Journal of Orthopaedic Surgery and Research最新文献

Background: Degenerative spondylolisthesis affects approximately 39 million patients worldwide. While consensus supports decompression with fusion for single-level pathology, optimal surgical approaches for multi-level disease remain disputed. Despite the frequency of this clinical presentation, evidence comparing outcomes between Single-Level versus Multi-Level interbody fusion procedures is surprisingly scarce. This study aims to determine how the level of interbody fusion extent impacts outcomes in patients undergoing lumbar fusion for degenerative spondylolisthesis.

Methods: Our systematic review methodology involved comprehensive database searches (Web of Science, Scopus, PubMed, and Cochrane Library) from inception through April 2025. Two independent reviewers performed article screening, data extraction, and quality assessment. Statistical analyses used R software (v4.4.2), with outcomes reported as risk ratios for categorical variables and mean differences for continuous measures (95% CI). The certainty of evidence was assessed using the GRADE approach.

Results: Our meta-analysis evaluated 10 studies (N = 1430 patients; 971 Single-Level, 366 Double-Level, 198 Multi-Level fusions). Single-Level procedures demonstrated 41% lower revision rates (RR = 0.59 [0.40-0.86], p = 0.007). Operative advantages included reduced surgical time (-60.73 min [- 80.89 to - 40.57], p < 0.001), blood loss (-286.99mL [- 496.71 to - 77.27], p = 0.007), and hospitalization (-1.22 days [- 2.09 to - 0.34], p = 0.006). Oswestry Disability Index (ODI) scores showed borderline improvement (-3.90 [- 7.89 to 0.10], p = 0.06). Screw loosening decreased by 84% (RR = 0.16 [0.08-0.34], p < 0.001). We observed no significant differences in lumbar lordosis (-0.01 [- 1.75 to 1.72], p = 0.99), infection rates (RR = 0.49 [0.19-1.25], p = 0.13), adjacent segment deterioration, vascular injuries, or dural tears. The certainty of evidence ranged from low to very low, and high heterogeneity was observed in perioperative outcomes.

Conclusions: Single-level fusion may offer a more favorable perioperative profile than double- or multi-level constructs, including lower revision risk, shorter operative time, reduced blood loss, shorter hospitalization, and fewer screw loosening events in pooled analyses. However, complications did not differ significantly between groups. Given substantial heterogeneity for perioperative outcomes and generally low to very low certainty of evidence, these findings should be interpreted cautiously and individualized to patient pathology and surgical context.

Background: Total knee arthroplasty plays a pivotal role in restoring patients' quality of life; however, challenges related to postoperative adaptation and self-care remain significant. Integrating technology into patient education through web-based and mobile application-supported interventions has emerged as an innovative approach to strengthen recovery and enhance patient outcomes. This study aimed to evaluate the impact of a web-based education (WBE) program on self-care power, self-efficacy, and quality of life in patients undergoing total knee arthroplasty.

Methods: This prospective, two-group clinical trial was conducted between January and October 2024 at the Orthopedics and Traumatology Clinic of a city hospital. A total of 67 patients were assigned to either the WBE group (n = 33) or the control group (n = 34). The control group received standard unstructured discharge education, whereas the WBE group received the same education plus a one-month web-based education program using a mobile application starting on the 15th day post-discharge. Data were collected via the Self-Care Agency Scale (SCAS), the Self-Efficacy Scale (SES), and the Short Form-36 Health Survey (SF-36) at 15 days and one-month post-discharge.

Results: No significant baseline differences were observed between the WBE and control groups (p > 0.05). After the intervention, the WBE group showed significantly greater improvements in self-care agency, self-efficacy, and quality of life compared with the control group (p < 0.05). Mixed-design ANOVA demonstrated significant group×time interaction effects for all outcomes, with large effects for self-care agency (ηp²=0.703-0.827) and moderate to large effects for self-efficacy (ηp² = 0.435-0.719) and SF-36 quality-of-life subdimensions (ηp²=0.451-0.713).

Conclusion: Web-designed education via mobile applications was shown to be effective in improving the self-care power and self-efficacy and increasing the quality of life of patients undergoing TKA.

Trial registration: This study was registered in the ClinicalTrials.gov database as (NCT06306027) Protocol Registration and Results System.

Background: Ankle fractures are common, and cryotherapy is routinely used to reduce pain, swelling and local skin complications, both before and after surgery. The aim of this study is to report the results with the use of pre-operative third-generation cryotherapy (Z-One^®, Zamar, Italy) in the management of patients with ankle fractures. We investigated the time to surgery, pain, opioid intake, and local skin complications.

Methods: 169 patients with ankle fracture were randomised into two groups, the cryotherapy group (89 patients) and the control group (C: 80 patients). The time-to-surgery, Visual Analogue Scale (VAS) and the analgesic drug demands (Morphine Sulfate 10 mg/ml solution for injection) were recorded. The development of skin complications was assessed on a daily basis. BMI and the number of cigarettes smoked were also recorded.

Results: The mean time-to-surgery was shorter in patients treated with cryotherapy compared to the control group (34.78 h vs. 91.44 h, p < 0.001). Significant differences between treatments and controls were found for VAS, morphine intake (number of vials), and skin complications. The mean preoperatory VAS and morphine consumption were lower in the cryotherapy group compared to controls (mean VAS 2.04 vs. 5.9, mean morphine consumption 0.1 mg vs. 0.83 mg). In the cryotherapy group, 4.5% of patients developed a skin complication compared to 28.7% of the control group; 85% of skin-related problems occurred in the non-cryotherapy group (p < 0.001).

Conclusion: Preoperative third-generation cryotherapy is effective in reducing time to surgery, preoperative pain, and opioid intake in patients hospitalised for ankle fractures. It is also effective in reducing the occurrence of skin complications. No major complications related to the use of the device were reported. Third-generation cryotherapy is useful in the perioperative management of patients necessitating surgery for ankle fractures. Clinical Trial Registration NCT06396364. Level of evidence I (RCT).

Background: Intervertebral disc degeneration (IVDD) is a prevalent condition causing substantial pain, muscle weakness, and functional impairment; however, the efficacy of current treatments remains limited. Therefore, candidate therapeutic targets must urgently be prioritized to guide future mechanistic and translational research. This study aims to identify genetic factors associated with IVDD and explore the underlying mechanisms through the comprehensive integration of multi-omics data.

Methods: We applied Mendelian randomization (MR) to prioritize candidate therapeutic genetic targets for IVDD using genome-wide summary statistics from the FinnGen consortium, with UK Biobank data serving as replication cohorts. We employed expression quantitative trait loci (eQTLs) and protein quantitative trait loci (pQTLs) to validate therapeutic targets at the transcriptomic and proteomic levels. We also integrated sensitivity, colocalization, SMR, genetic correlation, and reverse MR analyses. We applied PheWAS and drug prediction to assess off-target effects and evaluate therapeutic potential, respectively. Finally, we explored the potential mediation effects of candidate metabolites.

Results: We identified seven potential therapeutic targets significantly associated with IVDD risk across the FinnGen and UK Biobank cohorts. Bayesian colocalization analysis revealed strong evidence for shared causal variants at the DLK1 (PP.H4 = 0.94) and BMP6 (PP.H4 = 0.99) loci. The BMP6 cis-eQTL met the significance thresholds for SMR (p < 0.05) and HEIDI (p > 0.05). Protein-level MR analysis demonstrated that BMP6 significantly increased IVDD risk (OR = 1.19, 95% CI 1.09-1.30; p < 0.001), supported by a colocalization probability of 99% (PP.H4 = 0.99). Additionally, BMP6 satisfied the established validation thresholds in protein-level SMR and HEIDI analyses. Consequently, BMP6 was prioritized as a candidate therapeutic target for IVDD in subsequent analyses. Urate levels exhibited a nominal mediation signal linking BMP6 to IVDD (proportion mediated = 7.48%, p = 0.036), which remained suggestive after BH-FDR correction.

Conclusions: We prioritized BMP6 as a candidate therapeutic target for IVDD and identified circulating urate as a potential mediator based on a suggestive mediation signal. These findings offer new mechanistic insights into the potential relationship between BMP6, urate metabolism, and IVDD. This gene and its associated metabolite represent promising targets for IVDD intervention and may inform subsequent translational research and preclinical validation.

Objective: Femoral neck fracture (FNF) is a common type of hip fracture, for which cannulated screw fixation is a primary internal fixation method. The optimal configuration for cannulated screw fixation remains controversial, with debate primarily focused on two approaches: parallel fixation configuration (PFC) versus non-parallel fixation configuration (NFC). The objective of this study was to compare the efficacy and safety of two configurations in the treatment of femoral neck fractures.

Methods: Following PRISMA guidelines, we systematically searched PubMed, Embase, the Cochrane Library, and CNKI for studies comparing PFC and NFC in FNF fixation. Study quality was assessed using the Cochrane risk-of-bias tool and MINORS scale. Outcomes included femoral head necrosis, nonunion, femoral neck shortening, and fixation failure. Meta-analysis was conducted in RevMan 5.3, employing a fixed-effects model unless heterogeneity (I² > 50%) warranted an alternative approach.

Results: A total of 20 studies involving 1,508 patients were included in the meta-analysis. The meta-analysis showed that the NFC group had significantly better outcomes, including lower rates of femoral head necrosis (OR 0.50, 95% CI 0.34-0.74, P = 0.0005), nonunion (OR 0.41, 95% CI 0.26-0.65, P = 0.0001), femoral neck shortening (OR 0.40, 95% CI 0.28-0.57, P < 0.00001), and internal fixation failure (OR 0.34, 95% CI 0.22-0.52, P < 0.00001).

Conclusions: Our findings indicate that NFC is more effective than traditional PFC for internal fixation of FNFs. Level of evidence Level III.

Background: Female athletes face an elevated risk of ACL injuries and unique challenges in returning to sport, while sex-specific RTS outcomes remain insufficiently described. This study systematically evaluated RTS rates and time to RTS among female athletes following anterior cruciate ligament reconstruction.

Methods: A systematic search of five databases was conducted through October 2025 to identify studies reporting RTS outcomes in female athletes post-ACLR. Pooled RTS proportions were calculated using a random-effects model with logit transformation. Subgroup and meta-regression analyses were performed to assess heterogeneity. Study quality was evaluated using the MINORS tool. Sensitivity and publication bias analyses were also undertaken.

Results: Sixteen studies comprising 1,147 female athletes were included. The pooled RTS rate post-ACLR was 69% (95% CI 63-75%). RTS rates were higher among those returning to professional-level competition (78%) compared to general sports participation (63%) (p = 0.020). Meta-regression indicated an inverse association between RTS time and RTS rates (β = - 0.147, p = 0.046). The average time to RTS was 10.5 months.

Conclusion: This meta-analysis suggests that approximately 69% of female athletes return to sport after ACL reconstruction, with an average return time of 10.5 months, indicating that approximately one-third of female athletes may not return to sport, which is broadly consistent with prior literature. However, these pooled estimates should be interpreted with caution given substantial heterogeneity and potential publication bias. Higher RTS rates were observed among professional-level athletes, although this may reflect contextual rather than modifiable clinical factors. Meta-regression also suggested a negative association between RTS time and RTS rates, which should be interpreted cautiously as it may be influenced by residual confounding.

Purpose: Capitolunate fusion (CLF) has been proposed as a viable alternative to other motion-preserving techniques such as three-corner fusion (3CF) and four-corner fusion (4CF) for scapholunate advanced collapse (SLAC) and scaphoid nonunion advanced collapse (SNAC). This study systematically reviewed the literature comparing clinical outcomes and complication profiles of CLF versus 4CF; a small number of three-corner fusion cases were included.

Methods: The PubMed, EMBASE, and Web of Science databases were systematically searched for articles published between 1990 and 2025. Two independent authors performed blinded screening of titles and abstracts, followed by blinded full-text review. Outcomes of interest included the visual analog scale (VAS) score, Patient-Rated Wrist Evaluation (PRWE), grip strength, Disabilities of the Arm, Shoulder and Hand (DASH) score, reoperation rate, adverse events, and range of motion.

Results: Seven studies were included, consisting of six retrospective cohort studies and one randomized controlled trial, encompassing a total of 320 patients. The VAS score demonstrated a borderline non-significant standardized mean difference of 0.34 (95% confidence interval: - 0.004 to 0.69; p = 0.053) in favor of four corner fusion. No statistically significant differences were observed between CLF and 4CF for PRWE, DASH score, range of motion, overall complication rate, reoperation rate, or nonunion rate. Only seven patients underwent three-corner fusion, precluding subgroup-specific analysis.

Conclusions: Compared with four-corner fusion, capitolunate fusion yields comparable patient-rated outcome measures, strength, motion, and complication profiles. Higher-quality prospective studies are required to further validate these findings.

Level of evidence iv: Therapeutic study.