Enteral Nutrition ; instrumentation ; methods ; Female ; Fluoroscopy ; methods ; Gastrostomy ; adverse effects ; instrumentation ; methods ; Humans ; Male ; Middle Aged ; Outcome and Process Assessment (Health Care) ; Postoperative Complications ; classification ; diagnosis ; therapy ; Reproducibility of Results ; Retrospective Studies ; Singapore ; Surgery, Computer-Assisted ; methods ; Treatment Outcome

BACKGROUND: Localization of multiple small lung nodules is the technical difficulty of minimally invasive operation resection. However, there are few clinical studies on the preoperative localization of multiple small lung nodules. This study was designed to evaluate the clinical value of preoperative computed tomography (CT) guided microcoil localization for multiple small lung nodules compared with single small lung nodule before video-assisted thoracoscopic surgery (VATS). METHODS: A retrospective analysis of the clinical data of 235 patients with preoperative pulmonary nodules microcoil localization was performed. According to whether the nodules were single, they were divided into single nodule group (184 cases) and multiple nodules group (51 cases) (multiple nodules group). The single nodule group was positioned under CT-guided conventional methods. The multiple nodules group were CT guided localized by microcoil in batches according to priority before VATS. The success rate, complications, pathological results and localization operations related data were statistically analyzed. RESULTS: The success rate of localization in multiple nodule groups was 90.2%, there was no significant difference compared with the single nodule group (90.2% vs 94.6%, P=0.205). The occurrence rate of pneumothorax in multiple nodule group and single nodule group was no statistical difference (21.6% vs 14.1%, P=0.179), however, the operation time in the multiple nodule group was significantly longer than the single nodule group [(30.6±6.6) min vs (19.9±7.4) min, P=0.000]. There were no serious complications such as massive hemoptysis, air embolism or hemothorax. There was no conversion to thoracotomy due to failure of localizing the nodules during operation. Sub-lobectomy was the main method of operation. The majority of postoperative pathologies were non-invasive carcinomas. CONCLUSIONS For multiple small lung pulmonary nodules requiring thoracoscopic surgery, according to certain strategies, preoperative CT-guided localized by microcoil in batches according to priority before VATS is safe and effective, and worthy of promotion.
Adult ; Aged ; Aged, 80 and over ; Female ; Humans ; Lung Neoplasms ; diagnostic imaging ; pathology ; surgery ; Male ; Middle Aged ; Multiple Pulmonary Nodules ; diagnostic imaging ; pathology ; surgery ; Preoperative Period ; Retrospective Studies ; Surgery, Computer-Assisted ; Thoracic Surgery, Video-Assisted ; instrumentation ; Tomography, X-Ray Computed ; Treatment Outcome ; Tumor Burden

In order to help a surgeon to determine a proper canal filing cutting path in a hip replacement operation conveniently, this paper presents a kind of probe with combined structure. Firstly, the doctor can use this kind of combined probe to choose canal filing cutting path. Then, the doctor can use computer to guide the surgeon to file femoral cavity along the selected canal filing cutting path. Through hip replacement corpse experiments, filing effects and used time of using combined probe group and separate control group were analyzed. The experiment results showed that the methods introduced in this paper could lower the difficulty of hip replacement operations, improve the implantation of hip stem prostheses further, and reduce the incidence of surgical complications.
Arthroplasty, Replacement, Hip ; Femur ; Hip Prosthesis ; Humans ; Surgery, Computer-Assisted ; instrumentation

OBJECTIVE: To review endonasal endoscopic surgeries aided by Fusion image guided system, and to explore the application value of Fusion image guided system in endonasal endoscopic surgeries. METHOD: Retrospective research. Sixty cases of endonasal endoscopic surgeries aided by Fusion image guided system were analysed including chronic rhinosinusitis with polyp (n = 10), fungus sinusitis (n = 5), endoscopic optic nerve decompression (n = 16), inverted papilloma of the paranasal sinus (n = 9), ossifying fibroma of sphenoid bone (n = 1), malignance of the paranasal sinus (n = 9), cerebrospinal fluid leak (n = 5), hemangioma of orbital apex (n = 2) and orbital reconstruction (n = 3). RESULT: Sixty cases of endonasal endoscopic surgeries completed successfully without any complications. Fusion image guided system can help to identify the ostium of paranasal sinus, lamina papyracea and skull base. Fused CT-CTA images, or fused MR-MRA images can help to localize the optic nerve or internal carotid arteiy . Fused CT-MR images can help to detect the range of the tumor. It spent (7.13 ± 1.358) minutes for image guided system to do preoperative preparation and the surgical navigation accuracy reached less than 1mm after proficient. There was no device localization problem because of block or head set loosed. CONCLUSION Fusion image guided system make endonasal endoscopic surgery to be a true microinvasive and exact surgery. It spends less preoperative preparation time, has high surgical navigation accuracy, improves the surgical safety and reduces the surgical complications.
Cerebrospinal Fluid Leak ; surgery ; Endoscopy ; instrumentation ; Fibroma, Ossifying ; surgery ; Humans ; Nasal Surgical Procedures ; methods ; Neurosurgical Procedures ; Nose ; pathology ; Papilloma, Inverted ; surgery ; Paranasal Sinuses ; pathology ; Retrospective Studies ; Sinusitis ; surgery ; Sphenoid Bone ; pathology ; Surgery, Computer-Assisted ; methods

OBJECTIVETo explore the ideal screw entry point and optimal trajectory for anterior C1 lateral mass screw internal fixation, and provide an anatomical basis for the technique of anterior C1 lateral mass screw placement.

METHODSA radiographic analysis of the anatomy of the C1 lateral mass using Computed tomography, CT scan was performed in cervical spine of 56 healthy Chinese adults (28 males, 28 females; mean age, 36.5 years; age range, 18-55 years), by using the Mimics software to reconstruct the 3-D morphology of C1 lateral mass and measuring the inside, middle and outside effective height of the C1 lateral mass in front and back. Measuring the C1 lateral mass safe width with different extraversion angles range from 0° to 30° with a uniform interval of 5°, to find out the ideal extraversion angle. Measuring the range of sagittal angle, to find out the ideal sagittal angle.

RESULTSThe inside (H1), middle (H3) and outside (H5) effective height of the C1 lateral mass in front is 6.67 mm, 12.09 mm, and 17.51 mm, the inside (H2), middle (H4) and outside(H6) effective height of the C1 lateral mass in back is 8.17 mm, 13.20 mm, and 18.22 mm. When the extraversion angle choose 0°, 5°, 10°, 15°, 20°, 25°, 30°, and δ, the relative results of safe width (SW) of lateral mass were 4.73 mm, 5.36 mm, 5.90 mm, 6.33 mm, 6.44 mm, 5.70 mm, 4.38 mm, 6.95 mm averagely. The mean distance along the atlas anterior surface between the anterior tubercle and the screw entry point was 12.80 mm, the mean distance from the inferior border of the lateral mass to the screw entry point was 6.87 mm. The range of sagittal angle is 24.22° (-17.74°∼6.48°) .

CONCLUSIONSThe ideal extraversion angle was 21.14°. The mean distance along the atlas anterior surface between the anterior tubercle and the screw entry point was 12.80 mm. The mean distance from the inferior border of the lateral mass to the screw entry point was 6.87 mm. The ideal sagittal angle is -5.63°. These measurements may facilitate anterior C1 lateral mass screw fixation decreasing the risk of injury to the spinal cord, vertebral artery, and internal carotid artery theoretically. Delineating the individual anatomy in each case with CT scan before surgery is recommended.

Adolescent ; Adult ; Bone Screws ; Carotid Artery, Internal ; diagnostic imaging ; Cervical Atlas ; Cervical Vertebrae ; diagnostic imaging ; surgery ; Female ; Fracture Fixation, Internal ; instrumentation ; Humans ; Image Processing, Computer-Assisted ; Male ; Middle Aged ; Reconstructive Surgical Procedures ; Tomography, X-Ray Computed ; Vertebral Artery ; diagnostic imaging ; Young Adult

BACKGROUND: Several studies have shown that better placement of the acetabular cup and femoral stem can be achieved in total hip arthroplasty (THA) by using the computer navigation system rather than the free-hand alignment methods. However, there have been no comparisons of the relevant clinical advantages in using the computer navigation as opposed to the manual intraoperative measurement devices. The purpose of this study is to determine whether the use of computer navigation can improve postoperative leg length discrepancy (LLD) compared to the use of the measurement device. METHODS: We performed a retrospective study comparing 30 computer-assisted THAs with 40 THAs performed using a simple manual measurement device. RESULTS: The postoperative LLD was 3.0 mm (range, 0 to 8 mm) in the computer-assisted group and 2.9 mm (range, 0 to 10 mm) in the device group. Statistically significant difference was not seen between the two groups. CONCLUSIONS: The results showed good equalization of the leg lengths using both computed tomography-based navigation and the simple manual measurement device.
Acetabulum/surgery ; Adult ; Aged, 80 and over ; Arthroplasty, Replacement, Hip/instrumentation/*methods ; Body Weights and Measures ; Female ; Femur/surgery ; Humans ; Leg ; Leg Length Inequality/*surgery ; Male ; Middle Aged ; Retrospective Studies ; Surgery, Computer-Assisted ; Young Adult

Various systems of computer-assisted orthopaedic surgery (CAOS) in total hip arthroplasty (THA) were reviewed. The first clinically applied system was an active robotic system (ROBODOC), which performed femoral implant cavity preparation as programmed preoperatively. Several reports on cementless THA with ROBODOC showed better stem alignment and less variance in limb-length inequality on radiographic evaluation, less incidence of pulmonary embolic events on transesophageal cardioechogram, and less stress shielding on the dual energy X-ray absorptiometry analysis than conventional manual methods. On the other hand, some studies raise issues with active systems, including a steep learning curve, muscle and nerve damage, and technical complications, such as a procedure stop due to a bone motion during cutting, requiring re-registration and registration failure. Semi-active robotic systems, such as Acrobot and Rio, were developed for ease of surgeon acceptance. The drill bit at the tip of the robotic arm is moved by a surgeon's hand, but it does not move outside of a milling path boundary, which is defined according to three-dimensional (3D) image-based preoperative planning. However, there are still few reports on THA with these semi-active systems. Thanks to the advancements in 3D sensor technology, navigation systems were developed. Navigation is a passive system, which does not perform any actions on patients. It only provides information and guidance to the surgeon who still uses conventional tools to perform the surgery. There are three types of navigation: computed tomography (CT)-based navigation, imageless navigation, and fluoro-navigation. CT-based navigation is the most accurate, but the preoperative planning on CT images takes time that increases cost and radiation exposure. Imageless navigation does not use CT images, but its accuracy depends on the technique of landmark pointing, and it does not take into account the individual uniqueness of the anatomy. Fluoroscopic navigation is good for trauma and spine surgeries, but its benefits are limited in the hip and knee reconstruction surgeries. Several studies have shown that the cup alignment with navigation is more precise than that of the conventional mechanical instruments, and that it is useful for optimizing limb length, range of motion, and stability. Recently, patient specific templates, based on CT images, have attracted attention and some early reports on cup placement, and resurfacing showed improved accuracy of the procedures. These various CAOS systems have pros and cons. Nonetheless, CAOS is a useful tool to help surgeons perform accurately what surgeons want to do in order to better achieve their clinical objectives. Thus, it is important that the surgeon fully understands what he or she should be trying to achieve in THA for each patient.
Arthroplasty, Replacement, Hip/instrumentation/*methods ; Humans ; *Robotics ; Stereotaxic Techniques ; *Surgery, Computer-Assisted

The Angio-Seal is a widely used arterial closure device that helps achieve faster hemostasis and provide early ambulation to patients. However, it can cause various complications in clinical practice. We present the uncommon complication of popliteal artery occlusion following Angio-Seal deployment, and describe an effective interventional approach to its treatment. Because fluoroscopy-guided Fogarty embolectomy has the advantages of complete removal of the embolus without fragmentation, and clear visualization of the exact location of the embolus during the procedure, it is a suitable method for treating this complication.
Embolectomy/*instrumentation ; Embolism/radiography/*surgery ; Equipment Design ; Fluoroscopy/*methods ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; *Popliteal Artery ; Surgery, Computer-Assisted/*methods

Bone Plates ; Computer-Aided Design ; Fracture Fixation, Internal ; instrumentation ; methods ; Humans ; Radiography ; Surgery, Computer-Assisted ; Zygomatic Fractures ; diagnostic imaging ; surgery

OBJECTIVETo investigate the feasibility of hip arthroplasty in the treatment of elderly patients with Evans I-III intertrochanteric fracture of femur by analyzing its biomechanics characters.

METHODSWe solved the CT digital image files with the graphics processing software Mimics at DICOM 3.0 standard, and reconstructed the three-dimensional entity of femur with CAD modeling software Unigraphics. Then the fracture line was defined in the model as the line between the tip of greater trochanter and inferior margin of small trochanter, above which the upper bone was removed. Afterwards the two prosthesises with different stem lengths (120 mm and 170 mm) were implanted into the fracture model respectively as hip arthroplasty with 3 mm bone cement layer between prosthesis and femur, and the bone defect was repatched with 5 mm bone cement layer. A three-dimensional finite element model was established with finite element analysis software ABAQUS 6.5. We formulated different material parameters under the stress condition standing with single leg to build the stress distribution map of the femur prosthesis, and took 5 loci of region of stress concentration to calculate the mean value of stress.

RESULTSThe stress distribution maps of the short and long stem length prothesises were similar. And there were two areas of stress concentration, including the upper portion and the lower portion close to the joint of the prosthesis stem, and the stress concentration in the junction part was obviously between the lower portion and the upper area of the small trachanter. The stress reached the first concentration area at the junction and then gradually reached the second concentration area at the interior terminal of the stem. While the stress gradually increased along the lateral prosthesis stem, and reached the stress concentration area at the end.

CONCLUSIONSThe stress distribution maps in the femur prosthesises are similar between hip arthroplasty in the treatment of intertrochanteric fracture of femur and the traditional hip arthroplasty surgery. The peak stress values are higher in the long stem prosthesis in the treatment of intertrochanteric fracture of femur than the short type, while they are under the rupture value of the metal.

Aged ; Arthroplasty, Replacement, Hip ; instrumentation ; methods ; Biomechanical Phenomena ; Bone Cements ; Computer Simulation ; Female ; Finite Element Analysis ; Hip Fractures ; surgery ; Hip Prosthesis ; Humans ; Image Processing, Computer-Assisted ; Software ; Stress, Mechanical