Orthopaedic Surgery最新文献

Objective: The etiology of adjacent segment diseases and proximal junctional kyphosis has been related to biomechanical alterations after spinal operation. This study investigated the variation in pre- and postoperative range of motion in adjacent segments in patients with degenerative lumbar scoliosis (DLS) following posterior lumbar interbody fusion.

Patients and methods: Eight patients with symptomatic DLS were analyzed using a biplane radiographic imaging system while adopting different postures. Synchronized biplane radiographs from L1 to S1 and the motions of each vertebra were acquired pre- and postoperatively. Six degrees of freedom (DOF) of kinematic data were compared between different postoperative pelvic incidence-lumbar lordosis (PI-LL) groups (group A: PI-LL = -10°-~10°; group B: PI-LL = 10°-~20°).

Results: After surgery, the axial rotational movement (primary rotation) during flexion-extension, bending, and torsion in the first adjacent segment at L3-4 decreased significantly in three patients (8.14 ± 2.78 vs. 15.13 ± 6.71; 8.36 ± 5.59 vs. 9.08 ± 3.57; 5.07 ± 0.56 vs. 9.25 ± 5.06). At this level, the torsion around the crania-caudal (CC) axis during bending (1.48 ± 1.01 vs. 7.05 ± 5.84, p < 0.05) and flexion around the mediolateral (ML) axis and bending rotation around the anterioposterior (AP) axis during torsion decreased postoperatively (6.37 ± 6.01 vs. 13.83 ± 8.12, 4.53 ± 1.97 vs. 13.06 ± 6.65; p < 0.05, p < 0.05). After surgery, in the L1-2 segment, translation along the ML direction decreased during bending (3.69 ± 2.12 vs. 14.76 ± 7.99, p < 0.05). In the adjacent L5-S1 segment, primary flexed rotation around the ML axis increased in group B postoperatively during flexion-extension, but decreased in group A (6.08 ± 1.17 vs. -13.41 ± 2.99, p < 0.05). Coupled flexed rotation around the ML axis decreased and showed the opposite trend during bending (-10.76 ± 5.51 vs. 18.12 ± 39.83, p < 0.05).

Conclusions: Postoperative coupled motion at the adjacent segment decreased, which indicates an improved balance of the spinal order compared to before the surgery. However, primary motion changed according to the location of the upper instrumented vertebrae. Our results indicate that postoperative PI-LL values between 10° and 20° were associated with lower coupled motion and higher primary motion at L5-S1.

Objective: Intertrochanteric fractures (IF) in the elderly are often complicated by osteoporosis and high rates of fixation failure. Current treatment options have limitations in providing both stable fixation and early mobilization in this fragile population. This study aimed to introduce and evaluate a novel approach, the periprosthetic femoral fracture treatment concept (PFFtc), as a surgical strategy to guide hip arthroplasty in elderly IF patients.

Methods: A retrospective analysis was conducted on 209 elderly patients (mean age: 81.6 years; range: 70-93) with IF who underwent hip arthroplasty using the PFFtc protocol between March 2014 and August 2021, comprising 133 females and 76 males. All patients underwent treatment with the "PFFtc" and were subsequently followed up at intervals of 1 month, 3 months, 6 months, 1 year, 2 years, and annually thereafter. Clinical parameters such as ASA anesthesia grading, Visual Analogue Scale (VAS) scores, Harris Hip Scores (HHS), and Short-Form 36 (SF-36) outcomes were meticulously recorded. The subsidence of the femoral stem was assessed using Pelligrini's method, while mortality rates, postoperative complications, and patient's survival status post-discharge were systematically documented. Multivariate logistic regression analysis was performed to identify independent risk factors for postoperative complications.

Results: Over a mean follow-up of 38.5 ± 6.0 months, prosthesis subsidence averaged 2.2 mm and stabilized. No deaths occurred within 30 days postoperatively. The 1- and 2-year cumulative mortality rates were 4.3% and 11%, respectively. The most common complications included DVT and urinary tract infections. Logistic regression identified hypoproteinemia (OR = 2.38, p = 0.032) and heart disease (OR = 2.74, p = 0.012) as independent risk factors for postoperative complications. At final follow-up, the mean VAS was 1.1 ± 1.0, HHS was 89.4 ± 3.9, PCS was 53.2 ± 8.5, and MCS was 50.5 ± 6.7. Among surviving patients, 63.0% lived independently at home.

Conclusion: The PFFtc-guided arthroplasty approach appears to be a safe and effective option for managing IF in elderly patients. It provides stable fixation and functional recovery of prostheses and muscles and offers a promising alternative to traditional fixation strategies.

Objective: Incorporating the sagittal stable vertebra (SSV) in posterior spinal fusion (PSF) may reduce postoperative distal junctional kyphosis (DJK) in adolescent idiopathic scoliosis (AIS), but its determination varies across reference methods and may be affected by patient posture. This study aims to investigate the SSV determined by different sagittal reference lines in predicting the risk of DJK after PSF in AIS patients.

Methods: This retrospective cohort study evaluated AIS patients with Lenke Type 1 or 2 curves treated with PSF between January 2009 and July 2017. The inclusion or exclusion of SSV in PSF based on SSV determined by different reference lines was assessed for its association with the postoperative DJK. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and odds ratio were calculated.

Results: One hundred twenty-two patients (mean age at surgery: 15.1 ± 3.2 years) were included with the incidence of postoperative DJK 6.6%. PSF with the exclusion of SSV, defined by the vertebral level at which 50% of the vertebral body was anterior to the posterior sacral vertical line (PSVL), the midline between PSVL and the C7 plumb line (PSVL-C7PL Midline), and the line connecting the center point of the C7 vertebral body and the posterior superior corner of the sacrum (C7PSL), was significantly associated with the occurrence of postoperative DJK. Among the evaluated reference lines, PSVL demonstrated numerically higher sensitivity, NPV, odds ratio, and area under the curve (AUC), although these differences in AUC did not reach statistical significance.

Conclusions: Although there are concerns about whether standing posture affects the SSV determined by a specific reference line, this study demonstrates that PSVL might be an effective and convenient reference line for identifying SSV.

Objective: This study compared the intraoperative neurophysiological monitoring (IONM) data between patients with Marfan syndrome (MFS) scoliosis undergoing posterior spinal correction surgery and those with idiopathic scoliosis (IS).

Methods: Patients diagnosed with MFS who underwent posterior spinal correction surgery between January 2018 and December 2023 were reviewed. Patients with IS who underwent posterior spinal correction surgery were randomly selected as the control group. Motor-evoked potentials (MEPs) and somatosensory-evoked potentials (SEPs) were measured separately on the convex and concave sides of the main curve. We recorded IONM failure and asymmetrical SEPs waveforms. For each patient, we assessed the apical vertebral translation, Cobb angle of the main curve, curve pattern, deformity angular ratio (DAR), and global kyphosis. Independent-sample t-test and chi-square tests were conducted to compare differences between the IS and MFS groups.

Results: We included 238 girls with IS and 118 patients with MFS scoliosis (45 men and 73 women). The rates of MEPs and SEPs were 95.4% and 93.7% in girls with IS, and 92.4% and 89.8% in patients with MFS scoliosis, respectively. In the MFS group, the average N45 latency, P37 latency, and amplitude of SEPs were 49.5 ± 3.9 ms, 39.9 ± 3.5 ms, and 2.5 ± 1.4 μV on the convex side and 50.1 ± 4.0 ms, 39.9 ± 3.5 ms, and 2.4 ± 1.3 μV on the concave side, respectively. The MEP amplitude was 731.7 ± 734.3 μV on the concave side and 854.3 ± 778.2 μV on the convex side. Patients in the IS group had lower SEP-N45 and SEP-P37 latencies than the patients in the MFS group (p < 0.001). Asymmetrical SEPs were observed in 102 patients in the IS group and 52 patients in the MFS group, respectively (p = 0.879). IONM waveform failure was identified in 21 patients in the IS group and 17 patients in the MFS group, respectively (p = 0.108). IONM failure was more likely in patients with a larger C-DAR, S-DAR, T-DAR, and Cobb angle of the main curve preoperatively (p = 0.017, 0.005, 0.001, and 0.001, respectively).

Conclusions: In patients with MFS scoliosis, the success rates of MEPs and SEPs during posterior spinal fusion were 92.4% and 89.8%. Compared to MFS patients, those with IS demonstrated shorter SEP latencies, with similar MEP and SEP amplitudes. MFS patients with higher DAR values and larger Cobb angles of the main curve preoperatively were at a higher risk of IONM failure.

Osteogenesis imperfecta (OI) is a hereditary connective tissue disorder characterized by increased bone fragility and a propensity for multiple fractures, often leading to various skeletal deformities. Spinal involvement, particularly the development of scoliosis, is one of the most serious clinical manifestations of OI, significantly impacting patients' quality of life. Scoliosis in OI is characterized by early onset and rapid progression, complicating its treatment and necessitating special attention. This review article consolidates the results of contemporary molecular-genetic studies on spinal deformities in children with OI and examines the risk factors for their progression. It provides an overview of existing methods for treating scoliotic deformities in OI, including surgical and conservative approaches, and discusses prospects for the implementation of new therapeutic strategies. The aim of the review is to enhance the understanding of the pathogenesis of spinal deformities in OI and to contribute to the development of more effective methods for their diagnosis and treatment.

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.