Takashi Nishii

Osaka City University, Ōsaka, Ōsaka, Japan

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Publications (151)275.72 Total impact

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    ABSTRACT: Purpose: A new method for acetabular cartilage segmentation in both computed tomography (CT) arthrography and magnetic resonance imaging (MRI) datasets with leg tension is developed and tested. Methods: The new segmentation method is based on the combination of shape and intensity information. Shape information is acquired according to the predictable nonlinear relationship between the U-shaped acetabulum region and acetabular cartilage. Intensity information is obtained from the acetabular cartilage region automatically to complete the segmentation procedures. This method is evaluated using 54 CT arthrography datasets with two different radiation doses and 20 MRI datasets. Additionally, the performance of this method in identifying acetabular cartilage is compared with four other acetabular cartilage segmentation methods. Results: This method performed better than the comparison methods. Indeed, this method maintained good accuracy level for 74 datasets independent of the cartilage modality and with minimum user interaction in the bone segmentation procedures. In addition, this method was efficient in noisy conditions and in detection of the damaged cartilages with zero thickness, which confirmed its potential clinical usefulness. Conclusions: Our new method proposes acetabular cartilage segmentation in three different datasets based on the combination of the shape and intensity information. This method executes well in situations where there are clear boundaries between the acetabular and femoral cartilages. However, the acetabular cartilage and pelvic bone information should be obtained from one dataset such as CT arthrography or MRI datasets with leg traction.
    International Journal of Computer Assisted Radiology and Surgery 10/2015; DOI:10.1007/s11548-015-1313-z · 1.71 Impact Factor
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    ABSTRACT: Rotation of the femur is usually measured by the posterior condylar line (PCL). However, the functional position of the PCL has not been studied well. The angles between the PCL and the horizontal body line (HBL) were measured on preoperative computed tomographic (CT) images of 324 hips with osteoarthritis and compared with the CT images taken after hip arthroplasty. The PCL rotated 0.4° (±10.9° SD) internally from the HBL on preoperative CT images and was significantly correlated with femoral anteversion, Kellgren-Lawrence grade, and sex. On postoperative CT images, the PCL rotated 10.1° (interquartile range, 1.7°-15.5°) internally from the HBL. There was individual variance in the position of the PCL, and caution may be needed when using it as a rotational reference.
    The Journal of arthroplasty 09/2015; DOI:10.1016/j.arth.2015.08.038 · 2.67 Impact Factor
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    ABSTRACT: The optimal reorientation of the acetabulum for developmental dysplasia of the hip (DDH) is unknown in terms of hip range-of-motion (ROM). The simulated ROMs of 52 DDHs after rotational acetabular osteotomy (RAO) with several patterns of femoral head coverage and those of 73 normal hips were analyzed using computer models reconstructed from CT images. After RAO with a lateral center edge angle (LCEA) of 30° and an anterior center edge angle (ACEA) of 55° producing coverage similar to that of normal hips, the maximal flexion and maximal internal rotation at 110° flexion with 20° adduction were significantly smaller than those of the normal group. To achieve ROMs after RAO similar to those of the normal group, an LCEA of 30° with an ACEA of 45°, an LCEA of 25° with an ACEA of 45° to 50°, and an LCEA of 20° with an ACEA of 50° could be preferred angles to target, even though they provided smaller coverage than that of normal hips. After RAO producing femoral head coverage similar to that of normal hips, the maximal flexion and the maximal internal rotation at 110° flexion with 20° adduction were significantly smaller than those of the normal group. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
    Journal of Orthopaedic Research 08/2015; DOI:10.1002/jor.23024 · 2.99 Impact Factor
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    ABSTRACT: Some studies have cautioned about the possibility of bleeding complications with routine use of anticoagulants like fondaparinux (FPX) for thrombophylaxis after elective hip surgery. Overdosing or prolonged periods of anticoagulant use should be avoided. We trialed a new regimen using FPX and tranexamic acid (TA) to reduce the risk of bleeding complications while maintaining efficacy in preventing deep vein thrombosis (DVT). The present study evaluated the effectiveness and safety of this regimen in 391 consecutive patients. Each patient was assigned either the FPX group, administered a once-daily subcutaneous injection of 1.5 mg of FPX on postoperative days 2, 3, and 4; or the intermittent pneumatic compression (IPC) group, which used an IPC device continuously for 1-2 days with no administration of any anticoagulant drugs. Ultrasonography was performed to diagnose DVT in all patients. No cases of fatal or symptomatic pulmonary embolism were encountered in either group, but six patients (3.1 %) in the FPX group and nine patients (6.0 %) in the IPC group showed asymptomatic distal DVT. The incidence of DVT tended to be lower (p = 0.19), volumes of intraoperative (p < 0.01) and postoperative (p < 0.01) blood loss were significantly smaller, and hemoglobin level was significantly higher in the FPX group than in the IPC group (p < 0.01). Our new thrombophylactic regimen using FPX and TA appears effective and safe for use after elective hip surgery.
    Journal of Thrombosis and Thrombolysis 07/2015; DOI:10.1007/s11239-015-1249-8 · 2.17 Impact Factor
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    ABSTRACT: To compare changes in T1rho and T2 values of the femoral cartilage in porcine knee joints under staged loading and unloading conditions. Sixteen porcine knee joints with intact capsules and surrounding muscle were imaged using a custom-made pressure device and 3.0 T magnetic resonance imaging. Sagittal T1rho and T2 images were obtained for the lateral and medial condyles under the following compression loads: none (Load 0), 140 N (Load 140), 300 N (Load 300), and no compression after decompression (Post-load). The percentage changes of cartilage T1rho and T2 values under each loading condition from those at Load 0 were calculated for weight-bearing overall and eight subdivided regions of interest (ROIs) in both femoral condyles. The actual contact pressure under Load 140 and Load 300 was measured using pressure-sensitive film. For the overall ROI, the mean decreases of T1rho and T2 values were 4.4% and 5.1% under Load 140 and 10.9% and 10.6% under Load 300 in the medial condyle and were 5.2% and 4.0% under Load 140 and 10.6% and 6.0% under Load 300 in the lateral condyle. In the medial condyle, the actual contact pressure correlated highly with percentage changes in T1rho (r = -0.84, p < 0.01) and T2 (r = -0.79, p < 0.01), but those correlations were relatively low in the lateral condyle. Although there were side-dependent variations in the correlations with actual pressure, cartilage T1 rho and T2 showed similarly sensitive responses to applied load. Copyright © 2015. Published by Elsevier Ltd.
    Osteoarthritis and Cartilage 05/2015; DOI:10.1016/j.joca.2015.05.019 · 4.17 Impact Factor
  • Takashi Nishii · Takashi Sakai · Masaki Takao · Nobuhiko Sugano ·
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    ABSTRACT: We evaluated real-time angular changes during press-fit cup insertion in 70 total hip arthroplasties. Inclination and anteversion cup angles on navigation system were recorded after each procedure of five hammer blows during cup insertion, and maximum deviated inclination (MDI) and anteversion (MDA) angles until the cup was fully seated were measured. We found 1 (1%) and 29 (41%) hips with increases and decreases in MDI of 5° or more, and 13 (19%) and 6 (8%) hips with increases and decreases in MDA of 5° or more, respectively. The MDI in men was significantly lower and the MDA for left-side surgery was significantly higher. Surgeons should pay attention to fluctuation in angular changes during cup insertion and may consider countermeasures to minimize cup malpositioning. Copyright © 2015. Published by Elsevier Inc.
    The Journal of arthroplasty 05/2015; 30(10). DOI:10.1016/j.arth.2015.04.037 · 2.67 Impact Factor
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    ABSTRACT: The purpose of this study was to investigate the effects of different surgical approaches, the posterolateral approach (PLA) and the direct anterior approach (DAA), on postoperative femoral anteversion and stem coronal and sagittal alignment in total hip arthroplasty (THA), and to identify the factors related to postoperative femoral anteversion and stem alignment. A total of 209 hips of 181 patients were evaluated. THA was performed through the PLA in 80 hips and through the DAA in 129 hips. Femoral anteversion and stem alignment were measured on postoperative computed tomography images. The factor related to postoperative anteversion change was preoperative femoral anteversion, and the surgical approaches did not affect the postoperative anteversion change, while surgical approach did have an effect on stem sagittal alignment. Copyright © 2015. Published by Elsevier Inc.
    The Journal of arthroplasty 04/2015; 30(10). DOI:10.1016/j.arth.2015.04.026 · 2.67 Impact Factor
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    ABSTRACT: There is increasing awareness of prevalence of adverse local tissue reaction (ALTR) surrounding metal-on-metal (MoM) and highly cross-linked polyethylene (HXLPE) bearings, and sensitive and simple screening modalities for ALTR are required. We examined reliability of ultrasound screening for ALTR in 131 hips of 105 patients who received both ultrasound and MRI examinations after hip arthroplasty with MoM or HXLPE bearings. Using the MRI results as reference, sensitivity, specificity and accuracy of ultrasound were 74%, 92% and 84% around MoM bearings, and 90%, 83%, and 85% around HXLPE bearings. Ultrasound detected ALTR in 11hips that was not shown with MRI. Ultrasound examination is assumed to be a reliable screening tool for detecting clinically important ALTR lesions developing in the anterior region around MoM or HXLPE bearings.
    The Journal of Arthroplasty 12/2014; 29(12). DOI:10.1016/j.arth.2014.04.030 · 2.67 Impact Factor
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    ABSTRACT: Purpose: Determination of acetabular cartilage loss in the hip joint is a clinically significant metric that requires image segmentation. A new semiautomatic method to segment acetabular cartilage in computed tomography (CT) arthrography scans was developed and tested. Methods: A semiautomatic segmentation method was developed based on the combination of anatomical and statistical information. Anatomical information is identified using the pelvic bone position and the contact area between cartilage and bone. Statistical information is acquired from CT intensity modeling of acetabular cartilage and adjacent tissue structures. This method was applied to the identification of acetabular cartilages in 37 intra-articular CT arthrography scans. Results: The semiautomatic anatomical-statistical method performed better than other segmentation methods. The semiautomatic method was effective in noisy scans and was able to detect damaged cartilage. Conclusions: The new semiautomatic method segments acetabular cartilage by fully utilizing the statistical and anatomical information in CT arthrography datasets. This method for hip joint cartilage segmentation has potential for use in many clinical applications.
    International Journal of Computer Assisted Radiology and Surgery 07/2014; 10(4). DOI:10.1007/s11548-014-1101-1 · 1.71 Impact Factor
  • Masaki Takao · Takashi Nishii · Takashi Sakai · Nobuhiko Sugano ·
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    ABSTRACT: Anterior sacroiliac joint plate fixation for unstable pelvic ring fractures avoids soft tissue problems in the buttocks; however, the lumbosacral nerves lie in close proximity to the sacroiliac joint and may be injured during the procedure. A 49 year-old woman with a type C pelvic ring fracture was treated with an anterior sacroiliac plate using a computed tomography (CT)-three-dimensional (3D)-fluoroscopy matching navigation system, which visualized the lumbosacral nerves as well as the iliac and sacral bones. We used a flat panel detector 3D C-arm, which made it possible to superimpose our preoperative CT-based plan on the intra-operative 3D-fluoroscopic images. No postoperative complications were noted. Intra-operative lumbosacral nerve visualization using computer navigation was useful to recognize the 'at-risk' area for nerve injury during anterior sacroiliac plate fixation. Copyright © 2013 John Wiley & Sons, Ltd.
    International Journal of Medical Robotics and Computer Assisted Surgery 06/2014; 10(2). DOI:10.1002/rcs.1556 · 1.53 Impact Factor
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    ABSTRACT: Background Percutaneous iliosacral screw insertion requires substantial experience and detailed anatomical knowledge to find the proper entry point and trajectory even with the use of a navigation system. Our hypothesis was that three-dimensional (3D) fluoroscopic navigation combined with a preoperative computed tomography (CT)-based plan could enable surgeons to perform safe and reliable iliosacral screw insertion. The purpose of the current study is two-fold: 1) to demonstrate the navigation accuracy for sacral fractures and sacroiliac dislocations on widely displaced cadaveric pelves; and 2) to report the technical and clinical aspects of percutaneous iliosacral screw insertion using the CT-3D-fluoroscopy matching navigation system. Methods We simulated three types of posterior pelvic ring disruptions with vertical displacements of 0, 1, 2 and 3 cm using cadaveric pelvic rings. A total of six fiducial markers were fixed to the anterior surface of the sacrum. Target registration error over the sacrum was assessed with the fluoroscopic imaging center on the second sacral vertebral body. Six patients with pelvic ring fractures underwent percutaneous iliosacral screw placement using the CT-3D-fluoroscopy matching navigation. Three pelvic ring fractures were classified as type B2 and three were classified as type C1 according to the AO-OTA classification. Iliosacral screws for the S1 and S2 vertebra were inserted. Results The mean target registration error over the sacrum was 1.2 mm (0.5 to 1.9 mm) in the experimental study. Fracture type and amount of vertical displacement did not affect the target registration error. All 12 screws were positioned correctly in the clinical series. There were no postoperative complications including nerve palsy. The mean deviation between the planned and the inserted screw position was 2.5 mm at the screw entry point, 1.8 mm at the area around the nerve root tunnels and 2.2 mm at the tip of the screw. Conclusion The CT-3D-fluoroscopy matching navigation system was accurate and robust regardless of pelvic ring fracture type and fragment displacement. Percutaneous iliosacral screw insertion with the navigation system is clinically feasible.
    Injury 06/2014; 45(6). DOI:10.1016/j.injury.2014.01.015 · 2.14 Impact Factor
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    ABSTRACT: In some atypical patients, pelvic sagittal inclination (PSI) changes posteriorly by >10° from supine to standing position before total hip arthroplasty (THA). Several studies have suggested PSI in standing position is related to lumbar degeneration. The purpose of this study was to investigate spinal factors influencing changes in PSI from supine to standing position before THA. Participants comprised 163 consecutive patients who had undergone THA. Presence of compression fractures, presence of lumbar spondylolisthesis, thoracic kyphosis angle, lumbar lordosis angle, S1 anterior tilt angle and T4 plumb line position were investigated as spinal factors. Presence of compression fractures, age, presence of lumbar spondylolisthesis and small S1 anterior tilt angle were independently associated with posterior change in PSI from supine to standing position in patients before THA.
    The Journal of arthroplasty 12/2013; 29(12). DOI:10.1016/j.arth.2013.11.014 · 2.67 Impact Factor
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    ABSTRACT: . The perforation and fracture of the femur during the removal of bone cement in revision total hip arthroplasty (THA) are serious complications. The ROBODOC system has been designed to selectively remove bone cement from the femoral canal, but results have not been reported yet. The purpose of our study was to evaluate the clinical and radiographic results of revision THA using the ROBODOC system for cement removal. Materials and Methods . The subjects comprised 19 patients who underwent revision THA using the ROBODOC system. The minimum duration of follow-up was 76 months (median, 109 months; range, 76–150 months). The extent of remaining bone cement on postoperative radiography, timing of weight bearing, and the complications were evaluated. Results . The mean Merle d’Aubigne and Postel score increased from 10 points preoperatively to 14 points by final follow-up. Bone cement was completely removed in all cases. Full weight bearing was possible within 1 week after surgery in 9 of the 19 cases and within 2 months in all remaining cases. No instances of perforation or fracture of the femur were encountered. Conclusions . Bone cement could be safely removed using the ROBODOC system, and no serious complications occurred. Full weight bearing was achieved early in the postoperative course because of circumferential preservation of the femoral cortex.
    10/2013; 2013(3):347358. DOI:10.1155/2013/347358
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    ABSTRACT: Objective: The purpose of this study was to evaluate cytokine level characteristics in the hip joint fluid, including rapidly destructive coxopathy (RDC), OA, osteonecrosis (ON) of the femoral head and RA. Methods: Thirty-three hips with RDC, 57 with OA, 36 with ON and 10 with RA were included in the study. OA hips were divided into two groups: 20 hips with early OA without joint space narrowing and 37 hips with terminal OA. ON hips were divided into three groups: 13 hips with <3 mm collapse, 14 hips with >3 mm collapse and 9 hips with terminal ON. Joint fluid was collected during surgery. Cytokine levels including IL-1β, IL-6, IL-8 and TNF-α were measured using homogeneous time-resolved fluorescence. Results: All measured cytokine levels in RDC were significantly higher than those in OA (P < 0.05). Terminal OA showed higher cytokine levels than those in early OA (P < 0.05). IL-6 and TNF-α levels in the ON group with >3 mm collapse were higher than those found in the ON group with <3 mm collapse. In comparing cytokine levels between RDC, terminal OA, RA and terminal ON, RDC showed significantly higher IL-8 levels than terminal OA and RA (P < 0.05). Conclusion: IL-8 levels in RDC were higher than in the other hip diseases. The IL-8 level may reflect the aggressiveness of joint destruction in RDC, and IL-6 and TNF-α levels may also reflect ongoing destruction in OA and ON.
    Rheumatology (Oxford, England) 10/2013; 53(1). DOI:10.1093/rheumatology/ket334 · 4.48 Impact Factor
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    ABSTRACT: BACKGROUND:Jogging has been classified as a high-impact sport, and jogging after total hip arthroplasty (THA) has not been well documented. PURPOSE:To investigate the participation rate for postoperative jogging as well as jogging parameters and the influence of jogging on implant stability and bearing wear. STUDY DESIGN:Case-control study; Level of evidence, 3. METHODS:Included in this study were 804 hips in 608 patients (85 men, 523 women) who underwent THA between 2005 and 2011 with follow-up longer than 1 year. The mean patient age was 62 years (range, 26-98 years), and mean follow-up duration was 4.8 years (range, 2.3-7.8 years). Hip resurfacing arthroplasty (HRA) was performed in 81 patients and conventional THA in 527 patients. During routine postsurgical visits, patients were given a questionnaire concerning preoperative and postoperative jogging routines. For joggers, frequency, distance, duration, and velocity of jogging were recorded. Patients who did not jog postoperatively were asked to provide reasons for not jogging. Radiographs concerning implant migration and polyethylene wear were evaluated with specialized software, and serum cobalt and chromium ion concentrations were investigated for patients with metal-on-metal articulation. RESULTS:A total of 33 patients (5.4%) performed jogging preoperatively, and 23 patients (3.8%) performed jogging postoperatively. Of the 23 who jogged postoperatively, conventional THA was performed in 13 patients and HRA in 10 patients. Postoperatively, joggers trained a mean of 4 times (range, 1-7 times) per week, covering a mean distance of 3.6 km (range, 0.5-15 km) in a mean time of 29 minutes (range, 5-90 minutes) per session and at a mean speed of 7.7 km/h (range, 3-18 km/h). No patient complained of pain or showed serum cobalt and chromium ion elevation greater than 7 ppb. No hip showed loosening, abnormal component migration, or excessive wear at a mean 5-year follow-up. There were 74 postoperative non-joggers with an interest in jogging. The reasons given for avoiding jogging included anxiety (45 patients; 61%); impossible because of several reasons, including pain, decreased range of motion, and muscle weakness (18 patients; 24%); and lumbar or knee pain (11 patients; 15%). Multivariate analysis revealed that male sex and a history of preoperative jogging demonstrated significant relationships with postoperative jogging. CONCLUSION:A total of 3.8% of THA patients participated in postoperative jogging. Short-term postoperative follow-up did not identify any negative influence of jogging on implant survival.
    The American Journal of Sports Medicine 10/2013; 42(1). DOI:10.1177/0363546513506866 · 4.36 Impact Factor
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    ABSTRACT: We examined the clinical efficacy of alendronate treatment for hip osteoarthritis using multiple outcome measures. Fifty patients with symptomatic hip osteoarthritis were enrolled in this prospective trial. The patients were randomly assigned to an alendronate group (35 mg/week alendronate and 600 mg/day calcium lactate) or a control group (600 mg/day calcium lactate) for 2 years. The groups were compared with regard to the following five parameters. The primary outcome measures are the following: (1) the Western Ontario and McMaster Universities (WOMAC) osteoarthritis pain score and the visual analog score (VAS). The secondary outcome measures are the following: (2) joint space width (JSW) measured on radiographs using a semiautomatic computer software, (3) the biochemical markers urinary N-telopeptide of type I collagen (NTX-I) and C-terminal cross-linking telopeptide of type II collagen (CTX-II), (4) dual-energy X-ray absorptiometry of the hip and lumbar spine, and (5) bone marrow edema on magnetic resonance images. The alendronate group showed pain improvement trends in VAS and WOMAC scores, whereas the control group showed worsening of pain. The alendronate group showed significant improvement in WOMAC pain scores after 12 months (p = 0.031) but no significant prevention of structural osteoarthritis progression, defined as a decrease in JSW >0.30 mm or conversion to total hip arthroplasty. There was significantly larger decrease in the biochemical markers and significantly increased bone density in the alendronate group. Alendronate treatment by standard dose for osteoporosis showed clinical efficacy for decreasing pain but failed to show preventive effects for structural progression of hip osteoarthritis.
    Clinical Rheumatology 07/2013; 32(12). DOI:10.1007/s10067-013-2338-8 · 1.77 Impact Factor
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    Takashi Nishii ·

    Journal of Orthopaedic Science 05/2013; 18(4). DOI:10.1007/s00776-013-0392-3 · 0.94 Impact Factor
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    ABSTRACT: The usefulness of navigation systems for revision total hip arthroplasty (THA) remains unclear. The purpose of this study was to evaluate the accuracy of cup positioning using a navigation system in revision THA. Cup alignment of thirty revision cases was evaluated. Data were also compared with those of 30 navigated primary THA cases. In the revision THA group, mean difference in postoperative measurement from preoperative plan was 0.5±4° (range, -9° to 8°) for inclination and -0.07°±5° (-14° to 13°) for anteversion. Mean difference in postoperative measurement from intraoperative record was 0.7°±3° (-5° to 8°) for inclination and -0.7°±3° (-12° to 5°) for anteversion. Compared with the primary THA group, none of these parameters were significantly different. This navigation system was useful even in revision THA.
    The Journal of arthroplasty 03/2013; 28(10). DOI:10.1016/j.arth.2012.11.015 · 2.67 Impact Factor
  • Masaki Takao · Takashi Nishii · Takashi Sakai · Nobuhiko Sugano ·
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    ABSTRACT: Objectives: The aim of the present study was to determine whether 3-dimensional (3D) fluoroscopic navigation combined with a preoperative computer tomography (CT)-based plan could enable surgeons to perform safe and reliable iliosacral screw insertion despite their limited experience. Methods: Eight pelvises with surrounding soft tissue donated from embalmed cadavers were used. Kirschner wires with a diameter of 3 mm were placed across the ilia bilaterally into the S1 and S2 vertebrae by 4 orthopaedic trainees. In 4 specimens, wires were placed across the right ilium using conventional technique and the left ilium using the CT-3D-fluoroscopy matching navigation system. In 4 other specimens, wires were placed across the right ilium using the 3D-fluoroscopic navigation system and the left ilium using the CT-3D-fluoroscopy matching navigation system. A postoperative CT-based analysis of wire localization was performed. The number of wire insertions until the final position check, operation duration, and radiation time and dose were also evaluated. Results: The percentage of wires inserted correctly was higher in the CT-3D-fluoroscopy matching navigated group (100%) than in the conventional technique group (50%) and 3D-fluoroscopic navigation group (50%). The number of wire insertions and radiation time were significantly lower with both navigation systems than with the conventional technique, whereas there was no significant difference between the navigation systems. There were no significant differences in operation time and radiation dose among the 3 groups. Conclusions: The CT-3D-fluoroscopy matching navigation system reduced the malposition rate of percutaneous iliosacral screw insertion when performed by less experienced surgeons.
    Journal of orthopaedic trauma 03/2013; 27(12). DOI:10.1097/BOT.0b013e31828fc4a5 · 1.80 Impact Factor

Publication Stats

2k Citations
275.72 Total Impact Points


  • 2000-2015
    • Osaka City University
      • • Department of Orthopaedic Surgery
      • • Graduate School of Medicine
      Ōsaka, Ōsaka, Japan
  • 1999-2013
    • Osaka University
      • • Division of Orthopaedic Surgery
      • • Department of Orthopaedic Medical Engineering
      Suika, Ōsaka, Japan
  • 2011
    • Osaka National Hospital
      • Department of Orthopaedic Surgery
      Ōsaka, Ōsaka, Japan