Background:Old pelvis fractures are among the most challenging fractures to treat because of their complex anatomy, difficult-to-access surgical sites, and the relatively low incidence of such cases. Proper evaluation and surgical planning are necessary to achieve the pelvic ring symmetry and stable fixation of the fracture. The goal of this study was to assess the use of three-dimensional (3D) printing techniques for surgical management of old pelvic fractures.Methods:First, 16 dried human cadaveric pelvises were used to confirm the anatomical accuracy of the 3D models printed based on radiographic data. Next, nine clinical cases between January 2009 and April 2013 were used to evaluate the surgical reconstruction based on the 3D printed models. The pelvic injuries were all type C, and the average time from injury to reconstruction was 11 weeks (range: 8–17 weeks). The workflow consisted of: (1) Printing patient-specific bone models based on preoperative computed tomography (CT) scans, (2) virtual fracture reduction using the printed 3D anatomic template, (3) virtual fracture fixation using Kirschner wires, and (4) preoperatively measuring the osteotomy and implant position relative to landmarks using the virtually defined deformation. These models aided communication between surgical team members during the procedure. This technique was validated by comparing the preoperative planning to the intraoperative procedure.Results:The accuracy of the 3D printed models was within specification. Production of a model from standard CT DICOM data took 7 hours (range: 6–9 hours). Preoperative planning using the 3D printed models was feasible in all cases. Good correlation was found between the preoperative planning and postoperative follow-up X-ray in all nine cases. The patients were followed for 3–29 months (median: 5 months). The fracture healing time was 9–17 weeks (mean: 10 weeks). No delayed incision healing, wound infection, or nonunions occurred. The results were excellent in two cases, good in five, and poor in two based on the Majeed score.Conclusions:The 3D printing planning technique for pelvic surgery was successfully integrated into a clinical workflow to improve patient-specific preoperative planning by providing a visual and haptic model of the injury and allowing patient-specific adaptation of each osteosynthesis implant to the virtually reduced pelvis.
Objective: To compare the postoperative inflammation and pain response between medial pivot (MP) and posterior stabilized (PS) prostheses among total knee arthroplasty (TKA) patients. Methods: A prospective cohort study was conducted from January 2019 to May 2019 at the Affiliated Hospital of Qingdao University. The study included patients diagnosed with stage III or IV Kellgren-Lawrence knee osteoarthritis (KOA) who had failed conservative treatment, had undergone no previous knee surgeries, had varus substantial deformities (11-20 deviation), and had received their first unilateral TKA. A total of 109 patients who underwent PS prosthesis TKA and 98 patients who underwent MP prosthesis TKA were continuously enrolled. Inflammation biomarkers, such as leukocyte (white blood cells), erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP), together with hemoglobin (Hb), the visual analog pain score (VAS) and range of motion (ROM) were compared between the two groups. The Student t-test was applied to analyze continuous parameters, and the χ 2-test was used for categorical parameters. The linear mixed model was used for the repeated measurement data from the follow-up visits. Multivariate backward logistic and linear regression models were used to determine the factors potentially influencing prostheses and VAS scores. Results: All these enrolled patients were followed up at 2, 4, 7, and 30 days after TKA. There were no significant differences between the PS group and the MP group in body mass index (BMI), gender, laterality, usage of nonsteroidal antiinflammatory drugs (NSAIDs) and opioids, and drain tube extubation time (P > 0.05). Compared with the PS group, the MP group were older (67.5 years vs 65.4 years), and had a higher mid-vastus approach rate (67.3% vs 26.6%), a shorter tourniquet duration (68.3 AE 10.2 h vs 73.9 AE 11.2 h), a larger prosthetic pad (10.8 AE 1.2 mm vs 10.4 AE 1.2 mm), and a lower drain tube diversion volume (187.6 AE 119.3 mL vs 234.0 AE 155.7 mL). In the linear mixed model, MP prostheses had less CRP and ESR elevation and less Hb decrease than PS prostheses (P for group × time < 0.001). There were no significant differences in the changing trends between MP and PS prostheses by time for VAS scores and ROM. In the multivariate logistic regression model, MP prostheses showed significant differences compared with PS prostheses in treatment approach (odds ratio [OR] = 3.371, 95% confidence interval [CI]: 1.953-7.127; P < 0.001), ultrasound treatment start time (OR = 2.669, 95% CI: 1.385-5.141; P = 0.003), and tourniquet duration (OR = 0.954, 95% CI: 0.925-0.984; P = 0.003). Higher VAS scores on the second day postoperatively were related to high VAS scores preoperatively, use of opioids, high drain tube diversion, long tourniquet duration, and long drain tube extubation (P < 0.05), respectively. Conclusion: The MP prostheses showed potential advantages compared with PS prostheses in TKA in inflammatory responses.
Objective To compare the clinical outcomes of Medial-pivot and Posterior-stablized total knee arthroplasty during 8 years follow-up. Methods 109 patients with osteoarthritis who underwent primary total knee arthroplasty were conducted and divided into two groups according to the choice of prosthesis,49 in the Medial-pivot(MP) group and 60 in the Postirior-stabilized(PS) group.There were no statistical differences in age,gender,BMI,operative side and operation time between the two groups (P>0.05).The same protocol of perioperative treatment was adopted in both groups. Comparison of clinical outcome and survival rates were acquired through minimum 8 years follow-up. Results The prosthesis survival rate andthe excellent and good rate of MP group were 93.9% and 88.9% during average 8.3 years follow-up period,versus the prosthesis survival rate and the excellent or good rate of PS group were 93.3% and 86.7% during average 8.4 years follow-up period.There were no statistical diferences in survival rate,excellent and good rate and radiolucency of weight-bearing areas between the two groups ( P >0.05). There were no statistical differences in range of motion,KSS score and WOMAC index between the two groups preoperatively (P>0.05).The range of motion at all follow-up time points and KSS score at 6 months postoperatively of PS group were superior than those of MP group ( P <0.05),while the WOMAC index at 8 years postoperatively and Kujala scores at 1year and 8 years postoperatively of PS group were better than those of MP group( P <0.05). Conclusion Either medial-pivot or post-stabilized total knee arthroplasty could obtain excellent or good mid-term clinical result. Although with less range of motion, the patients using MP prosthesis could obtain better results in bone loss, performance of the patellofemoral joint and mid-term satisfaction. However, the use of MP prosthesis required more professional and precise technology and it should be cautious when using for knees with severe valgus deformation.
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