Orthopedic Research and Reviews最新文献

Background: Ultrasound guided hip injections have played a major role in the in-office diagnosis and treatment of a variety of traumatic and degenerative hip joint conditions. There is limited information as to the onset and duration of relief from these types of injections using a uniform medication combination.

Hypothesis/purpose: The purpose of the study is to evaluate the clinical characteristics of a population of patients undergoing ultrasound guided hip corticosteroid injections. We hypothesized that these injections have a low complication rate and a high degree of pain relief for patients.

Study design: Case Series.

Methods: We performed a retrospective study on 117 first time hip intraarticular injections performed by one operator using a single ultrasound machine and using the identical technique. In all cases, the hip joint was injected with 4 mL of 1% lidocaine and triamcinolone 40mg. The preinjection pain score was available in 98 hips with a mean of 6.4 ± 1.9 (mean ± S.D).

Results: 96% of patients had immediate improvement of pain (113/117). There were more right than left hips (67 vs 50) and more females than males (63 vs 54). The most common underlying diagnosis was osteoarthritis (53%). The relief duration was less than 3 months for most patients but longer than 6 months in 4 patients. Adverse outcomes were minimal with no infections and one allergic reaction.

Conclusion: This series represents the largest series of first time hip intraarticular injections with lidocaine and triamcinolone. This regimen has a high probability of immediate pain relief and low complications based on this series of patients.

Background: Peripheral nerve injury (PNI) is characterized by poor functional outcomes, insufficient nerve regeneration, and deterioration of sensory and motor function. Factors such as nerve tissue loss and extended denervation of proximal nerves impede regeneration. Therapeutic interventions include microsurgical techniques and nerve-guide conduits. However, nerve adhesion, which restricts nerve mobility, also contributes to inadequate healing. Surgical modifications and chemical agents are used to mitigate adhesion.

Methods: We searched across four databases, PubMed, Cochrane Database of Systematic Reviews, EMBASE, and Medline, using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. The study quality and risk of bias were assessed using the systematic review center for laboratory animal experimentation (SYRCLE)'s and Cochrane RoB-2 tools.

Results: Out of 549 studies, 5 studies met our inclusion criteria, consisting of four animal studies and one randomized controlled trial involving human participants. Different nerve adhesion materials were evaluated in the studies included. Histological evaluation of nerve regeneration generally shows more advanced regenerative hallmarks in the intervention group. Additionally, in terms of motor and sensory function, improvements were seen in the majority of parameters observed in all studies included.

Conclusion: This systematic review indicates that nerve adhesion barriers show promising outcomes in promoting nerve regeneration and functional recovery by reducing adhesion and enhancing structural alignment in peripheral nerve injuries. Applicability of such barriers in humans may still be debatable as findings are limited by the small number of included studies and predominance of animal data. Further long-term trials may warrant its' clinical efficacy.

Introduction: Whether an innervated reverse digital artery island flap is superior remains controversial. To date, no thorough investigation has been undertaken regarding the exact factors underlying this phenomenon. We aim to systematically summarize the innervated reverse digital artery island flap by leveraging our dataset and extract the key contributing factors.

Materials and methods: A total of 79 patients from June 2016 to September 2019 who underwent innervated reverse digital artery island flap were evaluated retrospectively. Thirty nine underwent sensory nerve reconstruction with similar diameter of cutaneous branches of the proper digital nerve and stump of the proper palmar digital nerve (S-innervated group), while 40 with different diameter (D-innervated group). Sensory function was assessed by static two-point discrimination and the modified sensory evaluation standard of British Medical Research Council. Motor function was assessed by the total activity measurement. Pigmentation of the flap was also evaluated by Taylor hyperpigmentation scale. Seventy who underwent non-innervated reverse digital artery island flap at the same period was considered as the control group.

Results: All 149 flaps survived completely. There was significant difference in age, operation time, time from injury to surgery, s2PD of the flap within 1 year and pigmentation between S-innervated group and Non-innervated group, while operation time and s2PD of the flap within 1 year between D-innervated group and Non-innervated group.

Conclusion: The nerve diameter matching was a critical factor in innervated reverse digital artery island flap in the early restoration of sensory function and pigmentation. A significant discrepancy in nerve diameters not only compromised the intended therapeutic outcomes but also increased the incidence of neuroma formation.

Purpose: Sacroiliac (SI) joint dysfunction accounts for 15% to 30% of reported low back pain. Primary treatments of SI joint dysfunction include medications, bracing, physical therapy, injections, and ablations. When primary non-surgical treatments are unsuccessful, fusion or stabilization may be considered. Here, we report a multicenter study aimed to evaluate real-world outcomes of posterior sacroiliac joint fusion using cortical allograft across six United States clinical sites.

Methods: Patients diagnosed with sacroiliitis through physical examination and diagnostic injection who have failed conservative management that ultimately underwent percutaneous allograft implant with at least 6 months of follow up were included. Data extracted from electronic health records included demographic and clinical characteristics, Numeric Rating Scale (NRS) pain scores, and patient-reported adverse events. Descriptive statistics were utilized to summarize baseline characteristics, and proportion of patients achieving minimally clinically important difference (MCID) was assessed. Paired t-tests were employed to compare pre-operative and post-operative outcomes.

Results: A total of 258 patients were included. Of these, 63.9% were women and 36.1% were men, with a mean age of 69.2 years and an average body mass index of 29.6 kg/m². Average NRS at baseline was 7.61 ± 1.64 and 1.60 ± 1.86 (p < 0.05) at last follow-up visit. The mean pain reduction from baseline to the last follow-up (91.2 week mean or 1.75 years) was 6.01 points, exceeding MCID. The safety profile was favorable, with no serious adverse events reported in this cohort.

Conclusion: Our findings affirm that posterior SI joint fusion constitutes an effective and enduring treatment option for patients suffering from SI joint dysfunction unresponsive to conservative care. The results indicate that posterior SI joint fusion is safe and effective at achieving sustained pain relief. Our findings are congruent with previously published studies and provide further evidence of sustained durable pain outcomes.

Introduction: Facet cysts are degenerative lesions near the facet joints, often seen in older adults with lumbar or radicular pain. They can compress nerves and cause significant morbidity. Treatment options range from conservative care to surgery. This article outlines the Biportal Endoscopic Spine Surgery (BESS) technique using interlaminar ipsilateral or contralateral approaches for symptom relief.

Methods: This paper outlines the surgical techniques of Biportal Endoscopic Spine Surgery (BESS), utilizing both ipsilateral and contralateral interlaminar approaches. The choice of approach was determined by the location and characteristics of the synovial cyst. It details the surgical process, including portal placement, visualization, trajectory differences between approaches, and steps for cyst removal.

Results: Biportal endoscopic spine surgery is a safe and effective minimally invasive treatment for symptomatic lumbar facet cysts, especially in elderly patients. The contralateral approach offers better visualization, improved dural dissection, and greater facet joint preservation, making it ideal for medial or adherent cysts. It also reduces nerve root manipulation and postoperative instability. In contrast, the ipsilateral approach is more suitable for lateral cysts.

Conclusion: The choice between contralateral and ipsilateral approaches in biportal endoscopic facet cyst removal depends on cyst location and anatomical considerations. The contralateral approach is better suited for medial or adherent cysts, offering improved access with less facet disruption. Meanwhile, the ipsilateral approach provides a direct path for lateral cysts but may require more nerve manipulation and facet joint resection. A personalized surgical strategy is essential to optimize access, ensure nerve safety, and maintain spinal stability.

Background: Adjacent segment degeneration (ASD) is a common complication after anterior cervical decompression and fusion (ACDF). The spino cranial angle (SCA), a novel sagittal parameter reflecting head-to-cervical alignment, may be associated with ASD, yet its predictive value remains unclear.

Methods: A total of 98 patients who underwent single-level ACDF with at least 24 months of follow-up were retrospectively analyzed. Radiographic evaluations were conducted preoperatively and at 3, 6, 12, and 24 months postoperatively. Patients were classified into ASD and non-ASD groups based on established radiographic criteria. Pre- and postoperative cervical sagittal parameters, including SCA, T1 slope (T1s), sagittal segmental alignment (SSA), sagittal alignment of the cervical spine (SACS), and C2-C7 sagittal vertical axis (cSVA) were measured. Clinical outcomes were assessed using the Japanese Orthopedic Association (JOA) score, Neck Disability Index (NDI), and Visual Analog Scale (VAS) scores. Multivariate logistic regression and Receiver operating characteristic (ROC) curve analysis were performed to identify independent predictors of ASD.

Results: ASD occurred in 36 patients (36.7%). Preoperative SCA was significantly larger in the ASD group compared to the non-ASD group (86.7° ± 7.4° vs 80.5° ± 6.9°, p < 0.001), while T1s and SSA were significantly smaller (p = 0.015 and p = 0.001, respectively). Multivariate analysis identified preoperative SCA as the only independent risk factor for ASD (OR = 1.279, 95% CI: 1.010-1.619, p = 0.041). Patients with SCA > 84.2° showed a significantly higher incidence of ASD (55.8% vs 21.4%, p < 0.001). ROC analysis demonstrated that SCA had good predictive value for ASD development. No significant differences were observed in JOA, NDI, or VAS scores between the two groups at final follow-up.

Conclusion: Preoperative SCA is a significant predictor of ASD, and may be considered in preoperative risk assessment.

Background: Lipid droplet autophagy (lipophagy) is the breakdown and recycling of lipids within cells via autophagy. Some research suggests that enhancing lipophagy could have potential benefits for bone health. This study aimed to determine the key genes linked to lipophagy in osteoporosis (OP) and provided a reference for the treatment of OP.

Methods: The study analyzed OP-related datasets (GSE56815, GSE62402) and lipophagy-related genes (LRGs). Candidate genes associated with lipophagocytosis were identified through differential expression (DE) analysis and weighted gene co-expression network analysis (WGCNA). The minimum absolute contraction selection operator (LASSO), support vector machine recursive feature elimination (SVM-RFE) and Boruta algorithm are used to identify candidate genes for OP-related feature genes, and the expression of key genes is analyzed. In addition, we constructed a nomogram to predict the incidence of OP patients. Subsequently, multiple bioinformatics tools were used to reveal the associations between key genes and OP. Finally, quantitative real-time polymerase chain reaction (qRT-PCR) was used to detect the expression levels of key genes.

Results: Eight signature genes were identified by machine learning. Only EIF3K and SHMT2 had consistent, significantly different expression trends between OP and control in GSE56815 and GSE62402, being up-regulated in OP. Thus, they were recognized as lipophagy-related key genes. Enrichment analysis showed that EIF3K is related to "Mitochondrial cell assembly", etc., and SHMT2 to "Arf-3 pathway", etc. Both genes negatively linked to activated dendritic cells and mast cells. In regulatory networks, hsa-let-7 family miRNAs were upstream of these genes. Clindamycin and SCHEMBL14520730 targeted them. SHMT2 and EIF3K expression trends matched bioinformatic results.

Conclusion: This study identified lipophagy-related key genes (EIF3K and SHMT2) in OP, which contributed to the early diagnosis and clinical treatment of OP.

It is reported that there are approximately 2.2 million bone graft procedures every year due to injuries, bone tumors, marginal bone defects, and aging of the population. However, the scarcity of natural donors and graft rejection make it difficult to adequately fulfill clinical demands for bone repair. While β-tricalcium phosphate (β-TCP) is a key material in bone tissue engineering, it remains insufficient for treating large bone defects. Therefore, researchers have started investigating the combination of β-TCP with other biomaterials to achieve improved clinical outcomes. Such composite scaffolds possess excellent biocompatibility and effectively provide structural support to promote cell adhesion, proliferation, and differentiation-thereby accelerating new bone tissue formation. This review examines β-tcp-based composite scaffolds for bone regeneration, analyzing design innovations and biological mechanisms, and bone repair principles-with a focus on cellular dynamics and microenvironmental regulation. The discussion valuates β-TCP's osteoconductive properties while addressing its clinical limitations in mechanical strength and degradation control. Additionally, it systematically elucidates the specific application of β-TCP-based composite scaffolds in bone repair. These include osteoinductive, osteogenic, osteoconductive and inflammatory regulation. Moreover, clinical translation progress is discussed, highlighting applications in craniomaxillofacial reconstruction and osteonecrosis management. Finally, we summarize that β-TCP composite scaffolds face challenges including poor mechanical strength, asynchronous degradation-regeneration, and manufacturing limitations. Future directions should focus on developing synchronously degradable materials and intelligent scaffolds via 4D printing and AI-optimized designs, and clinical translation systems to achieve precise bone regeneration.

Introduction: Multipotent Stromal Cells (MSCs) are utilized as therapeutic agents for addressing musculoskeletal conditions, including knee osteoarthritis (OA). However, major challenges in the clinical application include maintenance of the cells in the joint capsule. Hyaluronic acid (HA) is endogenous in synovial joints and commercially available as a joint lubricant. We tested the hypothesis that delivery of MSCs in HA into an OA rat knee model could improve outcomes.

Methods: Rat bone marrow MSCs were suspended in a commercially available HA paste, and cell viability measured with live/dead stains. Biomarkers for MSC chondrogenesis and osteogenesis were monitored with PCR. MSCs with or without HA were injected into the knees of OA rats and histology conducted 6 weeks later.

Results: Suspending MSC in HA resulted in a slight reduction in viability. The gene expression profile showed an increase in MSC biomarkers for cells in HA with a decrease in osteogenic markers. Four groups of treatment (vehicle, MSCs alone, HA alone, MSCs + HA) were injected into the knees of osteoarthritic rats. Pain scores, collected weekly, showed no difference between the groups. Immunohistochemistry for inflammatory markers illustrated no obvious differences between groups. Proteoglycans, indicative of cartilage, showed a loss in the vehicle group and modest signs of cartilage with MSCs alone, but when mixed with the HA, any benefit was lost. OARSI Histological Scoring completed by 2 independent technicians concluded no improvement in joint integrity with the addition of HA.

Conclusion: A commercially available HA failed to enhance joint regeneration compared to MSCs alone.

Spinal degenerative diseases are major contributors to chronic back pain and disability. Transforaminal lumbar interbody fusion (TLIF) is a widely used surgical approach to address these conditions by achieving vertebral fusion. The success of TLIF is significantly influenced by bone health, particularly bone mineral density (BMD), as low BMD increases risks of complications such as cage subsidence and pseudarthrosis. This systematic review evaluated factors predictive of TLIF outcomes, focusing on BMD, bone graft materials, and postoperative bone health monitoring. A comprehensive literature search was conducted according to PRISMA modalities, and ten studies met the inclusion criteria. This review emphasizes the importance of preoperative BMD assessment and tailored surgical strategies in optimizing TLIF outcomes. Future research should focus on defining BMD thresholds, developing innovative graft materials, and long-term studies to improve surgical success in TLIF procedures.