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简介：AbstractJoint arthroplasty is an effective method for treating end-stage joint lesions and damages. Robotic arm-assisted arthroplasty, a rapidly developing technology that combines navigation technology, minimally invasive technology, and precise control technology of the robotic arm, can achieve accurate preoperative planning, optimal selection of implants, minimally invasive surgery, precise osteotomy, and accurate placement of the artificial joint. It has the characteristics of high accuracy and stability, and thus is more and more widely used in the field of joint surgery. In this paper, we systematically reviewed the application and clinical efficacy of robotic arm-assisted technology in hip and knee arthroplasty to provide reference for its future promotion.

简介：AbstractBackground:Transoral vestibular approach thyroidectomy using robotic system has advantages with articulating instrumentation. Transoral robotic thyroidectomy (TORT) can be done either using just two robot arms for instruments and an extra one for the endoscopic camera, or using three robot arms for instruments (third arm through axila) and an additional arm for the camera.Pros of additional axillary arm for TORT:The 4th arm through an additional axillary port is mainly responsible for a counter-traction of strap muscles and thyroid tissue. The additional axillary port tract is also an excellent passage for the specimen removal with lower risk of disruption or fragmentation. Ultimately, these merits from the additional axillary arm allows TORT to be performed safely in a wide range of patient groups.Cons of additional axillary arm for TORT:One of the issue with the additional axillary arm in TORT is that it leaves a cutaneous scar. Another issue to consider is the cost. In some places, robotic surgery operation fee varies with the number of arms used during the operation. Retraction of strap muscles through subcutaneous stitches applied after establishing the working space may make up for the lack of counter-traction.Conclusion:TORT can be done safely with or without the transaxillary arm and surgeon may consider pros and cons based on multiple factors.

简介：【摘要】目的：尽管导航系统辅助骨科手术的应用中已有20多年的发展历史，但目前由于设备价格昂贵等缺点，目前在临床上仍未被广泛的应用。O-arm导航系统在二十一世纪初期被引进到国内，其在脊柱外科手术中获得了较多的应用，但目前关于期应用于骨科其他亚科的报道相对较少。本文就目前关于国内外O-arm导航技术应用于骨科各亚科的相关研究进行综述，探讨其应用现状及应用前景。效性和安全性。

简介：Objective:Theaimofthisprospective,single-armphaseIItrialwastoconfirmthesafetyandefficacyofneoadjuvantchemotherapy(NAC)usingoxaliplatinpluscapecitabine(CapOX)forpatientswithoperablelocallyadvancedcoloncancer(CC).Methods:Patientswithcomputedtomography-definedT4orlymphnode-positiveCCswereenrolled.Afterradiologicalstaging,patientsweretreatedwithatleast2cyclesofNACconsistingof130mg/m2oxaliplatinond1,plus1,000mg/m2capecitabinetwicedailyfor14devery3weeks,followedbysurgery,andthenwiththerestcyclesofadjuvantchemotherapy.Radiologicalresponsewasevaluatedafter2cyclesofNAC.Tumorresponse,treatmenttoxicity,andsurgicalcomplicationswererecorded.Thepathologicalresponsetotherapywasevaluatedaccordingtothetumorregressiongrade(TRG)score.Theprimaryendpointwaspathologictumorresponse.ThistrialisregisteredinClinicalTrials.gov(No:NCT02415829).Results:Forty-sevenpatientswereenrolledinthestudy.Forty-twopatientscompletedtheplannedtreatments.Thetotalradiologicalresponseratewas68%(32/47),includingcompleteandpartialresponseratesof2%(1/47)and66%(31/47),respectively.Stablediseasewasobservedin32%(15/47)andprogressivediseasewasobservedinnone.Completepathologicresponse,majorregression,andatleastmoderateregressionwereachievedin1(2%),2(4%),and29(62%)patients,respectively.Fourpatientsdevelopedgrade3treatmenttoxicities.Onepatientwithwoundinfectionoccurredafteroperation(1/47,2%).Therewasnotreatment-relateddeath.Conclusions:OurresultssuggestthatNACwithCapOXisaneffectiveandsafetreatmentoptionforpatientswithlocallyadvancedCCs.

简介：AbstractBackground:C-arm-based flat-panel detector cone-beam computed tomography (CBCT) venography has never been used in the management of iliac vein compression syndrome (IVCS). This study aimed to determine the technical feasibility and safety of CBCT venography in the diagnosis of IVCS compared with conventional venography (CV).Methods:Twenty patients with clinical manifestations of lower extremity venous insufficiency were prospectively enrolled between May 2018 and December 2018. Each patient underwent both CV and CBCT venography. The feasibility and safety of CBCT venography were assessed by technical success rate and complication rate. The relationships between the clinical indexes and the results of CBCT venography and CV were analyzed with correlation analysis. The consistency of the diagnosis of IVCS using each modality was analyzed by the kappa test.Results:The technical success rate was 100% for CBCT venography and for CV, without any complications. Compared with CV, CBCT venography was able to show more details of adjacent tissues which might be helpful for making etiological diagnosis. The stenosis rate under CBCT venography had excellent consistency with that under CV (kappa= 0.78, Chi-square test). The stenosis rate under CBCT venography was positively correlated with the presence of collateral veins (odds ratio 1.12, 95% confidence interval: [1.00, 1.26], P= 0.049), while the stenosis rate under CV was not. Unexpectedly, only one patient had a venous pressure gradient of more than 2 mmHg (1 mmHg = 0.133 kPa).Conclusions:For the diagnosis of IVCS, C-arm-based CBCT venography was technically feasible, with good safety. The presence of collateral veins on CBCT was clinically significant. A C-arm fluoroscopy-based technique that combines CV and CBCT might be a promising protocol for the management of IVCS during a single session.

简介：目的探讨术中O-arm导航辅助下后路半椎体切除治疗半椎体所致先天性脊柱侧后凸畸形的应用价值。方法回顾性分析河北医科大学第三医院脊柱外科2014年1月—2叭5年3月收治的14例半椎体所致先天性脊柱侧后凸畸形患者的临床资料，其中男5例、女9例，年龄9～15岁。患者均为单发性完全分节半椎体畸形，其中半椎体位于T91例、T102例、T115例、T123例、L12例、L21例。患者术前均拍摄站立位全脊柱正、侧位X线片，测量冠状面及矢状面Cobb角。在O—arm导航辅助下植入椎弓根螺钉，术中O-grill导航3D重建半椎体畸形，明确半椎体切除范围，彻底切除半椎体畸形。术中经O-arm扫描、术后经CT扫描观察螺钉位置；分析手术前后Cobb角，评价脊柱侧凸、后凸矫正率。结果14例患者共置入椎弓根螺钉120枚，其中11例置入4对椎弓根螺钉，2例置入5对，1例置入6对；经术中O-arm扫描确认位置良好，术后CT扫描评估螺钉置入准确性：0级118枚（98．3％），1级2枚（1．7％）。本组病例手术时间平均为（195．4±17．4）min，术中出血量平均为（611．9±173．0）mL，术后随访3～15个月，平均9．6个月。术前侧凸Cobb角为62．8°±15．8°，术后为10．9°±5．3°，矫正率为83．34％±6．08％，末次随访时为12．1°±4．8°；术前后凸Cobb角为57．5°±15．5°，术后为17．0°±6．6°，矫正率为70．66％±6．79％，末次随访时为17．9°±7．0°。随访期间未见明显角度丢失。术后与末次随访时侧凸、后凸角度与术前比较，差异均有统计学意义（P值均〈0．01）；而术后与末次随访时比较，差异均无统计学意义（P值均〉0．05）。本组病例术后无神经并发症，未发生螺钉松动、脱出、折断等。结论在后路半椎体切除治疗先天性脊柱侧后凸畸形的手术中，O-arm导航能够指导椎弓根螺钉的准确置入和半椎体的精�

简介：AbstractBackground:Bendamustine was approved in China on May 26th, 2019 by the National Medical Product Administration for the treatment of indolent B-cell non-Hodgkin lymphoma (NHL). The current study was the registration trial and the first reported evaluation of the efficacy, safety, and pharmacokinetics of bendamustine in Chinese adult patients with indolent B-cell NHL following relapse after chemotherapy and rituximab treatment.Methods:This was a prospective, multicenter, open-label, single-arm, phase 3 study (NCT01596621; C18083/3076) with a 2-year follow-up period. Eligible patients received bendamustine hydrochloride 120 mg/m2 infused intravenously on days 1 and 2 of each 21-day treatment cycle for at least six planned cycles (and up to eight cycles). The primary endpoint was the overall response rate (ORR); and secondary endpoints were duration of response (DoR), progression-free survival (PFS), safety, and pharmacokinetics. Patients were classified according to their best overall response after initiation of therapy. Proportions of patients in each response category (complete response [CR], partial response [PR], stable disease, or progressive disease) were summarized along with a two-sided binomial exact 95% confidence intervals (CIs) for the ORR.Results:A total of 102 patients were enrolled from 20 centers between August 6th, 2012, and June 18th, 2015. At the time of the primary analysis, the ORR was 73% (95% CI: 63%-81%) per Independent Review Committee (IRC) including 19% CR and 54% PR. With the follow-up period, the median DoR was 16.2 months by IRC and 13.4 months by investigator assessment; the median PFS was 18.6 months and 15.3 months, respectively. The most common non-hematologic adverse events (AEs) were gastrointestinal toxicity, pyrexia, and rash. Grade 3/4 neutropenia was reported in 76% of patients. Serious AEs were reported in 29 patients and five patients died during the study. Pharmacokinetic analysis indicated that the characteristics of bendamustine and its metabolites M3 and M4 were generally consistent with those reported for other ethnicities.Conclusion:Bendamustine is an active and effective therapy in Chinese patients with relapsed, indolent B-cell NHL, with a comparable risk/benefit relationship to that reported in North American patients.Clinical trial registration:ClinicalTrials.gov, No. NCT01596621; https://clinicaltrials.gov/ct2/show/NCT01596621

简介：【摘要】目的 0-arm导航辅助下后路椎弓根螺钉复位内固定治疗寰枢椎骨折的效果。方法 随机抽取我院82例（2018年1月～2021年1月期间）寰枢椎骨折的患者开展研究，按照电脑随机法分为A组（41例）采用徒手后路椎弓根螺钉复位内固定治疗，B组（41例）采用0-arm导航辅助下后路椎弓根螺钉复位内固定治疗。然后对比两组患者的临床指标（骨折愈合时间、术中出血量、手术时间）和骨折复位质量（采用Matta影像学评分）。结果 治疗后，B组患者的临床指标优于A组，B组患者的骨折复位质量优于A组，P＜0.05；结论：对寰枢椎骨折的患者，应用

简介：摘要目的探讨O-arm导航辅助下后路椎弓根螺钉复位内固定治疗寰枢椎骨折的疗效。方法采用回顾性病例对照研究分析2016年1月至2018年6月河北医科大学第三医院收治的37例寰枢椎骨折患者临床资料，其中男22例，女15例；年龄29～68岁[(50.9±9.8)岁]。24例行O-arm导航辅助下后路椎弓根螺钉复位内固定术(导航组)，13例行徒手后路椎弓根螺钉复位内固定术(徒手组)。比较两组手术时间和术中出血量。术前、术后7 d及末次随访采用日本骨科学会(JOA)评分和颈椎功能障碍指数(NDI)评分对患者临床疗效进行评估。观察患者并发症情况。采用Neo分级评价螺钉位置分级及皮质穿透率。结果患者均获随访24～38个月[(27.7±4.0)个月]。导航组手术时间[(189.8±35.4)min]显著短于徒手组[(221.5±48.6)min](P<0.05)，术中出血量[300.0(250.0，537.5)ml]显著少于徒手组[500.0(425.0，625.0)ml](P<0.05)。两组患者术后7 d及末次随访JOA评分较术前显著升高(P<0.05)，NDI评分较术前显著降低(P<0.05)。而组间差异无统计学意义(P>0.05)。术中未见神经、血管损伤等严重相关并发症。导航组共置入椎弓根螺钉86枚，包括Neo分级0级83枚，1级2枚，2级1枚；徒手组共置入椎弓根螺钉44枚，包括Neo分级0级36枚，1级5枚，2级2枚，3级1枚(P<0.05)。导航组螺钉皮质穿透率为3%(3/86)，徒手组为18%(8/44)(P<0.05)。结论对于寰枢椎骨折，在行后路椎弓根螺钉复位内固定术时，应用O-arm导航辅助可以显著缩短或减少手术时间和术中出血量，提高椎弓根螺钉置入的精确率。

简介：摘要目的比较O-arm导航辅助下与C形臂X线机透视辅助下经皮骶髂关节螺钉内固定治疗骶髂关节复合体损伤的临床疗效。方法采用回顾性病例对照研究分析2016年7月— 2019年1月陆军军医大学第二附属医院收治的32例骶髂关节复合体损伤患者临床资料，其中男21例，女11例；年龄20～59岁，平均41.3岁。骨折按Tile分型：B1型7例，B2型13例，B3型5例，C1型5例，C2型2例。17例采用O-arm导航辅助下经皮骶髂螺钉内固定治疗(A组)，15例采用C形臂X线机透视辅助下经皮骶髂螺钉内固定治疗(B组)。比较两组单枚螺钉置钉时间、术中透视时间、术中出血量、骨折愈合时间，采用Matta标准评分评价术后骨折复位质量。采用Majeed功能评分评价末次随访时关节功能，并观察并发症情况。结果患者均获随访6～37个月，平均18.6个月。A组单枚螺钉置钉时间为(27.3±5.1)min，B组为(52.3±5.9)min(P<0.05)。A组术中透视时间为(43.3±3.2)s，B组为(64.6±5.4)s(P<0.05)。A组术中出血量为(17.8±2.6)ml，B组为(20.7±3.1)ml；A组骨折愈合时间为(13.4±1.4)周，B组为(14.1±1.9)周；A组和B组Matta标准评分的优良率分别为88%(15/17)和87%(13/15)；A组和B组末次随访时Majeed评分的优良率分别为94%(16/17)和87%(13/15)(P均>0.05)。术后B组1例患者出现1枚螺钉稍突破椎体前皮质。两组均无血管、神经损伤、伤口感染、螺钉松动等并发症。结论与C形臂X线机透视辅助下相比，O-arm导航辅助下经皮骶髂关节螺钉内固定治疗骶髂关节复合体损伤具有置钉时间短、术中透视时间短等优势。

简介：AbstractObjective:It remains unclear whether adjuvant chemoradiotherapy (CRT) improves survival outcome of pancreatic ductal adenocarcinoma (PDAC) patients after surgery. This study aimed to investigate the efficacy and safety of tegafur/gimeracil/oteracil (S-1)-based adjuvant concurrent chemoradiotherapy in resected PDAC patients with defined high-risk pathological features.Methods:We conducted a single-arm, prospective, and interventional study at Zhongshan Hospital Fudan University from December 2012 to December 2019 and the last follow-up was conducted in December 2021. This study was approved by the Ethics Committee of Zhongshan Hospital Fudan University on December 27, 2012 (approval No. B2012-139). Resected PDAC patients with high-risk pathological features, including positive resection margin, pathological T3-4N1-2M0 disease, peripancreatic fat invasion, microvascular invasion, and perineural invasion, were recruited. Primary endpoint was overall survival and secondary endpoints were disease-free survival, treatment toxicity, and 2-, 5-year survival rates.Results:A total of 54 patients were recruited. Mean age was 63.6 years old (±7.2). The distribution of T and N stages were 24.1% for T1, 46.3% for T2, 27.8% for T3, 1.9% for T4, 33.3% for N1, and 11.1% for N2. Seven patients had R1 resection. The median overall survival and disease-free survival were 27.1 and 13.7 months, respectively, while no fatal adverse events were recorded. Subgroup analyses showed differences in survival outcomes among patients with microvascular invasion, different N stages, and preoperative CA 19-9 levels. Further, a Cox proportional hazard model demonstrated associations of lymph node metastases, CA 19-9 level, and microvascular invasion with overall survival and disease-free survival.Conclusion:S-1 -based adjuvant CRT showed promising efficacy and manageable toxicity in resected PDAC patients with highrisk pathological features.

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