Journal of Orthopaedic Surgery and Research最新文献

Objective: To evaluate intraoperative and early postoperative clinical outcomes using the "tension band wiring first technique" to reduce C type patellar fractures.

Methods: Sixty-four patients with C type fractures were enrolled in this study. Thirty-four patients underwent open reduction and internal fixation (ORIF) surgeries using the traditional reduction technique by pointed clamps (TRT group). The other thirty patients received the patellar fracture reduction using the "Tension band wiring first technique" (TBWFT group). All patellar fractures were treated with a cable tension band and a cerclage cable. The duration of intraoperative procedure and X-ray exposure times were recorded. All patients were followed up at 1, 3, 6, and 12 months. Bone union time was recorded. The articular surface steps of the patellas were measured. After surgery, range of motion (ROM) of the knee, and complications were evaluated, and patellar function was evaluated using the Lysholm knee scores and Böstman scores.

Results: When compared to TRT group, the "Tension band wiring first technique" significantly reduced the intraoperative time and X-ray exposure times and tended to reduce the articular surface steps, though without statistical significance. In the two groups, there was no significant difference in bone union time, ROM, complications and patellar function.

Conclusion: The utilization of "Tension band wiring first technique" proved to be a straightforward, expeditious, and reproducible technique for reducing patellar fracture in comparison to the conventional reduction technique utilizing pointed clamps. Further studies are required to ensure the generalizability of these findings to additional patient populations at other institutions.

Background: Robotic-assisted surgery has emerged as an innovative approach widely adopted in the field of orthopedics. However, its application specifically for managing atlantoaxial dislocation with a high-riding vertebral artery (AAD-HVA) remains underreported in the existing literature.

Objective: To compare the perioperative outcomes of robotic-assisted (RA) and fluoroscopic-guided free-hand (FH) techniques for atlantoaxial dislocation in combination with a high-riding vertebral artery (AAD-HVA).

Study design: This was a retrospective study.

Setting: This research was performed at a single department of spine surgery.

Methods: Data from patients who underwent atlantoaxial internal fixation between July 2018 and January 2022 at our hospital were retrospectively analyzed. Among the cases, 14 were performed using free-hand (FH) techniques and 11 utilized robotic-assisted (RA) techniques. Data collected included case notes, imaging records, and follow-up data. The reliability of screw placement was evaluated based on the Gertzbein and Robbins scores, while treatment outcomes were assessed using the Japanese Orthopaedic Association (JOA) score, visual analog scale (VAS), neck disability index (NDI), and postoperative complication rate.

Results: Baseline patient characteristics were comparable between the FH and RA groups. The mean blood loss was markedly lower in the RA group (157.3 ± 49.7 ml) compared to the FH group (290.0 ± 110.3 ml) (p = 0.03). Although the average operative time was slightly higher in FH group than in RA group, this disparity did not achieve statistical significance (p = 0.7588). Moreover, the radiation exposure dose was remarkably higher in FH group (32.7 ± 4.4 mGy) than in RA group (23.0 ± 3.2 mGy) (p < 0.0001). The percentage of clinically acceptable screw placement was slightly lower in FH group (87.5%) than in RA group (97.8%), but the observed variance was not statistically meaningful (p = 0.3669). Furthermore, the differences in JOA, VAS, and NDI scores between the FH and RA groups were not statistically significant. Additionally, no obvious differences were found in clinical outcomes or complications related to screw implantation between the two groups.

Limitations: This study has inherent limitations as it was retrospective in nature and conducted at a single center.

Conclusion: Robotic-assisted surgery for AAD-HVA patients offers a minimally invasive approach, reduced bleeding and lower radiation exposure compared with traditional free-hand surgery.

Background: Respiratory compromise among ankylosing spondylitis (AS) patients is characterized by restrictive pulmonary function, leading to the need for a meticulous assessment of lung volume. Compared with conventional pulmonary function tests (PFTs), CT-based lung volume measurements have superior accuracy and are crucial for understanding functional limitations in AS. This study investigated the correlation between CT lung volume and PFT parameters in AS patients, with a focus on changes in CT parameters and lung volume in patients with compromised pulmonary function.

Methods: A total of 79 AS patients were included, and their full-length radiographs, thoracic CT scans, and PFT data were analysed. Specialized software was used to estimate the total and lobar lung volumes from the CT scans. The relationship between lung volume and PFT results was examined, and a multiple linear regression model was constructed to determine the influence of radiographic and CT parameters on total lung volume (TLV). Patients were classified into normal or impaired pulmonary function groups based on PFT outcomes, thus facilitating comparative analyses of radiographic and CT parameters and lung volumes between these groups.

Results: Among the 79 AS patients, 19 had normal function, 4 had mixed dysfunction, and 56 experienced restrictive dysfunction. PFT parameters, including FVC, FEV1, TLC, FEV1%, and TLC%, showed varying correlations with TLV and individual lobe volume. Patients with compromised pulmonary function exhibited more pronounced spinal kyphosis and experienced a decline in TLV. Multiple regression analysis revealed that lung height and horizontal and vertical lung diameters independently influenced TLV. Notably, a decrease in lung height was observed in patients with impaired pulmonary function, whereas the horizontal and vertical diameters of the lungs remained stable.

Conclusions: In AS patients, TLV was found to be correlated with pulmonary function, particularly parameter such as FVC, FEV1, and TLC. A significant reduction in TLV was observed in those with impaired pulmonary function, with the primary contributing factor being a decrease in lung height.

Background: Residual low back and leg pain can occur after percutaneous endoscopic interlaminar discectomy (PEID) and compromise early surgical outcomes. This study aimed to determine the efficacy of combining dexamethasone with vitamin B12 (VB12) via epidural injection in improving the symptoms of low back and leg pain after PEID, and the underlying mechanism of action.

Methods: Patients who underwent PEID for lumbar disc herniation (LDH) were enrolled and randomly assigned to the single surgery (SS) group, where disc removal was performed via PEID alone, or the combined treatment (CT) group, which received epidural injections of dexamethasone and VB12 alongside surgery. The outcome measures were the Visual Analog Scale (VAS), Japanese Orthopaedic Association (JOA) score, Oswestry Disability Index (ODI), serum inflammatory factor expression, adverse surgical events, duration of postoperative hospitalization, and modified MacNab criteria.

Results: Compared with the SS group, the CT group exhibited lower VAS scores for low back and leg pain at 1, 3, and 7 days post-surgery (P < 0.05). JOA and ODI scores were significantly improved in the CT group than in the SS group 7 days post-surgery (P < 0.05); however, no significant differences were observed at other time points. Serum inflammatory factors were lower in the CT group than in the SS group 3 days post-surgery (P < 0.05). The duration of postoperative hospitalization was shorter in the CT group (P < 0.05). Both groups had similar good outcomes (89.3% vs. 92.2%, P = 0.945).

Conclusions: Epidural injection of dexamethasone and VB12 effectively reduces early postoperative low back and leg pain, lowers postoperative inflammatory factor expression, and improves early PEID outcomes. Its clinical adoption merits consideration.

Trial registration: This trial was registered with the China Clinical Trial Registration Center (Identifier: ChiCTR2400088854).

Background: The coracoclavicular ligament reconstruction (CLR) technique for the treatment of acromioclavicular joint (ACJ) dislocation has gained immense clinical popularity. However, this technique also has some limitations including complications such as distal clavicle fractures, coracoid fractures, bone tunnel widening, implant failure, and loss of reduction. A study was conducted to analyse the extent of CTW after single-bundle CLR by measuring radiographic parameters to determine its relationship with clinical variables to reduce the risk of clavicular tunnel widening (CTW), thereby providing important insights for clinical practice.

Methods: This retrospective analysis was conducted at Affiliated Fuyang People's Hospital of Bengbu Medical University, and data from 96 patients who underwent single-bundle CLR for type III-VI ACJ dislocation between January 2018 and December 2023 were initially collected. Finally, 84 patients met the inclusion criteria (63 male and 21 female, mean age: 49.5 ± 12.36 years). The clavicle tunnel (CT) width and coracoclavicular distance (CCD) was measured immediately postoperatively and at 6 months follow up using radiographic imaging, and the degree of expansion at 6 months was recorded. Preoperative variables including patient sex, age, injury cause, injury side, body mass index (BMI), Rockwood classification, extent of the CCD after surgery, and the CT location were recorded to analyze their correlation with the extent of CTW at 6 months follow up.

Results: With an average follow-up duration of 10 months (range: 6-18 months). Both the extent of the CCD and CTW measured at 6 months postoperatively were differently enlarged, compared to early postoperative period (EPO) (P < 0.05). The results showed that there were no statistically significant differences in the CTW at 6 months postoperatively with respect to patients' sex, causes of injury, sides of injury, and Rockwood classification types(P > 0.05). However, the location of CT was significantly associated with the extent of CTW at 6 months postoperatively (P < 0.05).

Conclusions: The location of CT drilling is a significant factor that affects tunnel widening. When the drilling site is situated closer to the conoid tubercle, the extent of CTW is greater than when the tunnel is located farther from the conoid tubercle.

Purpose: Pain following arthroscopic knee surgery remains a controversial clinical problem. Intra-articular (IA) glucocorticoid injections have demonstrated the potential to provide better analgesia in some orthopedic surgeries; however, due to the lack of studies, its role in knee arthroscopies remain unclear. This systematic review aimed to evaluate the efficacy and safety of intra-articular glucocorticoids after arthroscopic knee surgery.

Methods: A systematic review was conducted according to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guideline, with literature search performed on Medline, Embase, and the Cochrane Library. This systematic review has been registered with the International Prospective Register of Systematic Reviews (PROSPERO; ID: CRD42024509749). Inclusion criteria included randomized controlled trials published in English comparing IA glucocorticoid to placebo in patients undergoing knee arthroscopy. Risk of bias for all included studies was assessed using the Cochrane Collaboration's risk of bias tool. Clinical outcomes compared were pain score: visual analogue scale (VAS) or International Knee Documentation Committee (IKDC), time to first analgesia requirement, analgesia consumption, range of motion (ROM), patient satisfaction, and complications.

Results: A total of 7 studies (3 and 4 with evidence level I and II, respectively) involving 309 patients were included. All studies showed that IA glucocorticoids significantly decreased subjective pain scores. Three studies showed significantly longer duration to first postoperative analgesia use, while 6 showed significantly reduced postoperative analgesic administration with IA glucocorticoid use. Two studies showed significantly increased patient satisfaction with IA glucocorticoid (P = 0.001 and P = 0.01, respectively). No studies showed significant differences in complications such as nausea, vomiting, bradycardia, hypotension, or procedure-related adverse effects between the groups.

Conclusion: Current available randomized controlled trials suggest that IA glucocorticoids can significantly reduce postoperative pain, delay, and minimize postoperative analgesia use, and improve patient satisfaction. No postoperative complications or adverse events were reported, reflecting its safety as a postoperative analgesic modality.

Background: Calcaneal fractures are the most common type of tarsal fractures. The sustentaculum tali (ST) offers anatomical stability in calcaneal fractures, and recently, ST screws have been widely used in their treatment. This study aimed to investigate the clinical efficacy and value of ST screw fixation via a modified sinus tarsi approach (MSTA) for treating displaced intraarticular calcaneal fractures (DIACFs).

Methods: This study enrolled 64 patients (64 feet): 32 patients in the calcaneal locking plate combined with the ST screw group (CLP-STS Group) and 32 patients in the simple calcaneal locking plate internal fixation group (CLP Group). The minimum follow-up duration was 18 months. Ankle function was evaluated using VAS, AOFAS, and Short Form-36 scores. Imaging evaluation included the Böhler angle, Gissane angle, length, height, and width of the calcaneus, and the Böhler angle in both groups 1 year after surgery.

Results: Functional evaluation revealed that postoperative AOFAS and VAS scores in the CLP-STS Group were significantly better than those in the CLP Group. After surgery, the Böhler angle, Gissane angle, and length, height, and width of the calcaneus were significantly corrected compared to the preoperative values; however, the difference in these indicators between the two groups was not significant. Nevertheless, at the 1-year postoperative follow-up, the calcaneal Böhler angle loss in the CLP-STS Group was significantly better than that in the CLP Group.

Conclusion: Compared to simple calcaneal locking plate internal fixation, combining the plate with the additionally free ST screw can resolve the limited intraoperative exposure of MSTA, reduce postoperative foot pain in patients, and improve clinical efficacy.

Background: Orthopedic surgeries often involve the insertion of bone screws for various fixation systems. The risk of postoperative screw loosening is usually assessed through experimental or finite element (FE) evaluations of the screw pull-out strength. FE simulations are based on either personalized complex but accurate heterogeneous modeling or non-personalized simple but relatively less accurate homogeneous modeling. This study aimed to develop and validate a novel personalized computed tomography (CT)-based homogeneous FE simulation approach to predict the pull-out force of cancellous bone screws.

Methods: Twenty FE simulations of L1-L5 vertebral screw pull-out tests were conducted, i.e., 10 heterogeneous and 10 homogenous models. Screws were inserted into the lower-middle region of vertebrae. In our novel homogeneous model, the region around approximately twice the diameter of the screw was used as a bone material reference volume. Subsequently, the overall material property of this region was homogeneously attributed to the entire vertebra, and pull-out simulations were conducted.

Results: The mean error of the predicted pull-out forces by our novel homogenous simulations was ~ 7.9% with respect to our heterogeneous model. When solely the cancellous bone was involved during the pull-out process (i.e., for L1, L2, and L3 vertebral bodies whose cortical bone in the inferior region is thin), the novel homogenous model yielded small mean error of < 6.0%. This error, however, increased to ~ 11% when the screw got involved to the cortical bone (for L4 and L5 vertebrae whose cortical bone in the inferior region is thick).

Conclusion: The proposed personalized CT-based homogenous model was highly accurate in estimating the pull-out force especially when only the cancellous bone was involved with the screw.

Background: The purpose of this study is to explore the feasibility and accuracy of a robot-assisted technique in four-corner fusion compared with traditional freehand operation.

Methods: Twenty cadaver specimens were randomly assigned to the robot-assisted group and freehand groups. Three screws were placed percutaneously to fix the capitate-lunate joint, lunate-triquetrum joint, and triquetrum-hamate-capitate joint in each specimen by robot-assisted or freehand technique. The offset between the actual and planned screw positions was determined by merging the images of intraoperative and postoperative CT scans in the robot-assisted group. The centrality of the screw, time-consuming, drilling attempts, and radiation exposure were compared between the two groups.

Results: The mean offset between the actual and planned screw position was 1.09 (SD: 0.56) mm. The offset at the start point of the screw was significantly lower than that at the endpoint. There was no significant difference in the centrality of the screws, surgical time between the two groups. The number of drilling attempts and the radiation dose received by surgeons were significantly lower in the robot-assisted group.

Conclusions: Although there was no significant difference in screw centrality between the two groups, the slight offset between the actual and planned screw positions confirmed the feasibility of the robot-assisted technique in four-corner fusion. The robot-assisted technique has advantages in reducing the difficulty of surgery and protecting the surgeon from exposure to large doses of radiation.

Background: Manipulation under anesthesia (MUA) has been recommended for refractory arthrofibrosis after anterior cruciate ligament (ACL) reconstruction. However, the effectiveness of MUA to restore normal kinematics of the arthrofibrotic knee is still unclear. The objective of this study was to evaluate tibiofemoral and patellofemoral kinematics in six degrees-of-freedom (6DOF) in patients with arthrofibrosis before and after MUA.

Methods: Computed tomography and dual fluoroscopic imaging system were used to assess in vivo knee kinematics. Ten patients (6 women and 4 men; 32.6 ± 6.5y, 168.4 ± 7.8 cm, 61.8 ± 13.2 kg) were included in this study. The tibiofemoral and patellofemoral kinematics in 6DOF were collected before and one year after MUA. A simple analysis of variance was used to evaluate kinematic data of preoperative arthrofibrotic knee, postoperative arthrofibrotic knee, and the contralateral knee.

Results: The patella in the postoperative arthrofibrotic knee shifted significantly more inferiorly compared to the preoperative knee at 45° (P = 0.010), 60° (P = 0.008), and 75° (P = 0.049) of flexion. The patellar flexion in the postoperative arthrofibrotic knee significantly increased at 45° (P = 0.048), 60° (P = 0.037), and 75° (P = 0.006) of flexion compared to the preoperative arthrofibrotic knee. The patellar tilt was significantly decreased at 60° (P = 0.006) and at 75° (P = 0.037) of knee flexion in the postoperative arthrofibrotic knee compared to the contralateral knee. MUA significantly increased tibial internal rotation angle in the arthrofibrotic knee at 45° (P = 0.047), at 60° (P = 0.033), and at 75° (P = 0.021) of knee flexion.

Conclusions: MUA could restore normal patellar inferior shift, flexion, and tibial rotation compared to the contralateral side. However, the MUA could not restore normal patellar tilt of the arthrofibrotic knee. This indicated that improvement of patellar tilt should be emphasized in postoperative rehabilitation.