Orthopaedic Surgery最新文献

Objective: Lumbar fusion surgery is a significant surgical approach for degenerative lumbar spine diseases. However, lumbar fusion can cause adjacent vertebral diseases, about 50% of which is spinal stenosis. Unilateral laminectomy is an effective treatment for lumbar spinal stenosis. Therefore, this study aims to assess whether concurrent unilateral laminotomy decompression of the proximal adjacent vertebrae during primary lumbar fusion reduces long-term adjacent spinal stenosis incidence.

Methods: Patients (n = 179) who underwent lumbar fusion surgery between January 2021 and June 2023 were included in this retrospective analysis. A total of 110 patients underwent single-segment lumbar fusion surgery, including 28 (A1) in the adjacent vertebral decompression group and 82 (B1) in the non-decompression group. The mean follow-up duration was 11.74 ± 4.64 months for group A1 and 12.01 ± 4.83 months for group B1. 69 patients underwent two-segment lumbar fusion surgery, including 28 (A2) in the adjacent vertebral decompression group and 41 (B2) in the non-decompression group. The mean follow-up duration was 12.49 ± 4.57 months for group A2 and 12.12 ± 5.97 months for group B2. The visual analog scale (VAS) score, Oswestry disability index (ODI), and dural sac cross-sectional area (DSCA) were used to evaluate clinical outcomes. Operation time, blood loss, and complications were recorded. All continuous variables with normal distribution were analyzed using the t-test, while count data were compared using the chi-square test or Fisher's exact test.

Results: After surgery, the DSCA of the adjacent vertebral canal in the adjacent vertebral decompression group was significantly increased (A1: 111.64 ± 24.45 vs. 135.69 ± 35.46 mm², p < 0.001; A2: 99.95 mm² ± 16.81 vs. 115.29 ± 21.19 mm², p < 0.001). The DSCA of the adjacent vertebral canal in the non-decompression group was significantly decreased (B1: 114.38 ± 28.83 vs. 111.41 ± 30.73 mm², p = 0.032; B2: 109.28 ± 23.39 mm²vs. 102.04 ± 25.52 mm², p = 0.001). There was no significant difference between the decompression and non-decompression group in preoperative pain scores (A1 vs. B1: 5.29 ± 1.41 vs. 5.42 ± 1.31, p = 0.661; A2 vs. B2: 6.07 ± 1.78 vs. 5.88 ± 1.81, p = 0.662), ODI (A1 vs. B1: 57.07 ± 15.73 vs. 55.44 ± 12.49, p = 0.578; A2 vs. B2: 62.07 ± 14.86 vs. 59.46 ± 16.69, p = 0.508) and postoperative pain scores (A1 vs. B1:0.93 ± 0.94 vs. 1.22 ± 0.96, p = 0.166; A2 vs. B2: 1.21 ± 1.07 vs. 1.46 ± 0.95, p = 0.313), ODI (A1 vs. B1: 7.14 ± 4.40 vs. 8.05 ± 5.03, p = 0.398; A2 vs. B2:7.71 ± 5.62 vs. 9.12 ± 6.28, p = 0.344). The difference in complication incidence was not significant.

Conclusions: These results showed that decompression of adjacent spine would maintain the spinal canal after lumbar fusion surgery.

Objective: Insufficient correction of segmental lordosis is an important risk factor for adjacent segment disease (ASD). This study aimed to investigate the relationship between segmental lordosis-related parameters and ASD following lumbar facet joint fusion (FJF).

Methods: A retrospective analysis was conducted on 29 patients who underwent revision surgery for ASD after posterior lumbar fusion at our institution between February 2014 and February 2024. A matched control group of 29 non-ASD patients was selected based on age at initial surgery, sex, fusion level, and follow-up duration. Preoperative, postoperative, and final follow-up lumbar radiographs were analyzed. Parameters assessed included lumbar lordosis (LL), segmental lordosis (SL), sacral slope (SS), and relative disc height of adjacent segments. General baseline characteristics, sagittal parameters before and after the initial surgery, and correction values of sagittal alignment were compared between the two groups. Parameters showing significant differences were further analyzed using binary logistic regression, and receiver operating characteristic (ROC) curves were used to determine predictive thresholds of independent risk factors for ASD.

Results: There were no significant differences in baseline characteristics between the two groups (p > 0.05). After the primary fusion surgery, LL and SS were significantly lower in the ASD group compared with the control group (p < 0.05). Regarding sagittal correction, the relative change in SL (r△SL) was significantly smaller in the ASD group (p < 0.05), confirming insufficient local curvature reconstruction. Logistic regression identified r△SL as an independent risk factor for ASD (p = 0.004, OR = 0.976, 95% CI: 0.960-0.992). ROC curve analysis revealed an area under the curve (AUC) of 0.712 (95% CI: 0.580-0.844), with an optimal predictive threshold of 2.6% for r△SL.

Conclusion: Insufficient correction of segmental lordosis is a key risk factor for ASD following lumbar facet joint fusion, and prioritizing the restoration of local sagittal alignment during surgery may effectively reduce the incidence of postoperative ASD.

Background: Robotic-assisted technology has increasingly been applied in orthopedic surgery; however, its safety and efficacy in the treatment of scaphoid fractures remain controversial and lack high-level evidence. This systematic review and meta-analysis aimed to compare robotic-assisted techniques with conventional fluoroscopy-guided techniques in the treatment of scaphoid fractures.

Methods: A systematic literature search was conducted in PubMed, CNKI, VIP, Cochrane Library, Web of Science, and Scopus. Randomized controlled trials and cohort studies comparing robotic-assisted and conventional fluoroscopy-guided screw fixation for scaphoid fractures were included. Primary outcomes included operative time, fluoroscopy frequency, frequency of guidewire adjustments, intraoperative blood loss, fracture healing time, postoperative Visual Analog Scale (VAS), Mayo functional score, and complication rates. Meta-analysis was performed using Review Manager 5.4.

Results: Compared with conventional fluoroscopy-guided techniques, robotic-assisted technology significantly reduced operative time, fluoroscopy frequency, frequency of guidewire adjustments, intraoperative blood loss, and fracture healing time (all p < 0.05). In addition, the Mayo functional score was significantly higher in the robotic-assisted group (p < 0.05). No statistically significant differences were observed between the two groups in postoperative VAS scores or complication rates (p > 0.05).

Conclusions: Robotic-assisted technology demonstrates superior safety and efficacy compared with conventional fluoroscopy-guided techniques in the treatment of scaphoid fractures. It offers advantages in surgical efficiency, radiation reduction, fracture healing, and functional recovery, supporting its clinical application.

Background: Acetabular fractures in children are extremely rare, accounting for approximately 1%-4.6% of all pediatric fractures. Due to their rarity, literature on these injuries is limited, with only a few reported cases. The primary objective of this study was to present a series of uncommon pediatric injuries, outline our management approach, and demonstrate that even patients undergoing delayed surgical intervention can achieve favorable clinical outcomes.

Materials and methods: This retrospective study reviewed records of skeletally immature patients with traumatic acetabular fractures treated at our institution. Patients were surgically treated with open reduction and internal fixation through lateral rectus abdominis approach; follow-ups included radiological assessment of bone union and internal fixation integrity. Postoperative reduction was evaluated using Matta's criteria, while functional outcomes were measured via the Modified Merle d'Aubigné and Postel Method (pain, gait, mobility) and the Harris Hip Score (HHS). Complications were documented throughout follow-up.

Results: Between January 2019 and January 2025, 14 pediatric patients with acetabular fractures (five males, nine females; mean age 11.42 ± 2.24 years) were treated and followed for an average of 33.71 ± 14.41 months. Injuries resulted from falls (57.14%), car accidents (28.57%), and motorcycle/bicycle accidents (7.14% each). According to Judet and Letournel classification, fractures included double-column (57.14%), transverse (35.72%), and anterior with posterior hemi-transverse (7.14%). All underwent surgery, achieving bone union. The mean Harris Hip Score was 90.35 ± 5.58, with 71.42% rated excellent, 21.42% good, and 7.14% fair. The mean Merle d'Aubigné score was 17.21 ± 1.12. Mild hip pain occurred in three patients, with no other complications.

Conclusion: Pediatric acetabular fractures, typically caused by high-energy trauma, require treatment focused on optimal outcomes and anatomical reduction, even in delayed cases. This study shows that, in specialized centers, experienced surgical teams can achieve successful reduction and satisfactory results despite delayed intervention.

Objective: At present, there is no clear clinical consensus on the optimal surgical method for the specific population of patients aged 60-70 years with unstable Pauwels Type III femoral neck fractures. Few studies have investigated the efficacy of the Femoral Neck System (FNS) in hip-preserving treatment for this patient group. Therefore, it is necessary to analyze the safety and efficacy of FNS in treating this population.

Methods: A retrospective analysis with pair matching of 93 patients who received FNS or total hip arthroplasty (THA) for Pauwels type III unstable femoral neck fracture in our hospital between January 2021 and August 2023 was conducted. This study used the inverse probability weighting (IPW) method to balance the baseline covariates between the THA group and the FNS group. The effect of covariate balance was evaluated by calculating the standardized mean difference (SMD). The operation duration, intraoperative blood loss, time to begin weight-bearing, Harris score, and complication rate were compared between the two groups. For Harris hip score, generalized estimation equations (GEE) were used. For continuous outcomes, weighted linear regression was used. All statistical analyses report estimates, standard errors, test statistics, p-values, and 95% confidence intervals (CI), with p < 0.05 indicating statistically significant differences.

Results: After inverse probability weighting (IPW), the standardized mean difference (SMD) of all covariates was < 0.1, indicating well-balanced baseline covariates between groups and effective reduction of confounding bias. The THA group had significantly longer operation duration (119.23 ± 4.62 min vs. 69.61 ± 2.23 min; between-group difference: -49.62 min, 95% CI: -59.51~-39.73 min, p < 0.05) and greater intraoperative blood loss (205.20 ± 8.60 mL vs. 80.99 ± 7.36 mL; between-group difference: -124.22 mL, 95% CI: -146.62~-101.82 mL, p < 0.05) than the FNS group, but significantly shorter time to begin weight-bearing (3.12 ± 0.15 d vs. 73.38 ± 1.04 d; between-group difference: 70.26 d, 95% CI: 68.19~72.34 d, p < 0.05). During follow-up, HSS scores increased over time in both groups, but the between-group difference trend varied. Complication rate was 6.5% in THA group vs. 8.5% in FNS group; relative risk: 3.709 (95% CI: 0.53~26.08, p = 0.1877), with no statistical significance.

Conclusion: For the treatment of Pauwels type III unstable femoral neck fractures in elderly patients aged 60-70 years, FNS can achieve satisfactory joint range of motion and clinical efficacy. Compared with THA, FNS can preserve the normal anatomical structure of the hip joint and has less blood loss and shorter operation time.

Introduction: Elbow instability often arises from collateral ligament (LUCL) complex failure, causing varus and posterolateral rotatory subluxations. Conventional docking repair requires technical expertise balancing slack and tension. Existing suture anchors lack adjustable tensioning and rely on bone tunnel length for mechanical performance. A novel tensegrity-based suture anchor system was developed to enhance implant-bone fixation and optimize suture tensioning for early stability.

Methodology: Static three-point bending tests were conducted using Sawbones (n = 20) and paired cadaveric elbows (n = 14) with either conventional suture docking (CON) or elbow tensegrity screw (TEN). Force-displacement relationships were plotted. Stiffness, maximum force, and displacement at peak force were measured and compared using nonparametric Mann-Whitney U tests in GraphPad Prism 10.5.0.

Results: In foam elbows, TEN demonstrated significantly higher stiffness (3.46 ± 1.44 N/mm) than CON (1.44 ± 1.17 N/mm, p < 0.01). Maximum forces were 132.60 ± 28.82 N for TEN versus 75.02 ± 20.28 N for CON (p < 0.01), while displacement at peak force was slightly lower in TEN (35.54 ± 5.80 mm) versus CON (39.03 ± 9.05 mm, p = 0.22). In cadaveric elbows, TEN also had greater stiffness (12.79 ± 9.73 N/mm) versus CON (3.53 ± 2.43 N/mm, p < 0.05). Maximum forces were significantly greater for TEN (199.93 ± 35.89 N) compared to CON (140.11 ± 37.23 N, p < 0.05), while displacements at peak force were lower in TEN (22.31 ± 10.06 mm) than CON (38.68 ± 8.64 mm, p < 0.05). All CON samples failed from irreversible yielding and suture stretching, whereas most TEN samples failed due to suture rupture, suggesting superior bone-implant and suture-implant interface resistance.

Conclusion: TEN devices significantly improved mechanical strength and pretensioning over conventional docking, enhancing early stability and reducing yield failure risk.

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.