128层螺旋CT血管造影联合富士Synapse v3.0后处理软件模拟切除肝肿瘤

目的评价128螺旋CT快速血管造影成像(肝动脉+门静脉成像)富士synapse v3.0后处理软件模拟切除肝肿瘤的临床价值。方法应用多层螺旋CT对52例超声发现肝占位患者进行检查,富士synapse v3.0后处理软件对扫描所得的原始图像进行模拟重建,模拟切除。结果 52例患者均能清晰显示肿瘤大小,边界及其与周缘大血管的关系,手术切除肝脏体积与模拟切除肝体积量一致。结论应用富士synapse v3.0医学影像分析系统进行肝脏肿瘤三维重建、并且模拟肝脏肿瘤切除重现,可以更为精确、安全地施行复杂的肝脏大部分切除术,尽可能减少术后肝功能衰竭的出现,可以为临床医师准确制定的手术方案和采取正确的术中策略提供重要的术前参考。     

Influence of hip-preservation surgeries on subsequent total hip arthroplasty for osteonecrosis of the femoral head北大核心

BACKGROUND: Hip-preservation surgery is an important method for the treatment of young patients with early femoral head necrosis. However, there are many types of hip-preservation surgery, and all kinds of hip-preservation surgery have their own limitations and inevitable failure rate. Some patients received poor results after hip-preservation surgery, and had to undergo total hip arthroplasty. OBJECTIVE: To review the research progress on the influence of various hip-preservation surgeries on subsequent total hip arthroplasty for osteonecrosis of the femoral head. METHODS: Databases of Embase, CNKI and PubMed were searched with the key words of “osteonecrosis of the femoral head, hip-preservation surgery, core decompression, bone grafting, osteotomy, porous tantalum implantation, hip resurfacing arthroplasty” in Chinese and English, respectively. By reading the titles and abstracts, repetitive studies and low-quality or irrelevant articles were excluded. Finally, 58 articles were included for reviewing. RESULTS AND CONCLUSION: (1) At present, the clinical application of hip-preservation surgery mainly includes core decompression, non-vascularized bone grafting, vascularized bone grafting, osteotomy, tantalum rod implantation and other categories, and different hip-preservation surgeries have their own characteristics and different influences on subsequent total hip arthroplasty. (2) As a “minimally invasive” operation, simple core decompression has little impact on subsequent total hip arthroplasty, but it may change the bone structure in the intertrochanteric region and increase the risk of intraoperative fracture in total hip arthroplasty. (3) Residual bone graft materials (especially fibula graft) in bone grafting affected the opening and expansion of medullary cavity and placement of femoral stem prosthesis during total hip arthroplasty. Vascularized bone grafting (especially musculoskeletal flap graft) increased the trauma of soft tissue, which was not conducive to the functional recovery of hip joint after total hip arthroplasty. (4) Osteotomy has the greatest influence on subsequent total hip arthroplasty, because it causes greater local soft tissue trauma and femoral deformity. Total hip arthroplasty after osteotomy is relatively difficult, and compared with other hip-preservation surgeries, osteotomy has disadvantages based on its influence on subsequent total hip arthroplasty. (5) There is a problem that the removal of tantalum rod implants increases the difficulty of total hip arthroplasty in the follow-up, and although the study found that the residual tantalum fragments did not increase the linear wear rate of the prosthesis in the short term, we still need to pay attention to the long-term effects of residual tantalum fragments. (6) Although all types of hip-preservation surgeries increase the difficulty of subsequent total hip arthroplasty to a certain extent, literature reports are generally positive. There is no literature report that previous hip-preservation surgery is not conducive to the prosthesis survival rate and hip function score after subsequent total hip arthroplasty, and total hip arthroplasty can still be used as a reliable treatment after hip preservation failure. © 2023, Publishing House of Chinese Journal of Tissue Engineering Research. All rights reserved.