ODI and VAS scores (P > 0.05) at different time points. The correlation between the registration errors and the puncture errors requires further analysis. Also, due to the relatively small number of cases studied, additional cases need to be collected to obtain reliable results. The volume navigation technique can be used for PELD because it helps to guide percutaneous posterolateral transforaminal puncture accurately with reduced puncture times and intraop radiation. Lumbar disc herniation (LDH), ultrasound volume navigation (US VNav), percutaneous endoscopic lumbar discectomy (PELD), foramen, puncture.