Journal of Orthopaedic Surgery and Research最新文献

Background: The combined injury of multiple knee ligaments, commonly referred as "multiligament knee injury" (MKI), is a rare pathology that most often occurs in high-energy trauma. The associated lesions present a technical challenge for surgical reconstruction in terms of operative strategy. Various anatomical techniques have been described. Despite their proven advantages over non-anatomical techniques, these techniques have several disadvantages, such as the need for multiple grafts and allografts and the creation of multiple tunnels. Our technique aims to overcome these disadvantages.

Materials and methods: We present an original surgical technique for the anatomical reconstruction of the medial collateral ligament and the posterior oblique ligament using a pediculated autograft from the semitendinosus or gracilis. Fourteen patients were analysed.

Results: The minimum follow-up period was 2 years (mean: 44 months, 33-61). Good clinical and objective paraclinical results were achieved, with a mean range of motion of 0-1-119° at the last follow-up. 93% of patients showed no valgus laxity and 100% of patients had an objective IKDC score of A or B.

Conclusion: We propose a new approach to reconstructing the medial and posteromedial structures. This involves anatomical and isometric ligamentoplasty using an autograft. Our results confirm the effectiveness of this technique, demonstrating good clinical and paraclinical outcomes.

Level of evidence: IV.

Background: For internal-fixation of femoral neck fractures, determining the femoral neck central axis intraoperatively and calculating screw coordinates accurately remain crucial but extremely challenging. Previous research has shown that the flat anterior cortex of the femoral neck base (AC-FNB) can be used to establish a constant spatial coordinate system parallel to the surgical central axis (SCA) of the femoral neck theoretically, promising for solving the above conundrums. In this study, based on osseous marker AC-FNB, three guide pins of femoral neck surgical central axis (GPs-SCA) were implanted to build the stable implanting-screws spatial coordinate system, for providing convenience for controllable inserting femoral neck screws accurately during surgery.

Methods: After three-dimensional-reconstruction of forty sawbone synthetic femoral necks by CT scanning, the axial safety target areas (ASTA) for drilling femoral neck screw channels were determined by the intersection method to measure parameters such as superior-inferior diameter (D-SI) and anterior-posterior diameter (D-AP), verifying sawbones meet the inclusion criteria. Utilizing the robot-assisted patented technologies, the GPs-SCA were drilled with reference to the AC-FNB. Postoperatively, the ratio coordinates of each GP-SCA and the angle deviations between the GPs-SCA and the SCA of the corresponding femoral neck were measured using orthogonal X-rays and CT three-dimensional-reconstructions. The parameters of each GP-SCA on both X-rays and CT scans were then calculated, and paired t-tests were conducted.

Results: All preoperative parameters were within normal ranges for the femoral neck. Postoperatively, angular deviations between GPs-SCA and SCA were less than 5° on both orthogonal X-rays and CT scans. The Y-axis ratio coordinates of GP-SCA were - 0.41% ± 2.32% on orthogonal X-rays and - 0.32% ± 2.29% on axial CT, while the Z-axis ratio coordinates of GP-SCA were 0.74% ± 2.76% on orthogonal X-rays and 0.64% ± 2.87% on axial CT, respectively. There were no significant differences found (Py = 0.245, Pz = 0.185).

Conclusions: By utilizing the AC-FNB as a landmark, GPs-SCA could be successfully implanted within the allowable error ranges to facilitate building a reliable spatial rectangular coordinate system for controllable implanting screws. This coordinate system offers convenience in determining the directions of implanting screws, standardizing orthogonal fluoroscopies, registering X-rays and CT images, and converting X-ray data to axial coordinates.

Objectives: This randomized controlled trial aimed to evaluate the short term effects of adding different doses of corticosteroids to periarticular infiltration analgesia (PIA) on pain control and functional recovery after total knee arthroplasty (TKA).

Methods: A total of 234 patients undergoing TKA were randomly assigned to one of three groups: Group H (PIA with 21 mg betamethasone), Group N (PIA with 7 mg betamethasone), and Group C (PIA without corticosteroid). The PIA cocktail (80 mL) consisted of 300 mg of 0.75% ropivacaine, 5 mg morphine, 50 mg flurbiprofen, and 0.4 mL of 1:1000 epinephrine. The primary outcome was the Visual Analog Scale (VAS) score during active knee flexion. Secondary outcomes included resting VAS scores, active range of motion (AROM), 1-min walking distance, knee circumference (measured at three levels: 10 cm above the superior patellar pole, mid-patella, and 10 cm below the inferior patellar pole), total rescue analgesic consumption, serum C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and fasting blood glucose. Tertiary outcomes involved the incidence of postoperative adverse events.

Results: No significant intergroup differences were observed in active flexion VAS scores at any postoperative time point. From postoperative days 1-4, A ROM was significantly greater in Groups H and N than in Group C. Group H also demonstrated significantly reduced mid-patella circumference and lower rescue analgesic consumption compared to the other groups. In addition, CRP and ESR levels were significantly lower in Group H. However, this group exhibited transiently elevated blood glucose at 6 h post-surgery. No significant differences were found among the three groups in other secondary outcomes, including resting VAS, 1-min walking distance, additional knee circumference measurements, and adverse event rates.

Conclusion: The adjunct use of corticosteroids in PIA did not enhance short-term pain control or ambulation capacity after TKA. Although corticosteroid supplementation reduced inflammation, improved early ROM, and decreased rescue analgesic requirements, it induced dose-related hyperglycemia. Therefore, high-dose steroid-containing PIA should be avoided in patients with diabetes or glucose intolerance.

Objective: Progressive collapsing foot deformity is a complex clinical presentation of combined deformities, which affects articular joint relationships. Herein, the study aimed to characterize joint interactions of the ankle, tibiofibular, talofibular, subtalar, talonavicular, calcaneocuboid, naviculo-cuneiform, and tarso-metatarsal joints.

Materials and methods: We quantified and compared the results between 23 female patients with progressive collapsing foot deformity and 23 female asymptomatic individuals. We used a multi-domain correspondence model from statical shape modeling to compare the alignment and morphology followed by calculating the joint-level measurements including the joint space distance and the congruence index between groups.

Results: From our results we found that almost all bones and joints were affected by the progressive collapsing foot deformity. Our main results for joint space distances were narrowing in the sinus tarsi, gapping at the medial of the calcaneocuboid joint, and narrowing at the 3rd, 4th, and 5th tarso-metatarsal joints. The primary results for the congruence index were shifted to the lateral side in the talonavicular joint and a less congruent middle facet of the subtalar joint in the progressive collapsing foot deformity group. In addition, the joint space distance was mainly influenced by alignment, and the congruence index was influenced by bone morphology.

Conclusion: We believe that assessing multi-joint interactions in progressive collapsing foot deformity will lead to a better understanding of the pathophysiology and assist in surgical treatment planning.

Background: Osteoporosis affects millions of people worldwide, and current medications such as bisphosphonates and denosumab are not effective enough to reverse bone loss. Moreover, these treatments have drawbacks, including jaw osteonecrosis and skin eczema. Hence, there is an urgent need for new drugs to treat osteoporosis.

Methods: Drug library screening was performed via alkaline phosphatase (ALP) staining in osteoblasts to identify potential candidates for osteoporosis treatment. qPCR, Western blotting, ALP staining, alizarin red staining, and tartrate-resistant acid phosphatase (TRAP) staining were conducted to assess the impact of ZM-306416 (ZM) on osteoblast and osteoclast differentiation in vitro. Additionally, RNA sequencing and pathway analysis were carried out to explore the underlying molecular mechanisms involved. Micro-CT scanning and immunostaining were used to determine bone phenotypes in vivo.

Results: Drug library screening revealed that ZM enhances ALP activity in osteoblasts, indicating its potential as a pro-osteogenic agent. ZM exerts dual effects by promoting osteoblast differentiation through the Wnt/β-catenin signaling pathway and simultaneously inhibiting osteoclast differentiation through the NF-κB and MAPK signaling pathways. In an OVX mouse model, ZM effectively prevents bone loss by stimulating osteoblast formation and inhibiting osteoclast development.

Conclusions: Our study revealed that ZM has a dual anti-osteoporosis effect by promoting osteoblastogenesis and inhibiting osteoclastogenesis, which is mediated by activation of the Wnt/β-catenin signaling pathway and suppression of the NF-κB/MAPK cascades. These findings suggest that ZM could be a promising therapeutic agent for alleviating osteoporosis.

Purpose: This study aimed to examine the relationships between the serum follicle-stimulating hormone (FSH) levels and lumbar intervertebral disc degeneration (IVDD) severity in women undergoing the menopausal transition.

Methods: Consecutive women aged 45-55 years were enrolled in the cross-sectional study. Fasting serum FSH levels were measured, and lumbar IVDD severity was evaluated using modified Pfirrmann grading on magnetic resonance images.

Results: A total of 324 subjects, including 117 pre, 62 peri- and 145 postmenopausal women, were included. Compared with the pre- and perimenopausal groups, the postmenopausal group demonstrated higher FSH levels and IVDD severity, which was better supported by an age-matched comparison. Notably, the serum FSH levels showed statistically positive correlations (P < 0.001) with L1/2 (r_s = 0.534), L2/3 (r_s = 0.633), L3/4 (r_s = 0.568), L4/5 (r_s = 0.365) and L5/S1 (r_s = 0.430). For the first time, immunohistochemistry results revealed FSH receptor (FSHR) expression in human nucleus pulposus tissue, although histochemistry scores did not differ across groups.

Conclusion: There were significant associations between elevated FSH levels and IVDD severity in women during the menopausal transition, which is beneficial for further exploring the potential mechanisms underlying postmenopausal IVDD. These findings suggest that FSH may be a novel biomarker for assessing IVDD risk in menopausal women and highlight the FSHR as a potential therapeutic target for mitigating disc degeneration.

Purpose: To describe and standardize a reproducible posterolateral approach to the posterior iliac crest for bone marrow aspirate (BMA) harvesting, based on a palpation-guided technique with optional ultrasonographic confirmation, emphasizing anatomical accuracy, safety, and procedural simplicity.

Methods: The technique was performed in 63 patients using a Jamshidi-type cannula introduced through a lateral entry point aligned with the posterior superior iliac spine (PSIS). Guided by palpable anatomical landmarks and optionally confirmed by ultrasound, small-volume aspirations (4-5 mL) were performed with systematic needle reorientation to minimize peripheral blood dilution and optimize marrow cell yield. The procedure was conducted under local anesthesia, with the patient positioned laterally to ensure comfort and ergonomic access for the operator, allowing multiple aspirations through a single entry site.

Results: The posterolateral PSIS approach, using a palpation-based method with optional ultrasonographic confirmation, was feasible and anatomically consistent in this descriptive case series of 63 patients. Using predefined anatomical criteria for procedural success, correct subendosteal cannula positioning at the level of the PSIS was achieved in all procedures. In cases in which ultrasonography was employed, correct positioning was sonographically confirmed. When ultrasonographic confirmation was not used, the procedure was completed based on anatomical landmark guidance alone, without any intention of comparative assessment. The lateral patient position offered ergonomic advantages for the operator and enhanced patient comfort, while maintaining a low risk to adjacent neurovascular structures.

Conclusions: This standardized, palpation-guided lateral technique provides a safe, efficient, and anatomically reliable method for bone marrow harvesting that can be performed under local anesthesia in an outpatient or office-based setting.

Clinical relevance: By combining anatomical precision with procedural simplicity and eliminating the need for fluoroscopy or continuous ultrasound guidance, this approach facilitates broader access to bone marrow aspiration for orthopedic and regenerative applications, enhancing both procedural efficiency and patient experience.

Objective: To compare clinical outcomes and radiographic parameters between interspinous process fixation (ISPF) and posterior lumbar interbody fusion (PLIF) in patients with single-level degenerative lumbar spinal stenosis (LSS) associated with Meyerding Grade I spondylolisthesis.

Methods: We retrospectively analyzed 107 patients who underwent ISPF (n = 55) or PLIF (n = 52) between January 2019 and January 2023. Propensity score matching (PSM) was performed using covariates including age, sex, BMI, symptom duration, smoking history, diabetes mellitus, hypertension, and affected spinal level, resulting in 36 matched pairs. Clinical efficacy was evaluated using the Visual Analog Scale (VAS), Oswestry Disability Index (ODI), Japanese Orthopaedic Association (JOA) score, and Macnab criteria. Radiographic assessments included lumbar lordosis (LL), pelvic incidence (PI), pelvic tilt (PT), segmental angle (SA), and disc height (DH). All patients completed more than 24 months of follow-up.

Results: Post-matching analysis demonstrated good baseline balance (SMD < 0.20, P > 0.05). ISPF showed superior short-term outcomes, with significantly greater improvement in VAS scores both immediately postoperatively (2.52 ± 1.39 vs. 3.21 ± 1.23, P = 0.0078) and at the 3-month follow-up (1.83 ± 1.31 vs. 2.54 ± 1.20, P = 0.0042). Similarly, ODI favored ISPF at the immediate postoperative evaluation (38.64 ± 8.86 vs. 42.17 ± 6.77, P = 0.0221) and at 3 months (25.61 ± 8.84 vs. 30.15 ± 6.75, P = 0.0035), whereas no significant between-group differences were observed at 1 year and at the final follow-up (both P > 0.05). Radiographically, ISPF achieved superior LL (45.13° ± 4.97 vs. 40.37° ± 7.37, P = 0.0002) and lower PT (12.49° ± 7.62 vs. 15.80° ± 8.26, P = 0.0334), whereas PLIF demonstrated greater correction of the slip angle (SA: 10.99° ± 2.53 vs. 12.52° ± 1.48, P = 0.0004). Long-term clinical outcomes and patient satisfaction rates were comparable (Macnab excellent-to-good: 86.11% ISPF vs. 83.33% PLIF, P = 0.9420).

Conclusions: ISPF provided better short-term clinical recovery and maintenance of sagittal alignment, whereas PLIF offered greater slip correction. Both procedures yielded comparable long-term clinical outcomes, supporting individualized surgical decision-making in patients with degenerative LSS and Grade I spondylolisthesis.