Journal of Orthopaedic Surgery and Research最新文献

Background: Osteoporotic fractures (OPF) cause pain and trigger physical and mental health problems for patients. However, the underlying mechanism of OPF remains unclear. This study aims to investigate the diagnostic value and inhibitory effect on fracture healing of miR-204 in OPF.

Methods: A total of 104 osteoporosis patients and 119 OPF patients were included from the clinic. The RT-qPCR was performed to detect serum miR-204 level. The ROC curves were plotted based on miR-204 expression. Correlations between miR-204 and clinical factors were analyzed by the chi-square test in the OPF group. Independent risk factors were analyzed by multivariate logistic regression. The effect of miR-204 on fracture healing was explored in vitro experiments on BMSCs cells. The expression of miR-204 and TGF-β1 was assayed by the RT-qPCR in BMSCs transfected with miR-204 mimic NC, mimic, inhibitor NC, and inhibitor. The CCK-8 was applied to detect cell proliferation.

Results: Serum miR-204 level was significantly increased in the OPF group. The ROC curve confirmed the diagnostic value of miR-204 for OPF. The levels of Ca²⁺, β-CTX, 25(OH)D3, and T-score were correlated with miR-204 expression. The levels of Ca²⁺, miR-204, and T-score were identified as risk factors for OPF. miR-204 overexpression inhibited the proliferation of BMSCs, reduced the expression of osteogenic differentiation factors (ALP and BSP), and decreased the expression of factors (TGF-β1 and BMP) that promote fracture healing.

Conclusion: Elevating miR-204 promotes OPF development and impairs BMSC-mediated osteogenic differentiation and repair of fractures, warranting further in vivo validation. Inhibition of miR-204 may enhance osteogenic differentiation and fracture healing, representing a potential avenue for future therapeutic investigation in OPF.

Background: The follow-up scales following total knee arthroplasty (TKA) are numerous and complex, which may adversely affect completion rates. The growing popularity of rehabilitation applications facilitates the collection of patient information at any time. However, no efforts have been made to leverage this capability to enhance follow-up scales.

Objective: This study aimed to develop a novel mode of scale follow-up utilizing rehabilitation applications. The completion rate of this new mode was assessed, and the differences in assessment results between the two methods at various time points were analyzed comparatively.

Methods: In this prospective study, a total of 120 patients who underwent total knee arthroplasty (TKA) were enrolled using the Vital Health app. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and the Knee Society Score (KSS) scales were combined to create a set of 31 questions. Four to five questions were sent to patients daily via the app, and patients responded during interactive question-and-answer sessions. WOMAC and KSS scores were aggregated weekly. During the 6-week and 12-week outpatient follow-ups, the complete WOMAC and KSS questionnaires were administered, with all questions answered in a single session.

Results: The completion rate for the new follow-up mode at both 6 weeks and 12 weeks post-surgery was 100%. There was no significant difference in the evaluation scores of patients following TKA surgery between the new mode and conventional follow-up methods. Both the Interclass Correlation Coefficient (ICC) and the Bland-Altman plot demonstrated a strong consistency in the assessment scores between the two follow-up strategies.

Conclusions: The new survey mode, based on the rehabilitation app, demonstrated a high level of consistency with the conventional mode of scale investigation regarding assessment scores. This innovative approach has the potential to replace the traditional scale. Furthermore, the new mode significantly reduces the response burden on patients while enhancing the completion rate of follow-up assessments.

Objective: The Closed Flowing Vacuum-Assisted Technique (CFVAT) is an innovative approach achieving continuous irrigation within a sealed wound environment, which enables active fluid circulation and establishes an efficient flowing-drainage mode under negative pressure. This study aims to conduct the first evaluation comparing the clinical outcomes of CFVAT versus the traditional Vacuum Sealing Drainage (VSD) technique in the management of early (≤ 6 weeks) fracture-related infection (FRI) involving internal fixation and classified as Cierny-Mader type II.

Methods: A retrospective study was conducted on 33 patients with early FRI (≤ 6 weeks, Cierny-Mader II) following internal fixation between 2021 and 2024. All patients underwent debridement with retention of internal fixation. The study group (n = 13) received CFVAT, while the control group (n = 20) received VSD. Patient demographics, fracture site, time from initial surgery to infection, inflammatory markers, number of required surgeries, total treatment duration, and costs were compared.

Results: The primary healing rate was 92.3% in the CFVAT group and 60% in the VSD group. The one-year long-term healing rates were 92.3% and 90%, respectively. The CFVAT group demonstrated advantages in the number of surgeries, treatment duration, and overall cost (P < 0.05).

Conclusion: For a narrow clinical scenario-specifically early FRI (≤ 6 weeks) with retained internal fixation and Cierny-Mader type II anatomy-CFVAT may yield better outcomes than VSD in selected process and cost endpoints. These findings suggest that CFVAT has the potential to achieve wound closure after initial debridement while controlling infection. However, VSD remains a standard adjuvant therapy in FRI care, and the superiority of CFVAT requires validation through prospective randomized controlled trials.

Clinical trial number: Not applicable.

Background: Nel-like molecule-1 (Nell-1) could prevent the damage of cartilage in osteoarthritis (OA), including temporomandibular joint osteoarthritis (TMJOA), though, the definite mechanism of the process is unclear. Fibrocartilage stem cells (FCSCs) were discovered in the temporomandibular joint (TMJ), and were associated with the TMJ health and disease. However, little information is available on the effect of Nell-1 on FCSCs fate in TMJOA progression.

Methods: In this study, TMJOA was induced in rabbits through collagenase injection. 8 weeks after injection, the left and right joints of the rabbits were injected with AAV9-CMV-Nell-1 and AAV9 vector virus supernatant respectively. FCSCs were isolated, cultured, and transfected with recombinant AdNell-1. Histology staining, immunofluorescence staining, micro-CT, qRT-PCR and western blot were applied to detect the condition of FCSCs and condyles in vitro and in vivo.

Results: In the collagenase injection group, we observed histological changes consistent with OA, meanwhile, the expression of Nell-1 was decreased, but Indian hedgehog (Ihh) and Sonic hedgehog (Shh) were significantly elevated in FCSCs and condylar cartilage. Further in vitro and in vivo analyses revealed that Nell-1 markedly reduced Ihh and Shh. In addition, Nell-1 induced the chondrogenic differentiation of FCSCs by stimulating the expression of Collagen II, Aggrecan and Sox-9.

Conclusion: Nell-1 leads to improved chondrogenic capacity of FCSCs in TMJOA and demonstrated an inhibitory effect on Hh signal transduction while concurrently facilitating the process of cartilage remodeling. Collectively, Nell-1 may be a promising drug candidate for the treatment of TMJOA.

Objective: The primary purpose of this study was to determine whether open reduction and internal fixation (ORIF) utilizing parallel or orthogonal dual plating resulted in improved function, as measured by the Mayo Elbow Performance Score (MEPS). Additionally, this study investigated whether union time was influenced by the method of fixation.

Methods: A systematic review and pooled analysis were conducted utilizing five databases to search for articles examining orthogonal and parallel dual plating methods for the treatment of distal humerus fractures. Statistical analysis was conducted utilizing IBM SPSS Statistics for Windows, version 29. Included studies were randomized controlled trials and prospective cohort studies. Outcomes of interest were the Mayo Elbow Performance Score (MEPS) and fracture union time.

Results: MEPS were assessed across six studies via pooled analysis. The orthogonal plating group included five studies with 152 participants. MEPS was evaluated at 6, 12, and 24 months, yielding scores of 75.35 ± 3.18, 88.11 ± 0.18, and 85.10 ± 0.00, respectively. MEPS for the parallel plating group were assessed across four studies containing 176 participants at 6, 12, and 24 months postoperatively. The analysis yielded scores of 78.73 ± 0.00, 93.61 ± 0.00, and 88.745 ± 0.92, respectively. Union time was assessed across five studies. Pooled analysis for the orthogonal plating group across four studies (n = 89 participants) revealed a union time of 22.96 ± 5.05 weeks. Pooled analysis for the parallel plating group across four studies (n = 100 participants) revealed a union time of 19.59 ± 6.08 weeks.

Conclusion: A comparative pooled analysis of orthogonal plate repair versus parallel plate repair for distal humerus fractures revealed that parallel fixation provided superior MEPS scores across all time points and achieved fracture union approximately three weeks earlier than the orthogonal group.

Background: With the increasing prevalence of knee arthroplasty (TKA), the utilization of segmental prostheses with distal femur replacement (DFR) has expanded, particularly in revision surgeries. Concerns regarding early loosening of cemented femoral stems in these prostheses persist.

Questions/purposes: This study aimed to analyze the rate of early femoral component loosening and associated factors in DFR prostheses.

Patients and methods: A retrospective multicenter study was conducted, including patients who underwent DFR with cemented stems between 2015 and 2019. Epidemiological variables and outcomes, including femoral component loosening and prosthetic replacement, were analyzed. Statistical methods included survival analysis and subgroup comparisons.

Results: Seventy patients were included, with a femoral component loosening rate of 15.7% within two years. Women exhibited a lower risk of loosening (OR 0.258, 95% CI 0.068-0.098, p = 0.038). Survival analysis showed no significant age-related differences (p = 0.064), but better survival was observed in women (p = 0.045). Previous canal cementation did not significantly affect loosening rates (p = 0.82). Reoperation rates were 24.3%, primarily for mechanical causes.

Conclusions: Early loosening of cemented femoral stems in DFR prostheses is notable, emphasizing the need for enhanced fixation strategies, especially in patients with a history of femoral canal cementation. This study provides valuable insights into optimizing stem fixation systems and addressing concerns related to prosthetic survival.

Aims: Literature has reported favorable outcomes of reverse total shoulder arthroplasty (RSA) for treating neglected anterior shoulder dislocation (NASD). However, few studies have specifically addressed the treatment outcomes and management of NASD in the presence of glenoid bone loss. The aim of this study is to evaluate the clinical outcomes of RSA in patients with NASD associated with glenoid bone defects.

Methods: We conducted a retrospective cohort study of NASD patients treated with RSA from January 2018 to December 2022. Neglected dislocation was defined as lasting more than three weeks. Glenoid bone defect size and patient demographics were recorded. A matched control group of patients who underwent RSA for classical indications was included. NASD patients were divided into those who received autologous bone grafting (BG) and those who did not (N-BG). Outcome measures included range of motion (ROM), visual analogue scale (VAS) for pain, subjective shoulder value (SSV), Constant score (CS), and American Shoulder and Elbow Surgeons (ASES) score.

Results: Twenty-four NASD patients (mean duration 3.0 ± 1.3 months) were included, with an average glenoid defect of 25.3 ± 8.5%. Eleven underwent bone grafting due to defect sizes ≥ 30%. Compared to cuff tear arthropathy patients, NASD patients had worse preoperative ROM and functional scores. At final follow-up, the NASD group demonstrated marked postoperative improvements in forward flexion (from 44.7° to 121.3°), external rotation (from 2.2° to 26.9°), and abduction (from 57.8° to 95.9°). Functional outcomes were comparable between the NASD group and the matched cuff tear arthropathy group, with VAS scores of 1.4 vs. 1.2 (p = 0.370) and CS, SSV, and ASES scores of 75.2 vs. 77.4 (p = 0.290), 80.3 vs 81.3 (p = 0.751), and 77.6 vs. 80.4 (p = 0.165), respectively. Similarly, no significant differences were observed between the BG and N-BG groups, with VAS scores of 1.6 vs. 1.2 (p = 0.187) and CS, SSV, and ASES scores of 74.4 vs. 75.8 (p = 0.730), 81.4 vs. 79.4 (p = 0.692), and 76.6 vs. 78.4 (p = 0.585), respectively.

Conclusion: RSA is effective for NASD with glenoid bone loss, yielding outcomes comparable to cuff tear arthropathy cases. Bone grafting for defects ≥ 30% provided favorable results without significant differences in functional recovery compared to non-grafted cases.