Journal of Orthopaedic Surgery and Research最新文献

Objective: To determine the incidence of secondary vertebral compression fracture (SVCF) after percutaneous vertebral augmentation (PVA) and its correlative risk factors, and to provide theoretical evidence for clinical practice.

Methods: A retrospective analysis of 288 cases of PVA completed in our hospital from June 2020 to June 2023 was performed, and the patients were divided into the non-secondary vertebral compression fracture group (N-SVCF group) and the secondary vertebral compression fracture group (SVCF group) according to whether SVCF occurred during the postoperative follow-up review. Gender, age, body mass index (BMI), T value of bone mineral density (BMD-T), underlying diseases (hypertension, diabetes mellitus, coronary heart disease, chronic obstructive pulmonary disease), intravertebral vacuum cleft (IVC), amount of bone cement injected, classification of cement diffusion, anterior vertebral recovery ratio, local Cobb angle correction rate, leakage of bone cement into the intervertebral space, and fat infiltration rate (FIR) of paraspinal muscles were collected from the patients. The incidence and risk factors of SVCF after PVA were evaluated using univariate and multivariate logistic regression analysis, and the predictive value of the independent risk factors was evaluated using receiver operating characteristic curve (ROC) to determine the cut-off points at which they were meaningful for the development of SVCF.

Results: In our study, the incidence of SVCF was 14.60% (42/288) in 288 patients who underwent PVA. Univariate analysis showed that age, BMI, fat infiltration rate of paraspinal muscles, cement leakage into the intervertebral space, unilateral/bilateral pedicle puncture approach and presence of IVC were statistically different between N-SVCF and SVCF (P < 0.05). Multifactorial regression analysis and ROC regression analysis revealed that the fat infiltration rate of the psoas major and erector spinae muscles, cement leakage into the intervertebral space, and IVC (P < 0.05) were risk factors for the incident of SVCF after PVA (P < 0.05). Psoas major (FIR) more than 5.490% and erector spinae (FIR) more than 52.413% had a high possibility of the occurrence of SVCF after PVA.

Conclusion: In this study, logistic regression combined with ROC curve analysis indicated that FIR of psoas major and erector spinae, cement leakage in the intervertebral space, and IVC were risk factors for the occurrence of SVCF after PVA. Psoas major (FIR) more than 5.490% and erector spinae (FIR) more than 52.413% had a high possibility of the occurrence of SVCF after PVA.

Background: Hallux valgus is a deformity characterized by lateral deviation of the big toe and medial deviation of the first metatarsal, causing difficulty in walking and requiring various treatments. Despite its multifactorial etiology, the role of the tibialis anterior tendon in hallux valgus and its variations in the morphology of tibialis anterior tendon distal insertion sites have not been fully explored. This study aimed to evaluate the effect of such variations on hallux valgus using magnetic resonance imaging.

Methods: This was a retrospective study and included 115 individuals aged 18 years and older who underwent foot radiographs and MRI. The participants were divided into a hallux valgus group of 53 patients and a control group of 62 people based on radiographic measurements. Tibialis anterior tendon distal attachment was classified into five types according to the attachment morphology. Statistical analyses were performed to evaluate the relationship between the tibialis anterior tendon types and hallux valgus severity.

Results: Among the participants, patients who underwent foot radiography and MRI due to any medical indication 70.4% were female, with a mean age of 43.83 ± 15.25 years. In terms of tibialis anterior tendon distal attachment, the most common type was Type 5 (40.9%), followed by Type 2 (34.8%). Type 4 was not observed in any case. In all participants, the mean hallux valgus angle was 20.63 ± 8.42^o, and the mean intermetatarsal angle was 9.69 ± 2.68^o. Tibialis anterior tendon distal attachment Type 5 was significantly associated with an increased hallux valgus angle but not with the intermetatarsal angle. We found a significant relationship between the diameter of the tibialis anterior tendon and hallux valgus angle.

Conclusions: This study revealed a significant association between hallux valgus and Type 5 tibialis anterior tendon distal attachment, suggesting that tibialis anterior tendon morphology influences hallux valgus severity. The findings underscore the importance of considering variations in tibialis anterior tendon distal attachment sites in the etiopathogenesis and treatment planning of hallux valgus.

Background: The long-term outcomes (≥ 2 years of follow-up) of volar locked plate (VLP) fixation versus closed reduction and casting (CRC) for the treatment of displaced distal radial fractures (DRFs) remain unclear. This study aimed to conduct a meta-analysis comparing the long-term clinical outcomes of VLP and CRC in elderly patients (aged ≥ 60 years).

Methods: A comprehensive search of PubMed, Web of Science, and Cochrane Library was performed to identify studies comparing the long-term outcomes of VLP and CRC for DRFs. Only randomized controlled trials (RCTs) with a mean follow-up duration of at least 2 years and participants aged 60 years or older were included. The risk of bias in the included studies was assessed. The primary outcome measure was the Patient-Rated Wrist Evaluation (PRWE). Secondary outcomes included the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, EuroQol 5 Dimension 5-level score (EQ-5D-5 L), grip strength, and incidence of reoperation.

Results: Four RCTs, comprising 423 patients, were included. The meta-analysis revealed that VLP fixation was associated with significantly improved outcomes compared to CRC in terms of PRWE score (pooled mean difference: -6.21; 95% CI: -10.28 to -2.15; p = 0.003), DASH score (pooled mean difference: -8.18; 95% CI: -13.35 to -3.01; p = 0.002), and grip strength (pooled mean difference: -6.63; 95% CI: 0.25 to 13.01; p = 0.04). There were no significant differences in EQ-5D-5 L score (95% CI: -0.08 to 0.05; p = 0.74) or incidence of reoperation (RR = 0.56; 95% CI: 0.22 to 1.42; p = 0.22).

Conclusions: A two-year follow-up of displaced DRFs in elderly patients showed no significant long-term clinical advantage of VLP fixation over CRC.

Background: The Functional Assessment Scale for Acute Hamstring Injuries (FASH) which measure symptom's severity and impact on physical activity and sports ability in individuals with acute hamstring muscle injury, is not available in Persian. The aim of this study was to translate and cross-culturally adapt the FASH questionnaire to Persian and to assess the psychometric properties of the translated version.

Methods: The Persian-translation and cross-cultural adaptation processes were based on World Health Organization method. A total of 160 participants compromising of four groups: (1) acute hamstring injury (N = 40), (2) other lower extremity injury (N = 40), (3) risk of acute injury (N = 40), and (4) healthy control (N = 40) were recruited to complete the Persian version of FASH (FASH-P) questionnaire twice with an interval of 48-60 h. The Short Form Health Survey (SF-36) and Lower Extremity Functional Scale (LEFS) were used to assess the criterion validity. Test-retest reliability, internal consistency, criterion validity, Dimensionality and floor/ceiling effects were evaluated to assess the FASH-P psychometric properties.

Results: The FASH questionnaire were translated to Persian without any major problems. The FASH-P showed excellent power of differentiation because the scores were significantly different among the four groups. Regarding psychometric performances, excellent test-retest reliability (Intraclass correlation coefficient of 0.997) and a high level of internal consistency (Cronbach's alpha of 0.966) were observed. The FASH-P total score was significantly correlated with SF-36 and LEFS questionnaires representing an excellent criterion validity. No floor or ceiling effect were found for total score in Hamstring muscle injury group.

Conclusions: Due to the excellent psychometric performance, the FASH-P can be used as a reliable and valid tool for evaluating the severity of symptoms and sports ability in Persian-speaking patients with hamstring muscle injury.

Objectives: To investigate the risk factors for short-term residual low back pain (SRBP) following percutaneous kyphoplasty (PKP) in patients with initial thoracolumbar osteoporotic vertebral compression fractures (OVCFs).

Methods: The clinical data of 389 patients with primary thoracolumbar OVCFs treated with PKP in our hospital from January 2018 to December 2022 were retrospectively analysed. A numerical rating scale (NRS) was used to evaluate whether SRBP was present 2 days after the operation. Patients with NRS scores > 4 were assigned to the SRBP group, and those with NRS scores ≤ 4 were assigned to the non-SRBP group. The general clinical data and surgical imaging-related data of the two groups were statistically analysed. Risk factors were analysed using binary logistic regression analysis.

Results: Binary logistic regression analysis showed four independent predictors of SRBP after PKP, including bone mineral density (BMD) (OR = 0.087, P = 0.044), preoperative injured vertebral kyphosis (OR = 1.26, P = 0.01), preoperative thoracolumbar fascia injury (TLFI) (OR = 8.929, P < 0.001), and cement distribution type (OR = 5.921, P < 0.001) and bone cement filling ratio (OR = 0.651, P < 0.001).

Conclusions: A decreased BMD, a larger preoperative kyphosis angle of the injured vertebra, preoperative TLFI, bone cement distributed in blocks and a low cement filling ratio of the injured vertebra are closely related to the occurrence of SRBP in OVCF patients after PKP. Clinicians should pay more attention to the prevention and treatment of risk indicators to further improve the therapeutic effect of PKP.

Trial registration: The trial was registered in the China Trial Registry (ChiCTR 2200067164).

Background: Osteonecrosis of the femoral head (ONFH) primarily affects young individuals and is a leading cause of total hip arthroplasty in this population. Joint-preserving regenerative therapies involving core decompression (CD), enhanced with cells, growth factors, and bone substitutes, have been developed but lack extensive validation. Exosomes are emerging as a promising regenerative therapy. Human adipose stem cell (hADSC)-derived exosomes exhibit angiogenic and wound-healing effects on damaged and diseased tissues, suggesting their potential efficacy in treating early-stage ONFH. We aimed to investigate the efficacy of hADSC-derived exosomes based on CD in a medium-sized animal model (rabbit).

Methods: Exosomes were extracted using the ultrafiltration filter technique from the culture supernatants of two types of hADSCs. Characterization of exosomes was performed through nanoparticle tracking analysis, transmission electron microscopy, and the detection of specific biomarkers (CD9, CD63, and CD81) by western blotting. Eighteen rabbits underwent surgical vascular occlusion and intramuscular corticosteroid injections to induce ONFH. Concurrently, CD treatment with local administration of hADSC-derived exosomes (exosome group) or saline (control group) was performed. Femoral heads were harvested at 4, 8, and 12 weeks postoperatively and evaluated using micro-computed tomography and tissue staining to assess the protective effects on osteonecrosis, angiogenesis, and osteogenesis.

Results: Exosomes had average particle concentrations of 1.8 × 10¹² or 1.8 × 10⁹ particles/mL, with particle size distributions averaging 61.2 ± 14.7 or 123.1 ± 46.3 nm, and were confirmed by specific biomarkers. The exosome group exhibited a significant reduction in the severe progression of ONFH to stages 3 or 4 of the modified Ficat and Arlet classification, compared to the control group, which had four cases of stages 3 or 4. The exosome group showed significantly fewer empty lacunae in the subchondral bone area (p < 0.05) and significantly less articular cartilage injury (p < 0.05) compared to the corresponding in the control group. There were no significant differences in the microvessel number, bone trabecular structure, or volume of new bone in the medial region of the CD.

Conclusions: hADSC-derived exosomes can prevent the progression of ONFH by inhibiting osteonecrosis and cartilage damage. The ultrafiltration filter technique is effective for exosome extraction, indicating that exosomes hold potential as a therapeutic agent for ONFH.

Background: Osteoporosis screening strategies vary according to a country's policies. Simple and highly accurate diagnostic predictors should be developed and utilized. This cross-sectional study aimed to determine the diagnostic performances of weight, body mass index (BMI), and age for osteoporosis. Moreover, this study proposes and validates new cutoff values for these indicators.

Methods: Women aged 50 years or older who underwent Dual-energy x-ray absorptiometry (DXA) and did not receive any treatment for osteoporosis were enrolled. Age, weight, and BMI were used to analyze the diagnostic models. New cutoff values were proposed using the maximum Youden index value.

Results: A total of 1598 women were classified into normal bone mineral density, osteopenia, and osteoporosis groups. The mean age, weight, and BMI were 73.2 years, 53.6 kg, and 23.2 kg/m², respectively, in the osteoporosis group, which significantly differed from those of the other groups. The new cutoff values for diagnosing osteoporosis at any site were 57.4 kg for weight, 23.8 kg/m² for BMI, and 72 years for age. The area under the receiver operating characteristic curve (AUC) for weight < 57.4 kg, BMI < 23.8 kg/m², and age ≥ 72 years cutoff values were 0.664, 0.633, and 0.558, respectively. The weight cutoff value yielded a significantly higher AUC than the BMI and age cutoff values (P = 0.002 and P < 0.001, respectively).

Conclusions: This study proposes new cutoff values for simple clinical predictors to facilitate directive decision-making in osteoporosis screening in women. Weight, which are easily obtained in clinical practice, are the most effective predictors of osteoporosis screening.

Background: The incidence of adjacent vertebral body re-fracture after percutaneous kyphoplasty (PKP) is associated with a number of variables, of which decreased bone mineral density is one of the major risk factors. Forearm bone mineral density (BMD) measurements are gaining attention because of their convenience and validity, but there is a lack of systematic research on the specific relationship between forearm BMD and the risk of adjacent vertebral re-fracture after PKP.

Purpose: To investigate the correlation between forearm BMD and the risk of adjacent vertebral re-fracture after PKP in osteoporotic vertebral compression fractures (OVCF) patients.

Methods: Retrospective evaluation of 198 OVCF patients receiving PKP was conducted in this study. The patients were divided into two groups: the no-fracture group and the re-fracture group, according to whether or not they had undergone vertebral re-fracture. Obtain basic information about the patient's age, sex, body mass index, bone cement leakage, smoking history, diabetes history, and surgical segmentation. Using computed tomography, the mean Hounsfield unit (HU) values for the BMD of the L1 lumbar spine were determined. For the dual-energy X-ray BMD test, the distal one-third lengths of the patient's nondominant forearm's radius and ulna were chosen. Receiver operating characteristic curves were utilized to evaluate the predictive value of forearm BMD versus lumbar CT values for vertebral re-fracture, and univariate and multivariate logistic regression analyses were employed to identify characteristics related with vertebral re-fracture following PKP.

Results: Re-fracture rate after PKP was 17.2% at a minimum 12-month follow-up. Significant differences were seen between the refracture and non-fracture groups in terms of hypertension, Cobb angle correction, vertebral height recovery rate, intradiscal cement leakage, forearm bone density, and vertebral HU values. In multifactorial logistic regression analysis, forearm bone density (OR 0.821; 95% CI 0.728-0.937, p = 0.008) and HU values (OR 0.815; 95% CI 0.733-0.906, p = 0.005) were independent risk factors for vertebral re-fracture. The area under the curve (AUC) for forearm BMD values and HU values predicting adjacent vertebral re-fracture were 0.956 and 0.967, respectively.

Conclusions: Forearm BMD is an independent risk factor for re-fracture of adjacent vertebrae after PKP. In addition, forearm BMD, as a valid indicator of postoperative re-fracture after PKP in patients with OVCF, and the HU value of lumbar spine CT were both powerful tools for predicting re-fracture.

Background: Osteonecrosis of the femoral head (ONFH) is a significant postoperative complication following femoral neck fractures (FNFs) in adolescents, that has garnered considerable attention from researchers. Despite this interest, the incidence of ONFH in adolescents post-FNF surgery has not been extensively evaluated. To contribute to the body of research, we performed a meta-analysis utilizing articles sourced from multiple databases, with an emphasis on the rate of ONFH occurrence in young adolescents following FNF surgery.

Objective: The purpose of this study was to investigate the incidence of ONFH after FNFs in adolescents worldwide and analyse potential risk factors affecting its occurrence to provide guidance for the treatment and rehabilitation after FNFs in adolescents and reduce the incidence of ONFH.

Methods: A comprehensive search of medical literature databases, including MEDLINE, Web of Science, the Cochrane Library, and Embase, was conducted to identify relevant studies on ONFH and its associated risk factors after surgical treatment for FNFs in adolescents, covering the period from the establishment of the database to April 2024. Studies that did not meet the inclusion criteria were excluded. The study was conducted based on the preferred reporting items for systematic reviews and meta-analyses (PRISMA). Literature extraction, management, and data entry were performed using Zotero 6.0 and Excel 2016. The meta-analysis was conducted using R Studio 4.2.2. Subgroup analysis, sensitivity analysis, and assessment of publication bias were performed to explore sources of heterogeneity and evaluate the reliability of the results. This study has been registered on Prospero. (registration number: CRD4202452794; date of registration: 03/04/2024) RESULTS: A total of 17 publications involving 862 patients with FNFs were included in this meta-analysis. The findings revealed that the incidence of ONFH after FNF surgery in adolescents was 24.02% [95% CI (0.2118, 0.2712)]. The included studies demonstrated good consistency, and no publication bias was observed.

Conclusion: This study revealed that the incidence of ONFH after FNFs in adolescents is high (24.02%). Early screening and effective treatment of postoperative patients are crucial.