Journal of Orthopaedic Surgery最新文献

IntroductionProximal tibia osteotomy has advanced with various techniques, such as dome and modified oblique osteotomies, to correct angular deformities and redistribute knee stress, thereby slowing arthritic progression. Despite advancements, a gap remains in understanding the biomechanical strengths of these techniques, especially concerning correction angles. The study aims to compare the stability of the construct for different degrees of osteotomy.Materials and methodsEighteen synthetic tibias were osteotomised based on the dome and modified oblique osteotomy technique. For dome osteotomy, the osteotomy site was fixed with two Kirschner wires 2.0 mm for different degrees of osteotomy, which were 10^o, 20^o, and 30^o. Three samples from each construct were tested for rotational force. For modified osteotomy, two screws 3.5 mm were used to fix the osteotomy site and tested for rotational forces.ResultsThe constructs were stiffest at ten degrees for rotational force, both in dome and modified oblique osteotomy (0.39 Nmm and 0.4 Nmm). The stiffness of dome osteotomy in correction angles of 10° and 20° is almost similar (p > 0.95), and it reduces significantly at 30°(p < 0.001). There were significant differences in stiffness of the oblique osteotomy construct when comparing 10° with 20° (p = 0.003), 10° with 30°(p < 0.001) and 20° with 30° (p < 0.001) correction angles. This is further proved by comparing the means of stiffness between the two methods, where dome osteotomy did better compared to modified oblique osteotomy at 20° and similar at 10°.ConclusionIn performing proximal tibia osteotomy, we recommend limiting the acute angle of correction to 20°, and we suggest that for a larger correction angle, dome osteotomy exhibits better biomechanical stiffness. An angle exceeding 30^o will predispose to higher rate of non-union or malunion as the stiffness of the surgical construct drops significantly, making it less resistant to rotational forces.

BackgroundKey instruments used in posterior cervical expansive open-door laminoplasty (CEOL), such as the high-speed drill (HSD) and the ultrasonic bone scalpel (UBS), are selected based on surgeon preference. However, skepticism remains among some surgeons regarding the superiority of the HSD over the widely used UBS, necessitating a scientific evaluation of its practical utility.ObjectiveTo evaluate the efficacy and safety of the ultrasonic bone scalpel compared to the high-speed drill in cervical expansive open-door laminoplasty using a posterior cervical approach in a prospective randomized controlled trial.MethodsThis prospective study, conducted after obtaining prior informed consent, involved 40 patients diagnosed with cervical degenerative diseases who underwent cervical expansive open-door laminoplasty between July 2018 and June 2021. The patients were randomly divided into two groups: the ultrasonic bone scalpel group (n = 20) and the high-speed drill group (n = 20). Surgeons could not be blinded due to the nature of the intervention, but outcome assessors were blinded to group allocation where feasible. Surgical time, open-door time, intraoperative blood loss, postoperative drainage loss, post-operative complications, and functional outcomes were compared between the two groups.ResultsNo statistically significant difference was observed between the two groups in terms of intraoperative blood loss, post-operative complications, screw migration, plate fracture, or spinal cord expansion. However, the ultrasonic bone scalpel group demonstrated significantly shorter surgical time, open-door time, and reduced postoperative drainage loss compared to the high-speed drill group (p < .05). The reduced drainage volume may be attributed to thermal sealing of small vessels by the UBS rather than solely reduced tissue trauma. No significant differences were observed in the Visual Analog Scale (VAS) scores, bony union at the hinge, or Japanese Orthopedic Association (JOA) score improvement rates between the two groups at 1 week, 3 months, and 1 year postoperatively. While the UBS group showed numerical reductions in complication rates (e.g., dural tear: 0% vs 5%, p = .311), these differences did not reach statistical significance, likely due to the limited sample size.ConclusionsThe study concluded that USB significantly reduces operation time, open-door time, and postoperative drainage loss. However, the study's limited sample size may have been insufficient to detect differences in complication rates between groups.

This study aimed to assess the biomechanical stability of pedicle screws combined with titanium mesh bone grafting for spinal reconstruction and fixation during surgery for lumbar spine (L4-L5) tuberculosis using the finite-element method. A model of the L1-sacral segment of the human body was developed using the finite-element method. After verifying its effectiveness, a postoperative model was developed for treating vertebral tuberculosis at the L4-L5 level, which involved implanting an interbody titanium mesh and securing it with pedicle screws. Subsequently, the internal fixation materials and bone stress at L4 and L5 were analyzed. The verification of the finite element model proved to be effective. The titanium mesh exhibited a maximum von Mises stress of 477.9 MPa during forward bending and a minimum of 229.9 MPa during backward extension. The stress concentration was primarily observed at the cut edges, screws, and connections. Similarly, the rod experiences a maximum stress of 235.8 MPa when leaning to the right and a minimum of 101.4 MPa during backward extension. High-stress areas were identified on the screws and connecting rods. In the titanium mesh model, the maximum von Mises stresses on L4 and L5 reached 215.9 MPa during forward bending and exceeded 90 MPa in five directions. In the treatment of lumbar tuberculosis, titanium mesh fusion and pedicle screw-reinforced fixation carry the risk of prosthesis subsidence and screw breakage. Therefore, patients receiving this treatment should be cautious and avoid excessive forward and lateral flexion movements.

BackgroundOsteoporosis (OP) is a progressive metabolic disorder resulting from an uncoupling of bone formation and breakdown processes.ObjectivesThis study mainly explored the effects of lncRNA DUXAP8 on the biological functions and osteogenic potential of hBMSCs (human bone marrow mesenchymal stem cells).MethodsThis study enrolled 35 OP patients and 35 healthy individuals. The expression profiles of lncRNA DUXAP8 and miR-24-3p in serum and cells were analyzed using RT-qPCR. Additionally, osteogenic marker expression at mRNA and protein levels was assessed. The proliferation ability of hBMSCs was evaluated by CCK-8 assay, with cell motility and invasiveness assessed by Transwell assay. The regulatory relationship between lncRNA DUXAP8 and miR-24-3p was verified by Dual-Luciferase.ResultsSerum lncRNA DUXAP8 levels were reduced in OP patients, with an AUC of 0.967 (95% CI: 0.931-1.000), sensitivity 0.914, and specificity 0.943. Inhibition of lncRNA DUXAP8 decreased osteogenic markers (mRNA/protein) and hBMSCs proliferation, migration, invasion, while overexpression had opposite effects. LncRNA DUXAP8 targeted miR-24-3p, and miR-24-3p overexpression reversed the promoting effects of oe-DUXAP8 on hBMSCs functions.ConclusionLncRNA DUXAP8 in the serum of OP patients is decreased. LncRNA DUXAP8 has a high diagnostic value for patients with OP. Overexpression of lncRNA DUXAP8 may enhance hBMSCs' proliferative and osteogenic potential by targeting miR-24-3p.

The Achilles tendon is one of the most robust tendons of the human body, and unfortunately, the most ruptured. Historically, surgical management was the golden standard, aiming to restore baseline activity with low re-rupture rates. With the development of new functional rehabilitation protocols, the paradigm started shifting towards nonoperative approaches, to avoid surgical complications. Moreover, the introduction of adjunct therapies, such as low-level laser therapy, extracorporeal shockwave therapy, or plasma-rich-protein injections, widened the scope of treatment. While both surgical and nonoperative approaches have demonstrated comparable outcomes, an ideal treatment algorithm is still a subject of debate. This literature review meticulously studies major trends in surgical and nonoperative management of acute Achilles tendon ruptures, describing most prevalent techniques and protocols, comparative results, and complication rates. It also highlights the latest updates on the use of adjunct therapies and injections, aiming to guide clinical decision making in treating this common injury.

Total hip and knee arthroplasty are common surgical procedures aimed at improving mobility and quality of life. Despite surgical advances, postoperative complications remain a concern, particularly for patients with comorbidities and poor nutritional status. Immunonutrition, the targeted administration of nutrients that modulate inflammation, such as arginine, omega-3 fatty acids, and antioxidants, has been shown to reduce infections, complications in wound healing, and shorten hospital length of stay. This review examines current evidence on the role of immunonutrition in hip and knee arthroplasty, focusing on the mechanisms of key nutrients, clinical application of supplementation, and areas for future investigation. Despite promising outcomes, further research is needed within orthopedics to establish guidelines for patient screening, nutrient dosage, and timing of administration.

ObjectiveIt aimed to explore the nursing effect of intermittent pneumatic compression pump (IPC) plus enteral nutrition support (ENS) in the prevention of deep venous thrombosis (DVT) in lower limbs of patients after orthopedic surgery (OS).Methods235 patients who underwent hip joint surgery between January 2021 and January 2022 were enrolled as regular group (RG, routine care plan), and 268 patients who underwent hip joint surgery between February 2022 and February 2023 were enrolled as joint group (JG, IPC combined with ENS care plan). The RG only received routine nursing, and the JG received IPC plus ENS nursing. The subjects' coagulation indicators, DVT incidence, postoperative recovery, and other indicators were sorted out.ResultsAfter IPC plus ENS nursing, hemoglobin (Hb) and platelet (PLT) in the JG were visibly lower as against the RG (p < .05); As against the RG, the diameter of bilateral common femoral vein (CFV) did not decrease, and the maximum blood flow velocity (BFV) and average BFV of bilateral CFV were visibly higher in the JG (p < .05). In the JG, fibrinogen (FIB), prothrombin time (PT), activated partial thromboplastin time (APTT) were visibly increased, while D-dimer (D-D) and thrombin time (TT) were visibly decreased; the incidence of DVT was visibly lower; the immobile time in bed and hospital stay was visibly shortened, and the nursing satisfaction of patients was visibly increased (all p < .05).ConclusionIPC plus ENS in the nursing of patients after OS can effectively reduce the incidence of DVT and promote postoperative recovery.

IntroductionProximal femoral tumor resection poses a major challenge in orthopaedic oncology, particularly in very young pediatric patients (<9 years), where the need to preserve function and limb length collides with the limited availability of reconstructive options (3D-printed implants, endoprostheses, biological constructs such as vascularized fibular grafts, and allograft-prosthetic composites) or leads to amputation.ObjectiveTo describe in detail the surgical technique for proximal femoral tumor resection and reconstruction using an allograft-prosthetic composite (APC) with a proximal humerus allograft plus a hip prosthesis, documenting its applicability and outcomes regarding function, allograft survival, and oncologic disease status in two pediatric cases treated at a national cancer referral center in Bogotá, Colombia.MethodsWe report two pediatric cases and detail the surgical technique used for proximal femoral reconstruction after tumor resection, based on an APC (proximal humerus allograft + hip prosthesis). Data were collected from medical records with radiological and functional follow-up.ResultsIn both patients, proximal femoral reconstruction using our technique yielded a stable construct with preservation of limb function (MSTS >72), documented graft incorporation at 3 months, local disease control, and only one recorded complication (contact dermatitis).ConclusionProximal femoral reconstruction using an APC with a proximal humerus allograft is a viable and safe surgical option in pediatric patients with Ewing sarcoma. In our experience, the technique was successfully applied in two patients, allowing limb preservation with a favorable course. Thus, it offers a functional and reliable option for limb salvage in selected cases.