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Seok HG, Park WT, Park SJ, Park SG. Small volar fragment in the lunate fossa leads to volar tilt loss after volar plate fixation for AO/OTA type-C distal radius fracture. HAND SURGERY & REHABILITATION 2024; 43:101674. [PMID: 38431044 DOI: 10.1016/j.hansur.2024.101674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 02/18/2024] [Accepted: 02/19/2024] [Indexed: 03/05/2024]
Abstract
OBJECTIVES The relationship between volar fragment size and postoperative volar tilt loss in complete articular distal radius fracture is not well known. In this study, we measured precise radiological parameters to help identify other factors that might contribute to volar tilt loss. MATERIAL AND METHODS We retrospectively reviewed the radiological examinations and charts of 256 patients with distal radial fracture who underwent volar locking plate fixation between March 2014 and July 2022. Radiological parameters were measured based on preoperative CT and immediate postoperative radiographs. Univariate and multivariate linear regression analysis was performed to identify relevant factors associated with volar tilt loss following volar locking plate fixation. The receiver operating characteristic curve was used to identify the cutoff value of the independent parameters. RESULTS On univariate analysis, 2 radiologic parameters on preoperative CT (volar fragment length at the lunate fossa, and teardrop angle) and 4 on immediate postoperative X-ray (radial inclination, radial length, capitate shift, and volar tilt) were significantly associated with postoperative volar tilt loss. On multivariate linear regression analysis, the risk of volar tilt loss increased as the capitate moved toward the back of the radial shaft. The cut-off for anteroposterior length in the lunate fossa was 6.5 mm. CONCLUSIONS AO/OTA type-C distal radius fractures with <6.5 mm anteroposterior length in the lunate fossa had significantly higher rates of malunion with dorsal deformity. In addition, preoperative teardrop angle <37.2 ° and immediate postoperative volar tilt <3.7º are also predictors of postoperative volar tilt loss.
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Affiliation(s)
- Hyun-Gyu Seok
- Department of Orthopedic Surgery, Yeungnam University Medical Center, Daegu, Republic of Korea
| | - Wook Tae Park
- Department of Orthopedic Surgery, Yeungnam University Medical Center, Daegu, Republic of Korea
| | - Sung-Jin Park
- Department of Orthopedic Surgery, Yeungnam University Medical Center, Daegu, Republic of Korea
| | - Sam-Guk Park
- Department of Orthopedic Surgery, Yeungnam University Medical Center, Daegu, Republic of Korea.
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O'Connor O, Patel R, Thahir A, Sy J, Jou E. The use of Three-Dimensional Printing in Orthopaedics: a Systematic Review and Meta-analysis. THE ARCHIVES OF BONE AND JOINT SURGERY 2024; 12:441-456. [PMID: 39070875 PMCID: PMC11283294 DOI: 10.22038/abjs.2024.74117.3465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 03/13/2024] [Indexed: 07/30/2024]
Abstract
Objectives 3D-printing is a rapidly developing technology with applications in orthopaedics including pre-operative planning, intraoperative guides, design of patient specific instruments and prosthetics, and education. Existing literature demonstrates that in the surgical treatment of a wide range of orthopaedic pathology, using 3D printing shows favourable outcomes. Despite this evidence 3D printing is not routinely used in orthopaedic practice. We aim to evaluate the advantages of 3D printing in orthopaedic surgery to demonstrate its widespread applications throughout the field. Methods We performed a comprehensive systematic review and meta-analysis. AMED, EMBASE, EMCARE, HMIC, PsycINFO, PubMed, BNI, CINAHL and Medline databases were searched using Healthcare Databases Advanced Search (HDAS) platform. The search was conducted to include papers published before 8th November 2020. Clinical trials, journal articles, Randomised Control Trials and Case Series were included across any area of orthopaedic surgery. The primary outcomes measured were operation time, blood loss, fluoroscopy time, bone fusion time and length of hospital stay. Results A total of 65 studies met the inclusion criteria and were reviewed, and 15 were suitable for the meta-analysis, producing a data set of 609 patients. The use of 3D printing in any of its recognised applications across orthopaedic surgery showed an overall reduction in operative time (SMD = -1.30; 95%CI: -1.73, -0.87), reduction in intraoperative blood loss (SMD = -1.58; 95%CI: -2.16, -1.00) and reduction in intraoperative fluoroscopy time (SMD = -1.86; 95%CI: -2.60, -1.12). There was no significant difference in length of hospital stay or in bone fusion time post-operatively. Conclusion The use of 3D printing in orthopaedics leads to an improvement in primary outcome measures showing reduced operative time, intraoperative blood loss and number of times fluoroscopy is used. With its wide-reaching applications and as the technology improves, 3D printing could become a valuable addition to an orthopaedic surgeon's toolbox.
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Affiliation(s)
- Olivia O'Connor
- Department of Trauma and Orthopaedics, Addenbrookes Major Trauma Unit, Cambridge University Hospitals, United Kingdom
- School of Clinical Medicine, University Of Cambridge, Cambridge, United Kingdom
- Contributed equally to this article as first authors
| | - Reece Patel
- Department of Trauma and Orthopaedics, Addenbrookes Major Trauma Unit, Cambridge University Hospitals, United Kingdom
- School of Clinical Medicine, University Of Cambridge, Cambridge, United Kingdom
- Contributed equally to this article as first authors
| | - Azeem Thahir
- Department of Trauma and Orthopaedics, Addenbrookes Major Trauma Unit, Cambridge University Hospitals, United Kingdom
| | - Jamie Sy
- Department of Medicine, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Eric Jou
- Kellogg College, University of Oxford, Oxford, United Kingdom
- Medical Sciences Division, Oxford University Hospitals, University of Oxford, Oxford, United Kingdom
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Raghoebar II, Dubois L, de Lange J, Schepers T, Don Griot P, Essig H, Rozema F. The Effectiveness of Three-Dimensional Osteosynthesis Plates versus Conventional Plates for the Treatment of Skeletal Fractures: A Systematic Review and Meta-Analysis. J Clin Med 2023; 12:4661. [PMID: 37510776 PMCID: PMC10380957 DOI: 10.3390/jcm12144661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 06/07/2023] [Accepted: 06/25/2023] [Indexed: 07/30/2023] Open
Abstract
PURPOSE To assess the difference between preformed anatomically shaped osteosynthesis plates and patient-specific implants versus conventional flat plates for the treatment of skeletal fractures in terms of anatomical reduction, operation time, approach, patient outcomes, and complications. MATERIAL AND METHODS MEDLINE (1950 to February 2023), EMBASE (1966 to February 2023), and the Cochrane Central Register of Controlled Trials (inception to February 2023) databases were searched. Eligible studies were randomised clinical trials, prospective controlled clinical trials, and prospective and retrospective cohort studies (n ≥ 10). Inclusion criteria were studies reporting the outcomes of preformed anatomically shaped osteosynthesis plates and patient-specific implants versus conventional flat plates after treating skeletal fractures. Outcome measures included anatomical reduction, stability, operation time, hospitalisation days, patients' outcomes, and complications. Two independent reviewers assessed the abstracts and analysed the complete texts and methodologies of the included studies. RESULTS In total, 21 out of the 5181 primarily selected articles matched the inclusion criteria. A meta-analysis revealed a significant difference in operation time in favour of the preformed anatomical plates and patient-specific implants versus conventional plates. Significant differences in operation time were found for the orbital (95% CI: -50.70-7.49, p = 0.008), upper limb (95% CI: -17.91-6.13, p < 0.0001), and lower limb extremity groups (95% CI: -20.40-15.11, p < 0.00001). The mean difference in the rate of anatomical reduction in the lower limb extremity group (95% CI: 1.04-7.62, p = 0.04) was also in favour of using preformed anatomical plates and patient-specific implants versus conventional plates. CONCLUSIONS This systematic review showed a significant mean difference in surgery time favouring the use of preformed anatomical plates and patient-specific implants for orbital, upper, and lower limb extremity fractures. Additionally, preformed anatomical plates and patient-specific implants in the lower limb group result in a significantly higher rate of anatomical reduction versus conventional flat plates.
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Affiliation(s)
- Iva Ilse Raghoebar
- Academic Center for Dentistry (ACTA), University of Amsterdam, 1012 WX Amsterdam, The Netherlands
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Leander Dubois
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Jan de Lange
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Tim Schepers
- Department of Surgery, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, 1012 WX Amsterdam, The Netherlands
| | - Peter Don Griot
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, University of Amsterdam, 1012 WX Amsterdam, The Netherlands
| | - Harald Essig
- Department of Oral and Maxillofacial Surgery, University Hospital Zuerich, Frauenklinikstrasse 24, 8091 Zürich, Switzerland
| | - Frederik Rozema
- Academic Center for Dentistry (ACTA), University of Amsterdam, 1012 WX Amsterdam, The Netherlands
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
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Bodansky DMS, Sandow MJ, Volk I, Luria S, Verstreken F, Horwitz MD. Insights and trends review: the role of three-dimensional technology in upper extremity surgery. J Hand Surg Eur Vol 2023; 48:383-395. [PMID: 36748271 DOI: 10.1177/17531934221150498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The use of three-dimensional (3-D) technology in upper extremity surgery has the potential to revolutionize the way that hand and upper limb procedures are planned and performed. 3-D technology can assist in the diagnosis and treatment of conditions, allowing virtual preoperative planning and surgical templating. 3-D printing can allow the production of patient-specific jigs, instruments and implants, allowing surgeons to plan and perform complex procedures with greater precision and accuracy. Previously, cost has been a barrier to the use of 3-D technology, which is now falling rapidly. This review article will discuss the current status of 3-D technology and printing, including its applications, ethics and challenges in hand and upper limb surgery. We have provided case examples to outline how clinicians can incorporate 3-D technology in their clinical practice for congenital deformities, management of acute fracture and malunion and arthroplasty.
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Affiliation(s)
- David M S Bodansky
- Department of Plastic Surgery, Chelsea and Westminster NHS Foundation Trust, London, UK
| | | | - Ido Volk
- Hadassah Medical Organisation, Jerusalem, Israel
| | - Shai Luria
- Hadassah Medical Organisation, Jerusalem, Israel
| | | | - Maxim D Horwitz
- Department of Plastic Surgery, Chelsea and Westminster NHS Foundation Trust, London, UK
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Clinical Applications of Three-Dimensional Printing in Upper Extremity Surgery: A Systematic Review. J Pers Med 2023; 13:jpm13020294. [PMID: 36836528 PMCID: PMC9961947 DOI: 10.3390/jpm13020294] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 02/02/2023] [Accepted: 02/03/2023] [Indexed: 02/10/2023] Open
Abstract
Three-dimensional printing for medical applications in surgery of the upper extremity has gained in popularity as reflected by the increasing number of publications. This systematic review aims to provide an overview of the clinical use of 3D printing in upper extremity surgery. METHODS We searched the databases PubMed and Web of Science for clinical studies that described clinical application of 3D printing for upper extremity surgery including trauma and malformations. We evaluated study characteristics, clinical entity, type of clinical application, concerned anatomical structures, reported outcomes, and evidence level. RESULTS We finally included 51 publications with a total of 355 patients, of which 12 were clinical studies (evidence level II/III) and 39 case series (evidence level IV/V). The types of clinical applications were for intraoperative templates (33% of a total of 51 studies), body implants (29%), preoperative planning (27%), prostheses (15%), and orthoses (1%). Over two third of studies were linked to trauma-related injuries (67%). CONCLUSION The clinical application of 3D printing in upper extremity surgery offers great potential for personalized approaches to aid in individualized perioperative management, improvement of function, and ultimately help to benefit certain aspects in the quality of life.
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Zhang W, Mou L, Zhang S, Liu W, Remila A, Han M, Xiang W, Fang R. 3D-printed individualized navigation template versus the fluoroscopic guide to defining the femoral tunnel for medial patellofemoral ligament reconstruction: A retrospective study. Medicine (Baltimore) 2023; 102:e32729. [PMID: 36705383 PMCID: PMC9876018 DOI: 10.1097/md.0000000000032729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
During medial patellofemoral ligament (MPFL) reconstruction, fluoroscopic determination of the femoral tunnel point is the most common method. However, there is a decrease in tunnel position accuracy due to rotation of the femur during fluoroscopy, as well as the damage to the operator from multiple fluoroscopies, whereas the 3D-printed individualized navigation template is not affected by this factor. This study focuses on the accuracy and early clinical efficacy of 2 different ways to determine the femoral tunnel (Schöttle point) for double-bundle isometric MPFL reconstruction. This is a retrospective study, conducted between 2016 and 2019, in which 60 patients with recurrent patellar dislocation were divided into 2 groups: 30 with MPFL reconstruction at the Schöttle point determined by 3D-printed individualized navigation template (group A) and 30 with MPFL reconstruction at the Schöttle point determined by fluoroscopic guidance (group B). The changes in patella congruence angle and patella tilt angle before and after surgery were assessed using computed tomography scans of the knee, knee function was assessed using the Kujala knee score and the international knee documentation committee (IKDC) score, and the 2 approaches were compared for the intraoperative establishment of the femoral tunnel position at a distance from Schöttle point. At a minimum of 3 years follow-up, patella tilt angle and patella congruence angle returned to normal levels and were statistically different from the preoperative range, with no significant differences between the 2 groups at the same period, and Kujala and IKDC scores of knee function were significantly improved in both groups after surgery. The mean Kujala and IKDC scores were statistically different between groups A and B at 3 and 6 months postoperatively. No statistically significant differences were seen between the 2 groups at the final follow-up. Both femoral tunnel localization approaches for double-bundle isometric MPFL reconstruction resulted in good knee function. At no < 3 years of follow-up, the use of a 3D-printed individualized navigation template did result in more accurate isometric points and higher knee function scores in the early postoperative period.
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Affiliation(s)
- Wenhao Zhang
- Xinjiang Medical University, Urumqi, Xinjiang Province, China
- Department of Orthopedics, The Fourth Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang Province, China
| | - Limin Mou
- Emergency Trauma Surgery, Yichang Central Hospital, affiliated with Three Gorges University, Yicang, Hubei Province
| | - Shiping Zhang
- Xinjiang Medical University, Urumqi, Xinjiang Province, China
- Department of Orthopedics, The Fourth Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang Province, China
| | - Wei Liu
- Xinjiang Medical University, Urumqi, Xinjiang Province, China
| | - Aimaiti Remila
- Xinjiang Medical University, Urumqi, Xinjiang Province, China
- Department of Orthopedics, The Fourth Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang Province, China
| | - Mingzhan Han
- Xinjiang Medical University, Urumqi, Xinjiang Province, China
| | - Wenyuan Xiang
- Department of Orthopedics, The Fourth Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang Province, China
| | - Rui Fang
- Department of Orthopedics, The Fourth Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang Province, China
- * Correspondence: Rui Fang, Department of Orthopedics, The Fourth Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang Province 830054, China (e-mail: )
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Ikumi A, Yoshii Y, Eda Y, Ishii T. Computer-Aided Assessment of Three-Dimensional Standard Bone Morphology of the Distal Radius. Diagnostics (Basel) 2022; 12:diagnostics12123212. [PMID: 36553219 PMCID: PMC9777835 DOI: 10.3390/diagnostics12123212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 12/07/2022] [Accepted: 12/15/2022] [Indexed: 12/23/2022] Open
Abstract
The present study attempted to define the three-dimensional (3D) locations of reference points and standard measures of the distal radius of a normal wrist joint. One hundred wrists from 50 males and 50 females who matched the age distribution (19−95 years old, mean: 56.0 years old) were evaluated. Computed tomography (CT) images of normal wrist joints acquired for comparison with the affected side were used. The absence of a previous history and complaints in the unaffected wrist was confirmed in an interview and with medical records. Three-dimensional images of the distal radius were reconstructed using the data obtained from CT scans. The site at which the major axis of the radial diaphysis contacted the distal radius joint surface was defined as the origin. The 3D coordinates of reference points for the radial styloid process (1), sigmoid notch volar edge (2), and sigmoid notch dorsal edge (3) as well as the barycenter for the joint surface and joint surface area were evaluated. A slope of the line connecting coordinates 1−2 in the coronal plane was evaluated as the 3D radial inclination (3DRI) and that connecting coordinates 2−3 in the sagittal plane as the 3D palmar tilt (3DPT). Each measurement value was compared between males and females. The positions of each reference point from the origin were as follows: (1) 14.2 ± 1.3/12.6 ± 1.1 mm for the distal-palmar-radial position; (2) 19.3 ± 1.3/16.9 ± 1.3 mm for the proximal-palmar-ulnar position; (3) 15.6 ± 1.4/14.1 ± 0.9 mm for the proximal-dorsal-ulnar position; and (barycenter) 4.1 ± 0.7/3.7 ± 0.7 mm for the proximal-volar-ulnar position for males and females, respectively. The areas of the radius articular surface were 429.0 ± 67.9/347.6 ± 44.6 mm2 for males and females, respectively. The 3DRI and 3DPT were 24.2 ± 4.0/25.7 ± 3.1° and 10.9 ± 5.1/13.2 ± 4.4° for males and females, respectively. Significant differences were observed in all measurement values between males and females (p < 0.01). The reference points and measured values obtained in the present study will serve as criteria for identifying the dislocation direction and reduction conditions of distal radius fractures in 3D images.
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Affiliation(s)
- Akira Ikumi
- Department of Orthopaedic Surgery, Tsukuba University Hospital, Tsukuba, Ibaraki 305-8576, Japan
| | - Yuichi Yoshii
- Department of Orthopaedic Surgery, Tokyo Medical University Ibaraki Medical Center, Ami, Ibaraki 300-0395, Japan
- Correspondence: ; Tel.: +81-29-887-1161
| | - Yusuke Eda
- Department of Orthopaedic Surgery, Mito Kyodo General Hospital, Mito, Ibaraki 310-0015, Japan
| | - Tomoo Ishii
- Department of Orthopaedic Surgery, Tokyo Medical University Ibaraki Medical Center, Ami, Ibaraki 300-0395, Japan
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Asmara AAGY, Karna MB, Meregawa PF, Deslivia MF. Outcomes of the Management of Distal Radius Fractures in the Last 5 Years: A Meta-analysis of Randomized Controlled Trials. Rev Bras Ortop 2022; 57:899-910. [PMID: 36540735 PMCID: PMC9757966 DOI: 10.1055/s-0042-1754379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 06/14/2022] [Indexed: 12/23/2022] Open
Abstract
Objective Over the last decades, volar locking plates (VLPs) have been the mainstay treatment for distal radius fractures (DRFs). With the growing body of evidence, we systematically reviewed studies on recent VLP modifications. Methods A systematic search was performed in the PubMed/MEDLINE database for studies published in English in the past five years. The inclusion criteria were randomized controlled trials (RCTs) on the operative treatment of DRFs. We excluded ongoing trials and studies not directly addressing DRF. The primary outcomes assessed were subjective (such as the scores on the Disabilities of the Arm, Shoulder and Hand [DASH] questionnaire, the Patient-rated Wrist Evaluation [PRWE], the European Quality of Life-5 Dimensions [EQ-5D], the 36-item Short Form Health Survey [SF-36], and the Visual Analog Scale [VAS]) and objective clinical outcomes (the complication rate). Results We identified 29 articles published from 2016 to 2020 with high quality of evidence, except for one, which had evidence of moderate quality. In total, 3,079 DRFs were analyzed in the present study. All studies except one had a greater proportion of female participants, and only in 1 study the mean age of the sample was < 40 years old. There were no significant differences between the VLP and external fixation (EF) in terms of the scores on the DASH ( p = 0.18) and PRWE ( p = 0.77). The VLP alone without pronator quadratus (PQ) repair yielded significantly better outcomes. Conclusion In unstable fractures, the VLP and EF yielded comparable long-term results. There is no clear benefit of adding PQ repair to current the VLP surgical technique. Level of Evidence Level I.
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Affiliation(s)
- Anak Agung Gede Yuda Asmara
- Departamento de Ortopedia e Traumatologia, Faculdade de Medicina, Udayana University, Sanglah General Hospital, Bali, Indonésia,Endereço para correspondência Anak Agung Gede Yuda Asmara Orthopedics and Traumatology Department, Faculty of Medicine, Udayana University, Sanglah General HospitalJl, Kesehatan no.1, BaliIndonesia
| | - Made Bramantya Karna
- Departamento de Ortopedia e Traumatologia, Faculdade de Medicina, Udayana University, Sanglah General Hospital, Bali, Indonésia
| | - Putu Feryawan Meregawa
- Departamento de Ortopedia e Traumatologia, Faculdade de Medicina, Udayana University, Sanglah General Hospital, Bali, Indonésia
| | - Maria Florencia Deslivia
- Departamento de Ortopedia e Traumatologia, Faculdade de Medicina, Udayana University, Sanglah General Hospital, Bali, Indonésia
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Wang S, Zhao S, Yu J, Gu Z, Zhang Y. Advances in Translational 3D Printing for Cartilage, Bone, and Osteochondral Tissue Engineering. SMALL (WEINHEIM AN DER BERGSTRASSE, GERMANY) 2022; 18:e2201869. [PMID: 35713246 DOI: 10.1002/smll.202201869] [Citation(s) in RCA: 38] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 05/12/2022] [Indexed: 06/15/2023]
Abstract
The regeneration of 3D tissue constructs with clinically relevant sizes, structures, and hierarchical organizations for translational tissue engineering remains challenging. 3D printing, an additive manufacturing technique, has revolutionized the field of tissue engineering by fabricating biomimetic tissue constructs with precisely controlled composition, spatial distribution, and architecture that can replicate both biological and functional native tissues. Therefore, 3D printing is gaining increasing attention as a viable option to advance personalized therapy for various diseases by regenerating the desired tissues. This review outlines the recently developed 3D printing techniques for clinical translation and specifically summarizes the applications of these approaches for the regeneration of cartilage, bone, and osteochondral tissues. The current challenges and future perspectives of 3D printing technology are also discussed.
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Affiliation(s)
- Shenqiang Wang
- Zhejiang Provincial Key Laboratory for Advanced Drug Delivery Systems, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, 310058, China
| | - Sheng Zhao
- Zhejiang Provincial Key Laboratory for Advanced Drug Delivery Systems, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, 310058, China
| | - Jicheng Yu
- Zhejiang Provincial Key Laboratory for Advanced Drug Delivery Systems, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, 310058, China
- Liangzhu Laboratory, Zhejiang University Medical Center, Hangzhou, 311121, China
| | - Zhen Gu
- Zhejiang Provincial Key Laboratory for Advanced Drug Delivery Systems, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, 310058, China
- Liangzhu Laboratory, Zhejiang University Medical Center, Hangzhou, 311121, China
- Department of General Surgery, Sir Run Run Hospital, School of Medicine, Zhejiang University, Hangzhou, 310016, China
- MOE Key Laboratory of Macromolecular Synthesis and Functionalization, Department of Polymer Science and Engineering, Zhejiang University, Hangzhou, 310027, China
- Jinhua Institute of Zhejiang University, Jinhua, 321299, China
| | - Yuqi Zhang
- Zhejiang Provincial Key Laboratory for Advanced Drug Delivery Systems, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, 310058, China
- Department of Burns and Wound Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310009, China
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McKibben NS, Lindsay SE, Friess DM, Zusman NL, Working ZM. Methods of Quantifying Intraoperative Blood Loss in Orthopaedic Trauma Surgery: A Systematic Review. J Orthop Trauma 2022; 36:e215-e226. [PMID: 34799543 DOI: 10.1097/bot.0000000000002313] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/15/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To collect and present the recently published methods of quantifying blood loss (BL) in orthopaedic trauma. DATA SOURCES A systematic review of English-language literature in PubMed, Cochrane Library, and Scopus databases was conducted according to the PRISMA guidelines on articles describing the methods of determining BL in orthopaedic trauma published since 2010. STUDY SELECTION English, full-text, peer-reviewed articles documenting intraoperative BL in an adult patient population undergoing orthopaedic trauma surgery were eligible for inclusion. DATA EXTRACTION Two authors independently extracted data from the included studies. Articles were assessed for quality and risk of bias using the Cochrane Collaboration's tool for assessing risk of bias and ROBINS-I. DATA SYNTHESIS The included studies proved to be heterogeneous in nature with insufficient data to make data pooling and analysis feasible. CONCLUSIONS Eleven methods were identified: 6 unique formulas with multiple variations, changes in hemoglobin and hematocrit levels, measured suction volume and weighed surgical gauze, transfusion quantification, cell salvage volumes, and hematoma evacuation frequency. Formulas included those of Gross, Mercuriali, Lisander, Sehat, Foss, and Stahl, with Gross being the most common (25%). All formulas used blood volume estimation, determined by equations from Nadler (94%) or Moore (6%), and measure change in preoperative and postoperative blood counts. This systematic review highlights the variability in BL estimation methods published in current orthopaedic trauma literature. Methods of quantifying BL should be taken into consideration when designing and evaluating research.
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Affiliation(s)
- Natasha S McKibben
- Department of Orthopaedics and Rehabilitation, Oregon Health and Science University, Portland, OR
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Lu L, Chai L, Wan D, Li P, Chen D. Effect Comparison of Assisted Surgery Simulated by Preoperative 3D Reconstruction and Minimally Invasive Surgery with the Assist of Knee Arthroscopy in the Treatment of Tibial Plateau Fracture under the Background of Intelligent Medicine. COMPUTATIONAL INTELLIGENCE AND NEUROSCIENCE 2022; 2022:3397998. [PMID: 35619761 PMCID: PMC9129929 DOI: 10.1155/2022/3397998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 04/29/2022] [Accepted: 05/06/2022] [Indexed: 11/17/2022]
Abstract
Objective To explore the effect comparison of the assisted surgery simulated by preoperative 3D reconstruction and the minimally invasive surgery with the assist of knee arthroscopy in the treatment of tibial plateau fracture (TPF) under the background of intelligent medicine. Methods 100 patients with TPF admitted to our hospital from January 2021 to January 2022 were selected as the study subjects. According to the order of admission, the patients were divided into the simulation group with 3D reconstruction (n = 50) and the auxiliary group with knee arthroscopy (n = 50), and the clinical indicators were compared between the two groups. Results There was no significant difference in any other clinical treatment indexes between the two groups except the surgery time (P > 0.05), and there was no significant difference in knee flexion ability, walking ability, and Rasmussen scores between the two groups after treatment (P > 0.05). However, compared with the auxiliary group with knee arthroscopy, the mean posterior slope angle and varus angle of the patients were significantly higher (P < 0.001), and the total incidence of complications was significantly lower (P < 0.05). Conclusion Based on the analysis under the background of intelligent medicine, it is found that the assisted surgery simulated by preoperative 3D reconstruction has a better effect and a higher safety, but they have the similar effects on improving the knee joint function of patients.
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Affiliation(s)
- Lei Lu
- Department of Orthopedics and Trauma, Bozhou People's Hospital, 236800 Bozhou, Anhui, China
| | - Leizi Chai
- Department of Orthopedics and Trauma, Bozhou People's Hospital, 236800 Bozhou, Anhui, China
| | - Deyu Wan
- Department of Orthopedics and Trauma, Bozhou People's Hospital, 236800 Bozhou, Anhui, China
| | - Peng Li
- Department of Orthopedics and Trauma, Bozhou People's Hospital, 236800 Bozhou, Anhui, China
| | - Duozi Chen
- Department of Pediatrics, Bozhou People's Hospital, 236800 Bozhou, Anhui, China
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12
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Catena N, Arrigoni C, Origo C. Use of a 3D Model for the Correction of a Complex Madelung Deformity in a Teenager: A Case Report. JBJS Case Connect 2022; 12:01709767-202206000-00008. [PMID: 36099456 DOI: 10.2106/jbjs.cc.21.00622] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
CASE The aim of the article is to report on a case of a teenager affected by Madelung deformity treated with a double osteotomy, planned by means of a 3D model. Using a custom-made cutting guide, the radial osteotomy was performed, and after the reorientation, a shortening ulnar osteotomy completed the procedure. Postoperative clinical assessment showed a normal alignment of the ulna with increased range of motion wrist motion. CONCLUSIONS Using a 3D model when planning a multidirectional correction of a Madelung deformity may be advantageous to achieve a more accurate and precise realignment of the carpus and distal radioulnar joint.
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Affiliation(s)
- Nunzio Catena
- Reconstructive Surgery and Hand Surgery, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Chiara Arrigoni
- Pediatric Orthopaedic and Traumatology Unit, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Carlo Origo
- Pediatric Orthopaedic and Traumatology Unit, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
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13
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Robb H, Scrimgeour G, Boshier P, Przedlacka A, Balyasnikova S, Brown G, Bello F, Kontovounisios C. The current and possible future role of 3D modelling within oesophagogastric surgery: a scoping review. Surg Endosc 2022; 36:5907-5920. [PMID: 35277766 PMCID: PMC9283150 DOI: 10.1007/s00464-022-09176-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 02/24/2022] [Indexed: 01/02/2023]
Abstract
BACKGROUND 3D reconstruction technology could revolutionise medicine. Within surgery, 3D reconstruction has a growing role in operative planning and procedures, surgical education and training as well as patient engagement. Whilst virtual and 3D printed models are already used in many surgical specialities, oesophagogastric surgery has been slow in their adoption. Therefore, the authors undertook a scoping review to clarify the current and future roles of 3D modelling in oesophagogastric surgery, highlighting gaps in the literature and implications for future research. METHODS A scoping review protocol was developed using a comprehensive search strategy based on internationally accepted guidelines and tailored for key databases (MEDLINE, Embase, Elsevier Scopus and ISI Web of Science). This is available through the Open Science Framework (osf.io/ta789) and was published in a peer-reviewed journal. Included studies underwent screening and full text review before inclusion. A thematic analysis was performed using pre-determined overarching themes: (i) surgical training and education, (ii) patient education and engagement, and (iii) operative planning and surgical practice. Where applicable, subthemes were generated. RESULTS A total of 56 papers were included. Most research was low-grade with 88% (n = 49) of publications at or below level III evidence. No randomised control trials or systematic reviews were found. Most literature (86%, n = 48) explored 3D reconstruction within operative planning. These were divided into subthemes of pre-operative (77%, n = 43) and intra-operative guidance (9%, n = 5). Few papers reported on surgical training and education (14%, n = 8), and were evenly subcategorised into virtual reality simulation (7%, n = 4) and anatomical teaching (7%, n = 4). No studies utilising 3D modelling for patient engagement and education were found. CONCLUSION The use of 3D reconstruction is in its infancy in oesophagogastric surgery. The quality of evidence is low and key themes, such as patient engagement and education, remain unexplored. Without high quality research evaluating the application and benefits of 3D modelling, oesophagogastric surgery may be left behind.
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Affiliation(s)
- Henry Robb
- Imperial College Healthcare NHS Trust, London, UK
- Imperial College London, London, UK
| | | | - Piers Boshier
- Imperial College Healthcare NHS Trust, London, UK
- Imperial College London, London, UK
| | - Anna Przedlacka
- Imperial College Healthcare NHS Trust, London, UK
- Imperial College London, London, UK
| | | | - Gina Brown
- Imperial College London, London, UK
- The Royal Marsden NHS Foundation Trust, London, UK
| | | | - Christos Kontovounisios
- Imperial College London, London, UK.
- The Royal Marsden NHS Foundation Trust, London, UK.
- Chelsea Westminster NHS Foundation Trust, London, UK.
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14
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Meyer-Szary J, Luis MS, Mikulski S, Patel A, Schulz F, Tretiakow D, Fercho J, Jaguszewska K, Frankiewicz M, Pawłowska E, Targoński R, Szarpak Ł, Dądela K, Sabiniewicz R, Kwiatkowska J. The Role of 3D Printing in Planning Complex Medical Procedures and Training of Medical Professionals-Cross-Sectional Multispecialty Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:3331. [PMID: 35329016 PMCID: PMC8953417 DOI: 10.3390/ijerph19063331] [Citation(s) in RCA: 50] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 02/18/2022] [Accepted: 03/05/2022] [Indexed: 12/19/2022]
Abstract
Medicine is a rapidly-evolving discipline, with progress picking up pace with each passing decade. This constant evolution results in the introduction of new tools and methods, which in turn occasionally leads to paradigm shifts across the affected medical fields. The following review attempts to showcase how 3D printing has begun to reshape and improve processes across various medical specialties and where it has the potential to make a significant impact. The current state-of-the-art, as well as real-life clinical applications of 3D printing, are reflected in the perspectives of specialists practicing in the selected disciplines, with a focus on pre-procedural planning, simulation (rehearsal) of non-routine procedures, and on medical education and training. A review of the latest multidisciplinary literature on the subject offers a general summary of the advances enabled by 3D printing. Numerous advantages and applications were found, such as gaining better insight into patient-specific anatomy, better pre-operative planning, mock simulated surgeries, simulation-based training and education, development of surgical guides and other tools, patient-specific implants, bioprinted organs or structures, and counseling of patients. It was evident that pre-procedural planning and rehearsing of unusual or difficult procedures and training of medical professionals in these procedures are extremely useful and transformative.
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Affiliation(s)
- Jarosław Meyer-Szary
- Department of Pediatric Cardiology and Congenital Heart Defects, Faculty of Medicine, Medical University of Gdańsk, 80-210 Gdańsk, Poland
| | - Marlon Souza Luis
- Department of Pediatric Cardiology and Congenital Heart Defects, Faculty of Medicine, Medical University of Gdańsk, 80-210 Gdańsk, Poland
- First Doctoral School, Medical University of Gdańsk, 80-211 Gdańsk, Poland
| | - Szymon Mikulski
- Department of Head and Neck Surgery, Singapore General Hospital, Singapore 169608, Singapore
| | - Agastya Patel
- First Doctoral School, Medical University of Gdańsk, 80-211 Gdańsk, Poland
- Department of General, Endocrine and Transplant Surgery, Faculty of Medicine, Medical University of Gdańsk, 80-214 Gdańsk, Poland
| | - Finn Schulz
- University Clinical Centre in Gdańsk, 80-952 Gdańsk, Poland
| | - Dmitry Tretiakow
- Department of Otolaryngology, Faculty of Medicine, Medical University of Gdańsk, 80-214 Gdańsk, Poland
| | - Justyna Fercho
- Neurosurgery Department, Faculty of Medicine, Medical University of Gdańsk, 80-210 Gdańsk, Poland
| | - Kinga Jaguszewska
- Department of Gynecology, Obstetrics and Neonatology, Division of Gynecology and Obstetrics, Faculty of Medicine, Medical University of Gdańsk, 80-210 Gdańsk, Poland
| | - Mikołaj Frankiewicz
- Department of Urology, Faculty of Medicine, Medical University of Gdańsk, 80-210 Gdańsk, Poland
| | - Ewa Pawłowska
- Department of Oncology and Radiotherapy, Faculty of Medicine, Medical University of Gdańsk, 80-210 Gdańsk, Poland
| | - Radosław Targoński
- 1st Department of Cardiology, Faculty of Medicine, Medical University of Gdańsk, 80-210 Gdańsk, Poland
| | - Łukasz Szarpak
- Institute of Outcomes Research, Maria Sklodowska-Curie Medical Academy, 03-411 Warsaw, Poland
- Research Unit, Maria Sklodowska-Curie Bialystok Oncology Center, 15-027 Bialystok, Poland
- Henry JN Taub Department of Emergency Medicine, Baylor College of Medicine, Houston, TX 77030, USA
| | - Katarzyna Dądela
- Department of Pediatric Cardiology, University Children's Hospital, Faculty of Medicine, Jagiellonian University Medical College, 30-663 Krakow, Poland
| | - Robert Sabiniewicz
- Department of Pediatric Cardiology and Congenital Heart Defects, Faculty of Medicine, Medical University of Gdańsk, 80-210 Gdańsk, Poland
| | - Joanna Kwiatkowska
- Department of Pediatric Cardiology and Congenital Heart Defects, Faculty of Medicine, Medical University of Gdańsk, 80-210 Gdańsk, Poland
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15
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Zhang Y, Luo J, Cao L, Zhang S, Tong Y, Bi Q, Zhang Q. Preoperative Simulation and Three-Dimensional Model for the Operative Treatment of Forearm Double Fracture: A Randomized Controlled Clinical Trial. J INVEST SURG 2022; 35:1231-1238. [PMID: 34983284 DOI: 10.1080/08941939.2021.2024305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND To assess the safety and efficacy of preoperative simulation and three-dimensional (3D) models in the treatment of ulnoradial diaphyses fracture. It was hypothesized that preoperative simulation and 3D printing might significantly shorten the mean operative time, intraoperative bleeding, and intraoperative fluoroscopy. MATERIAL AND METHODS Forty patients with forearm double fracture were divided into 3D printing group and conventional surgery group. Preoperative simulation and 3D printing were performed on patients in the 3D printing group to examine implant reduction and placement as well as preoperative plate/screw size. The operation time, intraoperative bleeding, and frequency of fluoroscopies were recorded. RESULTS In the conventional surgery group, the operative time, intraoperative bleeding, and the frequency of fluoroscopy were 106.2 ± 15.92 min, 61.45 ± 11.33 ml and 5.65 ± 1.23 times, whereas in the 3D printing group, values of all the three parameters were better than those of the conventional surgery group (91.3 ± 14.85 min, 48.6 ± 10.39 ml and 3.85 ± 1.04 times, respectively). The forearm pronation and supination of the 3D printing group improved to 79.55 ± 5.12° and 76.80 ± 3.96°, respectively. In the conventional surgery group, patients also had significant improvement in these indicators, which improved to 78.60 ± 5.18° and 75.4 ± 5.30°. CONCLUSIONS The results showed that preoperative simulation and 3D printing can enhance the safety as well as personalization of the surgical process during the treatment of forearm double fracture and therefore holds potential for future application in clinical practice. TRIAL REGISTRY Name of the registry: This study was registered in the Chinese Clinical Trial Registry; Trial registration number: ChiCTR2100045790.
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Affiliation(s)
- Yin Zhang
- Department of Orthopedic Surgery, Zhejiang Provincial People's Hospital and People's Hospital of Hangzhou Medical College, Hangzhou, Zhejiang, China.,The First Affiliated Hospital of Bengbu Medical University, Bengbu, Anhui, China
| | - Junchao Luo
- Department of Orthopedic Surgery, Zhejiang Provincial People's Hospital and People's Hospital of Hangzhou Medical College, Hangzhou, Zhejiang, China.,The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Li Cao
- Department of Orthopedic Surgery, Zhejiang Provincial People's Hospital and People's Hospital of Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Shuijun Zhang
- Department of Orthopedic Surgery, Zhejiang Provincial People's Hospital and People's Hospital of Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Yu Tong
- Department of Orthopedic Surgery, Zhejiang Provincial People's Hospital and People's Hospital of Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Qing Bi
- Department of Orthopedic Surgery, Zhejiang Provincial People's Hospital and People's Hospital of Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Qiong Zhang
- Department of Orthopedic Surgery, Zhejiang Provincial People's Hospital and People's Hospital of Hangzhou Medical College, Hangzhou, Zhejiang, China
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16
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Wong RMY, Wong PY, Liu C, Chung YL, Wong KC, Tso CY, Chow SKH, Cheung WH, Yung PSH, Chui CS, Law SW. 3D printing in orthopaedic surgery: a scoping review of randomized controlled trials. Bone Joint Res 2021; 10:807-819. [PMID: 34923849 PMCID: PMC8696518 DOI: 10.1302/2046-3758.1012.bjr-2021-0288.r2] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Aims The use of 3D printing has become increasingly popular and has been widely used in orthopaedic surgery. There has been a trend towards an increasing number of publications in this field, but existing literature incorporates limited high-quality studies, and there is a lack of reports on outcomes. The aim of this study was to perform a scoping review with Level I evidence on the application and effectiveness of 3D printing. Methods A literature search was performed in PubMed, Embase, and Web of Science databases. The keywords used for the search criteria were ((3d print*) OR (rapid prototyp*) OR (additive manufactur*)) AND (orthopaedic). The inclusion criteria were: 1) use of 3D printing in orthopaedics, 2) randomized controlled trials, and 3) studies with participants/patients. Risk of bias was assessed with Cochrane Collaboration Tool and PEDro Score. Pooled analysis was performed. Results Overall, 21 studies were included in our study with a pooled total of 932 participants. Pooled analysis showed that operating time (p < 0.001), blood loss (p < 0.001), fluoroscopy times (p < 0.001), bone union time (p < 0.001), pain (p = 0.040), accuracy (p < 0.001), and functional scores (p < 0.001) were significantly improved with 3D printing compared to the control group. There were no significant differences in complications. Conclusion 3D printing is a rapidly developing field in orthopaedics. Our findings show that 3D printing is advantageous in terms of operating time, blood loss, fluoroscopy times, bone union time, pain, accuracy, and function. The use of 3D printing did not increase the risk of complications. Cite this article: Bone Joint Res 2021;10(12):807–819.
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Affiliation(s)
- Ronald Man Yeung Wong
- Department of Orthopaedics & Traumatology, The Chinese University of Hong Kong, Hong Kong, Hong Kong.,Department of Orthopaedics & Traumatology, Prince of Wales Hospital, Hong Kong, Hong Kong
| | - Pui Yan Wong
- Department of Orthopaedics & Traumatology, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Chaoran Liu
- Department of Orthopaedics & Traumatology, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Yik Lok Chung
- Department of Orthopaedics & Traumatology, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Kwok Chuen Wong
- Department of Orthopaedics & Traumatology, Prince of Wales Hospital, Hong Kong, Hong Kong
| | - Chi Yin Tso
- Department of Orthopaedics & Traumatology, Prince of Wales Hospital, Hong Kong, Hong Kong
| | - Simon Kwoon-Ho Chow
- Department of Orthopaedics & Traumatology, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Wing-Hoi Cheung
- Department of Orthopaedics & Traumatology, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Patrick Shu-Hang Yung
- Department of Orthopaedics & Traumatology, The Chinese University of Hong Kong, Hong Kong, Hong Kong.,Department of Orthopaedics & Traumatology, Prince of Wales Hospital, Hong Kong, Hong Kong
| | - Chun Sing Chui
- Department of Orthopaedics & Traumatology, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Sheung Wai Law
- Department of Orthopaedics & Traumatology, The Chinese University of Hong Kong, Hong Kong, Hong Kong.,Department of Orthopaedics & Traumatology, Prince of Wales Hospital, Hong Kong, Hong Kong
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17
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Three-Dimensional Printing in Hand Surgery. J Hand Surg Am 2021; 46:1016-1022. [PMID: 34274209 DOI: 10.1016/j.jhsa.2021.05.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 05/05/2021] [Accepted: 05/14/2021] [Indexed: 02/02/2023]
Abstract
The medical application of 3-dimensional printing technology has evolved in the last decade, with an increasing variety of uses in hand surgery. The ability for patient-specific design, rapid prototyping, and low cost of production of 3-dimensional printed materials has led to this rise in clinical applications, both for common procedures and complex reconstructions. Within hand surgery, 3-dimensional printing can be applied in several broad categories: to construct patient-specific models for preoperative planning, to design orthotics and prosthetics to meet specific patient demands, to create patient-specific aids for intraoperative use, to generate patient-specific hardware and prostheses for implantation, and for applications for trainee education.
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18
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Yang S, Lin H, Luo C. Meta-Analysis of 3D Printing Applications in Traumatic Fractures. Front Surg 2021; 8:696391. [PMID: 34532337 PMCID: PMC8439573 DOI: 10.3389/fsurg.2021.696391] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 07/27/2021] [Indexed: 12/12/2022] Open
Abstract
Background: Traumatic fracture is a common orthopaedic disease, and application of 3D printing technology in fracture treatment, which entails utilisation of pre-operative printed anatomic fracture model, is increasingly gaining popularity. However, effectiveness of 3D printing-assisted surgery lacks evidence-based findings to support its application. Materials and Methods: Embase, PubMed and Cochrane Library databases were systematically searched until October, 2020 to identify relevant studies. All randomised controlled trials (RCTs) comparing efficacy of 3D printing-assisted surgery vs. conventional surgery for traumatic fractures were reviewed. RevMan V.5.3 software was used to conduct meta-analysis. Results: A total of 12 RCTs involving 641 patients were included. Pooled findings showed that 3D printing-assisted surgery had shorter operation duration [standardised mean difference (SMD) = −1.52, 95% confidence interval (CI) – 1.70 ~ −1.34, P < 0.00001], less intraoperative blood loss (SMD = 1.34, 95% CI 1.74 ~ 0.94, P < 0.00001), fewer intraoperative fluoroscopies (SMD = 1.25, 95% CI 1.64 ~ 0.87, P < 0.00001), shorter fracture union time (SMD = −0.15, 95% CI −0.25 ~ −0.05, P = 0.003), and higher rate of excellent outcomes (OR = 2.40, 95% CI 1.07 ~ 5.37, P = 0.03) compared with conventional surgery. No significant differences in complication rates were observed between the two types of surgery (OR = 0.69, 95% CI 0.69 ~ 1.42, P = 0.32). Conclusions: Indicators including operation duration, intraoperative blood loss, number of intraoperative fluoroscopies, fracture union time, and rates of excellent outcomes showed that 3D printing-assisted surgery is a superior alternative in treatment of traumatic fractures compared with conventional surgery. Moreover, the current study did not report significant differences in incidence of complications between the two approaches. Systematic Review Registration: CRD42021239507.
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Affiliation(s)
- Sha Yang
- Department of Orthopaedics, Children's Hospital of Chongqing Medical University, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing Engineering Research Center of Stem Cell Therapy, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Huapeng Lin
- Department of Intensive Care Unit, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Cong Luo
- Department of Orthopaedics, Children's Hospital of Chongqing Medical University, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing Engineering Research Center of Stem Cell Therapy, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
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19
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Overview of In-Hospital 3D Printing and Practical Applications in Hand Surgery. BIOMED RESEARCH INTERNATIONAL 2021; 2021:4650245. [PMID: 33855068 PMCID: PMC8019389 DOI: 10.1155/2021/4650245] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 01/03/2021] [Accepted: 03/22/2021] [Indexed: 12/12/2022]
Abstract
Three-dimensional (3D) printing is spreading in hand surgery. There is an increasing number of practical applications like the training of junior hand surgeons, patient education, preoperative planning, and 3D printing of customized casts, customized surgical guides, implants, and prostheses. Some high-quality studies highlight the value for surgeons, but there is still a lack of high-level evidence for improved clinical endpoints and hence actual impact on the patient's outcome. This article provides an overview over the latest applications of 3D printing in hand surgery and practical experience of implementing them into daily clinical routine.
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20
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Aleemardani M, Bagher Z, Farhadi M, Chahsetareh H, Najafi R, Eftekhari B, Seifalian A. Can Tissue Engineering Bring Hope to the Development of Human Tympanic Membrane? TISSUE ENGINEERING PART B-REVIEWS 2021; 27:572-589. [PMID: 33164696 DOI: 10.1089/ten.teb.2020.0176] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The tympanic membrane (TM), more commonly known as the eardrum, consists of a thin layer of tissue in the human ear that receives sound vibrations from outside of the body and transmits them to the auditory ossicles. The TM perforations (TMPs) are a common ontological condition, which in some cases can result in permanent hearing loss. Despite the spontaneous healing capacity of the TM to regenerate in the majority of cases of acute perforation, chronic perforations require surgical interventions. However, the disadvantages of the surgical procedure include infection, anesthetic risks, and high failure of graft patency. The tissue engineering strategy, which includes the applications of a three-dimensional (3D) scaffold, cells, and biomolecules or a combination of them for the closure of chronic perforation, has been considered as an emerging treatment. Using this approach, emerging products are currently under development to regenerate the TM structure and its properties. This research aimed to highlight the problems with the current methods of TMP treatment, and critically evaluate the tissue engineering approaches, which may overcome these drawbacks. The focus of this review is on recent literature to critically discuss the emerging advanced materials used as a 3D scaffold in the development of a TM with cellular engineering, biomolecules, cells, and the fabrications of the TM and its pathway to the clinical application. In this review, we discuss the properties of TM and the advantages and disadvantages of the current clinical products for repair and replacement of the TM. Furthermore, we provide an overview of the in vitro and preclinical studies of emerging products over the past 5 years. The results of recent preclinical studies suggest that the tissue engineering field holds significant promise.
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Affiliation(s)
- Mina Aleemardani
- Biomedical Engineering Department, Amirkabir University of Technology, Tehran, Iran
| | - Zohreh Bagher
- ENT and Head & Neck Research Centre and Department, The Five Senses Institute, Hazrat Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Farhadi
- ENT and Head & Neck Research Centre and Department, The Five Senses Institute, Hazrat Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Hadi Chahsetareh
- Department of Life Science Engineering, Faculty of New Science and Technologies, University of Tehran, Tehran, Iran
| | - Roghayeh Najafi
- Department of Life Science Engineering, Faculty of New Science and Technologies, University of Tehran, Tehran, Iran
| | - Behnaz Eftekhari
- Biomedical Engineering Department, Amirkabir University of Technology, Tehran, Iran
| | - Alexander Seifalian
- Nanotechnology and Regenerative Medicine Commercialisation Centre (NanoRegMed Ltd.), London BioScience Innovation Centre, London, United Kingdom
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21
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Kong L, Fu M, Lu J, Zhou Y, Zhang Z, Zhang B. The effect of distal radius fractures involving the distal radioulnar articular joint on forearm rotation. J Orthop Surg Res 2020; 15:548. [PMID: 33213493 PMCID: PMC7678168 DOI: 10.1186/s13018-020-02091-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 11/11/2020] [Indexed: 11/10/2022] Open
Abstract
Background The objective of this study was to predict the function of the forearm rotation on the basis of the articular surface of the sigmoid notch from three-dimensional reconstruction images. Methods We retrospectively reviewed patients who underwent volar plate fixation for intra-articular distal radius fractures (DRFs) in our institution between January 2017 and July 2019. The 3D image of the sigmoid notch on the fractured distal radius was reconstructed and looked up from the ulnar view to determine the existence of gaps or steps. Patients with or without gaps/steps on the sigmoid notch were included in the case group or control group, respectively. The patients’ basic data and postoperative data were collected and compared. Results A total of 81 patients were included. There were 33 patients in the case group, and 48 patients in the control group. There was no significant difference between the two groups at baseline. The total range of motion (ROM) of rotation in the case group and control group was 130.3 ± 6.2° and 145.3 ± 6.7°, respectively (P < 0.001). The percentage of rotation ROM of contralateral limb in the case group and control group was 72.3 ± 3.1% and 80.7 ± 3.6%, respectively (P < 0.001). VAS during forearm rotation was 2.1 ± 0.7 in the case group, which is significantly higher than that in the control group (1.5 ± 0.5, P < 0.001). Conclusion This study proposed a new method to assess the articular surface of the sigmoid notch which is based on 3D reconstruction images. With the assistance of this method, we found that gaps or steps on the sigmoid notch not only limit forearm pronation rotation and supination rotation, but also cause apparent wrist pain during forearm rotation movement and poor wrist ability.
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Affiliation(s)
- Lingde Kong
- Department of Orthopedics, The Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, Hebei, 050051, P. R. China
| | - Meng Fu
- Medical Examination Center, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, P. R. China
| | - Jian Lu
- Department of Orthopedics, The Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, Hebei, 050051, P. R. China
| | - Yanqing Zhou
- Department of Orthopedics, The Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, Hebei, 050051, P. R. China
| | - Zuzhuo Zhang
- Department of Radiology, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, P. R. China
| | - Bing Zhang
- Department of Orthopedics, The Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, Hebei, 050051, P. R. China.
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22
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Kong L, Zhang Z, Lu J, Zhang B, Zhou Y, Tian D. Clinical Utility of 3-Dimensional Reconstruction Images to Predict Conservative Treatment Outcomes of Intra-Articular Distal Radius Fractures. MEDICAL SCIENCE MONITOR : INTERNATIONAL MEDICAL JOURNAL OF EXPERIMENTAL AND CLINICAL RESEARCH 2020; 26:e926894. [PMID: 33082303 PMCID: PMC7590525 DOI: 10.12659/msm.926894] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Background Three-dimensional (3D) images can provide additional information on bone fractures, especially in patients with intra-articular distal radius fractures (DRFs). We aimed to identify possible risk factors for adverse outcomes using a 3D reconstruction technique. Material/Methods We retrospectively reviewed adult patients who underwent plaster immobilization with or without closed reduction for DRFs in our hospital between February 2016 and May 2019. The 3D reconstruction image of DRFs was viewed from multiple angles to determine the existence of gaps or steps. Then, a semiquantitative standard was used to assess the severity of fracture. The patients’ basic data and radiographic data were collected, and multiple linear regression analyses were used to identify possible risk factors associated with adverse outcomes. Results A total of 89 cases were analyzed in our study. There were 28, 39, and 22 patients with level 1, 2, or 3 fractures, respectively, based on the semiquantitative standard. In a multiple linear regression, preoperative severity degree (β, 0.393; 95% confidence interval [CI], 0.260–0.526) and postoperative rehabilitation exercise (β, 0.352; 95% CI, 0.023–0.681) were associated with the Patient-Rated Wrist Evaluation during follow-up. Conclusions Our study presents a new method based on 3D reconstruction images to assess the severity of intra-articular DRFs. Patients who were identified as having severe fractures based on this method were found to have worse functional outcome.
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Affiliation(s)
- Lingde Kong
- Department of Orthopedics, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China (mainland)
| | - Zuzhuo Zhang
- Department of Radiology, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China (mainland)
| | - Jian Lu
- Department of Orthopedics, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China (mainland)
| | - Bing Zhang
- Department of Orthopedics, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China (mainland)
| | - Yanqing Zhou
- Department of Orthopedics, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China (mainland)
| | - Dehu Tian
- Department of Orthopedics, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China (mainland)
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Zhu D, Zhang Z, Zhang J, Chen D, Shan Y, Xie B, Liu P, Yan L. The efficacy of 3D printing-assisted surgery in treating distal radius fractures: systematic review and meta-analysis. J Comp Eff Res 2020; 9:919-931. [PMID: 32969712 DOI: 10.2217/cer-2020-0099] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: To compare the efficacy of 3D printing-assisted surgery with routine surgery in the treatment of distal radius fractures to evaluate whether 3D printing technology has more advantages. Materials & methods: To retrieve all published studies that compared the efficacy of 3D printing-assisted surgery with routine surgery for distal radius fractures. Operation time, frequency of intraoperative fluoroscopy, blood loss and other outcomes were assessed. Results: The results suggested that 3D printing-assisted surgery was better than routine surgery in the fields of operation time, frequency of intraoperative fluoroscopy, and blood loss. Conclusion: In the treatment of distal radius fractures, 3D printing-assisted surgery may be superior to routine surgery.
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Affiliation(s)
- Dongming Zhu
- Department of Orthopedics, Dalian Medical University, Dalian 116044, China
| | - Zhen Zhang
- Department of Orthopedics, Dalian Medical University, Dalian 116044, China
| | - Jie Zhang
- Department of Orthopedics, Xiangya Second Hospital, Central South University, Changsha 410012, Hunan, China
| | - Duoyun Chen
- Department of Orthopedics, Dalian Medical University, Dalian 116044, China
| | - Yuzhou Shan
- Department of Orthopedics, Clinical Medical College of Yangzhou University, Subei People's Hospital of Jiangsu Province, Yangzhou 225001, China
| | - Bin Xie
- Department of Orthopedics, Dalian Medical University, Dalian 116044, China
| | - Pengran Liu
- Department of Orthopedics, Xiangya Second Hospital, Central South University, Changsha 410012, Hunan, China
| | - Lianqi Yan
- Department of Orthopedics, Clinical Medical College of Yangzhou University, Subei People's Hospital of Jiangsu Province, Yangzhou 225001, China
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Kong L, Zhai Y, Zhang Z, Lu J, Zhang B, Tian D. Radiocarpal joint stiffness following surgical treatment for distal radius fractures: the incidence and associated factors. J Orthop Surg Res 2020; 15:313. [PMID: 32782009 PMCID: PMC7422592 DOI: 10.1186/s13018-020-01857-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 07/31/2020] [Indexed: 12/21/2022] Open
Abstract
Background Postoperative radiocarpal joint stiffness (RJS) is common in patients with distal radius fractures (DRFs). The purpose of this study was to record the incidence of RJS and to determine potential risk factors that may be associated with it. Methods We retrospectively included a series of patients who suffered from DRFs and underwent volar plate fixation. Patients’ basic data, radiographic data, and postoperative data were collected. The incidence of RJS during follow-up was recorded, and both univariate analyses and multivariate logistic regression were used to determine factors associated with it. Results A total of 119 patients were included in this study. After surgical procedures, there were 42 (35.3%) patients with RJS and 77 (64.7%) patients without. The incidence of RJS after surgical treatment is 35.3%. Multivariate analysis showed that intra-articular fracture (OR, 1.43; 95% CI, 1.13–1.81), pre-operative severe swelling (OR, 1.35; 95% CI, 1.05–1.74), post-operative unsatisfied volar tile (OR, 1.38; 95% CI, 1.01–1.89), and improper rehabilitation exercise (OR, 1.72; 95% CI, 1.18–2.51) were correlated with the incidence of RJS during follow-up. Conclusions Patients with intra-articular fracture, pre-operative severe swelling, post-operative unsatisfied volar tile, and improper rehabilitation exercise were factors associated with the incidence of wrist stiffness. Preoperative risk notification and postoperative precautions are necessary for relevant patients.
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Affiliation(s)
- Lingde Kong
- Department of Orthopedics, The Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Yajie Zhai
- Department of Orthopedics, The Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Zuzhuo Zhang
- Department of Radiology, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Jian Lu
- Department of Orthopedics, The Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Bing Zhang
- Department of Orthopedics, The Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Dehu Tian
- Department of Orthopedics, The Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, People's Republic of China.
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