中国修复重建外科杂志最新文献

Objective: To analyze the changing trends in the burden of gout disease attributable to high body mass index (BMI) and impaired kidney function in China from 1990 to 2023, and predict the burden of gout disease attributable to high BMI and impaired kidney function in China from 2024 to 2035, to provide a scientific basis for gout prevention and control.

Methods: Based on the 2023 Global Burden of Disease (GBD) study data, this study analysed the characteristics of the burden of gout attributable to high BMI and impaired kidney function by gender and age group. It employed the Joinpoint regression model to examine trends in the age-standardized disability-adjusted life years (DALYs) rate and utilized the autoregressive integrated moving average (ARIMA) model to predict the disease burden trend from 2024 to 2035.

Results: From 1990 to 2023, the age-standardized DALYs rate for gout attributable to high BMI in China increased (1990: 3.79 per 100 000, 95% UI: 2.15 per 100 000-6.24 per 100 000; 2023: 7.34 per 100 000, 95% UI: 4.22 per 100 000-11.39 per 100 000). Joinpoint analysis results showed that from 1990 to 2023, the age-standardized DALYs rate for gout attributable to high BMI in China exhibited an overall upward trend [average annual percent change (AAPC) for males=2.12%, 95% CI: 2.02%-2.22%; AAPC for females=1.92%, 95% CI: 1.79%-2.04%, both P<0.05]. For gout attributable to impaired kidney function, the age-standardized DALYs rate showed a slow overall increase in males, while the change in females was not significant (AAPC for males=0.36%, 95% CI: 0.27%-0.45%, P<0.05; AAPC for females=0.11%, 95% CI: -0.11%-0.33%). According to the ARIMA model predictions, by 2035, the age-standardized DALYs rates of gout attributable to high BMI in males and females and attributable to impaired kidney function in females were projected to stabilize at 10.85 per 100 000, 3.48 per 100 000, and 1.75 per 100 000, respectively. In contrast, the age-standardized DALYs rate of gout attributable to impaired kidney function in males was predicted to continue rising until 2035, reaching an estimated 5.98 per 100 000.

Conclusion: The disease burden of gout associated with high BMI and impaired kidney function continues to worsen in China. The age-standardized DALYs rate for gout attributable to impaired kidney function in males is projected to continue rising until 2035. Therefore, there is an urgent need to improve population-wide BMI management strategies and enhance medical support for patients with kidney diseases, with targeted interventions prioritized among specific groups such as middle-aged obese individuals and middle-aged and elderly patients with kidney diseases.

Objective: To address the lack of unified group standards, inconsistent rehabilitation service processes, and waste of rehabilitation resources in the field of traumatic spinal cord injury (TSCI) rehabilitation in China, a standardized rehabilitation specifications for TSCI was established based on the 2017 expert consensus, the latest evidence-based medical evidence, and the International Classification of Functioning, Disability and Health (ICF) framework.

Methods: Led by the China Rehabilitation Research Center and funded by the National Key Research and Development Program of China and the Capital Health Research and Development of Special Funds, this guideline was developed by experts from multiple renowned domestic institutions, drawing on international experience and combining it with clinical practice in China.

Results: Rehabilitation Guidelines and Specifications for Traumatic Spinal Cord Injury (2025 Edition) clarifies the terminology and definitions of TSCI and specifies standards for the entire process, including pre-hospital first aid, emergency management, clinical diagnosis, acute phase clinical treatment, rehabilitation assessment, and rehabilitation therapy. It details rehabilitation protocols such as physical therapy (motor therapy), occupational therapy, vocational rehabilitation, social rehabilitation, and psychological rehabilitation. Furthermore, it provides specific rehabilitation management strategies for common complications involving the respiratory system, bowel, bladder, cardiovascular system, as well as pain, spasticity, and pressure injuries.

Conclusion: This guideline is applicable to medical and health institutions at all levels involved in the diagnosis and treatment of TSCI. Early, accurate, and standardized rehabilitation treatment can effectively reduce disability rates, restore limb function, and improve patients' quality of life. The formulation of this guideline provides a significant basis for the standardized treatment and rehabilitation of TSCI patients in China.

Objective: To clarify the clinical application of the disease terms "subchondral insufficiency fracture of the knee (SIFK)" and "osteonecrosis of the knee (ONK)", and to review the research progress on this pathological condition.

Methods: The research literature in the field of SIFK and ONK both domestically and internationally in recent years was widely reviewed, and the research progress of SIFK and ONK was summarized from the aspects of the current conceptual frameworks, etiological factors and pathogenic mechanisms, clinical and imaging manifestations, therapeutic approaches, and prognostic outcomes.

Results: The exact etiology of SIFK remains controversial, and its specific pathogenesis has not been fully elucidated. Subchondral fracture has been identified as the primary pathological feature of this disease entity. SIFK predominantly affects the females over 65 years old, presenting with sudden onset of severe and persistent pain. MRI serves as the gold standard for diagnosis of early-stage SIFK. The characteristic MRI findings include bone marrow edema-like signals and a subchondral low-signal line in the affected femoral condyle. Generally, if bone morphology is preserved without subchondral bone collapse, conservative management is typically the first-line treatment approach. Surgical intervention should be considered if there is no clinical or radiographic improvement after 3 to 4 months of conservative therapy.

Conclusion: Considering the pathological features of bone specimens, adopting the SIFK for ONK demonstrates greater appropriateness in diagnosis and management of these disorders. Early diagnosis and management are important for improving the prognosis of SIFK patients.

Objective: To review the research on tibial tunnel positioning techniques in posterior cruciate ligament (PCL) reconstruction to provide references for clinical practice.

Methods: Relevant literature on tibial tunnel positioning techniques in PCL reconstruction was extensively reviewed, and summarized. Their advantages, disadvantages, and clinical outcomes were compared.

Results: The position of the tibial tunnel is crucial to the prognosis of PCL reconstruction. The commonly used tibial tunnel positioning techniques include transtibial anteromedial anatomical reconstruction, transtibial anterolateral anatomical reconstruction, Inlay technique, and modified tibial low tunnel reconstruction. Recent studies have shown that there is no significant difference in clinical function scores between anterolateral and anteromedial reconstructions, but the former is associated with greater postoperative posterior tibial translation, which may lead to poor knee joint stability in the long-term follow-up. Compared with other techniques, the Inlay technique is more invasive and is generally not the first clinical choice. In contrast to anteromedial reconstruction, modified tibial low tunnel reconstruction can reduce graft wear. But, studies have demonstrated no significant difference in clinical outcomes between the two techniques. In addition, the modified tibial low tunnel reconstruction is a non-anatomical reconstruction method. Studies have indicated that the degree of posterior tibial translation after non-anatomical reconstructions is greater than that after anatomical reconstruction. Whether the knee joint stability can be guaranteed after non-anatomical reconstruction remains unclear, so the advantages of this technique need to be further investigated.

Conclusion: Different tibial positioning techniques have their own merits and demerits. At present, there is no clear evidence that any technique has absolute advantages. Surgeons should make a choice based on their own specific conditions and the patient's specific situation.

Acute isolated meniscal injury is a common sports-related knee injury in clinical practice. In June 2024, the American Academy of Orthopaedic Surgeons (AAOS) released the latest Clinical Practice Guideline for the Management of Acute Isolated Meniscal Pathology. Based on rigorous evidence-based methodology, the guideline provides systematic recommendations regarding physical examination, imaging evaluation, and both non-operative and operative management strategies, classifying these recommendations according to the strength of evidence. This article aims to interpret the key points in the diagnosis and management of acute isolated meniscal injury, to inform clinical practice and guide future research.

Objective: To summarize the research in tissue regeneration and engineered scaffold materials for the prevention and treatment of lymphedema.

Methods: The recent domestic and international literature about lymphangiogenesis-related factors, stem cells, and tissue engineered scaffold materials for the prevention and treatment of lymphedema was extensively reviewed and summarized, and the progress of tissue engineered scaffold materials in prevention and treatment of lymphedema was emphatically introduced.

Results: Lymphangiogenesis-related factors, stem cells, and tissue engineered scaffold materials utilize two main strategies to prevent and treat lymphedema: promoting lymphatic network regeneration in vivo and constructing functional lymphatic tissues for transplantation in vitro.

Conclusion: Tissue regeneration and engineered scaffold materials provide new approaches for the prevention and treatment of lymphedema. Although innovative developments have been made, most are still at the basic research stage, and clinical translation remains a challenge.

Objective: Based on the data from the 2023 Global Burden of Disease (GBD) study, the changing trends of the disease burden of neck pain and its demographic characteristics in China from 1990 to 2023 was systematically evaluated, in order to provide evidence for the formulation of neck pain prevention and control strategies.

Methods: Data on the incidence, prevalence, years lived with disability (YLDs), and their age-standardized rates of neck pain in China were extracted from the GBD 2023 database. A descriptive analysis was conducted by stratifying data by gender and age. The Joinpoint regression model was used to analyze the temporal trends of age-standardized incidence, prevalence, and YLDs rates, and the average annual percentage change (AAPC) was calculated.

Results: From 1990 to 2023, the number of incident cases, prevalent cases, and YLDs of neck pain in China increased by 66.08%, 83.06%, and 80.49%, respectively, while the age-standardized rates showed relatively small fluctuations overall (rate of change<1.2%). The incidence, prevalence, and YLDs rates in females were higher than those in males, and the age-standardized YLDs rate in females showed a continuous upward trend (AAPC=0.067%, P<0.05). The disease burden of neck pain gradually increased with age, being most concentrated in middle-aged, elderly, and advanced-age populations. Joinpoint regression analysis revealed that the age-standardized incidence, prevalence, and YLDs rates exhibited multi-stage changes, with a common upward phase from 2005 to 2009 and a slight decline after 2021.

Conclusion: The increase in the absolute burden of neck pain in China is mainly driven by population aging. Priority should be given to focusing on female, middle-aged, and elderly populations, and early intervention should be strengthened to reduce long-term disability burden.

Objective: To summarize recent research advances of hydrogels for the treatment of osteonecrosis of the femoral head (ONFH).

Methods: The literature on hydrogels for treatment of ONFH at home and abroad in recent years was extensively reviewed, and the fundamental research and clinical application were summarized and analyzed.

Results: In the field of fundamental research, functionalized hydrogels (including thermosensitive, oxygen-controlled release, and ion-doped types) demonstrate significant advantages in achieving targeted delivery, controlled release, and microenvironment regulation. Particularly, the development of novel material systems, such as composite scaffold systems, gene-activated hydrogels, and engineered exosomes, has further enhanced treatment precision and biological efficacy. In terms of clinical application, the materials like recombinant human fibroblast growth factor 2 (rhFGF-2) gelatin hydrogels have been validated in multiple trials, showing promising joint preservation rates and bone regeneration capabilities. This opens a promising new clinical pathway for hip-preserving treatment of ONFH. Among these, hydrogel-based multilevel composite scaffolds represent the most promising materials for clinical translation.

Conclusion: Hydrogel systems, by synergistically regulating osteogenesis, angiogenesis, and immunomodulation, and leveraging the unique advantages of functionalized materials in precise drug control and microenvironment regulation, have evolved into advanced platforms for the comprehensive treatment of ONFH. Among them, rhFGF-2 gelatin hydrogels, with their remarkable clinical efficacy, offer a new strategy of significant translational value for hip-preserving therapy.

Objective: To analyze the current status and temporal trends of the disease burden of osteoarthritis (OA) in China from 1990 to 2023, stratified by anatomical sites (knee, hip, hand, and other), utilizing data from the 2023 Global Burden of Disease (GBD) study, and to explore the site-specific heterogeneity of disease burden attributed to high body mass index (BMI), providing a scientific basis for formulating precision prevention and control strategies.

Methods: Based on the GBD 2023 database, data on the incidence, prevalence, and years lived with disability (YLDs), as well as their corresponding age-standardized rates of OA in China from 1990 to 2023, were collected and stratified by gender, age, and anatomical site (knee, hip, hand, and other). A log-linear regression model was employed to calculate the estimated annual percentage change (EAPC) to analyze temporal trends. Additionally, the population attributable fraction (PAF) was used to quantify the contribution of high BMI to OA across different sites and to analyze the heterogeneity of this attribution.

Results: In 2023, the disease burden of OA in China increased. In terms of anatomical distribution, knee OA constituted the heaviest burden, with 115.0032 million prevalent cases, accounting for approximately 65.78% of the total. Attribution analysis showed that knee OA was slightly more affected by high BMI than hip OA, and the PAF increased significantly over time. In 2023, the PAFs for knee and hip OA in females (29.49% and 28.57%, respectively) were substantially higher than those in 1990 (19.10% and 18.38%). A similar upward trend was observed in males (26.65% and 25.92% in 2023). Regarding attribution differences, female PAF levels were consistently higher than those of males across all years and sites. Hand OA exhibited the fastest growth rate, with the EAPC of its age-standardized YLDs rate reaching 1.64%, far exceeding that of knee OA (0.43%). Demographically, all burden indicators were higher in females than in males. Hand OA demonstrated an intergenerational cumulative effect. The difference in YLDs rates between 2023 and 1990 widened with age, reaching 123.29 per 100 000 in the >95 years old group, highlighting the severe challenges posed by population aging.

Conclusion: From 1990 to 2023, the disease burden of OA in China continued to rise. Knee OA remains the heaviest burden category and is significantly driven by high BMI, whereas hand OA shows the fastest growth trend. Prevention and control strategies should focus on weight management for knee and hip OA, while prioritizing the prevention and care of hand OA in the elderly population.

Objective: To analyze the trends in the burden of osteoporosis-related disease in China and worldwide from 1990 to 2023, and to further estimate the attributable burden of key determinants, so as to inform the formulation of prevention and control strategies for osteoporosis.

Methods: Based on the 2023 Global Burden of Disease (GBD) study database, the data on mortality, disability adjusted life years (DALYs), years lived with disability (YLDs), and years of life lost (YLLs) attributable to low bone mineral density (LBMD) among individuals aged 40 years and older in China and globally from 1990 to 2023 were collected. Metrics focused primarily on age-standardized rates, and data were stratified by age group and gender. Joinpoint regression models were employed to estimate the annual percentage change (APC) and average annual percentage change (AAPC) to assess trends in the burden. An age-period-cohort analysis was conducted to characterize age, period, and birth cohort effects. Additionally, the Das Gupta decomposition method was applied to decompose the changes in the number of LBMD-attributable deaths in China from 1990 to 2023, quantifying the contributions of population growth, population aging, and changes in age-specific mortality rates.

Results: From 1990 to 2023, DALYs rates and YLLs rates attributable to LBMD showed an overall decreasing trend in both China and the world. DALYs rates declined from 311.54/100 000 to 268.55/100 000 in China and from 288.85/100 000 to 265.11/100 000 globally. In China, the YLDs rate increased from 170.42/100 000 to 197.91/100 000, whereas the global YLDs rate remained relatively stable. The burden of LBMD-related disease was consistently higher in women than in men. Falls were the leading cause of LBMD-attributable deaths and DALYs, followed by road injuries, while other types of injuries accounted for a relatively small proportion. Gupta decomposition showed that the number of LBMD-attributable deaths increased by 62.88% in men and 138.25% in women, primarily driven by population growth (contributing 108.33% in men and 138.98% in women) and population aging (contributing 42.26% in men and 70.59% in women), while changes in age-specific mortality rates offset the increase by 87.72% in men and 71.32% in women.

Conclusion: From 1990 to 2023, the mortality burden attributable to LBMD in China has decreased overall, but the disability burden has continued to rise, suggesting a shift in osteoporosis-related disease burden from lethality toward disability. Falls are the main attributable cause, and the burden is particularly high among older adults and women. Strengthening bone mineral density screening, fall prevention, and secondary fracture prevention and management is essential to reduce the long-term health losses associated with osteoporosis.