This study was aimed to improve the surgical accuracy of plating and screwing for complicated tibial plateau fracture assisted by 3D implants library and 3D-printed navigational template. Clinical cases were performed whereby complicated tibial plateau fractures were imaged using computed tomography and reconstructed into 3D fracture prototypes. The preoperative planning of anatomic matching plate with appropriate screw trajectories was performed with the help of the library of 3D models of implants. According to the optimal planning, patient-specific navigational templates produced by 3D printer were used to accurately guide the real surgical implantation. The fixation outcomes in term of the deviations of screw placement between preoperative and postoperative screw trajectories were measured and compared, including the screw lengths, entry point locations and screw directions. With virtual preoperative planning, we have achieved optimal and accurate fixation outcomes in the real clinical surgeries. The deviations of screw length was 1.57 ± 5.77 mm, P > 0.05. The displacements of the entry points in the x-, y-, and z-axis were 0.23 ± 0.62, 0.83 ± 1.91, and 0.46 ± 0.67 mm, respectively, P > 0.05. The deviations of projection angle in the coronal (x-y) and transverse (x-z) planes were 6.34 ± 3.42° and 4.68 ± 3.94°, respectively, P > 0.05. There was no significant difference in the deviations of screw length, entry point and projection angle between the ideal and real screw trajectories. The ideal and accurate preoperative planning of plating and screwing can be achieved in the real surgery assisted by the 3D models library of implants and the patient-specific navigational template. This technology improves the accuracy and efficiency of personalized internal fixation surgery and we have proved this in our clinical applications.
Limited-angle computed tomography (CT) image reconstruction is a challenging reconstruction problem in the fields of CT. With the development of deep learning, the generative adversarial network (GAN) perform well in image restoration by approximating the distribution of training sample data. In this paper, we proposed an effective GAN-based inpainting method to restore the missing sinogram data for limited-angle scanning. To estimate the missing data, we design the generator and discriminator of the patch-GAN and train the network to learn the data distribution of the sinogram. We obtain the reconstructed image from the restored sinogram by filtered back projection and simultaneous algebraic reconstruction technique with total variation. Experimental results show that serious artifacts caused by missing projection data can be reduced by the proposed method, and it is hopeful to solve the reconstruction problem of 60° limited scanning angle.
Background: Currently, both minimally invasive plate osteosynthesis (MIPO) and intramedullary nailing are the two most commonly used methods of treatment in distal tibial fractures, but controversy still exists regarding the clinical effects of 2 techniques. Our purposes were to compare MIPO and intramedullary nailing for distal tibia shaft fractures by assessing functional outcomes and complications. Methods: Data were collected retrospectively from the charts of patients treated for distal tibial extra-articular fractures between May 2012 and July 2018. All cases were performed by a single surgeon. Institutional review board approval in the Second Affiliated Hospital of Army Medical University was obtained prior to conducting chart review and analysis. The criteria for inclusion in the study were being aged at least 18 years at the time of diagnosis and having a closed or type I open fracture of the distal third of the tibial diaphysis. The primary outcome compared between the 2 groups was the American Orthopedic Foot and Ankle surgery score. The secondary outcome measures in this trial included Olerud and Molander Ankle Score, radiographic outcomes, and complications. Statistical analysis was performed using SPSS version. P values < .05 were considered statistically significant. Results: We hypothesized that MIPO would be associated with better functional outcomes and fewer complications. Trial registration: This study protocol was registered in Research Registry (researchregistry5808).
Projection and back-projection are the most computationally intensive parts in Computed Tomography (CT) reconstruction, and are essential to acceleration of CT reconstruction algorithms. Compared to back-projection, parallelization efficiency in projection is highly limited by racing condition and thread unsynchronization. In this paper, a strategy of Fixed Sampling Number Projection (FSNP) is proposed to ensure the operation synchronization in the ray-driven projection with Graphical Processing Unit (GPU). Texture fetching is also used utilized to further accelerate the interpolations in both projection and back-projection. We validate the performance of this FSNP approach using both simulated and real cone-beam CT data. Experimental results show that compare to the conventional approach, the proposed FSNP method together with texture fetching is 10~16 times faster than the conventional approach based on global memory, and thus leads to more efficient iterative algorithm in CT reconstruction.
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