Pub Date : 2024-08-30DOI: 10.3389/fsurg.2024.1421732
Mehmet Can, Malik Ergin, Özkan Okur, Ayşe Demet Payza, Kamer Polatdemir, Akgün Oral
IntroductionThe employment of laparoscopic surgical techniques has reignited the debate on managing Meckel's Diverticulum (MD) due to its low complication rates. Nevertheless, concerns have been raised regarding completely removing any potential heterotopic mucosa. Our study aimed to compare surgical approaches in MD and assess the effectiveness of simple diverticulectomy.MethodsBetween 2003 and 2022, 139 patients with MD were retrospectively analysed. The study examined the morphometric measurements of the diverticulum and the location of the heterotopic mucosa in the diverticulum regarding growth and symptoms.ResultsSimple diverticulectomy achieved the lowest postoperative complication rate among excision techniques (p = 0.03). MD's length, diameter, and distance to the ileocecal valve increase linearly with growth in the first three years of life (p = 0.00, p = 0.01, p = 0.00) but not in subsequent years (p = 0.81, p = 0.43, p = 0.21). As the length of the MD increases, the heterotopic mucosa (HM) is displaced distally (p = 0.01). Patients in whom HM reaches the base of the diverticulum always present with bleeding (p = 0.02).DiscussionSimple diverticulectomy is a safe technique for Meckel's diverticulum resection. Meckel's diverticulum continues to grow until the age of 3. With this growth, the heterotopic mucosa is displaced distally and moves away from the base of the diverticulum. Bleeding is the main symptom in patients with HM reaching the base of the diverticulum. In patients with bleeding or younger than three years of age, simple diverticulectomy may not be considered safe.Level of Evidence: III
{"title":"Can deciphering the growth of Meckel's diverticulum help us to decide the resection technique?","authors":"Mehmet Can, Malik Ergin, Özkan Okur, Ayşe Demet Payza, Kamer Polatdemir, Akgün Oral","doi":"10.3389/fsurg.2024.1421732","DOIUrl":"https://doi.org/10.3389/fsurg.2024.1421732","url":null,"abstract":"IntroductionThe employment of laparoscopic surgical techniques has reignited the debate on managing Meckel's Diverticulum (MD) due to its low complication rates. Nevertheless, concerns have been raised regarding completely removing any potential heterotopic mucosa. Our study aimed to compare surgical approaches in MD and assess the effectiveness of simple diverticulectomy.MethodsBetween 2003 and 2022, 139 patients with MD were retrospectively analysed. The study examined the morphometric measurements of the diverticulum and the location of the heterotopic mucosa in the diverticulum regarding growth and symptoms.ResultsSimple diverticulectomy achieved the lowest postoperative complication rate among excision techniques (<jats:italic>p</jats:italic> = 0.03). MD's length, diameter, and distance to the ileocecal valve increase linearly with growth in the first three years of life (<jats:italic>p</jats:italic> = 0.00, <jats:italic>p</jats:italic> = 0.01, <jats:italic>p</jats:italic> = 0.00) but not in subsequent years (<jats:italic>p</jats:italic> = 0.81, <jats:italic>p</jats:italic> = 0.43, <jats:italic>p</jats:italic> = 0.21). As the length of the MD increases, the heterotopic mucosa (HM) is displaced distally (<jats:italic>p</jats:italic> = 0.01). Patients in whom HM reaches the base of the diverticulum always present with bleeding (<jats:italic>p</jats:italic> = 0.02).DiscussionSimple diverticulectomy is a safe technique for Meckel's diverticulum resection. Meckel's diverticulum continues to grow until the age of 3. With this growth, the heterotopic mucosa is displaced distally and moves away from the base of the diverticulum. Bleeding is the main symptom in patients with HM reaching the base of the diverticulum. In patients with bleeding or younger than three years of age, simple diverticulectomy may not be considered safe.Level of Evidence: III","PeriodicalId":12564,"journal":{"name":"Frontiers in Surgery","volume":"2 1","pages":""},"PeriodicalIF":1.8,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142213861","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-29DOI: 10.3389/fsurg.2024.1394575
Xiaowei Wu, Yanbin Lin, Yangkai Xu, Linglan Yan, Shaochen Tu
In femoral intertrochanteric fractures, poor incision positioning may result in inaccurate intramedullary nail placement direction, which increases the difficulty of reduction and thus the size and number of incisions. Repeated intraoperative fluoroscopy not only increases the radiation exposure of the surgeon but also affects the operative outcomes. This technical note proposes a method of identifying incision positioning preoperatively using the “3-2-1” body surface localization method. This auxiliary positioning technique uses a body surface locator and the lower limb force axis. It can predict the incisions for the needle insertion point, spiral blade, and locking nails, create minimally invasive incisions, avoid incorrect incision position, facilitate accurate intraoperative intramedullary nail placement, reduce the incision size, intraoperative bleeding, and radiation exposure, and improve surgical efficiency and reduction quality.
{"title":"Application of the “3-2-1” body surface localization method in intertrochanteric femoral fractures: a technical note","authors":"Xiaowei Wu, Yanbin Lin, Yangkai Xu, Linglan Yan, Shaochen Tu","doi":"10.3389/fsurg.2024.1394575","DOIUrl":"https://doi.org/10.3389/fsurg.2024.1394575","url":null,"abstract":"In femoral intertrochanteric fractures, poor incision positioning may result in inaccurate intramedullary nail placement direction, which increases the difficulty of reduction and thus the size and number of incisions. Repeated intraoperative fluoroscopy not only increases the radiation exposure of the surgeon but also affects the operative outcomes. This technical note proposes a method of identifying incision positioning preoperatively using the “3-2-1” body surface localization method. This auxiliary positioning technique uses a body surface locator and the lower limb force axis. It can predict the incisions for the needle insertion point, spiral blade, and locking nails, create minimally invasive incisions, avoid incorrect incision position, facilitate accurate intraoperative intramedullary nail placement, reduce the incision size, intraoperative bleeding, and radiation exposure, and improve surgical efficiency and reduction quality.","PeriodicalId":12564,"journal":{"name":"Frontiers in Surgery","volume":"3 1","pages":""},"PeriodicalIF":1.8,"publicationDate":"2024-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142213905","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-29DOI: 10.3389/fsurg.2024.1377921
Wei Jie Tee, Kuei Siong Andy Yeo, David Thai Chong Chua, Ing How Moo
IntroductionPatella fractures account for 1% of skeletal fractures in orthopedic surgery. Simple two-part patella fractures are uncommon; most fractures are comminuted with significant articular involvement. Traditionally, patella fractures have been fixed using a tension band technique with cerclage wire, which has several complications including soft-tissue irritation, implant migration, and breakage, leading to secondary implant removal in up to 37% of patients. Newer fixation methods using cannulated screws, hook plates, mesh plates, and locking plates show promise but are costly and require extensive soft-tissue dissection. There is a need for a better alternative, especially for the elderly with osteoporotic bones.Recent developmentsVarious authors have described patellar fixation techniques augmented with sutures and suture tape, showing satisfactory outcomes. This paper proposes a novel all-suture tape method for patellar fixation, suitable for common types of patella fractures including AO 34C1.1 (transverse), AO 34C2 (transverse and split), and 34C3 (comminuted). Suture tape is biomechanically superior in both soft tissue and bone.Operative techniqueThe patient is laid supine with the knee in full extension. A standard anterior midline approach is adopted. After reducing the fracture fragments and securing them with K-wires, non-absorbable suture tapes are used instead of cerclage wire. The tapes are passed multiple times through the soft tissue, creating loops that are then tensioned to compress the fracture fragments. The technique is completed by creating a tension band fixation with additional suture tapes.Expected outcomesThis technique offers several benefits, including reduced operative time, minimized soft-tissue dissection, and lower risk of implant prominence and irritation. The suture tape's superior tensile strength and low tissue reactivity reduce complications and the need for secondary surgeries. Early results from two cases show union achieved at 3 months without complications, with patients regaining full range of motion.ConclusionThis preliminary technical paper demonstrates the feasibility of using non-metallic implants for patella fracture fixation. The proposed method shows promising results, suggesting a potential shift in the approach to fracture fixation. Further research and larger cohort studies are needed to validate these findings.
导言髌骨骨折占骨科手术中骨骼骨折的1%。简单的两部分髌骨骨折并不常见；大多数骨折为粉碎性骨折，关节受累严重。传统上，髌骨骨折的固定方法是使用带环钢丝的张力带技术，这种方法有多种并发症，包括软组织刺激、假体移位和断裂，导致多达37%的患者需要二次移除假体。使用插管螺钉、钩板、网状板和锁定板的新型固定方法前景看好，但成本高昂，且需要进行大量软组织剥离。最近的发展多位学者介绍了使用缝合线和缝合带增强的髌骨固定技术，结果令人满意。本文提出了一种新型的全缝合带髌骨固定方法，适用于常见类型的髌骨骨折，包括 AO 34C1.1（横断型）、AO 34C2（横断型和劈裂型）和 34C3（粉碎型）。缝合带在软组织和骨骼的生物力学方面都更胜一筹。手术技巧患者仰卧，膝关节完全伸直。采用标准的前正中线入路。缩小骨折碎片并用 K 线固定后，使用非吸收性缝合带代替Cerclage 线。缝合带多次穿过软组织，形成环状，然后拉紧以压迫骨折片。这项技术的优点包括缩短手术时间、最大限度地减少软组织剥离、降低植入物突出和刺激的风险。缝合带的抗张强度高、组织反应性低，可减少并发症和二次手术的需要。两例病例的早期结果显示，患者在 3 个月后实现了骨结合，没有出现并发症，并恢复了完全的活动范围。所提出的方法显示出良好的效果，表明骨折固定方法有可能发生转变。要验证这些发现，还需要进一步的研究和更大规模的队列研究。
{"title":"Novel technique for comminuted patellar fixation using suture tape in spiderweb configuration","authors":"Wei Jie Tee, Kuei Siong Andy Yeo, David Thai Chong Chua, Ing How Moo","doi":"10.3389/fsurg.2024.1377921","DOIUrl":"https://doi.org/10.3389/fsurg.2024.1377921","url":null,"abstract":"IntroductionPatella fractures account for 1% of skeletal fractures in orthopedic surgery. Simple two-part patella fractures are uncommon; most fractures are comminuted with significant articular involvement. Traditionally, patella fractures have been fixed using a tension band technique with cerclage wire, which has several complications including soft-tissue irritation, implant migration, and breakage, leading to secondary implant removal in up to 37% of patients. Newer fixation methods using cannulated screws, hook plates, mesh plates, and locking plates show promise but are costly and require extensive soft-tissue dissection. There is a need for a better alternative, especially for the elderly with osteoporotic bones.Recent developmentsVarious authors have described patellar fixation techniques augmented with sutures and suture tape, showing satisfactory outcomes. This paper proposes a novel all-suture tape method for patellar fixation, suitable for common types of patella fractures including AO 34C1.1 (transverse), AO 34C2 (transverse and split), and 34C3 (comminuted). Suture tape is biomechanically superior in both soft tissue and bone.Operative techniqueThe patient is laid supine with the knee in full extension. A standard anterior midline approach is adopted. After reducing the fracture fragments and securing them with K-wires, non-absorbable suture tapes are used instead of cerclage wire. The tapes are passed multiple times through the soft tissue, creating loops that are then tensioned to compress the fracture fragments. The technique is completed by creating a tension band fixation with additional suture tapes.Expected outcomesThis technique offers several benefits, including reduced operative time, minimized soft-tissue dissection, and lower risk of implant prominence and irritation. The suture tape's superior tensile strength and low tissue reactivity reduce complications and the need for secondary surgeries. Early results from two cases show union achieved at 3 months without complications, with patients regaining full range of motion.ConclusionThis preliminary technical paper demonstrates the feasibility of using non-metallic implants for patella fracture fixation. The proposed method shows promising results, suggesting a potential shift in the approach to fracture fixation. Further research and larger cohort studies are needed to validate these findings.","PeriodicalId":12564,"journal":{"name":"Frontiers in Surgery","volume":"282 1","pages":""},"PeriodicalIF":1.8,"publicationDate":"2024-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142213902","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-29DOI: 10.3389/fsurg.2024.1405487
Bedrettin Akar, Fatih Ugur, Mucahid Osman Yucel, Ferhan Aytug
ObjectiveThis retrospective study investigated the risk factors leading to a decrease in Renal glomerular filtration rate (eGFR) and the development of acute kidney injury (AKI) during the early postoperative period in patients undergoing simultaneous bilateral total knee arthroplasty (SBTKA).MethodsSBTKA was performed on 862 patients between 2014 and 2021 in a single center, by a single surgeon. The risk factors affecting the development of AKI were analyzed by monitoring the changes in pre-and postoperative serum creatinine (Scr) levels and eGFR values. RIFLE criteria were used to evaluate the kidney functions of the patients, who were followed up for an average of 6 months.ResultsWhile there was no decrease in eGFR or AKI in 818 patients postoperatively, eGFR decreased and AKI of different stages developed in 44 patients, according to the RIFLE criteria. Of the 44 patients with AKI, 31 had Risk, 9 had Injury, 3 had Failure, and one had Loss of kidney function. Two patients with American Society of Anaesthesiologists (ASA) class IV died due to deepening of postoperative renal dysfunction.ConclusionWe found that the direct risk factors in SBTKA in terms of eGFR decrease and AKI development include long operation time, increased need for blood transfusion, and diabetic nephropathy, while increased body mass index (BMI) is an indirect risk factor. When planning for a SBTKA, we presume that a thorough analysis of these factors will decrease AKI risk.
目的 这项回顾性研究调查了导致肾小球滤过率（eGFR）下降和术后早期急性肾损伤（AKI）发生的风险因素，这些风险因素发生在接受同期双侧全膝关节置换术（SBTKA）的患者身上。通过监测术前和术后血清肌酐（Scr）水平和 eGFR 值的变化，分析了影响 AKI 发生的风险因素。结果根据 RIFLE 标准，818 例患者术后 eGFR 和 AKI 均未下降，但有 44 例患者 eGFR 下降，并出现不同程度的 AKI。在这 44 例发生 AKI 的患者中，31 例为风险期，9 例为损伤期，3 例为衰竭期，1 例为肾功能丧失期。结论我们发现，在 SBTKA 中，eGFR 下降和 AKI 发生的直接风险因素包括手术时间长、输血需求增加和糖尿病肾病，而体重指数（BMI）增加则是间接风险因素。在计划进行 SBTKA 时，我们认为对这些因素进行全面分析将降低 AKI 风险。
{"title":"Effect of potential risk factors on renal functions in simultaneous bilateral total knee arthroplasty","authors":"Bedrettin Akar, Fatih Ugur, Mucahid Osman Yucel, Ferhan Aytug","doi":"10.3389/fsurg.2024.1405487","DOIUrl":"https://doi.org/10.3389/fsurg.2024.1405487","url":null,"abstract":"ObjectiveThis retrospective study investigated the risk factors leading to a decrease in Renal glomerular filtration rate (eGFR) and the development of acute kidney injury (AKI) during the early postoperative period in patients undergoing simultaneous bilateral total knee arthroplasty (SBTKA).MethodsSBTKA was performed on 862 patients between 2014 and 2021 in a single center, by a single surgeon. The risk factors affecting the development of AKI were analyzed by monitoring the changes in pre-and postoperative serum creatinine (Scr) levels and eGFR values. RIFLE criteria were used to evaluate the kidney functions of the patients, who were followed up for an average of 6 months.ResultsWhile there was no decrease in eGFR or AKI in 818 patients postoperatively, eGFR decreased and AKI of different stages developed in 44 patients, according to the RIFLE criteria. Of the 44 patients with AKI, 31 had Risk, 9 had Injury, 3 had Failure, and one had Loss of kidney function. Two patients with American Society of Anaesthesiologists (ASA) class IV died due to deepening of postoperative renal dysfunction.ConclusionWe found that the direct risk factors in SBTKA in terms of eGFR decrease and AKI development include long operation time, increased need for blood transfusion, and diabetic nephropathy, while increased body mass index (BMI) is an indirect risk factor. When planning for a SBTKA, we presume that a thorough analysis of these factors will decrease AKI risk.","PeriodicalId":12564,"journal":{"name":"Frontiers in Surgery","volume":"24 1","pages":""},"PeriodicalIF":1.8,"publicationDate":"2024-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142213904","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-29DOI: 10.3389/fsurg.2024.1437290
Shengchun Wang, Lingjie Tan, Bin Sheng
ObjectiveNondisplaced femoral neck fractures constitute a substantial portion of these injuries. The optimal treatment strategy between internal fixation (IF) and hemiarthroplasty (HA) remains debated, particularly concerning cost-effectiveness.MethodsWe conducted a cost-effectiveness analysis using a Markov decision model to compare HA and IF in treating nondisplaced femoral neck fractures in elderly patients in China. The analysis was performed from a payer perspective with a 5-year time horizon. Costs were measured in 2020 USD, and effectiveness was measured in quality-adjusted life-years (QALYs). Sensitivity analyses, including one-way and probabilistic analyses, were conducted to assess the robustness of the results. The willingness-to-pay threshold for incremental cost-effectiveness ratio (ICER) was set at $11,083/QALY following the Chinese gross domestic product in 2020.ResultsHA demonstrated higher cumulative QALYs (2.94) compared to IF (2.75) but at a higher total cost ($13,324 vs. $12,167), resulting in an ICER of $6,128.52/QALY. The one-way sensitivity analysis identified the costs of HA and IF as the most influential factors. Probabilistic sensitivity analysis indicated that HA was more effective in 69.3% of simulations, with an ICER below the willingness-to-pay threshold of $11,083 in 58.8% of simulations.ConclusionsHA is a cost-effective alternative to IF for treating nondisplaced femoral neck fractures in elderly patients in mainland China.
目的股骨颈无移位骨折在股骨颈损伤中占很大比例。我们使用马尔可夫决策模型进行了一项成本效益分析，比较了 HA 和 IF 在治疗中国老年股骨颈非脱位骨折中的疗效。分析从支付方的角度进行，时间跨度为 5 年。成本以 2020 美元计算，疗效以质量调整生命年（QALYs）计算。为评估结果的稳健性，进行了包括单向分析和概率分析在内的敏感性分析。结果显示，与 IF（2.75）相比，HA 的累积 QALYs（2.94）更高，但总成本更高（13,324 美元对 12,167 美元），因此 ICER 为 6,128.52 美元/QALY。单向敏感性分析表明，HA 和 IF 的成本是影响最大的因素。概率敏感性分析表明，在69.3%的模拟中，HA更有效，在58.8%的模拟中，ICER低于11,083美元的支付意愿阈值。
{"title":"Hemiarthroplasty vs. internal fixation for nondisplaced femoral neck fracture in mainland China: a cost-effectiveness analysis","authors":"Shengchun Wang, Lingjie Tan, Bin Sheng","doi":"10.3389/fsurg.2024.1437290","DOIUrl":"https://doi.org/10.3389/fsurg.2024.1437290","url":null,"abstract":"ObjectiveNondisplaced femoral neck fractures constitute a substantial portion of these injuries. The optimal treatment strategy between internal fixation (IF) and hemiarthroplasty (HA) remains debated, particularly concerning cost-effectiveness.MethodsWe conducted a cost-effectiveness analysis using a Markov decision model to compare HA and IF in treating nondisplaced femoral neck fractures in elderly patients in China. The analysis was performed from a payer perspective with a 5-year time horizon. Costs were measured in 2020 USD, and effectiveness was measured in quality-adjusted life-years (QALYs). Sensitivity analyses, including one-way and probabilistic analyses, were conducted to assess the robustness of the results. The willingness-to-pay threshold for incremental cost-effectiveness ratio (ICER) was set at $11,083/QALY following the Chinese gross domestic product in 2020.ResultsHA demonstrated higher cumulative QALYs (2.94) compared to IF (2.75) but at a higher total cost ($13,324 vs. $12,167), resulting in an ICER of $6,128.52/QALY. The one-way sensitivity analysis identified the costs of HA and IF as the most influential factors. Probabilistic sensitivity analysis indicated that HA was more effective in 69.3% of simulations, with an ICER below the willingness-to-pay threshold of $11,083 in 58.8% of simulations.ConclusionsHA is a cost-effective alternative to IF for treating nondisplaced femoral neck fractures in elderly patients in mainland China.","PeriodicalId":12564,"journal":{"name":"Frontiers in Surgery","volume":"6 1","pages":""},"PeriodicalIF":1.8,"publicationDate":"2024-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142213903","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-29DOI: 10.3389/fsurg.2024.1443231
Jucai Li, Yanli Song, Lumei Wu, Dan Su, Lin-Feng Wang
BackgroundUnilateral biportal endoscopic discectomy (UBED) is a widely accepted minimally invasive surgery for the treatment of lumbar degenerative diseases. However, some patients continue to have persistent low back pain (LBP) symptoms in the short and long term after surgery, which may be related to improper postoperative nursing and rehabilitation of patients. Further research is needed to determine whether continuous nursing can improve the symptoms of patients after UBED.MethodsThis study retrospectively enrolled 282 lumbar disc herniation (LDH) patients who underwent UBED in our hospital from January 2019 to January 2022. The patients were divided into two groups according to whether they accepted the continuous nursing program: 147 patients in the traditional nursing group and 135 patients in the continuous nursing group. Demographic characteristics, radiological parameters, and follow-up data of the patients were collected. Finally, the risk factors of LBP after UBED were analyzed.ResultsThe visual analog scale (VAS) score of LBP in the continuous nursing group was 0.97 ± 1.159 at 3 months and 0.61 ± 0.954 at 12 months after operation, and VAS of leg pain was 0.23 ± 0.421 at 12 months after operation, which were better than those in the traditional nursing group (1.51 ± 1.313, 1.10 ± 1.076, 0.68 ± 0.788, respectively, <jats:italic>p</jats:italic> < 0.001) The Oswestry disability index (ODI) score of the continuous nursing group was lower than that of the traditional nursing group at 12 months after operation (7.36 ± 6.526 vs. 12.43 ± 6.942, <jats:italic>p</jats:italic> < 0.001). The rehabilitation completion (7.98 ± 1.857), efficacy satisfaction (9.13 ± 1.101), and re-herniation worry scores (1.97 ± 1.217) in the continuous nursing group were better than those in the traditional nursing group (4.14 ± 3.066, 8.28 ± 1.240, 2.79 ± 1.973, respectively, <jats:italic>P</jats:italic> < 0.001). The re-herniation rate within 1 year was similar between the two groups (3/135 vs. 2/147, <jats:italic>p</jats:italic> = 0.673). No incision infection occurred. Multivariate regression analysis showed that risk factors for persistent LBP at 3-month follow-up were degenerative disc [odds ratio (OR): 2.144, CI: 1.306–3.519, <jats:italic>p</jats:italic> = 0.03], Pfirrmann grade (OR: 3.073, CI: 1.427–6.614, <jats:italic>p</jats:italic> = 0.04), and surgical time (OR: 0.969, CI: 0.937–1.003, <jats:italic>p</jats:italic> = 0.74). At the 12-month follow-up, the risk factors for persistent LBP were preoperative VAS of the legs (OR: 1.261, CI: 1.000–1.591, <jats:italic>p</jats:italic> = 0.05) and Pfirrmann grade (OR: 3.309, CI: 1.460–7.496, <jats:italic>p</jats:italic> = 0.04).ConclusionContinuous nursing programs can improve the symptoms of short-term and long-term persistent LBP in patients after UBED, enhance the completion of rehabilitation training after UBED, alleviate patients' concerns about recurrence, and improve patients' satisfacti
{"title":"Effects of a new continuous nursing program on the short-term and long-term low back pain in patients after UBED: a retrospective study based on 282 patients","authors":"Jucai Li, Yanli Song, Lumei Wu, Dan Su, Lin-Feng Wang","doi":"10.3389/fsurg.2024.1443231","DOIUrl":"https://doi.org/10.3389/fsurg.2024.1443231","url":null,"abstract":"BackgroundUnilateral biportal endoscopic discectomy (UBED) is a widely accepted minimally invasive surgery for the treatment of lumbar degenerative diseases. However, some patients continue to have persistent low back pain (LBP) symptoms in the short and long term after surgery, which may be related to improper postoperative nursing and rehabilitation of patients. Further research is needed to determine whether continuous nursing can improve the symptoms of patients after UBED.MethodsThis study retrospectively enrolled 282 lumbar disc herniation (LDH) patients who underwent UBED in our hospital from January 2019 to January 2022. The patients were divided into two groups according to whether they accepted the continuous nursing program: 147 patients in the traditional nursing group and 135 patients in the continuous nursing group. Demographic characteristics, radiological parameters, and follow-up data of the patients were collected. Finally, the risk factors of LBP after UBED were analyzed.ResultsThe visual analog scale (VAS) score of LBP in the continuous nursing group was 0.97 ± 1.159 at 3 months and 0.61 ± 0.954 at 12 months after operation, and VAS of leg pain was 0.23 ± 0.421 at 12 months after operation, which were better than those in the traditional nursing group (1.51 ± 1.313, 1.10 ± 1.076, 0.68 ± 0.788, respectively, <jats:italic>p</jats:italic> &lt; 0.001) The Oswestry disability index (ODI) score of the continuous nursing group was lower than that of the traditional nursing group at 12 months after operation (7.36 ± 6.526 vs. 12.43 ± 6.942, <jats:italic>p</jats:italic> &lt; 0.001). The rehabilitation completion (7.98 ± 1.857), efficacy satisfaction (9.13 ± 1.101), and re-herniation worry scores (1.97 ± 1.217) in the continuous nursing group were better than those in the traditional nursing group (4.14 ± 3.066, 8.28 ± 1.240, 2.79 ± 1.973, respectively, <jats:italic>P</jats:italic> &lt; 0.001). The re-herniation rate within 1 year was similar between the two groups (3/135 vs. 2/147, <jats:italic>p</jats:italic> = 0.673). No incision infection occurred. Multivariate regression analysis showed that risk factors for persistent LBP at 3-month follow-up were degenerative disc [odds ratio (OR): 2.144, CI: 1.306–3.519, <jats:italic>p</jats:italic> = 0.03], Pfirrmann grade (OR: 3.073, CI: 1.427–6.614, <jats:italic>p</jats:italic> = 0.04), and surgical time (OR: 0.969, CI: 0.937–1.003, <jats:italic>p</jats:italic> = 0.74). At the 12-month follow-up, the risk factors for persistent LBP were preoperative VAS of the legs (OR: 1.261, CI: 1.000–1.591, <jats:italic>p</jats:italic> = 0.05) and Pfirrmann grade (OR: 3.309, CI: 1.460–7.496, <jats:italic>p</jats:italic> = 0.04).ConclusionContinuous nursing programs can improve the symptoms of short-term and long-term persistent LBP in patients after UBED, enhance the completion of rehabilitation training after UBED, alleviate patients' concerns about recurrence, and improve patients' satisfacti","PeriodicalId":12564,"journal":{"name":"Frontiers in Surgery","volume":"123 1","pages":""},"PeriodicalIF":1.8,"publicationDate":"2024-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142213860","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
ObjectiveThe purpose of this study was to evaluate the effect of residual varus/valgus deformity on the mechanical characteristics of the meniscus and cartilage after tibial shaft fracture.MethodsA finite element model of the lower extremity of a healthy volunteer was constructed from CT and MRI images. The upper and middle tibial fracture models were modified to produce 3°, 5°, and 10° tibial varus/valgus models. For model validation, a patient-specific model with a 10° tibial varus deformity was constructed and simulated under the same boundary conditions.ResultsThe contact area and maximum stress of the normal and modified deformity models were similar to those of the reported studies and a patient-specific model. The maximum stress, contact area, and contact force of the medial tibial cartilage in a normal neutral position were 0.64 MPa, 247.52 mm2, and 221.77 N, respectively, while those of the lateral tibial cartilage were 0.76 MPa, 196.25 mm2, and 146.12 N, respectively. From 10° of valgus to 10° of varus, the contact force, contact area, and maximum stress values of the medial tibial cartilage increased, and those of the lateral tibial cartilage gradually decreased. The maximum stress, contact area, and contact force of the medial tibial cartilage in the normal neutral position were 3.24 MPa, 110.91 mm2, and 62.84 N, respectively, while those of the lateral tibial cartilage were 3.45 MPa, 135.83 mm2, and 67.62 N, respectively. The maximum stress of the medial tibial subchondral bone in a normal neutral position was 1.47 MPa, while that of the lateral was 0.65 MPa. The variation trend of the medial/lateral meniscus and subchondral bone was consistent with that of the tibial plateau cartilage in terms of maximum stress, contact area, and contact force.ConclusionThe residual varus/valgus deformity of the tibia has a significant impact on the mechanical loads exerted on the knee joint. This study provides a mechanical basis and references for the clinical evaluation of tibial fracture reduction and osteotomy for tibial deformity.
{"title":"Frontiers | Residual coronary malformation after tibial shaft fracture alters contact status of meniscus and cartilage on knee joint: A computational study","authors":"Kai Ding, Dacheng Sun, Zhang Yifan, Chuan Ren, Xiaodong Cheng, Haicheng Wang, Yanbin Zhu, Xin Xing, Wei Chen","doi":"10.3389/fsurg.2024.1325085","DOIUrl":"https://doi.org/10.3389/fsurg.2024.1325085","url":null,"abstract":"ObjectiveThe purpose of this study was to evaluate the effect of residual varus/valgus deformity on the mechanical characteristics of the meniscus and cartilage after tibial shaft fracture.MethodsA finite element model of the lower extremity of a healthy volunteer was constructed from CT and MRI images. The upper and middle tibial fracture models were modified to produce 3°, 5°, and 10° tibial varus/valgus models. For model validation, a patient-specific model with a 10° tibial varus deformity was constructed and simulated under the same boundary conditions.ResultsThe contact area and maximum stress of the normal and modified deformity models were similar to those of the reported studies and a patient-specific model. The maximum stress, contact area, and contact force of the medial tibial cartilage in a normal neutral position were 0.64 MPa, 247.52 mm2, and 221.77 N, respectively, while those of the lateral tibial cartilage were 0.76 MPa, 196.25 mm2, and 146.12 N, respectively. From 10° of valgus to 10° of varus, the contact force, contact area, and maximum stress values of the medial tibial cartilage increased, and those of the lateral tibial cartilage gradually decreased. The maximum stress, contact area, and contact force of the medial tibial cartilage in the normal neutral position were 3.24 MPa, 110.91 mm2, and 62.84 N, respectively, while those of the lateral tibial cartilage were 3.45 MPa, 135.83 mm2, and 67.62 N, respectively. The maximum stress of the medial tibial subchondral bone in a normal neutral position was 1.47 MPa, while that of the lateral was 0.65 MPa. The variation trend of the medial/lateral meniscus and subchondral bone was consistent with that of the tibial plateau cartilage in terms of maximum stress, contact area, and contact force.ConclusionThe residual varus/valgus deformity of the tibia has a significant impact on the mechanical loads exerted on the knee joint. This study provides a mechanical basis and references for the clinical evaluation of tibial fracture reduction and osteotomy for tibial deformity.","PeriodicalId":12564,"journal":{"name":"Frontiers in Surgery","volume":"38 1","pages":""},"PeriodicalIF":1.8,"publicationDate":"2024-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142213909","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-28DOI: 10.3389/fsurg.2024.1372310
Mengyu Wang, Liangyuan Wen, Ze Zhang, Fengpo Sun, Yi Zhu, Ruining Han, Zijie Pei, Zhaoshuo He, Junzhi Liu
BackgroundPauwels type III femoral neck fractures, as a serious type of femoral neck fractures, have brought about a heavy economic burden on families and society for the high disability rate. Through bibliometric research and visualized analysis, this study aimed at elucidating the global research status of Pauwels type III femoral neck fractures to date, and predicting the future research trends in this field.MethodsPublications and associated information on Pauwels type III femoral neck fractures to date were retrieved from Web of Science Core Collection, and by VoSviewer and R package “bibliometrix”, bibliometric analysis and visual presentation was conducted.ResultsBy retrieval, a total of 98 studies were refinedly extracted, and the volume of publications in this field increased year-over-year. China ranked first in terms of total publication volume and H-Index, with its total citation records second only to the United States. The country with the highest average citation frequency was Switzerland. SHANGHAI JIAO TONG UNIVERSITY was the most productive research institution. Among the authors in this field, Li, Jiantao had published the most researches. INJURY INTERNATIONAL JOURNAL OF THE CARE OF THE INJURED and JOURNAL OF ORTHOPAEDIC TRAUMA were the two magazines with the highest publication volume, total citation records, and H-index. According to keywords co-occurrence analysis, the research content in the past 24 years is mainly divided into four different dimensions. Finite element analysis, femoral neck system, medial buttress plate, cannulated screws, hip screw, open reduction, complications are hot topics for future research.ConclusionsAccording to the global trends analysis of publications production, Pauwels type III femoral neck fractures are receiving increasing attention and input from scholars. China has made the greatest scientific research contribution among countries, but its academic quality should be improved further. The modified therapeutic methods designed for addressing the complications of traditional internal fixation for Pauwels III femoral neck fractures will be the future research hotspot.
背景Pauwels III型股骨颈骨折是股骨颈骨折的一种严重类型，因其致残率高，给家庭和社会带来了沉重的经济负担。本研究旨在通过文献计量学研究和可视化分析，阐明迄今为止全球对Pauwels III型股骨颈骨折的研究现状，并预测该领域未来的研究趋势。方法从Web of Science Core Collection中检索迄今为止有关Pauwels III型股骨颈骨折的文献及相关信息，并通过VoSviewer和R软件包 "bibliometrix "进行文献计量分析和可视化展示。中国的出版物总量和 H 指数均居首位，总被引频次仅次于美国。平均被引频次最高的国家是瑞士。上海交通大学是成果最多的研究机构。在该领域的作者中，李剑涛发表的研究成果最多。国际伤科杂志》（INJURY INTERNATIONAL JOURNAL OF THE CARE OF THE INJURED）和《创伤骨科杂志》（JOURNAL OF ORTHOPAEDIC TRAUMA）是发表量、总被引频次和 H 指数最高的两本杂志。根据关键词共现分析，过去 24 年的研究内容主要分为四个不同的维度。有限元分析、股骨颈系统、内侧支撑钢板、套管螺钉、髋螺钉、切开复位、并发症是未来研究的热点。中国是科研贡献最大的国家，但学术质量有待进一步提高。针对传统内固定治疗 Pauwels III 型股骨颈骨折并发症的改良治疗方法将是未来的研究热点。
{"title":"Frontiers | Global trends of Pauwels type III femoral neck fractures: bibliometric analysis and visualized study","authors":"Mengyu Wang, Liangyuan Wen, Ze Zhang, Fengpo Sun, Yi Zhu, Ruining Han, Zijie Pei, Zhaoshuo He, Junzhi Liu","doi":"10.3389/fsurg.2024.1372310","DOIUrl":"https://doi.org/10.3389/fsurg.2024.1372310","url":null,"abstract":"BackgroundPauwels type III femoral neck fractures, as a serious type of femoral neck fractures, have brought about a heavy economic burden on families and society for the high disability rate. Through bibliometric research and visualized analysis, this study aimed at elucidating the global research status of Pauwels type III femoral neck fractures to date, and predicting the future research trends in this field.MethodsPublications and associated information on Pauwels type III femoral neck fractures to date were retrieved from Web of Science Core Collection, and by VoSviewer and R package “bibliometrix”, bibliometric analysis and visual presentation was conducted.ResultsBy retrieval, a total of 98 studies were refinedly extracted, and the volume of publications in this field increased year-over-year. China ranked first in terms of total publication volume and H-Index, with its total citation records second only to the United States. The country with the highest average citation frequency was Switzerland. SHANGHAI JIAO TONG UNIVERSITY was the most productive research institution. Among the authors in this field, Li, Jiantao had published the most researches. INJURY INTERNATIONAL JOURNAL OF THE CARE OF THE INJURED and JOURNAL OF ORTHOPAEDIC TRAUMA were the two magazines with the highest publication volume, total citation records, and H-index. According to keywords co-occurrence analysis, the research content in the past 24 years is mainly divided into four different dimensions. Finite element analysis, femoral neck system, medial buttress plate, cannulated screws, hip screw, open reduction, complications are hot topics for future research.ConclusionsAccording to the global trends analysis of publications production, Pauwels type III femoral neck fractures are receiving increasing attention and input from scholars. China has made the greatest scientific research contribution among countries, but its academic quality should be improved further. The modified therapeutic methods designed for addressing the complications of traditional internal fixation for Pauwels III femoral neck fractures will be the future research hotspot.","PeriodicalId":12564,"journal":{"name":"Frontiers in Surgery","volume":"44 1","pages":""},"PeriodicalIF":1.8,"publicationDate":"2024-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142258245","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-28DOI: 10.3389/fsurg.2024.1416801
Dong-Lin He, Runlin Feng, Jiagui Chai, Xin Guo, Chang-Xing Ke
BackgroundAn adrenal collision tumor (ACT) denotes the presence of distinct tumors with diverse behavioral, genetic, and histological features independently co-existing within the adrenal tissue without intermingling, and occurrences of such cases are infrequent. The concurrent occurrence of adrenal schwannoma and adrenal ganglioneuroma is exceedingly rare, and the diagnosis of these ACTs has been notably challenging due to their atypical clinical manifestations and imaging characteristics.Case summaryA 37-year-old man presented to the hospital 3 weeks after a computed tomography (CT) examination that revealed a left adrenal mass. Physical examination findings were unremarkable. Both CT and magnetic resonance imaging scans indicated the presence of a left adrenal mass. Plasma cortisol, adrenocorticotropic hormone, and renin–angiotensin–aldosterone system tests yielded normal results. Preoperative imaging confirmed the diagnosis of left adrenal pheochromocytoma. After thorough surgical preparation, a laparoscopic partial left adrenalectomy was performed. Subsequent postoperative pathological analysis identified adrenal schwannoma in conjunction with adrenal ganglioneuroma. The patient recovered well and was discharged on postoperative day 4. A routine urology clinic visit was included in his postoperative care plan. During follow-up assessments, CT scans of the left adrenal gland revealed no abnormalities.ConclusionAdrenal schwannoma combined with ganglioneuroma represents an exceptionally rare collision tumor characterized by the absence of typical clinical or imaging features, leading to potential misdiagnosis. Adrenal incidentalomas present as multifaceted conditions, and this case serves to heighten awareness of their intricate nature. Due to the challenges in preoperative differentiation of various adrenal mass types, postoperative pathological analysis is imperative for guiding the subsequent treatment course for the patient.
{"title":"Frontiers | Case report: Adrenal schwannoma associated with ganglioneuroma","authors":"Dong-Lin He, Runlin Feng, Jiagui Chai, Xin Guo, Chang-Xing Ke","doi":"10.3389/fsurg.2024.1416801","DOIUrl":"https://doi.org/10.3389/fsurg.2024.1416801","url":null,"abstract":"BackgroundAn adrenal collision tumor (ACT) denotes the presence of distinct tumors with diverse behavioral, genetic, and histological features independently co-existing within the adrenal tissue without intermingling, and occurrences of such cases are infrequent. The concurrent occurrence of adrenal schwannoma and adrenal ganglioneuroma is exceedingly rare, and the diagnosis of these ACTs has been notably challenging due to their atypical clinical manifestations and imaging characteristics.Case summaryA 37-year-old man presented to the hospital 3 weeks after a computed tomography (CT) examination that revealed a left adrenal mass. Physical examination findings were unremarkable. Both CT and magnetic resonance imaging scans indicated the presence of a left adrenal mass. Plasma cortisol, adrenocorticotropic hormone, and renin–angiotensin–aldosterone system tests yielded normal results. Preoperative imaging confirmed the diagnosis of left adrenal pheochromocytoma. After thorough surgical preparation, a laparoscopic partial left adrenalectomy was performed. Subsequent postoperative pathological analysis identified adrenal schwannoma in conjunction with adrenal ganglioneuroma. The patient recovered well and was discharged on postoperative day 4. A routine urology clinic visit was included in his postoperative care plan. During follow-up assessments, CT scans of the left adrenal gland revealed no abnormalities.ConclusionAdrenal schwannoma combined with ganglioneuroma represents an exceptionally rare collision tumor characterized by the absence of typical clinical or imaging features, leading to potential misdiagnosis. Adrenal incidentalomas present as multifaceted conditions, and this case serves to heighten awareness of their intricate nature. Due to the challenges in preoperative differentiation of various adrenal mass types, postoperative pathological analysis is imperative for guiding the subsequent treatment course for the patient.","PeriodicalId":12564,"journal":{"name":"Frontiers in Surgery","volume":"18 1","pages":""},"PeriodicalIF":1.8,"publicationDate":"2024-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142257969","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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