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Comparison of Different Insertion Techniques for Lumbosacral Fixation Improvement: A Finite Element Study.

不同置入技术对腰骶部固定改良的比较: 有限元研究。

  • 影响因子:1.43
  • DOI:10.1111/os.12624
  • 作者列表:"Han DP","Wang JY
  • 发表时间:2020-02-01
Abstract

OBJECTIVE:We create a new S1 cortical screw trajectory technique using 3D reconstruction and the finite element (FE) method to provide a more reliable theoretical basis for clinical practices and to advance internal fixation technology for treatment of lumbosacral degenerative diseases. METHODS:This retrospective study included patients (aged from 40 to 70 years) who needed intervertebral fusion surgery between August 2016 and August 2017. Data of patients with lumbosacral lesions was scanned and measured by 64-row spiral CT, and were then transmitted to the GE-AW4.3 post-processing system for 3D reconstruction. The trajectories of the three different screws were simulated by FE software and processed by mimics software to simulate the screw path: traditional PS fixation (Model A); traditional cortical screw (Model B); and new cortical screw (Model C). The CT value of the bone around the screw canal was recorded. Biomechanical effects of the three screws were analyzed and compared. RESULTS:The displacement of flexion and extension, the vertebral body stress of right torsion, and the cage stress of flexion showed no significant differences among the three models (P > 0.05). The results demonstrated that cortical screws exceeded pedicle screws in stability and pullout force. Models B and C showed higher vertebral displacement in left bending (0.41 and 0.31 mm) and right bending (0.58 and 0.40 mm), lower vertebral body stress on extension (48.37 and 38.92 MPa), left bending (0.76 and 0.74 mm) and right bending (0.50 and 0.53 mm), and higher cage stress on left bending (162.19 and 160.63 MPa), right bending (150.02 and 150.05 MPa), left torsion (158.45 and 146.27 MPa) and right torsion (167.33 and 171.15 MPa) (all P < 0.05) compared to model A. Compared to Model B, Model C had higher displacement of left and right torsion, lower pressure in extension and flexion, and lower stress on cages in extension (P < 0.05). CONCLUSION:The new cortical screw insertion method has similar effects to traditional cortical screw fixation. However, it demonstrated advantages in promoting lumbosacral interbody fusion, which protects vessels and nerves.

摘要

目的: 建立一种新的S1皮质螺钉运动轨迹三维重建与有限元 (FE) 方法,为临床实践提供更可靠的理论依据,推进内固定技术在腰骶部退行性疾病治疗中的应用。 方法: 本回顾性研究包括2016年8月至2017年8月需要椎间融合手术的患者 (年龄40至70岁)。采用64排螺旋ct对腰骶部病变患者的数据进行扫描测量,然后传输至GE-AW4.3后处理系统进行三维重建。通过FE软件模拟三种不同螺钉的轨迹,并通过mimics软件进行处理,以模拟螺钉路径: 传统PS固定 (模型A); 传统皮质螺钉 (模型B); 以及新型皮质螺钉 (模型C)。记录螺钉管周围骨的ct值。分析比较三种螺钉的生物力学效果。 结果: 3种模型的屈伸位移、右侧扭转椎体应力、屈曲cage应力差异无统计学意义 (P> 0.05)。结果表明,皮质螺钉在稳定性和拔出力方面超过了椎弓根螺钉。模型B和C显示左侧弯曲 (0.41和0.31  mm) 和右侧弯曲 (0.58和0.40  mm) 的椎体位移较高,伸展时椎体应力较低 (48.37和38.92 MPa),左侧弯曲 (0.76和0.74  mm) 和右侧弯曲 (0.50和0.53  mm),和更高的笼应力对左弯曲(162.19和160.63 MPa) 、右弯曲 (150.02和150.05 MPa) 、左扭转 (158.45和146.27 MPa) 和右扭转 (167.33和171.15 MPa) (均P <0.05) 与模型A相比。与模型B相比,模型C的左右扭转位移较高,伸屈压力较低,伸直笼应力较低 (P <0.05)。 结论: 新型皮质螺钉置入方法与传统皮质螺钉固定方法效果相似。然而,它在促进腰骶部椎间融合方面显示出优势,其保护血管和神经。

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发表时间:2020-01-01
来源期刊:European radiology
DOI:10.1007/s00330-019-06319-0
作者列表:["Delattre BMA","Boudabbous S","Hansen C","Neroladaki A","Hachulla AL","Vargas MI"]

METHODS:OBJECTIVES:The aim was to evaluate the image quality and sensitivity to artifacts of compressed sensing (CS) acceleration technique, applied to 3D or breath-hold sequences in different clinical applications from brain to knee. METHODS:CS with an acceleration from 30 to 60% and conventional MRI sequences were performed in 10 different applications in 107 patients, leading to 120 comparisons. Readers were blinded to the technique for quantitative (contrast-to-noise ratio or functional measurements for cardiac cine) and qualitative (image quality, artifacts, diagnostic findings, and preference) image analyses. RESULTS:No statistically significant difference in image quality or artifacts was found for each sequence except for the cardiac cine CS for one of both readers and for the wrist 3D proton density (PD)-weighted CS sequence which showed less motion artifacts due to the reduced acquisition time. The contrast-to-noise ratio was lower for the elbow CS sequence but not statistically different in all other applications. Diagnostic findings were similar between conventional and CS sequence for all the comparisons except for four cases where motion artifacts corrupted either the conventional or the CS sequence. CONCLUSIONS:The evaluated CS sequences are ready to be used in clinical daily practice except for the elbow application which requires a lower acceleration. The CS factor should be tuned for each organ and sequence to obtain good image quality. It leads to 30% to 60% acceleration in the applications evaluated in this study which has a significant impact on clinical workflow. KEY POINTS:• Clinical implementation of compressed sensing (CS) reduced scan times of at least 30% with only minor penalty in image quality and no change in diagnostic findings. • The CS acceleration factor has to be tuned separately for each organ and sequence to guarantee similar image quality than conventional acquisition. • At least 30% and up to 60% acceleration is feasible in specific sequences in clinical routine.

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影响因子:2.98
发表时间:2020-01-01
DOI:10.1136/neurintsurg-2019-014962
作者列表:["Guo W","Liu H","Tan Z","Zhang X","Gao J","Zhang L","Guo H","Bai H","Cui W","Liu X","Wu X","Luo J","Qu Y"]

METHODS:BACKGROUND:The main surgical techniques for spontaneous basal ganglia hemorrhage include stereotactic aspiration, endoscopic aspiration, and craniotomy. However, credible evidence is still needed to validate the effect of these techniques. OBJECTIVE:To explore the long-term outcomes of the three surgical techniques in the treatment of spontaneous basal ganglia hemorrhage. METHODS:Five hundred and sixteen patients with spontaneous basal ganglia hemorrhage who received stereotactic aspiration, endoscopic aspiration, or craniotomy were reviewed retrospectively. Six-month mortality and the modified Rankin Scale score were the primary and secondary outcomes, respectively. A multivariate logistic regression model was used to assess the effects of different surgical techniques on patient outcomes. RESULTS:For the entire cohort, the 6-month mortality in the endoscopic aspiration group was significantly lower than that in the stereotactic aspiration group (odds ratio (OR) 4.280, 95% CI 2.186 to 8.380); the 6-month mortality in the endoscopic aspiration group was lower than that in the craniotomy group, but the difference was not significant (OR=1.930, 95% CI 0.835 to 4.465). A further subgroup analysis was stratified by hematoma volume. The mortality in the endoscopic aspiration group was significantly lower than in the stereotactic aspiration group in the medium (≥40-<80 mL) (OR=2.438, 95% CI 1.101 to 5.402) and large hematoma subgroup (≥80 mL) (OR=66.532, 95% CI 6.345 to 697.675). Compared with the endoscopic aspiration group, a trend towards increased mortality was observed in the large hematoma subgroup of the craniotomy group (OR=8.721, 95% CI 0.933 to 81.551). CONCLUSION:Endoscopic aspiration can decrease the 6-month mortality of spontaneous basal ganglia hemorrhage, especially in patients with a hematoma volume ≥40 mL.

影响因子:0.96
发表时间:2020-02-01
DOI:10.1002/jcu.22762
作者列表:["Meng L","Zhao D","Yang Z","Wang B"]

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