Orthopedic Research and Reviews最新文献

Objective: To investigate the correlation between serum levels of G protein-coupled receptor 4 (GPR4) and Biglycan (BGN) with the severity of Intervertebral Disc Degeneration (IVDD).

Methods: A total of 162 patients with IVDD treated at our hospital from August 2023 to August 2024 were included. The general information of patients was retrospectively collected. MRI was used to assess IVDD severity using the Pfirrmann grading system. Serum GPR4 and BGN levels were measured by enzyme-linked immunosorbent assay (ELISA). Multiple linear regression analysis was performed to identify risk factors for IVDD severity. Spearman's and Pearson's correlation analyses were used to evaluate the relationships between serum GPR4, BGN, and IVDD severity. Receiver operating characteristic (ROC) curve analysis was used to evaluate the diagnostic value of serum GPR4 and BGN in IVDD.

Results: Significant differences in age and the proportion of diabetic patients as well as serum GPR4 and BGN were found among different Pfirrmann grades (P<0.05). Serum GPR4 levels increased but BGN levels decreased with higher Pfirrmann grades (P<0.05). Multiple linear regression analysis showed that age and serum GPR4 and BGN levels were risk factors for IVDD severity (P<0.05). The results of the correlation analysis showed that serum GPR4 and age were positively correlated with the severity of IVDD (r=0.651, r=0.488, P<0.001), while BGN was negatively correlated with the severity of IVDD (r=-0.591, P<0.001). The results of Spearman correlation analysis showed a negative correlation between serum GPR4 and BGN (P<0.05). ROC curve analysis revealed that the AUC values for the diagnosis of IVDD using serum GPR4 alone, BGN alone, and the combination of GPR4 and BGN were 0.918, 0.811, and 0.919, respectively (P<0.05). Moreover, the combination of GPR4 and BGN demonstrated higher sensitivity and specificity compared to either marker alone.

Conclusions: Serum GPR4 and BGN levels are identified as effective diagnostic indicators for IVDD, with serum GPR4 positively correlated but BGN negatively correlated with the severity of IVDD.

Background: Congenital talipes equinovarus (CTEV), continues to rank among the most common congenital musculoskeletal deformities. The management of CTEV, particularly when it is part of a syndromic presentation or associated with conditions such as myelomeningocele (MMC), presents a significant challenge due to the deformity's tendency to be stiffer and more complex. Most children with CTEV may require surgical intervention. The current case report highlights the functional outcome of minimally invasive percutaneous surgical correction in a late-presenting, rigid, and severe foot deformity in an MMC patient, aiming to have accepted residual deformity that gave better function with less surgical complication.

Methods: A case involving an eight-year-old girl having a deformity in her left foot secondary to low lumbar level MMC was referred for management. The Pirani score total was 6, signifying a severe deformity according to received initial assessments. Upon review of treatment alternatives, minimally invasive percutaneous surgical correction was performed consisting of percutaneous plantar fascia release followed by Achilles tendon lengthening and flexor digitorum tenotomy. We followed up with the patient for one year for wound healing and functional outcomes. An early weight bearing in cast was achieved 1 week with walker frame. Removal of cast and application of custom walker orthosis for walking on the 6th week post-operation. Following up to one year, she is a walker, and residual deformity of the foot did not affect her mobilization.

Results: As of the one-year follow-up, she is self-ambulatory, thanks to her custom walking orthosis. Residual deformity did not affect her functional outcome. We recommend further follow-up, and future surgery may be necessary if her deformity worsens.

Conclusion: The functional outcome, the social and economic status of the family, and the psychological impact on the patient significantly influence the selection of the most suitable method.

Patient dissatisfaction after joint arthroplasty remains common. Synovitis is known to contribute to patient dissatisfaction in patients with osteoarthritis. Methotrexate (MTX) is commonly used to prevent joint deterioration in rheumatoid arthritis, however it is much less common in the treatment of osteoarthritic patients. This review explores the effect of MTX on surgical outcomes in the general arthroplasty patient population. While most of the papers reviewed include patients with rheumatoid arthritis, we also review papers that include patients with osteoarthritis and juvenile idiopathic arthritis. Publications were queried in PUBMED and OVID MEDLINE using the following terms: arthroplasty, joint replacement, methotrexate, DMARDs, osteoarthritis, rheumatoid arthritis, arthritis. After applying exclusion criteria, we identified 12 publications for this review. Our results showed no significant increase in revisions or long-term infections were reported in patients taking MTX. One study reported detriment to nerve function with postoperative MTX use. All other studies reported no difference in post-operative pain or function scores. One study investigating the effect of MTX on mobility in rheumatoid arthritis patients following arthroplasty showed improvement in function in patients taking MTX. Thus, based on this review, perioperative MTX use does not appear to worsen arthroplasty outcomes. This review should suffice as a building block for further investigations and trials into MTX's utility for arthroplasty patients.

Background: Orthopaedic surgeons commonly prescribe weight-bearing parameters for their patients for a variety of reasons. Weight-bearing may be limited in order to control the healing environment, but advancing a patient's weight-bearing status is preferably done as quickly as possible to maximize functional recovery. However, it is entirely unclear to what extent these prescriptions are followed in practice. The purpose of this scoping review is to identify and compare non-invasive devices used for the measurement of weight-bearing following lower extremity fractures.

Methods: Database searches of MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials (CENTRAL) were completed to identify relevant studies. Titles were screened for relevance, and abstracts were screened against the eligibility criteria. We identified studies that investigated the use of external force, pedal pressure, or activity monitoring devices used in adults after lower extremity fractures and excluded studies involving compartment pressure measurement.

Findings: Sixty-two studies met the inclusion criteria. About 39% of studies used an insole-type device, which could be worn in a shoe or integrated into a removable boot. Other device types included step count or activity monitors (52%), force plates (18%), pressure film (2%) and external pedobarography systems (27%).

Interpretation: We found that different monitors offered varying types of measurements and are suitable for a variety of applications. Therefore, selecting the ideal device depends on the metric of interest. Further high-quality prospective studies utilizing device monitoring are needed to validate the theory that early weight-bearing is beneficial and safe for patients with lower extremity fractures.

Background: The lacertus fibrosus serves as a site of entrapment for the proximal median nerve. Traditionally, surgical intervention has been the preferred method for resolution. This study demonstrates that perineural corticosteroid injection of the proximal median nerve entrapment under ultrasound guidance can improve nerve compression, strength, and pain in patients with lacertus fibrosus syndrome (LFS).

Methods: A retrospective quasi-experimental cohort study without a control group following the STROBE guidelines was conducted from July 2020 to May 2023. The patient selection was carried out considering Elisabet Hagert's diagnostic criteria. Ultrasound-guided proximal perineural corticosteroid injections were administered in the region of the lacertus fibrosus. Contingency tables were constructed to compare pre-and post-intervention data. The McNemar test was performed to evaluate the differences. Odds ratios (with 95% CI) were calculated to estimate the likelihood of improvement. A level of less than 0.05 was considered statistically significant. All analyses were performed using the R program.

Results: Twenty-four patients with LFS (61% female, median age: 36 years), were analyzed. Significant improvements were observed in muscle strength perception for the flexor carpi radialis [OR: 33.0, 95% CI: 24.95-41.0; p < 0.001], index flexor digitorum profundus [OR: 37.0, 95% CI: 29.0-45.0; p < 0.001], and flexor pollicis longus [OR: 39.0, 95% CI: 31.0-45.0; p < 0.001]. The scratch test positivity significantly decreased [OR: 4.56, 95% CI: 1.94-15.67; p < 0.001], and pain levels were notably reduced [OR: 2.33, 95% CI: 0.97-5.63; p < 0.001].

Conclusion: Perineural corticosteroid injection under ultrasound guidance proved to be a minimally invasive approach for managing LFS. The intervention significantly improves muscle strength perception and reduces nerve compression and pain. These findings underscore the potential of this technique as a viable option for patients who have exhausted other therapeutic approaches before considering surgery.

Level of evidence: III cohort, treatment study.

Purpose: Gout, a common form of arthritis, is characterised by recurrent episodes of severe inflammation owing to the accumulation of monosodium urate crystals in the joints and tissues, resulting from elevated serum uric acid levels. While the roles of gut microbiota and mitochondria in gout have been studied, their causal interactions remain unclear. The purpose of this study is to investigate the interplay between gut microbiota and mitochondrial biological function in the pathogenesis of gout.

Methods: This study utilized Mendelian randomization to explore causal links between mitochondrial biological function, gut microbiota, and gout, by leveraging data from genome-wide association studies. Bidirectional causal effects of mitochondrial biological functions on gout and serum uric acid levels were analysed; moreover, the causal effects of gut microbiota on gout and uric acid levels were evaluated through mediation analysis of the gut microbiota in the pathway linking mitochondrial biological function with gout.

Results: A causal relationship was found between mitochondrial biological function and gout mediated by gut microbiota. The NAD-dependent protein deacylase sirtuin-5 mediated 18.24% of the total effect on the adverse effects of gout by reducing creatinine degradation I. Calcium uptake protein 3 had a substantial impact on mitigating the negative effects of serum uric acid by decreasing the abundance of the order Burkholderiales and class Betaproteobacteria, which accounted for 16.52% and 15.83%, respectively, of the overall effect.

Conclusion: This analysis elucidated the complex relationships between mitochondrial biological function, gut microbiota, and gout, providing novel perspectives for gout prevention and treatment. Further investigations will enhance our understanding of the interactions between these biological processes and guide future intervention strategies.

Distal clavicle fractures, accounting for a significant portion of clavicle fractures, present a treatment challenge due to their high non-union rate and the controversy surrounding operative versus non-operative management strategies. This review synthesizes recent studies and clinical evidence to compare the effectiveness of operative and non-operative approaches for distal clavicle fractures. It discusses the anatomical and classification aspects of these fractures, the indications for surgery, and the rationale behind different treatment options. Surgical fixation, predominantly through locking plates or hook plates, generally provides high union rates and stable outcomes; however, complications such as hardware irritation, subacromial impingement, and implant removal rates are significant concerns. Recent surgical advancements, including ligament repair, distal augmentation, and arthroscopic techniques, have shown promise in improving outcomes. Conversely, conservative treatment is recommended for certain fracture types, with emerging evidence suggesting it provides comparable functional outcomes to those of surgical methods. Despite a high non-union rate, non-operative treatment can be effective in restoring functions. However, challenges such as symptomatic nonunion and osteoarthritis are noted. The choice between surgical and conservative treatments depends on multiple factors, including fracture type, patient age, activity level, and overall health status. This review highlights the need for a personalized approach in managing distal clavicle fractures, considering the evolving evidence and advancements in treatment strategies.

Purpose: The aim of this study was to explore short-term radiological findings after contiguous two-level ACDF with Zero-P VA devices.

Methods: Patients who underwent contiguous two-level anterior cervical discectomy and fusion (ACDF) from C3 to C7 with a Zero-P VA system were followed. Cervical anteroposterior and lateral X-rays and functional outcomes were assessed 3 months after surgery.

Results: Overall, 34.9% of patients had prosthesis subsidence and 74.6% screw loosening. Up to 46.8% of the patients with screw loosening also experienced prosthesis subsidence compared with 0 patients without screw loosening (p=0.0005). The screw-loosening rate was 91.7% in patients with poor positioning of the screw/cage and 70.6% in patients without poor positioning of the screw/cage, but no statistical difference was found between the groups (p=0.267). The subsidence rate was 50% in patients with poor positioning of the screw/cage and 31.4% in patients without poor positioning of the screw/cage, but no statistical difference was found between the groups (p=0.314). VAS scores of patients with prosthesis subsidence were much higher than those without (p=0.031), but this difference was not found for patients with or without screw loosening (p=0.116). The NDI scale was much higher in patients regradless of screw loosening or subsidence.

Conclusion: Screw loosening and prosthesis subsidence happen frequently after contiguous two-level ACDF with Zero-P VA. Screw loosening seems to be the only risk factor for prosthesis subsidence.

Abstract: The source of ulnar-sided wrist pain is difficult to determine because the history and physical examination findings of various illnesses frequently coincide, and are multifactorial. Pain on the ulnar side of the wrist can be identified on the basis of the tissue from which it arises. Knowledge of the anatomy of the ulnar side of the wrist is required for correct diagnosis, as in numerous diagnostic tests. Given the complex nature of disease diagnosis, various methods have been proposed. This article discusses systematic methods for obtaining a patient's medical history, physical examination, and treatment principles to assist surgeons in determining the source of common ulnar-sided wrist pain.

Level of evidence: D.

Study design: Retrospective chart review.

Objective: This study aims to investigate the application of robots in treating adult degenerative scoliosis (ADS) with circumferential minimal invasive surgery (cMIS).

Background: The cMIS is useful but faces a lot of challenges in correcting ADS. One of the most important challenges is the difficulty in screw placement. Robot-assisted technique demonstrates lots of advantages but the data about its application in treating ADS is limited in literatures.

Methods: A total of 51 cases diagnosed with ADS were retrospectively analyzed. All patients underwent cMIS technique with staged surgeries (OLIF and PPS fixation). Group A enrolled 21 patients and performed robot-assisted technique. Group B enrolled 30 patients and performed fluoroscopy guided technique. Clinical outcomes like the operation time, radiation exposure, pressure curve and post-operation VAS score were recorded. 3D-CT scan was also performed to evaluate the accuracy of the screws.

Results: The average preparation time were much higher in group A (23.4 ± 2.8 vs 3.1 ± 1.0 min, p < 0.0001). But the total operation time was similar (62.7 ± 12.5 vs 55.7 ± 20.6 min, p = 0.174). The average fluoroscopic scan number were 9.4 ± 1.7 in group A, much lower than that of group A (27.7 ±5.9, p < 0.001). No statistical difference was found with the VAS scale between the groups (p = 0.631). No matter considers only screws of grade A as perfect screws (81.5% vs 73.8%) or considers both grade A and B as acceptable screws (93.8% vs 87.7%), group A demonstrated significant higher screw accuracy (p = 0.038, p = 0.018, respectively). Also, the robots demonstrated significant less facet joint violence (p < 0.0001), larger inward tilt angle (p < 0.0001), and longer screw length (p = 0.0008).

Conclusion: The robot-assisted technique demonstrated significant advantages like higher pedicle screw accuracy, better trajectory, less radiation exposure, but similar operation time compared with fluoroscopy guided technique in treating ADS with CMIS.