Cranial reconstruction: 3D biomodel and custom-built implant created using additive manufacturing

Additive manufacturing (AM) technology from engineering has helped to achieve several advances in the medical field, particularly as far as fabrication of implants is concerned. The use of AM has made it possible to carry out surgical planning and simulation using a three-dimensional physical model which accurately represents the patient's anatomy. AM technology enables the production of models and implants directly from a 3D virtual model, facilitating surgical procedures and reducing risks. Furthermore, AM has been used to produce implants designed for individual patients in areas of medicine such as craniomaxillofacial surgery, with optimal size, shape and mechanical properties. This work presents AM technologies which were applied to design and fabricate a biomodel and customized implant for the surgical reconstruction of a large cranial defect. A series of computed tomography data was obtained and software was used to extract the cranial geometry. The protocol presented was used to create an anatomic biomodel of the bone defect for surgical planning and, finally, the design and manufacture of the patient-specific implant.     

Developing a craniomaxillofacial and cervical equipment module for surgeons in the austere environment: a systematic review

The treatment of craniomaxillofacial and cervical wounds in a disaster relief setting is done by clinicians from local medical treatment facilities, non-governmental organisations (NGO), or the military. Although each group and individual surgeon will need specific equipment, this will be restricted by weight, portability and interoperability. We systematically reviewed scientific and commercial publications according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The papers we identified described the portable equipment that is required to treat patients who need damage-control surgery (decompressive craniectomy, temporary stabilisation, and internal and external fixation of the facial bones) for craniomaxillofacial and cervical injuries in austere or military settings. Austere settings are those in which there is an inherent lack of infrastructure, such as facilities, roads, and power. A total of 35 papers or scientific articles recommended the equipment that is needed to manage these injuries, but we could find no module that was specifically designed for use in these environments. Multiple modules are currently required to provide comprehensive surgical care and many of the items in the existing maxillofacial and neurosurgical kits are rarely used, which increases the cost of initial procurement and resupply. Duplications in equipment between modules also increase the size, weight, and financial cost. We suggest the equipment that is required to make up a rationalised, lightweight, and compact module that can be used for all craniomaxillofacial and cervical operations in austere settings.     

经不同动脉途径使用Onyx18栓塞前颅窝底硬脑膜动静脉瘘

目的探讨经不同动脉途径栓塞前颅窝底硬脑膜动静脉瘘的安全性、有效性。方法回顾性分析2004年5月—2012年4月,首都医科大学宣武医院介入放射诊断治疗科使用Onyx18栓塞治疗的前颅窝底硬脑膜动静脉瘘患者的临床资料,共16例,其中男14例,女2例,年龄33～71岁,平均50岁。分析栓塞所选用的不同动脉入路、栓塞的治愈率及并发症的发生率。结果①血管造影显示所有患者的硬脑膜动静脉瘘均由眼动脉的筛前动脉和筛后动脉供血,9例另由脑膜中动脉和蝶腭动脉参与供血,其中2例还伴有额极动脉供血;3例另由蝶腭动脉参与供血。②在16例患者中,1例经蝶腭动脉、8例经脑膜中动脉分支、7例经眼动脉供血的筛前动脉分支进行超选择置管栓塞。所有患者均得到影像学治愈,术后恢复良好。无任何相关并发症的发生。③术后半年门诊随访7例,无任何相关症状;半年影像学随访3例,无影像学复发表现。结论经动脉途径使用Onyx18栓塞前颅窝底硬脑膜动静脉瘘是一种安全、有效的治疗方法。根据供血情况选择合适的供血动脉进行栓塞,可以提高手术的安全性和成功率。     

磁共振血管成像和血管造影对急性脑梗死患者颅外段颈动脉狭窄的对比研究

目的研究磁共振血管成像技术对急性脑梗死患者颅外段颈动脉狭窄的诊断价值。方法对32例临床怀疑颈动脉狭窄的急性脑梗死患者行磁共振血管成像(magnetic resonance angiography MRA)及数字减影血管造影(digital subtraction angiography,DSA)检查,DSA以NASCET法计算狭窄率,MRA分别以NASCET法和截面积法计算狭窄率。结果以DSA诊断为金标准,32例128条颅外段颈动脉狭窄,MRA以NASCET法诊断的敏感性63%,特异性100%,准确性78.1%,Kappa=0.593;MRA截面积法诊断的敏感性63%,特异性100%,准确性79.7%,Kappa=0.622。结论MRA在诊断急性脑梗死颅外段颈动脉狭窄病变时,具有较高的敏感性、准确性和特异性,可用于筛选可疑颅外段颈动脉狭窄或闭塞的患者,使大部分患者免除DSA检查,但MRA尚不能代替DSA。     

关节镜下尺骨鹰嘴窝、冠突窝成形术治疗肘关节屈伸活动受限

目的 对肘关节屈伸活动受限患者关节镜下行尺骨鹰嘴窝、冠突窝成形手术疗效的探讨.方法 2009年11月～2010年12月选择肘关节屈伸活动受限患者17例,行关节镜下尺骨鹰嘴窝、冠突窝成形术,术后随访6～8个月,测定术前、术后的肘关节最大伸曲角度,以Mayo肘关节评分评价肘关节功能.结果 患者肘关节疼痛明显缓解或消失,关节...     

微创手术在后颅窝出血中的应用

目的总结后颅窝出血包括小脑出血及硬膜外/下血肿的微创手术治疗。方法对30例后颅窝出血,小脑出血19例,枕部硬膜外/下血肿11例选用YL-1型一次性脑内血肿粉碎穿刺针微创锥颅/钻孔引流方法患者选用传统方法钻孔,放入硅胶引流管引流与传统开颅血肿清除方法进行对比。结果选用YL-1型一次性脑内血肿粉碎穿刺针微创锥颅/钻孔放入硅胶引流管引流钻孔组30例患者中,除1例术后再次出血并出现脑疝行开颅血肿清除去骨瓣减压外,均取得良好效果。结论选用YL-1型一次性脑内血肿粉碎穿刺针微创锥颅/钻孔引流方法患者选用传统方法钻孔,放入硅胶引流管引流与传统开颅血肿清除方法进行对比患者创伤小,恢复快,并发症少。大大降低住院费用,提高了治愈率和生活质量。     

颈椎的应用解剖学观察

本文测量了重庆地区成年人干燥颈椎100套(男性58套、女性42套)椎体上面的最大横径和矢径,椎孔的横径和矢径,C_3～7侧隐窝的横径和矢径,且观察了侧隐窝的出现率。同时还测量了82套(男性44套、女性38套)C_3～7颈椎椎间管的长度和宽度     

经胸骨切迹入路与经胸骨上窝入路腔镜辅助甲状腺手术的比较

目的探讨经胸骨切迹入路腔镜辅助甲状腺手术的安全性和可行性。方法 2009年1月~2010年9月,51例单侧甲状腺病变分别采用2种入路行腔镜辅助甲状腺手术,其中胸骨切迹入路27例,经胸骨上窝入路24例,分别记录其切口长度、手术时间、出血量和手术相关不良事件等。结果 51例均顺利完成手术,无中转开放手术。胸骨切迹组手术时间、探查甲状腺时间分别为（13.9±6.0）min、5 min（2.0~20.0 min）明显长于胸骨上窝组（11.0±2.4）min（t=2.136,P=0.035）、2.5 min（2.0~5.0 min）（Z=3.490,P=0.000）。胸骨切迹组术中出血量和切口长度分别为（22.0±11.8）g和2 cm（2.0~2.5cm）,与胸骨上窝组（17.4±10.3）g（t=1.474,P=0.147）和2 cm（1.7~2.8 cm）（Z=0.284,P=0.777）比较无统计学意义。2组均无手术并发症发生。结论经胸骨切迹入路与胸骨上窝入路腔镜辅助甲状腺手术有相似的安全性和可行性。     

颅后窝胆脂瘤显微外科治疗

目的 为了提高颅后窝胆脂瘤的手术治疗效果。方法 回顾性总结１６２例颅后窝胆脂瘤的临床症状、诊断方式、显微手术入路与疗效。 结果 １４９例（９２．０％）肿瘤获全切除;１３例（８．０％）为次全切除。４例（２．５％）于术后２周内因脑干缺血、水肿或肺部感染而死亡。１３４例获长期随访（平均４．５年）,其中１２９例（９６．３％）恢复良好,２例（１．５％）肿瘤复发。 结论 采用显微手术治疗颅后窝胆脂瘤是一种安全     

Arnold ChiariⅠ畸形合并脊髓空洞的手术分析

目的 探讨Arnold Chiari Ⅰ畸形（Arnold Chiari Malformation type Ⅰ,ACM）合并脊髓空洞（Syringomyelia,SM）的外科治疗方法.方法 对2000～2006年36例ACM合并SM的患者采用后颅窝减压、成形术,并根据不同的临床特点予以空洞切开引流、下疝小脑扁桃体切除、颈枕交界区粘连分离以及脊髓中央管口松解术.结果 术后随访1年以上,症状明显缓解28例,稳定无变化7例,1例疼痛加重并出现对侧上肢麻木;MRI检查示2例脊髓空洞消失,26例空洞明显缩小,8例空洞无明显变化.结论 缓解颅颈交界区的压迫和疏通脑脊液循环是手术成功的根本.