Journal of Orthopaedic Surgery最新文献

BackgroundSuperior labrum anterior and posterior (SLAP) lesions are a common cause of shoulder pain and instability. Accurate diagnosis remains challenging in clinical practice. This study aims to develop and evaluate radiomics models and combined models integrating radiomics and clinical features for SLAP lesion detection.MethodsThis retrospective study included 149 patients who underwent shoulder arthroscopic surgery with preoperative shoulder magnetic resonance imaging (MRI) between 2019 and 2024. Regions of interest (ROIs) were manually delineated on MRI oblique coronal proton density-weighted fat-suppressed (PD FS) images, and radiomics features were subsequently extracted from these defined regions. Feature selection employed independent t-tests, Mann-Whitney U tests, Pearson correlation analysis, and least absolute shrinkage and selection operator (LASSO) regression. Common machine learning models including Support Vector Machine (SVM), Random Forest (RF), and Light Gradient Boosting Machine (LightGBM) were employed to construct diagnostic models based on radiomics features. A combined model integrating radiomics and clinical features was developed and visualized using nomograms.ResultsIn the test cohort, the LightGBM-based radiomics model achieved optimal performance with the Area Under the Curve (AUC) of 0.867, sensitivity of 0.952, and specificity of 0.625. The combined model demonstrated enhanced diagnostic capability with AUC of 0.899, sensitivity of 0.762, and specificity of 0.917. Manual diagnosis of SLAP injury using MRI achieved an accuracy of 50.3%, with a sensitivity of 27.7%, specificity of 78.8%, and AUC of 0.619.ConclusionMachine learning models based on MRI radiomics features demonstrated superior diagnostic accuracy compared to traditional radiologist assessment for SLAP lesions. The combined model incorporating both radiomics and clinical features provides effective risk prediction for SLAP lesions.

ObjectiveTo investigate the clinical efficacy and incidence of complications in the treatment of adult congenital high scapula (Sprengel deformity) using the modified combined Woodward and Green surgical approach.MethodsFrom January 2020 to January 2024, 9 adult patients with congenital Sprengel deformity were treated with the modified Woodward and Green combined procedure. There were two males and seven females, aged 18-35 years (mean: 23.5 ± 4.2 years), with 6 cases on the left and 3 on the right. The surgical procedure involved the modified combined Woodward and Green technique. Postoperatively, routine infection prevention, 4-weeks brace fixation, and rehabilitation guidance were performed. Shoulder appearance was evaluated using the Cavendish grading system; bilateral scapular height difference was measured; and shoulder function was assessed using the UCLA Shoulder Function Rating System, including pain, daily activity ability, range of motion, and muscle strength. Paired t-tests were used to analyze pre- and postoperative data with SPSS 22.0 software.ResultsAll 9 patients were followed up for 12-36 months (mean: 24.11 ± 6.63 months). Postoperatively, shoulder appearance significantly improved, with marked reduction in scapular position, good correction of elevation and shrugging deformities, and near-normal shoulder contour. Cavendish grading improved significantly (p < 0.05). The scapular height difference decreased from 4.50 ± 0.67 cm preoperatively to 0.89 ± 0.77 cm at the last follow-up, and the UCLA shoulder function score increased from 23.44 ± 1.57 to 30.33 ± 0.67, with statistically significant differences (p < 0.001 for both).ConclusionThe modified combined Woodward and Green procedure is a safe and effective treatment for adult congenital Sprengel deformity, significantly improving shoulder appearance and joint function. However, due to the small sample size and short follow-up period, future studies with larger samples and longer follow-ups are needed to accurately evaluate the long-term efficacy.

ObjectiveTo investigate the effects of denosumab on pain relief, bone mineral density (BMD), and refracture risk during long-term follow-up in patients with osteoporotic vertebral compression fractures (OVCF) after percutaneous vertebroplasty, and to identify factors associated with refracture.MethodsThis retrospective study included 396 OVCF patients who underwent percutaneous vertebroplasty and received denosumab between January 2021 and June 2023. Patients were classified into a completed-treatment group (n = 184) and a discontinued-treatment group (n = 212). After 1:1 propensity score matching, 101 patients were included in each group. Changes in visual analog scale (VAS) scores and lumbar spine and femoral neck T-score were compared over 24 months. Refracture risk was assessed using Kaplan-Meier analysis and multivariable Cox regression in the matched cohort.ResultsAfter matching, baseline characteristics were well balanced between groups. Over 24 months of follow-up, the completed-treatment group showed significantly lower VAS scores and greater improvements in lumbar spine and femoral neck T-score compared with the discontinued-treatment group. The incidence of refracture was significantly lower in the completed-treatment group. In the PSM cohort, multivariable Cox regression analysis demonstrated that completed denosumab treatment was independently associated with a lower risk of refracture (HR = 0.314, 95% CI 0.125-0.792, P = 0.014).ConclusionIn patients with OVCF treated with percutaneous vertebroplasty, persistent denosumab therapy for at least 24 months is associated with sustained pain relief, improved BMD, and a lower risk of refracture, underscoring the importance of long-term treatment adherence.

ObjectiveThis study examined the associations of visceral adiposity index (VAI), body roundness index (BRI), and lipid accumulation product (LAP) with the risk, severity, and prognosis of knee osteoarthritis (KOA). The aim was to evaluate the clinical utility of these novel adiposity indices for early screening and prognostic assessment of KOA.MethodsA total of 124 patients with clinically and radiographically confirmed KOA and 120 healthy individuals who underwent routine physical examinations during the same period were enrolled as the KOA and control groups, respectively. Baseline data were collected retrospectively from electronic medical records. KOA patients were further classified into mild, moderate, and severe subgroups based on K-L grading and were followed for 12 months.ResultsCompared with controls, the KOA group had significantly higher BMI, TG, TC, LDL-C, VAI, BRI, and LAP, and lower HDL-C (p < 0.05). VAI, BRI, and LAP increased progressively with KOA severity (p < 0.05), showing positive correlations (r = 0.608, 0.489, 0.551, p < 0.001), and were confirmed as independent risk factors (p < 0.05). ROC analysis yielded AUCs of 0.775 (95% CI: 0.718-0.833; cutoff: 2.91) for VAI, 0.752 (95% CI: 0.692-0.813; cutoff: 5.21) for BRI, and 0.779 (95% CI: 0.722-0.836; cutoff: 48.58) for LAP, with a combined AUC of 0.880 (95% CI: 0.839-0.922). Survival time differed significantly across groups stratified by these cutoffs (VAI: χ² = 4.238; BRI: χ² = 3.956; LAP: χ² = 6.043; all p < 0.05).ConclusionThis study concludes that VAI, BRI, and LAP are closely linked to KOA. Firstly, their levels are significantly raised in patients and show a positive correlation with disease severity, marking them as useful clinical indicators. Secondly, the combined detection of these indices provides superior predictive value for KOA and is associated with an unfavorable prognosis, suggesting their utility in comprehensive risk assessment.

Total knee arthroplasty (TKA) is a frequently performed surgery for restoring function in patients with severe knee osteoarthritis. TKA is associated with significant healthcare costs, partly due to complications leading to readmissions. This study aimed to identify biomarkers predictive of readmission after TKA. Data of adult patients who underwent primary TKA between 2014 and 2022 extracted from the Chang Gung Medical Research Database were retrospectively reviewed. Associations between the monocyte-to-albumin ratio (MAR), red cell distribution with (RDW)-to-albumin ratio (RAR), hemoglobin-to-albumin ratio (HAR), leukocyte-to-albumin ratio (LAR), and platelet-to-albumin ratio (PAR) with 14-day readmission were determined using univariate and multivariable regression analyses. A score termed the 'MAR-LAR-PAR' score was developed using the combination of these 3 markers, and its prognostic value was assessed. Data from 1,137 patients were included. Elevated MAR (adjusted odds ratio [aOR] = 1.77, 95% confidence interval [CI]: 1.08-2.89, p = 0.022), LAR (aOR = 1.59, 95% CI: 1.02-2.45, p = 0.039), and PAR (aOR = 1.88, 95% CI: 1.12-3.15, p = 0.016) were significantly associated with increased risk of 14-day readmission. The highest MAR-LAR-PAR score (score = 3) was significantly associated with 14-day readmission compared to score = 0 (aOR = 4.24, 95% CI: 1.91-9.44, p < 0.001). This study highlights the potential of MAR, LAR, PAR, and the score based on their combination, as significant predictors of short-term readmission following TKA. Incorporating these biomarkers into preoperative assessment may help determine the risk of readmission, and provide additional care for these patients.

PurposePatients withspinal degenerative diseases are often older and have multiple comorbidities. This study aims to evaluate the impact of epidural patient-controlled analgesia (PCA) on postoperative pain relief in patients undergoing lumbar spine surgeries for spinal degenerative diseases.MethodsThis retrospective case-control study included patients who underwent lumbar spine surgeries for degenerative spinal stenosis, spondylolisthesis, herniated intervertebral discs, or osteoporotic spinal fractures with spinal stenosis. The PCA group consisted of patients who received 72-h epidural PCA for postoperative pain control, while the control group received standard postoperative pain management. All patients were allowed to request intramuscular rescue analgesics for additional pain control. The primary endpoint was defined as the mean visual analogue scale (VAS) score during the effective PCA period (postoperative day [POD] 1-3). Secondary endpoints included individual daily VAS scores, rebound pain, rescue analgesic injections, morphine consumption, drainage duration, drainage volume, length of hospital stay, and complications.ResultsA total of 209 patients (mean age 73.8 years) were included, with 88 patients in the PCA group and 121 in the control group. Mean VAS score across POD 1-3 was significantly lower in the PCA group (Cohen's d = -1.89, 95% CI = -2.22 to -1.56, p < 0.001). During hospitalization, the PCA group required significantly fewer rescue analgesic injections (Cohen's d = -2.47, 95% CI = -2.84 to -2.11) and less total morphine consumption (Cohen's d = -0.39, 95% CI = -0.67 to -0.11) compared to the control group. Although the PCA group experienced greater drainage volume and longer duration of drainage placement, the incidence of infection and the length of hospital stay were comparable between the two groups.ConclusionIn this real-world cohort of elderly patients with multiple comorbidities undergoing lumbar spinal surgery, epidural PCA provided effective pain relief without an observed increase in infection rates in this study population.

PurposeThis study aimed to evaluate the efficacy and safety of an elastic constriction ring compared to traditional pneumatic tourniquets in patients undergoing surgery for closed distal radius fractures.MethodsA total of 60 participants were enrolled, with 30 in the experimental group (elastic constriction ring) and 30 in the control group (traditional tourniquet). Key indicators assessed included preoperative exsanguination time, intraoperative blood loss, tourniquet-related complications, and so on.ResultsThe experimental group demonstrated a significantly shorter average exsanguination time (8.36 ± 2.72 s vs 55.98 ± 3.61 s) and lower intraoperative blood loss (12.07 ± 6.54 mL vs 17.07 ± 8.29 mL). No significant differences were observed in tourniquet time or operation time between the groups. Besides, adverse events related to the device are minimal in two groups.ConclusionsThe elastic constriction ring is an effective alternative to traditional pneumatic tourniquets, offering significant advantages in reducing exsanguination time and intraoperative blood loss without increasing complication rates.

ObjectivesThis study compared outcomes of primary repair and palmaris longus tendon reconstruction in patients with lateral ulnar collateral ligament (LUCL) injuries.Material and MethodA retrospective comparative cohort study was conducted between 2017 and 2023, including 40 patients who underwent surgery for elbow dislocation or fracture-dislocation with intraoperatively confirmed LUCL injury. Surgical choice was made intraoperatively: repair was performed if the ligament could be reattached without tension, while reconstruction was selected if the tissue was shortened, retracted, or degenerative. Patients were divided into a repair group (n = 17) and a reconstruction group (n = 23). Clinical outcomes included Visual Analog Scale (VAS), Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH), Mayo Elbow Performance Score (MEPS), range of motion (ROM), fracture healing, and complications, with a mean follow-up of 26.4 months.ResultsThe repair group showed mean VAS 16.2, QuickDASH 9.7, MEPS 89.9, and ROM 137.2°, while the reconstruction group had VAS 17.2, QuickDASH 8.4, MEPS 89.0, and ROM 133.6°. There were no significant differences in VAS, QuickDASH, or MEPS, though the repair group demonstrated superior ROM (p = 0.029). The absolute ROM difference (∼3-4°) was not considered clinically meaningful. In isolated LUCL cases (n = 15), no significant differences were observed between groups. All associated fractures achieved union without non-union or malunion. Complications included heterotopic ossification in seven patients (three repairs, four reconstructions) and two superficial infections, all successfully managed without reoperation. No patient developed recurrent instability, nerve deficits, or clinically significant stiffness.ConclusionBoth primary repair and palmaris longus tendon reconstruction provided satisfactory outcomes and durable stability. Although the repair group showed slightly greater ROM, this difference was not clinically relevant and disappeared when patients with concomitant fractures were excluded. Injury complexity, rather than surgical technique, appears to be the main determinant of long-term function.

ObjectiveTo evaluate and compare pain management, complication patterns, and functional outcomes between cannulated screw and Kirschner wire fixation for treating pediatric medial epicondylar fractures.MethodA retrospective cohort study was conducted at a tertiary hospital from 2013 to 2023, involving 31 pediatric patients with displaced medial epicondylar fractures (Watson-Jones Types III and IV). Patients were divided into two groups: 16 received cannulated screw fixation, while 15 underwent Kirschner wire fixation. Clinical outcomes, including operation time, fracture healing, pain levels, and complications, were assessed.ResultsBoth groups demonstrated similar long-term functional outcomes, with no significant difference in Mayo Elbow Performance Scores (p > 0.05). The cannulated screw group experienced significantly lower pain on the third postoperative day compared to the Kirschner wire group (p < 0.001). The Kirschner wire group had a higher rate of pin-track infections (13.3%) and delayed union (6.7%), whereas the cannulated screw group had fewer complications, with one case of superficial wound infection. Hardware removal occurred significantly earlier in the Kirschner wire group (p < 0.001).ConclusionBoth fixation methods offer effective treatment for pediatric medial epicondylar fractures, with cannulated screws providing better pain control and fewer complications but requiring longer retention. Kirschner wires allow for earlier removal but carry a higher risk of infection and delayed healing. Treatment decisions should be individualized, considering factors such as pain sensitivity, family preferences, and medical resources.

ObjectiveThe feasibility of placing longer, larger diameter double-threaded screws into the pedicle for good fixation in osteoporotic patients with lumbar spondylolisthesis was investigated via robot-assisted optimal access planning.MethodA total of 80 patients with degenerative lumbar spondylolisthesis needed posterior incision decompression and bone grafting combined with pedicle screw fixation due to spondylolisthesis. The patients were equally and randomly assigned to a robot-assisted group and a bone cement-strengthened group. The operative time, intraoperative blood loss, and intraoperative radiation dose were recorded. X-ray and CT scans were routinely reviewed after the surgery. The ratio of screw diameter to pedicle width (SD/PW) was calculated. The pedicle position was graded. The Bub score assessed proximal facet joint invasion. Visual analogue pain scale (VAS) was recorded before surgery and 3 days after surgery. The Oswestry Disability Index (ODI) and health Survey Summary Form (SF-36 to assess patients' quality of life) were performed before surgery and 6 months after surgery. The rate of screw loosening, removal, complications and revision were evaluated by X-ray and CT 12 months after operation.ResultsVAS score on day 3 after surgery was significantly better in the robot-assisted group than in the bone cement-strengthened group. (p = 0.027). The operative time and intraoperative radiation dose of the robot-assisted group were lower than those of the bone cement-strengthened group (p < 0.001). The ratios of screw length, screw diameter, and SD/PW in both groups were significantly better in the robot-assisted group than in the bone cement-strengthened group (p < 0.001). The incidence of screw small joint invasion was 10.2% in the robot-assisted group and 19.1% in the bone cement-strengthened group, with a statistically significant difference between the two (p = 0.020). The Oswestry Disability Index (ODI) and Health Survey Summary Form (SF-36) at 6 months after surgery were significantly improved in both groups.ConclusionPatients with osteoporotic lumbar spondylolisthesis who use robot assistance to implant longer, thicker-diameter double-threaded screws achieved a similar fixation effect as those of bone cement-reinforced screws. Meanwhile, the operation time was shorter, the radiation damage was less, and the difficulty of later revision surgery was reduced. Thus, the proposed surgical protocol can be applied as a new option for patients with osteoporotic lumbar spondylolisthesis.