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Effect of Decellularized Amniotic Membrane on the Tendon-Bone Integration in Rotator Cuff Repair: A Comparative Rat Model Study. 脱细胞羊膜对肩袖修复中肌腱-骨融合的影响:大鼠模型比较研究。
IF 1.8 2区 医学 Q2 ORTHOPEDICS Pub Date : 2025-02-01 Epub Date: 2024-12-11 DOI: 10.1111/os.14316
Jiangtao Wang, Chunbao Li, Jiating Zhang, Mingyang An, Gang Zhao, Samuel D Stark, Yujie Liu

Objective: Rotator cuff retear after arthroscopy repair is a difficult complication that is often due to poor tendon-bone healing. Decellularized amniotic membrane (DAM) has a variety of bioactive substances which have great potential to enhance tendon-bone healing. However, DAM has three layers, of which the middle basement layer is dense and thick. Whether DAM will hinder tendon-bone healing of rotator cuff after surgical repair is unclear. Our study aims to investigate the effect of DAM on tendon-bone healing of the rotator cuff after surgical repair.

Methods: Thirty-three Sprague-Dawley (SD) rats were selected to establish unilateral supraspinatus (ST) tear models and were randomly treated with only suturing repair (OSR group, n = 11), and suturing repair with DAM placed between the ST and bone (DAM group, n = 11). In the normal control group (NCT group, n = 11), the supraspinatus was only exposed but not detached or repaired. After 4 weeks the rats were sacrificed. The assessment of specimens was conducted by micro-CT analysis, histopathological evaluation, and biomechanical testing.

Results: The DAM group had a significantly higher ultimate load to failure, new bone volume, and histological evaluation at 4 weeks after surgery than the OSR group. When comparing the DAM group to the NCT group, the DAM group performed slightly worse in biomechanical testing, micro-CT analysis, and histological evaluation.

Conclusion: When placed between tendon and bone at the rotator cuff footprint, DAM, despite its dense and thick basement layer, does not impede tendon-bone healing after surgical repair for rotator cuff injury, but rather promotes increased healing quality and biomechanical properties. However, the healing quality and biomechanical properties are still lower than that of the normal rotator cuff, and further improvement should be made to the application strategy of a DAM.

目的:关节镜修复后肩袖撕裂是一种困难的并发症,通常是由于肌腱-骨愈合不良。脱细胞羊膜(DAM)具有多种生物活性物质,具有促进肌腱-骨愈合的巨大潜力。然而,DAM有三层,其中中层基底层致密而厚。DAM是否会阻碍手术修复后的肌腱-骨愈合尚不清楚。本研究旨在探讨DAM对肩袖手术修复后肌腱-骨愈合的影响。方法:选择SD大鼠33只,建立单侧冈上肌撕裂模型,随机分为单纯缝合修复组(OSR组,n = 11)和在冈上肌与骨间放置DAM缝合修复组(DAM组,n = 11)。正常对照组(NCT组,n = 11)冈上肌只暴露,未分离或修复。4周后处死大鼠。通过显微ct分析、组织病理学评估和生物力学测试对标本进行评估。结果:DAM组术后4周的极限衰竭负荷、新骨体积和组织学评估明显高于OSR组。当DAM组与NCT组比较时,DAM组在生物力学测试、微ct分析和组织学评估方面的表现略差。结论:当将DAM置于肌腱和骨之间时,尽管其基底层致密且厚实,但不会阻碍肌腱-骨在肌腱袖损伤手术修复后的愈合,而是促进愈合质量和生物力学性能的提高。然而,其愈合质量和生物力学性能仍低于正常肩袖,DAM的应用策略有待进一步改进。
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引用次数: 0
The Health-Related Quality of Life for Cemented Versus Uncemented Hemiarthroplasty in Elderly Patients With Femoral Neck Fractures: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. 老年股骨颈骨折患者骨水泥与非骨水泥半关节置换术的健康相关生活质量:随机对照试验的系统回顾和荟萃分析
IF 1.8 2区 医学 Q2 ORTHOPEDICS Pub Date : 2025-02-01 Epub Date: 2024-12-26 DOI: 10.1111/os.14339
Mohanad Samaheen, Maen Mohammad, Mikhail Salzmann, Nikolai Ramadanov

Objective: Femoral neck fractures in the elderly are a global health issue, with the choice between cemented and uncemented hemiarthroplasty remaining a topic of debate. This systematic review and meta-analysis aims to compare the effects of the two surgical options on health-related quality of life (HRQoL), mortality, and functional outcomes.

Methods: We searched PubMed, Embase, and Cochrane databases for randomized controlled trials (RCTs) comparing cemented with uncemented hemiarthroplasty in patients aged 50 years and older with femoral neck fractures. The primary outcome of interest was HRQoL as measured by the European Quality of Life 5-Dimension Questionnaire (EQ-5D) score. Secondary outcomes included mortality, surgical, general, and local complications.

Results: We included 20 RCTs with a total of 3680 patients with femoral neck fractures, of whom 1871 (50.5%) underwent cemented and 1809 (49.5%) uncemented hemiarthroplasty. The follow-up ranged from 1 to 6 years. The early (after 3-4 months) EQ-5D utility score (MD 0.07; 95% CI 0.03-0.12; p = 0.003; I 2 = 22%) and the 12-month EQ-5D utility score (MD 0.08; 95% CI 0.00-0.16; p = 0.04; I 2 = 67%) suggested an improved HRQoL in the cemented hemiarthroplasty group. The outcomes of 1-year mortality, requirement for additional surgeries, surgery duration, risk of pulmonary embolism, pressure sores or ulcers, intraoperative fractures, and periprosthetic or postoperative fractures demonstrated significant differences between the two groups.

Conclusions: The use of cemented hemiarthroplasty in patients with femoral neck fractures presented better results when compared to uncemented hemiarthroplasty in terms of HRQoL during the first year after surgery and greater mortality reduction at 1 year follow-up and reduced the need for further surgery. Therefore, the use of cemented hemiarthroplasty may be preferred for the treatment of femoral neck fractures in elderly patients.

目的:老年人股骨颈骨折是一个全球性的健康问题,选择骨水泥和非骨水泥半关节置换术仍然是一个有争议的话题。本系统综述和荟萃分析旨在比较两种手术选择对健康相关生活质量(HRQoL)、死亡率和功能结局的影响。方法:我们检索PubMed、Embase和Cochrane数据库,比较50岁及以上股骨颈骨折患者骨水泥与非骨水泥半关节置换术的随机对照试验(rct)。主要观察指标为HRQoL,由欧洲生活质量5维问卷(EQ-5D)评分衡量。次要结局包括死亡率、手术、一般和局部并发症。结果:我们纳入了20项随机对照试验,共纳入3680例股骨颈骨折患者,其中1871例(50.5%)行骨水泥半关节置换术,1809例(49.5%)行非骨水泥半关节置换术。随访时间为1 - 6年。早期(3-4个月后)EQ-5D效用评分(MD 0.07;95% ci 0.03-0.12;p = 0.003;I2 = 22%)和12个月EQ-5D效用评分(MD 0.08;95% ci 0.00-0.16;p = 0.04;I2 = 67%)表明骨水泥半关节置换术组HRQoL有所改善。两组1年死亡率、额外手术需求、手术持续时间、肺栓塞、压疮或溃疡、术中骨折、假体周围或术后骨折的风险均有显著差异。结论:股骨颈骨折患者采用骨水泥半关节置换术后第一年的HRQoL优于非骨水泥半关节置换术,随访1年死亡率降低幅度更大,减少了进一步手术的需要。因此,骨水泥半关节置换术可能是治疗老年股骨颈骨折的首选方法。
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引用次数: 0
Management of Bone Defects and Complications After Bone Tumor Resection Using Ilizarov Method. 使用 Ilizarov 方法处理骨肿瘤切除术后的骨缺损和并发症
IF 1.8 2区 医学 Q2 ORTHOPEDICS Pub Date : 2025-02-01 Epub Date: 2024-12-12 DOI: 10.1111/os.14318
Kai Zheng, Xiu-Chun Yu, Jinfang Cai, Ming Xu, Haocheng Cui, Qian Chen, Jing-Yu Zhang

Objective: Ilizarov technology is highly effective in addressing complex orthopedic challenges. This study aims to describe our experience with distraction osteogenesis in managing bone tumors in the lower extremity, focusing on composite bone defects and associated complications.

Methods: A retrospective clinical study was conducted to analyze patients with primary bone tumors who underwent distraction osteogenesis using the Ilizarov method from 2010 to 2020. Some young children received epiphyseal distraction and bone transport as part of their sarcoma surgical treatment. Additionally, external fixation, bone transport, or limb lengthening were employed to address complex postoperative complications associated with bone tumors. The clinical outcomes assessed included the patient's general information, the location of bone defects, the length of bone repair, the status of bone healing, and limb function.

Results: Eleven patients were followed up for an average of 66 months (range, 24-132 months). The average length of repaired bone defects was 13 cm (range, 2.5-32 cm). The cohort comprised three females and eight males, with ages at presentation ranging from 6 to 42 years (mean, 18 years). The sites of involvement included the distal femur (n = 4), femoral diaphysis (n = 3), proximal tibia (n = 2), and the distal tibia (n = 2). Nine patients were diagnosed with osteosarcoma, while one presented with Ewing's sarcoma and another with a giant cell tumor of bone. Three young children were successfully treated with epiphyseal stretching; however, one patient experienced treatment failure. Additionally, seven patients underwent external fixation to address complex postoperative complications, including infection, bone defects, and limb shortening. At the last follow-up, with the exception of one failure, the average Musculoskeletal Tumor Society (MSTS) limb function scores for the remaining 10 patients were 25 (range, 21-30). Three months post-fixator removal, the Asociación Latinoamericana de Oncología (ASAMI) bone score was rated as excellent in 63.6% (7/11) of patients, whereas the ASAMI function score was excellent in 36.4% (4/11) and good in 54.5% (6/11) of cases.

Conclusion: The Ilizarov method demonstrates some clinical value in the resection and reconstruction of bone tumors, as well as in the management of postoperative complications associated with such tumors.

目的:Ilizarov技术在解决复杂骨科难题方面非常有效。本研究旨在介绍我们使用牵张成骨术治疗下肢骨肿瘤的经验,重点关注复合骨缺损和相关并发症:方法:我们进行了一项回顾性临床研究,分析了2010年至2020年期间使用Ilizarov方法接受牵张成骨术的原发性骨肿瘤患者。部分幼儿在肉瘤手术治疗中接受了骺端牵引和骨搬运。此外,还采用了外固定、骨转运或肢体延长术来解决与骨肿瘤相关的复杂术后并发症。评估的临床结果包括患者的一般信息、骨缺损位置、骨修复长度、骨愈合状况和肢体功能:对 11 名患者进行了平均 66 个月(24-132 个月)的随访。修复的骨缺损平均长度为 13 厘米(2.5-32 厘米)。患者中有 3 名女性和 8 名男性,发病年龄从 6 岁到 42 岁不等(平均 18 岁)。受累部位包括股骨远端(4例)、股骨干骺端(3例)、胫骨近端(2例)和胫骨远端(2例)。九名患者被诊断为骨肉瘤,一名为尤文氏肉瘤,另一名为骨巨细胞瘤。三名幼儿成功接受了骨骺拉伸治疗,但一名患者治疗失败。此外,七名患者接受了外固定治疗,以解决复杂的术后并发症,包括感染、骨缺损和肢体缩短。在最后一次随访中,除一名患者治疗失败外,其余 10 名患者的肌肉骨骼肿瘤协会(MSTS)肢体功能平均评分均为 25 分(21-30 分不等)。取出固定器三个月后,63.6%(7/11)的患者的拉丁美洲肿瘤协会(ASAMI)骨评分为优,36.4%(4/11)的患者的ASAMI功能评分为优,54.5%(6/11)的患者的ASAMI功能评分为良:结论:Ilizarov 法在骨肿瘤的切除和重建以及术后并发症的处理方面具有一定的临床价值。
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引用次数: 0
Augmented Reality Navigation System Enhances the Accuracy of Spinal Surgery Pedicle Screw Placement: A Randomized, Multicenter, Parallel-Controlled Clinical Trial. 增强现实导航系统提高脊柱手术椎弓根螺钉置入的准确性:一项随机、多中心、平行对照的临床试验。
IF 1.8 2区 医学 Q2 ORTHOPEDICS Pub Date : 2025-02-01 Epub Date: 2025-01-15 DOI: 10.1111/os.14295
Yichao Ma, Jiangpeng Wu, Yanlong Dong, Hongmei Tang, Xiaojun Ma

Objective: The pedicle screw insertion technique has evolved significantly, and despite the challenges of precise placement, advancements like AR-based surgical navigation systems now offer enhanced accuracy and safety in spinal surgery by integrating real-time, high-resolution imaging with virtual models to aid surgeons. This study aims to evaluate the differences in accuracy between novel AR-guided pedicle screw insertion and conventional surgery techniques.

Methods: A randomized controlled trial was conducted from March 2019 to December 2023 to compare the efficacy of AR-guided pedicle screw fixation with conventional freehand surgery using CT guidance. The study included 150 patients, aged 18-75, with 75 patients in each group. The total number of pedicle screws planned for the clinical trial placement was 351 and 348 in the experimental and control groups. The safety and efficacy of the procedures were evaluated by assessing screw placement accuracy and complication rates.

Results: In the full analysis set (FAS) analysis, the difference in the excellent and good rates of screw placement (experimental group - control group) and 95% confidence interval was 6.3% [3.0%-9.8%], with a p value of 0.0003 for the superiority test. In the FAS sensitivity analysis, the success rate was 98.0% (344 out of 351) in the experimental group and 91.7% (319 out of 348) in the control group, with a difference and 95% confidence interval of 6.3% [2.9% and 9.8%, respectively]. In the per-protocol set (PPS) analysis, the difference in the excellent and good rates of screw placement between the experimental and control groups, and the 95% confidence interval was 6.4% [3.3%-9.5%], with a p value of 0.0001 for the superiority test. In the actual treatment set (ATS) analysis, the excellent and good rates of screw placement were 99.1% in the experimental group and 91.7% in the control group. The difference in the excellent and good rates of screw placement (experimental group - control group) and 95% confidence interval was 7.3% [4.1%-10.6%], with a p value of < 0.0001 for the superiority test.

Conclusions: The AR surgical navigation system can improve the accuracy of pedicle screw implantation and provide precise guidance for surgeons during pedicle screw insertion.

目的:椎弓根螺钉置入技术已经有了显著的发展,尽管精确置入存在挑战,但基于ar的手术导航系统等技术的进步现在通过将实时、高分辨率成像与虚拟模型相结合来帮助外科医生,从而提高了脊柱手术的准确性和安全性。本研究旨在评估新型ar引导椎弓根螺钉置入与传统手术技术在准确性上的差异。方法:2019年3月至2023年12月进行随机对照试验,比较ar引导下椎弓根螺钉固定与CT引导下常规徒手手术的疗效。该研究包括150名年龄在18-75岁之间的患者,每组75名患者。实验组和对照组临床试验计划放置的椎弓根螺钉总数分别为351枚和348枚。通过评估螺钉放置准确性和并发症发生率来评估手术的安全性和有效性。结果:在全分析集(FAS)分析中,实验组与对照组置入螺钉优良率及95%置信区间的差异为6.3%[3.0% ~ 9.8%],优势检验的p值为0.0003。FAS敏感性分析中,实验组的成功率为98.0%(351例中有344例),对照组的成功率为91.7%(348例中有319例),差异及95%可信区间为6.3%[分别为2.9%和9.8%]。在按方案集(PPS)分析中,实验组和对照组置入螺钉优良率和良率的差异,95%置信区间为6.4%[3.3%-9.5%],优势检验的p值为0.0001。在实际治疗集(ATS)分析中,实验组置钉优良率为99.1%,对照组置钉优良率为91.7%。实验组与对照组置入螺钉优良率及95%置信区间的差异为7.3% [4.1% ~ 10.6%],p值为。结论:AR手术导航系统可提高椎弓根螺钉置入的准确性,为外科医生置入椎弓根螺钉提供精确的指导。
{"title":"Augmented Reality Navigation System Enhances the Accuracy of Spinal Surgery Pedicle Screw Placement: A Randomized, Multicenter, Parallel-Controlled Clinical Trial.","authors":"Yichao Ma, Jiangpeng Wu, Yanlong Dong, Hongmei Tang, Xiaojun Ma","doi":"10.1111/os.14295","DOIUrl":"10.1111/os.14295","url":null,"abstract":"<p><strong>Objective: </strong>The pedicle screw insertion technique has evolved significantly, and despite the challenges of precise placement, advancements like AR-based surgical navigation systems now offer enhanced accuracy and safety in spinal surgery by integrating real-time, high-resolution imaging with virtual models to aid surgeons. This study aims to evaluate the differences in accuracy between novel AR-guided pedicle screw insertion and conventional surgery techniques.</p><p><strong>Methods: </strong>A randomized controlled trial was conducted from March 2019 to December 2023 to compare the efficacy of AR-guided pedicle screw fixation with conventional freehand surgery using CT guidance. The study included 150 patients, aged 18-75, with 75 patients in each group. The total number of pedicle screws planned for the clinical trial placement was 351 and 348 in the experimental and control groups. The safety and efficacy of the procedures were evaluated by assessing screw placement accuracy and complication rates.</p><p><strong>Results: </strong>In the full analysis set (FAS) analysis, the difference in the excellent and good rates of screw placement (experimental group - control group) and 95% confidence interval was 6.3% [3.0%-9.8%], with a p value of 0.0003 for the superiority test. In the FAS sensitivity analysis, the success rate was 98.0% (344 out of 351) in the experimental group and 91.7% (319 out of 348) in the control group, with a difference and 95% confidence interval of 6.3% [2.9% and 9.8%, respectively]. In the per-protocol set (PPS) analysis, the difference in the excellent and good rates of screw placement between the experimental and control groups, and the 95% confidence interval was 6.4% [3.3%-9.5%], with a p value of 0.0001 for the superiority test. In the actual treatment set (ATS) analysis, the excellent and good rates of screw placement were 99.1% in the experimental group and 91.7% in the control group. The difference in the excellent and good rates of screw placement (experimental group - control group) and 95% confidence interval was 7.3% [4.1%-10.6%], with a p value of < 0.0001 for the superiority test.</p><p><strong>Conclusions: </strong>The AR surgical navigation system can improve the accuracy of pedicle screw implantation and provide precise guidance for surgeons during pedicle screw insertion.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":"631-643"},"PeriodicalIF":1.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11787979/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143009238","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Measured Resection as Gap Balance Method in Mobile-Bearing Medial Unicompartmental Knee Arthroplasty: A Randomized Controlled Trial. 测量切除作为间隙平衡法在可活动承重的内侧单室膝关节置换术中:一项随机对照试验。
IF 1.8 2区 医学 Q2 ORTHOPEDICS Pub Date : 2025-02-01 Epub Date: 2025-01-05 DOI: 10.1111/os.14346
Qian Liu, Jianhua Ren, Wenhui Zhang, Tangzhao Liang, Zhe Wang, Siwei Xie, Yuhang Li, Jianfeng Hou, Kun Wang, Ronghan He

Objective: Gap balancing is a vital process during mobile-bearing unicompartmental knee arthroplasty (MB-UKA). However, this process commonly depends on the surgeon's experience and lacks specific unified standards. This study aimed to propose and evaluate a novel "measured resection" method for gap balance in MB-UKA.

Methods: This prospective study included 49 consecutive patients (52 knees) who underwent MB-UKA from February 1, 2023, to September 1, 2023. Gap balance was achieved by the traditional "two-finger" method (Group 1, 26 knees) or the measured resection method (Group 2, 26 knees). The novel "measured resection" method was performed by measuring the thickness of the resected posterior femoral condyle and resected medial posterior tibial plateau to assess proper meniscal bearing thickness. Data were collected at baseline and the 6-month follow-up. Prosthetic angles, range of motion (ROM), visual analog scale (VAS) score, Oxford knee score (OKS), and Global Perceived Scale (GPE) were used to evaluate clinical outcomes. Independent samples t-test and Mann-Whitney U test were used to compare the differences.

Results: There were significant improvements in all measured outcomes at the 6-month follow-up from baseline in both groups (p < 0.01). Patients using measured resection method showed better ROM (130° vs. 120°, p = 0.007), VAS score (1 vs. 2, p = 0.013), and OKS scores (39.9 vs. 38.1, p = 0.013) at 6-month follow-up than the traditional "two-finger" method group. The prosthetic angles, ROM improvement, and GPE showed no significant difference between the groups (p > 0.05).

Conclusions: The measured resection method is a reliable method for assisting surgeons in choosing the ideal meniscal bearing thickness in MB-UKA to achieve proper gap balance and gain better clinical outcomes.

Trial registration: ClinicalTrials.gov (NCT03815448).

目的:间隙平衡是活动承载单间室膝关节置换术(MB-UKA)中的一个重要过程。然而,这一过程通常取决于外科医生的经验,缺乏具体的统一标准。本研究旨在提出并评估一种用于 MB-UKA 间隙平衡的新型 "测量切除 "方法:这项前瞻性研究纳入了 2023 年 2 月 1 日至 2023 年 9 月 1 日期间接受 MB-UKA 手术的 49 例连续患者(52 个膝关节)。采用传统的 "双指 "法(第 1 组,26 个膝关节)或测量切除法(第 2 组,26 个膝关节)实现间隙平衡。新颖的 "测量切除 "法是通过测量切除的股骨后髁和切除的胫骨内侧后平台的厚度来评估半月板的适当承托厚度。在基线和 6 个月的随访中收集了数据。假体角度、活动范围(ROM)、视觉模拟量表(VAS)评分、牛津膝关节评分(OKS)和全球感知量表(GPE)用于评估临床结果。采用独立样本 t 检验和 Mann-Whitney U 检验比较差异:结果:两组患者在随访 6 个月时,所有测量结果均较基线有明显改善(P 0.05):结论:测量切除法是一种可靠的方法,可帮助外科医生在MB-UKA手术中选择理想的半月板承托厚度,以达到适当的间隙平衡,获得更好的临床效果:试验注册:ClinicalTrials.gov (NCT03815448)。
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引用次数: 0
Enhanced Biomechanical Stability in Proximal Humeral Fractures: Finite Element Analysis of a Novel Endosteal Anatomical Support Nail for Improved Fixation in Elderly Patients. 增强肱骨近端骨折的生物力学稳定性:用于改善老年患者固定效果的新型骨内解剖支撑钉的有限元分析。
IF 1.8 2区 医学 Q2 ORTHOPEDICS Pub Date : 2025-02-01 Epub Date: 2024-11-27 DOI: 10.1111/os.14297
Jiawen Chen, Zhonghe Wang, Changda Li, Peiyu He, Zhongxuan Chen, Lijun Sun, Xiaoyan Cao, Na Tian, Xiang Dong, Peifu Tang, Hua Chen

Objectives: Intramedullary nailing is preferred for treating elderly proximal humeral fractures, but secondary reductions are common, particularly in elderly and osteoporotic patients. This occurs due to the intramedullary nail fixation's insufficient anti-varus and anti-rotational capacities and high stress at the bone-implant interface. We aim to enhance the anti-varus and anti-rotational stability of the fixation structure while reducing the stresses on the bone and internal fixation through structural design.

Materials and methods: We developed a novel endosteal anatomical support nail (EASN) that integrates an endosteal torus construct into the proximal portion of the angle-stable proximal humerus nail. The endosteal torus construct includes endosteal anatomical support (EAS) with a flat plane that allows direct fixation of the humeral head fragments and is shaped to conform to the medial side of the medullary cavity of the proximal humerus. We conducted finite element analysis to assess the biomechanical stability of four constructs: EAS with a calcar screw (CS), EAS without CS, non-EAS with CS, and non-EAS without CS. This analysis determined the contribution of the EAS to the mechanical stability of the proximal humerus in two-part PHF with medial column disruption. Specimens were subjected to loads simulating partial-weight-bearing (as in rising from a chair or using crutches) and full-weight-bearing (as in rising from bed). We evaluated the stiffness of the construct, displacement at the fracture site, von Mises stress, and stress distribution.

Results: Under compressive or rotational loads, the EAS construct, with or without CS, was significantly stiffer than the non-EAS construct. Displacement at the fracture site was significantly less with the EAS fixation than with the non-EAS fixation. However, the stiffness and displacement at the fracture site of the EAS fixation without CS were comparable to those of the non-EAS construct with CS. The EAS construct reduced the load on the nail and decreased the risk of implant failure. Both von Mises stress and stress distribution were significantly lower following fixation with the EAS constructs.

Conclusions: This study introduces a novel EAS concept to enhance the anti-varus and anti-rotational capabilities of the humeral head and distribute stress at the bone-implant interface in treating elderly PHFs. This strategy shows promise based on our limited analysis.

目的:髓内钉是治疗老年肱骨近端骨折的首选方法,但二次复位很常见,尤其是在老年和骨质疏松患者中。出现这种情况的原因是髓内钉固定的抗旋转能力不足,以及骨-植入物界面的应力过高。我们的目标是通过结构设计提高固定结构的抗旋转稳定性,同时降低骨和内固定的应力:我们开发了一种新型骨内膜解剖支撑钉(EASN),它将骨内膜环形结构整合到角度稳定的肱骨近端钉的近端部分。骨内环形结构包括骨内解剖支撑(EAS),其平面可直接固定肱骨头碎片,其形状与肱骨近端髓腔的内侧相吻合。我们进行了有限元分析,以评估四种结构的生物力学稳定性:EAS 带有胫骨螺钉 (CS)、EAS 不带 CS、非 EAS 带有 CS 和非 EAS 不带 CS。该分析确定了在内侧柱破坏的两部分 PHF 中,EAS 对肱骨近端机械稳定性的贡献。试样承受了模拟部分负重(如从椅子上站起来或使用拐杖)和完全负重(如从床上站起来)的载荷。我们评估了结构的刚度、骨折部位的位移、冯-米塞斯应力和应力分布:结果:在压缩或旋转负荷下,EAS结构(无论有无CS)的刚度明显高于非EAS结构。采用 EAS 固定结构时,骨折部位的位移明显小于非 EAS 固定结构。然而,无CS的EAS固定结构与有CS的非EAS固定结构在骨折部位的硬度和位移量相当。EAS 结构减轻了钉子的负荷,降低了植入失败的风险。使用EAS结构固定后,冯米斯应力和应力分布都明显降低:本研究提出了一种新颖的 EAS 概念,以增强肱骨头的抗旋转能力,并在治疗老年 PHF 时分散骨与植入物界面的应力。根据我们有限的分析,这一策略前景广阔。
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引用次数: 0
New-Occurrence of Postoperative Modic Changes and Its Influence on the Surgical Prognosis After Percutaneous Endoscopic Lumbar Disc Discectomy. 经皮内窥镜腰椎间盘切除术后形态改变的新发生及其对手术预后的影响。
IF 1.8 2区 医学 Q2 ORTHOPEDICS Pub Date : 2025-02-01 Epub Date: 2024-12-05 DOI: 10.1111/os.14308
Lei Li, Chao Wang, Hao Zhang, Zhiming Liu, Zheng Lian, Han Li, Hao Tao, Xuexiao Ma

Objectives: Lumbar disc herniation (LDH) is a common degenerative spinal disease in clinical practice. This study aims to investigate the impact of Modic changes (MCs) on postoperative recovery and disease recurrence following percutaneous endoscopic lumbar disc discectomy (PELD), providing important insights for improving the management of chronic low back pain. This study investigates the 1-year progression rate of MCs after PELD and their impact on surgical outcomes and recurrence.

Methods: This retrospective cohort study analyzed data from 419 patients with single-segment lumbar disc herniation who underwent PELD between January 2019 and December 2022. Lumbar MRI assessed preoperative and postoperative MCs. Pain levels and surgical outcomes were evaluated using the visual analog scale, Oswestry Disability Index, and Macnab criteria. Univariate analysis explored the relationship between postoperative MCs and pain, while subgroups investigated the associations between postoperative efficacy, recurrence, and MCs type and area.

Results: One-year follow-up revealed that the probability of MCs postsurgery was 24.8%. Patients with postoperative MCs had significantly lower pain scores compared with the control group (p < 0.05). Univariate analysis indicated that the type and area of postoperative MCs were risk factors for poor outcomes in PELD patients (p < 0.05). During the 1-year follow-up, recurrence rates in the no-MCs and MCs groups were 3.8% and 9.6%, respectively (p < 0.05). Univariate analysis concluded that the area of postoperative MCs was a risk factor for PELD recurrence.

Conclusion: The postoperative MCs, as a risk factor, may have a detrimental effect on the surgical efficacy and short-term recurrence of LDH following PELD based on a large sample. Furthermore, the harmful effect is affected by the area and type of the postoperative MCs.

目的:腰椎间盘突出症(LDH)是临床常见的退行性脊柱疾病。本研究旨在探讨Modic改变(MCs)对经皮内镜腰椎间盘切除术(PELD)术后恢复和疾病复发的影响,为改善慢性腰痛的治疗提供重要见解。本研究探讨PELD后MCs的1年进展率及其对手术结果和复发的影响。方法:本回顾性队列研究分析了2019年1月至2022年12月期间接受PELD治疗的419例单节段腰椎间盘突出症患者的数据。腰椎MRI评估术前和术后MCs。采用视觉模拟量表、Oswestry残疾指数和Macnab标准评估疼痛水平和手术结果。单因素分析探讨术后MCs与疼痛之间的关系,而亚组研究术后疗效、复发、MCs类型和面积之间的关系。结果:随访1年,术后MCs发生率为24.8%。结论:基于大样本研究,术后MCs作为一种危险因素,可能对PELD术后LDH的手术疗效和短期复发产生不利影响。此外,有害影响受术后MCs的面积和类型的影响。
{"title":"New-Occurrence of Postoperative Modic Changes and Its Influence on the Surgical Prognosis After Percutaneous Endoscopic Lumbar Disc Discectomy.","authors":"Lei Li, Chao Wang, Hao Zhang, Zhiming Liu, Zheng Lian, Han Li, Hao Tao, Xuexiao Ma","doi":"10.1111/os.14308","DOIUrl":"10.1111/os.14308","url":null,"abstract":"<p><strong>Objectives: </strong>Lumbar disc herniation (LDH) is a common degenerative spinal disease in clinical practice. This study aims to investigate the impact of Modic changes (MCs) on postoperative recovery and disease recurrence following percutaneous endoscopic lumbar disc discectomy (PELD), providing important insights for improving the management of chronic low back pain. This study investigates the 1-year progression rate of MCs after PELD and their impact on surgical outcomes and recurrence.</p><p><strong>Methods: </strong>This retrospective cohort study analyzed data from 419 patients with single-segment lumbar disc herniation who underwent PELD between January 2019 and December 2022. Lumbar MRI assessed preoperative and postoperative MCs. Pain levels and surgical outcomes were evaluated using the visual analog scale, Oswestry Disability Index, and Macnab criteria. Univariate analysis explored the relationship between postoperative MCs and pain, while subgroups investigated the associations between postoperative efficacy, recurrence, and MCs type and area.</p><p><strong>Results: </strong>One-year follow-up revealed that the probability of MCs postsurgery was 24.8%. Patients with postoperative MCs had significantly lower pain scores compared with the control group (p < 0.05). Univariate analysis indicated that the type and area of postoperative MCs were risk factors for poor outcomes in PELD patients (p < 0.05). During the 1-year follow-up, recurrence rates in the no-MCs and MCs groups were 3.8% and 9.6%, respectively (p < 0.05). Univariate analysis concluded that the area of postoperative MCs was a risk factor for PELD recurrence.</p><p><strong>Conclusion: </strong>The postoperative MCs, as a risk factor, may have a detrimental effect on the surgical efficacy and short-term recurrence of LDH following PELD based on a large sample. Furthermore, the harmful effect is affected by the area and type of the postoperative MCs.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":"482-491"},"PeriodicalIF":1.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11787988/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142786186","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Reducing the Brace Correction Stress on the Secondary Lumbar Curve Results in Excellent Muscle, Bone, and Disc Mechanical Performance: A Musculoskeletal Finite Element Simulation of AIS Patient With Rigo A3. 减少腰椎二次曲线上的支撑矫正应力可获得出色的肌肉、骨骼和椎间盘机械性能:使用 Rigo A3 的 AIS 患者的肌肉骨骼有限元模拟。
IF 1.8 2区 医学 Q2 ORTHOPEDICS Pub Date : 2025-02-01 Epub Date: 2024-11-12 DOI: 10.1111/os.14296
Xiaohui Zhang, Di Wang, Danyu Lv, Jinmiao Lv, Huiyi Tang, Jinlin Qian, Bagen Liao

Objectives: The biomechanical mechanism of brace intervention on bone, muscle, and disc should be comprehensively considered for AIS patients. We aimed to developmentally construct a musculoskeletal finite element model of adolescent idiopathic scoliosis to simulate the coupling of corrective forces and analyze the mechanical properties of bone, muscle, and disc. Investigateing, more effective clinical interventions to break the vicious cycle of patients during growth.

Methods: A finite element model, including muscle, bone, and disc, was established using computed tomography data of a patient with RigoA3 adolescent idiopathic scoliosis. The three-point force coupling, antigravity, and bending effects of the Chêneau brace were simulated, and the correction force of the secondary lumbar bend was gradually reduced while observing the mechanical characteristics of bone, muscle, and disc. The correction force in line with symmetrical spine growth was comprehensively evaluated.

Results: The correction rate of the main thoracic (MT) curve, the intervertebral space height on the concave side of the vertebrae at the apex, and the stress ratio of the intervertebral discs were optimal when the maximum corrective pressure threshold was reached. However, the proximal thoracic (PT) curve was aggravated and the axial forces on the concave side were unbalanced. At this time, the biomechanical performance of the model is also not optimal. The correction rate of the Cobb Angle of the MT curve decreased with the decrease of the correction pressure in the lumbar region. When reduced to 25% of the maximum threshold, the convex side of disc stress, intervertebral space, and muscle axial force is more in line with the biomechanical mechanism of correction and can avoid sacrificing the PT curve.

Conclusions: Downward adjustment of the corrective force to the secondary lumbar curve, using the Chêneau brace, results in better primary thoracic curvature mechanics in the musculoskeletal finite element model, suggesting that breaking the vicious cycle of scoliosis progression to guide benign spinal growth is beneficial.

目标:对于特发性脊柱侧凸(AIS)患者,应全面考虑支撑干预对骨骼、肌肉和椎间盘的生物力学机制。我们旨在构建青少年特发性脊柱侧凸的肌肉骨骼有限元模型,模拟矫正力的耦合,分析骨、肌肉和椎间盘的力学特性。研究更有效的临床干预措施,以打破患者在成长过程中的恶性循环:利用 RigoA3 青少年特发性脊柱侧凸患者的计算机断层扫描数据,建立了包括肌肉、骨骼和椎间盘在内的有限元模型。模拟了三点力耦合、反重力和 Chêneau 支架的弯曲效应,并在观察骨骼、肌肉和椎间盘的力学特征的同时,逐渐减小了腰椎二次弯曲的矫正力。结果表明:主胸椎弯曲矫正率和主腰椎弯曲矫正率之间存在明显差异:结果:当达到最大矫正压力阈值时,主胸椎(MT)曲线的矫正率、顶点椎体凹面的椎间隙高度以及椎间盘的应力比均达到最佳状态。然而,近胸椎(PT)曲线恶化,凹侧的轴向力不平衡。此时,模型的生物力学性能也不理想。MT 曲线的 Cobb 角矫正率随着腰部矫正压力的降低而降低。当降低到最大阈值的25%时,椎间盘应力、椎间隙和肌肉轴向力的凸侧更符合矫正的生物力学机制,可以避免牺牲PT曲线:结论:在肌肉骨骼有限元模型中,使用Chêneau支架向下调整次级腰椎曲线的矫正力,可获得更好的初级胸椎曲度力学效果,这表明打破脊柱侧凸进展的恶性循环以引导脊柱良性生长是有益的。
{"title":"Reducing the Brace Correction Stress on the Secondary Lumbar Curve Results in Excellent Muscle, Bone, and Disc Mechanical Performance: A Musculoskeletal Finite Element Simulation of AIS Patient With Rigo A3.","authors":"Xiaohui Zhang, Di Wang, Danyu Lv, Jinmiao Lv, Huiyi Tang, Jinlin Qian, Bagen Liao","doi":"10.1111/os.14296","DOIUrl":"10.1111/os.14296","url":null,"abstract":"<p><strong>Objectives: </strong>The biomechanical mechanism of brace intervention on bone, muscle, and disc should be comprehensively considered for AIS patients. We aimed to developmentally construct a musculoskeletal finite element model of adolescent idiopathic scoliosis to simulate the coupling of corrective forces and analyze the mechanical properties of bone, muscle, and disc. Investigateing, more effective clinical interventions to break the vicious cycle of patients during growth.</p><p><strong>Methods: </strong>A finite element model, including muscle, bone, and disc, was established using computed tomography data of a patient with RigoA3 adolescent idiopathic scoliosis. The three-point force coupling, antigravity, and bending effects of the Chêneau brace were simulated, and the correction force of the secondary lumbar bend was gradually reduced while observing the mechanical characteristics of bone, muscle, and disc. The correction force in line with symmetrical spine growth was comprehensively evaluated.</p><p><strong>Results: </strong>The correction rate of the main thoracic (MT) curve, the intervertebral space height on the concave side of the vertebrae at the apex, and the stress ratio of the intervertebral discs were optimal when the maximum corrective pressure threshold was reached. However, the proximal thoracic (PT) curve was aggravated and the axial forces on the concave side were unbalanced. At this time, the biomechanical performance of the model is also not optimal. The correction rate of the Cobb Angle of the MT curve decreased with the decrease of the correction pressure in the lumbar region. When reduced to 25% of the maximum threshold, the convex side of disc stress, intervertebral space, and muscle axial force is more in line with the biomechanical mechanism of correction and can avoid sacrificing the PT curve.</p><p><strong>Conclusions: </strong>Downward adjustment of the corrective force to the secondary lumbar curve, using the Chêneau brace, results in better primary thoracic curvature mechanics in the musculoskeletal finite element model, suggesting that breaking the vicious cycle of scoliosis progression to guide benign spinal growth is beneficial.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":"525-539"},"PeriodicalIF":1.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11787989/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142625203","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Comparison of Therapeutic Effects of Different Rehabilitation Methods on Patients Undergoing Total Knee Arthroplasty: A Network Meta-Analysis of Randomized Controlled Trials. 不同康复方法对全膝关节置换术患者治疗效果的比较:随机对照试验的网络meta分析。
IF 1.8 2区 医学 Q2 ORTHOPEDICS Pub Date : 2025-02-01 Epub Date: 2025-01-08 DOI: 10.1111/os.14332
Zhaokai Jin, Yi Tang, Hua Huang, Lei Chen, Zhongyi Zhang, Tianyou Ma, Zhengming Wang, Hai Su, Haojing Zhou, Shuaijie Lv, Peijian Tong

Objective: The rehabilitation methods after total knee arthroplasty (TKA) can affect the recovery of complications and joint function, and the selection and comparison of rehabilitation methods after TKA still need further research.

Methods: A comprehensive search of five databases and two clinical trial registration platforms was conducted from inception through March 31, 2024, and conducted to identify eligible randomized controlled trials (RCTs). We extracted the required data according to the Cochrane Handbook for Systematic Reviews of Interventions. Finally, 32 trials involving 2292 patients were included, the mean age of the enrolled patients was ~69.10 years, the sex ratio of males was (31.6%), and the longest follow-up time was 2 years. And we have summarized nine rehabilitation intervention measures: conventional physical therapy (CPT), cryotherapy, thermal therapy (TT), acupuncture, hydrotherapy, neuromuscular training (NT), electrotherapy, continuous passive motion (CPM), continuous active motion (CAM). And use the range of motion (ROM), visual analog scale (VAS), Western Ontario and McMaster Universities osteoarthritis index (WOMAC) as the outcome measure to evaluate the effectiveness of various interventions. A Bayesian network meta-analysis (NMA) was carried out for calculating standardized mean difference (SMD) and the surface under cumulative ranking curve (SUCRA) of improvement of knee joint function after TKA by different rehabilitation methods.

Result: After treatment, the ROM results showed that cryotherapy, electrotherapy, and NT had better therapeutic effects. Among them, cryotherapy (WMD = 10.3, 95% CI 1.63-18.2) had a significant therapeutic effect. In terms of VAS, NT and TT showed good therapeutic effects. Among them, NT had a more significant therapeutic effect, while CAM had less effect. After treatment, in terms of WOMAC, TT, hydrotherapy, cryotherapy, and NT had better therapeutic effects. TT had the best therapeutic effect, while Hydrotherapy and Cryotherapy also had certain advantages.

Conclusion: NT, TT, cryotherapy, hydrotherapy, and electrotherapy rehabilitation therapies have good therapeutic effects for TKA patients compared with other interventions. Among them, NT may be the best postoperative rehabilitation therapy.

目的:全膝关节置换术(TKA)术后康复方式影响并发症及关节功能的恢复,TKA术后康复方式的选择与比较仍需进一步研究。方法:综合检索5个数据库和2个临床试验注册平台,从建立之日起至2024年3月31日止,筛选符合条件的随机对照试验(rct)。我们根据Cochrane干预措施系统评价手册提取所需数据。最终纳入32项试验2292例患者,入组患者平均年龄~69.10岁,男性性别比为(31.6%),最长随访时间为2年。并总结了9种康复干预措施:常规物理治疗(CPT)、冷冻疗法(crt)、热疗法(TT)、针灸、水疗、神经肌肉训练(NT)、电疗、持续被动运动(CPM)、持续主动运动(CAM)。并以活动度(ROM)、视觉模拟量表(VAS)、Western Ontario And McMaster Universities osteoarthritis index (WOMAC)作为结局指标,评价各种干预措施的有效性。采用贝叶斯网络meta分析(NMA)计算不同康复方法对全膝关节置换术后膝关节功能改善的标准化平均差(SMD)和累积排序曲线下曲面(SUCRA)。结果:治疗后ROM结果显示冷冻疗法、电疗、NT治疗效果较好。其中冷冻治疗效果显著(WMD = 10.3, 95% CI 1.63-18.2)。在VAS方面,NT和TT表现出良好的治疗效果。其中,NT治疗效果更显著,CAM效果较差。治疗后,在WOMAC方面,TT、水疗法、冷冻疗法和NT治疗效果较好。TT治疗效果最好,水疗和冷冻治疗也有一定优势。结论:与其他干预措施相比,NT、TT、冷冻、水疗法、电疗康复疗法对TKA患者的治疗效果较好。其中,NT可能是最佳的术后康复治疗方法。
{"title":"Comparison of Therapeutic Effects of Different Rehabilitation Methods on Patients Undergoing Total Knee Arthroplasty: A Network Meta-Analysis of Randomized Controlled Trials.","authors":"Zhaokai Jin, Yi Tang, Hua Huang, Lei Chen, Zhongyi Zhang, Tianyou Ma, Zhengming Wang, Hai Su, Haojing Zhou, Shuaijie Lv, Peijian Tong","doi":"10.1111/os.14332","DOIUrl":"10.1111/os.14332","url":null,"abstract":"<p><strong>Objective: </strong>The rehabilitation methods after total knee arthroplasty (TKA) can affect the recovery of complications and joint function, and the selection and comparison of rehabilitation methods after TKA still need further research.</p><p><strong>Methods: </strong>A comprehensive search of five databases and two clinical trial registration platforms was conducted from inception through March 31, 2024, and conducted to identify eligible randomized controlled trials (RCTs). We extracted the required data according to the Cochrane Handbook for Systematic Reviews of Interventions. Finally, 32 trials involving 2292 patients were included, the mean age of the enrolled patients was ~69.10 years, the sex ratio of males was (31.6%), and the longest follow-up time was 2 years. And we have summarized nine rehabilitation intervention measures: conventional physical therapy (CPT), cryotherapy, thermal therapy (TT), acupuncture, hydrotherapy, neuromuscular training (NT), electrotherapy, continuous passive motion (CPM), continuous active motion (CAM). And use the range of motion (ROM), visual analog scale (VAS), Western Ontario and McMaster Universities osteoarthritis index (WOMAC) as the outcome measure to evaluate the effectiveness of various interventions. A Bayesian network meta-analysis (NMA) was carried out for calculating standardized mean difference (SMD) and the surface under cumulative ranking curve (SUCRA) of improvement of knee joint function after TKA by different rehabilitation methods.</p><p><strong>Result: </strong>After treatment, the ROM results showed that cryotherapy, electrotherapy, and NT had better therapeutic effects. Among them, cryotherapy (WMD = 10.3, 95% CI 1.63-18.2) had a significant therapeutic effect. In terms of VAS, NT and TT showed good therapeutic effects. Among them, NT had a more significant therapeutic effect, while CAM had less effect. After treatment, in terms of WOMAC, TT, hydrotherapy, cryotherapy, and NT had better therapeutic effects. TT had the best therapeutic effect, while Hydrotherapy and Cryotherapy also had certain advantages.</p><p><strong>Conclusion: </strong>NT, TT, cryotherapy, hydrotherapy, and electrotherapy rehabilitation therapies have good therapeutic effects for TKA patients compared with other interventions. Among them, NT may be the best postoperative rehabilitation therapy.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":"348-360"},"PeriodicalIF":1.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11787976/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142952714","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Predictive Value of Preoperative Nutritional Risk Index for Screw Loosening After Lumbar Interbody Fusion in Elderly Patients With Lumbar Spine Diseases.
IF 1.8 2区 医学 Q2 ORTHOPEDICS Pub Date : 2025-01-30 DOI: 10.1111/os.14369
Youwei Ai, Qian Chen, Li Li, Juehan Wang, Ce Zhu, Hong Ding, Yongdi Wang, Zhuojie Xiao, Yuting Zhan, Yueming Song, Ganjun Feng, Limin Liu

Objective: Pedicle screw loosening is one of the common complications in elderly patients undergoing transforaminal lumbar interbody fusion (TLIF) for lumbar spine disease. Malnutrition, prevalent among elderly patients, has been shown to be associated with increased complications. The Geriatric Nutritional Risk Index (GNRI) serves as a simple indicator of nutritional status. However, the relationship between malnutrition, particularly GNRI, and pedicle screw loosening has not been adequately investigated. This study aims to investigate the relationship between GNRI and pedicle screw loosening following TLIF to guide the perioperative nutritional management of patients and prevent postoperative complications.

Methods: A retrospective review was conducted on clinical data from patients who underwent single-level TLIF between 2014 and 2022. Data collection encompassed patient demographics, preoperative laboratory parameters, surgery-related data, perioperative radiographic data, and patient-reported outcomes were comprehensively documented. All patients were followed up for a minimum of 12 months. The relationship between GNRI and pedicle screw loosening was evaluated by univariate and multivariate Cox regression analysis, restricted cubic spline (RCS) analysis, receiver operating characteristic (ROC) analysis, and Kaplan-Meier survival analysis.

Results: A total of 426 patients were included in the study. The rate of pedicle screw loosening rate was 16.4% at a minimum follow-up of 12 months. Patients with pedicle screw loosening exhibited significantly lower GNRI (89.0 ± 8.0 vs. 99.2 ± 9.3, p < 0.001) and volumetric bone mineral density measured by quantitative computed tomography (QCT-vBMD) (84.2 [interquartile range (IQR) 79.6-92.2] vs. 104.0 [IQR 88.2-126.0] mg/cm3, p < 0.001) compared with those in the non-loosening group. Multivariate Cox regression analysis identified sex (hazard ratio [HR] 1.433, 95% confidence interval [CI] 0.714-2.876, p = 0.027), age (HR 1.062, 95% CI 1.014-1.113, p = 0.012), GNRI (HR 0.841, 95% CI 0.711-0.994, p = 0.043), and QCT-vBMD (HR 0.982, 95% CI 0.967-0.997, p = 0.019) as independent risk factors for screw loosening. RCS analysis showed that GNRI was negatively correlated with screw loosening (p < 0.0001). The area under the curve (AUC) for the GNRI in predicting pedicle screw loosening was 0.794, with a cut-off value of 95.590 (sensitivity, 85.7%; specificity 65.2%). Kaplan-Meier survival analysis identified that the lower-level GNRI group exhibited a higher cumulative incidence of screw loosening (log-rank test, p < 0.0001).

Conclusion: The GNRI was an independent risk factor for postoperative screw loosening in elderly patients undergoing TLIF for lumbar spine disease. Preoperative GNRI may potentially serve as a valuable tool in predicting postoperative screw loosening in elderly patients undergoing TLIF.

{"title":"Predictive Value of Preoperative Nutritional Risk Index for Screw Loosening After Lumbar Interbody Fusion in Elderly Patients With Lumbar Spine Diseases.","authors":"Youwei Ai, Qian Chen, Li Li, Juehan Wang, Ce Zhu, Hong Ding, Yongdi Wang, Zhuojie Xiao, Yuting Zhan, Yueming Song, Ganjun Feng, Limin Liu","doi":"10.1111/os.14369","DOIUrl":"https://doi.org/10.1111/os.14369","url":null,"abstract":"<p><strong>Objective: </strong>Pedicle screw loosening is one of the common complications in elderly patients undergoing transforaminal lumbar interbody fusion (TLIF) for lumbar spine disease. Malnutrition, prevalent among elderly patients, has been shown to be associated with increased complications. The Geriatric Nutritional Risk Index (GNRI) serves as a simple indicator of nutritional status. However, the relationship between malnutrition, particularly GNRI, and pedicle screw loosening has not been adequately investigated. This study aims to investigate the relationship between GNRI and pedicle screw loosening following TLIF to guide the perioperative nutritional management of patients and prevent postoperative complications.</p><p><strong>Methods: </strong>A retrospective review was conducted on clinical data from patients who underwent single-level TLIF between 2014 and 2022. Data collection encompassed patient demographics, preoperative laboratory parameters, surgery-related data, perioperative radiographic data, and patient-reported outcomes were comprehensively documented. All patients were followed up for a minimum of 12 months. The relationship between GNRI and pedicle screw loosening was evaluated by univariate and multivariate Cox regression analysis, restricted cubic spline (RCS) analysis, receiver operating characteristic (ROC) analysis, and Kaplan-Meier survival analysis.</p><p><strong>Results: </strong>A total of 426 patients were included in the study. The rate of pedicle screw loosening rate was 16.4% at a minimum follow-up of 12 months. Patients with pedicle screw loosening exhibited significantly lower GNRI (89.0 ± 8.0 vs. 99.2 ± 9.3, p < 0.001) and volumetric bone mineral density measured by quantitative computed tomography (QCT-vBMD) (84.2 [interquartile range (IQR) 79.6-92.2] vs. 104.0 [IQR 88.2-126.0] mg/cm<sup>3</sup>, p < 0.001) compared with those in the non-loosening group. Multivariate Cox regression analysis identified sex (hazard ratio [HR] 1.433, 95% confidence interval [CI] 0.714-2.876, p = 0.027), age (HR 1.062, 95% CI 1.014-1.113, p = 0.012), GNRI (HR 0.841, 95% CI 0.711-0.994, p = 0.043), and QCT-vBMD (HR 0.982, 95% CI 0.967-0.997, p = 0.019) as independent risk factors for screw loosening. RCS analysis showed that GNRI was negatively correlated with screw loosening (p < 0.0001). The area under the curve (AUC) for the GNRI in predicting pedicle screw loosening was 0.794, with a cut-off value of 95.590 (sensitivity, 85.7%; specificity 65.2%). Kaplan-Meier survival analysis identified that the lower-level GNRI group exhibited a higher cumulative incidence of screw loosening (log-rank test, p < 0.0001).</p><p><strong>Conclusion: </strong>The GNRI was an independent risk factor for postoperative screw loosening in elderly patients undergoing TLIF for lumbar spine disease. Preoperative GNRI may potentially serve as a valuable tool in predicting postoperative screw loosening in elderly patients undergoing TLIF.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143066797","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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Orthopaedic Surgery
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