Table of Content

  

10 March 2023
Volume 61 Issue 3

Expert overview


Expert Overview

Computer vision and lumbar degenerative disease

Shiqing FENG

Journal of Shandong University (Health Sciences). 2023, 61(3):  1-6.  doi:10.6040/j.issn.1671-7554.0.2022.0902

Abstract ( 359 )   HTML ( 6 )   PDF (2583KB) ( 319 )   Save

Figures and Tables | References | Related Articles | Metrics

As an important branch of computer science, computer vision has gradually attracted people's attention, benefited by the development of artificial intelligence in recent years. Some classical algorithms have been industrialized in areas such as autonomous driving or security cameras. Medical image analysis is currently considered one of the most likely areas to achieve industrialization and a hotspot in artificial intelligence research. Computer vision research on lumbar degenerative diseases has sprung up with the development of deep learning algorithms lately. We will review the status of computer vision research related to lumbar degenerative disease, which will be helpful for the understanding of the situation and future trend in the topic.

Progresses and trends of intelligent technologies in orthopedic shock wave therapy

Yajun LIU,Zhao LANG,Anyi GUO,Wenyong LIU

Journal of Shandong University (Health Sciences). 2023, 61(3):  7-13.  doi:10.6040/j.issn.1671-7554.0.2022.1331

Abstract ( 533 )   HTML ( 14 )   PDF (1260KB) ( 221 )   Save

References | Related Articles | Metrics

Extracorporeal shock wave therapy (ESWT) is widely adopted in clinical orthopedics for its safe and non-invasive treatment. However, the experience-based subjective decision-making and long-lasting manual operation of physicians in the conventional orthopedic ESWT have limited its further development. As intelligent technologies are rapidly getting into the orthopedic ESWT, this review summarizes the state-of-the-art of research and application of intelligent technologies in orthopedic ESWT from aspects of computer navigation, machine learning and robotics. Computer navigation technologies can intuitively assist physicians to accurately locate the shock wave probe on the anatomical target of patients. The machine learning methods can automatically predict energy parameters in ESWT. Robotic systems have demonstrated their potential advantages in clinical efficacy especially in the dramatical alleviation of the operation intensity of physicians. These intelligent technologies provide comprehensive support for intellectualization of orthopedic ESWT from eye, brain and hand, respectively. This review also concludes the future technical trends from aspects of the ESWT biological mechanism and dose-effect relationship, the treatment protocol planning and usability of machine learning, and the treatment automation and robotic assistance.

Application of artificial intelligence in the diagnosis and treatment of spinal deformity

Nan WU,Jianguo ZHANG,Yuanpeng ZHU,Guilin CHEN,Zefu CHEN

Journal of Shandong University (Health Sciences). 2023, 61(3):  14-20.  doi:10.6040/j.issn.1671-7554.0.2022.0956

Abstract ( 397 )   HTML ( 9 )   PDF (1691KB) ( 182 )   Save

References | Related Articles | Metrics

Spinal deformity is a highly teratogenic and disabling disease, whose age of onset covers the entire life cycle. With the rapid development of computer technology, artificial intelligence has made remarkable progress, and has huge application potential in the diagnosis and treatment of diseases, especially in the screening, diagnosis and treatment, surgical decision-making, intraoperative operations and complication prediction of spinal deformities. In the past few years, a large number of researches have explored in the related fields and proposed plentiful well-working and promising projects and models. This paper will review the latest advances.

Robotics/navigation-assisted pedicle screw implantation in spinal deformity correction surgery

Xinyu LIU,Donglai LI,Wenlong ZHAO,Zheng WANG,Chao LI,Lianlei WANG,Suomao YUAN,Yonghao TIAN

Journal of Shandong University (Health Sciences). 2023, 61(3):  21-28.  doi:10.6040/j.issn.1671-7554.0.2022.1125

Abstract ( 358 )   HTML ( 7 )   PDF (1351KB) ( 98 )   Save

References | Related Articles | Metrics

Surgical robotics and navigation systems are the results of technological advances that start a new approach for accurate insertion of the pedicle screw in spine surgery. The anatomical complexity of the spinal region and its proximity to many important blood vessels and nerves, spinal deformities such as vertebral body rotation and variation, narrow pedicle, kyphosis and scoliosis place higher demands on the accuracy of spine surgery. Free-hand placement of pedicle screws relies heavily on operators' experience and intraoperative judgment, but does not allow surgeons to monitor the process of insertion. As a result, the misplacement rate is high. The robotic and navigation systems can provide real-time, three-dimensional images during the operation. Thus, they can assist surgeons in adjusting screws promptly, improving the safety and accuracy of the operation and reducing surgical incision and radiation exposure. However, the expensive equipment costs, long learning curve and high radiation exposure for patients cannot be ignored. Despite the lack of research on long-term outcomes and the uncertainty of intraoperative radiation exposure, robotic and navigation systems have influenced the development of spinal deformity correction surgery.

Application status and research progress of knee arthroplasty surgical robot

Hua QIAO,Huiwu LI

Journal of Shandong University (Health Sciences). 2023, 61(3):  29-36.  doi:10.6040/j.issn.1671-7554.0.2022.1470

Abstract ( 602 )   HTML ( 10 )   PDF (1380KB) ( 144 )   Save

References | Related Articles | Metrics

As a new technology, surgical robots can significantly improve the accuracy, efficiency and safety of knee arthroplasty. However, owing to the wide variety of surgical robots in the market, there is still no comprehensive evaluation of the application status and research progress. This article firstly introduces surgical robots used in the unicondylar knee arthroplasty, patellofemoral arthroplasty, and total knee arthroplasty, then analyzes their advantages and disadvantages, and finally discusses the shortcomings and proposes possible solutions, hoping to provide reference for the future development.

Research advances of artificial intelligence in the diagnosis and treatment of orthopaedic diseases

Lin HUANG,Zhen CHE,Ming LI,Yuxi LI,Qing NING

Journal of Shandong University (Health Sciences). 2023, 61(3):  37-45.  doi:10.6040/j.issn.1671-7554.0.2022.1426

Abstract ( 584 )   HTML ( 13 )   PDF (1382KB) ( 374 )   Save

References | Related Articles | Metrics

Artificial intelligence (AI) is a new technical science, which conducts deep research and development of theories, methods, core technologies, application software and control systems for the simulation, extension and expansion of human brain intelligence. Its professional fields include robotics, image recognition and expert systems, and so on. AI has an important application value in many medical disciplines, especially in orthopedics. It not only improves the working efficiency of imaging doctors and orthopedic surgeons and reduces the workload, but also provides more safe, reliable and powerful clinical technical support for patients, bringing a great promotion to the diagnosis and treatment of orthopedic diseases. This paper reviews the latest research achievements and limitations of AI in orthopedic diseases, aiming to provide literature reference for the deep integration of AI and orthopedics.

Research advances of spine surgery robot

Fuxin DU,Tichong ZHANG,Qianqian LI,Rui SONG

Journal of Shandong University (Health Sciences). 2023, 61(3):  46-56.  doi:10.6040/j.issn.1671-7554.0.2023.0018

Abstract ( 683 )   HTML ( 32 )   PDF (24492KB) ( 293 )   Save

Figures and Tables | References | Related Articles | Metrics

Spine surgery robot has advantages of accurate positioning, stable operation and reduced radiation exposure. With great clinical application value, it has become a hot field of research and application in recent years. This paper classifies spine surgery robot into guided and active operation according to different scenarios, and introduces spine robots developed by domestic and foreign research institutions and companies and their latest achievements, and elaborates and summarizes the key technologies and future development trends.

基础医学

Electrical impedance recognition of spine tissue in vitro based on support vector machine

CHEN Bingrong, SHI Yongwang, LI Jiahao, ZHAI Jiliang, LIU Liang, LIU Wenyong, HU Lei, ZHAO Yu

Journal of Shandong University (Health Sciences). 2023, 61(3):  57-62.  doi:10.6040/j.issn.1671-7554.0.2022.1299

Abstract ( 340 )   PDF (2509KB) ( 55 )   Save

References | Related Articles | Metrics

Objective To measure impedances of different spinal tissues, to develop a tissue classification algorithm based on the impedance data using support vector machine(SVM), in order to verify the accuracy of the algorithm and to search for thresholds for impedance classification of different tissues. Methods Isolated spinal tissue was collected, and the electrical impedances of cortical bone, cancellous bone, spinal cord, muscle, and nucleus pulposus were collected using an electrochemical analyzer in the frequency range of 10-100 kHz. The data sets of two pigs were used as training set and test set, respectively. Principal component analysis(PCA)was used to reduce the dimensionality to two-dimensional data, and SVM based classification algorithm was trained and validated. Ensemble learning method was used to calculate the electrical impedance threshold for different tissue classifications. Results The electrical impedances of the five tissues were significantly different(P<0.001)within the measurement frequency of 10-100 kHz. The accuracy of PCA dimensionality reduction based SVM classification algorithm was 100%. Ensemble learning based multi-classifiers were used to compute impedance classification thresholds for different tissues. Conclusion Accurate identification of the electrical impedance of tissues in spinal surgery can be achieved based on support vector machines, which are expected to help surgeons improve the accuracy of tissue identification.

A study on the microstructure and properties of additively manufactured NiTi alloy scaffolds

ZHANG Bo, GAO Na, XI Rui, WANG Xiebin

Journal of Shandong University (Health Sciences). 2023, 61(3):  63-70.  doi:10.6040/j.issn.1671-7554.0.2022.1421

Abstract ( 318 )   PDF (14540KB) ( 48 )   Save

References | Related Articles | Metrics

Objective To explore the effects of process parameters and feature sizes on the microstructure and properties of NiTi alloy scaffolds fabricated with laser powder bed fusion(L-PBF), so as to provide reference for the fabrication of NiTi alloy orthopaedic implants. Methods The following two groups of NiTi alloy scaffolds with body-centered cubic structure were fabricated: (1) NiTi scaffolds fabricated with different laser scanning speeds of 500-1 000 mm/s, while the beam size was fixed at 200 μm, to investigate the effects of L-PBF process parameters; (2) NiTi scaffolds with different struct sizes of 150-500 μm fabricated with the same L-PBF process parameters, to investigate the size effects. The microstructure, phase transformation behavior and mechanical properties of NiTi scaffolds were examined with scanning electron microscope, differential scanning calorimeter and mechanical testing machine. Results The actual struct size, the martensite transformation temperatures, and the compression strength decreased with the increase of laser scanning speed, while the recoverable strain during cycling compression tests increased with the decrease of scanning speed. The martensite transformation temperatures increased with the increase of the strut size, indicating a clear size effect. Conclusion Both the process parameters and feature size can affect the microstructure and properties of the L-PBF fabricated NiTi scaffolds. Therefore, in order to fabricate NiTi orthopaedic implants with predictable properties, the featured size at different locations has to be considered to optimize the L-PBF process conditions.

临床医学

Comparison of MRI diagnosis of 140 cases of MCs using intelligent network automatic detection and classification methods

WANG Lei, ZHANG Shuai, LIU Gang, YOU Shengnan, WANG Zhi, ZHU Shan, CHEN Chao, MA Xinlong, YANG Qiang

Journal of Shandong University (Health Sciences). 2023, 61(3):  71-79.  doi:10.6040/j.issn.1671-7554.0.2022.1238

Abstract ( 375 )   PDF (7290KB) ( 104 )   Save

References | Related Articles | Metrics

Objective To explore the performance of Yolov5 network to detect and classify Modic changes(MCs)and to comparethe performance of Yolov5 alone and Yolov5 plus Resnet34. Methods Clinical data of 140 patients with MCs who under went MRI diagnosis and met the inclusion and exclusion criteria during June 2020 and June 2021 were retrospectively analyzed, including 55 males and 85 females, mean age(59.0±13.7)years(range 25-89 years). After the MRI images were labeled, they were imported into the deep learning model, and were expanded by using the conventional enhancement of medical data and Mosaic data enhancement to reduce the effects caused by two few factors of the training data sets. Transfer learning method was used to solve the problem of network overfitting on small data sets. Average precision(AP), mean average precision(mAP), recall, precision, F1 and other performance indicators were used to evaluate and compare the two methods. Results When Yolov5 was adopted, them AP, recall, precision and F1 were 87.56%, 82.05%, 89.44% and 0.845, respectively. When Yolov5 and Resnet34 were used in combination, the recall rate, precision rate and F1 reached 88.41%, 88.68% and 0.885, respectively. Conclusion The Yolov5 network model can help diagnose lumbar MCs. When Yolov5 and Resnet 34 models are used together, the performance is improved, which indicates that it is possible to use the Yolo series network in the diagnosis of spine diseases.

Preliminary exploration of automatic planning of lumbar pedicle screws based on cone-beam CT in 130 cases

LIU Yajun, YUAN Qiang, WU Jingye, HAN Xiaoguang, LANG Zhao, ZHANG Yong

Journal of Shandong University (Health Sciences). 2023, 61(3):  80-89.  doi:10.6040/j.issn.1671-7554.0.2022.1280

Abstract ( 363 )   PDF (12225KB) ( 79 )   Save

References | Related Articles | Metrics

Objective To develop an automatic pedicle screw planning system based on cone-beam CT(CBCT)images using deep learning technology, and to evaluate its efficiency and planning efficiency. Methods The CBCT and screw planning data of 130 cases who underwent robot-assisted lumbar pedicle screw fixation from a single academic institution during Jan. 2017 and Dec. 2019 were retrospectively analyzed, including 100 cases for network training for spinal segmentation and automatic planning, and 30 cases for validation. The segmentation results were evaluated using Dice coefficient and qualitative validation. The pedicle screw placement was evaluated using the Ravi and Zdichavsky grading systems. The viocation of superior facet joint was evaluated with Babus method. Interobserver reliability was assessed with Kappa statistics. Results In the quantitative assessment of segmentation in 10 cases, the Dice value was 0.99. In the qualitative evaluation of segmentation in 30 cases, the average acceptance rate of the segmentation results by experts was 94.9%, and the average satisfaction rate was 80.5%. In total, the automatic placed 300 pedicle screws between the L1 and L5 spinal levels, including 300(100%)Zdichavsky 1A, 298(99.0%)Ravi 1, and 2(1.0%)Ravi 2(<2 mm breech), both of which were laterally deviated from the cortex. Of the 300 screws, 294(98%)were Grade 0, 6(2%, all L5)of which had superior facet joint violation, including 3(1%)Grade 1, 2(0.67%)Grade 2, and 1(0.33%)Grade 3. Kappa statistics showed excellent overall agreement between raters(K=0.71-0.94; 90%-96% agreement). In running speed evaluation, the average time required for automatic segmentation was 3.52 seconds, the time required for feature point extraction was 3.81 seconds, and the total average running time was 7.33 seconds. Conclusion The automatic planning system of pedicle screws based on CBCT images shows excellent automatic segmentation and screw planning, which has the potential to aid surgeons in screw planning and improve the navigation workflow of spinal surgical robots.

Minimally invasive channel of the lumbar spine surgery for Chinese: anatomical data based on CT imaging measurements

ZHAO Geng, MAI Ruopeng, ZHAO Jingcai, LIU Xinyu

Journal of Shandong University (Health Sciences). 2023, 61(3):  90-96.  doi:10.6040/j.issn.1671-7554.0.2022.1217

Abstract ( 361 )   PDF (4663KB) ( 19 )   Save

References | Related Articles | Metrics

Objective To measure the imaging data of lumbar spine of Chinses, so as to provide anatomical data for the designing of a minimally invasive decompression surgery channel of lumbar vertebrae. Methods Imaging data of 88 consecutive Chinese without related diseases were evaluated, including 40 male and 48 female. Average age was(28.6±5.6)years. The related parameters measured included the width of facet joint from L1 to L5, distance from lateral edge of superior articular process of the inferior vertebra to the root of superior spinous process of the superior vertebra, distance between the lower edge of pedicle of the superior vertebra and the upper edge of pedicle of the inferior vertebra, distance between lower edge of the interverbal disc and the upper edge of pedicle of the inferior vertebra, distance between the upper edge of pedicle of the superior vertebra and the lower edge of pedicle of the inferior vertebra and distance between the lower edge of pedicle of the superior vertebra and the lower edge of pedicle of the inferior vertebra. Results The width of facet joint reached the maximum of 17.6 mm in L4/5 and L5/S1. The distance from the lateral edge of superior articular process of the inferior vertebra to the root of superior spinous process of the superior vertebra reached the maximum of 24.9 mm in L5/S1. The distance between the lower edge of the vertebra of the superior vertebra and the upper edge of pedicle of the inferior vertebra reached the maximum of 19.5 mm in L2/3 and L3/4. The distance between upper edge of the interverbal disc and the upper edge of pedicle of the inferior vertebra reached the maximum of 11.1 mm in L2/3 and L3/4. The distance between the upper edge of pedicle of the superior vertebra and the lower edge of pedicle of the inferior vertebra reached the maximum of 48.5 mm in L1/2 and L2/3. The distance between the lower edge of pedicle of the superior vertebra and the lower edge of pedicle of the inferior vertebra reached the maximum of 34.0 mm in L1/2 and L2/3. Conclusion The surgery channel for minimally invasive decompression of lumbar vertebrae for Chinses lacks statistical support in various parameters, which might cause unnecessary damage during surgery. The research of the anatomical parameters of the lumbar spine has great significance for the design of more suitable minimally invasive surgical channels for Chinese.

Comparison of robot-assisted minimally invasive and freehand open transforaminal lumbar interbody fusion for degenerative lumbar spinal diseases: a 2-year follow-up

WANG Zheng, SUN Xiaogang, LI Chao, WANG Lianlei, LI Donglai, YUAN Suomao, TIAN Yonghao, LIU Xinyu

Journal of Shandong University (Health Sciences). 2023, 61(3):  97-106.  doi:10.6040/j.issn.1671-7554.0.2022.1113

Abstract ( 363 )   PDF (5600KB) ( 110 )   Save

References | Related Articles | Metrics

Objective To prospectively compare the clinical and radiographic outcomes between robot-assisted minimally invasive transforaminal lumbar interbody fusion(MIS-TLIF)and freehand open transforaminal lumbar interbody fusion(TLIF)in patients with degenerative lumbar spinal diseases. Methods A total of 127 patients with lumbar degenerative diseases receiving surgery in Qilu Hospital of Shandong University were enrolled, including 73 who underwent robot-assisted MIS-TLIF(group A)and 54 who underwent open TLIF(group B). Group A was subdivided into subgroup AI(52 single-level patients)and subgroup AII(21 double-level patients). Group B was subdivided into subgroup BI(39 single-level patients)and subgroup BII(15 double-level patients). The clinical outcome parameters were compared, including the Visual Analog Scale(VAS)score, Oswestry Disability Index(ODI)score, operation time, number of intraoperative fluoroscopies, intraoperative blood loss, postoperative hospital stay, and postoperative complications. The radiographic measures included the accuracy of screw placement, facet joint violation(FJV), fusion status, and change in disc height at the proximal adjacent segment at 2-year follow-up. Results Group A had lower VAS score for back pain at 3 days postoperatively, and less blood loss than group B(P<0.05). There were no significant differences between the two groups in terms of postoperative hospital stay, VAS score and ODI score at 2 years postoperatively(P>0.05). Group A needed longer operation time than group B(P<0.05), subgroup AI needed longer operation time than subgroup BI(P<0.05); however, there was no significant difference between subgroups AII and BII(P>0.05). The number of intraoperative fluoroscopies for patients was significantly higher in group A than in group B(P<0.05), while it was significantly lower in group A than in group B for surgeons(P<0.05). In Group A, three guide pins exhibited drift and one patient developed a lateral wall violation by a pedicle screw. In Group B, two pedicle screws caused an inner wall violation. The rate of clinically acceptable screws(grades A and B)was higher in group A than in group B(P<0.05). The FJV grade was significantly higher in group B than in group A(P<0.05). During the 2-year follow-up, there was no significant difference in classification of interbody fusion between the two groups(P>0.05), but the decrease in disc height at the proximal adjacent segment was significantly less in group A than in group B (P<0.05). Conclusion Robot-assisted percutaneous pedicle screw placement is a safer and more accurate alternative to conventional freehand open pedicle screw insertion in TLIF.

Clinical application of robotic-assisted navigation based on 3D C-arm in 44 cases of scoliosis surgery

LI Chao, SUN Xiaogang, LI Hao, TIAN Yonghao, YUAN Suomao, LIU Xinyu, WANG Lianlei

Journal of Shandong University (Health Sciences). 2023, 61(3):  107-114.  doi:10.6040/j.issn.1671-7554.0.2022.1116

Abstract ( 349 )   PDF (5931KB) ( 99 )   Save

References | Related Articles | Metrics

Objective To evaluate the accuracy and safety of robotic-assisted navigation with three-dimensional(3D)C-arm-assisted pedicle screw insertion for scoliosis surgery and compare it with freehand technique. Methods Clinical data od 96 scoliosis patients were involved, including 44 undergoing robotic-assisted technique(robot group), and 52 patients undergoing freehand technique(freehand group). Operation time, intraoperative blood loss, intraoperative radiation dose, postoperative hospital stay and complications were recorded. Changes in coronal and sagittal position parameters, apex rotation angle, postoperative rotation grade, and pedicle screw placement accuracy were evaluated with X-ray and computed tomography(CT)before and after treatment. Results Cobb angle, SVA and apex rotation angle were improved in both groups(P<0.05), but there was no differences between the two groups in the improvement rate of apex rotation and rotation grade(P>0.05). Compared with the freehand group, the robot group had higher accuracy in pedicle screw placement(96.5% vs 88.6%, P<0.05), higher radiation exposure on patients ［(4.85±0.44)μSv vs(15.97×10^-5±2.35×10^-5)μSv, P<0.05］, lower radiation exposure on surgeons ［(2.96×10^-5±0.75×10^-5)μSv vs(6.35×10^-5±0.93×10^-5)μSv, P<0.05)］, and longer operation time ［(7.1±2.2)h vs(5.5±1.6)h, P<0.05］. There were no significant differences in blood loss and postoperative stay between the two groups. Conclusion Robotic-assisted navigation based on 3D C-arm effectively increases the accuracy and safety of pedicle screw insertion in scoliosis surgery.

Learning curve of domestic “Skywalker” robotic-assisted total knee arthroplasty

GUO Yongyuan, SUN Houyi, ZHANG Yuankai, YAN Tingbin, LIU Peilai, JIA Yuhua

Journal of Shandong University (Health Sciences). 2023, 61(3):  115-120.  doi:10.6040/j.issn.1671-7554.0.2022.1398

Abstract ( 427 )   PDF (514KB) ( 94 )   Save

References | Related Articles | Metrics

Objective To investigate the clinical efficacy and learning curve of robot-assisted total knee arthroplasty(TKA)by retrospectively analyzing the operation time and imaging data of TKA procedures performed with the "Skywalker" robot. Methods A total of 25 robotic-assisted TKA procedures performed by the same surgical group were retrospectively analyzed. The operation time was analyzed using the cumulative sum analysis(CUSUM)method to plot the learning curve, based on which the learning curve was divided into two stages. The operation time, bleeding volume, hospital days, hip-knee-ankle angle and other imaging data, and clinical scores of the two stages were compared. Results The CUSUM analysis revealed the maximum turning point of the learning curve at 13 cases. Based on this, the learning curve was divided into two stages: the learning improvement stage and the mastery stage. There were no significant differences in general data, postoperative hip-knee-ankle angle and other imaging data, HSS scores, knee ROM and FSJ-12 scores between the two stages(P>0.05). However, in the mastery stage, the overall operation time decreased by 23 min, the spatial positioning time decreased by 4.4 min, the optical target installation decreased by 5.0 min; the time to position the lower limb force line and joint surface alignment reduced by 2.9 min and 5.2 min, respectively, and the robotic arm osteotomy operation time reduced by 14.1 min. Conclusion The learning curve of robot-assisted TKA is precisely profiled by CUSUM analysis, indicating that operators need to perform at least 13 surgical cases to master the technique. The learning curve of robot-assisted TKA is short, and the clinical results are satisfactory.

Effects of lower limb exoskeleton robot rehabilitation training on lower limb motion of hemiplegic patients after stroke

LI Xi, WANG Bingxiang, LI Na, CAO Lina, LI Aihua, GUAN Xiao, ZHANG Zhimian

Journal of Shandong University (Health Sciences). 2023, 61(3):  121-126.  doi:10.6040/j.issn.1671-7554.0.2022.1321

Abstract ( 513 )   PDF (1590KB) ( 181 )   Save

References | Related Articles | Metrics

Objective To explore the effects of lower limb exoskeleton robot rehabilitation training on lower limb motor function of hemiplegic patients after stroke. Methods A total of 54 patients with stroke hemiplegia within 12 months of onset were randomly divided into the test group(n=27)and control group(n=27). The control group received routine rehabilitation training and walking training, while the test group received routine rehabilitation training combined with lower limb exoskeleton robot rehabilitation training. Walking function was assessed before, 2 weeks and 4 weeks after training. The 6 minute walking test(6MWT), 10 meter walking test(10MWT), functional ambulation category(FAC), and Fugl-Meyer assessment for lower extremity(FMA-LE)were used to assess the lower extremity motor function. Gait analysis was collected by using the motion capture system. Results (1) After 2 and 4 weeks of training, the 6MWT and 10MWT of both groups were significantly improved(P<0.05); after 4 weeks of training, the 6MWT of both groups was further improved compared with that of 2 weeks(P<0.001); the 10MWT of the test group was significantly improved compared with that of 2 weeks(P=0.008 5). (2) After 2 and 4 weeks of training, FAC and FMA-LE in both groups were significantly improved(P<0.01); FMA-LE in the two groups was further improved after 4 weeks of training compared with that of 2 weeks(P<0.001). (3) After 4 weeks of training, the gait cycle of the test group was significantly improved compared with that before training(P=0.003 5)and 2 weeks of training(P=0.003 2). Conclusion The lower limb exoskeleton robot can effectively improve the lower limb motor function, walking function and walking cycle, and its effect is equivalent to that of conventional walking training.

Artificial intelligence-assisted 3D printing of surgical guides for pedicle screw Insertion in scoliosis surgeries

WANG Hui, WANG Lianlei, WU Tianchi, TIAN Yonghao, YUAN Suomao, WANG Xia, LYU Weijia, LIU Xinyu

Journal of Shandong University (Health Sciences). 2023, 61(3):  127-133.  doi:10.6040/j.issn.1671-7554.0.2022.1328

Abstract ( 384 )   PDF (7426KB) ( 113 )   Save

References | Related Articles | Metrics

Objective To assess the value of artificial intelligence-assisted 3D printing surgical guides in scoliosis surgeries. Methods The clinical data of 66 patients who underwent scoliosis orthopedic surgery during Jun. 2018 and Sep. 2022 were retrospectively analyzed. Artificial intelligence-assisted design of 3D printed guides for pedicle screws were placed in 24 cases(intelligent guide group), including 10 cases of congenital scoliosis, 8 cases of idiopathic scoliosis, and 6 cases of degenerative scoliosis, and all patients used SurigiPlan V1.0 to assist in the preoperative planning of the screw type and path. Freehand pedicle screws were placed in 42 cases(freehand group), including 16 cases of congenital scoliosis, 13 cases of idiopathic scoliosis, and 13 cases of degenerative scoliosis. The postoperative stay, operation time, intraoperative bleeding, intraoperative radiation, accuracy and safety of postoperative pedicle screw placement, compliance between preoperative planning and actual placement of screws, and changes in pre- and postoperative imaging spine parameters were compared between the two groups. Results A total of 1,342 pedicle screws were placed, including 468 in the intelligent guide group and 874 in the freehand group. The intelligent guide group had a higher safety than the freehand group(98.29% vs 92.33%, P<0.05)and a higher accuracy(94.23% vs 82.95%, P<0.05). Of the 468 screws in the intelligent guide group, the preoperative planning of screw length and diameter matched the actual application of screws by 97.01%(454 screws)and 95.51%(447 screws)respectively. There were no statistically significant differences in the Cobb angle, apical vertebral rotation, operation time and bleeding between the two groups before and after operation(P>0.05). The intraoperative radiation dose of patients in the intelligent guide group was lower than that in the freehand group(P<0.05), but there was no statistically significant difference in the intraoperative radiation dose of surgeons(P>0.05). Conclusion Compared to freehand screws placement, the artificial intelligence-assisted 3D printing of surgical guides can significantly improve the accuracy, safety and efficiency of screws placement.

Application of 3D-printed titanium interbody fusion cage in 37 cases of single level lumbar surgery

ZHU Chao, SUN Chao, LIU Xuchang, XIA Dawei, MA Chuncheng, FENG Rongjie

Journal of Shandong University (Health Sciences). 2023, 61(3):  134-140.  doi:10.6040/j.issn.1671-7554.0.2020.1018

Abstract ( 345 )   PDF (3125KB) ( 59 )   Save

References | Related Articles | Metrics

Objective To investigate the advantages and early clinical effects of 3D-printed interbody fusion cage in single level posterior lumbar decompression and bone grafting and internal fixation. Methods Clinical data of 73 patients who underwent single segment posterior lumbar decompression, bone grafting, fusion and internal fixation during May 2021 and Jan. 2022 were retrospectively analyzed. The patients were divided into two groups: 3D-printed titanium cage group(n=37)and poly-ether-ether-ketone(PEEK)cage group(n=36). The visual analogue scale(VAS)and oswestry disability index(ODI)were observed before and after surgery to evaluate the lumbar function and postoperative improvement. The bone mineral density(BMD), operation time, intraoperative bleeding, intraoperative allograft implantation, postoperative drainage, short-term complications, lumbar lordosis(LL), disc height(DH), loss of LL, loss of DH and interbody fusion rate were compared between the two groups. Results All operations were successful and patients were followed up for 3 months. There were no statistical significances between the two groups in operation time, intraoperative bleeding volume, postoperative drainage volume, VAS score and ODI score 3 months after operation(P>0.05). The amount of allogeneic bone implantation in 3D cage group was less than that in PEEK cage group(P<0.05). LL and DH of both groups were significantly larger after operation(P>0.05). There were no significant differences in loss of LL and loss of DH 3 months after surgery between the two groups(P<0.05). However, for patients complicated with osteoporosis, loss of LL and loss of DH in the 3D cage group were smaller than those in the peek cage group(P<0.05). The fusion rate 3 months after surgery was 72.97% in the 3D cage group and 69.44% in the PEEK cage group, with no statistically significant difference(P>0.05). No internal fixation fracture, loosening or displacement occurred. Conclusion The use of 3D-printed interbody fusion cage in single level lumbar fusion has a good effect of vertebral fusion, which can restore and maintain the lumbar lordosis and interbody height. Particularly in patients complicated with osteoporosis, 3D-printed cage has good anti-settlement properties, reduces the risk of vertebral collapse and improves the overall stability of the mechanical structure of the lumbar spine.