Orthopaedic Surgery最新文献

Osteoarthritis (OA) is a prevalent degenerative joint disease primarily affecting hip and knee joints, with an estimated 300 million cases globally. This study is crucial as it provides an updated, comprehensive comparison of unicompartmental knee arthroplasty (UKA) and high tibial osteotomy (HTO) for treating medial knee osteoarthritis, offering valuable insights into their relative effectiveness. The findings aim to inform clinical decision-making and improve patient outcomes by identifying the superior treatment option. A comprehensive search was conducted across PubMed, Cochrane Library, and Google Scholar until August 1, 2024. Statistical analysis used Review Manager 5.4 with a random-effects model, risk ratio (RR), and mean differences (MD) with 95% confidence intervals (CI) for the dichotomous and continuous outcomes, respectively. The Newcastle-Ottawa Scale was used for quality assessment, and funnel plots were used to analyze publication bias. GRADE assessment was done to gauge the certainty of the evidence. Thirty-nine studies, involving a total of 56,686 patients, were evaluated for comparison. UKA significantly reduced the complications (RR = 0.37; 95% CI: [0.25, 0.54]; p < 0.0001; I² = 30%), revision rates to total knee arthroplasty (TKA) (RR = 0.64; 95% CI: [0.41, 0.99]; p = 0.05; I² = 72%) and postoperative pain (MD = -0.33; 95% CI: [-0.64, -0.03]; p = 0.03; I² = 89%) compared to HTO, while range of motion (ROM) (RR = -3.55; 95% CI: [-7.16, 0.52]; p = 0.09; I² = 98%) and walking speed (MD = 0.02; 95% CI: [-0.04, 0.07]; p = 0.56; I² = 0%) and surgical site infections(RR = 1.40; 95% CI: [0.30, 6.53]; p = 0.67; I² = 86%) were comparable. All the functional knee scores are comparable except the Hospital for Special Surgery (HSS) score, which is increased in UKA (MD = 2.63; 95% CI: [0.52, 4.74]; p = 0.01; I² = 76%). UKA is superior to HTO, offering lower revision rates, reduced postoperative pain, fewer complications, and better functional scores.

Objective: In thoracic posterior decompression surgery, the traditional pedicle-to-pedicle (PTP) approach may have limitations in achieving complete decompression and may also pose potential risks of injury to the spinal cord. Through comparative analysis with the PTP method, the study explored the safety of posterior thoracic decompression via the pedicle-ossification tunnel (POT), aiming to provide a more scientific and safer clinical surgical pathway selection.

Methods: Combined with preoperative image data and intraoperative operation images, the POT decompression method was deeply analyzed. In this study, the thoracic vertebrae of sheep were taken as experimental specimens. The water sac was placed close to the joint level of the articular process to simulate the spinal cord, and the experiment was carried out by the surgical methods of PTP and POT respectively with a high-speed bur. The laser displacement sensor (LDS) was used to monitor the vibration displacement of the water sac, and the collected vibration data was divided into 0.1 s/frame (500 vibration signal data points), which were used to calculate the curvature change of the vibration displacement curve. The Wilcoxon rank sum test was used for statistical analysis. Milling parameters for the high-speed bur were set to: milling depth 0.5 mm, milling speed 0.5 mm/s, milling angle 45^°, and spherical bit size 4 mm.

Results: Combining the detailed preoperative image data and intraoperative images of key operations, the study first provides a detailed description of the surgical steps for safe posterior thoracic decompression via the POT. Then, based on Euler-Bernoulli beam theory, the vibration of the "spinal cord" under different surgery pathways (POT and PTP) in posterior thoracic decompression was further studied. The statistical analysis showed that the vibration amplitude and curvature value of the vibration curve of POT and PTP were significantly different (p < 0.05). As the milling position approached POT, the amplitude and curvature values also decreased gradually.

Conclusion: Through theoretical analysis and experimental verification, the safety and effectiveness of posterior thoracic decompression via POT was thoroughly investigated. The milling pathway via POT could not only achieve the surgical purpose of complete decompression, but also avoid the contact area between OLF and dura as much as possible, thus reducing the irritation to the spinal cord.

Objective: Creating a 3D lumbar model and planning a personalized puncture trajectory has an advantage in establishing the working channel for percutaneous endoscopic lumbar discectomy (PELD). However, existing 3D lumbar models, which seldom include lumbar nerves and dural sac reconstructions, primarily depend on CT images for preoperative trajectory planning. Therefore, our study aims to further investigate the relationship between different virtual working channels and the 3D lumbar model, which includes automated MR image segmentation of lumbar bone, nerves, and dural sac at the L4/L5 level.

Methods: Preoperative lumbar MR images of 50 patients with L4/L5 lumbar disc herniation were collected from a teaching hospital between March 2020 and July 2020. Automated MR image segmentation was initially used to create a 3D model of the lumbar spine, including the L4 vertebrae, L5 vertebrae, intervertebral disc, L4 nerves, dural sac, and skin. Thirty were then randomly chosen from the segmentation results to clarify the relationship between various virtual working channels and the lumbar 3D model. A bivariate Spearman's rank correlation analysis was used in this study.

Results: Preoperative MR images of 50 patients (34 males, mean age 45.6 ± 6 years) were used to train and validate the automated segmentation model, which had mean Dice scores of 0.906, 0.891, 0.896, 0.695, 0.892, and 0.892 for the L4 vertebrae, L5 vertebrae, intervertebral disc, L4 nerves, dural sac, and skin, respectively. With an increase in the coronal plane angle (CPA), there was a reduction in the intersection volume involving the L4 nerves and atypical structures. Conversely, the intersection volume encompassing the dural sac, L4 inferior articular process, and L5 superior articular process increased; the total intersection volume showed a fluctuating pattern: it initially decreased, followed by an increase, and then decreased once more. As the cross-section angle (CSA) increased, there was a rise in the intersection volume of both the L4 nerves and the dural sac; the intersection volume involving the L4 inferior articular process grew while that of the L5 superior articular process diminished; the overall intersection volume and the intersection volume of atypical structures initially decreased, followed by an increase.

Conclusion: In terms of regularity, the optimal angles for L4/L5 PELD are a CSA of 15° and a CPA of 15°-20°, minimizing harm to the vertebral bones, facet joint, spinal nerves, and dural sac. Additionally, our 3D preoperative planning method could enhance puncture trajectories for individual patients, potentially advancing surgical navigation, robots, and artificial intelligence in PELD procedures.

Objective: Operation for thoracic spinal stenosis (TSS) is considered a high-risk surgery. Because of the frailty of elderly patients, the prediction for postoperative complications is crucial. This study investigated the relationship between frailty, as measured by the modified frailty index-11 (mFI-11), and postoperative complications in elderly patients with thoracic myelopathy secondary to TSS.

Methods: A retrospective review was conducted of 391 patients aged 65 years or older, with 209 males and 182 females, who underwent surgery for TSS at Peking University Third Hospital from 2012 to 2023. Patients were stratified into subgroups based on mFI-11 score. Data on perioperative complications, including systemic and local events, were collected. Univariate and multivariate analyses were performed to determine the association between frailty and perioperative complications and to identify independent risk factors.

Results: A total of 391 elderly patients undergoing decompression and fusion for TSS were included and categorized by mFI-11 score: 0 (n = 73), 0.09 (n = 159), 0.18 (n = 98), and ≥ 0.27 (n = 61). Multivariate analysis identified the mFI-11 as an independent risk factor for surgical site infection (SSI) (OR = 7.250, p = 0.022), gastrointestinal complications (OR = 2.461, p = 0.029), urologic complications (OR = 4.855, p = 0.001), respiratory complications (OR = 13.968, p = 0.033), postoperative fever (OR = 2.256, p < 0.001), and postoperative transfusion (OR = 1.962, p = 0.014). Moreover, mFI ≥ 0.27 is a threshold for severe complications (OR = 15.886, p = 0.017), and mFI ≥ 0.18 is a threshold for any postoperative complications (OR = 6.338, p < 0.001) and minor complications (OR = 5.915, p < 0.001).

Conclusions: The mFI-11 score is an effective predictor of the risk of surgical site infection, gastrointestinal complications, urologic complications, respiratory complications, postoperative fever, and postoperative transfusion in elderly patients undergoing TSS surgery. Patients with mFI scores ≥ 0.18 are at a significantly higher risk of any postoperative complications or minor complications, with mFI scores ≥ 0.27 indicating severe complications. Frailty, as assessed by mFI-11, and non-neurological complications did not significantly impact the long-term recovery rate.

Objectives: Congenital dislocation of patella (CDP) is a rare condition and surgery is needed to treat CDP once a diagnosis is made. The 4in1 procedure includes lateral release, correction of quadriceps, Roux-Goldthwait procedure, and medial patello-femoral ligament (MPFL) reconstruction. This study was aimed at evaluating the efficacy and outcome of the 4in1 procedure in the operative treatment of CDP.

Methods: CDP patients were retrospectively collected from two operative centers from January 2013 to December 2024. For all patients, patellae on both sides were examined by x-ray, CT, and MR bilaterally. Ten patients (14 patellae) underwent 4in1 procedure. Gradual passive and active exercises of knee motion and quadriceps were begun as tolerated. Kujala Score was collected before and after the operation.

Results: This cohort included 10 patients (4 males, 6 females), with 4 cases of bilateral involvement and 6 unilateral cases (total 14 limbs). The mean age at surgery was 8.36 years (4-14 years), with an average surgical duration of 157.7 min and intraoperative blood loss of 35.6 mL. Kujala scores improved from 39.9 preoperatively to 82.9 postoperatively (p < 0.001). All patients were followed up for at least 1 year. All patellae were centerized on the groove postoperatively with no recurrence.

Conclusion: CDP is a rare lower limb skeletal disorder requiring thorough evaluation. Early diagnosis and 4in1 procedure optimize patellar stability and knee function, preventing long-term complications.

Objective: Hinge fracture is a known complication of lateral open wedge distal femoral osteotomy (LOWDFO). However, few studies have differentiated between intraoperative hinge fractures (IHF) and postoperative hinge fractures (PHF). This study aims to investigate the causes of these two types of fractures to help reduce complication rates and improve surgical outcomes.

Methods: We retrospectively analyzed data from 100 patients with genu valgum deformity and lateral unicompartmental osteoarthritis who underwent distal femoral osteotomy at our hospital between January 1st, 2022, and January 1st, 2024, in our hospital. Clinical parameters, radiological data, and the associated factors influencing IHF and PHF were analyzed. Radiological data such as mechanical axis deviation (MAD) and mechanical lateral distal femur angle (mLDFA) were collected. Clinical outcomes such as osteoarthritis index and time of healing were evaluated. Based on fracture morphology, IHF and PHF were further classified into Type 1 (extension), Type 2 (distal) and Type 3 (proximal) for detailed analysis. Statistical analyses included t-tests, Chi-square tests, and regression models to identify factors associated with IHF and PHF.

Results: A total of 87 patients were included in this study. The mean healing time of patients with all kinds of hinge fractures (3.4 ± 1.2 months) was longer than that of patients with no hinge fractures (2.8 ± 0.7 months), which was significant, p = 0.013. The MAD correction, mLDFA correction, and mLDFA correction ratio were related to hinge fractures (p = 0.010, 0.002, and 0.002 respectively). The body weight was higher in all types of hinge fractures group (IHF and PHF together) than the no hinge fractures group. The IHF group had a longer time of healing than the no IHF group. In the IHF group, the mLDFA correction (p = 0.005), mLDFA correction ratio (p = 0.005), and BMI (p = 0.031) were higher than the no IHF group. The PHF was related to hinge position. The group of hinge localized proximal to the adductor tubercle (AT) had a higher rate of PHF than the group of hinge localized in the adductor tubercle (p = 0.001). The healing time in the IHF group (3.9 ± 1.4 months) was significantly longer than the healing time in the PHF group (2.7 ± 0.4 months) (p = 0.002).

Conclusion: In patients with genu valgum undergoing LOWDFO, IHF and PHF represent distinct clinical entities. IHF is associated with greater mLDFA correction, higher mLDFA correction ratios, and increased body weight. In contrast, PHF is primarily associated with hinge position, with a higher incidence observed when the hinge is located proximal to the adductor tubercle. Among the two, IHF has a more pronounced impact on delayed bone healing.

Level of evidence: Retrospective study Level IV.

Objectives: Rotator cuff injuries are a leading cause of shoulder dysfunction, where bio-inductive collagen implants have demonstrated promising results in promoting tendon regeneration and reducing retear rates. However, existing evidence lacks consistent evaluation across varying follow-up durations, while the specific factors influencing their safety and effectiveness remain undetermined. This study aims to evaluate the quality of evidence regarding the safety, efficacy, and impact factors of applying the resorbable bio-inductive collagen implant clinically to repair rotator cuff injuries.

Methods: The study protocol was registered on PROSPERO (CRD42022367522). A systematic literature search of PubMed, Web of Science, Embase, and Cochrane Library (from inception to October 2024) for clinical studies on bio-inductive collagen implants for rotator cuff repair. Two investigators independently screened studies, extracted data, and assessed quality (using RoB1 for RCTs, NOS for cohort studies and JBI critical appraisal tools for case series). Primary outcomes included postoperative tendon thickness, shoulder function scores (ASES/Constant), and re-tear rates. Data were analyzed using random/fixed-effects models to calculate mean differences (MDs) with 95% CIs, with subgroup analyses for tear type, patient age, and postoperative mobilization time. Statistical analyses were performed using Stata 17.0.

Results: Seventeen studies were included. The meta-analysis results showed that postoperative tendon thickness of the patients increased statistically compared with the baseline, at 3 months (MD = 2.22; 95% CI: 1.61, 2.83; p < 0.001), 6 months (MD = 2.30; 95% CI: 1.44, 3.16; p < 0.001), 12 months (MD = 2.15; 95% CI: 1.58, 2.72; p < 0.001), and 24 months (MD = 1.05; 95% CI: 0.02, 2.08; p = 0.045). Postoperative shoulder joint function improved significantly. The ASES score and Constant score of the patients were significantly higher than the baseline at 6 months (ASES: MD = 35.90; 95% CI: 32.97, 38.83; p < 0.001), 12 months (ASES: MD = 40.83; 95% CI: 37.56, 44.10; p < 0.001; Constant: MD = 28.59; 95% CI: 21.44, 35.74; p < 0.001), and 24 months (ASES: MD = 39.80; 95% CI: 31.32, 48.27; p < 0.001; Constant: MD = 32.84; 95% CI: 28.72, 36.97; p < 0.001).

Conclusion: The bio-inductive collagen implant is effective and safe for healing rotator cuff injuries. Patient age may be an important moderator affecting its efficacy. The impact of tear size and postoperative activities on efficacy needs to be further explored through in-depth clinical studies.

Objective: Aseptic hip revision arthroplasty often results in significant postoperative pain, inflammation, nausea, and vomiting. While perioperative dexamethasone has demonstrated benefits in primary hip arthroplasty, its efficacy and safety in revision procedures remain unclear. This study aims to evaluate the effects of perioperative dexamethasone on postoperative pain, inflammation, postoperative nausea and vomiting (PONV), and safety in aseptic hip revision.

Methods: A retrospective cohort study was conducted on 414 patients undergoing aseptic hip revision arthroplasty between 2008 and 2023. Patients were categorized into two groups: those receiving dexamethasone perioperatively (n = 218) and a control group (n = 196). Outcomes included Visual Analog Scale (VAS) pain scores, inflammation markers including C-reactive protein (CRP) and interleukin-6 (IL-6), PONV incidence, analgesic and antiemetic usage, length of stay (LOS), and postoperative complications. Independent samples t-test or Mann-Whitney U test is applied to continuous variables based on normality, while chi-square test or Fisher's exact test is used for categorical variables according to sample size.

Results: The dexamethasone group (average dose: 12.67 mg) exhibited significantly lower VAS scores (p < 0.001) and reduced morphine use on postoperative days (PODs) 1-3. CRP (POD2: 40.60 mg/L vs. 111.66 mg/L) and IL-6 levels (POD1: 31.85 pg/mL vs. 138.28 pg/mL) were significantly lower in the dexamethasone group (both p < 0.001). PONV incidence (28.4% vs. 40.81%) and antiemetic usage were reduced in the dexamethasone group. No significant differences were observed in LOS or postoperative complications between the two groups.

Conclusion: Perioperative low-dose dexamethasone effectively mitigates pain, inflammation, and PONV in aseptic hip revision arthroplasty without increasing the risk of complications.

Several meta-analyses of surgical versus non-operative treatment of femoroacetabular impingement syndrome (FAIS) have been published, but reliable evidence is still lacking. The aim of this meta-analysis of randomized controlled trials (RCTs) was to assess the outcomes of FAIS patients treated conservatively compared with those treated with hip arthroscopy (HAS). PubMed, CENTRAL of the Cochrane Library, Epistemonikos, and Embase databases were searched up to March 31, 2025. Quality was assessed using the Cochrane Risk of Bias 2 tool, the level of evidence for each outcome parameter was determined using the GRADE system, and publication bias was presented in funnel plots. In a common effect and random effects meta-analysis, mean differences (MDs) between the conservative treatment group and the HAS group were calculated with 95% confidence intervals (CIs) using the Hartung-Knapp-Sidik-Jonkman heterogeneity estimator. A total of 7 RCTs with a total of 489 patients in the conservative treatment group and 484 patients in the HAS group met the inclusion criteria. Of the 7 RCTs included, four were assessed as having a low risk of bias, one as having a moderate risk of bias, and two as having a high risk of bias. The outcomes "post-intervention functional MCID" and "iHOT at ≤ 12 months post-intervention" had a high level of evidence, and the outcome "HOS-ADL at ≤ 8 months post-intervention" had a moderate level of evidence. No significant publication bias was detected for any outcome. The HAS group had a statistically significant 0.85 higher post-intervention functional MCID (common effect model: MD: 0.85 CIs 0.53-1.17; random effects model: MD: 0.85 CIs 0.64-1.06; I ² = 0%; τ ² = 0.02; p = 0.96) and a statistically significant 10.74 higher iHOT at ≤ 12 months post-intervention than the conservative treatment group (common effect model: MD: 10.74 CIs 7.06 to 14.42; random effects model: MD: 10.98 CIs 6.62 to 15.34; I ² = 0%; τ ² = 7.52; p = 0.62). There was no difference between the HAS group and the conservative treatment group in HOS-ADL at ≤ 8 months post-intervention (common effect model: MD: 5.62 CIs 1.76 to 9.48; random effects model: MD: 4.10 CIs -12.31 to 20.50; I ² = 69%; τ ² = 29.88; p = 0.04). This meta-analysis using high-quality statistical methods showed a statistically significant higher post-intervention functional MCID and iHOT at ≤ 12 months post-intervention in favor of the HAS group compared to the conservative treatment group. HOS-ADL at ≤ 8 months post-intervention showed no differences.

Background: Two-dimensional (2D) radiographic methods are suggested for evaluating radiographic outcomes following indirect decompression via extreme lateral interbody fusion (XLIF). Nonetheless, assessing neural decompression in a single imaging plane could potentially lead to an underestimation of the effects on central canal and foraminal volumes.

Objective: This study aims to evaluate the radiographic changes associated with XLIF procedures using three-dimensional (3D) volumetric measurements and to investigate the effect of indirect decompression achieved through this procedure.

Methods: The retrospective clinical and radiological data of 44 patients between June 2019 and June 2022 who underwent single- or multilevel XLIF were analyzed. Preoperative and postoperative computed tomography (CT) scans facilitated 3D reconstructions. The effect of indirect decompression, manifesting as the elevation of the cranial vertebra, was quantified by measuring the volumetric change in the spinal canal, calculated through the subtraction of the spinal canal's geometry from a cylinder predefined both preoperatively and postoperatively. The relationship between these volumetric changes and clinical outcomes was then determined. Correlations between changes in volumetric measurements and clinical outcomes were assessed using Pearson's or Spearman's correlation coefficients, depending on the data distribution.

Results: Change in the spinal canal volume (ΔV) due to the XLIF proved to be significant (mean ΔV = 1629.28 ± 775.43 mm³, n = 44, p < 0.05). A significant, positive correlation was found between ΔV significant association between pain intensity (low back and leg pain) and the magnitude of the volumetric increase of the spinal canal was shown (p < 0.05 for LP and ODI, p = 0.06 for LBP).

Conclusion: The developed method demonstrates accuracy, reproducibility, and applicability for analyzing XLIF, with significant potential for application in other spinal surgical methods. The volumetric changes exhibit predictive capability regarding the extent of indirect spinal canal decompression. A larger ΔV correlates with greater clinical benefits observed in XLIF surgery.