Comparison between Weightbearing-CT semiautomatic and manual measurements in Hallux Valgus

BackgroundRadiographic measurements are an essential tool to determine the appropriate surgical treatment and outcome for Hallux Valgus (HV). HV deformity is best evaluated by weight-bearing computed tomography (WBCT).The objective was (1) to assess the reliability of WBCT computer-assisted semi-automatic imaging measurements in HV, (2) to compare semi-automatic with manual measurements in the setting of an HV, and (3) to compare semi-automatic measurements between HV and control group.MethodsIn this retrospective IRB (ID# 201904825) approved study, we assessed patients with hallux valgus deformity. The sample size calculation was based on the hallux valgus angle (HVA). Thus to obtain the 0.8 power, including 26 feet with HV in this study, was necessary. Our control group consisted of 19 feet from 19 patients without HV. Raw multiplanar data was evaluated using software CubeVue®. In the axial plane, hallux valgus angle (HVA), intermetatarsal angle (IMA), and interphalangeal angle (IPA) were measured. The semiautomatic 3D measurements were performed using the Bonelogic®Software. Inter-rater reliabilities were performed using ICC. Agreement between methods was tested using the Bland-Altman plots. The difference between Patologic and Control cases using semi-automatic measurements was assessed with the Wilcoxon signed-rank test. Alpha risk was set to 5% (α = 0.05). P ≤ 0.05 were considered significant.ResultsReliabilities utilizing ICC were over 0.80 for WBCT manual measurements and WBCT semi-automatic readings. Inter and intraobserver agreement for Manual and Semi-automatic WBCT measurements demonstrated excellent reliability.ConclusionsSemi-automatic measurements are reproducible and comparable to measurements performed manually. The software differentiated pathological from non-pathological conditions when subjected to semi-automatic measurements. The development of advanced semi-automatic segmentation software with minimal user intervention is essential for the establishment of big data and can be integrated into clinical practice, facilitating decision-making.     

Negative pressure wound therapy reduces incidence of postoperative wound infection and dehiscence after long-segment thoracolumbar spinal fusion: a single institutional experience

Background contextWound dehiscence and surgical site infections (SSIs) can have a profound impact on patients as they often require hospital readmission, additional surgical interventions, lengthy intravenous antibiotic administration, and delayed rehabilitation. Negative pressure wound therapy (NPWT) exposes the wound site to negative pressure, resulting in the improvement of blood supply, removal of excess fluid, and stimulation of cellular proliferation of granulation tissue.PurposeTo assess the incidence of wound infection and dehiscence in patients undergoing long-segment thoracolumbar fusion before and after the routine use of NPWT.Study designRetrospective study.Patient sampleOne hundred sixty patients undergoing long-segment thoracolumbar spine fusions were included in this study.Outcome measuresPostoperative incidence of wound infection and dehiscence.MethodsAll adult patients undergoing thoracolumbar fusion for spinal deformity over a 6-year period at Duke University Medical Center by the senior author (CB) were included in this study. In 2012, a categorical change was made by the senior author (CB) that included the postoperative routine use of incisional NPWT devices after primary wound closure in all long-segment spine fusions. Before 2012, NPWT was not used. After primary wound closure, a negative pressure device is contoured to the size of the incision and placed over the incision site for 3 postoperative days. We retrospectively review the first 46 cases in which NPWT was used and compared them with the immediately preceding 114 cases to assess the incidence of wound infection and dehiscence.ResultsOne hundred sixty (NPWT: 46 cases, non-NPWT: 114 cases) long-segment thoracolumbar spine fusions were performed for deformity correction. Baseline characteristics were similar between both cohorts. Compared with the non-NPWT cohort, a 50% decrease in the incidence of wound dehiscence was observed in the NPWT patient cohort (6.38% vs. 12.28%, p=.02). Similarly, compared with the non-NPWT cohort, the incidence of postoperative SSIs was significantly decreased in the NPWT cohort (10.63% vs. 14.91%, p=.04).ConclusionsRoutine use of incisional NPWT was associated with a significant reduction in the incidence of postoperative wound infection and dehiscence.     

乳突区皮瓣法在先天性中重度杯状耳三维重建中的应用

目的 探讨中重度杯状耳三维立体重建的有效方法及临床效果.方法 采用乳突区皮瓣及自体肋软骨切取的Ⅱ期再造方法对中重度杯状耳进行三维重建.Ⅰ期行外耳皮肤脱套、乳突区皮瓣分离;切取肋软骨与耳轮软骨桥接重建耳上极及乳突区皮瓣包盖.Ⅱ期行再造耳上极掀起,耳后筋膜瓣覆盖及植皮重建.结果 18例中重度杯状耳畸形患者,1例桥接处糜烂,软骨部分坏死,其余均Ⅰ期成活,随访3～26个月,外形满意.结论 应用乳突区皮瓣法重建中重度杯状耳,强调细节亚单位构建,再造耳更加安全、美观,手术成功率和医患满意率高,并发症少.     

The oblique plane deformity in slipped capital femoral epiphysis

Background

Slipped capital femoral epiphysis (SCFE) is commonly treated with in situ pinning. However, a severe slip may not be suitable for in situ pinning because the required screw trajectory is such that it risks perforating the posterior cortex and damaging the remaining blood supply to the capital epiphysis. In such cases, an anteriorly placed screw may also cause impingement. It is also possible to underestimate the severity of the slip using conventional radiographs. The aim of this study was to describe and evaluate a novel method for calculating the true deformity in SCFE and to assess the interobserver and intraobserver reliability of this technique.

Methods

We selected 20 patients with varying severity of SCFE who presented to our institution. Cross-sectional imaging [either axial computed tomography (CT) scans or magnetic resonance imaging (MRI) scans] and anteroposterior (AP) pelvis radiographs were assessed by four reviewers with varying levels of experience on two occasions. The degree of slip on the axial image and on the AP pelvis radiographs were measured and, from this, the oblique plane deformity was calculated using the method as popularised by Paley. The intraclass correlation coefficient (ICC) was calculated to determine the interobserver and intraobserver reliabilities between and amongst the raters.

Results

The interobserver reliability for the calculated oblique plane deformity in SCFE ICC was 0.947 [95 % confidence interval (CI) 0.90–0.98] and the intraobserver reliability for the calculated oblique plane deformity of individual raters ranged from 0.81 to 0.94. The deformity in the oblique plane was always greater than the deformity measured in the axial or the coronal plane alone.

Conclusion

This method for calculating the true deformity in SCFE has excellent interobserver and intraobserver reliability and can be used to guide treatment options. This technique is a reliable and reproducible method for assessing the degree of deformity in SCFE. It may help orthopaedic surgeons with varying degrees of experience to identify which hips are suitable for in situ pinning and those which require surgical dislocation and anatomical reduction, given that plain radiographs in a single plane will underestimate the true deformity in the oblique plane.

Level of evidence

Level II diagnostic study.     

烧伤后瘢痕挛缩畸形行植皮术后的护理体会

目的探讨烧伤后瘢痕挛缩畸形行植皮术后的护理体会。方法选取我院收治的71例烧伤患者为研究对象,所有患者行整形植皮术,并从术后创面护理、体位、植皮区、术后功能锻炼等方面护理。观察患者术后皮片成活及融合情况,并统计患者术后皮肤恢复及并发症发生情况。结果皮片成活率(94.27±3.48)%,皮片融合时间为(10.27±2.02)d;患者皮肤恢复评分总分为(3.68±0.79)分;护理后总并发症发生率为5.64%。结论烧伤后瘢痕挛缩畸形行植皮术后患者为预防粘连,巩固整形手术效果,防止瘢痕挛缩复发,需加强术后功能锻炼。     

小脑扁桃体延髓下疝畸形的临床及磁共振扫描

本文对8例经磁共振扫描证实的小脑扁桃体延髓下疝畸形进行分析,发现其主要临床表现为延髓高颈髓、小脑、尾组脑神经和上位颈神经综合征,其中以延髓高颈髓症状阳性率最高。症状的轻重与小脑扁桃体延髓下疝的程度不成正此。磁共振扫描在本病的诊断和鉴别诊断方面均有重要价值。     

脊柱胸腰段陈旧性骨折伴后凸畸形的侧前路矫形治疗效果评价

目的：探究侧前路矫形治疗脊柱胸腰段陈旧性骨折伴后凸畸形的效果,以便为治疗提供指导。方法回顾性分析该院收治的46例脊柱胸腰段陈旧性骨折伴后凸畸形患者资料,所有患者均进行侧前路矫形治疗,观察记录术前以及术后1年内患者的Cobb角和VAS评分。结果术后1年后凸Cobb角平均为(12.4±5.2)o;术前VAS评分平均为(5.78±0.85),术后1年VAS评分平均为(0.56±0.13),所有患者后凸Cobb角、VAS评分较术前均有明显改善,差异有统计学意义(P<0.05)。结论对脊柱胸腰段陈旧性骨折伴后凸畸形患者进行前侧路矫形治疗效果明显,能够防止术后并发症的发生,减轻患者的疼痛程度,改善后凸Cobb角,值得临床推广。