Frontiers in Surgery最新文献

Introduction: Digital tomosynthesis (DTS) has broad non-orthopaedic applications and has seen limited use within orthopaedics for imaging of the wrist. The utility of DTS for assessing reduction and hardware placement following operative treatment of pelvic ring injuries and acetabular fractures has not previously been investigated.

Methods: All operatively treated acetabular fractures and pelvic ring injuries that underwent surgical fixation within a one-year time span received both a computed tomography (CT) scan and a DTS scan as part of their routine postoperative imaging workup. Three orthopaedic traumatologists independently reviewed the images for face-value clinical utility. Radimetrics and PCXMC software were utilized on a subset of the study population's DTS and CT studies to calculate the effective and organ radiation doses delivered.

Results: 52 patients (22 acetabular fractures, 22 pelvic ring injuries, 7 pelvic ring and acetabular fractures, 2 femoral head & acetabular fractures) were included. DTS was considered adequate to assess reduction 83% of the time, hardware position 83% of the time, and sufficient to replace the CT scan 67% of the time. DTS was associated with an 8.3 times lower effective radiation dose than CT. All organ doses were lower for DTS than CT.

Discussion: DTS appears to have face-value clinical utility for assessing reduction and hardware position following surgical treatment of acetabular fractures and pelvic ring injuries. Given that DTS is associated with significantly lower radiation doses to patients, further study utilizing more objective criteria is warranted.

Background: Chronic subdural hematoma (CSDH) is a common disease in neurosurgery. Although many studies have investigated the factors affecting the recurrence of CSDH, no comprehensive prediction model has been established for the risk effect of postoperative recurrence of the disease.

Objective: This study aims to collect and analyze the data of CSDH patients treated in our hospital to determine the influence of preoperative, postoperative and treatment factors on the recurrence of CSDH, and to establish a corresponding prediction model to provide neurosurgeons with more accurate basis for identifying high-risk patients and guiding treatment.

Methods: A total of 431 patients were collected in this study, including 323 patients who underwent traditional hematoma removal and 108 patients who underwent endoscopic hematoma removal. Relevant preoperative and postoperative data and medical history of patients were collected respectively to study the relevant factors affecting postoperative hematoma recurrence of patients, and to establish a prediction model.

Results: A total of 431 patients were enrolled in this study, 71 of whom had subdural blood recurrence. Possible relevant factors were included in univariate logistic regression, and the results showed that the preoperative GCS score, postoperative residual gas, preoperative CT hematoma thickness, coagulation function, unilateral and bilateral surgery, whether statin was taken after surgery, hematoma site, hematoma density and hematoma volume were all P < 0.2. It is a risk factor for recurrence of chronic subdural hematoma. The obtained data were further included in a multi-factor review. Six factors, including preoperative GCS score, postoperative gas residual, abnormal coagulation function, high-density hematoma, large hematoma volume, and irregular statin use after surgery, were independent risk factors for chronic subdural hematoma recurrence (P < 0.05).

Conclusion: This study confirmed that six factors, including preoperative GCS score, postoperative gas residual, abnormal coagulation function, high-density hematoma, large hematoma volume, and irregular statin use, were independent risk factors for recurrence of chronic subdural hematoma. At the same time, long-term use of statins can reduce the recurrence rate of hematoma to a certain extent. In addition, the predictive model in this study could help neurosurgeons accurately identify high-risk CSDH patients.

Ochrobactrum intermedium (O. intermedium) is a gram-negative, non-fermenting bacterium closely related to Brucella genus. O. intermedium resembles an emergent human pathogen that has rarely been detected in both immunocompetent and immunodeficient patients. A musculoskeletal infection with O. intermedium has not been described in the literature. We present the first case of an osteosynthesis-associated infection (OAI) with O. intermedium in an 80-year-old female patient after osteosynthesis of an acetabular fracture. The patient was admitted to the emergency department 6 months after osteosynthesis of a posterior column acetabular fracture treated via open reduction and internal plate fixation of the posterior column. The patient demonstrated tenderness, redness and swelling at the insertion site as well as a fistula. The radiological controls showed femoral head necrosis and partial protrusion of the head into the pelvis. The laboratory parameters showed no pathological findings. OAI was assumed and a two-stage revision with implant removal and resection arthroplasty in the first stage and hip arthroplasty in the second stage was performed. All microbiological specimens taken at the osteosynthesis site and the hip joint grew O. intermedium. The pathogen was determined using the matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF) method. Antibiotic regime consisted of intravenous (IV) meropenem for two weeks followed by oral ciprofloxacin and cotrimoxazole. Implantation of the hip prosthesis was performed 6 weeks after the index surgery using a cementless revision cup and a cemented stem. Meropenem and vancomycin IV were given for one week followed by ciprofloxacin and doxycycline for another 5 weeks. 24 months after the surgery, the patient is infection free and satisfied with the result. With this case report we would like to increase awareness of possible implant-associated bacterial infections caused by O. intermedium.

Percutaneous vertebroplasty (PVP), a minimally invasive surgery technique, has become the common treatment for osteoporotic vertebral compression fractures (OVCF). The complications of PVP will lead to severe damage to spinal neuro systems due to bone cement leakage. A patient tailored preoperative assessment approach was developed to reduce the risks of complications in this study. The porcine OVCF model was fabricated to mimic the patient vertebral fracture in vitro using decalcification process. The 3D reconstructed model based on the imagological examination data acquired from the porcine vertebral bone was implemented for finite element (FE) simulation. The vertebral body with bone cement injected was scanned using CT for comparison with the finite element simulation results. This study showed a practical method for predicting the flow of bone cement in OVCF, which enabled the surgeons to evaluate the bone cement flow during preoperative assessment to reduce the cement leakage risks.

Background: Large soft tissue defects of the lower limb and foot are common occurrence in clinical practice and a considerable number of flaps have been used to treat them. However, there have been few reports using the superficial inferior epigastric artery (SIEA) flap. This review aims to present the experience of using the SIEA flaps for the repair of large soft tissue defects of the lower limb and foot.

Methods: A retrospective review of data from 11 patients who underwent coverage of lower limb and foot defects exceeding 120 cm² (15 × 9 cm) using SIEA flaps from March 2018 to July 2022 were retrospectively reviewed. The average size of the defects was 18 × 11 cm² (range 15 × 9 cm²-32 × 16 cm²). Flap survival rates, surgical complications and overall long-term outcomes were recorded.

Results: All 11 flaps survived. One flap was partially necrotic at the edge and healed after several changes of dressing. Additionally, one flap presented with mild venous congestion. The mean follow-up period was 18 months (ranging from 12 to 30 months). The mean size of the flaps was 20 × 12 cm² (range 17 × 9 cm²-34 × 18 cm²). The flaps were observed to be aesthetically pleasing and exhibited a well-defined texture. The donor wounds were successfully closed primarily, with only linear scarring remaining.

Conclusions: The SIEA flap is characterised by concealed donor area, superficial vascular location, easy access and primary closure, which results in favourable aesthetic outcomes. It is an appropriate choice for the repair of large soft tissue defects of the lower limb and foot.

Background: In blunt chest trauma, patient management is challenging because clinical guidelines miss tools for risk assessment. No clinical scale reliably measures the severity of cases and the chance of complications.

Aim: The objective of the study was to optimize the management of patients with blunt chest trauma by creating models prognosticating the transfer to the intensive care unit and in-hospital length of stay (LOS).

Methods: The study cohort consisted of 212 cases. We retrieved information on the cases from the hospital's trauma registry. After segmenting the lungs with Lung CT Analyzer, we performed volumetric feature extraction with data-characterization algorithms in PyRadiomics.

Results: To predict whether the patient will require intensive care, we used the three groups of findings: ambulance, admission, and radiomics data. When trained on the ambulance data, the models exhibited a borderline performance. The metrics improved after we retrained the models on a combination of ambulance, laboratory, radiologic, and physical examination data (81.5% vs. 94.4% Sn). Radiomics data were the top-accurate predictors (96.3% Sn). Age, vital signs, anthropometrics, and first aid time were the best-performing features collected by the ambulance service. Laboratory findings, AIS scores for the lower extremity, abdomen, head, and thorax constituted the top-rank predictors received on admission to the hospital. The original first-order kurtosis had the highest predictive value among radiomics data. Top-informative radiomics features were derived from the right hemithorax because the right lung is larger. We constructed regression models that can adequately reflect the in-hospital LOS. When trained on different groups of data, the machine-learning regression models showed similar performance (MAE/ROV $\approx$ 8%). Anatomic scores for the body parts other than thorax and laboratory markers of hemorrhage had the highest predictive value. Hence, the number of injured body parts correlated with the case severity.

Conclusion: The study findings can be used to optimize the management of patients with a chest blunt injury as a specific case of monotrauma. The models we built may help physicians to stratify patients by risk of worsening and overcome the limitations of existing tools for risk assessment. High-quality AI models trained on radiomics data demonstrate superior performance.

Background: In many diseases, sex differences in diagnostics and therapy play role that is increasingly becoming recognized as important. C-reactive protein (CRP) and white blood cell (WBC) levels are determined as inflammatory markers to detect inflammation and even infection after total shoulder arthroplasty (TSA). The general course of white blood cell, CRP, and hemoglobin (Hb) levels after TSA is well known, but there is insufficient evidence of a possible association with sex. Therefore, we aimed to investigate whether there is an influence of sex on CRP, WBCs, and Hb after TSA in the first 10 days after surgery in a complication-free course in male and female patients and to re-evaluate the specific postoperative CRP, WBC, and Hb course with their maximums (minimum for Hb) and further course until the end of the inpatient period.

Methods: We retrospectively studied patients treated with TSA, reverse shoulder arthroplasty (RSA), and prosthesis replacement between 2015 and 2021. Patients with active inflammation, rheumatoid arthritis, secondary osteoarthritis, active cancer, and documented postoperative complications were not included. CRP, WBC, and Hb levels before shoulder arthroplasty (SA) and up to 10 days after SA were recorded and analyzed for sex differences.

Results: Data from a total of 316 patients (209 women and 107 men) were finally analyzed. There were no sex differences in the CRP and WBC values, but women had significantly lower preoperative Hb values, postoperative Hb values, and minimum Hb values. There were no significant differences in Hb, CRP, or WBC levels in the prosthesis exchange group.

Conclusion: The progression of CRP and WBC levels showed no sex-specific significant differences after TSA within the first 7 postoperative days. The study confirmed a decreased Hb value for women at all stages of SA. Blood loss was significantly higher for RSA than for TSA for both men and women.

Background: Cerebellar hemorrhage is a severe cerebrovascular disease. The small posterior fossa space can cause compression of surrounding brain tissue with even a small amount of bleeding, leading to increased intracranial pressure, disruption of blood supply to surrounding brain tissue, and exacerbation of brain function damage. The most common surgical approach currently is craniotomy for hematoma evacuation, inevitably causing damage to surrounding nerves and blood vessels. In this study, we introduced C-arm CT scanning combined with simple laser device technology to assist in puncture drainage for cerebellar hemorrhage, aiming to improve the accuracy of surgery and maximize the protection of patients' brain function, providing a physiological basis for better clinical prognosis.

Materials and methods: From January 2023 to February 2024, a total of 8 patients (6 males, 2 females) with cerebellar hemorrhage underwent C-arm CT-assisted puncture therapy combined with a simple laser device at the affiliated hospital of Binzhou Medical University. Statistical analysis was performed on operation time, number of punctures, impact on important structures and vessels, postoperative hematoma clearance, complications, and neurological function recovery.

Results: All 8 patients underwent the surgery smoothly without causing damage to important structures or blood vessels. There was no rebleeding intraoperatively. Among the 8 patients, 5 were discharged smoothly, while 3 patients opted to discontinue treatment and requested discharge. At the 3-month follow-up, 3 patients showed no ataxia, while 2 patients had impaired cerebellar motor function.

Conclusion: C-arm CT scanning combined with a simple laser device technology can accurately locate the position of the hematoma, effectively avoid important structures and vessels, reduce damage to surrounding normal brain tissue, and maximize the protection of normal brain tissue function. Real-time navigation and dynamic adjustments during surgery allow immediate access to imaging data postoperatively. It also has the advantages of being minimally invasive, highly precise, easy to operate, and short operation time, demonstrating high practicality and feasibility.

Background and objectives: Robotic approach in colorectal surgery is rapidly gaining interest, particularly in the context of rectal cancer resection. Despite economic barriers, substantial proliferation of robotic colorectal procedures has been observed throughout Latin America. However, there is a lack of data regarding intraoperative and early postoperative outcomes, as well as oncological and long-term results. This systematic review aims to provide an overview of the surgical outcomes of robotic-assisted colorectal approaches across Latin America.

Material and methods: A systematic literature search of electronic databases, including PubMed, LILACS, Scopus, Cochrane Library and Scielo, was performed and reported in line with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The main target of the literature search was studies that reported outcomes of colorectal robotic surgery in Latin America.

Results: A total of 9,694 published articles were identified from the initial search. Nine thousand six hundred thirty-six publications were excluded after title and abstract review and removal of duplicates. Fifty-eight articles were thoroughly reviewed, and 11 studies met the inclusion criteria. The critical appraisal of study quality (biases risk assessment) was performed according to the Joanna Briggs Institute (JBI) Manual for Evidence Synthesis. In general, the overall study quality was poor. Of the 11 studies included in the analysis, ten addressed intraoperative and early postoperative outcomes, seven addressed oncological/pathological outcomes, and just one addressed long-term outcomes. Ten studies evaluated intraoperative and early postoperative outcomes, encompassing a total of 425 patients, the majority of whom were diagnosed with colorectal cancer. Morbidity rates exhibited a range between 0% and 45.9%, while mortality ranged from 0% to 2.5%.

Conclusion: Few studies have been published addressing intraoperative, postoperative, pathological, and oncological outcomes of robotic colorectal surgery in this region. Undoubtedly, there are unique challenges not encountered by developed countries, including economic obstacles in establishing structured training programmes and high-quality centres for the development of robotic surgery. Further studies are needed to assess the real extent of robotic surgery in the region and its results.

Systematic review registration: https://www.crd.york.ac.uk/, PROSPERO (CRD42023494112).

Background: To investigate the safety and efficacy of percutaneous nephrolithotomy (PCNL) in the treatment of complicated renal calculi by integrating three-dimensional (3D) computed tomography (CT) reconstruction with the Sampaio classification of the renal collecting system.

Methods: Sixty-four consecutive patients with complex kidney calculi who underwent PCNL between January 2019 and October 2023 were retrospectively analyzed and divided into experimental group (3D printing) and control group (CT imaging) according to their willingness to pay for 3D imaging. Both groups underwent preoperative CT urography. The Digital Imaging and Communications (DICOM) in Medicine data of the experimental group from CT imaging were used for 3D reconstruction and model printing. Then, the Sampaio classification system was used to design the puncture channel and develop a surgical strategy.

Results: The 3D-printed models of the experimental group successfully displayed the Sampaio classification system. There was no significant difference in the baseline parameters between the groups. Compared with the control group, the experimental group exhibited significant improvements in the puncture time, number of puncture needles, number of puncture channels, target calyx consistency, number of first puncture channels, and stone clearance. There were no significant differences in the total operative time, decrease in the hemoglobin level, length of hospital stay, and postoperative complications between the groups.

Conclusions: Integration of 3D technology with the Sampaio classification of the renal collecting system can enhance the preoperative evaluation and planning of percutaneous renal access. This approach allows a more precise method of PCNL for treating complex renal calculi.