Objective To investigate the effectiveness of digital three-dimensional (3D) assisted unilateral biportal endoscopy (UBE) in the treatment of highly isolated lumbar disc herniation (LDH) with translaminar approach. Methods The clinical data of 59 patients who met the selection criteria and underwent UBE treatment due to highly isolated LDH between January 2022 and December 2023 were retrospectively analyzed. Among them, 25 cases were treated with digital 3D assisted translaminar approach (observation group) and 34 cases were treated with interlaminar approach (control group). There was no significant difference in gender, age, disease duration, surgical segment, and preoperative visual analogue scale (VAS) score and Oswestry disability index (ODI) between the two groups (P>0.05). The operation time, intraoperative blood loss, and lateral articular surface preservation rate were recorded and compared between the two groups. VAS score and ODI were used to evaluate the improvements of pain and function before operation and at 3 and 6 months after operation. The modified MacNab criteria was used to evaluate the effectiveness at last follow-up. Results One patient in the control group had dural tear, and the other patients had no nerve injury, infection, dural tear, or other related complications. There was no significant difference in operation time and intraoperative blood loss between the two groups (P>0.05). Patients in both groups were followed up 6-13 months, with an average of 8.3 months. The lateral articular surface preservation rate in the observation group was significantly higher than that in the control group (P<0.05). Three patients in the observation group and 2 patients in the control group had calf muscle venous thrombosis, which was cured after anticoagulant treatment with rivaroxaban and delayed exercise time. There was no recurrence or second operation during the follow-up period. The VAS score and ODI of the two groups at 3 and 6 months after operation significantly improved when compared with those before operation (P<0.05). There was no significant difference between the two groups at each time point after operation (P>0.05). At last follow-up, the effectiveness was evaluated according to the modified MacNab criteria, and there was no significant difference in the evaluation grade and excellent and good rate between the two groups (P>0.05). Conclution UBE via translaminar approach is safe and effective for the treatment of highly isolated LDH, which is beneficial to protect the facet joint, maintain spinal stability, and reduce soft tissue injury. With the assistance of digital 3D technique, preoperative planning can be performed accurately.
More and more relevant research results show that anatomical segmentectomy has the same effect as traditional lobectomy in the surgical treatment of early-stage non-small cell lung cancer (diameter<2.0 cm). Segmentectomy is more difficult than lobotomy. Nowadays, with the promotion of personalization medicine and precision medicine, three-dimensional technique has been widely applied in the medical field. It has advantages such as preoperative simulation, intraoperative positioning, intraoperative navigation, clinical teaching and so on. It plays a key role in the discovery of local anatomical variation of pulmonary segment. This paper reviewed the clinical application of three-dimensional technique and briefly described the clinical application value of this technique in segmentectomy.
Objective To evaluate effectiveness of three-dimensional (3D) printed patient-specific cutting guides (PSCGs) in Cole midfoot osteotomy for treatment of rigid pes cavus deformity associated with Charcot-Marie-Tooth (CMT) disease, and to analyze learning curve for PSCGs-assisted surgery. MethodsA retrospective analysis was conducted of 20 patients (40 feet) with rigid pes cavus deformity associated with CMT who were admitted between March 2021 and July 2023 and met the inclusion criteria. The cohort comprised 13 men and 7 women, with ages ranging from 17 to 62 years (mean, 37.3 years). All patients underwent whole-genome sequencing, which identified 17 patients with CMT type 1 and 3 patients with CMT type 2. Preoperatively, 3D models of bilateral feet were reconstructed based on CT data, and PSCGs were designed and fabricated accordingly. All patients underwent a Cole midfoot osteotomy assisted by the guides. Operation time, number of intraoperative fluoroscopic exposures, and intraoperative complications were recorded. Pre- and post-operative outcomes were compared using the visual analogue scale (VAS) score for pain, the American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score, and domain scores of the 36-Item Short Form Health Survey (SF-36), as well as radiographic parameters including the Meary’s angle, Pitch angle, talo-first metatarsal angle (T1MT), talocalcaneal angle (TCA), and Djian-Annonier angle, to assess the corrective effect of the osteotomy. A modified cumulative sum analysis was performed to evaluate the learning curve for PSCGs-assisted surgery. ResultsAll procedures in the 20 patients (40 feet) were completed successfully, with no cases of massive hemorrhage or injury to critical neurovascular or tendinous structures. The operation time ranged from 63 to 129 minutes (mean, 82.9 minutes), and fluoroscopy was performed 2-11 times (mean, 4.7 times). Postoperatively, 1 patient (1 foot) developed a mild superficial surgical-site infection, which resolved with symptomatic treatment; no deep infections occurred. All patients were followed up 8-43 months (mean, 17 months). At last follow-up, the AOFAS ankle-hindfoot score and all domain scores of the SF-36 were significantly higher than preoperative values, and the VAS score, the Meary’s angle, T1MT, TCA, and Djian-Annonier angle significantly decreased, Pitch angle significantly increased (P<0.05). The imaging confirmed osteotomy union in all feet, and no fixation-related complications was observed. Learning-curve analysis indicated that both operation time and fluoroscopy usage plateaued after the 13th case, suggesting stabilization of surgical performance from that point onward. ConclusionThe use of PSCGs during Cole midfoot osteotomy enables precise and efficient correction of complex midfoot deformities while significantly reducing intraoperative fluoroscopic exposure. Moreover, this technique appears to have a short learning-curve and good reproducibility, which may facilitate its broader adoption in clinical practice.