-
Medicina (Kaunas, Lithuania) May 2024Despite advancement in surgical innovation, C1-C2 fixation remains challenging due to risks of screw malposition and vertebral artery (VA) injuries. Traditional...
Despite advancement in surgical innovation, C1-C2 fixation remains challenging due to risks of screw malposition and vertebral artery (VA) injuries. Traditional image-based navigation, while useful, often demands that surgeons frequently shift their attention to external monitors, potentially causing distractions. In this article, we introduce a microscope-based augmented reality (AR) navigation system that projects both anatomical information and real-time navigation images directly onto the surgical field. In the present case report, we discuss a 37-year-old female who suffered from os odontoideum with C1-C2 subluxation. Employing AR-assisted navigation, the patient underwent the successful posterior instrumentation of C1-C2. The integrated AR system offers direct visualization, potentially minimizing surgical distractions. In our opinion, as AR technology advances, its adoption in surgical practices and education is anticipated to expand.
Topics: Humans; Female; Adult; Augmented Reality; Atlanto-Axial Joint; Spinal Fusion; Odontoid Process; Surgery, Computer-Assisted
PubMed: 38929491
DOI: 10.3390/medicina60060874 -
BMC Musculoskeletal Disorders Jun 2024Autologous iliac bone is commonly used as a bone graft material to achieve solid fusion in craniocervical junction (CVJ) surgery. However, the developing iliac bone of...
OBJECTIVE
Autologous iliac bone is commonly used as a bone graft material to achieve solid fusion in craniocervical junction (CVJ) surgery. However, the developing iliac bone of children is less than ideal as a bone graft material. The matured rib bone of children presents a potential substitute material for iliac bone. The aim of this study was to evaluate the efficacy of autologous rib grafts for craniocervical junction surgery in children.
METHODS
The outcomes of 10 children with abnormalities of the craniocervical junction who underwent craniocervical junction surgery between January 2020 and December 2022 were retrospectively reviewed. All patients underwent posterior fusion and internal fixation surgery with autologous rib grafts. Pre- and post-operative images were obtained and clinical follow-ups were conducted to evaluate neurological function, pain level, donor site complications, and bone fusion rates.
RESULTS
All surgeries were successful. During the 8- to 24-month follow-up period, all patients achieved satisfactory clinical results. Computed tomography at 3-6 months confirmed successful bone fusion and regeneration of the rib defect in all patients with no neurological or donor site complications.
CONCLUSION
Autologous rib bone is a safe and effective material for bone grafting in craniocervical junction fusion surgery for children that can reduce the risks of donor site complications and increase the amount of bone graft, thereby achieving a higher bone fusion rate.
Topics: Humans; Child; Male; Female; Retrospective Studies; Spinal Fusion; Bone Transplantation; Ribs; Transplantation, Autologous; Treatment Outcome; Child, Preschool; Adolescent; Atlanto-Axial Joint; Follow-Up Studies; Cervical Vertebrae; Atlanto-Occipital Joint; Tomography, X-Ray Computed
PubMed: 38926741
DOI: 10.1186/s12891-024-07607-7 -
Brazilian Dental Journal 2024Rehabilitation of edentulous atrophic mandibles involves the placement of implants in the anterior segment of the mandible. The primary stability of these implants can...
Rehabilitation of edentulous atrophic mandibles involves the placement of implants in the anterior segment of the mandible. The primary stability of these implants can be improved using the base of the mandible as complementary anchorage (bicorticalization). This study aimed to analyze the biomechanics of atrophic mandibles rehabilitated with monocortical or bicortical implants. Two three-dimensional virtual models of edentulous mandibles with severe atrophy were prepared. Four monocortical implants were placed in one model (McMM), and four bicortical implants were placed in the other (BcMM). An implant-supported total prosthesis was prepared for each model. Then, a total axial load of 600 N was applied to the posterior teeth, and its effects on the models were analyzed using finite element analysis. The highest compressive stresses were concentrated in the cervical region of the implants in the McMM (-32.562 Mpa); in the BcMM, compressive stresses were distributed in the upper and lower cortex of the mandible, with increased compressive stresses at the distal implants (-63.792 Mpa). Thus, we conclude that axial loading forces are more uniformly distributed in the peri-implant bone when using monocortical implants and concentrated in the apical and cervical regions of the peri-implant bone when using bicortical implants.
Topics: Humans; Mandible; Dental Implants; Finite Element Analysis; Atrophy; Dental Prosthesis, Implant-Supported; Jaw, Edentulous; Biomechanical Phenomena; Dental Stress Analysis
PubMed: 38922249
DOI: 10.1590/0103-6440202405621 -
Zhongguo Xiu Fu Chong Jian Wai Ke Za... Jun 2024To investigate the impact of the bone mass and volume of the low-density area under the tibial plateau on the lower limb force line by finite element analysis, offering...
OBJECTIVE
To investigate the impact of the bone mass and volume of the low-density area under the tibial plateau on the lower limb force line by finite element analysis, offering mechanical evidence for preventing internal displacement of the lower limb force line in conjunction with knee varus in patients with knee osteoarthritis (KOA) and reducing bone mass under the tibial plateau.
METHODS
A healthy adult was selected as the study subject, and X-ray film and CT imaging data were acquired. Mimics 21.0 software was utilized to reconstruct the complete knee joint model and three models representing low-density areas under the tibial plateau with equal volume but varying shapes. These models were then imported into Solidworks 2023 software for assembly and verification. Five KOA finite element models with 22%, 33%, 44%, 55%, and 66% bone mass reduction in the low-density area under tibial plateau and 5 KOA finite element models with 81%, 90%, 100%, 110%, and 121% times of the low-density area model with 66% bone mass loss were constructed, respectively. Under physiological loading conditions of the human lower limb, the distal ends of the tibia and fibula were fully immobilized. An axial compressive load of 1 860 N, following the lower limb force line, was applied to the primary load-bearing area on the femoral head surface. The maximum stress within the tibial plateau, as well as the maximum displacements of the tibial cortical bone and tibial subchondral bone, were calculated and analyzed using the finite element analysis software Abaqus 2022. Subsequently, predictions regarding the alteration of the lower limb force line were made based on the analysis results.
RESULTS
The constructed KOA model accorded with the normal anatomical structure of lower limbs. Under the same boundary conditions and the same load, the maximum stress of the medial tibial plateau, the maximum displacement of the tibial cortical bone and the maximum displacement of the cancellous bone increased along with the gradual decrease of bone mass in the low-density area under the tibial plateau and the gradual increase in the volume of the low-density area under tibial plateau, with significant differences ( <0.05).
CONCLUSION
The existence of a low-density area under tibial plateau suggests a heightened likelihood of knee varus and inward movement of the lower limb force line. Both the volume and reduction in bone mass of the low-density area serve as critical initiating factors. This information can provide valuable guidance to clinicians in proactively preventing knee varus and averting its occurrence.
Topics: Humans; Finite Element Analysis; Tibia; Bone Density; Biomechanical Phenomena; Tomography, X-Ray Computed; Osteoarthritis, Knee; Knee Joint; Adult; Lower Extremity; Weight-Bearing; Male; Imaging, Three-Dimensional; Stress, Mechanical; Computer Simulation; Software
PubMed: 38918196
DOI: 10.7507/1002-1892.202312026 -
Journal of Pediatric Orthopedics Jun 2024Osteochondromas are benign osseous lesions often excised for pain, growth abnormalities, and aesthetic concerns. While characteristic clinical and radiographic features...
BACKGROUND
Osteochondromas are benign osseous lesions often excised for pain, growth abnormalities, and aesthetic concerns. While characteristic clinical and radiographic features leave little diagnostic ambiguity in most cases of osteochondroma, pathologic analysis to confirm the diagnosis and screen for malignancy is routinely performed following surgical excision. The purpose of this study was to determine the clinical and economic value of routine pathologic analysis after osteochondroma excision in a pediatric population.
METHODS
A retrospective review of clinical records from 2 pediatric orthopaedic hospitals (St. Louis Children's Hospital and Shriner's Hospital for Children, St. Louis) identified 426 osteochondroma lesions surgically resected from 201 patients. Patients with solitary and multiple lesions were included. Clinical, radiographic, and surgical data were recorded for each resection surgery. Pathologic reports were evaluated. Costs incurred for routine pathologic assessment was also noted.
RESULTS
Totally, 132 patients were treated with surgical resection of a solitary osteochondroma lesion, while an additional 291 lesions were resected from 69 patients with multiple lesions. Average age at the time of surgical resection was 13.0 years (2.1 to 17.9). The most common anatomic locations of excised lesions included the distal femur (110, 25.8%), proximal tibia/fibula (95, 22.3%), and distal radius/ulna (58, 13.6%). All resected specimens were sent for pathologic analysis. The average size of the resected lesions was 19.9 mm3 (0.02 to 385.0 mm3). In all cases, the histologic diagnosis confirmed benign osteochondroma. The total charges of pathologic analysis including processing and interpretation fees was ∼$755.00 for each lesion assessed, for a total cohort charge of $321,630.
CONCLUSION
We propose that in most cases of pediatric osteochondroma excision procedures, postoperative histologic analysis is not strictly indicated as it rarely, if ever, alters diagnosis or management. We suggest using a "gross only" analysis in these cases. However, we do believe that with preoperative diagnostic ambiguity, or if patients present with concerning features such as rapidly expansile lesions or cortical destruction, have axial skeleton or pelvic involvement, or enlarged cartilaginous caps, full histologic evaluation of the excised lesions will continue to be prudent.
LEVEL OF EVIDENCE
Level IV-case series.
PubMed: 38916216
DOI: 10.1097/BPO.0000000000002750 -
International Ophthalmology Jun 2024To assist in surgical planning in endoscopic approaches, we analyzed the morphometric measurements of the superior orbital fissure (SOF) and optic canal (OC) by...
Morphometric evaluation of the anatomical relationships between the superior orbital fissure and the orbital structures based on computed tomography images with clinical implications.
PURPOSE
To assist in surgical planning in endoscopic approaches, we analyzed the morphometric measurements of the superior orbital fissure (SOF) and optic canal (OC) by three-dimensional multislice computed tomography (3D MDCT) and evaluated them according to age, gender, and lateralization.
METHODS
The study analyzed 219 MDCT images (114 women, 105 men) from individuals aged 18-90. Measurements of SOF and OC were performed on 3D MDCT images in the axial plane and with 3D-Slicer software.
RESULTS
The distance between the infraorbital foramen and the anterior entrance of the maxillary sinus (CBW) (p < 0.001), the distance between the CBW and the lateral point of the SOF (p = 0.001), and the Angle 1 (p = 0.028) were higher in women than in men. While the SOF length and on 3D the SOF width were higher in women than men (p < 0.001 and (p = 0.001, respectively), the lateral wall length OC was higher in men than women (p = 0.045). According to SOF classification, SOF length was highest in type II and lowest in type VIII (p = 0.025), SOF width was highest in type I and lowest in type VI (p < 0.001). No significant difference was found based on age groups and lateralization in all parameters.
CONCLUSION
We found that as the SOF width increased, the SOF length also increased, and there was a statistically strong positive correlation. These findings can contribute to a more effective and safe operation by improving and updating surgeons' knowledge about safe distances to SOF in endoscopic procedures from a 3D MDCT perspective.
Topics: Humans; Male; Female; Adult; Adolescent; Orbit; Young Adult; Middle Aged; Imaging, Three-Dimensional; Aged; Multidetector Computed Tomography; Aged, 80 and over; Retrospective Studies; Endoscopy
PubMed: 38913238
DOI: 10.1007/s10792-024-03196-5 -
Zhongguo Gu Shang = China Journal of... Jun 2024To explore dose-effect relationship of biomechanical parameters in treating atlantoaxial joint disorder by slimming manipulation.
OBJECTIVE
To explore dose-effect relationship of biomechanical parameters in treating atlantoaxial joint disorder by slimming manipulation.
METHODS
From October 2022 to May 2023, 18 patients with atlantoaxial joint disorders were treated, including 10 males and 8 females;aged from 24 to 27 years old with an average of (25.50±1.10) years old;CT of cervical vertebra showed 16 patients with right side distortion and 2 patients with left side distortion. The mechanical parameters of treatment of atlantoaxial joint disorder by tendon relaxation manipulation were measured by wearing massage manipulation gloves. The magnitude, frequency and mechanical curve of force during tendon relaxation and starting force, pulling force, pulling time and mechanical curve during rehabilitation were quantified, the differences between the affected and contralateral manipulations were compared.
RESULTS
The maximum force and frequency of Fengchi(GB20) on the affected side were (19.82±2.02) N and (116.83±14.49) times/min, and opposite side were (13.87±2.19) N and (188.89±16.03) times/min, respectively. There were statistically difference in the maximum force and frequency of both sides (<0.05). The maximum force and frequency of Quepen (ST12) on the affected side were (14.44±3.27) N and (139.06±28.47) times/min, and those on the opposite side were (9.41±1.38) N and (142.50±28.47) times/min. There was difference in maximum force on both sides (<0.05). The starting force, turning force and turning time of the affected side were (14.16±5.98) N, (11.56±6.63) N, (0.14±0.03) S, and the contralateral side were (8.94±3.39) N, (8.30±4.64) N, (0.18±0.04) S, respectively. The difference of starting force, turning force and turning time on both sides were statistically significant (<0.05).
CONCLUSION
By applying a light relaxation force on the affected side, the mechanical balance between cervical vertebrae could be restored, and recovery trend of atlantoaxial joint disorder could be strengthened. On this basis, the atlantoaxial odontoid process could be reversed by applying a light rotation force, which reflects the characteristics of high safety of the manipulation.
Topics: Humans; Male; Female; Adult; Atlanto-Axial Joint; Tendons; Biomechanical Phenomena; Young Adult; Joint Diseases
PubMed: 38910379
DOI: 10.12200/j.issn.1003-0034.20230957 -
Aging Clinical and Experimental Research Jun 2024Radiofrequency Echographic Multi Spectrometry (REMS) is a radiation-free, portable technology, which can be used for the assessment and monitoring of osteoporosis at the... (Review)
Review
Radiofrequency Echographic Multi Spectrometry (REMS) is a radiation-free, portable technology, which can be used for the assessment and monitoring of osteoporosis at the lumbar spine and femoral neck and may facilitate wider access to axial BMD measurement compared with standard dual-energy x-ray absorptiometry (DXA).There is a growing literature demonstrating a strong correlation between DXA and REMS measures of BMD and further work supporting 5-year prediction of fracture using the REMS Fragility Score, which provides a measure of bone quality (in addition to the quantitative measure of BMD).The non-ionising radiation emitted by REMS allows it to be used in previously underserved populations including pregnant women and children and may facilitate more frequent measurement of BMD.The portability of the device means that it can be deployed to measure BMD for frail patients at the bedside (avoiding the complications in transfer and positioning which can occur with DXA), in primary care, the emergency department, low-resource settings and even at home.The current evidence base supports the technology as a useful tool in the management of osteoporosis as an alternative to DXA.
Topics: Humans; Osteoporosis; Absorptiometry, Photon; Bone Density; Lumbar Vertebrae; Femur Neck; Female; Ultrasonography
PubMed: 38904870
DOI: 10.1007/s40520-024-02784-w -
BMC Musculoskeletal Disorders Jun 2024The Ilizarov bone transport technique is widely recognised as an effective method for treating large segment bone defects in clinical practice. However, axial deviation...
INTRODUCTION
The Ilizarov bone transport technique is widely recognised as an effective method for treating large segment bone defects in clinical practice. However, axial deviation is a common complication in the treatment of tibial large segment bone defects, which can have a serious impact on the clinical efficacy of bone transport. Our study aims to construct and validate a nomogram for predicting axial deviation of tibial bone transport.
METHOD
This study retrospectively collected data from 363 patients who underwent the tibial Ilizarov technique for bone transport. Univariate and multivariate logistic regression analyses were performed to determine the independent risk factors for axial deviation, which were later used to construct a nomogram. The nomogram was evaluated using the decision curve analysis (DCA), the calibration curve, and the area under the receiver operating characteristic curve (AUC).
RESULTS
Of the 363 patients who underwent Ilizarov tibial bone transport, 31.7% (115/363) experienced axial deviation. Multivariate logistic regression analysis showed that gender, height, defect site, and external fixation index were important risk factors for axial deviation. The AUC value of the nomogram model was 0.705. The calibration curve and the decision curve analysis showed a good consistency between the actual axial deviation and the predicted probability.
CONCLUSION
The model assigns a quantitative risk score to each variable, which can be used to predict the risk of axial deviation during tibial bone transport.
Topics: Humans; Ilizarov Technique; Female; Male; Nomograms; Retrospective Studies; Adult; Tibia; Middle Aged; Risk Factors; Young Adult; Adolescent; Aged; Postoperative Complications
PubMed: 38898453
DOI: 10.1186/s12891-024-07603-x -
Sensors (Basel, Switzerland) May 2024The serve is the most important stroke in tennis. It is a complex gesture consisting of numerous rotations with a wide amplitude, which are important to manage for...
The serve is the most important stroke in tennis. It is a complex gesture consisting of numerous rotations with a wide amplitude, which are important to manage for performance. The aim of this study was to investigate whether correlations exist between joint kinematic parameters and racket velocity. A quantitative kinematics analysis of four ranked players (two boys and two girls) was carried out using an optoelectronic system composed of 10 cameras (150 Hz). Five flat serves per player were analyzed. Eighty-two markers were located across the 15 body segments and on the racket. A descriptive statistical analysis including a correlation analysis was carried out between joint angles and racket kinematic parameters (vertical position, velocity, and acceleration) during the cocking and acceleration phases. Ten very high (0.7 < r < 0.9) and three almost perfect (r > 0.9) correlations were found. Shoulder and hip axial rotations, knee flexion, and trunk extension were correlated linearly with racket vertical position and velocity during the cocking phase. For the acceleration phase, elbow flexion, trunk flexion/extension, and trunk axial rotation were linked to racket kinematics. Some of these parameters showed differences between slow and fast serves. These parameters, which are involved in transmitting ball velocity, are important to consider for tennis players and coaches in training programs, education, and performance enhancement.
Topics: Humans; Tennis; Biomechanical Phenomena; Male; Female; Range of Motion, Articular; Movement; Joints; Motion Capture
PubMed: 38894086
DOI: 10.3390/s24113292