Orthopaedic Surgery最新文献

As a core minimally invasive technique for treating osteoporotic vertebral compression fracture (OVCF), percutaneous kyphoplasty (PKP) is widely employed clinically but continues to face significant technical challenges. These include uneven cement distribution, loss of vertebral height reduction, cement leakage, and adjacent vertebral re-fractures. To overcome these limitations, multi-dimensional technical refinements have emerged in recent years: innovations in surgical access and propping instruments (e.g., percutaneous curved kyphoplasty (PCKP), Sky system) optimize cement spatial distribution; intravertebral support implants (e.g., SpineJack, vertebral body stenting [VBS], stabilizing augmented Intervertebral Force [SAIF]) provide sustained mechanical support and mitigate loss of reduction height; and cement flow control techniques (e.g., Bone-filled bag systems, Kiva system), coupled with the use of high-viscosity bone cement, have significantly reduced leakage risks. This paper systematically reviews recent advancements in propping technology and intravertebral implants addressing these PKP challenges, aiming to provide an evidence-based foundation for optimizing the minimally invasive management of OVCF. Future development requires bioactive bone cements (e.g., magnesium/calcium phosphate-based composites) integrated with precise personalized design to advance PKP toward facilitating physiological bone remodeling.

Objectives: Obesity significantly influences the future of total knee arthroplasty (TKA). However, body mass index (BMI), the prevailing proxy for obesity, has limited predictive value for TKA outcomes, necessitating a more accurate obesity indicator. This study aimed to assess the utility of the fat-to-muscle ratio (FMR) in predicting postoperative outcomes related to obesity in patients undergoing TKA and compared its predictive value with that of BMI.

Methods: After excluding patients with secondary osteoarthritis, severe joint deformity, or neuromotor deficits, prospective data from 146 unilateral primary TKA patients were analyzed, including demographics, BMI, and systemic and leg-specific FMR. Primary outcomes included complications and 12-month patient-reported function (assessed using the University of California, Los Angeles [UCLA] activity scale and the Hospital for Special Surgery [HSS] score) and secondary outcomes including hospitalization length and surgery information were analyzed. Multivariable regression models were used to identify significant obesity-related predictors of outcomes, with linear regression employed for continuous outcomes (UCLA activity score, HSS score) and logistic regression for binary outcomes (complications).

Results: The mean BMI was 28.6 ± 4.4 kg/m², systemic FMR 0.70 ± 0.23, and leg-specific FMR 0.62 ± 0.19. Both systemic FMR (OR 1.094, p = 0.036) and BMI (OR 1.050, p = 0.015) predicted systemic complications, with FMR explaining more variance (partial R ² = 0.134 vs. 0.088). Likewise, systemic FMR (RR, 0.950, p = 0.045; partial R ² = 0.227) and leg-specific FMR (RR, 0.922, p = 0.033; partial R ² = 0.344) showed stronger associations with HSS functional score, than BMI (RR, 0.974, p = 0.037; partial R ² = 0.118). Only leg-specific FMR predicted wound complications (OR 1.063, p = 0.024; partial R ² = 0.262), and HSS pain scores (RR = 0.923, p = 0.025; partial R ² = 0.077). Neither FMR nor BMI was correlated with surgical duration, hospitalization, activity, or ULCA activity scores (p > 0.05).

Conclusions: In this single-center study, FMR demonstrated statistically stronger associations than BMI with both perioperative complications and 12-month functional outcomes following TKA. FMR assessment may provide incremental value for preoperative risk stratification and functional outcome prediction in elective TKA.

Objective: Dorsal articular collapse in distal radius fractures presents unique fixation challenges. While volar locking plating (VLP) dominates current practice, dorsal vertical double plating (DVDP) offers direct biomechanical support but carries perceived tendon risks. This study compares DVDP versus VLP for dorsally collapsed comminuted fractures.

Methods: A retrospective cohort of 106 patients (2022-2024) with AO type C2/C3 fractures received either VLP (n = 50) or DVDP (n = 56). General information encompassed gender, age, injured side, injury mechanism, AO classification, time from injury to surgery, operative time and complication profiles. Primary outcomes included 12-month radiographic parameters (volar tilt, ulnar inclination, and radial height), wrist range of motion (ROM), functional scores (DASH, Gartland-Werley), and complications. Continuous variables were compared using the Mann-Whitney U test. Categorical variables were analyzed with Pearson's χ ² test.

Results: The study cohort comprised 106 patients with dorsally collapsed distal radius fractures (VLP = 50, DVDP = 56). Baseline characteristics, including age (VLP median 59 years [IQR: 55-61.25] vs. DVDP 57 [53-61]), gender distribution (36% vs. 35.7% male), injury mechanism (72% vs. 71.4% falls), and AO classification (C3: 76% vs. 76.8%), showed no significant differences (all p > 0.05). At 12-month follow-up, all fractures achieved union with comparable radiographic outcomes: volar tilt (10° [8°-12°] vs. 10° [9°-12°]), ulnar inclination (22° [20°-23°] vs. 23° [22°-23°]), and radial height (11 mm [9-12] vs. 11 mm [10-12]) (all p > 0.05). Functional assessments revealed equivalent ranges of motion: dorsiflexion (69.5° [62°-76°] vs. 70° [68°-75°]), palmar flexion (68° [60°-70°] vs. 69.5° [66°-70°]), and rotation (pronation-supination: 80° [67.75°-65°]/71.5° [61.5°-81.25°] vs. 75.5° [70°-82°]/75° [68°-80°]). Patient-reported outcomes were similar: Gartland-Werley scores (5 [3-8] vs. 5 [3-7.75]) and DASH scores (12.5 [10-15.42] vs. 12.5 [12.5-15]) (all p > 0.05). Complication rates were comparable (VLP: 10% transient median neuropathy vs. DVDP: 12.5% tendon adhesions, p = 0.69), with all cases resolving conservatively within 3 months. Crucially, the DVDP group demonstrated zero tendon ruptures using tendon-sparing techniques.

Conclusion: DVDP demonstrates non-inferior functional and radiographic outcomes to VLP for dorsally collapsed fractures. With meticulous technique-including intercompartmental approaches and low-profile implants-DVDP eliminates historical tendon risks and serves as a viable surgical alternative.

Objective: Early readmission following total hip arthroplasty (THA) is not uncommon and impacts patient outcomes and healthcare costs. However, easily accessible biomarkers for early identification of high-risk patients remain limited. This study aims to evaluate the association between various blood component-derived ratios and 14-day readmission after THA.

Methods: Data from the Chang Gung Medical Research Database (CGRD) from 2014 to 2022 were retrospectively analyzed. Patients ≥ 20 years old who underwent primary THA by a single surgeon were included. The primary outcome was 14-day readmission. Five hematologic markers were evaluated: monocyte-to-albumin ratio (MAR), red cell distribution width (RDW)-to-albumin ratio (RAR), hemoglobin-to-albumin ratio (HAR), leukocyte-to-albumin ratio (LAR), and RDW-to-platelet ratio (RPR). Ratios were calculated from blood collected within 1 month before to 1 week after surgery. Receiver operating characteristic (ROC) Curve analysis was used to determine their optimal thresholds, and multivariable logistic regression assessed associations between these markers and readmission risk.

Results: A total of 307 patients were included in the analysis. Among the ratios evaluated, only high RPR (≥ 0.10; aOR = 5.92, 95% CI: 2.19-16.00, p = 0.001) was significantly associated with increased risk of 14-day readmission after adjustment in the multivariable analysis.

Conclusion: RPR is independently associated with 14-day readmission following THA in this exploratory study. As an easily obtainable marker, it may aid postoperative risk stratification, and the findings provide a foundation for future multicenter prospective investigations incorporating more granular perioperative factors and additional biomarkers before clinical application.

Objective: Osteoarthritis (OA) is a progressive joint disease characterized by cartilage degradation driven by matrix-degrading enzymes. Reproducible ex vivo models are essential for studying early degenerative processes and evaluating potential therapeutics. However, there remains a lack of accessible, cost-effective models that accurately replicate the biochemical environment and early-stage damage of OA. This study aimed to develop and validate a bovine cartilage explant model that replicates key features of early OA through enzymatic induction of tissue damage.

Methods: Bovine stifle cartilage explants were exposed to combinations of matrix metalloproteinases, aggrecanases, and cartilage biomarkers. Tissue damage was evaluated histologically, and semiquantitative scoring was used to assess structural changes. Statistical analyses were conducted to determine differences between treatment groups.

Results: Enzyme-treated samples exhibited significantly greater cartilage degradation compared to controls. The addition of cartilage oligomeric matrix protein (COMP) increased tissue damage, suggesting an active role in matrix destabilization. In contrast, the inclusion of TIMP-3, a known protease inhibitor, did not reduce degradation, raising questions about its protective efficacy in this context.

Conclusion: This chemically induced bovine model successfully simulates early cartilage degeneration consistent with OA pathology. Supported by recent literature on the roles of MMPs, ADAMTS-5, and COMP in joint disease, the model offers a valuable platform for future studies on OA mechanisms and therapeutic screening.

Objectives: Over the past three decades, orthopedic surgical robots have experienced rapid advancements. This study, a case series, aimed to investigate the effectiveness, limitations, and technical improvements associated with the application of robots in the surgical treatment of bone tumors.

Methods: From November 2021 to October 2023, 54 patients with bone tumors who provided consent for robot-assisted surgery were included. Patients were divided into three groups based on specific objectives: robot-assisted path planning, pedicle screw insertion, and intraoperative real-time navigation-assisted tumor resection. Perioperative conditions were meticulously recorded for all patients, including intraoperative blood loss, operation duration, postoperative complications, and tumor diameter.

Results: Nineteen patients underwent robot-assisted tissue biopsies, and pathological examinations confirmed a positive rate of 84.21%. Among the 21 patients undergoing robot-assisted pedicle screw placement, surgical planning was executed with high accuracy. Twenty patients undergoing robot-assisted lesion excision achieved precise resection of the tumor-affected bone segments as planned preoperatively, and no secondary osteotomies were required. No perioperative complications related to the use of robots were observed in the 54 patients. To address the limitation of orthopedic robots in differentiating soft tissues, we integrated ultrasound technology and the da Vinci robot. Additionally, patient-specific cutting guides were utilized to compensate for the prolonged operation time associated with planar planning using orthopedic robots.

Conclusions: Robot-assisted technology facilitates the precise planning of the surgical path and determination of the osteotomy plane. The integration of orthopedic robots with intraoperative ultrasound or Da Vinci robots can potentially further ensure the safety of bone tumor surgery while maintaining its accuracy, thereby minimizing the risk of complications associated with surgical procedures. Furthermore, this technology combined with patient-specific cutting guides may be conducive to reducing operation time.

Objective: The periprosthetic fractures occur frequently in modern society, and Vancouver type B fractures have the highest incidence. Surgical treatment of fractures was necessary; however, the traditional operations have obvious disadvantages. This study aimed to explore the clinical efficacy of a novel technique-minimally invasive percutaneous plate osteosynthesis (MIPPO) combined with noncontact bridging plate for periprosthetic fracture (NCB.PP) for treating Vancouver type B femoral periprosthetic fractures.

Methods: The clinical data of 24 patients with Vancouver type B femoral periprosthetic fractures who were admitted between October 2018 and January 2023 were retrospectively analyzed. Fourteen were male and 10 were female; the average age was 74.82 ± 12.11 years (range 65-93 years). All patients underwent biological hip arthroplasty, including 14 total hip replacements and 10 hemi-arthroplasties. All patients were injured by falls, and the average time from injury to hip replacement was 17.16 ± 7.17 months (range 7-34 months). According to Vancouver classification, 7, 14, and 3 patients were type B1, B2, and B3 fractures, respectively. Both MIPPO and NCB.PP were employed for fracture reduction and fixation for all patients. All patients were followed up for 18 months continuously. The operation duration, intraoperative blood loss, number of bicortical screws at the proximal end of the fracture, postoperative complications, fracture healing rate, and time of fractures were recorded for all the patients. The clinical efficacy was assessed using the Harris Hip Score.

Results: The average operation duration was 83.33 ± 12.16 min (range 60-150 min), the average intraoperative blood loss was 448.14 ± 186.24 mL (range 300-750 mL), and the average number of bicortical screws at the proximal end of the fracture was 3.62 ± 0.57 (range 3 ± 5). The fracture healing rate was 91.67%, and the average healing time was 7.83 ± 1.24 months (6-18 months). The average Harris Hip Score in the last follow-up was 73.75 ± 12.62 (range 45 ± 95). No cases of reduction loss, internal fixation failure, prosthesis dislocation, or renovation were reported. Two cases of superficial wound infection, three cases of postoperative pulmonary infection, and three cases of postoperative urinary tract infectionwere successfully treated with targeted interventions.

Conclusion: MIPPO combined with NCB.PP for treating Vancouver type B femoral periprosthetic fractures can shorten the operation duration, reduce intraoperative blood loss, alleviate iatrogenic surgical trauma, provide sufficient internal fixation strength, facilitate fracture healing, and stabilize the prosthesis effectively, and can be recommended for clinical use.

Anemia is a prevalent comorbidity among patients undergoing total hip replacement (THR) surgery, significantly affecting surgical outcomes and patient prognosis. This review synthesizes current literature on the relationship between anemia and THR, with a focus on postoperative complications, recovery times, and overall patient satisfaction. While several recent meta-analyses have quantified the risks associated with anemia, our review offers a novel perspective by linking cellular mechanisms to clinical management strategies. We analyze various studies that highlight the prevalence of anemia in this patient population and its potential impact on surgical risks, including increased rates of transfusion, infection, and prolonged hospital stays. Furthermore, we explore the implications of anemia on functional recovery and long-term outcomes, emphasizing the necessity for preoperative screening and management strategies. Our findings suggest that addressing anemia before THR may improve surgical outcomes and enhance patients' quality of life. This review underscores the importance of a multidisciplinary approach in the preoperative assessment and management of patients with anemia undergoing total hip replacement surgery.

Objective: Vertebroplasty with non-degradable polymethyl methacrylate bone cement is a common procedure in spine surgery. However, this bone cement reinforcement of the vertebral body could affect subsequent spinal surgeries, especially for pedicle screw insertion. This study proposes a novel method of inserting pedicle screws into bone cement-reinforced vertebral bodies through thermal softening via Kirschner wires (K-wires) drilling, and conducts preliminary in vitro experiments to assess its feasibility and safety.

Methods: This study includes bone cement block experiments and in vitro goat bone experiments. The bone cement block experiment utilized a CNC machine to drill into bone cement blocks with varying K-wire diameters, rotational speeds, and feed rates, followed by the insertion of pedicle screws. The highest temperature during the procedure and the pull-out strength of the pedicle screws were recorded for different groups. A two-way ANOVA was used for comparative analysis. The goat bone experiment consisted of an experimental group and a control group. The control group had screws inserted along the pedicle after drilling. In the experimental group, screws were inserted after softening the old bone cement within the vertebral body using a 3.5 mm K-wire for drilling. The highest temperature during the procedure was recorded for the experimental group, and pull-out tests were conducted on the screws of both groups after the procedure. The pull-out results from the goat bone experiment were analyzed using Student's t-test.

Results: Bone cement block experiment: Drilling with K-wires caused a significant temperature increase in the bone cement blocks, with temperature rises at 4 mm ranging from 28.1°C to 75.9°C. The maximum pull-out loads across all groups ranged from 2455.053 to 15201.94 N. In the goat bone experiment, the experimental group showed temperature increases of 8.38°C ± 3.07°C beneath the pedicle, 11.18°C ± 1.42°C in the spinal canal, and 8.26°C ± 3.46°C anterior to the vertebral body during drilling. The average maximum loads for the experimental and control groups were 910.5504 ± 221.6544 N and 294.229 ± 40.3475 N, respectively, indicating a statistically significant difference between the two groups (p = 0.0001).

Conclusion: The experimental results demonstrate that screws can be inserted into bone cement after thermal softening via K-wire drilling, achieving good pull-out resistance. In the goat bone experiment, the average temperature increase around the vertebral body was measured to be below 10°C, indicating a low risk of thermal damage to the surrounding tissues.

Steroid-induced osteonecrosis of the femoral head is a severe osteoarticular condition resulting from glucocorticoid overuse, characterized by femoral head bone structure collapse and cell death, now predominant among nontraumatic femoral head necroses. The increasing clinical use of glucocorticoids has led to a rise in the incidence of steroid-induced osteonecrosis of the femoral head, yet its precise molecular mechanisms remain incompletely understood, posing challenges for clinical management. This review proposes that the "GC-induced metabolic-inflammatory-oxidative stress vicious cycle" serves as the core driver propelling the activation of the SONFH multi-pathway PCD network. Centered on this thesis, the review systematically examines the synergistic and antagonistic interactions among PCD pathways-including pyroptosis, autophagy, and ferroptosis-in SONFH, emphasizing the pivotal role of mitochondrial dysfunction and ROS bursts. This framework not only integrates the independent functions of each PCD pathway but also reveals their interwoven molecular networks, offering novel perspectives for developing multi-target synergistic therapeutic strategies.