Introduction: Osteonecrosis of the femoral head (ONTF) is a debilitating condition. Several treatments have been proposed with controversial results. The aim of our study was to evaluate treatment by surgical drilling...Introduction: Osteonecrosis of the femoral head (ONTF) is a debilitating condition. Several treatments have been proposed with controversial results. The aim of our study was to evaluate treatment by surgical drilling coupled with in situ cancellous grafting. Materials and methods: Our study was a case-control study conducted at Brazzaville University Hospital from 1st January 2018 to 31 December 2023. It compared two groups of patients with ONTF: non-operated (13 patients, 20 hips) and operated (22 patients, 35 hips). We used the visual digital scale (VDS) for pain assessment, the Merle D’Aubigne-Postel (MDP) scoring system for clinical and functional assessment, and the evolution of necrosis. Results: The group of non-operated patients had a mean age of 35.69 ± 3.4 years, no improvement in pain with an EVN above seven at the last recoil and a mean global MDP score falling from 12.7 before offloading to 10.13 at one year. The group of patients operated on had a mean age of 37.86 ± 7.02 years, a significant reduction in pain (p = 0.00004) and a significantly increased MDP score (p = 0.0034). A comparison of the two groups of patients showed significant stabilization of the necrotic lesions in the operated patients (p = 0.00067), with better satisfaction in the same group. Conclusion: Surgical drilling combined with grafting in the treatment of early-stage ONTF has improved progress in our series. The technique is reproducible and less invasive. It has made it possible to delay unfavorable progression and, consequently, hip replacement surgery.展开更多
脊柱椎体的多层复合结构和易热损伤特性要求手术机器人在对椎弓根进行骨钻孔时需精确控制其轴向钻削力。然而人的个体差异和脊柱-软组织构成的刚软耦合结构会使得通用型力控制器的控制精度不足,手术安全性降低。本文旨在提高轴向钻削力...脊柱椎体的多层复合结构和易热损伤特性要求手术机器人在对椎弓根进行骨钻孔时需精确控制其轴向钻削力。然而人的个体差异和脊柱-软组织构成的刚软耦合结构会使得通用型力控制器的控制精度不足,手术安全性降低。本文旨在提高轴向钻削力控制的精度。首先建立了基于质量、弹簧和Maxwell黏弹性单元的脊柱-软组织系统的刚软耦合模型。然后在离体羊脊柱上进行了应力松弛实验,并基于实测力数据对模型参数进行了标定。采用PID(比例-积分-微分)控制器来调整骨钻的轴向进给速度,并基于标定后的刚软耦合模型的传递函数,使用动态权重的标准粒子群算法整定控制器参数。最后,仿真证明闭环控制系统具有较好的动态性能和鲁棒性。离体羊脊柱骨钻孔力控制实验结果表明,轴向钻削力的阶跃力响应稳态误差小于0.15 N,相对力控制误差小于3%,且无明显超调;正弦力响应幅度在频率为3.49 rad/s时衰减到-3 d B,闭环控制系统具有较好的控制带宽。所提方法的力控制精度和控制带宽能够满足手术机器人执行骨钻削时的力跟踪要求,提高了机器人自动骨钻削过程的安全性。展开更多
BACKGROUND:The present study aimed to explore the relationship between surgical methods,hemorrhage position,hemorrhage volume,surgical timing and treatment outcome of hypertensive intracerebral hemorrhage(HICH).METHOD...BACKGROUND:The present study aimed to explore the relationship between surgical methods,hemorrhage position,hemorrhage volume,surgical timing and treatment outcome of hypertensive intracerebral hemorrhage(HICH).METHODS:A total of 1 310 patients,who had been admitted to six hospitals from January 2004 to January 2008,were divided into six groups according to different surgical methods:craniotomy through bone fl ap(group A),craniotomy through a small bone window(group B),stereotactic drilling drainage(group C1 and group C2),neuron-endoscopy operation(group D) and external ventricular drainage(group E) in consideration of hemorrhage position,hemorrhage volume and clinical practice. A retrospective analysis was made of surgical timing and curative effect of the surgical methods.RESULTS:The effectiveness rate of the methods was 74.12% for 1 310 patients after onemonth follow-up. In this series,the disability rate was 44.82% 3–6 months after the operation. Among the 1 310 patients,241(18.40%) patients died after the operation. If hematoma volume was >80 mL and the operation was performed within 3 hours,the mortality rate of group A was signifi cantly lower than that of groups B,C,D,and E(P<0.05). If hematoma volume was 50–80 mL and the operation was performed within 6–12 hours,the mortality rate of groups B and D was lower than that of groups A,C and E(P<0.05). If hematoma volume was 20–50 mL and the operation was performed within 6–24 hours,the mortality rate of group C was lower than that of groups A,B and D(P<0.05).CONCLUSIONS:Craniotomy through a bone f lap is suitable for patients with a large hematoma and hernia of the brain. Stereotactic drilling drainage is suggested for patients with hematoma volume less than 80 mL. The curative effect of HICH individualized treatment would be improved via the suitable selection of operation time and surgical method according to the position and volume of hemorrhage.展开更多
文摘Introduction: Osteonecrosis of the femoral head (ONTF) is a debilitating condition. Several treatments have been proposed with controversial results. The aim of our study was to evaluate treatment by surgical drilling coupled with in situ cancellous grafting. Materials and methods: Our study was a case-control study conducted at Brazzaville University Hospital from 1st January 2018 to 31 December 2023. It compared two groups of patients with ONTF: non-operated (13 patients, 20 hips) and operated (22 patients, 35 hips). We used the visual digital scale (VDS) for pain assessment, the Merle D’Aubigne-Postel (MDP) scoring system for clinical and functional assessment, and the evolution of necrosis. Results: The group of non-operated patients had a mean age of 35.69 ± 3.4 years, no improvement in pain with an EVN above seven at the last recoil and a mean global MDP score falling from 12.7 before offloading to 10.13 at one year. The group of patients operated on had a mean age of 37.86 ± 7.02 years, a significant reduction in pain (p = 0.00004) and a significantly increased MDP score (p = 0.0034). A comparison of the two groups of patients showed significant stabilization of the necrotic lesions in the operated patients (p = 0.00067), with better satisfaction in the same group. Conclusion: Surgical drilling combined with grafting in the treatment of early-stage ONTF has improved progress in our series. The technique is reproducible and less invasive. It has made it possible to delay unfavorable progression and, consequently, hip replacement surgery.
文摘脊柱椎体的多层复合结构和易热损伤特性要求手术机器人在对椎弓根进行骨钻孔时需精确控制其轴向钻削力。然而人的个体差异和脊柱-软组织构成的刚软耦合结构会使得通用型力控制器的控制精度不足,手术安全性降低。本文旨在提高轴向钻削力控制的精度。首先建立了基于质量、弹簧和Maxwell黏弹性单元的脊柱-软组织系统的刚软耦合模型。然后在离体羊脊柱上进行了应力松弛实验,并基于实测力数据对模型参数进行了标定。采用PID(比例-积分-微分)控制器来调整骨钻的轴向进给速度,并基于标定后的刚软耦合模型的传递函数,使用动态权重的标准粒子群算法整定控制器参数。最后,仿真证明闭环控制系统具有较好的动态性能和鲁棒性。离体羊脊柱骨钻孔力控制实验结果表明,轴向钻削力的阶跃力响应稳态误差小于0.15 N,相对力控制误差小于3%,且无明显超调;正弦力响应幅度在频率为3.49 rad/s时衰减到-3 d B,闭环控制系统具有较好的控制带宽。所提方法的力控制精度和控制带宽能够满足手术机器人执行骨钻削时的力跟踪要求,提高了机器人自动骨钻削过程的安全性。
基金supported by a grant from Shanghai Pudong New Area(PWZxkq2011-01)
文摘BACKGROUND:The present study aimed to explore the relationship between surgical methods,hemorrhage position,hemorrhage volume,surgical timing and treatment outcome of hypertensive intracerebral hemorrhage(HICH).METHODS:A total of 1 310 patients,who had been admitted to six hospitals from January 2004 to January 2008,were divided into six groups according to different surgical methods:craniotomy through bone fl ap(group A),craniotomy through a small bone window(group B),stereotactic drilling drainage(group C1 and group C2),neuron-endoscopy operation(group D) and external ventricular drainage(group E) in consideration of hemorrhage position,hemorrhage volume and clinical practice. A retrospective analysis was made of surgical timing and curative effect of the surgical methods.RESULTS:The effectiveness rate of the methods was 74.12% for 1 310 patients after onemonth follow-up. In this series,the disability rate was 44.82% 3–6 months after the operation. Among the 1 310 patients,241(18.40%) patients died after the operation. If hematoma volume was >80 mL and the operation was performed within 3 hours,the mortality rate of group A was signifi cantly lower than that of groups B,C,D,and E(P<0.05). If hematoma volume was 50–80 mL and the operation was performed within 6–12 hours,the mortality rate of groups B and D was lower than that of groups A,C and E(P<0.05). If hematoma volume was 20–50 mL and the operation was performed within 6–24 hours,the mortality rate of group C was lower than that of groups A,B and D(P<0.05).CONCLUSIONS:Craniotomy through a bone f lap is suitable for patients with a large hematoma and hernia of the brain. Stereotactic drilling drainage is suggested for patients with hematoma volume less than 80 mL. The curative effect of HICH individualized treatment would be improved via the suitable selection of operation time and surgical method according to the position and volume of hemorrhage.
