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取對側大隱靜脈移植橋接治療腘動脈外膜囊腫一例

虛擬現實技術聯合電磁導航手術機器人輔助治療復雜骨盆骨折一例

EFFECTIVENESS OF REPAIRING OR RECONSTRUCTING DEFECTS OF FOREFOOT

ObjectiveTo evaluate the effectiveness of repairing or reconstructing defects of the forefoot. MethodsBetween February 2006 and February 2013, 57 patients with defects of the forefoot were treated. There were 41 males and 16 females with an average age of 38.9 years (range, 19-68 years). The disease causes included motor vehicles crush injury in 28 cases, crashing injury in 17 cases, and machine extrusion injury in 12 cases. The left side was involved in 25 cases and the right side in 32 cases, with a mean disease duration of 4.7 hours (range, 0.5-75.0 hours). Defect located at the 1st metatarsus in 9 cases, at the 5th metatarsus in 8 cases, at the 1st and the 2nd metatarsus in 16 cases, at the 4th and 5th metatarsus in 11 cases, at multiple metatarsus and the forefoot in 13 cases. The bone defect ranged from 2.5 cm×1.9 cm×1.4 cm to 13.3 cm×11.2 cm×2.7 cm. The soft tissue defect ranged from 12.4 cm×6.3 cm to 27.2 cm×18.7 cm. The iliac bone or vascularized iliac bone or vascularized fibula bone was used to rebuild the arch of the foot, and free flap was used to repair defects of the forefoot. The donor site was sutured directly or covered with skin graft. ResultsVenous crisis and partial necrosis occurred in 3 and 2 flaps respectively, which healed after symptomatic treatment. The other flaps and grafted skins survived, and wounds healed primarily. Fifty-one cases were followed up 1.5-2.5 years (mean, 2.1 years). The appearance was excellent and the feeling of the flap recovered at different levels. The two-point discrimination was 8.4-19.8 mm (mean, 13.7 mm) at 1.5 years after operation. According to upper extremity functional evaluation standard by hand surgery branch of Chinese Medical Association, sensation recovered to S2 in 6 cases, to S3 in 18 cases, and to S4 in 27 cases. The patients began to walk with weight loading at 2-6 months after operation (mean, 3.9 months). The bone healing time was 3-6 months (mean, 4.2 months). Based on American Orthopaedic Foot and Ankle Society (AOFAS) standards, the results were excellent in 19 cases, good in 24 cases, fair in 7 case, and poor in 1 case, and the excellent and good rate was 84.3%. ConclusionIt is a good solution to treat defects of the forefoot to use iliac bone or vascularized iliac bone or vascularized fibula bone for rebuilding the arch of the foot and use free flap for repairing defect.

增強現實技術聯合 3-D 打印技術行半椎體置換治療椎體腫瘤一例

目的 總結增強現實（augmented reality，AR）技術聯合 3-D 打印技術行半椎體置換治療椎旁巨大神經鞘膜瘤 1 例經驗。 方法 2017 年 3 月收治 1 例 66 歲男性椎旁巨大神經鞘膜瘤患者。術前 CT 增強掃描顯示，脊柱腰骶部右側旁盆腔內見一 8.9 cm×7.8 cm×7.6 cm 大小的不均勻明顯強化腫塊。利用 Mimics 軟件處理 CT 掃描數據，模擬手術切除腫瘤，設計 L5、S1 椎體模型，并 3-D 打印鈦合金椎體。術中術者佩戴導入了術前重建 AR 影像的 Hololens 眼鏡，徹底切除腫瘤后，植入打印鈦合金椎體。 結果 患者手術順利完成，手術時間 245 min，術中出血量約 1 200 mL。術后病理檢查結果示：（腹膜后脊柱旁）神經鞘瘤。術后 6 個月隨訪，患者疼痛視覺模擬評分（VAS）由術前 5 分降至 2 分；X 線片及 CT 復查示鈦金屬椎體呈部分骨性融合，位置良好，無斷裂、脫出，椎體無塌陷。 結論 應用 AR 技術輔助腫瘤切除，聯合 3-D 打印假體置換治療椎旁巨大腫瘤可行。