MUSCULOSKELETAL SURGERY最新文献

3D-printed (3DP) drill guides have demonstrated significant potential to accurately guide pedicle screw insertion in spinal surgery. However, their role in the upper cervical spine is not well established. This review aimed to compare the efficacy and safety of 3DP drill guides to the conventional fluoroscopic-guided free-hand technique for pedicle screw insertion in the upper cervical spine. A comprehensive literature search was conducted across five databases (Medline, Scopus, CENTRAL, Web of Science, and Embase). The meta-analysis compared the accuracy of pedicle screw placement, screw placement time, operative time, blood loss, fluoroscopy usage, and post-operative JOA and VAS scores between the two approaches. Seven studies were included in the review, encompassing 386 patients and 1,512 screws. The meta-analysis demonstrated that 3DP drill guides increased the rate of perfect screw insertion (OR: 4.34, P < 0.00001) and lowered the incidence of moderate (OR: 0.26, P < 0.00001) and poor (OR: 0.09, P < 0.00001) screw insertion compared to the free-hand technique. Additionally, operative time (MD: -36.07, P < 0.00001), blood loss (MD: -83.82, P < 0.00001), and fluoroscopy usage (MD: -3.47, P < 0.0001) was significantly reduced in the 3DP cohort. No significant difference was detected in screw placement time (MD: -2.65, P = 0.07), or post-operative JOA (MD: 0.17, P = 0.47), and VAS (MD: -0.09, P = 0.19) scores between the two cohorts. The review demonstrated that 3DP drill guides are a safe and effective tool to assist pedicle screw fixation in the upper cervical spine.

The aim is to identify the 50 most cited papers and thus the most influential papers pertaining to ACJ reconstruction, and specifically, analysing the level of evidence (LOE), article content, journals occurring, and countries represented within the 50 most cited. A search of the Web of Science database was carried out using the following terms: "Acromioclavicular joint" OR "AC joint" (Topic) AND Reconstruction OR Repair (Topic). The top 50 relevant articles were analysed in relation to citations, citation density, geographic origin of the article, year published, and article type. The articles were cited a total of 6053 times. The most cited article was cited 347 times. The highest citation density was 20.02, with a mean citation density of 7.71 ± 4.13. Seventy per cent of the articles involved clinical research, 74% of which involved level IV evidence. Fifty-two per cent of the articles were published in the American Journal of Sports Medicine (AJSM). Most authors originated from USA (n = 26 or 52%), followed by Germany (n = 14 or 28%). This study revealed a paucity of articles with higher LOE among the most cited. Eight of the top 10 are either theoretical or biomechanical studies, and one reports an examination technique. Only two of the top 10 reported outcomes following surgical intervention and can thus directly guide treatment. Future research in the area of ACJ reconstruction should focus on generating high-quality interventional studies capable of informing/impacting patient care. Publishing in journals such as AJSM or Arthroscopy may lead to more citations.

Purpose: Avascular necrosis (AVN) of the humeral head is a relatively frequent complication after proximal humerus fractures (PHF), often leading to poor outcomes and reoperation. This study investigates both non-modifiable (fracture type, trauma energy, age, sex, Charlson comorbidity index) and modifiable (surgical access, bone graft use, reduction quality) risk factors for post-operative AVN in Neer 3-4-part PHFs.

Methods: Patients with Neer 3-4-part PHFs treated using angular stable plates and followed for at least 6 months were included. Clinical and radiographic elements were evaluated. Statistical analysis was performed with SPSS 26, evaluating the data by both descriptive and univariate analyses.

Results: Among 121 patients (mean age 63, mean follow-up 10.1 months), 8 developed AVN (6.6% incidence). Only 50% of AVN cases occurred within the first 15 months of follow-up. AVN was significantly associated with 4-part fractures (p = 0.050), medial hinge disruption (p = 0.022), tuberosity comminution (p = 0.003), failure to restore the cervico-diaphyseal angle (p = 0.022), and residual varus/valgus deformity (p = 0.01). The presence of a bone graft suggested a fourfold-increased risk of AVN (OR = 4.219).

Conclusions: The present study confirms that the risk of necrosis is predicted by the type of fracture, as well as by the quality of fixation. Age, sex and CCI of the patient, varus/valgus fracture displacement, glenohumeral dislocation and energy of the trauma did not suggest the risk of AVN. These findings underscore the importance of meticulous surgical techniques to address these factors and potentially reduce the incidence of AVN.

Level of evidence iii: Prospective cohort study.

Purpose: Pain management after total hip arthroplasty (THA) is crucial for patient recovery and satisfaction. Various analgesic techniques exist, including the pericapsular nerve group (PENG) block and local infiltration analgesia (LIA). This study aims to compare the efficacy of PENG and LIA in postoperative pain management following THA.

Methods: A random-effects meta-analysis of randomized controlled trials (RCTs) comparing PENG and LIA in primary THA was conducted. A systematic search of MEDLINE, Embase, Cochrane Library, and SCOPUS was performed up to October 24, 2024. Pain scores, opioid consumption, and secondary outcomes such as complications and postoperative nausea and vomiting (PONV) were analysed.

Results: Four RCTs were included, with 128 patients receiving PENG and 130 receiving LIA. Demographics, including age, BMI, ASA status, and surgery duration, were comparable. Pain scores at 6, 12, 24, and 48 h were higher in the PENG group but not statistically significant. At 24 h, cumulative opioid consumption was higher in the LIA group [4.23 mg (95% CI: 0.50-7.96) vs. 3.97 mg (95% CI: 0.24-7.70)] though not statistically significant (p = 0.92). At 48 h, PENG had higher cumulative opioid consumption [6.78 mg (95% CI: 1.04-12.52) vs. 6.18 mg (95% CI: 0.91-11.45)] though not statistically significant (p  = 0.88). Secondary outcomes, including overall complication rates and PONV, showed no significant differences.

Conclusions: PENG and LIA are comparable in terms of their effectiveness post THA. LIA is non-inferior to PENG in terms of postoperative pain scores, cumulative opioid consumption, overall complication rates and rates of PONV.

Background: Short cementless femoral stems, designed for bone-preserving elective THA, are increasingly used for femoral neck fractures, yet their safety and effectiveness remain unclear.

Objective: To map current evidence on short cementless stems in fracture-related THA, focusing on complications, function, and revisions.

Methods: MedLine and Web of Science were searched to 30 April 2025. Studies reporting ≥ 5 THAs with short cementless stems for femoral neck fractures were included; data were charted and narratively synthesized.

Results: Five studies (477 short-stem, 70 standard-stem THAs; mean age 63 years; mean follow-up 65 months) met criteria. Short stems showed a 4.4% complication rate (0.6% intra-op fractures, 0.6% dislocations, 2.1% aseptic loosening) and 3.7% reoperations. Mean Harris Hip Score was 86.8-comparable to standard stems-with fewer surgical complications (4.4 vs. 15.7%).

Conclusion: Current evidence suggests short cementless stems are a safe, effective option for selected femoral neck fracture patients, but higher-quality, long-term studies are needed.

Background: Knee osteoarthritis (OA) is a common degenerative condition that significantly affects quality of life. Total Knee Arthroplasty (TKA) is an effective treatment for end-stage OA, but recovery can be challenging. Enhanced Recovery After Surgery (ERAS) protocols aim to optimize perioperative care and improve outcomes.

Methods: This prospective cohort study evaluated the impact of ERAS protocols on 300 patients undergoing primary TKA. Patients were divided into an ERAS group (n = 150) and a traditional care group (n = 150). ERAS included preoperative education, multimodal analgesia, early mobilization, and multidisciplinary care. Primary outcomes were postoperative pain, length of hospital stay (LOS), and complication rates. Secondary outcomes included functional recovery and patient satisfaction.

Results: The ERAS group had significantly shorter LOS (3 vs. 7 days, P = 0.01) and lower blood transfusion rates (21.3% vs. 36.7%, P = 0.01). Postoperative pain scores were consistently lower in the ERAS group (P = 0.01-0.04). Functional recovery, measured by Knee Society Score, and patient-reported outcomes were significantly better in the ERAS group at 3, 6, 12, and 24 months (P < 0.01).

Conclusion: ERAS protocols significantly improve outcomes in TKA, reducing hospital stays and enhancing patient satisfaction and recovery, supporting their broader use in orthopaedic surgery.

Traditional methods for evaluating spinal curves, such as the Cobb angle, are limited in their ability to capture the full complexity of spinal deformities. This manuscript presents a novel method that builds on Cobb's principle and Ferguson's approach to provide a more comprehensive assessment of spinal curves. The method involves identifying the centroid-based endpoints of the curve to define its "radius of curvature" and calculating the true curve length through a three-point measurement, including the apical vertebra. The curve's type and sharpness are determined using ratios of distances derived from apical and adjacent lines, enabling detailed geometric characterization.This approach allows for precise analysis of complex deformities, such as continuous kyphotic curves in ankylosing spondylitis, and facilitates improved preoperative planning by aligning surgical strategies with the geometry of the curve. Additionally, it extends to evaluating bent rods in spinal instrumentation, ensuring accurate alignment. The method's ability to integrate multiple curve characteristics addresses critical limitations of existing techniques and holds potential for enhancing outcomes in both clinical and research settings.

Purpose:  Ulnar nerve entrapment is a common condition, with a recurrence rate after surgery reaching up to 25%. In such cases, treatment remains controversial. During elbow surgery, management of the ulnar nerve and performing neurolysis are often the initial steps, even in the absence of clear symptoms. In this study, we assessed the clinical applicability of using an adipofascial flap to cover the nerve during elbow surgery.

Methods:  A retrospective study of 53 patients with elbow conditions who underwent surgery between December 2020 and December 2023 was performed. All patients received an X-ray of the elbow and electromyography (ENMG). The following scores were recorded: NRS, MEPS, and McGowan, both preoperatively and at the 1-year follow-up.

Results:  The NRS score decreased from 7.9 ± 0.8 (range: 6-9) to 2.8 ± 1.3 (range: 0-7) at the 1-year follow-up. MEPS improved from 70.7 ± 15.9 (range: 20-100) to 96.5 ± 7.2 (range: 70-100), indicating reduced pain and improved elbow function. The McGowan scale showed improvements in 49 out of 53 cases. All patients, except one, were satisfied with the surgery, and no recurrence of ulnar nerve-related pain was observed.

Conclusion:  Preliminary results suggest that covering the ulnar nerve with an adipofascial flap following neurolysis and/or anterior transposition is an effective method for managing ulnar nerve entrapment. It appears to help prevent post-surgical complications and adhesions, which are the main causes of the high recurrence rates reported in the literature.

Introduction: Previously published literature from our institution found that patients with a fragility hip fracture were estimated to have a 4-10% risk of sustaining a second contralateral hip fracture. A follow-up, multi-centre study found that 1 in 11 (9.1%) patients sustained a contralateral hip fracture within three years of index hip fracture. Previous studies have examined the anatomic geometry of the hip joint as a risk factor for hip fractures. Our study aimed to establish a relationship between the neck-shaft angle (NSA) of the contralateral hip in patients who had already suffered a hip fragility fracture in terms of timing to second hip fracture.

Methods: A 7-year, single-institution, retrospective cohort study of patients that presented with a second contralateral fragility hip fracture from 2013 to 2019 were reviewed. Inclusion criteria were all patients 60 years old and above who suffered a second contralateral hip fracture. Exclusion criteria were all patients who were aged less than 60 years old, high-energy injuries or those who suffered peri-prosthetic fractures. The NSA was calculated by measuring the intersection of the femoral neck axis and the femoral shaft axis of the hip. Age, gender, surgery type and American Society of Anaesthesiologists Physical Status Classification (ASA) score were also examined.

Results: Ninety-four patients were suitable for analysis. NSA ranged from 113 to 146.5 degrees with an average of 130.2 degrees. Female patients had an average NSA of 129.7 degrees compared to 131.3 degrees in male patients. Average time to second hip fracture was 3.5 years, ranging from 0.08 years (29 days) to 20 years (7326 days). There was a 2.3:1 ratio of female-to-male presentations. Patient age ranged from 60 to 100 years old. The largest age group included patients aged 80-89 years, with 38 patients (28 females and 10 males). Correlation analysis performed showed no statistical significance between NSA and timing of second contralateral hip fracture with a p value of 0.235. There was an association between fracture type, specifically intracapsular hip fractures, and time to second hip fracture, but this was not statistically significant (p value 0.052).

Conclusion: There is no statistically significant association between femoral NSA and time to second fragility hip fracture. As we have excluded NSA as an independent risk factor, further studies may now be carried out to look for other potential predictors of timing to second hip fracture.