Orthopaedic Surgery最新文献

Objective: Percutaneous vertebroplasty (PVP) is a widely used minimally invasive procedure for the treatment of osteoporotic vertebral compression fracture (OVCF), yet accelerating postoperative recovery and reducing complications remain critical clinical challenges that require urgent resolution. This study aimed to evaluate the clinical effectiveness of an optimized perioperative management strategy based on the Enhanced Recovery After Surgery (ERAS) concept in patients undergoing PVP.

Methods: From May 2022 to April 2024, a total of 301 patients with OVCF who underwent PVP were retrospectively enrolled in the retrospective cohort study. Using May 2023 as the implementation time point for the optimized perioperative management strategy in our department, all subjects were divided into the traditional group (155 cases) and the optimized strategy (ERAS) group (146 cases). The two groups were analyzed for visual analog scale (VAS) scores for low back pain at various time points before and after surgery, Oswestry Disability Index (ODI) at preoperative and 3 months postoperatively, postoperative first ambulation time, total length of hospital stay (LOS), postoperative LOS, postoperative rehydration volume, and postoperative complications. Group comparisons of continuous variables were performed using independent samples t-tests or Mann-Whitney U tests, while categorical variables were compared using χ ² tests or Fisher's exact tests. p-value < 0.05 was considered statistically significant.

Results: Compared to the traditional group, patients in the ERAS group exhibited significantly lower VAS pain scores at 2 and 4 h postoperatively, earlier postoperative first ambulation time, shorter total and postoperative LOS, and reduced postoperative intravenous rehydration volume (p < 0.05). However, no statistically significant differences were observed between the two groups in preoperative VAS scores, VAS scores at 24 h postoperatively and on the day of discharge, as well as in ODI scores both preoperatively and at 3 months postoperatively (p > 0.05). Additionally, the complication rates were similar between the two groups (p > 0.05).

Conclusion: For patients with OVCF, performing PVP under the optimized perioperative management strategy facilitates early pain relief, reduces the average LOS, shortens the postoperative first ambulation time, and significantly improves perioperative clinical outcomes.

Objective: Modic changes (MC) are pathological signal alterations occurring in the vertebral endplates and adjacent bone marrow. These changes are frequently linked to degenerative disc diseases and are associated with low back pain symptoms. However, despite increasing research interest, existing studies are fragmented, mostly descriptive, and lack a comprehensive, quantitative assessment of research patterns, hotspots, and collaboration networks in this field. This study aims to evaluate the current research landscape and global trends regarding spinal MC using bibliometric analysis.

Methods: We retrieved relevant publications on spinal MC from the Web of Science Core Collection database, spanning January 2004 to August 2024. Using CiteSpace, we conducted a comprehensive analysis of keywords, co-authors, institutions, countries, research domains, cited literature, cited authors, and cited journals.

Results: This study analyzed 603 articles published in 168 journals from 193 countries. China emerged as the leading contributor in terms of publication volume, while the University of Oulu in Finland demonstrated the most significant institutional impact. J. Karppinen was identified as the most prolific author, whereas M. Modic was the most frequently cited. Among journals, Spine accounted for the highest number of publications and citations. Key research hotspots identified through keyword analysis include "degenerative disease," "bone marrow changes," "abnormalities," "type II changes," "lower back," "protrusion," "discectomy," "paraspinal muscles," "obesity," and "overweight".

Conclusion: This study represents the first known bibliometric analysis and visualization of MC, offering clinicians valuable insights into research priorities and directions. Future investigations should prioritize the classification, pathophysiological mechanisms, and clinical significance of different types of MC, especially their roles in pain and functional impairment. Research should also explore the impact of obesity and paraspinal muscles on the progression of MC. Moreover, studies should examine the potential benefits of weight loss and muscle strengthening in alleviating symptoms. Finally, researchers should focus on leveraging artificial intelligence to improve the identification and understanding of MC.

Objectives: Knee osteoarthritis (OA) is a common cause of pain and disability, and conventional conservative treatments often provide only limited and temporary relief. Platelet-rich plasma (PRP) injections have emerged as a promising biological therapy; however, patient response is highly variable, and biomechanical factors such as lower extremity malalignment may influence treatment outcomes. This study aimed to evaluate the effect of the lower extremity mechanical axis angle (MAA) on the clinical efficacy of PRP injection therapy in improving knee function and pain in patients with OA.

Methods: A total of 210 patients with knee OA who consented to PRP treatment between January 1, 2018, and January 1, 2023, were enrolled. Patients were stratified into three groups according to baseline varus angle: Group 1, 0°-5° (n = 70); Group 2, 6°-10° (n = 70); and Group 3, 11°-15° (n = 70). Clinical evaluations were performed at baseline and at 1, 3, 6, 12, and 24 months post-treatment using the Knee Injury and Osteoarthritis Outcome Score (KOOS), Kujala Patellofemoral Score, knee joint range of motion (ROM), MAA measurement, and a Visual Analogue Scale (VAS) for pain.

Results: All groups demonstrated significant improvements in pain and functional scores over the 24-month follow-up compared to baseline (p < 0.001), with the most notable gains observed at 3 and 6 months. At 3, 6, and 12 months, Group 1 achieved significantly better VAS and KOOS Pain subscale scores than Group 3 (p < 0.05). Both Groups 1 and 2 had higher KOOS Total scores than Group 3 at these time points (p < 0.05). Spearman correlation analysis revealed moderate negative associations between baseline MAA and changes from baseline to 6 months in VAS (ρ = -0.58), KOOS Total (ρ = -0.54), and Kujala scores (ρ = -0.53) (all p < 0.001). Statistical analyses were conducted using ANOVA or Kruskal-Wallis tests as appropriate, and effect sizes (Cohen's d) with 95% confidence intervals were calculated.

Conclusion: PRP injection therapy yields significant improvements in pain and functional outcomes in patients with knee OA. However, increased MAA is associated with reduced clinical benefit, indicating that baseline lower extremity alignment should be considered in treatment planning.

Purpose: Curved intertrochanteric varus osteotomy (CVO) is a joint-preserving option for young patients with osteonecrosis of the femoral head (ONFH), but postoperative leg length discrepancy (LLD) remains a concern. This study investigated factors associated with leg shortening in both the early postoperative phase (P1) and the healing phase until bone union (P2).

Methods: This retrospective study included 48 patients (51 hips) with non-traumatic ONFH who underwent CVO. Radiographic evaluations were performed preoperatively, immediately postoperatively, and at bone union. Pearson's correlation coefficient was used to correlations between radiographic parameters and leg shortening in P1 and P2. Patients were divided into groups based on whether leg shortening ≥ 5 mm was observed in each phase, and statistical comparisons were conducted. Multivariate logistic regression analyses were performed to identify independent risk factors for leg shortening ≥ 5 mm.

Results: Leg shortening ≥ 5 mm occurred in 17.6% of hips in P1 and 47.1% in P2. Lateral shift of the osteotomy arc center correlated with leg shortening in P1 (r = 0.689, p < 0.0001). Varus angle and changes in femoral anteversion were also correlated in both P1 and P2 (P1: r = 0.362/0.322; P2: r = 0.404/0.754, all p < 0.05). Greater varus angle and lateral/distal shift of the osteotomy center were significantly associated with P1 shortening. In P2, greater changes in femoral anteversion, increased osteotomy distance from the midpoint of the lesser trochanter, and larger varus angle were significant factors. Multivariate analysis identified lateral shift of the osteotomy center as an independent predictor in P1 (OR, 1.30; 95% CI, 1.06-1.81; p = 0.004). In P2, change in femoral anteversion was an independent predictor of leg shortening ≥ 5 mm (OR: 1.24, 95% CI: 1.07-1.51; p = 0.003).

Conclusion: Leg shortening post-CVO progresses during surgery and bone healing. Careful surgical planning and postoperative management, particularly in cases requiring extensive varus correction or anteversion changes, is essential for minimizing LLD and optimizing outcomes.

Objectives: Cage retropulsion (CR) is a common complication following posterior lumbar interbody fusion (PLIF). Symptomatic patients with CR often require revision surgery. However, there is a lack of literature supporting the effectiveness of conservative treatment for CR. This study compares clinical and radiographic outcomes between conservative treatment and revision surgery in patients with CR after PLIF.

Methods: A total of 55 patients with CR after PLIF treated at our institution between 2016 and 2023 were retrospectively reviewed; postoperative radiographic data of follow-up were used to diagnose CR. Clinical outcomes were assessed before therapy and at the final follow-up using the visual analog scale (VAS) for lower back pain and leg pain, Oswestry Disability Index (ODI) scores, and Japanese Orthopedic Association 29 (JOA-29) scores. The treatment effectiveness was evaluated based on whether the score change reached the minimally clinically important difference (MCID). Radiographic indicators included the fusion rates, the extent of CR into the spinal canal, and the total displacement distance. Continuous variables were compared using independent samples t-tests or Mann-Whitney U tests, while categorical variables were analyzed using Chi-square or Fisher's exact tests, as appropriate. A p-value < 0.05 was considered statistically significant.

Results: The fusion rates at the final follow-up for the conservative treatment group and the revision surgery group were 87.5% and 84.6%, respectively. There were no significant differences in final follow-up fusion rates, lower back pain VAS scores, leg pain VAS scores, JOA scores, or ODI scores between the two groups (all p > 0.05). Additionally, there was no difference in the proportion of patients whose lower back pain VAS, ODI, and JOA scores achieved MCID between groups (all p > 0.05). However, in the revision surgery group, the proportion of patients whose leg VAS scores reached MCID was significantly higher than in the conservative group (p = 0.001). In the revision surgery subgroup analysis, patients who did not achieve leg VAS MCID demonstrated significantly more severe cage retropulsion distance compared to MCID achievers (p = 0.03).

Conclusions: Conservative treatment yields satisfactory outcomes in mild, symptomatic CR patients, particularly for low back pain. For patients with a CR distance less than 8.8 mm, conservative treatment and revision surgery showed comparable outcomes, whereas when the CR distance is ≥ 8.8 mm, revision surgery was recommended to improve clinical results. Both conservative treatment and revision surgery can yield favorable outcomes when appropriately indicated.

Objective: If the appropriate internal fixation surgical method is not adopted for femoral neck fractures in young people, it may lead to serious consequences such as poor fracture healing and femoral head necrosis, affecting the quality of life and working ability of young people. Therefore, it is crucial to conduct in-depth research on the internal fixation surgical methods. This study compared the therapeutic effects of triple cannulated screws combined with a bone graft sleeve for parallel implantation of DBM Crunch internal fixation (CCSBGS) and cannulated compression screws (CCS).

Methods: Medical records on the young and middle-aged patients with femoral neck fracture treated with two different internal fixation methods from January 2020 to June 2023 were collected and retrospectively analyzed in the Trauma Emergency Center of the Third Hospital of Hebei Medical University. Two internal fixation groups are: CCSBGS group with 50 patients, 35 males and 15 females, aged (42.44 ± 14.07) years; CCS group with 80 males and 39 females, aged (41.5 ± 13.48) years. This study compared the outcome measures of two groups of patients, including Garden alignment index, Operation duration time, Intraoperative blood loss, Length of hospital stay, Postoperative complications, Femoral neck shortening, Postoperative ambulation time, Walking with sticks, Barthel score, and Harris score.

Results: There was a statistically significant difference in blood loss between the CCS group and the CCSBGS group; at the same time, the amount of bleeding in the CCS group was lower than that in the CCSBGS group (p < 0.01). During the follow-up period, there was a statistically significant difference in the incidence of osteonecrosis of the femoral head among the two groups (p < 0.05), 20 patients in the CCS group and 2 patients in the CCSBGS group developed osteonecrosis of the femoral head. At the last follow-up, the average degree of femoral neck shortening in the CCSBGS group [(0.49 ± 0.28) cm] was significantly lower than that in the CCS group [(0.87 ± 0.35) cm] (p < 0.05). Meanwhile, the postoperative ambulation time of the CCSBGS group is earlier than that of the CCS group (p < 0.05). In addition, the CCSBGS group had the highest Barthel scores [(95.50 ± 2.90)] (p < 0.05). The average Harris score in the CCSBGS group [(92.52 ± 2.41)] was higher than that in the CCS group [(90.47 ± 2.88)] (p < 0.05).

Conclusions: Compared with CCSBGS and CCS, CCSBGS shows better efficacy in terms of quicker return to weight-bearing activities, preservation of femoral neck length, reduction of the rate of osteonecrosis of the femoral head, and overall enhancement of hip function.

Background: Anteromedial cortex reduction and accurate placement of the cephalomedullary nail is the key point to confront implant failure of intertrochanteric fractures. Existing intramedullary nails cannot compensate for femoral neck-shaft offset (FNSO), potentially undermining surgical outcome. This study aimed to investigate the effect of FNSO on anteromedial cortex reduction and accurate placement of the cephalomedullary nail for intertrochanteric fractures.

Methods: This retrospective study included patients with intertrochanteric fractures treated with short intramedullary nails at our institution from January 2014 to December 2016, who were divided into acceptable and unacceptable groups according to the anteromedial cortex reduction quality. We measured the femoral neck-shaft offset (FNSO) and offset angle (FNSOA) on the uninjured femur CT. Postoperative CT of the fractured femur was used to measure the offset between the femoral neck axis and the cephalic nail axis (FNCO) and the corresponding angular offset (FNCOA). Cephalic nail insertion alignment was classified into three types (oblique-forward/rear, coincident, and oblique-backward/front) based on FNCO/FNCOA values. Group differences were analyzed, and logistic regression identified predictors of poor reduction.

Results: Fifty-seven patients (mean age 78.10 ± 13.47 years; 74% women) were included. The median FNSO and FNSOA of unaffected femurs were 4.31 (IQR 1.50) mm and 4.85° (IQR 2.01). 42.1% of cases had acceptable anteromedial reduction, while 57.9% were unacceptable. Cephalic nail insertion types were: 43.9% oblique-backward/front, 28.1% coincident, and 28.1% oblique-forward/rear. The unacceptable reduction group had significantly different FNCO (-2.32 vs. 2.14 mm) and FNCOA (-3.5° vs. 0°) compared to the acceptable group (both p < 0.001), despite similar fracture types and devices. Cephalic nail insertion type differed between groups (p < 0.001): oblique-backward/front and coincident insertions were more common in poor reductions. Logistic regression showed that oblique-backward/front insertion (OR = 51.33, 95% CI 7.60-346.85) and coincident insertion (OR = 9.00, 95% CI 1.52-53.40) were strong independent predictors of unacceptable reduction (both p < 0.001). Among insertion types, oblique-forward/rear had the lowest median FNCO (3.59 mm) and FNCOA (0.69°) and only 12.5% unacceptable reductions, versus coincident (0 mm, 0°, 56.3%) and oblique-backward/front (-3.06 mm, -5.84°, 88.0%) (p < 0.001).

Conclusions: It is difficult for existing intramedullary nails to achieve both the reduction of the anterior medial cortex and the accurate implantation of intramedullary nails due to the presence of FNSO. Optimizing intramedullary nailing design and surgical strategy according to FNSO may improve the treatment outcome of intertrochanteric fractures.

Objectives: The treatment of extensive acetabular bone defects presents significant challenges in revision total hip arthroplasty (rTHA). Custom-made implants, tailored to patient-specific anatomy via 3D printing, offer potential advantages regarding implant stability and alignment. Precise positioning of these large-volume implants is crucial for primary stability and long-term fixation, but can be surgically demanding, especially when intramedullary iliac press-fit stems are used. In contrast to triflange custom-made implants, data on the implantation accuracy of custom-made acetabular components with iliac stem fixation remain limited. This study aimed to assess the accuracy of implant positioning by comparing preoperatively planned component positions with postoperative radiographic outcomes, focusing on anteversion (AV), inclination (INCL), and the center of rotation (CoR).

Methods: In this retrospective cohort study, 24 patients with large acetabular defects (Paprosky ≥ 3A) underwent rTHA with custom-made acetabular components with intramedullary press-fit iliac stem fixation between November 2022 and April 2024. Implantation accuracy was evaluated by comparing the planned positions on preoperative CT scans with the actual implant positions observed on 6-week postoperative radiographs using a previously validated methodology. Discrepancies in AV, INCL, and the CoR were analyzed.

Results: A high degree of alignment with preoperative plans was observed. The mean postoperative AV was 9.96° ± 6.4° (planned: 10.2°), and the mean INCL was 46.3° ± 3.2° (planned: 44.6°). The deviations were minor (Δ AV: -0.25°, Δ INCL: 1.7°), confirming the precision of implant placement. Four implants had CoR deviations exceeding 5 mm cranially (mean cranial shift: 1.77 ± 3.97 mm), and five exceeded 5 mm laterally. Most deviations were within clinically acceptable ranges.

Conclusions: Our findings demonstrate that custom-made acetabular components with iliac stem fixation can be implanted with high accuracy. Moreover, our results support the use of standard radiographs for the postoperative assessment of implant positioning precision. This study provides valuable insights into the accuracy of implant placement in complex rTHA cases, highlighting the role of patient-specific implant technologies in enhancing surgical outcomes.

Objective: In spinal surgery, precise identification of high-speed bur milling states is crucial for patient safety. This study investigates whether integrating tactile and auditory perception can enhance the accuracy of milling state detection in robot-assisted cervical laminectomy.

Methods: Based on the mathematical and physical model of vibration and sound in high-speed bur milling bone, the feasibility of employing vibration and sound characteristics to identify the milling states of high-speed bur is studied systematically. Cervical laminectomy was performed on the cervical spine of the sheep. During the signal acquisition process, acceleration sensors and microphones were installed to collect vibration and sound signals, respectively. Seven milling states were set up in the experiment: (1) Milling depths of cortical bone (CTB): 0.5, 1.0, and 1.5 mm; (2) Milling depths of milling of cancellous bone (CCB): 0.5, 1.0, and 1.5 mm; (3) Boundary conditions: high-speed bur idling or complete penetration of bone (PT). The milling speed was set at 0.5 mm/s, the milling angle was 45°, and the bur diameter was 4 mm. The vibration or sound was extracted by Fast Fourier Transform (FFT) in the frequency domain of the first nine harmonics to generate the feature vector in 9 dimensions (9-D) space. These vibration and sound features were combined to form an 18-D multi-perception spatial vector for subsequent analysis, including five machine learning algorithms: Support Vector Machine (SVM), K Nearest Neighbors (KNN), Naive Bayes (NB), Linear Discriminant Analysis (LDA), and Decision Tree (DT), and deep learning models: Long Short-Term Memory networks (LSTM).

Results: Based on the 18-D features of tactile and auditory multisensory fusion, the LSTM model is trained using 6600 sets of high-speed bur milling data. In order to achieve the best performance, a layer-by-layer parameter optimization strategy was used to determine the optimal parameter configuration, and finally, a single-layer LSTM with 12 memory units was constructed. In terms of accuracy and stability, the model is significantly superior to the machine learning algorithms (SVM, KNN, NB, LDA, and DT), and the accuracy of LSTM is 99.32% in the milling states identification of cervical lamina milling with high-speed bur.

Conclusion: Through theoretical analysis and experimental verification, the study built a multi-perception fusion framework based on tactile and auditory perception and accurately identified the cervical vertebra milling states through the LSTM model, which can provide perception means for operational spinal surgery robots in the future.