Journal of Orthopaedic Surgery and Research最新文献

Background: Achieving bony fusion after anterior cervical corpectomy and fusion is crucial for restoring spinal stability; however, the risk factors associated with fusion failure, or pseudarthrosis, remain unclear. This study aims to identify risk factors for pseudarthrosis following anterior cervical corpectomy and fusion and evaluate the impact of C2 slope and uncovertebral joint degeneration on this condition.

Methods: Patients who underwent single-level anterior cervical corpectomy and fusion between May 2015 and April 2022 and had a minimum of 2 years of computed tomography follow-up were retrospectively enrolled. Preoperative demographic, surgical, clinical, and radiographic data were collected. Patients were divided into fusion and pseudarthrosis groups based on fusion status evaluated at the final follow-up computed tomography. After identifying statistically significant variables through intergroup comparisons, multivariate logistic regression analysis was conducted to determine the risk factors for pseudarthrosis.

Results: A total of 102 patients were included in the study, with an average follow-up duration of 3.78 ± 1.70 years. At final follow-up, 37 patients (36.3%) developed pseudarthrosis, while 65 patients (63.7%) achieved fusion. No significant differences were observed in demographic and clinical parameters between the groups. The pseudarthrosis group exhibited significantly greater preoperative C2-7 Cobb angles (p = 0.029), segment range of motion (p < 0.001), lower C2 slope (p < 0.001), and less severe uncovertebral joint degeneration grades (p = 0.001). Multivariate logistic regression analysis revealed that, after adjustment, greater segment range of motion (p = 0.003), lower C2 slope (p = 0.006), and milder uncovertebral joint degeneration grades (p = 0.023) were significant risk factors for pseudarthrosis following single-level anterior cervical corpectomy and fusion. The area under the curve of the regression model was 0.867.

Conclusions: Lower preoperative C2 slope, greater segment range of motion, and milder uncovertebral joint degeneration grades may be risk factors for pseudarthrosis following anterior cervical corpectomy and fusion. These characteristics should be further considered in surgical planning to identify high-risk patients.

Background: Accurate measurement of the spinal alignment parameters is crucial for diagnosing and evaluating adolescent idiopathic scoliosis (AIS). Manual measurement is subjective and time-consuming. The recently developed artificial intelligence models mainly focused on measuring the coronal Cobb angle (CA) and ignored the evaluation of the sagittal plane. We developed a deep-learning model that could automatically measure spinal alignment parameters in biplanar radiographs.

Methods: In this study, our model adopted ResNet34 as the backbone network, mainly consisting of keypoint detection and CA measurement. A total of 600 biplane radiographs were collected from our hospital and randomly divided into train and test sets in a 3:1 ratio. Two senior spinal surgeons independently manually measured and analyzed spinal alignment and recorded the time taken. The reliabilities of automatic measurement were evaluated by comparing them with the gold standard, using mean absolute difference (MAD), intraclass correlation coefficient (ICC), simple linear regression, and Bland-Altman plots. The diagnosis performance of the model was evaluated through the receiver operating characteristic (ROC) curve and area under the curve (AUC). Severity classification and sagittal abnormalities classification were visualized using a confusion matrix.

Results: Our AI model achieved the MAD of coronal and sagittal angle errors was 2.15° and 2.72°, and ICC was 0.985, 0.927. The simple linear regression showed a strong correction between all parameters and the gold standard (p < 0.001, r² ≥ 0.686), the Bland-Altman plots showed that the mean difference of the model was within 2° and the automatic measurement time was 9.1 s. Our model demonstrated excellent diagnostic performance, with an accuracy of 97.2%, a sensitivity of 96.8%, a specificity of 97.6%, and an AUC of 0.972 (0.940-1.000).For severity classification, the overall accuracy was 94.5%. All accuracy of sagittal abnormalities classification was greater than 91.8%.

Conclusions: This deep learning model can accurately and automatically measure spinal alignment parameters with reliable results, significantly reducing diagnostic time, and might provide the potential to assist clinicians.

Objective: This retrospective study aimed to conduct a comparative analysis of the impact of high tibial osteotomy (HTO) and supramalleolar osteotomy (SMOT) on lower limb alignment and ankle function after surgery.

Methods: A cohort of patients who underwent either HTO (n = 63) or SMOT (n = 51) for lower limb alignment issues was included in the study. Inclusion criteria comprised individuals who underwent the surgical procedures between June 2018 and June 2021; exclusion criteria encompassed incomplete medical records and inadequate follow-up data. Baseline characteristics, weight-bearing line ratios, ankle joint function, and lower limb lines of force were evaluated before surgery, postoperatively, and at the 6-month follow-up. Statistical analyses were performed to compare the outcomes between the HTO and SMOT groups, as well as between non-deviated and deviated subgroups. Spearman rank correlation analysis was used to reveal correlations between variables.

Results: The preoperative and immediate postoperative weight-bearing line ratios were similar between the HTO and SMOT groups. However, a notable difference emerged at the 6-month follow-up, suggesting distinct impacts of the two procedures on lower limb alignment. Additionally, the HTO group exhibited superior postoperative outcomes in ankle joint function, specifically in pain alleviation and functional improvement, compared to the SMOT group. The analysis of lower limb lines of force demonstrated a significant association between the surgical procedure and alterations in lower limb biomechanics, emphasizing the differential impact of HTO and SMOT. Furthermore, the comparison between non-deviated and deviated subgroups highlighted the potential impact of lower limb alignment on postoperative ankle function.

Conclusion: The findings contribute valuable insights into the comparative effectiveness of HTO and SMOT in addressing lower limb alignment and ankle function. This study's results have significant implications for orthopedic treatment and may guide treatment strategies for patients undergoing lower limb realignment surgery, ultimately enhancing the quality of life for affected individuals.

Background: Vacuum assisted closure (VAC) is an effective treatment that promotes wound healing in clinical practice. However, the pain caused by Vacuum assisted closure VAC dressing removal is still a challenge for patients and medical staff. The purpose of this study was to investigate the analgesic effect and safety of premixed nitrous oxide/oxygen in the treatment of pain caused by VAC dressing removal.

Methods/design: This study is a single center, randomized, placebo-controlled, double-blind clinical trial. A total of 100 patients requiring VAC dressing removal were recruited and randomly divided into an intervention group and a control group. The intervention group will receive routine treatment plus a premixed nitrous oxide/oxygen mixture, and the control group will receive routine treatment plus oxygen. Participants and researchers are all blind to the operation process. The results of each group will be monitored at baseline (T0), 5 min after intervention (T1), and 5 min after finishing intervention (T2), 15 min after finishing intervention (T3). The primary outcome measure was pain intensity. Secondary outcomes included physiological parameters, adverse reactions, operators, and patients' satisfaction.

Discussion: This study will explore the analgesic effect of oxide/oxygen mixture on VAC dressing removal. If it is beneficial to patients with VAC dressing change, it will be helpful for pain management of VAC dressing removal.

Trial registration: Chinese Clinical Trial Register ChiCTR2200056742. Registered on February 13, 2022.

Introduction: Uncoupled bone remodeling in the subchondral bone (SB) has recently been considered as an important process in the progression of knee osteoarthritis (KOA). In this study, we aimed to investigate changes in SB and articular cartilage using a mouse model of destabilization of the medial meniscus (DMM) and determine the effects of bone metabolism on KOA progression.

Methods: DMM or sham surgery was performed on the left knees of 40-week-old male wild-type (WT) mice and Tsukuba hypertensive mice (THM), which exhibit high-turnover bone metabolism. Bone volume/tissue volume (BV/TV) and bone mineral density (BMD) in the medial tibial SB were measured longitudinally in vivo using μCT at 0 (immediately after surgery), 1, 2, 4, 8, and 12 weeks postoperatively. Concurrently, histological evaluations of the articular cartilage in the medial tibial plateau were conducted. Furthermore, the number of endo-periosteal tartrate-resistant acid phosphatase-positive osteoclasts, trabecular RANKL-positive osteocytes, and osteocytes in the trabeculae were measured at 0, 1, 2, and 4 weeks.

Results: In the WT + DMM group, BV/TV and BMD in the SB significantly decreased with time, whereas cartilage degeneration significantly increased. In the THM + DMM group, these changes in BMD and cartilage degeneration were significantly pronounced. Interestingly, in the THM + DMM group, BV/TV significantly decreased up to 4 weeks but then began to increase, although BMD continued to decrease until the 12-week mark. The number of osteoclasts and the percentage of RANKL-positive osteocytes per total number of osteocytes within the total trabecular bone area (%) in the WT + DMM group significantly increased with time, with a significant difference between the WT + DMM and WT + sham groups at 4 weeks. The number of osteocytes in the WT + DMM group significantly decreased with time, and the difference between the WT + DMM and WT + sham groups was significant at 4 weeks postoperatively. These histological changes were significantly enhanced in the THM + DMM group.

Conclusions: The results indicate that early-stage osteocyte death in the SB and RANKL-mediated osteoclastic SB loss precede histological cartilage degeneration and contribute to uncoupled bone remodeling at the later stage. Acceleration of disease processes in the THM + DMM group suggests that high-turnover bone metabolism is a potential risk factor for KOA. Maintaining SB integrity and avoiding continuous SB overload may be key strategies for mitigating disease progression.

Introduction: To evaluate the structural and functional relationship between medial meniscus posterior root tear (MMPRT) and anterior cruciate ligament (ACL), the aim was to assess the structure and elasticity of the ACL in patients with MMPRT and to measure tibial anterior translation.

Materials and methods: Between January and June 2024, 56 patients (study group) were diagnosed with unilateral MMPRT on magnetic resonance imaging (MRI) and 31 healthy volunteers (control group) were included in the study. While the tibial anterior translation of the patients was evaluated using the KT 1000 device, the structure and stiffness of the ACL were assessed with ultrasound shear wave elastography (SWE). The tibial slope measurement was taken at 30 degrees of knee flexion on true lateral radiographs where the femoral condyles overlapped.

Results: A total of 87 participants were included in the study, consisting of 31 volunteers (25 females, 6 males) and 56 patients diagnosed with MMPRT (48 females, 8 males). The average SWE values of the ACL were compared between the study group (26.6 ± 8.9 kPa) and the control group (21.2 ± 5.7 kPa), with the study group demonstrating a significantly higher value (p: 0.004). In patients with MMPRT, the measurements of anterior translation using the KT 1000 device were an average of 6.19 ± 1.4 mm in the affected knees and 4.9 ± 0.78 mm in the unaffected knees. The comparison revealed a significantly greater anterior translation in the knees with MMPRT (p < 0.05). Multivariable regression analysis demonstrated a significant positive relationship between ACL SWE values and tibial slope (β = 1.11; CI, 0.24-1.99; P: 0.01).

Conclusions: Greater tibial anterior translation was observed on the side with MMPRT in the patients. There is a correlation between MMPRT and the stiffness of the ACL, which exhibits a higher elastic modulus. Additionally, an increase in tibial slope significantly affects the stiffness of the ACL.

Level of evidence: Level III, retrospective cohort study.

Background: Osteonecrosis of the femoral head can be a debilitating disease leading to collapse of the femoral head and the subsequent need for a hip arthroplasty. Core decompression has emerged as a leading treatment to prevent collapse. Adjunctive therapies, such as bone graft, bone marrow aspirate concentrates, or synthetic bone substitutes are utilized to promote native bone regeneration. Determining the amount of bone resected and the volume of adjunct required is challenging, especially with newer minimally invasive reamers. Under- or over-filling the defect may impact progression of the disease or cause morbidity.

Surgical technique: We introduce a mathematical method to be utilized intraoperatively to calculate the volume of bone resected during core decompression with an expandable reamer. This method approximates the core decompression defect as two cylinders using measurements that can be easily taken during the procedure and can be adapted for use with any of the expandable reamer systems available. Using this technique, surgeons can calculate the size of the defect created, which can be used to personalize the amount of adjunct delivered to each patient.

Conclusions: When adjunctive therapies are used with core decompression to treat ONFH, care must be taken when filling the core decompression defect to avoid under- or over-filling the defect, potentially increasing the risk of complications or reducing the efficacy of the procedure. We provide a simple worksheet that can be used by surgeons to help determine how much adjunct should be used.