Orthopaedic Surgery最新文献

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.

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.

Objective: There are limited data about the association between intramedullary increased signal intensity (ISI) on T2-weighted magnetic resonance imaging and surgical outcome in degenerative cervical myelopathy (DCM) after anterior decompressive surgery. This study aimed to explore factors contributing to unsatisfactory recovery following surgical treatment for DCM, with a particular focus on evaluating whether preoperative quantitative indicators of ISI on T2-weighted MRI could be used to forecast surgical outcomes.

Methods: In this retrospective analysis, 94 patients diagnosed with ISI and treated with anterior cervical decompression for DCM between January 2021 and June 2023 were reviewed. Based on a postoperative recovery rate cutoff of 50% at final follow-up, patients were categorized into optimal and suboptimal recovery groups. Multivariate logistic regression was employed to identify independent predictors of prognosis.

Results: Among the 94 patients, 39 (41.5%) had a suboptimal clinical outcome with a recovery rate below 50%. Multivariate analysis identified longer duration of symptoms, higher signal change ratio (SCR) on T2-weighted MRI, and the presence of snake-eye appearance (SEA) as significant predictors of poor recovery. The optimal SCR cutoff value for predicting a suboptimal outcome was 1.53, yielding a sensitivity of 64.1% and a specificity of 83.6%. While somatosensory and motor evoked potentials (SEP/MEP) were associated with baseline neurological function, they did not serve as standalone predictors of recovery.

Conclusions: Longer symptom duration, elevated SCR on T2-weighted MRI, and SEA features may be significant preoperative indicators of less favorable outcomes in DCM patients. Individuals exhibiting an SCR above 1.53 and SEA on imaging should be considered at increased risk for limited postoperative improvement. These insights highlight the potential benefit of earlier surgical intervention and underscore the need for prospective validation through multicenter studies.

To assess whether surgical treatment with predominantly volar locking plates has superior clinical and radiographic outcomes to conservative treatment with cast immobilization in the treatment of distal radius fractures by reviewing and investigating the literature with a high level of evidence. Thus, we systematically searched PubMed, Web of Science, and Embase databases for clinical trials comparing surgical and conservative treatments for distal radius fractures. Data extraction was performed to access parameters that included: wrist functional assessment, such as mobility and grip strength; subjective outcomes, such as DASH score, PRWE score, and quality of life score (EQ-5D); radiographic assessment (palmar inclination, ulnar variance, and articular subluxation, etc.); and complications, such as fracture nonunion, reoperation, infection, and neurologic symptoms, and then to conduct data organization and quantitative synthesis. Finally, a total of 19 clinical trials with 2729 patients were included in this report, including 1378 in the conservative treatment group and 1351 in the surgical treatment group. In terms of recovery of wrist function, wrist joints undergoing cast immobilization gained a greater range of extension (MD 1.5°, p = 0.02), whereas surgical treatment of the range of wrist rotation was significantly greater than with conservative treatment (MD 3°, p = 0.03), and wrist grip strength was significantly improved (MD 2 kg, p = 0.04). There were no significant differences between the two groups of patients in terms of wrist flexion and anterior rotation activities. In terms of patient subjective scores, patients in the plaster immobilization group showed significant improvement in PRWE scores compared with the surgical treatment group at 3 and 12 months after treatment (MD 3-7 points, p < 0.05). There was no significant difference between the two groups in terms of ulnar varus and dorsal tilt angle correction (p > 0.05). At the level of complications, the overall complication rate was significantly lower in patients who underwent surgical treatment than in the conservative treatment group (202/1046 [19.3%] vs. 361/1065 [33.9%], p = 0.001). The conclusions drawn were that when treating distal radius fractures, surgical treatment with predominantly metacarpal plate fixation achieves superior anatomical fracture repositioning and a lower complication rate compared to cast immobilization. However, no significant advantage was demonstrated in terms of recovery of wrist function and subjective patient perception. Overall, surgical treatment is an appropriate choice for patients with high motor function requirements who need to recover quickly, whereas more conservative treatments can be considered for patients with lower functional requirements.

Objective: Hip septic arthritis is a relatively rare yet severe cause of acute hip pain, with the potential to rapidly destroy articular cartilage, lead to osteonecrosis, and cause osteomyelitis. This life-threatening infection demands early diagnosis and appropriate treatment. Our study aims to assess the surgical safety and efficacy of arthroscopic management for this condition and to optimize the arthroscopic treatment protocol by customizing surgical interventions based on intraoperative findings and disease stages.

Methods: We conducted a retrospective study of 28 patients (18 females, 10 males; average age of 49 ± 10.5 years) from January 2018 to March 2022. Diagnosis of hip septic arthritis was confirmed via synovial fluid examination, culture, or synovial pathology. Patients underwent arthroscopic joint lavage, synovectomy, and drainage tailored to the intraoperative situation and the Gächter stage. Antibiotics were administered based on drug-sensitivity results or empirically. We recorded and analyzed symptoms, comorbidities, stages, inflammatory marker levels, culture results, antibiotic duration, outcomes, and complications.

Results: The mean time from symptom onset to surgery was 10.2 ± 8.6 (range, 4-45) days. All patients had elevated inflammatory markers. Pre-operative bacterial cultures were positive in 6 cases, and post-operative cultures were positive in 21 cases. Staphylococcus aureus was the most frequently detected pathogen (10 cases), accounting for approximately 47.6% of the positive culture cases. Antibiotic therapy lasted 4-6 weeks. The C-reactive protein normalized on average 43 days after surgery; the erythrocyte sedimentation rate normalized 54 days postoperatively. At final follow-up (mean 42 months), the visual analog scale score decreased from 6.6 ± 1.3 to 1.3 ± 0.2 (p = 0.003), and the modified Harris Hip Score improved from 52 ± 8.1 to 85 ± 8.6 (p = 0.001). Infection was controlled in all patients within 6 months. Two patients (Gächter stage III/IV) had recurrent infections at 8 and 11 months, successfully treated with repeat arthroscopy. Gächter stage III or IV was a significant risk factor for recurrence. Two patients underwent total hip arthroplasty due to secondary osteoarthritis and osteonecrosis. No major complications occurred.

Conclusion: Stage-based arthroscopic lavage, synovectomy, and drainage combined with antibiotics is effective for hip septic arthritis. The optimized procedure offers a safe and effective option, particularly for early-stage (Gächter I-II) disease, while advanced stages (III-IV) require cautious management due to higher recurrence risk.

Objectives: Ankle fracture with both deltoid ligament (DL) rupture and syndesmotic diastasis is often treated by syndesmotic fixation after fibular fixation. However, a second operation may be needed to remove the internal fixation, and screw breakage/misplacement may occur. The present study aimed to explore the mechanism and feasibility of DL augmentation instead of syndesmotic fixation from the perspective of biomechanics.

Methods: The CT data (in DICOM format) of a 33-year-old man were used to create a finite element model. External rotation stress and eversion stress were applied to the model, and the medial clear space (MCS) and tibiofibular clear space (TCS) were evaluated. In a separate experiment, preserved lower limb specimens were fixed on a hydraulic loading frame before undergoing DL augmentation and syndesmotic fixation in random order. A mechanical testing device was used to apply external rotation stress (4 N·m) and eversion stress (2.5 N·m) to the two groups (DL augmentation or syndesmotic fixation). The MCS and TCS were measured and compared between the two groups.

Results: In the finite element study, the MCS widening was lesser and the TCS widening was greater in the DL augmentation group than in the syndesmotic fixation group in both the external rotation and eversion tests. Nine specimens were analyzed in the biomechanical tests. There were no significant differences between the two groups in the widening of the TCS in the rotation tests (p = 0.093, Hodges-Lehmann median difference = -0.79, 95% confident interval: -1.70~0.27) and eversion tests (p = 0.237, HLD = -0.84, 95% CI: -2.57~1.09). However, the widening of the MCS was significantly lesser in the DL augmentation group than in the syndesmotic fixation group during the rotation tests (p = 0.036, HLD = 3.57, 95% CI: 0.40~6.41) and eversion tests (p = 0.018, HLD = 4.36, 95% CI: 1.84~7.35).

Conclusions: Compared with syndesmotic fixation, DL augmentation has better resistance to medial malleolar space widening under both external rotation and eversion forces and can restore the tibiofibular space to a certain extent. These results suggest that DL augmentation alone is a potential alternative to syndesmotic fixation for Weber-type C ankle fractures from a biomechanical point of view.

Objectives: Patellar malalignment (PM) is common and a deformed valgus knee is an uncommon contributing factor. A deformed valgus knee can magnify the traction forces laterally during knee extension, consequently leading to PM. Treatment of combined disorders without correction of the deformed valgus knee is often less effective. The objective of this study was to assess the possibility of using the retrograde intramedullary nailing technique with some modifications for the treatment of both disorders.

Methods: From January 2011 to December 2020, 36 consecutive adult patients with 36 combined disorders underwent surgical treatment. The distal femur was obliquely osteotomized by creating a posterior cam on the distal bony fragment. The cam was consequently inserted into the marrow cavity of the proximal bony fragment. After the bone marrow was reamed, a dynamically locked intramedullary nail was inserted using the retrograde technique. A lateral retinacular release was performed on the patella, and the articular surfaces of the lateral patellar facet and lateral femoral condyle were drilled. The chi-square test was used to analyze categorical data and the Mann-Whitney U test was used to analyze numerical data.

Results: Thirty-two patients were followed for an average of 2.8 years (range, 1.7-5.4 years) and all osteotomized sites healed (average, 2.8 months). All 32 deformed valgus knees were corrected to the acceptable axis (from an average of valgus 10° initially to valgus 2° finally in 32 knees on the mechanical axis, p < 0.001). All PM had improved congruence angle, lateral patellofemoral angle, and patellofemoral index (p < 0.001 in all three). Both the tibiofemoral and patellofemoral joints achieved satisfactory function in all patients (p < 0.001).

Conclusion: The described technique can concomitantly treat both the tibiofemoral and patellofemoral joints. Although the technique is relatively simple, the effect is remarkable, and the success rate is high. Therefore, it may be a valuable alternative for the treatment of combined disorders.

Background: Osteonecrosis of the femoral head (ONFH) is a progressive and disabling disease that commonly affects young and middle-aged adults. Without timely treatment, it often progresses to femoral head collapse and hip dysfunction, ultimately requiring total hip arthroplasty. Although core decompression (CD) and superselective intra-arterial perfusion have been applied clinically, their long-term efficacy as monotherapy remains limited, and the clinical value of combining these approaches has not been fully clarified.

Objectives: This study aimed to evaluate the clinical efficacy of CD combined with superselective intra-arterial perfusion in the treatment of ONFH, and to identify key prognostic factors influencing therapeutic outcomes.

Methods: This study enrolled 145 patients in the CD group, 123 in the SIAE group, and 89 in the combined group. Preoperative baseline characteristics, postoperative Harris Hip Scores (HHS), Visual Analog Scale (VAS) scores, MRI-derived collapse rates, and complication rates were compared. Patients were stratified into effective and non-effective groups to analyze risk factors. Receiver operating characteristic (ROC) curves assessed predictive performance.

Results: Baseline characteristics, including sex, age, body mass index (BMI), Association Research Circulation Osseous (ARCO) staging, etiology, and lesion location, showed no intergroup differences. The combined group exhibited superior postoperative HHS improvement, VAS reduction, and collapse rate mitigation compared to monotherapy groups. Complication rates were lowest in the combined group (2.2%) versus CD (7.6%) and SIAE (12.2%) groups. The combined group had the highest efficacy rate, with non-traumatic etiology and marginal necrosis predominating in the effective group. Logistic regression identified surgical approach, BMI, etiology, and lesion location as independent predictors of efficacy. Surgical approach demonstrated the highest predictive power (area under the curve (AUC) = 0.7838, sensitivity 83.75%, specificity 60.41%), while the constant term achieved optimal performance (AUC = 0.8549).

Conclusion: CD combined with SIAE significantly enhances clinical outcomes, alleviates pain, reduces collapse rates, and minimizes complications in ONFH. Surgical approach, BMI, etiology, and lesion location critically influence efficacy. The combined strategy represents a superior intervention with promising clinical applicability.