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Medical Engineering & Physics Sep 2023For robot-assisted pelvic fracture reduction, at least two bone needles need to be inserted into the ilium of the affected pelvis, and the robot clamping device is...
For robot-assisted pelvic fracture reduction, at least two bone needles need to be inserted into the ilium of the affected pelvis, and the robot clamping device is connected with the bone needles. The biomechanical properties of the pelvic musculoskeletal tissues are different with the different Spatial Position and Orientation (SPO) of the bone needles. In order to determine the optimal SPO of bone needle pairs, the constraints between the bone needles and the pelvis are analyzed, and the SPO vectors of 150 groups bone needles are obtained by the KNN-hierarchical clustering method; a batch modeling method of bone needles with different SPO is proposed. 150 finite element models of damaged pelvic musculoskeletal tissue with different SPO of bone needles are established and simulated. The stress and strain distribution homogenization of musculoskeletal tissue with bone needles as evaluation index, the simulation results of 150 models are evaluated. Results show that, the anterior superior iliac spine and the anterior inferior iliac spine are suitable regions to place bone needles in the pelvis, and the optimal distribution of the needle combination is found in this region. The overall stress and strain distribution of the damaged pelvic musculoskeletal tissue under the large reduction force is the best.
Topics: Humans; Traction; Needles; Pelvis; Fractures, Bone; Fracture Fixation
PubMed: 37634913
DOI: 10.1016/j.medengphy.2023.104031 -
CRSLS : MIS Case Reports From SLS 2023Endometriosis originating in mesonephric cyst is unusual and with unknown prevalence. Endometriotic lesion in vestigial remnant of wolffian duct (mesonephric cyst) is... (Review)
Review
OBJECTIVES
Endometriosis originating in mesonephric cyst is unusual and with unknown prevalence. Endometriotic lesion in vestigial remnant of wolffian duct (mesonephric cyst) is exceptional. In the extended literature review only three cases have been reported in animal studies, and our case reported here is the first in human beings. We present a case of mesonephric cyst endometrioma in a 37-year-old patient who was referred for severe dysmenorrhea, long duration pelvic and back pain, subfertility, severe dyspareunia, and groin discomfort. The patient underwent laparoscopic removal and we performed a literature review to gain insight about the origin and surgical management of an atypical site endometriosis.
METHODS AND PROCEDURES
Case report presentation rests on information obtained from the patient database. We performed the literature review using a Medline search with the keywords: mesonephric cyst endometriosis, atypical location of endometriosis in vestigial remnant in wolffian duct, and Gartner duct cyst endometrioma.
RESULTS
On physical examination, fullness and tenderness in left adnexa and lateral vaginal wall fullness on left side with restricted mobility of uterus was noted. Based on the examination and imaging the left ovarian cyst and mesonephric cyst were suspected. Surgical exploration revealed the left hemorrhagic cyst with deep infiltrating endometriosis involving left ureter and left uterosacral ligament with mesonephric cyst endometriosis. The review of literature revealed three cases where ectopic endometrial tissue in mesonephric cyst remnant was found in female dogs.
CONCLUSION
Mesonephric cyst endometrioma, although rare, can be a representative of extensive endometriosis. This case highlights an importance of careful clinical examination, correlation of patient symptoms with examination and imaging, and successful laparoscopic management of an atypical location endometriotic lesions. We completed the literature review on successful surgical management of such cases.
Topics: Animals; Dogs; Female; Humans; Adult; Endometriosis; Laparoscopy; Ovarian Cysts; Pelvis; Cysts
PubMed: 37808583
DOI: 10.4293/CRSLS.2023.00029 -
Journal of Pediatric Orthopedics Aug 2023Existing classification systems may not adequately describe the injury patterns seen pelvic ring and acetabular fractures in the skeletally immature population....
BACKGROUND
Existing classification systems may not adequately describe the injury patterns seen pelvic ring and acetabular fractures in the skeletally immature population. Pediatric patients, once stabilized, are often transferred for these injuries. We evaluated which commonly used systems correlate with clinical management in pediatric patients, including transfer patterns based on injury severity.
METHODS
A retrospective review of patients aged 1 to 15 treated for traumatic pelvic or acetabular fractures over a 10-year period at an academic level I Pediatric Trauma Center reviewed demographic, radiographic, and clinical data.
RESULTS
A total of 188 pediatric patients (average age 10.1 y) were included. Increasing injury severity based on classification Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association (AO/OTA P <0.001; Young and Burgess P <0.001; Torode/Zieg P <0.001), increasing Injury Severity Score ( P =0.0017), and decreasing hemoglobin levels ( P =0.0144) were significantly associated with operative management. Injury characteristics did not differ between patients who were transferred versus patients who were brought in directly from the field. Air transport was significantly associated with surgical treatment, pediatric intensive care unit admission, polytrauma, and Torode/Zieg classification ( P =0.036, <0.0001, 0.0297, 0.0003, respectively).
CONCLUSIONS
Although not fully descriptive of skeletally immature fracture patterns, the AO/OTA and Young and Burgess classification systems adequately assess the severity of pelvic rings and injuries in pediatric patients and predict management patterns. The Torode and Zieg classification also predicts management. In a large cohort, air transport was significantly associated with surgical treatment, need for pediatric intensive care unit stay, the presence of an additional injury, and instability in the Torode and Zieg classification. These findings suggest that air transfers are being utilized to expedite advanced-level care in more severe injuries. Further studies with long-term follow-up are required to assess the clinical outcomes of both nonoperatively and operatively treated pediatric pelvic fractures and to guide both triage and treatment decisions for these rare but severe injuries.
LEVEL OF EVIDENCE
Level III.
Topics: Humans; Child; Spinal Fractures; Fractures, Bone; Pelvic Bones; Hip Fractures; Pelvis; Injury Severity Score; Retrospective Studies
PubMed: 37130809
DOI: 10.1097/BPO.0000000000002426 -
MedEdPORTAL : the Journal of Teaching... 2023Cervical intraepithelial neoplasia 3 is associated with a high degree of progression to cervical cancer. Its risk is markedly reduced after excisional treatment. Hence,...
INTRODUCTION
Cervical intraepithelial neoplasia 3 is associated with a high degree of progression to cervical cancer. Its risk is markedly reduced after excisional treatment. Hence, it is critical that providers accurately diagnose and treat this condition. We present a simulation-based module focused on resident mastery of performance of colposcopy and loop electrosurgical excision procedure (LEEP).
METHODS
Learners were obstetrics and gynecology residents. Guidelines on performance of colposcopy and LEEP were presented prior to module participation. We used pelvic task trainers, kielbasa sausages, and routine equipment for performance of colposcopy and LEEP. Colposcopy and LEEP sessions each lasted 30 minutes. Learners completed questionnaires before and after regarding comfort level on aspects of colposcopy and LEEP performance and level of agreement with statements on performing procedures independently. Comfort levels and degrees of agreement were based on 5-point Likert scales (1 = 3 = 5 = respectively).
RESULTS
Modules were held in November 2021 and May 2022. Thirty-four residents participated. Mean comfort scores significantly increased from 3.1 to 4.3 ( < .001) before and after the module for all steps. There was an increase in level of agreement with statements on being able to independently perform colposcopy (2.2 to 3.5, < .01) and LEEP (2.9 to 3.6, = .06).
DISCUSSION
Simulation-based modules on performance of colposcopy and LEEP significantly increased resident learner comfort in the performance of these procedures. Comfort in performing these procedures is important in providing comprehensive gynecologic care.
Topics: Pregnancy; Female; Humans; Colposcopy; Electrosurgery; Computer Simulation; Obstetrics; Pelvis
PubMed: 37691878
DOI: 10.15766/mep_2374-8265.11344 -
Scientific Reports Feb 2024Clinical value of pelvimetry in modern obstetrics practices has never been established and normal values are set since the middle of the twentieth century. The aim of... (Observational Study)
Observational Study
Clinical value of pelvimetry in modern obstetrics practices has never been established and normal values are set since the middle of the twentieth century. The aim of this study was to describe current dimensions of pelvis in a female French Caucasian population. A retrospective, bi-centric observational study was conducted from August 2013 to August 2019 in two French departments of Obstetrics. We included all Caucasian women who had a computed tomography pelvimetry during pregnancy. The primary outcome was the values of the obstetric transverse diameter, obstetric conjugate diameter and bispinous diameter. Five hundred and fifty-one CT pelvimetries were analyzed. The median Obstetric Transverse Diameter (OTD) was 12.41 cm and the 3rd percentile was 11 cm. The median Obstetric Conjugate Diameter (OCD) was 12.2 cm and the 3rd percentile was 10.5 cm. The median Bispinous Diameter (BSD) in our data collection was 10.9 cm and the 3rd percentile was 9.3 cm. A significant correlation coefficient between women's height and OTD, OCD and BSD was found. In our study, the OCD and the BSD have not evolved since the middle of the twentieth century. The obstetric transverse diameter was smaller than the standard currently used.
Topics: Pregnancy; Female; Humans; Pelvimetry; Retrospective Studies; Pelvis; Reference Values
PubMed: 38321054
DOI: 10.1038/s41598-024-53603-1 -
Journal of Orthopaedic Research :... Aug 2023In this paper, we present and evaluate HipRecon, a noncommercial software package that simultaneously calculates pelvic tilt and rotation from an anteroposterior pelvis...
In this paper, we present and evaluate HipRecon, a noncommercial software package that simultaneously calculates pelvic tilt and rotation from an anteroposterior pelvis radiograph. We asked: What is the (1) accuracy and precision, (2) robustness, and (3) intra-/interobserver reliability/reproducibility of HipRecon to analyze both pelvic tilt and rotation on conventional AP pelvis radiographs? (4) How does the prediction of pelvic tilt on AP pelvis radiographs using HipRecon compare to established measurement methods? We compared the actual pelvic tilt of 20 adult human cadaveric pelvises with the calculated pelvic orientation based on an AP pelvis radiograph using HipRecon software. The pelvises were mounted on a radiolucent fixture and a total of 380 AP pelvis radiographs with different configurations were acquired. In addition, we investigated the correlation between actual tilt and the tilt calculated using HipRecon and seven other established measurement methods. The calculated software accuracy was 0.2 ± 2.0° (-3.6-4.1) for pelvic tilt and 0.0 ± 1.2° (-2.2-2.3, p = 0.39) for pelvic rotation. The Bland-Altman analysis showed values that were evenly and randomly spread in both directions. HipRecon showed excellent consistency for the measurement of pelvic tilt and rotation (intraobserver intraclass-correlation coefficient [ICC]: 0.99 [95% CI: 0.99-0.99] and interobserver ICC 0.99 [95% CI: 0.99-0.99]). Of all eight analyzed methods, the highest correlation coefficient was found for HipRecon (r = 0.98, p < 0.001). In the future, HipRecon could be used to detect changes in patient-specific pelvic orientation, helping to improve clinical understanding and decision-making in pathologies of the hip.
Topics: Adult; Humans; Reproducibility of Results; Rotation; Radiography; Posture; Pelvis; Acetabulum
PubMed: 36691861
DOI: 10.1002/jor.25521 -
American Journal of Biological... Jul 2024Integration reflects the level of coordinated variation of the phenotype. The integration of postcranial elements can be studied from a functional perspective,...
OBJECTIVES
Integration reflects the level of coordinated variation of the phenotype. The integration of postcranial elements can be studied from a functional perspective, especially with regards to locomotion. This study investigates the link between locomotion, femoral structural properties, and femur-pelvis complex morphology.
MATERIALS AND METHODS
We measured (1) morphological integration between femoral and pelvic morphologies using geometric morphometrics, and (2) covariation between femoral/pelvic morphologies and femoral diaphyseal cross-sectional properties, which we defined as morpho-structural integration. Morphological and morpho-structural integration patterns were measured among humans (n = 19), chimpanzees and bonobos (n = 16), and baboons (n = 14), whose locomotion are distinct.
RESULTS
Baboons show the highest magnitude of morphological integration and the lowest of morpho-structural integration. Chimpanzees and bonobos show intermediate magnitude of morphological and morpho-structural integration. Yet, body size seems to have a considerable influence on both integration patterns, limiting the interpretations. Finally, humans present the lowest morphological integration and the highest morpho-structural integration between femoral morphology and structural properties but not between pelvic morphology and femur.
DISCUSSION
Morphological and morpho-structural integration depict distinct strategies among the samples. A strong morphological integration among baboon's femur-pelvis module might highlight evidence for long-term adaptation to quadrupedalism. In humans, it is likely that distinct selective pressures associated with the respective function of the pelvis and the femur tend to decrease morphological integration. Conversely, high mechanical loading on the hindlimbs during bipedal locomotion might result in specific combination of structural and morphological features within the femur.
Topics: Animals; Femur; Female; Male; Humans; Locomotion; Pelvis; Pan paniscus; Pan troglodytes; Anthropology, Physical; Pelvic Bones; Adult; Papio
PubMed: 38491922
DOI: 10.1002/ajpa.24931 -
Journal of Strength and Conditioning... Mar 2024McHugh, MP, O'Mahoney, CA, Orishimo, KF, Kremenic, IJ, and Nicholas, SJ. Kinematic, kinetic, and temporal metrics associated with golf proficiency. J Strength Cond Res...
McHugh, MP, O'Mahoney, CA, Orishimo, KF, Kremenic, IJ, and Nicholas, SJ. Kinematic, kinetic, and temporal metrics associated with golf proficiency. J Strength Cond Res 38(3): 599-606, 2024-The biomechanics of the golf swing have been studied extensively, but the literature is unclear on which metrics are indicative of proficiency. The purpose of this study was to determine which metrics identified golf proficiency. It was hypothesized that discrete kinematic, kinetic, and temporal metrics would vary depending on proficiency and that combinations of metrics from each category would explain specific proficiency metrics. Kinematic, kinetic, and temporal metrics and their sequencing were collected for shots performed with a driver in 33 male golfers categorized as proficient, average, or unskilled (based on a combination of handicap, ball velocity, and driving distance). Kinematic data were collected with high-speed motion analysis, and ground reaction forces (GRF) were collected from dual force plates. Proficient golfers had greater x-factor at ball impact and greater trunk deceleration before ball impact compared with average ( p < 0.05) and unskilled ( p < 0.01) golfers. Unskilled golfers had lower x-factor at the top of the back swing and lower peak x-factor, and they took longer to reach peak trunk velocity and peak lead foot GRF compared with average ( p < 0.05) and proficient ( p < 0.05) golfers. A combination of 2 kinematic metrics (x-factor at ball impact and peak pelvis velocity), 1 kinetic metric (peak lead foot GRF), and 2 timing metrics (the timing of peak trunk and arm velocity) explained 85% of the variability in ball velocity. The finding that x-factor at ball impact and trunk deceleration identified golf proficiency points to the potential for axial trunk rotation training to improve performance.
Topics: Humans; Male; Biomechanical Phenomena; Golf; Pelvis; Kinetics; Movement; Hexachlorocyclohexane
PubMed: 38088880
DOI: 10.1519/JSC.0000000000004663 -
BMC Women's Health Oct 2023Nerve-sparing radical hysterectomy(NSRH)has the advantage of reducing postoperative complications and improving postoperative quality of life. The separation and...
BACKGROUND
Nerve-sparing radical hysterectomy(NSRH)has the advantage of reducing postoperative complications and improving postoperative quality of life. The separation and protection of the pelvic plexus in NSRH is extremely important and challenging.
METHODS
24 female cadaveric hemipelves were dissected. Morphologic patterns and compositions of pelvic plexus as well as relationship of pelvic plexus to the surrounding structures were observed and documented.
RESULTS
Two patterns of superior hypogastric plexus were observed, including fenestrated and cord-like shape. The origin of bilateral hypogastric nerves were inferiorly to upper margin of promontory about 1.6 ± 0.1 cm and parallel to the ureter in front of the sacrum. Pelvic splanchnic nerves(PSN)from the second sacral nerve, the third sacral nerve and the forth sacral nerve were observed combing with the hypogastric nerves within the lateral rectal ligament. The sacral sympathetic trunk can be identified anteriorly or medially to the anterior sacral foramen. We identified the boundaries of pelvic plexus as following: the upper margin is formed by the PSNs from the third sacral nerve, posterior margin by inferior rectal artery, and anteriorly by vesical venous plexus. The uterine branches from pelvic plexus were observed accompanying with uterine artery, while other branches were inferiorly to the artery. The PSNs were located beneath the deep uterine veins within the cardinal ligament. The upper margin of pelvic plexus was observed directly approach to urinary bladder within the vesico-vaginal ligament as a single trunk accompanying with ureter, between the middle and inferior vesical veins.
CONCLUSIONS
Our study clarified the intricate arrangement, distribution and relationship of female pelvic plexus and the related structures to provide reference index for NSRH application. The innervation patterns of bladder and uterine were clarified, and by tracing these visceral branches of pelvic plexus, we suggest several new important land markers for NSRH.
Topics: Female; Humans; Hypogastric Plexus; Quality of Life; Hysterectomy; Uterus; Urinary Bladder; Pelvis
PubMed: 37817116
DOI: 10.1186/s12905-023-02651-2 -
Anatomical Science International Mar 2024During the anatomical dissection of the pelvis, a duplication of the uterine artery was identified unilaterally on the left side in a 59-year-old Korean female cadaver....
During the anatomical dissection of the pelvis, a duplication of the uterine artery was identified unilaterally on the left side in a 59-year-old Korean female cadaver. The first uterine artery was found to arise directly from the anterior division of the internal iliac artery and supply the upper uterine body and tube. The second uterine artery shared a common stem with the superior and inferior vesical arteries, supplying the lower uterine body. The external diameter of each uterine artery at its origin on the left side was smaller than that of the right uterine artery. One vaginal artery was identified to arise from the left internal pudendal artery. Embryologically, a duplicated uterine artery could imply the presence of two primordial arteries separately supplying the cranial and caudal parts of the Müllerian duct during the early fetal period. This case of variational anatomy is noteworthy: clinicians could elucidate it and successfully perform uterine artery embolization or hysterectomy with minimal complications.
Topics: Female; Humans; Middle Aged; Uterine Artery; Anatomic Variation; Pelvis; Uterus; Iliac Artery
PubMed: 38091200
DOI: 10.1007/s12565-023-00752-4