Frontiers in Surgery最新文献

Objective: To evaluate clinical features and compare outcomes of conservative vs. surgical management in pediatric patients with congenital bipartite patella (BP) and patellar dislocation.

Methods: A retrospective study included 42 children (≤16 years) with BP and patellar dislocation treated between January 2019 and January 2024. Patients received either conservative treatment (n = 18; reduction, immobilization, and rehabilitation) or surgical treatment [n = 24; lateral retinacular release, medial patellofemoral ligament (MPFL) reconstruction, ± internal fixation of accessory fragments]. Functional outcomes were assessed using Lysholm, Kujala, and visual analog scale (VAS) scores preoperatively and at final follow-up. Radiological parameters included patellar congruence angle, tibial tubercle-trochlear groove distance, and accessory fragment healing. Complications and recurrence rates were recorded.

Results: Baseline characteristics were comparable, except for a higher proportion of having suffering recurrent dislocations in the surgical group (P = 0.001). Both groups improved significantly in functional scores (P < 0.05), but the surgical group demonstrated superior outcomes (Lysholm: 90.5 ± 4.8 vs. 76.3 ± 8.1; Kujala: 92.1 ± 3.9 vs. 78.9 ± 7.5; VAS: 1.2 ± 0.9 vs. 3.1 ± 1.4; P < 0.001). Surgical patients achieved normalization of patellofemoral alignment, and all eight patients undergoing internal fixation achieved solid bony union. Recurrence occurred in 27.8% of conservatively treated patients but in none of the surgical group. No major complications were reported.

Conclusion: In pediatric BP with patellar dislocation, surgical management combining MPFL reconstruction and lateral retinacular release, with selective internal fixation, provides superior functional recovery, pain relief, and lower recurrence compared to conservative therapy, suggesting that surgical management may provide superior outcomes in selected pediatric patients.

Background: Confocal laser endomicroscopy (CLE) is an emerging intraoperative "optical biopsy" tool that enables real-time, in vivo, cellular-resolution visualization of brain tumor histoarchitecture. It offers the potential to complement frozen section pathology by providing rapid intraoperative feedback. We conducted a scoping review of prospective clinical studies to characterize CLE platforms, fluorophores, operative applications, and diagnostic performance in neurosurgical patients.

Methods: This review followed PRISMA-ScR guidelines. A systematic search of PubMed, Scopus, and Embase was performed. Eligible studies were prospective clinical studies of intraoperative CLE imaging in neurosurgical patients. Two independent reviewers screened and extracted data on study design, CLE system, fluorophore use, pathology types, diagnostic performance, and workflow characteristics.

Results: From 379 initial records, 19 studies met final inclusion criteria, with most (63%) in the past five years. Five CLE platforms were studied: CONVIVO (47%), FIVE1 (16%), Cellvizio (16%), EndoMAG 1 (11%), and cCeLL (11%). These CLE systems use different fluorophores that lead to distinct image characteristics. Across tumor types, CLE demonstrated diagnostic accuracy comparable with frozen section, with reported sensitivity up to 93% and specificity up to 94% in certain scenarios. CLE interpretation was feasible within minutes, faster than frozen section, and several studies reported successful integration with fluorescence-guided surgery and telepathology platforms.

Conclusions: Clinical evidence supports the feasibility, safety, and efficiency of CLE in neurosurgery, offering rapid intraoperative histology without tissue removal. Current studies remain observational with varying study design and outcome definition, limiting assessment of the effectiveness and impact. Well-designed interventional trials are needed to determine CLE's definitive role as an intraoperative optical biopsy tool guiding tumor resection and patient outcomes.

Cervical spine fixation in oncological and tumor-like conditions poses unique mechanical and radiological challenges. The choice of implant material is crucial to ensure optimal biomechanical stability and minimize imaging artifacts that may hinder adjuvant radiotherapy. While traditional titanium constructs provide reliable mechanical performance, they generate significant postoperative artifacts. Carbon fiber-reinforced PEEK (CFR-PEEK) implants offer comparable biomechanical strength with markedly reduced imaging interference, facilitating radiotherapy planning. However, their application in the cervical spine remains extremely limited due to narrow anatomical corridors. This technical note reports the first use of CFR-PEEK cervical pedicle screws (CPS) guided by patient-specific 3D-printed templates in the treatment of an aggressive vertebral hemangioma. The study demonstrates the technical feasibility and clinical applicability of CFR-PEEK screws with customized 3D guides for posterior cervical fixation in complex oncologic cases.

Aim: The study was conducted to determine the effect of postoperative step count on pain and quality of recovery in patients undergoing cholecystectomy.

Method: This prospective observational cohort study was conducted with 136 patients who underwent cholecystectomy at a university hospital between October 2023 and July 2024. Preoperatively, patients' information was obtained, and a 6-minute walking test was performed. Postoperatively, the number of step counts recorded by the pedometer and pain levels assessed by the Visual Analog Scale were monitored for three days. On postoperative day three, the patients were administered Quality of Recovery-15 (QoR-15). Data were analyzed using descriptive statistics, Pearson correlation analysis, and multivariable linear regression.

Results: After cholecystectomy, the median postoperative step count was 245 on day 1, 719.50 on day 2, and 983.50 on day 3. Mean pain scores were 7.20 ± 1.10 on postoperative day 1, 5.26 ± 1.29 on day 2, and 3.76 ± 1.42 on day 3. On postoperative day 3, the mean total QoR-15 score was 124.75 ± 18.71. Postoperative step counts were negatively correlated with pain scores and positively correlated with total and subscale QoR-15 scores. In multivariable linear regression analysis, postoperative recovery quality was independently associated with surgical approach, step count on postoperative day 3, and pain level on postoperative day 3. Higher step counts on postoperative day 3 were associated with higher QoR-15 scores, whereas higher pain levels were associated with lower QoR-15 scores.

Conclusion: The findings indicate that increased postoperative physical activity is associated with reduced pain and improved quality of recovery after cholecystectomy, highlighting the importance of maintaining postoperative mobility as part of perioperative care.

Background: This study aimed to determine the impact of discectomy on back pain and to identify the factors associated with back pain improvement.

Methods: A retrospective analysis was conducted on patients with lumbar disc herniation who underwent lumbar microdiscectomy at Fujian Medical University Union Hospital. Visual Analogue Scale (VAS) scores for back and leg pain were assessed before and after the tubular lumbar microdiscectomy.

Results: A total of 111 patients were included in this study. Pre- and post-operative VAS scores for back pain were 4.86 and 2.59, respectively. For radicular leg pain, pre- and post-operative VAS scores were 4.86 and 2.59, respectively. Univariate and multivariate analyses showed that the preoperative lumbar VAS score was significantly associated with improvement in back pain after tubular discectomy.

Conclusion: Tubular microdiscectomy significantly alleviated back pain symptoms in patients with lumbar disc herniation. The findings of this study may help spine surgeons in better educating patients regarding post-operative expectations following this surgical procedure.

Introduction: Radiation cystitis (RC) is a well-recognized complication of pelvic irradiation, manifesting as symptoms and signs such as hematuria, pain during urination, chronic pelvic pain, urgency and incontinence, which negatively impact patients' quality of life. We conducted a retrospective observational clinical investigation to evaluate the effect of bladder instillation with Adelmidrol (ADM) and sodium hyaluronate (HA) in patients with symptomatic RC.

Methods: We collected data from the patients' clinical records for all patients treated in our hospital with a diagnosis of RC and undergoing a cycle of 8 weekly 60 min bladder instillations with 50 mL a solution of 2% ADM + 0.1% HA. We evaluated the presence of pain (measured with the VAS score), urinary urgency/frequency, macroscopic hematuria and incontinence (all registered as a dichotomous variable present/absent) before and at the end of the treatment.

Results: Pelvic pain, evaluated by Visual Analogue Scale (VAS), improved in 66.7% of patients, significantly decreasing from a mean score of 3.8 ± 0.47-1.1 ± 0.3 (p < 0.0001). Gross hematuria and urgency, presented by 83.3% and 90.0% of patients, were reported by 6.7% and 33.3%, respectively, after the end of treatment (p < 0.0001). Incontinence, at first reported by 43.3% of the considered patients, disappeared in 16.7% of the subjects (n.s.).

Discussion: These results suggest the beneficial effect of ADM + HA intravesical instillations in managing RC symptoms, especially pain, gross hematuria and urgency.

Background: The optimal surgical approach for hysterectomy in patients with complex large uteri remains controversial, particularly in those with uterine enlargement and obesity. This study aimed to compare perioperative outcomes and complication rates among three surgical techniques-open abdominal hysterectomy (LH), traditional laparoscopic hysterectomy (TLH), and Da Vinci robot-assisted hysterectomy (DV-RH)-to provide evidence for individualized surgical decision-making.

Methods: A retrospective analysis was conducted on 444 patients who underwent hysterectomy for benign gynecological diseases between April 2021 and April 2024 at the Ningxia Medical University General Hospital.Patients were divided into LH (n = 140), TLH (n = 179), and DV-RH (n = 125) groups. Baseline, perioperative indicators, and the incidence of both short- and long-term complications among the three groups were compared. Additionally, BMI was stratified to compare the related indicators separately.

Results: There were no significant differences in age, BMI, comorbidities, or surgical history among the groups. DV-RH showed significantly lower blood loss (P < 0.001), postoperative VAS scores (P < 0.001), and complication rates, especially in patients with uterine size ≥16 gestational weeks. TLH demonstrated comparable outcomes to DV-RH in selected indicators but had a higher incidence of Clavien-Dindo grade II complications (P = 0.032). Hospitalization costs were highest in the DV-RH group (P < 0.001).

Conclusion: DV-RH offers superior perioperative outcomes in complex and large uterus cases but incurs higher costs. TLH remains a cost-effective alternative in appropriate patients. Surgical decisions should be based on patient characteristics, technical complexity, and institutional resources.

Osteoarticular infections (OAIs) present a diagnostic challenge, particularly when conventional cultures fail to identify the causative pathogen. We developed and implemented a sequential diagnostic workflow for intraoperative orthopaedic tissue samples, integrating laboratory automation (LA), broth enrichment, and next-generation sequencing (NGS). Between September 2023 and March 2025, 702 samples from 117 patients with suspected OAIs were processed. LA identified pathogens in 42% of cases. Among LA-negative patients, broth enrichment and NGS yielded additional identifications in 23% and 11.5% of cases, respectively. Our workflow achieved a diagnostic result within 10 days while improving detection rates, particularly in culture-negative cases. Our experience demonstrates that combining advanced microbiology tools is feasible in the context of suspected OAIs. A multidisciplinary evaluation of results remains essential for optimal patient management.

Objective: The research was conducted to assess the therapeutic efficacy of the femoral neck system (FNS) and cannulated compression screw (CCS) in treating femoral neck fractures classified as Pauwels type II and III in young to middle-aged patients.

Methods: This retrospective cohort study included 46 patients treated at Yanbian University Affiliated Hospital between January 2021 and March 2023. Patients were allocated into two groups: FNS (n = 24) and CCS (n = 22). Clinical indicators, including bone healing duration, Visual Analog Scale (VAS), Harris Hip Score (HHS), and postoperative complications, were compared.

Results: Satisfactory fracture reduction was consistently accomplished in all individuals, with observation continuing over 9 to 24 months. Baseline characteristics were comparable across both groups. The FNS group showed a significantly shorter healing time (4.00 ± 1.00 vs. 4.79 ± 1.39 months, P < 0.05), and higher HHS at 3 and 6 months following surgery (P < 0.05). VAS scores and 1-month HHS showed no significant differences between groups. Femoral neck shortening (4.2% vs. 27.3%, P = 0.043) and hardware failure (4.2% vs. 31.8%, P = 0.020) were significantly less frequent in the FNS group, while rates of femoral head necrosis (4.2% vs. 9.1%) and nonunion (12.5% vs. 13.6%) were comparable.

Conclusion: FNS promotes faster fracture recovery, reduces fixation-related complications, and improves early hip function, making it a reliable and efficient option for surgical stabilization of femoral neck fractures in young and middle-aged populations.

Background: The relationship between fragment characteristics and nonunion risk in comminuted femoral shaft fractures remains controversial. This study aimed to investigate the relationship between radiographic fragment features and fracture union outcomes to assist clinical assessment.

Patients and methods: A retrospective analysis was conducted on 91 femoral shaft fractures from 89 patients. Patient demographics, injury characteristics, and radiographic parameters-including fragment size, displacement, gap area, nail-to-canal diameter ratio, and ALR (gap area/major fragment length)-were analyzed. Univariate and multivariate logistic regression were used to identify independent risk factors for nonunion.

Results: The overall nonunion rate was 16.5% (15/91). Univariate analysis revealed that a larger gap area (OR = 1.004, P < 0.001) and a lower distal nail-to-canal diameter ratio (OR = 0.013, P = 0.023) were associated with nonunion. The novel ALR parameter demonstrated a strong association with nonunion (OR = 2.349, P < 0.001). In multivariate analysis, ALR remained an independent predictor (OR = 2.304, P < 0.001), while traditional factors like fragment size, displacement, and the nail-to-canal ratio were not significantly associated.

Conclusion: Traditional radiographic measures such as fragment length, width, Nail-to-canal ratio and absolute displacement did not show a significant association with healing outcome in our cohort. While the ALR is a significant predictor of nonunion in comminuted femoral shaft fractures, may assist in the early identification of cases at higher risk for nonunion, which could inform clinical vigilance regarding the potential need for more intensive management strategies.