Journal of Orthopaedic Surgery and Research最新文献

Background: Hidden blood loss (HBL) is a notable complication in spinal endoscopic procedures. This study aims to compare tissue damage and hidden blood loss between two minimally invasive spinal techniques: unilateral biportal endoscopic lumbar discectomy (UBE) and percutaneous endoscopic interlaminar discectomy (PEID). Furthermore, the study examines the risk factors contributing to hidden blood loss in each procedure.

Patients and methods: A single-center retrospective cohort study was conducted on 86 patients who underwent unilateral biportal endoscopic lumbar discectomy (UBE) and 73 patients who received percutaneous endoscopic interlaminar discectomy (PEID) between January 2021 and December 2023.Demographic data, blood loss parameters, and serum levels of creatine kinase (CK) and C-reactive protein (CRP) were recorded. Pearson or Spearman correlation analyses were conducted to evaluate associations between patient characteristics and HBL. Additionally, multiple linear regression analysis was used to identify independent risk factors for HBL.

Results: A total of 159 consecutive patients were included in this study, consisting of 83 females and 76 males. The average hidden blood loss (HBL) was 431.00 ± 160.52 ml in the UBE group and 328.40 ± 87.71 ml in the PEID group, showing a statistically significant difference (P < 0.05). Pearson or Spearman correlation analysis indicated that in the UBE group, HBL was associated with operation time, preoperative hematocrit (Hct), ASA classification, and paraspinal muscle thickness. In the PEID group, HBL was correlated with operation time, preoperative activated partial thromboplastin time (APTT), paraspinal muscle thickness, and the presence of diabetes (P < 0.05). Multiple linear regression analysis demonstrated a positive correlation between HBL and operation time in both groups (P < 0.05), identifying operation time as an independent risk factor for HBL. Furthermore, CRP and CK levels were generally lower in the PEID group compared to the UBE group, particularly on postoperative day 3 for CRP and postoperative day 1 for CK. Both total blood loss and hidden blood loss were significantly lower in the PEID group than in the UBE group.

Conclusion: Compared to UBE, PEID shows superior results regarding surgical trauma, total blood loss, hidden blood loss (HBL), and postoperative hematocrit (Hct) reduction. Consequently, PEID is recommended as the treatment of choice for younger patients or those with compromised baseline perioperative conditions.Additionally, Hidden blood loss remains a critical factor, and surgical duration presents a shared risk in both procedures.

Photodynamic implants are an increasingly popular minimally invasive option for the surgical treatment of metastatic bone disease. Following surgery, adjuvant radiation therapy (RT) is frequently administered to achieve better disease control and improve patient quality of life, but the role of RT in implant failures associated with photodynamic implants remains unclear. The aim of this study is to determine if the therapeutic RT range of 10-50 Gy affects the biomechanical properties of photodynamic implants. For the experimental group, 15 photodynamic implants were divided evenly into 5 groups that were exposed to different doses of RT (10, 20, 30, 40 and 50 Gy). The control group consisted of 14 non-irradiated photodynamic implants. Four-point bending tests were conducted on all implants to determine bending stiffness. One-way ANOVA was conducted. Bending stiffness (N/mm) mean ± standard deviation for the non-irradiated control group was 38.0 ± 1.2. Bending stiffness (N/mm) mean ± standard deviation for the irradiated experimental groups was 39.2 ± 1.0. No significant difference was found between any groups. RT doses at a range of 10-50 Gy do not affect the bending stiffness of photodynamic implants. The yield and ultimate failure loads were 263.4 ± 5.2 (N) and 305.9 ± 5.5 (N) in the non-irradiated group vs. 266.8 ± 6.4 (N) and 306.8 ± 6.4 (N) in the irradiated group, respectively. The lack of statistical significance in the difference in stiffness, yield, and ultimate load properties among the groups means that it is less likely that RT at the evaluated doses contributes to intrinsic implant failure. Further studies need to be conducted to conclude the potential effect of RT on other mechanical properties of photodynamic implants.

Background: Hip fracture and multimorbidity represent significant health challenges for older people. Despite evidence that orthogeriatric co-management improves hip fracture management and patients' health outcomes, there is little evidence to understand its effectiveness for patients with multimorbidity. The study aimed to assess the effect of the orthogeriatric co-management care model on older hip fracture patients with multimorbidity.

Methods: This study was a post-hoc analysis of a recently completed trial. Patients were admitted to three urban hospitals and three suburban hospitals in Beijing, with diagnosed hip fracture. One urban hospital (intervention group) implemented the orthogeriatric co-management, while other hospitals (control group) continued orthopedics-led usual care. All enrolled patients were followed-up for three times within one year. Study outcome was patients' one-year cumulative adverse events, including re-operation, complication and death. Logistic regression models were used to compare the differences between the intervention and control groups, with adjustment for all potential confounders.

Result: A total of 2,071 patients with hip fracture (1,110 intervention, 961 control) were included. More than half of the patients had multimorbidity. Hypertension and diabetes were the leading disease cluster, while hypertension was the most prevalent disease condition across all observed disease clusters. Older hip fracture patients with multimorbidity in the intervention group saw a significantly reduced risk of adverse events compared to the control group (Odds Ratio = 0.59, 95% Confidence Interval: 0.48 to 0.73).

Conclusion: Multimorbidity is common among older hip fracture patients. Orthogeriatric co-management provides better outcomes for patients with multimorbidity, in reducing the risk of adverse events after a hip fracture.

Clinical trial registration information: The study was a post-hoc analysis using data from a non-randomized controlled trial. Registry name: Services Mapping Among Older Adults With Hip Fracture (HiFit) ClinicalTrials.gov ID: NCT03184896 URL: https://clinicaltrials.gov/study/NCT03184896.

Background: Patients with L4-S1 lumbar degenerative disease (LDD) with osteoporosis are prone to sacral-screw loosening during spinal internal fixation. We aimed to compare the clinical efficacy and imaging results of sacral bicortical, tricortical, and polymethylmethacrylate (PMMA)-augmented pedicle-screw fixation in the treatment of L4-S1 LDD with osteoporosis.

Methods: This is a retrospective study, 72 patients were enrolled and divided into three groups according to the S1-screw fixation method: PMMA-augmented pedicle-screw fixation (Group A, n = 26), bicortical fixation (Group B, n = 22), and tricortical fixation (Group C, n = 24). The visual analog scale (VAS) and Oswestry disability index (ODI) were recorded preoperatively and at the last follow-up, and the postoperative complications, screw-loosening rate, and fusion rate were compared between the three groups.

Results: Upon the last follow-up, the VAS and ODI scores of the three groups were significantly improved compared with those recorded preoperatively. The VAS and ODI scores of Group A were significantly smaller than those of Groups B and C (P < 0.05), with no significant difference between Groups B and C. Moreover, the screw-loosening rate of Group A was significantly lower than that of Groups B and C (P < 0.05), with no significant difference between Groups B and C. No significant difference was noted in postoperative complications, bone-cement leakage rates, and intervertebral fusion rates among the three groups. Furthermore, we found that osteoporosis and change of lumbar lordosis(LL) value were independent risk factors for sacral-screw loosening in patients with L4-S1 LDD with osteoporosis.

Conclusions: When patients with L4-S1 LDD with osteoporosis undergo lumbosacral fusion and fixation, the use of S1 pedicle screws with PMMA augmentation has better stability and less screw loosening. Furthermore, we recommend this surgery for patients with osteoporosis, and the LL should be increased as much as possible during the operation to restore the matching of lumbar and pelvic parameters.

Objective: This study aims to assess the significance of monitoring temperature change trends at various wound sites in the healing process of diabetic foot ulcers after microcirculation reconstruction surgery.

Methods: A retrospective analysis was conducted on individuals with diabetic foot ulcers who had been admitted to the Department of Orthopedics at the Second Hospital of Shanxi Medical University between July 2020 and February 2022. Temperature changes were regularly monitored at the center of the wound and the distal tibia of the ipsilateral lower leg to assess microcirculatory blood perfusion. Wound, ischemia, and foot infection (WIFi) grading was performed at admission and the final follow-up was to determine the value of temperature monitoring at various sites. Additionally, the formation of collateral microarterial vessels was monitored to determine their consistency with the observed trends in temperature differences. Follow-up assessments included the recurrence of ulcers, development of ulcers at different locations, re-amputation of the toe or limb, and diabetes-related mortality.

Results: A total of 29 patients were included in the follow-up, with an average age of 57.14 ± 14.75 years and a follow-up period of 9.79 ± 4.13 months. Following microcirculation reconstruction surgery, as the microvascular network formed, the temperature difference between the center of the wound and the distal tibia on the same side gradually decreased, with no statistical difference observed at 4 weeks postoperatively. At both admission and the final follow-up, there was a significant reduction in the wound (W) and ischemia (I) grades within the WIFi classification. The temperature at the wound center showed progressive improvement as collateral microarterial vessels developed. During the follow-up period, there were 2 cases of ulcer recurrence, 1 case of an ulcer appearing at a different location, no cases of re-amputation of the toe or limb, and 2 diabetes-related fatalities.

Conclusion: Skin temperature monitoring offers a direct and reliable indication of microcirculatory blood perfusion. Its simplicity and cost-effectiveness make it a valuable tool for widespread use in evaluating wound healing following microcirculation reconstruction surgery.

Purpose: This study aimed to evaluate the neurological outcomes of Metastatic epidural spinal cord compression (MESCC) patients who underwent decompressive surgery after experiencing over 48 h of paralysis.

Methods: This retrospective study hypothesizes that, unlike in cases of trauma and degenerative disorders where delayed decompression surgery often leads to poor outcomes, delayed decompression surgery for MESCC-induced paralysis yields relatively favorable results. This study included MESCC patients who had been paralyzed for more than 48 h and underwent decompressive surgery between January 2012 and December 2020. Data collected mainly included patient demographics, tumor pathologies, neurological function (Frankel grades), ambulatory status, and imaging manifestions. The primary outcome measure was neurological recovery.

Results: A total of 37 patients were included, with a median preoperative paralysis duration of 9 days. Following decompressive surgery, 30 patients (81.1%) improved by at least one Frankel grade. Specifically, 22 patients (59.5%) regained ambulatory ability. The percentages of patients with Frankel grades A, B, and C who regained ambulation after surgery were 28.6% (2 out of 7), 57.1% (8 out of 14), and 75.0% (12 out of 16), respectively.

Conclusions: Decompressive surgery is associated with significant neurological recovery in MESCC patients who have been non-ambulatory for more than 48 h. Surgical intervention remains beneficial even in cases of prolonged paralysis.

Background: Risk factors for local recurrence in patients with metastatic spinal cord compression (MSCC) has not been clearly investigated. So, the purpose of this study was to identify risk factors causing local recurrence following surgeries in patients with MSCC.

Methods: We conducted a retrospective comparative study on 304 patients who underwent surgery for MSCC between March 2014 and February 2020. Local recurrence rate (LRR) was analyzed according to demographic variables, radiological variables such as level of spinal metastasis, number of non-spinal bone metastases, degree of spinal cord compression, spinal instability, and pathological fracture, and treatment-related variables such as origin of tumor, surgical treatment methods, and pre- and post- operative radiation therapy. Univariate and multivariate logistic regression analyses were performed to reveal the risk factors for local recurrence.

Results: Among 304 patients with MSCC, 50 patients (16.4%) experienced local recurrence after surgery. Of the surgical methods, decompression alone (26/50, 52.0%) showed higher LRR compared to decompression with fixation (9/177, 5.1%) or corpectomy (11/89, 12.4%), (P = 0.002 and P = 0.018, respectively). Patients with renal cell carcinoma revealed higher LRR compared to other types (P = 0.014). It was found that the 3 or more level of spinal metastasis (P = 0.001), the 3 or more of extraspinal bone metastases (P = 0.028), and pathologic fracture (P = 0.003) were related with higher LRR. Smoking is also an independent risk factor for local recurrence in patients who underwent fixation (P = 0.026).

Conclusions: Symptomatic local recurrence may be influenced by several factors, including the extent of spinal and extraspinal bone metastasis, pathologic fractures, surgical approach, and tumor origin (RCC). These factors should be carefully considered by surgeons when evaluating the risk of symptomatic local recurrence after surgery.

Background: Percutaneous endoscopic lumbar discectomy (PELD) has demonstrated variable efficacy in alleviating low back pain (LBP) associated with lumbar disc herniation (LDH). Sinuvertebral nerve ablation (SNA), which targets the nociceptive pathway implicated in discogenic LBP pathogenesis, has emerged as a potential adjunctive therapy. The efficacy of endoscopic radiofrequency ablation in enhancing PELD for the treatment of LBP in patients with LDH remains unclear.

Methods: A retrospective cohort study was conducted on LDH patients with concomitant LBP treated at the Spinal Surgery Department, China-Japan Friendship Hospital, from June 2020 to June 2023. Participants were categorized into two groups: PELD combined with SNA (n = 51) and PELD alone (n = 46). Primary outcome measures included the Visual Analog Scale (VAS) for pain, the Japanese Orthopaedic Association (JOA) score, and the Oswestry Disability Index (ODI) at baseline and 1-, 3-, and 6-month follow-ups.

Results: Both groups exhibited significant improvements in VAS, JOA, and ODI scores for LBP and leg pain postoperatively compared to preoperative assessments. Notably, the PELD combined with SNA group demonstrated statistically significant superior outcomes in VAS, JOA, and ODI scores specifically for LBP compared to the PELD group.

Conclusion: The combination of PELD with SNA significantly improves LBP outcomes compared to PELD alone in LDH patients. While the observed improvements did not reach the minimal clinically important differences (MICD), these findings suggest that SNA may enhance the efficacy of PELD in LBP management.