Orthopaedic Surgery最新文献

Background and importance: Ankylosing spondylitis (AS) is a systemic chronic inflammatory disease. Andersson lesion (AL) is a late complication of advanced AS. Idiopathic spinal cord hernia (ISCH) is a rare disorder of the spinal cord. However, according to our literature review, the simultaneous occurrence of AL together with ISCH in a single AS patient had never been reported.

Clinical presentation: A 49-year-old male reported a 30-year history of thoracolumbar pain and limited mobility and was diagnosed with AS with dual complications of AL and ICSH. Before correction surgery, physical examination, x-ray, CT, MRI and Blood HLA-B27 examination were performed and a series of radiological parameters, including the degree of kyphosis and the T1-pelvic angle (TPA), were measured. Several days after surgery (Distal PSO was used), we performed examinations to check the patient's physical condition which showed the patient recovered remarkably. CTA was done, indicating that the patient's aorta moved anteriorly with the osteotomy side undamaged. A series of morphological parameters were measured again, including TPA, LL, and TK. CT and MRI were performed again, reflecting significant bone-to-bone fusion and successful recovery. The patient relieved the symptoms and regained his daily activities.

Conclusions: We deepen the understanding of the diagnosis and treatment of AS with rare complications of AL and ISCH. Distal PSO could be an effective option for severe AS patient.

Objective: Reverse obliquity intertrochanteric fracture is an unstable type of fracture. Current guidelines recommend intramedullary fixation, but there are still complications such as screw removal, hip varus, nail withdrawal, and nail fracture. The objective of this study was to use finite element analysis to compare the biomechanical properties of the novel proximal femoral bionic nail (PFBN), proximal femoral nail antirotation (PFNA), and combined compression interlocking intramedullary nail (InterTan) in the treatment of reverse obliquity intertrochanteric fractures (AO/OTA 31-A3.1).

Methods: The three-dimensional models of PFBN, PFNA, InterTan, and the A3.1 type intertrochanteric fracture model were established by using modeling software such as Mimics and Unigraphics. Different force loads were implemented using ANSYS software to compare finite element biomechanical parameters, such as maximum stress in the implant and maximum stress and displacement at the proximal femur.

Results: In this finite element study, we found that the distribution trend of maximum femoral stress and displacement in the femoral models of the three internal fixation groups was similar, but the maximum stress and maximum displacement were the lowest in the PFBN group, and the maximum stress of the internal fixation implant in the PFBN group was lower than that in the PFNA group and the InterTan group. The maximum stress and displacement of the femur in the PFNA group were 403.71 MPa and 14.274 mm, respectively, the maximum stress and displacement in the InterTan group were 362.72 MPa and 10.678 mm, and the maximum stress and displacement in the PFBN group were 186.23 MPa and 9.7068 mm. In the internal fixation implant model, the maximum stress of the PFNA group was 1445 MPa, the maximum stress of the InterTan group was 919.62 MPa, and the maximum stress of the PFBN group was the lowest, at 911.77 MPa.

Conclusion: Compared to PFNA and InterTan, PFBN designed by the "lever - reconstruction - balance" hypothesis can provide better biomechanical stability. It is a feasible choice for the future treatment of reverse intertrochanteric fracture, and additional clinical studies are required to substantiate its efficacy.

Objective: During percutaneous endoscopic interlaminar discectomy (PEID), a range of technologies including medical robotics, visual navigation, and spatial registration have been proposed to expand the application scope and success rate of minimally invasive surgery. The use of robotic technology in surgery is conducive to improving accuracy and reducing risk. This study aims to introduce a precise and efficient targeting method tailored for robot-assisted positioning under C-arm fluoroscopy inPEID.

Methods: This study conducted a retrospective analysis of 107 patients with lumbar disc herniation (LDH) who underwent surgical treatment at our hospital from February 2023 to February 2024 (average age: 43.3 ± 13.3 years; 61 males and 43 females). The method entails constructing a specialized end-effector capable of simultaneous fluoroscopy calibration and robot-to-image-space registration. The average time of the surgical procedure and the average number of fluoroscopy exposures were collected. Preoperative and postoperative follow-up data were collected, including assessment scores from the Japanese Orthopedic Association (JOA) and Visual Analog Scale (VAS). Paired t-tests were employed to compare differences in each clinical outcome between the preoperative and follow-up time.

Results: These techniques effectively reduce both radiation exposure and operation time. Clinical data reveals that the average time for robot-assisted positioning stands at 2.5 ± 0.7 min, with anteroposterior and lateral radiographs demonstrating accuracies of 2.4 ± 2.8 mm and 3.1 ± 3.7 mm, respectively, during robot-assisted positioning. Postoperative VAS scores for back pain and leg pain were significantly lower than preoperative scores (1.2 ± 1.8 vs. 4.1 ± 2.3, 0.9 ± 2.0 vs. 5.9 ± 1.8; p < 0.05, p < 0.05, respectively). Postoperative JOA scores were significantly higher than preoperative scores (26.1 ± 3.5 vs. 14.5 ± 4.9; p < 0.05).

Conclusions: Through the evaluation of the system in robot-assisted positioning during PEID, this study substantiates the accuracy and reliability of the proposed method in clinical applications.

Objective: An updated bibliometric analysis is needed to address the lack of comprehensive understanding of Ilizarov technique's research trends and hotspots, fostering collaboration and technology adoption. CiteSpace was utilized to perform co-citation analyzes on authors, countries, institutions, journals and cited journals, authors and cited literature, along with keywords. This approach aimed to identify leaders, collaborating institutions, and research hotspots associated with the Ilizarov technique, while also predicting future development trends.

Methods: Data relevant to Ilizarov technologies from 1994 to 2023 were extracted from Science Net's core collection. Excel was utilized to develop an exponential function for forecasting annual publication numbers. CiteSpace V5.5 was used to conduct co-citation analyzes, which included authors, countries (regions), institutions, journals, citation journals, authors, citations, and keywords. Burst detection algorithms were applied to analyze countries (regions), institutions, and keywords, with keyword clustering achieved using the logarithmic likelihood ratio.

Results: A total of 2030 studies were collected, with annual publications on the Ilizarov technique fitting an exponential model Y = 3E-37e^0.0439x (R ² = 0.7979). Morasiewicz Piotr from the University of Opole in Poland emerged as the most prolific author. The leading countries included the USA and China, and notable institutions included the Egyptian Knowledge Bank and the Ilizarov National Scientific Center for Restorative Traumatology and Orthopaedic. Research outputs appeared primarily in orthopedics and surgery, with a focus on keywords such as management, the Ilizarov technique, external fixation, distraction osteogenesis, reconstruction, and the Ilizarov method.

Conclusions: Based on current global trends, the number of publications in the Ilizarov field will continue to increase. Future studies will likely place more emphasis on advancing application concepts and device development.

Background and objectives: Total knee arthroplasty (TKA) is a standard treatment for end-stage knee osteoarthritis (KOA). While conventional TKA (cTKA) is widely used, robotic-assisted TKA (rTKA) has gained attention for its potential precision and improved outcomes. However, the comparative efficacy and safety of rTKA versus cTKA remain unclear due to inconsistent findings in existing studies. This study aims to systematically review and compare the efficacy and safety of rTKA and cTKA in patients with KOA.

Methods: A total of seven databases were searched. Only randomized controlled trials (RCTs) were included in this systematic review. Subgroup analysis, sensitivity analysis, and trial sequential analysis (TSA) were used to evaluate the stability of the results.

Results: Twenty-five RCTs involving 3156 patients with KOA were included. The only statistically significant clinical difference between patients who received rTKA and cTKA was that the rTKA group was associated with a longer operative duration (MD = 22.38 mins; 95% confidence interval [CI] [12.86, 31.91]; p < 0.00001; I² = 98%). As for functional parameters, the two groups had similar results in postoperative Knee Society Score (KSS), the Western Ontario and McMaster Universities (WOMAC), and Hospital for Special Surgery Score (HSS). Regarding the tibiofemoral angle and the coronal femoral component angle, no significant difference was observed between the two groups. Patients in the rTKA group had a higher hip-knee-ankle angle (HKA) (MD = 0.63; 95% CI [0.23, 1.03]; p = 0.002; I² = 52%), lower HKA deviation (MD = -0.99; 95% CI [-1.24, -0.74]; p < 0.00001; I² = 0%), and a higher coronal tibial component angle (MD = 0.46; 95% CI [0.07, 0.85]; p = 0.02; I² = 81%) after the surgery.

Conclusions: While rTKA appears to be a feasible and safe alternative to cTKA, the mixed evidence from our study highlights the need for further research to fully understand its clinical implications and long-term outcomes.

Trial registration: PROEPERO: CRD42024541052.

Objective: Aseptic loosening (AL) is a common mechanical complication following reconstruction of the distal femoral cemented prosthesis (DFCP), often resulting in severe bone loss, which complicates prosthesis revision. 3D-printed personalized implants represent an emerging solution for the reconstruction of complex bone defects. This study aimed to investigate the early therapeutic effects of using a 3D-printed, customized, uncemented stem prosthesis for revising aseptic AL in DFCP.

Methods: From June 2021 to December 2022, a retrospective review was conducted on six consecutive patients who underwent revision surgery due to AL of the DFCP with a 3D-printed customized uncemented stem prosthesis. The study included four male and two female patients, with an average age of 58 ± 11 (range: 46-75) years. All six patients had previously undergone limb salvage surgery using a cemented megaprosthesis after tumor resection. Preoperative imaging evaluation was performed for all patients, and the personalized design of the prostheses was achieved through 3D printing based on CT imaging data. Regular clinical and radiographic follow-up was conducted postoperatively, with the main outcome measures being oncological outcomes, prosthesis survival, osseointegration, complications, and lower limb function.

Results: All patients successfully underwent surgery and were followed up for a mean duration of 30.33 ± 6.15 (range: 24-38) months. All patients were alive at the last follow-up, with no tumor recurrence or distant metastasis. No complications such as infection, loosening, or fracture of the prosthesis occurred. Osseointegration was satisfactory, with a mean MSTS score of 26 (range: 20-28) points.

Conclusion: 3D-printed, customized, uncemented stem prosthesis exhibit immediate initial stability and reliable biocompatibility. Early clinical outcomes are satisfactory, making them an effective method for revision AL of DFCP.

Objectives: Delirium is one of the common complications in elderly patients after spinal surgery. Severe delirium can lead to a series of adverse consequences such as drainage tube removal, wound rupture, patient falls, and severe adverse effects. The current research on POD is mostly small sample studies. This study aimed to investigate longitudinal changes in the incidence of hyper-postoperative delirium in patients with lumbar degenerative disease at our institution over the past 11 years and to identify the potential causes of these changes.

Methods: This is a retrospective cohort study included 7250 patients who underwent surgical treatment for lumbar degenerative diseases at a single center from 2011 to 2021. These patients were diagnosed with delirium through the Confusion Assessment Method and then diagnosed with high activity delirium through the Richmond Agitation-Sedation Scale, totaling 130 cases. According to the incidence rate of hyper-postoperative delirium within 11 years, the trend test is divided into three groups: S1 upward trend (2011-2014), S2 downward trend (2015-2016) and S3 upward trend (2016-2021). The study collected variables from patients before, during, and after surgery, including gender, age, laboratory tests, anesthesia risk score, New York Heart Association cardiac function grading, number of surgical segments, surgical time, estimated intraoperative blood loss, anesthesia medication, and supplementary analgesic medication in the ward within 3 days after surgery. Kruskal Wallis one-way ANOVA test, Kruskal-Wallis H test, or chi-square test are used to evaluate inter group differences. p < 0.05 is considered statistically significant.

Results: The pooled incidence of hyper-postoperative delirium over the past 11 years was 1.79% (130/7250). The average age of 7250 patients was 54.5 ± 13 years, with a male/female ratio close to 1:1. We statistically analyzed the relevant influencing factors before, during, and after surgery of S1 and S3 in the incidence rate increase group and found no statistical difference between the two groups. Our research results show that the incidence of high activity delirium is correlated with age, number of surgical segments, surgical duration, use of dexmedetomidine, remifentanil, and benzodiazepines, with p < 0.05.

Conclusions: The reduced use of dexmedetomidine, increased use of benzodiazepines, and prolonged surgical time are the reasons for the increased incidence of hyper-postoperative delirium. The joint management of orthopedic surgeons and anesthesiologists during the perioperative period is of great significance in reducing the incidence of hyper-postoperative delirium in patients undergoing lumbar spine surgery.

Objective: There are many advantages to stabilize the posterior pelvic ring injuries with a transiliac-transsacral (TITS) screw percutaneously. To identify the correct entry point and insert a guidewire accurately for a TITS screw, we propose a method of specifying the optimal entry point, and introduce a technique of enabling freehand placement of a guidewire with fluoroscopic guidance.

Methods: In this retrospective study, 116 patients who underwent pelvic CT scans and pelvic lateral radiographs at our institution from January 2020 to April 2022 were enrolled. The optimal entry point for a TITS screw was formulated in the strict mid-sagittal CT plane, and then transferred to the pelvic lateral radiograph relying on the sacral cortexes which were easily visible even in the poor fluoroscopy. The relative position of this point to other anatomical markers was checked to confirm its feasibility as an entry point. With the method to locate the entry point, 18 patients suffered the posterior pelvic ring injuries were treated with TITS screws through hammering a reverse Kirschner wire (K-wire) to insert a guidewire assisted by a canula, followed by the validation of the screw placement accuracy.

Results: The transferred point in radiograph was consistently beneath the sacral alar slope, and located posteroinferior to the iliac cortical density (ICD) and anterosuperior to the sacral nerve root tunnel in all 116 patients. In clinical practice, 18 TITS screws were successfully placed in 18 patients without cortex violation. The average operative time for each screw was 20.11 ± 6.29 min, with an average of 14.11 ± 6.81 fluoroscopic shots per screw. At the 3-month follow-up, fracture healing was confirmed in all patients. The average Majeed score was 89.61 ± 6.90 at the final follow-up.

Conclusions: It's feasible to identify an entry point for a TITS screw based on the sacral cortexes, and hammering a reverse K-wire assisted by a percutaneous kyphoplasty (PKP) canula is a safe and practical technique for guidewire insertion.

Objective: Popliteal artery injury is a rare but serious complication of arthroscopic knee surgery. The absence of comprehensive data and standardized guidelines underscores the urgent need for further investigation. This study examines the incidence, risk factors, management strategies, and long-term outcomes of popliteal artery injury in the context of arthroscopic knee procedures.

Methods: We conducted a retrospective cohort study utilizing data from 21 medical institutions in Hunan Province, China, from January 2018 to December 2022. We identified patients who underwent arthroscopic knee surgery and complained of postsurgical popliteal artery injury. Patients were followed up for 43.1 ± 13.23 months (ranging from 22 to 58 months). The primary outcome was joint function, which was evaluated by a postoperative range of motion (ROM), International Knee Documentation Committee (IKDC) scores, Lysholm knee scores, and Visual Vascular Quality of Life Questionnaire (VascuQoL) scores. These data from different postoperative periods were compared via paired t-test to assess postoperative recovery. The secondary outcome was vascular patency of the affected limb, which was evaluated through vascular color Doppler ultrasound.

Results: Among the 17,000 knee arthroscopic procedures analyzed, 10 patients were identified with popliteal artery injury (0.059%). The surgeries performed included arthroscopic cystectomy for popliteal cysts, cruciate ligament reconstruction, and posterior horn of the lateral meniscus repair. Treatments for popliteal artery injury included percutaneous intravascular stent implantation (one patient), direct suture repair (four patients), allograft vascular transplantation (one patient), and reconstruction with an autogenous greater saphenous vein (four patients). After a mean follow-up time of 43.1 ± 13.23 months (ranging from 22 to 58 months), no complications were reported. Compared with patients at 1 month after surgery, patients at 2 years after surgery presented improved knee function and ROM. The average Lysholm score increased significantly from 13.8 ± 4.21 to 68.2 ± 15.50, the IKDC score increased from 11.6 ± 2.46 to 48.1 ± 11.75, and the VascuQoL score improved from 54.8 ± 9.54 to 92.5 ± 15.90. Knee extension improved from 13.3° ± 2.36° to 3.5° ± 4.12°, and knee flexion increased from 49.5° ± 12.57° to 107° ± 21.63°. All patients successfully resumed daily activities postoperatively.

Conclusion: Popliteal artery injury is a catastrophic complication that warrants significant attention during knee arthroscopy. This injury can occur in various types of arthroscopic knee procedures. Prompt diagnosis and effective intervention are crucial for minimizing the potential detriment associated with popliteal artery injury.

Varus posteromedial rotatory instability (VPMRI) of the elbow is one of the complex elbow instability. The primary sites of injury encompass fractures of the anteromedial coronoid process and injuries to the lateral collateral ligament of the elbow. Some patients may present with involvement of the medial collateral ligament of the elbow. Owing to its distinctive injury mechanism and imaging characteristics, this condition is infrequent in clinical practice and susceptible to misdiagnosis and missed diagnosis. Literature reviews indicate that conservative management of VPMRI is associated with numerous complications, such as persistent pain, traumatic arthritis, and chronic elbow instability. Consequently, surgical intervention has emerged as the recommended treatment modality. Nonetheless, the lack of systematic research on VPMRI in clinical practice has been inconclusive regarding the optimal internal fixation techniques and surgical approaches. Therefore, investigating the treatment modalities, surgical techniques, and internal fixation strategies for VPMRI associated with coronoid fractures holds substantial importance for informing clinical management. In this review, we systematically synthesize the existing literature on coronoid fractures with VPMRI for offering a valuable reference for future clinical treatment.