Journal of Orthopaedic Surgery and Research最新文献

Background: The alignment of the spine and pelvis significantly impacts overall body balance; therefore, alterations in hip and lumbar spine biomechanics following curved acetabular osteotomy (CPO) can help surgeons optimize acetabular correction. To achieve this goal, we conducted patient-specific finite element analyses to compare hip and lumbar disc contact pressure (CP) between patients with developmental dysplasia of the hip (DDH) and healthy individuals. Additionally, we examined the influence of CPO on the CP of both the hip and lumbar discs in patients with DDH.

Methods: We conducted finite element analyses of the hip and lumbar spine before and after CPO and compared them with those of a healthy human model. Subsequently, we simulated CPO on the preoperative model. Nonlinear contact analysis was employed to calculate the CP of the acetabular cartilage and lumbar discs during a single-leg stance.

Results: The maximum and average acetabular CP in patients with DDH were 5.4 MPa and 4.5 MPa, respectively. The average CP for the five lumbar discs were 3 MPa, 2.5 MPa, 2 MPa, 3.5 MPa, and 4.4 MPa. In contrast, the maximum and average acetabular CP in normal subjects were 3.7 MPa and 2.1 MPa, respectively, and the average CP of their lumbar discs were 1 MPa, 2 MPA, 1.88 MPa, 2.1 MPa, and 2.1 MPa, respectively. After CPO, the maximum and average CP of the hip decreased, as did the average CP of the lumbar discs. The maximum and average compressive stress of the acetabulum decreased to 3.79 MPa and 2.3 MPa, respectively, and the average compressive stress of the five intervertebral discs decreased to 1.96 MPa, 0.79 MPa, 0.78 MPa, 1.13 MPa, and 3.14 MPa, respectively.

Conclusion: Our finite element analysis indicated that CPO effectively normalizes hip contact pressure while reducing lumbar disc contact pressure. However, further investigation is required to elucidate the specific biomechanical mechanisms underlying these changes.

Introduction: Osteoporosis is a debilitating bone disease that significantly contributes to disability and a loss of autonomy among older adults. This study aimed to characterize osteoporosis and explore the feasibility of combining OSTA and BMR for osteoporosis prediction.

Methods: A cross-sectional study involving 1435 participants (1300 women and 135 men) was conducted. Spearman's correlation, simple linear regression analyses, and multiple linear regression models were utilized to investigate the association between OSTA, BMR, and bone mineral density (BMD). Furthermore, the efficacy of integrating OSTA with BMR for osteoporosis screening and prediction was assessed through receiver operating characteristic (ROC) curves.

Results: In the total population, the sensitivity of combination variable W was 58.63%, and the specificity was 70.90%. When OSTA and BMR were employed separately to diagnose osteoporosis, the sensitivity was 47.70% and 55.34%, respectively, while the specificity was 63.80% and 69.80%, respectively.

Conclusions: The combined utilization of OSTA and BMR formula represents an effective screening method for osteoporosis.

Background: Slipped Capital Femoral Epiphysis (SCFE), is one of the most common hip disorders in adolescents, and is treated surgically by performing an Imhäuser osteotomy. The use of 3D printed guides has shown promise in improving the accuracy of the osteotomy. However, misplacement of the guide may limit the improvement. Therefore, the aim of this study was to investigate, postoperatively, the degree of malalignment of 3D printed guides compared to the 3D planning.

Methods: Patients who underwent surgery between April 2018 and October 2022 and underwent postoperative CT were included in this study. The preoperative CT was used for 3D planning of surgical treatment using 3D printed patient-specific guides and plates. The positioning error of the femoral head and of the patient-specific guide and plate was quantified by analysing the postoperative CT scans using custom software.

Results: Five SCFE patients were included in the study. Femoral head malalignment improved from 16 to 40 mm preoperatively to 11-17 mm postoperatively. Rotational malalignment improved from 29-63⁰ preoperatively to 15-31⁰ postoperatively. Residual error was mostly attributed to plate malposition, with residual translation in the range of 3-13 mm and rotation of 8-28⁰.

Conclusion: Although the postoperative position improved after surgery with 3D printed surgical guides and plates, there was a residual deviation from the planned position persisted. Further research is recommended to improve the design, accuracy of guide placement and surgery in this anatomically challenging region.

Purpose: To develop a comprehensive and validated personalized scoring system based on anatomical characteristics to predict the probability of failure to return to sport after medial patellofemoral ligament reconstruction in patients with patellar dislocation.

Methods: 312 patients with medial patellofemoral ligament reconstruction in our hospital from 2013 to 2023 were included. Demographic and anatomical characteristics were collected retrospectively. A backward stepwise approach was used to identify independent predictors, and a nomogram was constructed to predict the probability of recurrence. The predictive performance was evaluated by receiver operating characteristic curves, calibration diagram and decision curve analysis.

Results: Multivariate analysis showed that increased tibial tubercle-trochlear groove (TT-TG) distance, trochlear dysplasia, increased femoral anteversion angle, and patellar alta were independent risk factors for failure of return to sport after medial patellofemoral ligament reconstruction. Validation of this column graph in the training cohort and validation cohort showed strong predictive power, with areas under the curve of 0.850 and 0.844, respectively. The nomogram has good calibration and good clinical practicability.

Conclusion: The study developed a personalized predictive nomogram with 4 predictors (increased TT-TG distance, trochlear dysplasia, increased femoral anteversion angle, and patellar alta) that allowed surgeons to stratify the risk of failure to return to sport after medial patellofemoral ligament reconstruction and recommend skeletal surgery for patients with these factors.

Level of evidence: Level III.

Background: Periarticular local infiltration analgesia (LIA) has become a widely used method for postoperative pain management after unicompartmental knee arthroplasty (UKA). However, the efficacy of using magnesium sulphate or sodium bicarbonate in LIA cocktails during UKA is not yet clear. The present study aimed to evaluate whether the modified LIA has advantages in pain control and joint function recovery after UKA surgery.

Methods: Sixty-one patients who underwent UKA were enrolled and randomly assigned to receive periarticular infiltration of a modified cocktail (comprising ropivacaine, epinephrine, dexamethasone, magnesium sulphate, and sodium bicarbonate) or a conventional cocktail (comprising ropivacaine, epinephrine, dexamethasone, ketorolac, and morphine). The outcomes included the consumption of patient-controlled intravenous analgesia (PCIA) medication used for postoperative analgesia, pain score, early joint functional recovery, discharge time, and complication rates.

Results: In the first 12 h after surgery, the conventional cocktail was not superior to the modified cocktail in terms of visual analogue scale (VAS) scores. However, beginning on the second postoperative day, the analgesic effect was significantly prolonged in the modified group, leading to lower VAS scores and better knee functional recovery. Additionally, patients in the modified group required less pain medication via PCIA, both within the first 24 h and cumulatively up to 48 h after surgery. Both groups had similar rates of complications.

Conclusions: The present modification of a conventional cocktail significantly prolonged the analgesic effect and reduced pain medication consumption after UKA surgery, which was associated with better functional recovery in the early postoperative days.

Trial registration: Chinese Clinical Trial Registry, ChiCTR2200060500. 21 March 2023.

Background: Fingertip amputation is a commonly encountered injury in emergency settings. Composite grafting is a non-microsurgical alternative maintaining digit length with no donor site morbidities. This meta-analysis was conducted to retrieve factors associated with composite graft survivability among patients with fingertip amputations.

Methods: A literature review throughout twelve databases was performed on 24 July 2023. All clinical studies comparing the patients-related, trauma-related, or amputation-related variables among patients with survived and non-survived composite grafting were eligible for meta-analysis. Single-arm studies reported the potential predictors of composite graft survival among patients with fingertip injuries treated with composite grafting were included.

Results: This review included ten articles with 720 fingertips composite grafting. Of them, 526 grafts survived, with a pooled overall survivability of 72.8%. There was a significant association between younger age (OR 2.31,95%CI 1.10, 4.87, P = 0.03), level of amputation (I) (OR 0.31,95% CI 0.14 to 0.67, P = 0.003), and successful composite grafting. There was no statistically significant (P = 0.449) impact of time to composite grafting on the likelihood of composite graft survivability.

Conclusion: Composite grafting is a feasible and effective procedure for restoring aesthetically functional digits among patients with traumatically amputated fingertips. The composite graft survived among the majority of the patients, with a more significant survival pattern among younger populations and patients with more distal amputations.

Level of evidence: Level III.

Objective: To investigate whether body mass index (BMI) affects the accuracy of vertebral bone quality (VBQ) in determining bone mineral density (BMD) in patients undergoing lumbar fusion surgery.

Methods: In this retrospective study, patients with preoperative noncontrast T1-weighted MRI were included. Restricted Cubic Spline (RCS) was employed to explore the nonlinear relationship between BMI and VBQ. Then patients were stratified according to the threshold of BMI. Pearson correlation analysis and linear regression were used to analyze the correlation between VBQ and the BMD in different groups. Receiver operating characteristic (ROC) analysis to calculate the area under the curve (AUC) was used to assess diagnostic efficacy according to BMI.

Results: A total of 328 patients (201 female and 127 male patients) with a mean age of 68.3 ± 3.3 years were included in the study. Significant nonlinear relationship was observed given the results of RCS. In patients with BMI < 23.8 kg/m², the correlation coefficient between VBQ and the lowest BMD was - 0.32 and significant distribution difference of VBQ score was observed between osteoporosis and normal as well as osteopenia subgroups. However, in patients with BMI ≥ 23.8 kg/m², the correlation coefficient between VBQ and the lowest BMD was - 0.39 and significant distribution difference of VBQ score was observed in all three subgroups. In addition, the ROC analysis revealed that the predictive performance in determining low BMD was superior in patients with BMI ≥ 23.8 kg/m² (AUC 0.80 vs. AUC 0.66, p = 0.034).

Conclusions: In this study, significant nonlinear relationship between BMI and VBQ was observed. Compared with patients with BMI < 23.8 kg/m², VBQ has better discrimination between higher BMI (≥ 23.8 kg/m²) patients with low BMD and those with normal bone density.

Background: Osteonecrosis of the femoral head (ONFH) is a progressive and debilitating condition characterized by the death of bone tissue due to inadequate blood supply. Despite advances in diagnostic imaging and treatment strategies, predicting the risk of femoral head collapse remains a significant clinical challenge. This study seeks to address this gap by developing a robust prognostic model that integrates clinical, imaging, and laboratory data to improve early diagnosis and guide therapeutic decision-making.

Methods: We conducted a qualitative systematic review and employed the Delphi method to select key prognostic factors from clinical data, imaging findings, and laboratory indicators. The study included ONFH patients treated from January 2014 to December 2021. We used univariate and multivariate Cox regression analyses to develop a nomogram for predicting the risk of femoral head collapse. The model's performance was evaluated using the concordance index (C-index), calibration plots, and decision curve analysis (DCA).

Results: The study included 297 patients (454 hips) with ONFH. Key prognostic factors identified included pain presence (p < 0.001, RR = 0.185, 95% CI: 0.11-0.31), JIC classification (C1: p < 0.001, RR = 0.096, 95% CI: 0.054-0.171; C2: p < 0.001, RR = 0.323, 95% CI: 0.215-0.487), necrotic area (3 < MNAI < 6: p < 0.001, RR = 0.107, 95% CI: 0.061-0.190; MNAI ≥ 6: p < 0.001, RR = 0.466, 95% CI: 0.314-0.692), weight-bearing reduction (p < 0.001, RR = 0.466, 95% CI: 0.323-0.672), preservation of the anterolateral pillar (p < 0.001, RR = 0.223, 95% CI: 0.223-0.473), and subchondral bone fracture on CT (p < 0.001, RR = 0.32, 95% CI: 0.217-0.472). The nomogram demonstrated a high C-index of 0.88, indicating excellent predictive accuracy. Calibration plots showed good agreement between predicted and observed outcomes, and DCA confirmed the model's clinical utility.

Conclusions: The prognostic model developed in this study provides a reliable tool for predicting femoral head collapse in ONFH patients. It allows for early identification of high-risk patients, guiding personalized treatment strategies to improve patient outcomes and reduce the need for invasive surgical procedures.

Introduction: To compare the biomechanical outcomes of C1.1 posterior pelvic ring fractures treated with different numbers of LC-II screws and plate internal fixation.

Materials and methods: Nine adult preserved pelvic specimens were used. After being measured by bone densitometry, the specimens were randomly divided into 3 groups of 3 pelvic specimens each. The C1.1 pelvic fractures were generated by iliac osteotomies and anterior pelvic ring osteotomies. The fractures were fixed and randomly divided into three groups: (1) one LC-II screw, (2) two LC-II screws, and (3) two reconstruction plates. The anterior pelvic rings were all fixed with pubic branch screws. A biomechanical testing machine loaded all specimens vertically, recording the displacement and ultimate load of the specimens to quantify the stiffness.

Results: When loads up to 1000 N were applied, the displacement of the iliac bone was close between the one LC-II screw and the two LC-II screw group specimens; (P > 0.05); when loads such as 1000 N, 1200 N and 1400 N were applied, there was no significant difference in displacement between the plate fixation group and the two LC-II screw fixation group (P > 0.05), both of which were superior to the one LC-II screw fixation group (P < 0.05). There was no significant difference in compressive stiffness between the two LC-II screw fixation groups and the plate fixation group (P > 0.05), and both were superior to the one LC-II screw fixation group (P < 0.05) the ultimate load of both the two LC-II screws and the steel plate is greater than that of one LC-II screw (1.74 times the ultimate load of one LC-II screw for the two LC-II screws and 1.83 times the ultimate load of one LC-II screw for the steel plate).

Conclusion: For posterior pelvic ring fractures of type C1.1, placement of two LC-II screws provides comparable posterior pelvic ring stability compared to reconstructed plates. At loads below 1000 N, one LC-II screw fixation and two LC-II screws were comparable in restoring posterior pelvic ring stability.

Rheumatoid arthritis (RA) is an autoimmune disease characterized by synovitis that can lead to joint deformities. To date, more than 18 million individuals worldwide have been diagnosed with RA, making it one of the most prevalent autoimmune diseases globally and posing a significant threat to public health and safety. Due to the complex pathogenesis of the disease, which involves autoimmunity, genetics, inflammation and oxidative stress in the body's tissues, the current drug therapy generally targets a single molecule, and effective and efficient drugs involving multiple levels and targets are lacking; thus, there is an urgent need for high-quality research and treatment in this field. Nuclear transcription factor erythroid 2-associated factor 2 (Nrf2) plays a crucial role in cellular resistance to oxidative stress and electrophilic attacks and is a potential pharmacological target for chronic disease treatment. While currently no drugs that target Nrf2 have been approved specifically for RA treatment, such an approach holds great significance. In recent years, the use of natural products to treat RA and other chronic conditions has become increasingly widespread because of their superior efficacy and minimal side effects. Therefore, this article provides a review of the mechanism of Nrf2 in RA and summarizes natural products that target Nrf2 and its associated pathways in the treatment of RA, aiming to offer new insights and strategies for the prevention and management of RA.