To study project of simpl icity and util ity for screw-plate system by pedicle of atlanto-axis mani pulatively hand by X-ray film and CT to prove the one success rate of putting screws. Methods Formulate personal program was used in operation by image save transmission of X-ray film and CT during January 2002 and September 2006 in 31 patients. There were 18 males and 13 femals, aged from 23 to 61 years old with an average age of 43.5 years. Putting screw points bypedicle of atlas were measured: left (19.93 ± 1.32) mm, right (19.16 ± 1.30) mm; putting screw obl iquity angle to inside by pedicle of atlas: left (23.72 ± 2.09)°, right (23.35 ± 1.91)°; putting screw obl iquity angle to side of head by pedicle of atlas: (9.00 ± 1.20)°. Screw points by pedicle of axis: left (13.14 ± 0.82) mm right (13.85 ± 0.79) mm; putting screw obl iquity angle to inside by pedicle of axis: left (24.52 ± 1.26)°, right (20.42 ± 1.42)°; putting screw obl iquity angle to side of head by pedicle of axis: (25.00 ± 3.00)°. The domestic location toward speculum was employed in operation and putting screw points and angles were formulated by X-CT program. The pedicle screws of suitable diameter and length were of exception and screws into pedicle of atlanto-axis were put by hand. Results Pain of the greater occipital nerve occurred in 2 patients after operation and was fully recovered by treatment 1 month after operation. The lateral cortical bone of pedicle was cut by 2 screws, but the spinal cord and vertebral artery were fine. The atlas and the fracture of odontoid process of axis were completely replaced in X-ray films of all patients 1 day after operation.The position relation of lag screw and vertebral artery or spinal cord was very good in CT sheets. All cases were followed up with an average of 10.5 months during 9 months to 5 years and 4 months, and obtained atlantoaxial arthrodesis. The breakage of screw and plate was not found in all cases. According to JOA score standard, 16 cases were excellent, 12 were good, 2 were fair, 1 was poor, and the excellent and good rate was 90.32% . Conclusion The personal design and cl inical appl ication of X-ray films and CT sheets are of great significance to screw-plate system by pedicle of atlanto-axis because of simpl ification of designs and methods and better personal ity.
ObjectiveTo discuss the feasibility and accuracy of distal femoral patient-specific cutting guide in total knee arthroplasty (TKA) based on knee CT and full-length X-ray film of lower extremities. MethodsBetween July 2016 and February 2017, 20 patients with severe knee joint osteoarthritis planned to undergo primary TKA were selected as the research object. There were 9 males and 11 females; aged 53-84 years, with an average of 69.4 years. The body mass index was 22.1-31.0 kg/m2, with an average of 24.8 kg/m2. The preoperative range of motion (ROM) of the knee joint was (103.0±19.4)°, the pain visual analogue scale (VAS) score was 5.4±1.3, and the American Hospital of Special Surgery (HSS) score was 58.1±11.3. Before operation, a three-dimensional model of the knee joint was constructed based on the full-length X-ray film of lower extremities and CT of the knee joint. The distal femoral patient-specific cutting guide was designed and fabricated, and the thickness of the distal femoral osteotomy was determined by digital simulation. The thickness of the internal and external condyle of the distal femur osteotomy before operation and the actual thickness of the intraoperative osteotomy were compared. The intraoperative blood loss, postoperative drainage loss, and hidden blood loss were recorded. The ROM of knee joint, VAS score, and HSS score at 3 months after operation were recorded to evaluate effectiveness. The position of the coronal and sagittal plane of the distal femoral prosthesis were assessed by comparing the femoral mechanical-anatomical angle (FMAA), anatomical lateral distal femoral angle (aLDFA), mechanical femoral tibial angle (mFTA), distal femoral flexion angle (DFFA), femoral prosthesis flexion angle (FPFA), anatomical lateral femoral component angle (aLFC), and the angle of the femoral component and femoral shaft (α angle) between pre- and post-operation.ResultsTKA was successfully completed with the aid of the distal femoral patient-specific cutting guide. There was no significant difference between the thickness of the internal and lateral condyle of the distal femur osteotomy before operation and the actual thickness of the intraoperative osteotomy (P>0.05). All patients were followed up 3 months. All incisions healed by first intention, and there was no complications such as periarticular infection and deep vein thrombosis. Except for 1 patient who was not treated with tranexamic acid, the intraoperative blood loss of the rest 19 patients ranged from 30 to 150 mL, with an average of 73.2 mL; the postoperative drainage loss ranged from 20 to 500 mL, with an average of 154.5 mL; and the hidden blood loss ranged from 169.2 to 1 400.0 mL, with an average of 643.8 mL. At 3 months after operation, the ROM of the knee was (111.5±11.5)°, and there was no significant difference when compared with the preoperative one (t=–1.962, P=0.065). The VAS score was 2.4±0.9 and HSS score was 88.2±7.5, showing significant differences when compared with the preoperative ones (t=7.248, P=0.000; t=–11.442, P=0.000). Compared with the preoperative measurements, there was a significant difference in mFTA (P<0.05), and there was no significant difference in aLDFA, FMAA, or DFFA; compared with the preoperative plan, there was no significant difference in FPFA, aLFC, or α angle (P>0.05). ConclusionThe use of distal femoral patient-specific cutting guide based on knee CT and full-length X-ray film of lower extremity can achieve precise osteotomy, improve coronal and sagittal limb alignment, reduce intraoperative blood loss, and obtain satisfactory short-term effectiveness.
Objective To investigate the relationship between hallux valgus and the indicators associated with medial cuneiform obliquity measured on feet weight-bearing anteroposterior X-ray films. Methods Based on the feet weight-bearing anteroposterior X-ray films taken between January 2018 and February 2021 and met the criteria, the hallux valgus angle (HVA), intermetatarsal angle (IMA), metatarsus adductus angle (MAA), metatarsus cuneiform angle (MCA), distal medial cuneiform angle (DMCA), and proximal metatarsal articular angle (PMAA) were measured and the morphology of the first tarsometatarsal (TMT) were recorded. According to the HVA, the X-ray films were divided into normal group (HVA<15°) and hallux valgus group (HVA≥15°). The gender, age, sides, IMA, MAA, MCA, DMCA, PMAA, and the morphology of TMT were compared between groups. The influencing factors of HVA and IMA were analyzed by multivariate linear regression analysis. Results X-ray films of 534 patients (679 feet) met the selection criteria and were included in the study. There were 220 males and 314 females, with an average age of 36 years (mean, 18-82 years). There were 154 cases (168 feet) in the normal group and 403 cases (511 feet) in the hallux valgus group. There were significant differences in gender and age between groups (P<0.05), and no significant difference in the side (P>0.05). The IMA, MAA, and MCA in the hallux valgus group were significantly bigger than those in the normal group (P<0.05); the difference in DMCA between the two groups was not significant (P>0.05). The TMT morphology of the two groups was mainly curved, and the difference in morphology classification was not significant (P>0.05). PMAA measurement showed that there were 3 kinds of metatarsal shapes: adductive metatarsal, neutral metatarsal, and abductive metatarsal, the difference in metatarsal shapes between groups was not significant (P>0.05). The PMAA of abductive metatarsal was significantly bigger in normal group than in hallux valgus group (P<0.05), there was no significant difference in PMAA of adductive metatarsal between groups (P>0.05). Multivariate linear regression analysis showed that age, MCA, and DMCA were the influencing factors of HVA (P<0.05), and age, MAA, MCA, and DMCA were the influencing factors of IMA (P<0.05). Conclusion The medial cuneiform obliquity is relatively constant and the DMCA can not be used as the characteristic angle to quantify hallux valgus. The morphology of TMT has no relationship with hallux valgus, while MAA, MCA, and PMAA are all factors to be considered, and MCA can be used as the characteristic angle to quantify hallux valgus.
Objective To explore the method of accurately estimating the acetabular cup prosthesis coverage rate (hereinafter referred to as “cup coverage rate”) in total hip arthroplasty (THA) based on X-ray films, and to determine the effective parameters that can be used to estimate the cup coverage rate. MethodsThe three-dimensional printed pelvic models were established based on CT data of 16 healthy pelvis, and the acetabular prosthesis were implanted according to conventional THA procedure. The length and width of the uncovered area of the acetabular cup prosthesis were measured by a modified X-ray recording method with a rotating C-arm X-ray machine, and the cup coverage rate was calculated. Then the differences among the traditional anteroposterior X-ray recording method, the modified method, and actual measurement on pelvic model were statistically analyzed. The correlation between the area of the uncovered area of the prosthesis and its width and length was analyzed by using multiple linear regression analysis. Results The cup coverage rates of traditional method, modified method, and actual measurement were 78.22%±3.36%, 86.74%±3.61%, and 89.62%±2.62%, respectively, with significant differences (P<0.05). The results of multiple linear regression analysis showed that the width and length were positively linear with the uncovered area of the prosthesis, and the regression equation was as follows: uncovered area of the prosthesis=−21.192+0.248×width+0.140×length, and the coefficient of determination R2=0.857, P<0.001. Conclusion Compared with the traditional method, the modified method can more accurately evaluate the cup coverage rate during THA, and the width of the uncovered area of the prosthesis can be used as an effective reference for the cup coverage rate.