Orthopaedic Surgery最新文献

Anterior cruciate ligament reconstruction (ACLR) is a widely performed orthopedic procedure, yet postoperative infection, although rare, poses a significant threat to graft integrity and long-term joint function. This review specifically focuses on therapeutic strategies for ACLR-associated infections. Management strategies constitute the core of this review, centering on early surgical debridement, targeted antimicrobial therapy, and, in selected cases, graft retention or removal. Preventive and rehabilitative measures such as graft presoaking with vancomycin, strict intraoperative asepsis, and structured postoperative rehabilitation are also discussed. Long-term functional outcomes are often suboptimal, emphasizing the importance of timely rehabilitation and individualized care. Rather than providing an exhaustive diagnostic review, we highlight therapeutic decision-making and evidence-based treatment pathways, supplemented by stratified comparisons of prospective and retrospective clinical studies. Ongoing research into biofilm-targeting therapies is essential to optimize treatment protocols and minimize infection-related complications.

Objective: Precise and reproducible control of wedge resection remains challenging in osteotomy correction for ankylosing spondylitis-related rigid kyphosis, and reports of robotic stereotactic execution beyond pedicle screw placement are limited. This technical note describes the operative workflow of robot-assisted stereotactic osteotomy (RASO), focusing on quantitative wedge planning and stereotactic execution feasibility.

Methods: The RASO technique and operative workflow are described. Patients with type II ankylosing spondylitis-related thoracolumbar deformity who underwent single-level three-column RASO between May and November 2023 were analyzed. Preoperative planning was performed using Surgimap wedge simulation with ratio-of-closure-based prediction, and stereotactic osteotomy trajectories were executed using the Mazor X Stealth Edition system. Perioperative parameters and immediate postoperative radiographic findings were descriptively assessed to evaluate the feasibility and reliability of the proposed operative workflow.

Results: This technique was successfully implemented in 15 patients. The mean operative duration was 304.2 ± 51.4 min, and the mean intraoperative blood loss was 486.7 ± 229.5 mL. Planning-execution concordance demonstrated acceptable agreement, with a maximal ratio-of-closure-related deviation of ≤ 5.18° and a mean difference of 0.2° between planned and achieved osteotomy Cobb angles. The mean thoracolumbar kyphosis (TLK) improved from 50.2° to 13.2°, the chin-brow vertical angle (CBVA) improved from 36.7° to 15.1°, the PT improved from 35.6° to 26.6°, and the sagittal vertical axis (SVA) improved from 207.6 to 93.7 mm. Three intraoperative durotomies occurred during the decompression phase; one patient developed delayed cerebrospinal fluid leakage. No neurological deficits, hardware failure, or mortality were observed. All patients achieved osseous fusion and demonstrated improvements in health-related quality of life measures.

Conclusions: This technical note demonstrates the technical feasibility and workflow reliability of robot-assisted stereotactic osteotomy for rigid ankylosing spondylitis-related thoracolumbar kyphotic deformity. Quantitative wedge planning can be reproducibly translated into robotic stereotactic intraoperative execution. Further studies are required to define the broader clinical role and potential applications of this technique.

Trial registration: Chinese Clinical Trial Registry: 2400090375.

Objectives: Clavicle fracture fixation is frequently complicated by implant mismatch and mechanical failure due to the complex and highly variable S-shaped anatomy of the clavicle. Conventional morphometric classification systems rely on subjective assessments of curvature and fail to capture the continuous spectrum of clavicular shape variation, limiting their utility for personalized implant design and preoperative planning. Furthermore, large-scale statistical shape modeling studies focusing on Asian populations remain scarce. Therefore, this study aimed to characterize clavicular morphology in an Asian cohort using statistical shape modeling (SSM), investigate sex- and side-related differences, and evaluate the validity of traditional morphological classification systems.

Methods: A retrospective study analyzed 288 clavicles reconstructed from CT scans of 144 adults (94 females, 50 males). Three-dimensional models were segmented in 3D Slicer, aligned, and processed using the Scalismo platform. Principal component analysis (PCA) was performed to establish the SSM and extract modes of variation (MoV). Morphometric parameters were calculated automatically. Independent t-tests assessed sex and side differences, and clustering analysis was conducted to compare data-driven groupings with traditional three-type classifications.

Results: The first six MoV explained 82.38% of total variance. PC01 (50.84%) reflected clavicular length and midshaft width; PC02-PC06 represented curvature and rotational variations. Significant sex differences were observed in PC01, PC02, and PC06 (p < 0.05), whereas no side differences were detected. Agglomerative clustering identified two morphological groups with poor concordance with traditional three-type classifications (Adjusted Rand Index≈0), indicating a continuous rather than discrete distribution of clavicular shapes.

Conclusion: Clavicular morphology exhibits sex-dependent but not side-dependent variability. Traditional categorical classifications inadequately capture anatomical diversity. Large-scale SSM provides objective morphometric evidence to guide personalized preoperative planning and improve implant design in clavicle fracture fixation.

Objectives: Spinal epidural abscess (SEA) is a life-threatening spinal infection with a pressing need for timely and effective surgical intervention. Conventional surgical approaches for SEA are often accompanied by extensive spinal tissue trauma and impaired spinal stability. This study retrospectively evaluates the efficacy of selective intersegmental laminectomy with irrigation (SILI), aiming to confirm that skip-level laminectomies combined with intraspinal direct irrigation can achieve effective abscess evacuation for SEA.

Methods: After ethics committee approval and patient consent, the authors studied patients with ≥ 3 affected segments and neurological deficits who had SILI from March 2020 to July 2024. Patients who had conventional continuous multisegmental laminectomy with drainage (CMLD) at the same time were controls. Inflammatory markers (WBC, CRP, ESR) were analyzed. MRI results were used to see changes in abscess volume and dura mater sac area. SILI's effect on neurological function was evaluated with 3, 6, and 12 months following up using JOA score, VAS, and modified MacNab criteria. Parametric tests (paired/independent t-test, repeated-measures ANOVA) were for normal data, nonparametric (Friedman test, Mann-Whitney U test, Chi-square test) for nonnormal and categorical data, with p < 0.05 for significance.

Results: All procedures were completed successfully without major complications. Significant improvements were observed across all outcome domains: inflammatory markers demonstrated substantial reductions, with WBC count decreasing from 13.44 ± 2.38 to 8.56 ± 2.26 × 10⁹/L (p < 0.001), C-reactive protein declining from 80.11 ± 21.43 mg/L to 21.18 ± 9.7 mg/L (p < 0.001), and erythrocyte sedimentation rate falling from 93.55 ± 21.75 mm/h to 29.74 ± 9.21 mm/h (p < 0.001). Radiographically, MRI measurements revealed a significant reduction in abscess axial area and abscess volume, alongside effective dural sac area expansion (p < 0.001). Functionally, both JOA scores and pain VAS scores showed statistically significant improvement (p < 0.001). Modified MacNab criteria documented a clinically meaningful increase in "Excellent rate" outcomes from 55.56% at 3 months to 91.67% at 12 months postoperatively (p < 0.001). Interestingly, the SILI technique produced better results in terms of JOA scores at 6 and 12 months postoperatively, as well as in terms of the Modified MacNab criteria at 12 months, compared to the CMLD group.

Conclusions: Through strategic laminectomy site selection, SILI achieves effective evacuation of epidural abscesses via hydrodynamic bidirectional irrigation, enabling sufficient intraspinal debridement. This approach significantly reduces inflammatory markers and improves neurological function postoperatively.

Background: Massive rotator cuff tears (RCTs) often lead to superior migration and poor function. While superior capsular reconstruction (SCR) using the long head of the biceps tendon (LHBT) autograft is a promising technique, the optimal management of its distal portion (tenotomy vs. retention) remains unclear.

Objective: To compare the clinical outcomes of SCR by a long head of the biceps tendon (LHBT) autograft with biceps tenotomy or not in massive RCTs.

Methods: In this retrospective cohort study, we enrolled and followed 59 patients following SCR using the LHBT between 2016 and 2021. Patients were divided into two groups based on intraoperative management of the distal LHBT: the LHBT-retained group and the LHBT-tenotomy group. Statistical comparisons included repeated-measures ANOVA, two-way mixed-design ANOVA, chi-square/Fisher's exact tests, and Mann-Whitney U tests as appropriate. The visual analog scale (VAS), American Shoulder and Elbow Surgeons (ASES) score, constant score and range of motion (ROM), and the acromiohumeral distance (AHD) were assessed as outcome measures.

Results: No major surgical complications were observed in any patient after surgery. The VAS score (7.0 vs. 0.6), AHD (3.2 ± 1.1 vs. 7.8 ± 0.8 mm), ASES (38 vs. 92), constant score (41 vs. 80), and ROM were statistically improved compared to their preoperative values. All patients were further subdivided into two groups according to the management of the distal end of the LHBT after transposition and fixation (retained group: the distal part of the LHBT was retained; tenotomy group: the distal part of the LHBT was resected). The two groups had comparable baseline demographic and clinical characteristics. We found that tenotomy group showed more significant function improvement within 12 months postoperatively (p < 0.05) compared with retained group. Nevertheless, compared with tenotomy group, the AHD of retsained group increased by 1.9 mm (5.0 ± 1.2 mm vs. 3.1 ± 0.8mm). Postoperative imaging assessment at 2 years revealed low and comparable retear rates (grades IV-V) between groups (retained group: 9.7% vs. tenotomy group: 7.1%).

Conclusion: SCR using the LHBT autograft significantly improves outcomes in massive RCTs. While both techniques are effective, patients with distal biceps tenotomy (tenotomy group) exhibited superior early functional recovery (within 12 months), whereas those with an intact distal LHBT (retained group) demonstrated significantly greater improvement in AHD. Both groups achieved comparably low retear rates.

Level of evidence: Level 4.

Pediatric spondylodiscitis is a rare but clinically significant infection affecting the intervertebral disc and adjacent vertebral bodies. Diagnostic delays are common due to its nonspecific presentation and the limited sensitivity of conventional microbiological methods. Early and accurate pathogen identification is essential to guide antimicrobial therapy, minimize unnecessary invasive procedures, and prevent long-term sequelae. Traditional diagnostic tools-including laboratory tests, imaging, blood cultures, biopsy, and histopathological evaluation-remain fundamental but are often insufficient, as they may yield nonspecific results or culture-negative cases, particularly after prior antibiotic exposure or infection with fastidious organisms. In recent years, molecular approaches, ranging from polymerase chain reaction assays to metagenomic next-generation sequencing, have markedly improved diagnostic accuracy. These techniques allow rapid and comprehensive pathogen detection, including atypical or previously uncultivable organisms, thereby overcoming many limitations of conventional methods. This narrative review synthesizes current evidence on pediatric spondylodiscitis, outlining its epidemiology, clinical features, and the evolving spectrum of diagnostic strategies-from conventional methods to advanced molecular and sequencing-based technologies-while discussing future directions in this challenging field.

Objective: Anterior cervical discectomy and fusion (ACDF) is a well-established surgical intervention for cervical disc herniation; however, the biological mechanisms underlying its superior pain relief compared to conservative treatment remain incompletely understood. This study aims to evaluate the efficacy of ACDF in treating neurogenic pain and its impact on inflammatory factors and substance P (SP).

Methods: We retrospectively analyzed 110 patients (2016-2023) with neurogenic pain, divided into an ACDF group (n = 51) and a conservative treatment group (n = 59). We assessed serum levels of inflammatory factors [interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), monocyte chemotactic protein 1 (MCP-1)], pain mediators [substance P (SP), β-endorphin (β-EP), nitric oxide (NO), prostaglandin E2 (PGE2)], electromyography F-wave parameters, and clinical scores [Visual Analog Scale (VAS) score, Present Pain Intensity (PPI) score, Japanese Orthopedic Association (JOA), Oswestry Dysfunction Index (ODI)] before and 3 months after treatment, with statistical analysis performed using t-tests, χ² tests, and rank-sum tests as appropriate.

Results: Baseline characteristics and complication rates were comparable (p > 0.05). The ACDF group achieved a higher excellent-good rate (72.55% vs. 54.24%, p < 0.05). After treatment, both groups showed improvements in all biomarkers and clinical scores, but the ACDF group demonstrated significantly greater reductions in IL-6, TNF-α, MCP-1, SP, NO, and PGE2, and a greater increase in β-EP (all p < 0.05). F-wave latency shortened and frequency increased more markedly in the ACDF group (p < 0.05). Clinical scores (VAS, PPI, ODI, JOA) also improved more significantly in the ACDF group (all p < 0.05).

Conclusion: ACDF is superior to conservative treatment in alleviating neurogenic pain and improving neurological function, and it is also safe. This study provides biochemical and electrophysiological evidence for the superior efficacy of ACDF by elucidating its modulatory effects on the neuro-inflammatory cascade, offering new insights into its mechanism of action. The significant modulation of inflammatory factors and pain mediators suggests their potential role as objective indicators for pain assessment.

Background: In the multiple ligament injury of the knee joint, apart from the anterior cruciate ligament and the posterior cruciate ligament, the Posterolateral Corner and the Posteromedial Corner are two structures that are easily overlooked. If not properly identified and repaired in one stage, the knee joint may be unstable, even failure of cruciate ligament reconstruction. The purpose of this article was to evaluate the effect of knee joint recovery after PLC (Posterolateral Corner) with or without PMC (Posteromedial Corner) injury.

Methods: From 2016 to 2020, we screened a total of 2564 patients, of which 292 patients met the inclusion and exclusion criteria. In the end, a total of 44 people completed the study. Follow-up was performed at 1, 3, 6, 9, and 12 months after surgery. We used pain visual analog scale (VAS) for pain, IKDC score, Lysholm score, Tegner score. Opti-knee (a portable motion analysis system) was used to evaluate the stability of the knee joint at 1 year. In our prospective cohort study, we used the unpaired Student's t-test for statistical analysis.

Results: The knee joint function of PLC group and PLC combined PMC group was better than that before operation at 3 or 6 months after operation. Except for IKDC at 9-month follow-up and Tegner score at 9-month and 12-month follow-up, there was no significant difference between the other groups.

Conclusions: PLC and PLC combined with PMC injury showed similar prognostic effects, although the PLC group was numerically superior to the other group. We recommend primary repair and reconstruction in patients with confirmed PLC and PMC injuries to achieve the best postoperative recovery.

Objective: Total elbow arthroplasty (TEA) is a commonly performed surgical technique for the management of elbow disorders. The Coonrad-Morrey (CM) prosthesis is the most commonly used prosthesis in TEA. The study from Chinese cohorts remains limited, particularly regarding differences between patients with and without RA. Therefore, the purpose of this study was to evaluate the medium- to long-term clinical outcomes using the CM prosthesis in a Chinese cohort, and to compare clinical outcomes between patients with and without RA.

Methods: A retrospective cohort study was conducted involving 74 patients (75 elbows) who underwent TEA using CM prostheses between March 2015 and February 2019. All patients were followed up for a minimum of 5 years (mean follow-up: 83.4 months) and were assessed for elbow range of motion (ROM), Mayo Elbow Performance Score (MEPS), Quick-Disabilities of the Arm, Shoulder and Hand (Quick-DASH) score, pain, complications, and revision surgeries. Kaplan-Meier survivorship analysis was conducted. The differences between patients with and without rheumatoid arthritis (RA) were compared in the subgroup analysis.

Results: At the final follow-up, the average flexion-extension ROM was 105.3° ± 33.6°. The mean MEPS was 85.5 ± 14.3, with a good-to-excellent rate of 81.3%. The mean Quick-DASH score was 30.8 ± 18.1. A total of 26 complications (26/75, 34.7%) were observed in 22 elbows (22/75, 29.3%). Nine elbows (9/75, 12.0%) underwent reoperation. The revision-free rates were 98.7% at 1 year, 94.7% at 2 years, and 90.7% at 5 years. There were no significant differences in elbow function or revision-free rate between patients with and without RA.

Conclusion: TEA using CM prosthesis in Chinese patients can achieve favorable functional outcomes regardless of RA status, with a high 5-year prosthesis survival rate. However, a larger sample size and a longer follow-up period are still required.

Objective: Kümmell's disease (KD) represents a delayed form of osteoporotic vertebral collapse and shares clinical features with osteoporotic vertebral compression fractures (OVCF). Percutaneous kyphoplasty (PKP) is commonly performed for both conditions, yet comparative evidence and predictors of 1-year outcomes in KD remain limited. This study aimed to evaluate the efficacy and safety of PKP for the treatment of stage I and II KD and to identify factors associated with the outcomes at 1-year follow-up.

Methods: We included 387 inpatients with KD or OVCF who underwent PKP from January 2016 to December 2022. All patients were assigned to the KD group (n = 107) and the OVCF group (n = 280). The difference of demographic data (age, gender, surgical segment, osteoporosis severity and disease duration), clinical efficacy (visual analog scale and Oswestry disability index of pre-operation, 3-day post-operation, 3-month post-operation, and 1-year post-operation), complications (bone cement leakage during surgery and postoperative refractures), and radiographic parameters (anterior vertebral height and kyphotic angle of pre-operation, post-operation, and 1-year follow-up) was analyzed. Intergroup comparisons of continuous variables were performed using the Student's t-test. Repeated measures ANOVA with Bonferroni post hoc correction was used to evaluate intra-group differences of visual analog scale (VAS), Oswestry disability index (ODI), anterior vertebral height (AVH) and kyphotic angle (KA) across different time points. Multivariate logistic regression analysis was employed to identify the independent factors influencing VAS and ODI scores during the follow-up period.

Results: The disease duration of the KD group was much longer than that of the OVCF group. Significant improvements in VAS and ODI were observed at three-day, three-month, and one-year after PKP. Multivariate regression analysis identified the blocky cement distribution pattern, higher preoperative VAS, and higher preoperative ODI as independent risk factors for suboptimal recovery during follow-up. Besides, the KD group had lower AVH and larger KA than the OVCF group preoperatively. Both groups showed significant improvements in AVH and KA after PKP. However, the KD group had a higher rate of type II bone cement leakage (BCL) and more severe cemented vertebral collapse at the final follow-up. The mean bone cement volume was significantly greater in the KD group. Refracture rates were similar between the two groups during follow-up.

Conclusions: PKP can effectively alleviate back pain, improve functional impairment, and correct local deformity in KD patients, with the risks of BCL and vertebral collapse or refractures during follow-up. It is suitable for KD treatment without nerve injury symptoms. Appropriate measures should be taken to reduce the risk of complications.