Frontiers in Surgery最新文献

Study design: Low back pain (LBP) is a widespread clinical symptom affecting nearly all age groups and is a leading cause of disability worldwide. Degenerative changes in the spine and paraspinal tissues primarily contribute to the etiology of LBP.

Objectives: We conducted this systematic review of animal models of paraspinal muscle (PSM) degeneration secondary to degenerative intervertebral disc (IVD), providing a comprehensive evaluation of PSM structural changes observed in these models at both macroscopic and microscopic levels.

Methods: PubMed, EMBASE, Web of Science, Cochrane Library, and MEDLINE Ovid databases were searched through November 2023. Literature was sequentially screened based on titles, abstracts, inclusion of animal models and full texts. A manual search of reference lists from all eligible studies was also performed to identify any eligible article. Two independent reviewers screened the articles according to inclusion and exclusion criteria. The risk of bias was assessed using the Systematic Review Centre for Laboratory Animal Experimentation's Risk of Bias tool.

Results: A total of nine studies were included in the final analysis after a comprehensive screening process. The included studies were assessed for various aspects of the multifidus muscle. Given the limited number of studies and the substantial heterogeneity among them, a quantitative meta-analysis was deemed inappropriate.

Conclusions: This systematic review shows a comprehensive analysis of structural changes in the multifidus muscle in animal models of IVD degeneration and offers crucial insights for developing improved rodent models of IVD degeneration and assessing a battery of approaches for multifidus degeneration.

Background: Tendon repairs often result in adhesion formation which can cause persisting functional deficits. Close proximity of healing tissues increases friction during tendon excursion, often leading to tendon tethering postoperatively. Despite continued improvements in techniques for tendon repairs, there is currently no consensus on the most effective modality to reduce adhesion formation. The VersaWrap Tendon Protector is a bioresorbable hydrogel that is FDA-cleared for use in tendon repair by separating healing tendons from surrounding tissues and improving tendon gliding. We conducted a study to assess the efficacy of VersaWrap in improving clinical outcomes related to adhesions and tethering in tendon repairs involving the hand.

Materials & methods: Age, sex, injury type, mechanism of injury, visual analogue scale (VAS) pain scores, active and passive range of motion (ROM), percent return to normal function, and patient-reported outcomes forms (QuickDASH) were collected at baseline and routine follow up visits. Functional outcomes were classified according to Strickland and Glogovac grading system.

Results: 90 patients were included, with an average age of 39.8 years and a 44% female gender. The most common mechanism of injury was sharp laceration, and the majority of repairs involved the extensor mechanism (58.8% extensor, 35.3% flexor, 5.8% both). At a mean follow-up of 4.6 months, the mean active and passive ROM was 88.8% and 94.3%, respectively. Mean percent return of function was 87.7%. Good or Excellent functional outcomes were achieved in 92.3% of patients - 70.5% Excellent, 21.8% Good, 6.4% Fair, 1.3% Poor. The average QuickDASH score was 30.7, and the average final VAS pain score was 1.3.

Conclusions: Tendon repairs and tenolysis procedures often result in reduced functionality due to impeded tendon gliding, and there is currently no consensus on optimal treatment to prevent tethering to surrounding tissues. The VersaWrap Tendon Protector creates a gelatinous layer between the tendon and surrounding soft tissue to improve gliding resistance, thereby limiting tendon sheath adhesions. Our data suggests that VersaWrap may be a useful adjunct in preventing tendon tethering adhesion post-repair.

Introduction: Retroperitoneal hematoma with ongoing hemorrhage is a rare but critical condition following blunt abdominal trauma, requiring urgent evaluation and management. This case details a large retroperitoneal hematoma in the right iliac fossa caused by a rupture of the deep circumflex iliac artery (DCIA), successfully treated with transcatheter arterial embolization.

Case description: A 66-year-old female presented to our hospital six hours after an electric tricycle accident with dizziness, fatigue, hypotension (80/50 mmHg), and tachycardia (105 beats/min). Laboratory tests revealed a hemoglobin level of 9.2 g/dl and a hematocrit level of 27.5%. Contrast-enhanced CT showed an 18 cm × 10 cm × 5 cm retroperitoneal hematoma in the right iliac fossa with active bleeding. Emergent angiography identified the bleeding source as a branch of the right DCIA. Embolization was performed using a microcoil through a coaxial microcatheter positioned proximal to the bleeding site, successfully stopping the hemorrhage. The patient's condition stabilized, and ultrasound monitoring showed a gradual reduction in hematoma size. The patient was discharged two weeks later.

Conclusion: This case highlights a rare but severe instance of retroperitoneal hematoma due to DCIA rupture, effectively managed with transcatheter arterial embolization. The utility of contrast-enhanced CT and angiography in diagnosing active bleeding is emphasized, underscoring the efficacy of transcatheter embolization as a critical intervention in such life-threatening situations.

Background: Hemophilic arthritis (HA) is associated with significant changes in the morphology of mature knee joints due to abnormal growth plate development. Previous studies have established marked distinctions between the femur and tibia of subjects with Haemophilia and those with osteoarthritis (OA). This study explored the morphological characteristics of the patella and patellofemoral joint in subjects with Haemophilia. These findings can inform the design of knee joint prostheses tailored to this condition, improve the precision of total knee replacement surgery, and reduce postoperative knee pain and patellar dislocation.

Methods: Before surgery, we conducted preoperative measurements of patellar length, patellar diagonal length, patellar ligament length, patellar width, patellar thickness, the INSALL index, the lateral patellofemoral angle, the trochlear groove angle,the patellar lateral displacement rate, and the patellofemoral index using lateral and axial x-ray images in 40 subjects with Haemophilia, 40 OA patients, and 40 normal individuals.

Results: Significant statistical differences in certain morphological parameters were observed among the three groups of patients (P < 0.05). Compared with the OA and normal control groups, the HA group presented significant disparities in patellar thickness, patellar ligament length, the Insall ratio, the patellar lateral shift rate, the lateral patellar angle, and the patellofemoral index.

Conclusion: Compared with OA and normal individuals, Subjects with Haemophilia presented with smaller and thinner patellae, more significant patellar ligament contracture, reduced patellar height, and more pronounced patellar dislocation. Consequently, during total knee arthroplasty, we lean toward patellar reshaping in subjects with Haemophilia, exercise caution when considering patellar replacement, and, for those with severe preoperative patellar dislocation, perform intraoperative lateral retinacular release.

Background: Intraoperative hemorrhage is one of the major complications of orthotopic liver transplantation (OLT_X) and is mainly caused by technical difficulties of the surgical procedure besides primary liver diseases. The present study aimed to evaluate the feasibility and clinical effects of a novel proceduralized donor liver back-table preparation (DLBTP) technique for use in OLT_X.

Methods: This retrospective study was conducted between January 2018 and June 2020 based on patients who had undergone OLT_X. All livers transplanted using the reported back-table procedures were defined as the control group A (n = 43), while those prepared using our new procedure as the experimental group B (n = 160). The first-hand surgical experience of transplant surgeons was surveyed in a post hoc comparative analysis.

Results: DLBTP time was significantly longer and the probability of low-quality hepatic artery skeletonization was lower in group B compared to group A patients. Compared to group A, the time for hemorrhage control was shorter [P < 0.05, 0.3 h (range, 0.17-0.58 h)], and the degree of blood loss was less [P < 0.05, 60 ml (range, 30-240 ml)] in group B. Major bleeding sites were soft tissue of the hepatic hilum and the wall of the inferior vena cava. Due to trimmed soft tissue in the first porta hepatis region, there was less blood oozing, making it easier to stem the bleeding and construct anastomosis.

Conclusion: Although the procedural DLBTP for OLT_X was time-consuming, the new procedure significantly reduced the degree of hemorrhage and the time required to control bleeding.

Bertolotti's Syndrome, a subset of lumbosacral transitional vertebrae (LSTV), is one cause of chronic low back pain (LBP), and a commonly overlooked differential diagnosis. The incidence of Bertolotti's Syndrome has been underestimated in the past and is common in those of younger ages around 30-40. Although diagnostics, imaging methods, and treatment algorithms have been improved in the past few years, there is no gold standard and more long-term, prospective research is needed. The purpose of this mini-review is to increase awareness of Bertolotti's Syndrome, discuss recent advancements in treatment algorithms, and highlight current gaps in the literature.

Background: Ovotesticular disorder of sex development is a rare form of disorder of sex development that manifests as ovotestis in individuals. The precise diagnosis and the choice of surgical procedures are still in conflict condition due to the rarity of the disease, diverse clinical presentations, and the lack of evidence-based medical studies on postoperative outcomes.

Case presentation: We present a 46, XX ovotesticular disorder of sex development case, aged 19, with Prader stage IV virilization who underwent feminizing genitoplasty surgery. Our surgical strategy prioritized the patient's genitourinary function restoration and cosmetic reconstruction achieved satisfactory results. We attribute the success of the treatment to the systematic diagnostic process and individualized surgical planning.

Conclusion: The purpose of this article is to provide an evaluation protocol for the ovotesticular disorder of sex development, improving the diagnostic rate and providing some fresh ideas for surgical management.

Though advancements have been made in the pharmacologic treatment of myasthenia gravis (MG), surgical resection is not only an option as a last line of defense for those patients who do not respond to medical therapy but also remains vital for those with thymic epithelial tumors (TET). While prior studies have shown the potential superiority of minimally invasive approaches via robotic- and video-assisted thoracoscopic surgery (RATS/VATS) for thymectomy compared to open surgery, in the setting of malignancies, this outcome delineation is controversial. As RATS/VATS may be associated with less post-operative complications in the treatment of TET, some surgeons argue that the open approach is necessary for complete resection (R0 resection) and to prevent potential seeding of the malignancy. In this review article, we will compare the efficacy and implications of the different surgical approaches and techniques themselves in performing a thymectomy for autoimmune and oncologic pathologies.

Background: Bone transport techniques are crucial for managing large bone defects, but the optimal approach for different defect lengths remains unclear. This study aimed to compare bone regeneration rates between short bifocal bone transport (SBBT), long bifocal bone transport (LBBT), and trifocal bone transport (TBT) using pixel value ratio (PVR) as an objective quantitative measure.

Methods: This retrospective study included 60 patients undergoing lower limb bone transport, divided into SBBT (n = 22, defects <6 cm), LBBT (n = 20, defects ≥6 cm), and TBT (n = 18, defects ≥6 cm) groups. PVR was measured at 4, 8, and 12 weeks postoperatively using standardized digital radiographs. Healing index (HI) and external fixation index (EFI) were calculated to assess treatment efficiency. Demographic data, surgical characteristics, and complications were also analyzed.

Results: TBT showed significantly higher PVR values compared to LBBT at all time points (4 weeks: 0.779 ± 0.036 vs. 0.719 ± 0.027, p < 0.001; 8 weeks: 0.822 ± 0.027 vs. 0.787 ± 0.025, p = 0.008; 12 weeks: 0.866 ± 0.024 vs. 0.835 ± 0.016, p = 0.023) and to SBBT at 4 and 8 weeks (p < 0.001 and p = 0.016, respectively). The TBT group demonstrated significantly lower HI and EFI compared to both SBBT and LBBT groups (p < 0.05), indicating faster healing and shorter treatment times. Although SBBT showed slightly higher PVR values than LBBT, the differences were not statistically significant.

Conclusion: Trifocal bone transport leads to faster bone regeneration and shorter treatment times compared to bifocal techniques, particularly for longer bone defects. The study demonstrates that defect length alone may not be the primary factor influencing regeneration rates in bifocal transport. PVR proves to be a reliable and cost-effective tool for assessing bone regeneration in different bone transport techniques, offering potential for guiding clinical decision-making. These findings suggest that trifocal transport should be considered as a preferred method for treating larger bone defects, especially when minimizing treatment time is crucial.