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3D planning in mandibular fractures using CAD/CAM surgical splints - A prospective randomized controlled clinical trial.

使用CAD/CAM手术夹板在下颌骨骨折中的3D规划-一项前瞻性随机对照临床试验。

  • 影响因子:2.15
  • DOI:10.1016/j.jcms.2020.02.004
  • 作者列表:"Ramanathan M","Panneerselvam E","Krishna Kumar Raja VB
  • 发表时间:2020-04-01
Abstract

:This randomized controlled trial assessed the role of CAD/CAM splints in achieving anatomic reduction of fractured fragments and ideal occlusion, in comparison with conventional splints. Patients diagnosed with displaced mandibular fracture and post-traumatic malocclusion were allocated to study and control groups by simple randomization. A standardized surgical approach was followed to expose the fractures. Reduction of fractures was carried out using CAD/CAM and conventional splints in the study and control groups, respectively. The parameters assessed were: occlusion, interfragmentary separation, fit of the splint, patient comfort, and surgeon comfort. Mann-Whitney U tests were used to compare the study and control groups. To compare the groups pre- and post-intervention Wilcoxon signed rank tests were used. Chi-square tests were applied for proportion comparisons. The sample consisted of 30 patients. The study group demonstrated superior clinical outcomes with regards to intraoperative reduction of fracture (p < 0.001; mean - 3.93, SD - 1.43), and to achieving intraoperative occlusion (p = 0.483) and postoperative occlusion (p = 0.224). Statistically significant improvements in both patient comfort (p < 0.001; mean - 0.20, SD - 0.41) and surgeon comfort (p < 0.001) were found in the study group. In conclusion, CAD/CAM splints improve precision in fracture reduction and restoration of occlusion through a simple fabrication process.

摘要

: 与传统夹板相比,这项随机对照试验评估了CAD/CAM夹板在实现骨折碎片解剖减少和理想闭塞方面的作用。通过简单随机化将诊断为移位的下颌骨骨折和创伤后错牙合畸形的患者分配到研究组和对照组。采用标准化手术方法暴露骨折。在研究组和对照组中分别使用CAD/CAM和常规夹板进行骨折复位。评估的参数是: 闭塞、片段间分离、夹板的配合、患者舒适度和外科医生舒适度。使用Mann-Whitney U检验来比较研究组和对照组。为了比较干预前和干预后的组,使用Wilcoxon符号秩和检验。应用卡方检验进行比例比较。样本由30名患者组成。研究组在术中骨折复位 (p < 0.001; 平均值-3.93,SD-1.43) 以及术中闭塞 (p = 0.483) 和术后闭塞 (p = 0.224) 方面显示出优越的临床结果。在研究组中发现了患者舒适度 (p < 0.001; 平均值-0.20,SD-0.41) 和外科医生舒适度 (p < 0.001) 的统计学显著改善。总之,CAD/CAM夹板通过简单的制造工艺提高了骨折复位和咬合恢复的精度。

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影响因子:4.08
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"]

METHODS:OBJECTIVE:The primary purpose of this study was to evaluate the effectiveness of a three-dimensional (3D) software tool (smart planes) for displaying fetal brain planes, and the secondary purpose was to evaluate its accuracy in performing automatic measurements. MATERIAL AND METHODS:This prospective study included singleton fetuses with a gestational age (GA) greater than 18 weeks. Transabdominal two-dimensional ultrasound (2DUS) and 3D smart planes images were respectively used to obtain the basic planes of the fetal brain, with five parameters measured. The images, by either two-dimensional (2D) manual or 3D automatic operation, were reviewed by two experienced sonographers. The agreements between two measurements were analyzed. RESULTS:A total of 226 cases were included. The rates of successful detection by automatic display were as high as 80%. There was substantial agreement between the measurements of the biparietal diameter, head circumference and transcerebellar diameter, but poor agreement between the measurements of cisterna magna and lateral ventricle width. CONCLUSIONS:Smart Planes might be valuable for the rapid evaluation of fetal brain, because it simplifies the evaluation process. However, the technology requires improvement. In addition, this technology cannot replace the conventional manual US scans; it can only be used as an additional approach.

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