Objective
To evaluate the directional significance of SurgiCase software in free fibula mandibular reconstruction.
Methods
Between September 2010 and March 2012, 10 patients with mandibular defect underwent free fibula mandibular reconstruction. There were 7 males and 3 females, with an age range of 19-43 years (mean, 27 years). The extent of lesions was 7 cm × 5 cm to 16 cm × 8 cm. In each case, three-dimensional spiral CT scan of the maxilla, mandible, and fibula was obtained before surgery. The CT data were imported into the SurgiCase software and the virtual surgery planning was performed. After that, the mandibular rapid prototyping was made according to customized design. The reconstruction surgery was then carried out using these preoperative data. During actual surgery, the extent of mandibular defect was from 6 cm × 3 cm to 16 cm × 5 cm; the length of fibula which was used to reconstruct mandible was 6-17 cm; and the area of flap was from 6 cm × 5 cm to 16 cm × 6 cm.
Results
Preoperative data could not be applied because the intraoperative size of tumor was larger than preoperative design in 1 case of mandibular ameloblastoma, and the fibula was shaped according to the actual osteotomy location; operations were performed successfully according to preoperative design in the other 9 patients. The operation time was 5-7 hours (mean, 6 hours). Primary healing of incision was obtained, without early complications. Ten patients were followed up 1 year. At last follow-up, 8 patients were satisfactory with the appearance and 2 patients complained with unsatisfied wide facial pattern. The panoramic radiograghs showed good bone healing. The range of mouth opening was 2.5-3.5 cm.
Conclusion
SurgiCase software can provide precise data for free fibula mandibular reconstruction during surgery. It can be applied widely in clinic.
Objective To review the vascular anatomy of the donor and the reci pient for the l iving kidney transplantation. Methods The recent l iterature about the vessels of donor and reci pient in cl inical appl ications was extensively reviewed. Results The pertinent vascular anatomy of the donor and recipient was essential for the screening of the proper candidates, surgical planning and long-term outcome. Early branching and accessory renal artery of the donor were particularly important to deciding the side of nephrectomy, surgical technique and anastomosing pattern, and their injuries were the most frequent factor of the conversion from laparoscopic to open surgery. With increase of laparoscopic nephrectomy indonors, accurate venous anatomy was paid more and more attention to because venous bleeding could also lead to conversion to open nephrectomy. Multidetector CT (MDCT) could supplant the conventional excretory urography and renal catheter angiography and could accurately depict the donors’ vessels, vascular variations. In addition, MDCT can excellently evaluate the status of donor kidney, collecting system and other pertinent anatomy details. Conclusion Accurate master of related vascular anatomy can facil iate operation plan and success of operation and can contribute to the rapid development of living donor kidney transplantation. MDCT has become the choice of preoperative one-stop image assessment for living renal donors.
【Abstract】 Objective To explore the methods and appl ication value of surface shaded display (SSD) and multiplanarreconstruction (MPR) in the evaluation of acetabular morphology in patients with developmental dysplasia of the hip (DDH) before total hip arthroplasty (THA). Methods From October 2003 to November 2006, 17 patients (3 males and 14 females, aging from 35 years to 61 years) with osteoarthritis secondary to DDH were scanned with spiral CT preoperatively. According to the Crowe standard, 19 dysplasia hips were classified as type I in 4 hips, type II in 9 hips, type III in 6 hips. The obtained hip CT data were developed with SSD and MPR to observe spational position and bone stock of the acetabula. Results The dislocated extent was 25%-89% in these dysplasia hips according to the Crowe method and their sharp angles all exceeded 45°. Bone defect occurred to each of the acetabula, among which it was located in anterosuperior acetabulum in 5 hips, in superolateral acetabulum in 11 hips and in posterosuperior acetabulum in 3 hips. The hip images made with MPR showed that the minimum thickness of the medial wall of acetabula ranged from 2.0 mm to 10.9 mm. Among 15 unilateral dysplasia patients, the opening difference anddepth difference between the dysplasia acetabulum and the contralateral one ranged from 2.7 mm to 19.1 mm and from 2.3 mm to 13.1 mm, respectively. Conclusion SSD and MPR of spiral CT are effective methods in evaluating acetabular morphology preoperation and contribute to intraoperative acetabular reconstruction in patients with DDH performed THA.
Objective To study the feasibil ity and rel iabil ity of the multi-plannar reformation (MPR) of multispiral CT (MSCT) in measuring the kyphosis angle (KA) after thoracolumbar fracture. Methods From December 2007 to December 2009, 45 thoracolumbar fracture patients who underwent computed radiology (CR) and MSCT were recruited. There were 32 males and 13 females with a mean age of 48 years (range, 24-63 years), including 36 simple compression fractures and 9 burst fractures. The fracture locations were T11 in 6 cases , T12 in 11 cases, L1 in 20 cases, and L2 in 8 cases. Fracture was caused by trafffic accident in 25 cases, by fall ing from height in 12 cases, and by others in 8 cases. The imaging examination was performed after 2 hours to 7 days of injury in 22 cases and after more than 7 days in 23 cases. The KA was measured on the lateral X-ray films of CR and MPR by two observers, then the measurements were done again after three weeks. The data were statistically analyzed. Results The average KA values on CR by two observers were (20.75 ± 8.31)° and (22.49 ± 9.07)°, respectively; showing significant difference (P lt; 0.05), and the correlation was good (r=0.882, P lt; 0.05). The average KA values on MPR by two observers were (16.65 ± 8.62)° and (17.08 ± 7.88)°, respectively, showing no significant difference (P gt; 0.05), the correlation was excellent (r=0.976, P lt; 0.05). The average KA values on CR and MPR were (21.61 ± 8.43)° and (16.87 ± 8.20)°, respectively; showing significant difference (P lt; 0.05), the correlation was good (r=0.852, P lt; 0.05). Conclusion It is more feasible and rel iable in measuring the KA on MRP of MSCT than CR, but the value is larger on CR.
【摘要】 目的 探討正常成人肺靜脈開口徑線（pulmonary vein ostia，PVO）的測量方法，并獲得我院PVO徑線值的95%參考值范圍。 方法 2005年6月-2006年1月收集無明顯心肺疾病的正常成人236例，對其進行多層螺旋CT掃描，利用斜冠面重建和三維標定的方法測量PVO徑線。 結果 四條PVO徑線的95%參考值范圍如下：右上肺靜脈長徑線為男性1.49~2.63 cm，女性1.31~2.37 cm，短徑線為男性0.87~2.05 cm，女性0.91~1.81 cm；右下肺靜脈長徑線為男性1.12~2.06 cm，女性1.05~1.95 cm，短徑線為男性0.77~1.83 cm，女性0.79~1.69 cm；左上肺靜脈長徑線為男性1.18~2.20 cm，女性1.09~2.11 cm，短徑線為男性0.82~1.72 cm，女性為0.80~1.62 cm；左下肺靜脈長徑線為男性0.96~1.98 cm，女性1.03~1.81 cm，短徑線為男性0.56~1.26 cm，女性0.51~1.33 cm。除左下肺靜脈短徑男女差異無統計學意義外，其余徑線值男性均大于女性。 結論 采用CT三維重建像改進測量方法測量PVO徑線值既簡便又準確。【Abstract】 Objective To measure and calculate the diameters of pulmonary vein ostia (PVO) by multi-slice spiral computed tomography (MSCT) in healthy people. Methods From June 2005 to January 2006, 236 healthy people were adopted to undergo MSCT. Their diameters of PVO were measured and calculated by oblique coronal planes reconstruction and 3D position-setting. Results Right superior vein: the 95% reference ranges of the long diameters were 1.49-2.63 cm in the male and 1.31-2.37 cm in the female;the ranges of the short diameters were 0.87-2.05 cm in the male and 0.91-1.81 cm in the female. Right inferior vein: the ranges of the long diameters were 1.12-2.06 cm in the male and 1.05-1.95 cm in the female;the ranges of the short diameters were 0.77-1.83 cm in the male and 0.79-1.69 cm in the female. Left superior vein: the ranges of the long diameters were 1.18-2.20 cm in the male and 1.09-2.11 cm in the female;the ranges of the short diameters were 0.82-1.72 cm in the male and 0.80-1.62 cm in the female. Left inferior vein: the ranges of the long diameters were 0.96-1.98 cm in the male and 1.03-1.81 cm in the female;the ranges of the short diameters were 0.56-1.26 cm in the male and 0.51-1.33 cm in the female. The diameters in the male were all longer than those in the female, except the short diameter of left inferior vein. Conclusions It is a convenient and accurate method to measure the diameters of PVO by blique coronal planes reconstruction and 3D position-setting.
摘要:目的: 探討64排多層螺旋CT(MSCT)和血清淀粉樣蛋白A(serum amyloid A protein, SAA)聯合術前評估直腸癌在腫瘤分期診斷中的作用。 方法 :納入經根治術治療的直腸癌患者通過MSCT掃描進行評估,同時取患者靜脈血測量術前SAA水平,行MSCT分期與MSCT和SAA聯合分期以比較二者的診斷價值。 結果 :本研究納入患者121例。MSCT檢測T分期的準確度為851%。在評估淋巴結轉移方面,MSCT和SAA聯合分期的準確度為760%,明顯高于MSCT分期(595%, 〖WTBX〗P lt;0001)。MSCT正確判斷所有遠處轉移。同單一的MSCT檢測相比,MSCT和SAA聯合評估能顯著的提高術前TNM分期的準確率(785% vs. 636%,〖WTBX〗P =0011)。 結論 :MSCT聯合SAA檢測比單一的MSCT檢測顯著提高了直腸癌術前腫瘤分期和淋巴結轉移方面的準確度。這種新的術前評估方法的為腫瘤進展評估和術前治療決策提供了更加可靠的信息。Abstract: Objective: To determine the role of combinative assessment of 64 multislice spiral computer tomography (MSCT) and serum amyloid A protein (SAA) in preoperative rectal cancer staging. Methods : Enrolled consecutive rectal cancer patients undergoing curative surgery were evaluated by MSCT scan. Meanwhile venous blood specimens were taken to measure preoperative SAA concentration. Both MSCT staging and MSCT plus SAA staging were performed to compare with each other. Results : The study population consisted of 121 patients. The accuracy of T staging was 851% for MSCT. The accuracy in evaluating lymph nodes metastases was 760% for MSCT plus SAA compared with 595% for MSCT alone (〖WTBX〗P lt;0001). All the distant metastases were correctly detected by MSCT. The method combining MSCT with SAA led to significant improvement on preoperative TNM staging compared with MSCT alone (785% vs. 636%, 〖WTBX〗P =0011). Conclusion : MSCT plus SAA showed greater accuracy than MSCT alone in rectal cancer staging and lymph node metastases. This novel strategy of preoperative evaluation appears to provide more accurate information on tumor progression and preoperative therapy decisionmaking.
Objective To investigate the spiral CT manifestations of the collateral circulation pathways resulting from splenic vein occlusion (SVO) duo to pancreatic diseases. Methods The CT imaging and clinical data of 33 cases of pancreatic disease with SVO, including 28 cases of pancreatic carcinoma, 3 cases of acute pancreatitis and 2 cases of chronic pancreatitis, were retrospectively analyzed.Results Tortuous and dilated vessels were observed in the areas between splenic hilum and gastric fundus and/or along the gastric greater curvature in all 33 cases. In isolated SVO cases, the short gastric vein (SGV, 86%)，coronary vein (CV, 79%)，gastroepiploic vein (GEV, 79%) and gastrocolic trunk (GCT, 57%) were varicose and dilated. While in nonisolated SVO，other collateral veins such as the right superior colic vein (RSCV, 37%），middle colic vein (MCV, 37%） and posterior superior pancreaticoduodenal vein (PSPDV, 21%） were seen as well. Conclusion The two predominant collateral pathways of SVO are ①SGV→gastric fundal veins→CV， and ②GEV→GCT→SMV. They have characteristic imaging features on spiral CT and are of clinical significance in both preoperative staging of pancreatic carcinoma and the evaluation of pancreatogenic segmental portal hypertension.
Objective To evaluate the accuracy of pedicle guide device for the placement of the pedicle screws. Methods Pedicle guide device was designed and made for the anatomical trait of pedicle. The 3-Danatomical data of the thoracic pedicles were measured by multislice spiral CT in two embalmed human cadaveric thoracic pedicles spine(T1 -T10). Depending on transverse section angle(TSA) and sagittal section angle(SSA) of pedicle axis, the degree of horizontal dial and sagittal dial were adjusted in the guide device. The screws wereinserted bilaterally in the thoracic pedicles by using the device. After pulling the screws out, the pathways were filled with contrast media. The TSA and SSA of developed pathways were measured. Results Analysis of the difference between pedicle axis and developed pathway was of no statistical significance(P＞0.05). Conclusion The guide device could be easilyoperated and guarantee high accuracy of the pathways of screws and the incidence of pedicle penetration could be significantly reduced.
