Frontiers in Surgery最新文献

Purpose: To investigate the efficacy and safety of intra-articular injection ratio of platelet rich plasma (PRP) and hyaluronic acid (HA), and provide evidence-based strategies for the treatment of knee osteoarthritis (KOA).

Methods: Search PubMed, Web of Science, China National Knowledge Infrastructure (CNKI), and Wanfang databases to retrieve literature published from the beginning of database establishment to October 2024. Include in published randomized controlled trials (RCTs) or cohort studies. The research subjects are KOA patients, with the experimental group receiving intra-articular injection of PRP and the control group receiving intra-articular injection of HA. Quality evaluation of the inclusion of Cochrane Handbook risk assessment tools using RevMan5 Perform meta-analysis on outcome measures using three software.

Results: 18 articles were included, with a total of 1,326 patients. PRP showed significantly better WOMAC scores at 6 months (SMD=-8.32, P < 0.0001) and 12 months (SMD=-3.15, P < 0.0001), superior IKDC scores at 6 months (SMD=0.85, P = 0.004), and greater pain reduction on VAS at 3 months (SMD=-0.56, P < 0.0001) and 6 months (SMD=-0.85, P < 0.0001). EQ-VAS scores also favored PRP at 2 months (SMD=0.20, P = 0.04) and 12 months (SMD=0.35, P = 0.001). No significant differences were found in adverse events (OR = 1.31, P = 0.21) or patient satisfaction (MD = 1.60, P = 0.08), indicating comparable safety profiles.

Conclusion: PRP has a good clinical therapeutic effect on KOA. Based on this meta-analysis, compared with simple intra-articular injection of HA, PRP can improve WOMAC score, VAS score, and IKDC index score after 6 months of treatment, and enhance patients' health status. In terms of the incidence of adverse events, the safety of the two treatment options is similar.

Objective: : Fractures of the inferior pole of the patella can cause disorders of the knee joint extensor mechanism. The fracture fragments are usually small and comminuted, presenting certain difficulties in fixation. The purpose of this study is to observe the clinical effect of the "Net cage" technique in the treatment of inferior pole patella fractures.

Methods: This is a retrospective study that included 16 cases of inferior patella fractures (AO/OTA 34-A1) who underwent the "Net cage" technique from March 2017 to June 2020. Their medical records and follow-up results were collected, and the measured indicators included surgical complications related to the fixation method, knee joint function, the number of fluoroscopies, fracture healing, and the incidence of soft tissue stimulation.

Results: All patients achieved smooth fracture healing without complications such as internal fixation failure or implant fracture. The average number of intraoperative fluoroscopies was 5.56 ± 1.82 times (range: 4-10 times); the average fracture healing time was 10.5 ± 1.96 weeks (range: 8-14 weeks). No patients reported internal fixation-related soft tissue irritation. At the last follow-up, the knee joint function evaluation showed that the average range of motion (ROM) was 133.75 ± 5.89° (range: 120°∼140°); the average Bostman score was 27.94 ± 1.83 points (range: 24-30 points). Due to the small sample size of this study, only descriptive statistical analysis was performed on the data.

Conclusion: The "Net cage" technique for the treatment of inferior pole patella fractures shows promising short- to mid-term results, with the potential advantages of reducing fluoroscopy times, providing stable fixation, facilitating early functional exercise, and achieving favorable postoperative knee joint function. However, given the limitations of the study design, the clinical application and advantages of this technique require further verification by large-sample, multi-center randomized controlled studies.

Objective: This study aims to investigate the efficacy of a simple and effective two-dimensional integrated navigation-guided spinal endoscopic interbody fusion surgery for the treatment of lumbar spondylolisthesis.

Methods: A retrospective analysis was conducted on the clinical data of patients with lumbar spondylolisthesis treated with or without navigation. Postoperative clinical data were collected, and pain levels were assessed using the Visual Analog Scale (VAS), while functional improvement was evaluated using the Oswestry Disability Index (ODI). At the final follow-up, x-ray imaging was used to measure disc height (DH), slip percentage (SP), lumbar lordosis (LL), and slip angle (SA) at the surgical segment. Interbody fusion status was assessed based on the Bridwell grading criteria.

Results: ULIF surgery for lumbar spondylolisthesis with navigation assistance yields favorable early outcomes, including reduced surgery duration, fewer fluoroscopy instances, lower intraoperative blood loss, and less postoperative drainage volume (P < 0.05). Patients in the navigation group also show greater early postoperative improvements in low back pain (P < 0.05). No significant differences were observed between the two groups in other evaluation indicators (P > 0.05).

Conclusion: Compared with the non-navigation group, the ULIF procedure guided by the two-dimensional integrated navigation system-which is simple and effective-can provide better early relief of low back pain in patients with lumbar spondylolisthesis, while also shortening operative time, reducing the number of fluoroscopy instances, minimizing intraoperative blood loss, and decreasing postoperative drainage volume. This surgical approach demonstrates great potential for widespread clinical application.

Objective: To evaluate the feasibility and preliminary outcomes of prone retroperitoneal robotic-assisted laparoscopic pyeloplasty (prRALP) for ureteropelvic junction obstruction (UPJO), an innovative approach designed to optimize surgical exposure and suturing.

Methods: This retrospective cohort study analyzed four patients who underwent prRALP between September 2023 and May 2024. The surgical technique involved prone positioning and multi-port robotic access, enabling direct posterior exposure of the renal pelvis and proximal ureter. Primary outcomes included operation time (OT), estimated blood loss (EBL), complications (Clavien-Dindo classification), and postoperative renal function (eGFR). Success was defined by radiographic resolution of obstruction, symptom relief, and no need for reintervention.

Results: All procedures were completed robotically without open conversion and reoperation. Mean OT was 64.6 ± 14.4 min, with minimal blood loss of 27.5 ± 15.0 mL and no transfusions. The mean postoperative hospital stay was 3.3 ± 0.5 days. One minor complication (fever, Clavien 1) occurred (25%). Postoperative eGFR improved by 1.3 ± 14.2 mL/min/1.73 m² at 90-day follow-up, with all patients achieving obstruction-free recovery and a mean eGFR of 87.2 ± 69.8 mL/min/1.73 m² being maintained at 1-year postoperatively.

Conclusion: prRALP demonstrates feasibility and safety, leveraging prone position to enhance retroperitoneal access and suturing precision. Larger prospective studies are warranted to validate its technical benefits and reproducibility.

Objective: The aim of this study was to explore the early and midterm efficacy of artificial intelligence (AI) involvement in assisted hip revision surgery and to summarize our clinical experience.

Methods: Clinical data were collected from 38 patients (39 hips) who underwent hip revision surgery and preoperative planning using AI technology in our hospital between June 2019 and November 2024. The cohort included 17 men and 22 women, with a mean age of 70.33 ± 10.42 years (range 44-90 years). Mean follow-up time was 39.67 ± 16.76 months (range 7-72 months). The initial revision was performed in 37 hips, second revision in three hips, and third revision in one hip. The function of the affected limb was evaluated using Harris Hip Scoring System (HHS) at preoperative and postoperative nodes.

Results: In this study, 38 patients were monitored for 7-72 months, with a mean follow-up of 34.64 ± 16.54 months. Matching of AI-planned prosthesis size with actual prosthesis size replaced during surgery: 3 cases (7.69%) showed a ±1 size discrepancy, 1 case (2.56%) showed a ±2 size discrepancy, and the remaining patients achieved precise matching. The HHS scores of all patients at 6 months postoperatively (82.99 ± 6.91) were higher than the preoperative scores (33.03 ± 7.36), and the difference was statistically significant (P < 0.05).

Conclusion: AI technology makes complex revision surgeries simple by accurately formulating individual preoperative plans for hip revision surgery. The feasibility and preliminary efficacy of AI-assisted revision total hip arthroplasty surgery are satisfactory. AI-assisted complex orthopedic surgeries warrant further in-depth clinical research.

Background: This study aims to evaluate the differences in analgesic efficacy between the SAPB and INB in cardiothoracic surgery through a meta-analysis.

Methods: PubMed, Cochrane Library, Embase, and Web of Science were searched from the establishment of the databases until July 10, 2025. All randomized controlled trials (RCTs) comparing the efficacy of SAPB and INB in cardiothoracic surgery were included. Quality assessment was performed using risk of bias. All data were analyzed using Stata 15 software.

Results: A total of 9 randomized controlled trials involving 606 patients were included, meta-analysis results indicated that no differences in 6-h pain scores [SMD = 0.28, 95% CI (-0.50, 1.06)], 12-h pain scores [SMD = -0.59, 95% CI (-1.71, 0.53)], 24-h pain scores [SMD = -0.07, 95% CI (-0.67, 0.52)], incidence of nausea and vomiting[RR = 0.84, 95% CI (0.27, 2.57)] and length of hospital stay [SMD = 0.01, 95% CI (-0.30, 0.32)]between the SAPB group and the INB group, However, compared with INB, SAPB may reduce total opioid consumption[SMD = -1.99, 95% CI (-3.21, -0.77)].

Conclusions: Overall, current evidence suggests that SAPB provides analgesic efficacy comparable to INB in cardiothoracic surgery. Subgroup analyses indicated that SAPB may be associated with lower pain scores in thoracotomy procedures and reduced opioid consumption in certain clinical settings; however, these findings should be interpreted cautiously due to heterogeneity across studies. Further high-quality randomized controlled trials are warranted to confirm these results.

Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD420251080642, PROSPERO CRD420251080642.

Introduction: Several surgical techniques have been described in the literature for the treatment of Hirschsprung's disease (HD). This study presents our surgical experience in managing patients with HD and the evolution of rectal dissection following the introduction of robotic technology. We developed a novel laparoscopic robot-assisted approach and report our initial experience with Restorative Proctocolectomy with minimal transanal endorectal dissection in HD patients, detailing the technical aspects of this procedure.

Patients and methods: We retrospectively reviewed data from patients with HD who underwent pull-through surgery at our Institution between January 2015 and July 2025.

Results: Sixty-five patients with HD were included. Fifty-four patients underwent conventional procedures performed at our Center: two open Soave endorectal pull-through (ERPT), forty-four laparoscopic Soave-Georgeson ERPT, and eight Totally Robotic Soave ERPT with limited transanal endorectal dissection. Beginning in 2023, eleven patients underwent a robot-assisted Restorative Proctocolectomy with minimal transanal endorectal dissection.

Conclusion: The advantages of robotic technology allow for safer performance of pelvic and particularly rectal surgery. Based on our experience, we suggest that in selected patients with HD, Restorative Proctocolectomy with minimal transanal endorectal dissection can be safely performed using robotic assistance in Centers with advanced minimally invasive expertise in HD management.

Background: Composite tissue defects (CTD) of the forearm and hand commonly result from industrial, agricultural, and traffic-related injuries and often involve multiple anatomical structures, making reconstruction challenging. Simple skin-flap coverage may leave deep dead space and fail to restore functional integrity. This study reports our experience using the free anterolateral thigh chimeric muscle flap (ALT-CMF) for CTD reconstruction and evaluates its effectiveness in achieving reliable defect coverage and functional recovery.

Methods: We retrospectively reviewed patients who underwent ALT-CMF reconstruction between February 2018 and January 2023. All patients had CTD of the forearm or hand and were followed for at least six months. Flap viability, postoperative complications, and donor-site outcomes were recorded. Digital functional recovery was assessed using the Total Active Motion (TAM) score. Two-point discrimination (2PD) were used to evaluate sensory recovery in the transplanted skin flaps.

Results: Twenty patients (15 males, 5 females; mean age 39.40 ± 9.90 years) were included. During surgery, the median area of the harvested anterolateral thigh perforator skin flap was 80.0 (66.0-99.0) cm², while the median area of the muscle flap component was 21.25 (20.00-30.00) cm². All donor sites were primarily closed. Over a mean follow-up period of 15.30 ± 5.78 months, 15 flaps (75.0%) survived uneventfully, while 5 patients (25.0%) developed vascular crisis; four flaps were salvaged after urgent re-exploration, and one experienced complete necrosis. At the six-month follow-up, the mean TAM score was 235.79° ± 8.35°, indicating satisfactory recovery of digital mobility. 2PD testing demonstrated no significant difference in sensory recovery between the transplanted flaps and the contralateral side (19.42 ± 2.59 mm vs. 18.16 ± 3.20 mm, P = 0.063).

Conclusions: The ALT-CMF is an effective reconstructive option for composite tissue defects of the forearm and hand. By providing reliable soft-tissue coverage, eliminating dead space through its chimeric muscle component, and supporting functional restoration in terms of joint mobility and sensation. This technique enables one-stage reconstruction with low donor-site morbidity and promotes favorable limb recovery.