Name: individualized stem-positioning in calcar-guided short-stem total hip arthroplasty
Uploaded: 2018-02-27T14:00:00.000+00:00
Duration: 9 min 31 s
Description: Watch this Scientific Journal Video about Individualized Stem-positioning in Calcar-guided Short-stem Total Hip Arthroplasty at JoVE.com

Mathys 有限公司, 瑞士支持临床和放射多中心研究的资金。

所提交的研究是按照所有机构、国家和国际人类福利准则进行的。已获得机构审查委员会的批准。
<ol><li>将病人放置在一个标准的手术台上, 用两支独立的腿支撑。让同侧的腿保持移动。</li>
	<li>适用于仰卧位 antero 侧入路的标准不育覆盖率。</li>
	<li>用膝辊稍稍弯曲同侧一侧。此外, hyperextend 对侧边约为股骨准备。</li>
	<li>以触诊为导向, 定位大转子的尖端以及髂前上棘。</li>
	<li>使用手术刀 (6-12 厘米, 根据病人的解剖) 进行皮肤切口, 以大转子的尖端为中心, 瞄准在臀臀和张量之间的肌间隔上方的髂前上棘阔阔.</li>
	<li>皮下脂肪切开后, 使用两个皮肤拉钩前方和向后。打开筋膜, 不会对张量阔阔造成损伤。</li>
	<li>使用你的食指做一个钝的解剖, 推动臀部肌肉向后没有损伤。</li>
	<li>用三拉钩暴露关节囊。</li>
	<li>在股骨颈旁执行 capsulectomy。 注意: 没有任何肌肉的尖锐解剖, 特别是臀肌, 是需要的。</li>
	<li>切除前关节囊, 暴露股骨颈, 以执行截骨通过放置两个面对弯曲拉钩髋关节周围的股骨颈 (图 1)。 注意: 在股骨引导的短茎的植入中最重要的一步是选择截骨的个体水平。这样, 阀杆定位可以在很大的变化中单独进行, 从而产生大量的 CCD 角带宽 (图 2;图 3)。因此, 术前规划是强制性的, 以显示确切的水平 (图 4: 红线 (OL: 截骨水平))。</li>
	<li>对于外科医生的定位, 为了确定截骨的水平, 对较小的转子和窝梨进行触诊。如果根据先前存在的解剖学需要一个外翻位置, 则通过切除大部分股骨颈 (图 5a) 远端截骨。根据术前计划 (图 5c), 为了使茎在内翻的位置, 切除下部, 保留大部分股骨颈。因此, 可以精确地维持股骨偏移和腿部长度 (图 5)。</li>
	<li>根据术前规划使用长的硬刃摆动锯, 执行截骨 (图 1) 在同侧腿轻微的外部旋转。</li>
	<li>用股骨头提取器从髋臼中取出股骨头。为了保护臀臀, 放置一个 "Langenbeck"-牵引器内侧和拉下部。</li>
	<li>在髋臼准备过程中, 在髋臼的近端插入一个 "多根斯氏" 针, 以保护臀肌。</li>
	<li>用两个萃取器暴露髋臼。</li>
	<li>根据术前规划, 根据患者的个体解剖, 植入髋臼部分。</li>
	<li>为股骨准备, 首先取出膝部卷和 hyperextend 的对侧腿约。现在执行90°外部旋转和最大的90°屈膝关节。让助手把主题的腿放在最大的内收 (约 40°)。</li>
	<li>定位两个拉钩在股骨近端的内侧, 下部在股骨颈的后 (内侧) 皮质端。避免接触大转子, 以尽量减少可能损害骨骼和肌肉插入的风险。</li>
	<li>应用 "圆角" 技术打开股骨近端的股骨与弧形开口锥。 注意: 后结构如大转子或臀肌不受影响。</li>
	<li>在轻柔的特殊弯曲, 种植体形状的锉在提升大小使用锤子, 以准备股骨近端和股管, 直到皮质接触和稳定的适应和填充达到。请注意, 双偏移微创锉手柄可用。在 "圆角" 技术 (图 6) 中, 执行由股骨引导的插入。</li>
	<li>根据术前计划, 选择两个可用的不同偏移量版本 (标准和横向偏移) 的试验锥之一。</li>
	<li>使用数字图像增强器在插入试验头并进行试验复位后, 评估术中透视图, 将锉 (试用植入物) 的定位与术前规划 (图 7) 进行比较。进行前后牙片。要屏蔽第二个平面, 还要执行轴向视图射线照相。如有必要, 执行调整。 注意: 到达皮质接触对术后塌陷的危险性至关重要。避免 undersizing!(图 8)</li>
	<li>移除试用植入物, 并插入含有所选胶印版本的最终植入器, 使用特殊的植入式撞击器。请注意, 原始词干与试用锉 (图 9) 完全一致。</li>
	<li>在最终复位后, 应用轴向张力和腿部内旋转, 完成标准伤口闭合的程序。</li>
	<li>在大多数情况下, 在手术后使用2根拐杖在理疗监视下开始4小时后, 允许全负重。 注意: 在重症患者中, 初级稳定性可能受损, 因此, 必须相应调整负重协议。</li>
	<li>根据所记录的疼痛强度, 非甾体抗炎药 (NSAID), 预防异位骨化, 静脉血栓栓塞预防, 提供止痛药。</li>
</ol>

<ol>
	<li>Jerosch, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=.">.</a> Kurzschaftendoprothesen an der H&#252;fte. , (2017).</li><li>Kutzner, K. P., Donner, S., Schneider, M., Pfeil, J., Rehbein, P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=One-stage+bilateral+implantation+of+a+calcar-guided+short-stem+in+total+hip+arthroplasty.">One-stage bilateral implantation of a calcar-guided short-stem in total hip arthroplasty.</a> Oper Orthop Traumatol. , (2017).</li><li>Anderl, C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=2-Jahres-Ergebnisse+mit+dem+Optimys-Kurzschaft+über+den+direkten+anterolateralen+Zugang.+JATROS.">2-Jahres-Ergebnisse mit dem Optimys-Kurzschaft über den direkten anterolateralen Zugang. JATROS.</a> Orthop&#228;die &amp; Rheumatologie 05/2015. 05, (2015).</li><li>Kutzner, K. P., Kovacevic, M. P., Roeder, C., Rehbein, P., Pfeil, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Reconstruction+of+femoro-acetabular+offsets+using+a+short-stem.">Reconstruction of femoro-acetabular offsets using a short-stem.</a> Int Orthop. 39 (7), 1269-1275 (2015).</li><li>Matsushita, A., Nakashima, Y., Jingushi, S., Yamamoto, T., Kuraoka, A., Iwamoto, Y. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Effects+of+the+Femoral+Offset+and+the+Head+Size+on+the+Safe+Range+of+Motion+in+Total+Hip+Arthroplasty.">Effects of the Femoral Offset and the Head Size on the Safe Range of Motion in Total Hip Arthroplasty.</a> J Arthroplasty. 24, 646-651 (2009).</li><li>Asayama, I., Chamnongkich, S., Simpson, K. J., Kinsey, T. L., Mahoney, O. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Reconstructed+hip+joint+position+and+abductor+muscle+strength+after+total+hip+arthroplasty.">Reconstructed hip joint position and abductor muscle strength after total hip arthroplasty.</a> J Arthroplasty. 20, 414-420 (2005).</li><li>Kutzner, K. P., Pfeil, J., Kovacevic, M. P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Preoperative+digital+planning+versus+postoperative+outcomes+in+total+hip+arthroplasty+using+a+calcar-guided+short+stem:+frequent+valgization+can+be+avoided.">Preoperative digital planning versus postoperative outcomes in total hip arthroplasty using a calcar-guided short stem: frequent valgization can be avoided.</a> Eur J Orthop Surg Traumatol. 27 (5), 643-651 (2017).</li><li>H&#246;hle, P., Schr&#246;der, S. M., Pfeil, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Comparison+between+preoperative+digital+planning+and+postoperative+outcomes+in+197+hip+endoprosthesis+cases+using+short+stem+prostheses.">Comparison between preoperative digital planning and postoperative outcomes in 197 hip endoprosthesis cases using short stem prostheses.</a> Clin Biomech. 30 (1), 46-52 (2015).</li><li>Kutzner, K. P., Freitag, T., Donner, S., Kovacevic, M. P., Bieger, R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Outcome+of+extensive+varus+and+valgus+stem+alignment+in+short-stem+THA:+clinical+and+radiological+analysis+using+EBRA-FCA.">Outcome of extensive varus and valgus stem alignment in short-stem THA: clinical and radiological analysis using EBRA-FCA.</a> Arch Orthop Trauma Surg. (3), 431-439 (2016).</li><li>Kutzner, K. P., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Incidence+of+heterotopic+ossification+in+minimally+invasive+short-stem+THA+using+the+modified+anterolateral+approach.">Incidence of heterotopic ossification in minimally invasive short-stem THA using the modified anterolateral approach.</a> Hip Int. , (2017).</li><li>Kutzner, K. P., Kovacevic, M. P., Roeder, C., Rehbein, P., Pfeil, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Reconstruction+of+femoro-acetabular+offsets+using+a+short-stem.">Reconstruction of femoro-acetabular offsets using a short-stem.</a> Int Orthop. , (2014).</li><li>Kutzner, K. P., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=One-stage+bilateral+versus+unilateral+short-stem+total+hip+arthroplasty:+comparison+of+migration+patterns+using+"Ein-Bild-Roentgen-Analysis+Femoral-Component-Analysis".">One-stage bilateral versus unilateral short-stem total hip arthroplasty: comparison of migration patterns using "Ein-Bild-Roentgen-Analysis Femoral-Component-Analysis".</a> Int Orthop. 41 (1), 61-66 (2017).</li><li>Kutzner, K. P., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Radiographic+alterations+in+short-stem+total+hip+arthroplasty:+a+2-year+follow-up+study+of+216+cases.">Radiographic alterations in short-stem total hip arthroplasty: a 2-year follow-up study of 216 cases.</a> Hip Int. 26 (3), 278-283 (2016).</li><li>Kutzner, K. P., Kovacevic, M. P., Freitag, T., Fuchs, A., Reichel, H., Bieger, R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Influence+of+patient-related+characteristics+on+early+migration+in+calcar-guided+short-stem+total+hip+arthroplasty:+a+2-year+migration+analysis+using+EBRA-FCA.">Influence of patient-related characteristics on early migration in calcar-guided short-stem total hip arthroplasty: a 2-year migration analysis using EBRA-FCA.</a> J Orthop Surg Res. 11 (1), 29 (2016).</li><li>Kovacevic, M. P., Pfeil, J., Kutzner, K. P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Implantation+of+a+new+short+stem+in+simultaneous+bilateral+hip+arthroplasty+-+a+prospective+study+on+clinical+and+radiographic+data+of+54+consecutive+patients.">Implantation of a new short stem in simultaneous bilateral hip arthroplasty - a prospective study on clinical and radiographic data of 54 consecutive patients.</a> OUP. 10, 456-461 (2014).</li><li>Hochreiter, J., Hejkrlik, W., Emmanuel, K., Hitzl, W., Ortmaier, R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Blood+loss+and+transfusion+rate+in+short+stem+hip+arthroplasty.+A+comparative+study.">Blood loss and transfusion rate in short stem hip arthroplasty. A comparative study.</a> Int Orthop. , 1-7 (2016).</li><li>Bieger, R., Ignatius, A., Decking, R., Claes, L., Reichel, H., D&#252;rselen, L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Primary+stability+and+strain+distribution+of+cementless+hip+stems+as+a+function+of+implant+design.">Primary stability and strain distribution of cementless hip stems as a function of implant design.</a> Clin Biomech. 27 (2), 158-164 (2012).</li><li>Loweg, L., Kutzner, K. P., Rehbein, P., Stephan, H., Pfeil, J., Schneider, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Wertigkeit+der+intraoperativen+R&#246;ntgenkontrolle+in+der+prim&#228;ren+H&#252;ftendoprothetik.">Wertigkeit der intraoperativen R&#246;ntgenkontrolle in der prim&#228;ren H&#252;ftendoprothetik.</a> OUP. 5 (6), 334-338 (2016).</li></ol>

j. Pfeil 是瑞士 Mathys 有限公司的一名医疗顾问。

在现代临屋区, 与传统的直杆设计相比, 股骨引导短茎在短期随访中提供了许多优势。然而, 在中期和长期后续行动方面, 只发表了一些结果。
由于股骨短茎的短而弯曲的设计, 软组织备用植入似乎在技术上很容易。然而, 个性化植入技术需要对不同的内翻和外翻定位的特点有明确的认识。必须考虑到一个严重的学习曲线。
修改和疑难解答:
考虑到股骨引导短茎的个性化定位, 术前规划的准备是绝对强制性的8 (图 4)。除了检测正确的种植体大小, 特别是对齐的茎和所期望的水平截骨可以确定。术, 使用插入的试验锉, 在髋部复位后, 可以通过执行术中透视19 (图 7) 进行术前规划的比较。植入物的侧肩作为方向关于腿长度。
技术的局限性:
调查建议使用股骨引导的短茎5,8 (图 2) 充分重建不同髋关节剖析的宽带宽。图 3)。以前的研究调查了广泛的内翻和外翻茎对齐的结果10。2年后, 不需要进行翻修手术, 而放射学改变表明总的异常应力分布率较低。然而, 尤其对于外翻髋, 有明显的初始沉降被观察到10。
尤其对于年轻和小看的外科医生来说, 所提出的技术可能会带来意想不到的缺陷。
对于现有方法的意义:
股骨引导短茎的植入技术不同于常规的直茎和某些颈部切除和颈部保留短茎。常规的直茎提供骨干锚地和主要标准化水平的股骨颈截骨。现有的髋关节解剖只能通过使用不同的植入体5的胶印版本来重建。例如, 在广泛的内翻剖析中, 这通常无法正确实现 (图 10)。Valgization 已经被发现是成功重建髋几何的限制因素也在许多以前的短茎设计, 导致减少偏移和增加腿部长度9。
议定书内的关键步骤:
最关键的一步是选择正确的截骨水平。此外, 为了术正确地实现术前规划, 需要使用透视法进行验证。
由于在股骨引导的短茎的茎部长度缩短, 主要稳定性可能引起有关18。主要的固定类型是骺锚固, 基于合适的填充原理。然而, 由于这些阀杆设计的个性化定位选择, 锚固类型可能会有明显的差异。在内翻排列三点锚定是常见的皮质接触到侧皮质的部分切除颈部, 内侧股骨, 和侧皮质在顶端的茎。然而, 根据定位和大小, 特别是在广泛的外翻对准, 发音骨干锚地是可能的10。在这种情况下, 安全地实现皮质接触远端侧皮质, 以及远端内侧皮质是至关重要的。在外翻位置, 在早期集体中经常观察到尖端的缺失皮质接触, 包括学习曲线, 特别是在 undersizing 的情况下。因此, 外科医生应该考虑到, 特别是在外翻髋部, undersizing 伴有与侧皮质缺乏接触, 可能导致最初的不稳定和随后的植入 micromovement10。因此强烈建议使用术中透视来识别茎 undersizing 的19。
目前关于偏移重建技术的描述仅指二维分析。然而, 由于部分保留股骨颈, 短茎将自己的位置几乎自动沿颈前倾角和前倾的现存股骨近端骨。特别是在内翻-臀部, 这导致明显的前倾在轴向平面与茎尖被定位前方 (图 11)。因此, 前偏移也可以重建。进一步监测这一代短茎和植入技术在中长期随访是强制性的。

近年来, 现代股骨的短茎在临屋区已越来越多地使用1。新的股骨引导, 骺锚固短茎正在出现, 重点放在保留肌肉, 软组织和骨骼2,3, 从而允许微创 (MIS) 技术和方法成功应用4.
股骨导向的短茎的可能的好处可以通过特殊的植入技术来完成, 这与传统的直杆设计技术不同。最重要的方面, 在这方面, 是解剖曲率, 已经适应了从股骨。茎的定位跟随单独解剖学在股骨曲线旁边, 并且允许个体化植入5。应用所谓的 "圆角" 技术, 较大的大转子区域和最重要的臀部肌肉, 可以几乎完全幸免于2。
现代临屋区主要依赖于成功保存的髋关节几何。髋关节解剖的准确重建对临床预后至关重要。股-髋臼偏移量越来越多地聚焦5。减少的偏移可能导致臀部不稳定和髋关节不稳定性, 并增加了脱位的风险6,7。另一方面, 严重的偏移量增加会引起转子滑囊炎。鉴于这些发现, 似乎不希望的偏移变化有很大的临床相关性。
股骨偏移的重建高度依赖于复制不同 CCD 角度8的能力。然而, valgization 已被发现是在许多茎设计成功重建髋几何的限制因素, 导致减少偏移和增加腿部长度9。在这方面, 不同 CCD 角度的重建似乎是完成髋关节解剖 retainment 的关键。
在股骨引导的短茎, 茎对位可以个性化, 支持成功重建股骨偏移8。在股骨的指导下, 股骨近端的茎部定位取决于股骨颈的切除水平。鉴于先前存在的内翻解剖, 高切除也导致植入物的内翻位置, 保持较大的股骨偏移量。另一方面, 鉴于已存在的外翻解剖, 低切除导致外翻位置, 造成一个小的股骨偏移量10 (图 1;图 2)。
因此, 所提出的个性化植入技术允许对 CCD 角进行广泛的重建, 从而能够精确地保存髋关节几何。所提出的技术不同于传统的全髋关节置换术, 有可能包括一个严重的学习曲线。

<table><tbody><tr><td>optimys short stem</td><td>Mathys Ltd., Switzerland</td><td></td><td>Implant</td></tr></tbody></table>

individualized stem-positioning in calcar-guided short-stem total hip arthroplasty

骨和软组织备用短茎越来越多地用于全髋关节置换术 (临区)。然而, 有大量的短茎的模型, 不同的设计和功能。股骨引导短茎提供一个解剖曲率在内侧股骨区域, 因此, 定位是单独完成股骨在 "圆角" 技术。根据颈部截骨的水平, 茎可以单独排列在一个大的内翻的带宽-和外翻剖析。这不同于传统的全髋关节置换术, 有可能包括一个严重的学习曲线。鉴于可保留大量的颈-骨干 (CCD) 角, 可以精确地实现股-髋臼偏移的重建。然而, 特别是广泛的内翻和外翻定位引起了关注的稳定性和骨重塑。本手稿的目的是展示植入技术在股骨指导的短茎, 并总结短期临床和放射结果。

研究的短茎的一些短期结果以前被出版了, 主要起因于一个持续的观察研究在作者的机关2,8,11,12, 13,14,15,16。利用所提出的技术, 可以精确地实现对不同股-髋臼偏移量的重构5。特别是保留现有 CCD 角度的能力允许生理髋关节几何 retainment8。两年后, 只有少量的放射学改变, 如应力屏蔽和皮质肥大是明显的14。微创技术导致异位血肿骨化相接的低发病率为11。因此, 与使用常规直茎17的植入技术相比, 失血和输血率保持在较低的速度。
优异的临床效果使该技术成功地应用于单级双侧短茎 (2)。对所提出的植入物的 "股骨成分分析" (EBRA) 的分析显示, 早期的轴向沉降增加, 特别是在重型和主动男性患者中, 由于术后完全负重, 但没有任何早期的临床后果13,15。特别是在外翻位置排列的茎导致早期下沉增加, 但 undersizing 和皮质接触不足的侧面, 可确定为主要原因18。
<img alt="Figure 1" class="xfigimg" src="/files/ftp_upload/56905/56905fig1.jpg"> 图 1: 股骨颈截骨.截骨是根据术前计划进行的。截骨的水平是由 palpating 小转子和大转子的尖端决定的, 作为参考。从2,4。
<img alt="Figure 2" class="xfigimg" src="/files/ftp_upload/56905/56905fig2.jpg"> 图 2: 外翻定位.在低位截骨术后, 茎部与外翻位置对齐。
<img alt="Figure 3" class="xfigimg" src="/files/ftp_upload/56905/56905fig3.jpg"> 图 3: 内翻定位.在高位截骨术后, 茎部与内翻位置对齐。
<img alt="Figure 4" class="xfigimg" src="/files/ftp_upload/56905/56905fig4.jpg"> 图 4: 术前规划.蓝色: 股骨导向短茎的模板;红色: 无水泥杯的模板。截骨水平是根据术前计划 (OL) 确定的。术, 并且种植体的侧肩的高度担当方向 (SH)。最重要的是茎必须升迁直到皮质接触侧向被到达 (CC)。
<img alt="Figure 5" class="xfigimg" src="/files/ftp_upload/56905/56905fig5.jpg"> 图 5: 对截骨和茎对齐的个性化水平.股骨近端的茎部定位取决于股骨颈的切除水平。由于内翻解剖, 高切除也导致植入物的内翻位置, 维持一个大的股骨偏移量 (c)。另一方面, 由于外翻解剖, 低切除导致外翻位置, 导致小股偏移 (a)。10,12从 Kutzner et 。2<a href="//cloudflare.jove.com/files/ftp_upload/56905/56905fig5large.jpg" target="_blank">请单击此处查看此图的较大版本.</a>
<img alt="Figure 6" class="xfigimg" src="/files/ftp_upload/56905/56905fig6.jpg"> 图 6: 圆角技术.插入是做与内侧股骨, 不影响侧向结构。尤其是大转子和臀部肌肉可以幸免。从 Kutzner et 。2<a href="//cloudflare.jove.com/files/ftp_upload/56905/56905fig6large.jpg" target="_blank">请单击此处查看此图的较大版本.</a>
<img alt="Figure 7" class="xfigimg" src="/files/ftp_upload/56905/56905fig7.jpg"> 图 7: 术中透视.在完成试验复位后, 使用数字图像增强器对两个平面中的术中造影进行评估, 应被认为是强制性的, 能够比较锉 (试验植入物) 的定位与术前规划。随后可以执行潜在的调整。从 Kutzner et 。2<a href="//cloudflare.jove.com/files/ftp_upload/56905/56905fig7large.jpg" target="_blank">请单击此处查看此图的较大版本.</a>
<img alt="Figure 8" class="xfigimg" src="/files/ftp_upload/56905/56905fig8v2.jpg"> 图 8: undersizing 的示例.皮质接触不足和 undersizing (a)导致随后2年后续行动(b)的下沉。<a href="//cloudflare.jove.com/files/ftp_upload/56905/56905fig8v2large.jpg" target="_blank">请单击此处查看此图的较大版本.</a>
<img alt="Figure 9" class="xfigimg" src="/files/ftp_upload/56905/56905fig9v2.jpg"> 图 9: 原始股骨引导的短茎的植入.最初的种植体位置本身完全一样的试验锉。从 Kutzner et 。2
<img alt="Figure 10" class="xfigimg" src="/files/ftp_upload/56905/56905fig10v2.jpg"> 图 10: 不同茎类型的内翻髋部的偏移重建示例.(a, b)由于骨干锚固和常规直茎的设计, 无法实现偏移重建。(c) 内翻-与股骨引导的短茎对齐, 完成偏移的精确重建。<a href="//cloudflare.jove.com/files/ftp_upload/56905/56905fig10v2large.jpg" target="_blank">请单击此处查看此图的较大版本.</a>
<img alt="Figure 11" class="xfigimg" src="/files/ftp_upload/56905/56905fig11.jpg"> 图 11: 两个平面中的术中透视示例.(a) "美联社"视图;(b) 轴向视图。短茎将自己的位置几乎自动沿颈前倾角和前倾的现有股骨近端骨。因此, 前偏移也可以恢复。<a href="//cloudflare.jove.com/files/ftp_upload/56905/56905fig11large.jpg" target="_blank">请单击此处查看此图的较大版本.</a>

Watch this Scientific Journal Video about Individualized Stem-positioning in Calcar-guided Short-stem Total Hip Arthroplasty at JoVE.com

Individualized Stem-positioning in Calcar-guided Short-stem Total Hip Arthroplasty

本协议描述了股骨引导短茎与内侧股骨的圆角技术和个体化茎定位, 这取决于截骨的水平。这不同于传统的全髋关节置换术, 包括学习曲线。

股骨引导下短茎全髋关节置换术的个体化茎定位

Bone- and soft-tissue sparing short stems are increasingly used in total hip arthroplasty (THA). However, there are a large variety of models of short ...

individualized-stem-positioning-calcar-guided-short-stem-total-hip

Nanyang Technological University

Research

JoVE Journal

Medicine

11.7K 次观看.  St. Josefs Hospital Wiesbaden. 本协议描述了股骨引导短茎与内侧股骨的圆角技术和个体化茎定位, 这取决于截骨的水平。这不同于传统的全髋关节置换术, 包括学习曲线。

视频: Individualized Stem-positioning in Calcar-guided Short-stem Total Hip Arthroplasty

Use of Human Perivascular Stem Cells for Bone Regeneration

Human perivascular stem cells (PSCs) can be isolated in sufficient numbers from multiple tissues for purposes of skeletal tissue engineering1-3. PSCs are a FACS-sorted population of 'pericytes' (CD146+CD34-CD45-) and 'adventitial cells' (CD146-CD34+CD45-), each of which we have previously reported to have properties of mesenchymal stem cells. PSCs, like MSCs, are able to undergo osteogenic differentiation, as well as secrete pro-osteogenic cytokines1,2. In the present protocol, we demonstrate the osteogenicity of PSCs in several animal models including a muscle pouch implantation in SCID (severe combined immunodeficient) mice, a SCID mouse calvarial defect and a femoral segmental defect (FSD) in athymic rats. The thigh muscle pouch model is used to assess ectopic bone formation. Calvarial defects are centered on the parietal bone and are standardly 4 mm in diameter (critically sized)8. FSDs are bicortical and are stabilized with a polyethylene bar and K-wires4. The FSD described is also a critical size defect, which does not significantly heal on its own4. In contrast, if stem cells or growth factors are added to the defect site, significant bone regeneration can be appreciated. The overall goal of PSC xenografting is to demonstrate the osteogenic capability of this cell type in both ectopic and orthotopic bone regeneration models.

Human perivascular stem cells (PSCs) are a novel stem cell class for skeletal tissue regeneration similar to mesenchymal stem cells (MSCs). PSCs can be isolated by FACS (fluorescence activated cell sorting) from adipose tissue procured during standard liposuction procedures, then combined with an osteoinductive scaffold to achieve bone formation in vivo.

人类血管周围干细胞用于骨再生

Human perivascular stem cells (PSCs) can be isolated in sufficient numbers from multiple tissues for purposes of skeletal tissue engineering1-3. PSCs are ...

科研

生物工程

A Teleoperated Robotic System-Assisted Percutaneous Transiliac-Transsacral Screw Fixation Technique

Transiliac-transsacral screw fixation is challenging in clinical practice as the screws need to break through six layers of cortical bone. Transiliac-transsacral screws provide a longer lever arm to withstand the perpendicular vertical shear forces. However, the screw channel is so long that a minor discrepancy can lead to iatrogenic neurovascular injuries. The development of medical robots has improved the precision of surgery. The present protocol describes how to use a new teleoperated robotic system to execute transiliac-transacral screw fixation. The Robot was operated remotely to position the entry point and adjust the orientation of the sleeve. The screw positions were evaluated using postoperative computed tomography (CT). All the screws were safely implanted, as confirmed using intraoperative fluoroscopy. Postoperative CT confirmed that all the screws were in the cancellous bone. This system combines the doctor's initiative with the Robot's stability. The remote control of this procedure is possible. Robot-assisted surgery has a higher position-retention capacity compared with conventional methods. In contrast to active robotic systems, surgeons have full control over the operation. The robot system is fully compatible with operating room systems and does not require additional equipment.

Teleoperated robotic system-assisted percutaneous transiliac-transsacral screw fixation is a feasible technique. Screw channels can be implemented with high accuracy owing to the excellent freedom of movement and stability of the robotic arms.

一种远程操作机器人系统辅助经皮经髂骶螺钉固定技术

Transiliac-transsacral screw fixation is challenging in clinical practice as the screws need to break through six layers of cortical bone. ...

工程学

Cone Beam Intraoperative Computed Tomography-based Image Guidance for Minimally Invasive Transforaminal Interbody Fusion

Transforaminal lumbar interbody fusion (TLIF) is commonly used for the treatment of spinal stenosis, degenerative disc disease, and spondylolisthesis. Minimally invasive surgery (MIS) approaches have been applied to this technique with an associated decrease in estimated blood loss (EBL), length of hospital stay, and infection rates, while preserving outcomes with traditional open surgery. Previous MIS TLIF techniques involve significant fluoroscopy that subjects the patient, surgeon, and operating room staff to non-trivial levels of radiation exposure, particularly for complex multi-level procedures. We present a technique that utilizes an intraoperative computed tomography (CT) scan to aid in placement of pedicle screws, followed by traditional fluoroscopy for confirmation of cage placement. Patients are positioned in the standard fashion and a reference arc is placed in the posterior superior iliac spine (PSIS) followed by intraoperative CT scan. This allows for image-guidance-based placement of pedicle screws through a one-inch skin incision on each side. Unlike traditional MIS-TLIF that requires significant fluoroscopic imaging during this stage, the operation can now be performed without any additional radiation exposure to the patient or operating room staff. After completion of the facetectomy and discectomy, final TLIF cage placement is confirmed with fluoroscopy. This technique has the potential to decrease operative time and minimize total radiation exposure.

The purpose of this article is to provide image-guidance for minimally invasive transforaminal interbody fusion.

锥形束术中计算机断层扫描图像指南,用于微创跨体间融合

Transforaminal lumbar interbody fusion (TLIF) is commonly used for the treatment of spinal stenosis, degenerative disc disease, and spondylolisthesis. ...

医学

C-arm-Free Simultaneous OLIF51 and Percutaneous Pedicle Screw Fixation in a Single Lateral Position

Oblique lumbar interbody fusion (OLIF) is an established technique for the indirect decompression of lumbar canal stenosis. However, OLIF at the L5-S1 level (OLIF51) is technically difficult because of the anatomical structures. We present a novel simultaneous technique of OLIF51 with percutaneous pedicle screw fixation without fluoroscopy. The patient is placed in a right lateral decubitus position. A percutaneous reference pin is inserted into the right sacroiliac joint. An O-arm scan is performed, and 3D reconstructed images are transmitted to the spinal navigation system. A 4 cm oblique skin incision is made under navigation guidance along the pelvis. The internal/external and transverse abdominal muscles are divided along the muscle fibers, protecting the iliohypogastric and ilioinguinal nerves. Using a retroperitoneal approach, the left common iliac vessels are identified. Special muscle retractors with illumination are used to expose the L5-S1 intervertebral disc. After disc preparation with navigated instruments, the disc space is distracted with navigated trials. Autogenous bone and demineralized bone material are then inserted into the cage hole. The OLIF51 cage is inserted into the disc space with the help of a mallet. Simultaneously, percutaneous pedicle screws are inserted by another surgeon without changing the lateral decubitus position of the patient.
In conclusion, C-arm-free OLIF51 and simultaneous percutaneous pedicle screw fixation are performed in a lateral position under navigation guidance. This novel technique reduces surgical time and radiation hazards.

C-arm-free oblique lumbar interbody fusion at the L5-S1 level (OLIF51) and simultaneous pedicle screw fixation are performed in a lateral position under navigation guidance. This technique does not expose the surgeon or operating staff to radiation hazards.

无 C 型臂同时 OLIF51 和经皮椎弓根螺钉固定在单个侧位

Oblique lumbar interbody fusion (OLIF) is an established technique for the indirect decompression of lumbar canal stenosis. However, OLIF at the L5-S1 ...

The Use of Mixed Reality in Custom-Made Revision Hip Arthroplasty: A First Case Report

The technology of 3D printing and visualization of anatomical structures is rapidly growing in various fields of medicine. A custom-made implant and mixed reality were used to perform complex revision hip arthroplasty in January 2019. The use of mixed reality allowed for a very good visualization of the structures and resulted in precise implant fixation. According to the authors' knowledge, this is the first described case report of the combined use of these two innovations. The diagnosis preceding the qualification for the procedure was the loosening of the left hip's acetabular component. Mixed reality headset and holograms prepared by engineers were used during the surgery. The operation was successful, and it was followed by early verticalization and patient rehabilitation. The team sees opportunities for technology development in joint arthroplasty, trauma, and orthopedic oncology.

A complex revision hip arthroplasty was performed using a custom-made implant and mixed reality technology. According to the authors&#39; knowledge, this is the first report of such procedure described in the literature.

混合现实在定制翻修髋关节置换术中的应用:第一份病例报告

The technology of 3D printing and visualization of anatomical structures is rapidly growing in various fields of medicine. A custom-made implant and mixed ...

Sensor Assessment of Gap Balance in Mobile-Bearing Unicompartmental Knee Arthroplasty

The most important procedure of mobile-bearing unicompartmental knee arthroplasty (UKA) is to balance the knee flexion and extension gap. Conventionally, the balance was determined by the subjective assessment of plugging out the feeling gauge. Since it mainly depended on the surgeons' experience, the accuracy was always in doubt. In the past 10 years, pressure sensors have been introduced to guide the gap balance in total knee arthroplasty (TKA). However, the sensor technique was introduced to UKA very recently. Herein is our sensor assessment of the gap balance in 20 cases UKA by one experienced surgeon. The sensor was a custom-designed force sensor matrix according to the shape of the tibial trial of mobile-bearing UKA. The postoperative clinical outcomes and radiographic results were recorded for future comparison. We aim to use this method to assess more than 200 cases of UKA by various surgeons to ultimately standardize the gap-balance result.

Here, we present a protocol to measure the gap contact force and gap balance in mobile-bearing unicompartmental knee arthroplasty (UKA). Along with the clinical and radiographic data, we hope to determine the normal range of the contact force and set up the threshold of the gap balance.

The most important procedure of mobile-bearing unicompartmental knee arthroplasty (UKA) is to balance the knee flexion and extension gap. Conventionally, ...

Augmented Reality Navigation-Guided Core Decompression for Osteonecrosis of Femoral Head

Osteonecrosis of the femoral head (ONFH) is a common joint disease in young and middle-aged patients, which seriously burdens their lives and work. For early-stage ONFH, core decompression surgery is a classical and effective hip preservation therapy. In traditional procedures of core decompression with Kirschner wire, there are still many problems such as X-ray exposure, repeated puncture verification, and damage to normal bone tissue. The blindness of the puncture process and the inability to provide real-time visualization are crucial reasons for these problems.
To optimize this procedure, our team developed an intraoperative navigation system on the basis of augmented reality (AR) technology. This surgical system can intuitively display the anatomy of the surgical areas and render preoperative images and virtual needles to intraoperative video in real-time. With the guide of the navigation system, surgeons can accurately insert Kirschner wires into the targeted lesion area and minimize the collateral damage. We conducted 10 cases of core decompression surgery with this system. The efficiency of positioning and fluoroscopy is greatly improved compared to the traditional procedures, and the accuracy of puncture is also guaranteed.

Augmented reality technology was applied to core decompression for osteonecrosis of the femoral head to realize real-time visualization of this surgical procedure. This method can effectively improve the safety and precision of core decompression.

增强现实导航引导的股骨头坏死核心减压

Osteonecrosis of the femoral head (ONFH) is a common joint disease in young and middle-aged patients, which seriously burdens their lives and work. For ...

The Transition to an Anterior-Based Muscle Sparing Approach Improves Early Postoperative Function but is Associated with a Learning Curve

Surgeons considering transitioning to an anterior-based approach for THA are concerned about the learning curve and the reported marginal clinical benefit. Accordingly, the first cohort of THAs, which were implanted by a single surgeon using the anterior-based muscle-sparing approach (ABMS), was analyzed. The goal of the study was to test 1) whether patient-reported outcomes improved and 2) whether the complication rate decreased with the number of THAs performed. A retrospective cohort study on the first 30 primary THA cases (27 patients) of one surgeon (January 2021-April 2021) using the ABMS approach was conducted. These 30 THAs were compared to 30 primary THA cases (30 patients) done immediately prior to the transition by the same surgeon (September 2020-December 2020) using the posterior approach (PA). The Oxford Hip Score (OHS), Hip Disability and Osteoarthritis Outcome Score (HOOS Junior), and Forgotten Joint Score (FJS) obtained 6 weeks and 6 months after surgery were compared. In addition, three consecutive groups based on equal numbers of THAs were compared for the incidence of complications and surgery time. At 6 weeks after THA, the OHS was 6 points higher after the ABMS approach (p = 0.0408), and the OHS was comparable at 6 months. The HOOS Junior and FJS were similar at 6 weeks and 6 months after surgery.&#160;In the first 10 THAs using the ABMS approach, one patient had a greater trochanter fracture, and one patient had an intraoperative proximal femur fracture. No further immediate interoperative or postoperative complications occurred. Surgery time significantly reduced with the number of THAs performed. Transitioning from the PA to the ABMS approach is associated with a learning curve, which is limited to the first 20 cases. The effect of improved clinical outcomes is apparent within the early postoperative period. After 6 months, THA patients do well regardless of the approach.

The anterior-based muscle-sparing approach for total hip arthroplasty (THA) is associated with a learning curve. However, the improved clinical outcome in the early post-operative phase makes the consideration to transition worthwhile.

过渡到基于前部的肌肉保留方法可改善术后早期功能，但与学习曲线相关

Surgeons considering transitioning to an anterior-based approach for THA are concerned about the learning curve and the reported marginal clinical ...

In Vitro Application of a Wireless Sensor in Flexion-Extension Gap Balance of Unicompartmental Knee Arthroplasty

Unicompartmental knee arthroplasty (UKA) is an effective treatment for end-stage anteromedial osteoarthritis (AMOA). The key to UKA is the flexion-extension gap balance, which is closely related to postoperative complications such as bearing dislocation, bearing wear, and arthritis progression. The traditional gap balance assessment is performed by indirectly sensing the tension of the medial collateral ligament by a gap gauge. It relies on the surgeon's feel and experience, which is imprecise and difficult for beginners. To accurately assess the flexion-extension gap balance of UKA, we developed a wireless sensor combination consisting of a metal base, a pressure sensor, and a cushion block. After osteotomy, the insertion of a wireless sensor combination allows the real-time measurement of intra-articular pressure. It accurately quantifies the flexion-extension gap balance parameters to guide further femur grinding and tibia osteotomy, to improve the accuracy of gap balance. We conducted an in vitro experiment with the wireless sensor combination. the results showed that there was a difference of 11.3 N after applying the traditional method of flexion-extension gap balance performed by an experienced expert.

In Vitro Application of a Wireless Sensor in Flexion-Extension Gap Balance of Unicompartmental Knee Arthroplasty

This protocol presents a cadaveric study of a wireless sensor used in medial unicompartmental knee arthroplasty. The protocol includes the installation of an angle measuring device, standardized Oxford unicompartmental knee arthroplasty osteotomy, preliminary assessment of flexion-extension balance, and application of the sensor to measure flexion-extension gap pressure.

体外 无线传感器在单间室膝关节置换术屈伸间隙平衡中的应用

Unicompartmental knee arthroplasty (UKA) is an effective treatment for end-stage anteromedial osteoarthritis (AMOA). The key to UKA is the ...

Clinical Application of Artificial Intelligence Preoperative Planning System Combined with Expert Database Retrieval in Complex Revision Hip Surgery

Accurate preoperative planning in revision hip arthroplasty is crucial for achieving successful outcomes. To enhance the intuitive evaluation of acetabular bone defect severity and leverage previous successful experience in revision hip arthroplasty, this study proposes a novel approach based on expert surgical case database retrieval and is initially implemented in clinical application.&#160;In this study, five patients who required revision hip arthroplasty were preoperatively planned to employ the expert case database surgical planning system.The patient&#39;s imaging data was entered into the system and matched with cases in the expert case database. Based on the expert&#39;s surgical experience, a revision surgery plan was recommended. If no suitable case was found, the model and position of the prosthesis were planned based on patient-specific reconstruction results. A total of five patients were enrolled in this study, four males and one female, with a mean age of 50.6 years. The diagnosis was aseptic prosthesis loosening after hip arthroplasty. The mean operative time was 123.2 min, and the mean intraoperative hemorrhage was 672 mL. No intraoperative complications, such as vascular or nerve injury, were observed. In Case 2, for instance, the application of this innovative planning scheme enabled the surgeon to delineate the revision surgery plan for this patient in the preoperative period, thereby reducing the operative time and intraoperative hemorrhage. Furthermore, patients could be apprised of the outcomes of analogous cases in advance. Leveraging a big data analysis approach through our comprehensive case database enables automated identification of matching expert treatment plans throughout the entire process. This particularly benefits inexperienced orthopedic surgeons by providing accurate guidance on surgical strategies to assist them in selecting appropriate prosthetic sizes and mounting positions. Additionally, the matching results can offer patients visualizations depicting predicted postoperative outcomes.

This study proposes a novel artificial intelligence preoperative planning approach based on expert surgical case database retrieval in revision hip arthroplasty. Additionally, the technique was initially employed in five patients, exhibiting a reduction in operative time and intraoperative hemorrhage.

股骨引导下短茎全髋关节置换术的个体化茎定位

摘要

探索更多视频

此视频中的章节

人类血管周围干细胞用于骨再生

一种远程操作机器人系统辅助经皮经髂骶螺钉固定技术

锥形束术中计算机断层扫描图像指南,用于微创跨体间融合

无 C 型臂同时 OLIF51 和经皮椎弓根螺钉固定在单个侧位

混合现实在定制翻修髋关节置换术中的应用:第一份病例报告

Sensor Assessment of Gap Balance in Mobile-Bearing Unicompartmental Knee Arthroplasty

增强现实导航引导的股骨头坏死核心减压

过渡到基于前部的肌肉保留方法可改善术后早期功能，但与学习曲线相关

体外无线传感器在单间室膝关节置换术屈伸间隙平衡中的应用

人工智能术前计划系统结合专家数据库检索在复杂翻修髋关节手术中的临床应用

股骨引导下短茎全髋关节置换术的个体化茎定位

摘要

探索更多视频

此视频中的章节

人类血管周围干细胞用于骨再生

一种远程操作机器人系统辅助经皮经髂骶螺钉固定技术

锥形束术中计算机断层扫描图像指南,用于微创跨体间融合

无 C 型臂同时 OLIF51 和经皮椎弓根螺钉固定在单个侧位

混合现实在定制翻修髋关节置换术中的应用:第一份病例报告

Sensor Assessment of Gap Balance in Mobile-Bearing Unicompartmental Knee Arthroplasty

增强现实导航引导的股骨头坏死核心减压

过渡到基于前部的肌肉保留方法可改善术后早期功能，但与学习曲线相关

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