Journal of Orthopaedic Surgery最新文献

Background: Adult spinal deformity (ASD) surgery has gained popularity, with significant improvements in patient-reported outcomes. Posterior lumbar interbody fusion with multiple grade II osteotomies (PLIF + MOs) and lateral lumbar interbody fusion (LLIF) have been utilized to correct ASD; however, no studies have compared these methods with regard to the pre- and postoperative changes in length and volume of the spinal canal. This study aimed to investigate the 3-dimensional changes in the anterior vertical column length (AVCL), spinal canal length (SCL), and spinal canal volume (SCV) in patients with ASD after surgery, employing LLIF and PLIF + MOs. Methods: This retrospective study examined 44 patients with ASD who underwent surgery between 2010 and 2021 using two corrective surgical methods, LLIF and PLIF + MOs. Radiographic parameters and clinical outcomes were assessed, and three-dimensional models were created from computed tomography images to analyze changes in AVCL, SCL, and SCV. Results: We compared the effects of LLIF and PLIF + MOs on spinal canal dimensions during ASD surgery. LLIF demonstrated an increase in lumbar segment (L1-S1) AVCL and whole spine (T1-S1) SCL by 6.5 ± 8.0 mm and 13.8 ± 7.6 mm, respectively, compared with PLIF + MOs. However, PLIF + MOs exhibited a reduction in the lengths of the lumbar segment AVCL. Postoperative differences were significant for AVCL (L1-S1), SCL fusion level, and first-standing lumbar lordosis between the groups (p < 0.0001, 0.002, and 0.016, respectively). LLIF significantly increased the SCV at the fusion level and whole spine T1-S1 by 14.5% and 10.6%, respectively, outperforming PLIF + MOs. Despite changes in dimensions, the postoperative Oswestry disability index scores showed no significant difference between the two groups. Conclusions: Our study suggests that LLIF can increase spinal canal space, lumbar lordosis, and anterior column length in the lumbar spinal segment. Knowledge of these variations may be critical for enhancing surgical outcomes and preventing neurological complications.

Objective: This study investigates the effectiveness of tibia periosteum distraction (TPD) applied to the tibial periosteum, an innovative approach grounded in Ilizarov's tension-stress theory, for the treatment of ischemic diabetic foot and vasculitic foot conditions.

Methods: A retrospective analysis was conducted on 33 patients (36 limbs) who underwent TPD between June 2019 and May 2022. The study comprised 21 males (23 limbs) and 12 females (13 limbs), aged 41 to 80 years (mean age: 63.4 years). Diabetic foot accounted for 27 cases, thromboangiitis obliterans for 2 cases, and arterial occlusive disease for 4 cases. The distribution of affected limbs included 15 left feet and 21 right feet. Periosteum traction commenced on the third postoperative day at a rate of approximately 0.75 mm/day, adjusted biweekly. The traction device was removed after two weeks. Evaluation included capillary refill and wound healing assessment, along with pre- and postoperative analysis of foot skin temperature, ankle-brachial index (ABI), visual analogue scale (VAS) pain scores, and peripheral blood oxygen saturation. CT angiography (CTA) was utilized to assess vascular conditions in both lower limbs.

Results: All 33 patients were successfully followed up for a duration ranging from 4 to 24 weeks (mean: 11.03 weeks). VAS pain scores significantly decreased from preoperative (5.09 ± 1.70, range: 2-8) to postoperative two weeks (2.24 ± 0.90, range: 1-4) (t = 9.44, p < .001). Oxygen saturation levels increased from 83.88% ± 11.82% (range: 58%-97%) preoperatively to 91.36% ± 5.69% (range: 76%-98%) at two weeks postoperatively (t = -4.21, p < .001). Foot skin temperature also showed a significant increase (t = -3.98, p < .001). Capillary refill test at two weeks postoperatively demonstrated notable improvement. CTA revealed evident neovascularization in the operated limbs compared to preoperative conditions. Wound improvement was significant in all 33 patients within two months postoperatively.

Conclusion: TPD emerges as a promising technique for chronic ischemic lower limb diseases, demonstrating favorable preliminary outcomes in wound healing promotion and amputation rate reduction. Nevertheless, large-scale randomized controlled trials are essential to further validate its efficacy.

Purpose: Non-selective closed kinetic chain exercises (NSKCE) and or selective closed kinetic chain exercises (SCKCE) has been shown to increase Vastus medialis obliquus (VMO) muscle power in patellofemoral pain syndrome (PFPS). However, the superiority of the exercises to each other has not been shown. This study aimed to evaluating the effects of different exercises on the stiffness of the VMO and vastus lateralis (VL) muscles, pain management, functional scores, and thigh circumferences.

Methods: One hundred 60 knees of 80 patients followed up in our outpatient clinic between December 2016 and February 2018 were included in the study. Patients were divided into two groups as 40 patients with single-sided PFPS (20 male and 20 female patients) and 40 healthy controls (20 male and 20 female patients). The patients in each group were divided into subgroups according to NSCKCE or SCKCE. VMO and VL muscles were measured by shear wave elastography (SWE) before and after a 6-weeks therapy.

Results: There was a significant decrease in Visual Analog Scale (VAS) score while a significant increase was found in Lysholm Knee Scale (LKS), however, no statistically difference was found between the two exercise groups in PFPS patients. The effect of both exercises on pain and functional improvement was similar.

Conclusion: Decrease in VAS scores, increase in LKS scores, increase in thigh circumference measurements, and increase in the stiffness of VMO and VL muscles were observed in both groups who received SCKCE and NSCKCE on PFPS patients.

Trial registration: Study registered at ClinicalTrials.gov (registration number: NCT05427357).

Design: Randomized controlled trial.

Purpose: This study aimed to evaluate the effect of distal blocking screws on the stability and healing of ulnar diaphyseal fractures treated with intramedullary (IM) nails. The primary research question was whether the addition of distal blocking screws enhanced fracture stabilization and promoted faster healing than the standard IM nailing techniques.

Methods: This retrospective study reviewed medical records of 30 patients with ulnar diaphyseal fractures treated from February 2018 to September 2023. The patients were divided into two groups: those treated using IM nails alone (n = 17) and those treated with using IM nails with distal blocking screws (n = 13). The surgical time, medullary canal space, fracture healing time, and complications were assessed. Functional outcomes were evaluated using the Grace and Eversmann rating system, the DASH scores, and the VAS scores.

Results: The addition of distal blocking screws resulted in a slightly longer surgical time (56 min vs 47 min). However, the group with distal blocking screws had smaller medullary canal space and showed significantly faster fracture healing times (2.3 months vs 3.9 months; p = .036). There were no reported complications of nonunion, nerve injury, or infection in the distal blocking screw group, whereas the IM nail-only group had one case of nonunion (5.7%).

Conclusion: The use of distal blocking screws in conjunction with IM nails for ulnar diaphyseal fractures improves fracture stability and promotes faster healing.

Purpose: Purpose of this study is to explore currently utilized readiness to return to sports (RTS) criteria after shoulder stabilization surgery used in elite athletes to gain novel insights into the RTS decision making process of professional team physicians.Methods: 19 qualitative semi-structured interviews with professional team physicians were conducted by a single trained interviewer. The interviews were used to identify team physician concepts and themes regarding the criteria used to determine RTS after shoulder stabilization surgery. General inductive analysis and a coding process were used to identify themes and sub-themes arising from the data. A hierarchical approach in coding helped to link themes.Results: We were able to identify five key themes that participating physicians focused on to determine RTS decision making: external influence, objective and subjective criteria, time elapsed since surgery and type of sport. The most important RTS criteria included: range of motion and muscle strength followed by clinical joint stability, time since surgery, ability of sporting movement, psychological readiness, functional testing, absence of pain and allied team support.Conclusion: This study identified several main themes and subordinate minor themes as having the most influence on RTS decision after shoulder surgery. We showed that even among specialized professional team physicians, the main criteria to RTS in these categories were inconsistent necessitating the future development of specific RTS guidelines.

Purpose: To examine the effects of tourniquet use in arthroscopic anterior cruciate ligament reconstruction in terms of (1) intraoperative visualization, (2) surgical time, (3) consumption of sterile saline, and (4) postoperative pain.

Methods: In this prospective randomized clinical trial, patients were assigned to Tourniquet Group or No Tourniquet treatment groups. The primary outcomes were intraoperative visualization, with scores ranging from 0 to 10 (0 = no visibility; 10 = clear and perfect display), surgical time, and the consumption of sterile saline. The secondary aim was to measure postoperative pain (24 h after surgery) with the visual analog scale (VAS) for pain.

Results: A total of 71 patients were included in the No Tourniquet group, and 75 were included in the Tourniquet group, with mean ages of 26.73 ± 8.05 years and 26.95 ± 10.11 years, respectively (p = .88). In the No Tourniquet group, 37 concomitant meniscal lesions were treated, whereas in the Tourniquet group, 38 (p = .99) were treated. The mean surgical times were 51.07 ± 6.90 and 50.03 ± 7.62 (p = .325), respectively, while the mean amount of saline consumed was 6.17 ± 1.18 L versus 5.89 ± 1.23 L (p = .217). Both groups achieved optimal visualization, with a sum of all surgical steps of 65.49 ± 1.86 for the no tourniquet group and 65.39 ± 1.88 for the Tourniquet group (p = .732). Postoperative pain was significantly lower in the No Tourniquet group (VAS score: 2.82 ± 1.33 vs 5.80 ± 1.22).

Conclusions: Tourniquet use during ACL reconstruction does not improve intraoperative visualization and does not reduce surgical time but leads to greater postoperative pain with a risk of well-known tourniquet-related complications.

Level of evidence: Level I - Randomized clinical trial.

Introduction: There have been osteotomy methods that corrected or overcorrected the ulna deformity as part of surgical treatment for chronic radial head dislocation.

Methodology: We reported surgical technique and outcome of oblique sliding ulna osteotomy that created acute lengthening, deformity correction or both to assist open reduction of radiocapitellar joint in four patients with neglected Monteggia fracture dislocation.

Result: Patients aged 3-12 years old had trauma duration of 4 weeks to 3 years. Two patients had Bado type I injury, and the other two had Bado type III. There was no acute nerve injury. During the final follow-up, all patients achieved union, with the limitation of motion range in the rotation arch being less than 20°. The radial head had no recurrent dislocation.

Conclusion: This case series has shown sliding osteotomy safely, providing acute correction and lengthening of the ulna without requiring bone graft to facilitate stable reduction of the neglected Monteggia lesion.

Total knee arthroplasty (TKA) is an effective treatment for end-stage knee joint diseases. The debate over preserving or sacrificing the posterior cruciate ligament (PCL) in mobile-bearing TKA (MB TKA) still needs to be solved due to the lack of high-quality evidence, particularly meta-analyses comparing these techniques. This study aims to conduct a meta-analysis to compare the outcomes of PCL retention (CR) and PCL sacrifice (PS) in terms of clinical and functional knee scores, range of motion, complication rates, and revision rates and to validate these findings through animal experiments. A comprehensive search was conducted using MEDLINE, Cochrane, and Embase databases. Relevant studies were selected for the meta-analysis using RevMan 5.3. Additionally, an animal experiment using Sprague-Dawley rats simulated MB TKA to compare the effects of PCL retention and sacrifice surgeries. 12 studies were included in the meta-analysis. No significant differences were found between CR and PS techniques regarding HSS, KSS, KSFS, WOMAC, ROM, and medial/lateral instability. However, CR MB showed slight superiority in NKJS, while PS MB had better outcomes in complication and revision rates. In the animal study, CR rats exhibited significant early postoperative inflammation, but both groups' knee structures gradually normalized. The meta-analysis indicates that PCL retention (CR MB) and sacrifice (PS MB) have similar effects on various clinical and functional knee scores. However, PS MB is significantly better at reducing complications and revision rates. The animal experiment confirms PS MB's advantages in reducing inflammation and promoting joint recovery. Despite the strong evidence, long-term follow-up and larger-scale randomized controlled trials are necessary to confirm these findings.