Frontiers in Surgery最新文献

Introduction: This study compared implant-related complications after femoral neck fracture fixation using partially vs. fully threaded cannulated screws in non-geriatric patients.

Methods: This retrospective cohort study included 1,035 patients with femoral neck fractures aged 18-60 years treated with cannulated screws from 2012 to 2022. Patients were followed until clinical failure-defined as the occurrence of any of the following: implant cut-out, femoral neck shortening, nonunion, or avascular necrosis-or for a minimum of 2 years. Patients were categorized into two groups according to thread type and balanced using propensity score matching. The primary outcome was the clinical failure rate. Subgroup analyses were performed for comminuted vs. non-comminuted fractures.

Results: The overall clinical failure rate was 35.4%, including implant cut-out (1.9%), femoral neck shortening (15.0%), nonunion (9.3%) and avascular necrosis (23.5%); this rate was significantly higher for those with comminuted fractures. After balancing covariates, the partially threaded group demonstrated higher rates of femoral neck shortening (13.7% vs. 6%, p = 0.017) and avascular necrosis (17.9% vs. 9.5%, p = 0.027) than the fully threaded group in the overall cohort. In the non-comminuted subgroup, the partially threaded group was associated with significantly lower rates of implant cut-out (0% vs. 8.7%, p < 0.01) than the fully threaded group. However, in the comminuted fracture subgroup, the fully threaded group exhibited significantly lower incidences of femoral neck shortening (6.6% vs. 22.4%, p < 0.01) and avascular necrosis (10.5% vs. 36.2%, p < 0.01).

Conclusions: Fracture comminution increases the risk of femoral neck shortening and avascular necrosis. In non-comminuted fractures, the use of partially threaded screws should be prioritized. However, in comminuted fractures, using fully threaded screws decreases rates of femoral neck shortening and avascular necrosis. This study provides evidence to guide cannulated screw thread type selection for comminuted fractures and paves the way for future randomized controlled trials.

Anti-Yo antibody-positive paraneoplastic cerebellar degeneration (PCD) is a rare immune-mediated neurological syndrome associated with malignancy, presenting significant diagnostic and therapeutic challenges. This case describes an elderly female patient who developed delayed-onset subacute cerebellar symptoms three years after ovarian cancer resection, ultimately diagnosed with anti-Yo antibody-positive PCD. Although immunotherapy was administered, the patient's ataxia exhibited only limited improvement, suggesting that PCD may progress to an irreversible pathological stage. This case challenges the conventional understanding that PCD typically precedes tumour detection, offering a new perspective on clinical diagnosis and management due to the three-year interval. This case underscores the importance of considering paraneoplastic etiology in patients with unexplained neurological deficits who have a history of tumor surgery. Maintaining awareness for long-term screening for PCD and early management of primary malignancies alongside immunological interventions is crucial for delaying disease progression.

Objective: Current intraoperative navigation systems have shown significant effectiveness for organs with fixed shapes, but they struggle to adapt to the challenges of tissue deformation and displacement in gastrointestinal surgeries. This study evaluates the established YOLOv8 and the emerging YOLOv12 with enhanced feature extraction capabilities, aiming to identify an optimal real-time model for dynamic surgical scenarios to improve procedural efficiency and safety.

Methods: In this multi-center retrospective study, object detection and instance segmentation was achieved by training YOLOv8 and YOLOv12 models on 1,847 images extracted from 22 surgical videos collected across four hospitals nationwide. The models were subsequently validated and tested and performance was rigorously compared using standard metrics, such as precision, recall, mAP@0.5, mAP@0.5-0.95, and the size of the weight file. Furthermore, the clinical applicability of the top-performing models was evaluated via a questionnaire survey.

Results: Both YOLOv8 and YOLOv12 demonstrated competent performance in object detection and instance segmentation tasks. For the test set, YOLOv12 achieved significantly higher recall rates than YOLOv8 in both object detection and instance segmentation (P = 0.037 and P = 0.031, respectively). Furthermore, when evaluating the YOLOv12 model on the test set, object detection significantly outperformed instance segmentation in terms of mAP@0.5 and recall (P = 0.045 and P = 0.036, respectively). The weights files of YOLOv8 and YOLOv12 have sizes of 6.8 megabytes (MB) and 6.0 megabytes (MB) respectively. Questionnaire results indicated a trend suggesting that AI-assisted technology has the potential to reduce surgical time and lower the risk of missed lymph node detection among junior surgeons.

Conclusion: In scenarios with limited hardware resources, the object detection task using the YOLOv12 model is strongly recommended to assist in robotic colon cancer surgery, enhancing surgical efficiency and safety.

Background: Osteogenesis imperfecta, commonly referred to as brittle bone disease, is the most prevalent monogenic bone disorder and is characterized by osteoporosis and heightened bone fragility. Most patients experience multiple fractures, some of which can be managed conservatively; however, patients with numerous fractures frequently develop significant limb deformities and growth abnormalities that require surgical intervention. For adult patients, intramedullary fixation of osteotomies is typically the preferred option; however, this approach is less suitable for children due to their ongoing growth and development, which necessitates periodic replacement of intramedullary nails and thus repeated surgeries. Moreover, increased bone fragility and a high propensity for fractures in children with osteogenesis imperfecta contribute to frequent postoperative complications, such as refractures and displacement of internal fixation. To address these challenges, extendable intramedullary nails have been developed. In this context, we used these nails to treat a pediatric patient with multiple femoral fractures and severe deformity, with favorable clinical outcomes during a 2-year postoperative follow-up.

Case report: We present the case of a 12-year-old female patient with postnatally diagnosed osteogenesis imperfecta who sustained multiple fractures over time, the most severe being bilateral femoral fractures. She was admitted to our facility on two occasions for femoral shaft fractures. We employed osteotomy, orthopedic techniques, and extendable intramedullary nailing for her treatment. Postoperatively, she showed satisfactory recovery from bilateral femoral deformities, with successful fracture healing and near-normal lower limb lengths.

Conclusion: Extendable intramedullary nailing exhibits favorable clinical efficacy in the management of fracture-related deformities in pediatric patients with osteogenesis imperfecta, offering novel insights and options for clinical diagnosis and treatment, thereby demonstrating significant clinical utility.

Objective: To explore the predictive value of key preoperative cardiopulmonary exercise testing (CPET) indicators for cardiopulmonary complications following thoracoscopic lung resection.

Methods: Patients who underwent lung resection at the Department of Thoracic Surgery, Fourth Hospital of Hebei Medical University were selected. Information was collected for patients who completed CPET using the incremental exercise protocol. Hospitalization information, postoperative complications and follow-up data were analyzed. Correlations between postoperative cardiopulmonary complications and preoperative CPET indices were analyzed to identify threshold values.

Results: Among 376 thoracoscopic lung resection patients, 52 experienced at least one complication (13.8%). Comparison between the cardiopulmonary complications group (CCP) and no complications group (NCCP) revealed significant differences in age, extent of lung resection, and lymph node metastasis (P < 0.05). Core CPET indicators including peak heart rate (peak HR), peak oxygen uptake (peak VO2), peak VO2%pred, peak metabolic equivalent (peak MET), and maximal workload %pred were significantly lower in the CCP group (P < 0.05). The sensitivity and specificity of peak VO2%pred <70%, peak MET <5, and maximal workload %pred <80% all exceeded 60%, with negative predictive values surpassing 90%. Positive predictive values of peak VO2 < 15 mL/(min·kg), peak VO2%pred <60%, peak MET <4, and maximal workload %pred < 60% exceeded 30%. Using these cutoff values resulted in high diagnostic accuracy with odds ratios of 6.2, 4.0, 4.6, and 3.2, respectively.

Conclusion: Key preoperative CPET indicators effectively evaluate postoperative complication risk in thoracoscopic lung resection patients. Peak VO2, peak VO2%pred, peak MET, and maximal workload %pred are associated with postoperative cardiopulmonary complications.

Background: Esophageal variceal (EV) rupture is a life-threatening complication of liver cirrhosis. Although upper gastrointestinal endoscopy is recommended for routine screening and risk assessment of EV bleeding, it is an invasive and often unpleasant procedure. This study aims to develop a non-invasive nomogram model based on spleen volume changes to predict the presence of high-risk esophageal varices (HREVs).

Methods: A total of 150 patients with liver cirrhosis (mean age 62.3 ± 10.0 years; 95 men and 55 women) who underwent upper gastrointestinal endoscopy were retrospectively included. Spleen volume was measured using abdominal computed tomography. Predictors were identified through multivariate logistic regression and subsequently used to construct a nomogram model. The discriminative ability, calibration ability, and clinical utility were assessed. Internal validation was performed using 1,000 bootstrap resampling iterations.

Results: Based on endoscopic findings, 74 patients were categorized into the HREV group and 76 patients were categorized into the non-HREV group. Multivariate regression identified three independent predictors of HREV: the presence of ascites [odds ratio (OR) = 2.656, 95% confidence interval (CI): 1.224-5.763], prothrombin time (OR = 1.217, 95% CI: 1.043-1.419), and spleen volume enlargement rate (OR = 1.589, 95% CI: 1.276-1.979). These variables were incorporated into the nomogram model. The area under the receiver operating characteristic curve of the nomogram model was 0.793 (95% CI: 0.723-0.863), outperforming previously reported models, such as the platelet-to-spleen volume ratio (0.724), platelet-to-spleen diameter ratio (0.673), aspartate aminotransferase-to-platelet ratio index (0.590), and aspartate aminotransferase-to-alanine aminotransferase ratio (0.558). At a probability cutoff of 0.421, the nomogram demonstrated a sensitivity of 0.797, a specificity of 0.671, a positive predictive value of 0.702, a negative predictive value of 0.773, and an accuracy of 0.733. Internal validation yielded a C-index of 0.779 (95% CI: 0.714-0.853). Overall, the nomogram model exhibited good calibration and favorable clinical utility.

Conclusion: The nomogram incorporating ascites, prothrombin time, and spleen volume enlargement rate effectively predicts HREVs in patients with liver cirrhosis. This non-invasive and user-friendly tool offers an efficient approach for timely HREV evaluation and preventive treatment of variceal bleeding.

Background: Adult orbital xanthogranulomatous disease is a rare non-Langerhans cell histiocytosis, among which the adult-onset asthma with periocular xanthogranuloma (AAPOX) subtype is particularly uncommon. Recent studies have suggested an association between this condition and IgG4-related disease (IgG4-RD), possibly falling within its disease spectrum.

Case presentation: A 60-year-old male presented with a one-year history of bilateral eyelid swelling accompanied by difficulty in opening the right eye. Examination revealed significant swelling and bulging of the right upper eyelid, with a well-defined, cord-like mass palpable on palpation. The left eyelid showed mild swelling without a detectable mass. The patient had a documented history of asthma, a positive bronchial provocation test, and significantly elevated serum IgE levels. Surgical intervention was performed on the right eye, followed by postoperative glucocorticoid therapy. Histopathological findings were consistent with xanthogranuloma, and IgG4 positivity suggested an association with IgG4-related disease (IgG4-RD). Serum IgG4 levels further supported this association. After treatment, the patient's serum IgG4 levels normalized, eyelid morphology improved significantly, and no progression was observed during a two-year follow-up period.

Conclusion: This case further confirms the strong association between AAPOX and IgG4-RD, and represents the first report of asymmetric AAPOX. Surgical excision combined with systemic glucocorticoid therapy proved effective for this condition. Furthermore, the article explores the potential role of IgG4 produced during asthma desensitization therapy in the pathogenesis of IgG4-RD, suggesting that this potential risk should be considered during asthma treatment. This report provides valuable clinical experience for the diagnosis and treatment of such rare diseases.

Objective: To identify risk factors for intra-aortic balloon pump (IABP) requirement following heart valve replacement surgery (HVRS) and to develop a predictive model.

Methods: This retrospective cohort study analyzed 161 HVRS patients (October 2023 to January 2025) from the First Affiliated Hospital of Xinjiang Medical University. Patients were stratified into IABP (n = 58) and non-IABP (n = 103) groups. Independent risk factors were identified through univariate analysis, LASSO regression, and multivariate logistic regression. The cohort was randomly split into training and validation sets (7:3 ratio) for model development and internal validation. Model performance was assessed using receiver operating characteristic (ROC) curves, Hosmer-Lemeshow calibration, and decision curve analysis (DCA).

Results: Significant differences were observed between groups across multiple parameters (all P < 0.05), including demographics, inflammatory markers, cardiac biomarkers, and echocardiographic indices. Multivariate analysis identified five independent risk factors for postoperative IABP use: age (OR = 1.138, 95% CI: 1.067-1.226), stroke volume (SV) (OR = 1.155, 95% CI: 1.060-1.296), cardiac output (CO) (OR = 5.700, 95% CI: 2.700-12.040), cardiac index (CI) (OR = 4.982, 95% CI: 2.879-10.119), and left ventricular end-systolic diameter (LVESD) (OR = 1.463, 95% CI: 1.157-1.849). The prediction model showed excellent discrimination in both the training set (AUC = 0.946, 95% CI: 0.910-0.982) and the validation set (AUC = 0.933, 95% CI: 0.876-0.990). Good calibration was indicated by Hosmer-Lemeshow test (P > 0.05 for both sets), and decision curve analysis confirmed the model's clinical utility.

Conclusion: A model incorporating five routinely available preoperative variables effectively stratifies the risk of requiring IABP after HVRS, demonstrating strong discriminatory performance and potential clinical applicability for preoperative risk assessment.

Facial nerve schwannomas are rare tumors that pose diagnostic and surgical challenges. We report a 17-year-old female with progressive right-sided facial paresis initially misdiagnosed as Bell's palsy. MRI revealed a contrast-enhancing lesion of the facial nerve. She underwent a two-stage surgery: tumor resection via mastoidectomy and hearing rehabilitation, followed by facial nerve reconstruction using masseteric-to-facial nerve transfer and cross-face sural grafting. At nine months postoperatively, facial function improved from House-Brackmann grade V to III, and hearing was preserved. Early imaging and multidisciplinary management can enable complete tumor resection with functional restoration and favorable outcomes.

Background: Suprascapular nerve entrapment is a cause of shoulder pain and dysfunction, often complicated by symptomatic overlap with other shoulder pathologies. Entrapment most commonly occurs at two anatomical constrictions: the suprascapular notch and the spinoglenoid notch. Compression of the nerve's inferior branch at the spinoglenoid notch by a paralabral cyst, leading to isolated infraspinatus weakness and atrophy, is a relatively common pattern. Diagnosis relies on a detailed physical examination, multimodal imaging evaluation including MRI and ultrasound, and confirmation by electromyography. For patients who do not respond to conservative management or who have definitive space-occupying compression, surgical decompression is an effective treatment option.

Case presentation: This is the case of a 27-year-old man presenting with progressive right shoulder weakness and pain over just one month, already demonstrating isolated infraspinatus atrophy. Imaging revealed the etiology to be a paralabral cyst that, notably, occupied both the suprascapular and spinoglenoid notches, creating a "double-crush" compression on the suprascapular nerve. This case clearly illustrates how a strategically located space-occupying lesion can lead to rapid and characteristic neurologic deficit, even within a short clinical course.

Conclusion: This case clearly illustrates the classic presentation of an isolated spinoglenoid notch cyst causing suprascapular nerve compression, underscoring that this diagnosis must be considered in patients with isolated external rotation weakness even without a clear traumatic etiology, and highlighting that early recognition and systematic evaluation are key to successful management and neurological recovery.