Orthopaedics and Trauma最新文献

英文中文

Congenital spinal deformity: patient evaluation and treatment 先天性脊柱畸形：患者评价与治疗

Q4 Medicine

Orthopaedics and Trauma

Pub Date : 2025-12-01 DOI: 10.1016/j.mporth.2025.09.003

Simon B Roberts, Athanasios I Tsirikos

Congenital spinal deformities develop due to the presence of congenital anomalies that impact one or more vertebrae, leading to asymmetrical vertical growth of the spine, with the curvature worsening as skeletal development progresses. In Part 1 of this review, the aetiology, classification and associated anomalies related to the congenital spinal deformity are discussed. In Part 2 of this review, the evaluation of patients presenting with a congenital spinal deformity, necessary investigations, as well as both conservative and surgical treatment strategies are discussed. Accurate and timely identification of the specific type of congenital spinal deformity and the likelihood of progression of the curve will determine the initiation of appropriate treatment. Bracing has proven ineffective in managing congenital scoliosis other than when trying to control structural compensatory curves that develop at the levels above or below the congenital vertebral defect. Surgical interventions are designed to promote balanced spinal growth and prevent both severe deformities and neurological complications. Surgical management may include in situ fusion, growth arrest techniques, hemivertebra excision, posterior correction and instrumented spinal fusion, and growth-sparing techniques, each carrying varying risks of significant medical and neurological complications. In cases of severe deformities with risk of spinal cord compression, spinal osteotomies and vertebral column resection may be necessary.

先天性脊柱畸形是由于先天畸形影响一个或多个椎骨，导致脊柱垂直生长不对称，随着骨骼发育的进展，弯曲度恶化。在这篇综述的第一部分，讨论了先天性脊柱畸形的病因、分类和相关的异常。在这篇综述的第2部分，对先天性脊柱畸形患者的评估、必要的检查以及保守和手术治疗策略进行了讨论。准确和及时地识别特定类型的先天性脊柱畸形和曲线进展的可能性将决定适当治疗的开始。除了试图控制先天性椎体缺损上方或下方的结构代偿曲线外，支具已被证明在先天性脊柱侧凸的治疗中是无效的。手术干预旨在促进脊柱平衡生长，防止严重畸形和神经系统并发症。外科治疗包括原位融合术、生长抑制技术、半椎体切除、后路矫正和固定脊柱融合术以及生长保留技术，每种技术都有不同的重大医学和神经并发症风险。在有脊髓压迫风险的严重畸形病例中，可能需要脊柱截骨术和脊柱切除术。

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引用次数: 0

CME questions on Spinal Deformity and Other Spinal Conditions CME关于脊柱畸形和其他脊柱疾病的问题

Q4 Medicine

Orthopaedics and Trauma

Pub Date : 2025-12-01 DOI: 10.1016/j.mporth.2025.09.014

引用次数: 0

Embryological development of the spine and implications on the development of vertebral abnormalities and spinal deformities 脊柱的胚胎发育及其对椎体畸形和脊柱畸形发展的影响

Q4 Medicine

Orthopaedics and Trauma

Pub Date : 2025-12-01 DOI: 10.1016/j.mporth.2025.09.001

Chloe Thimonier, Olga Stepanova, Athanasios I Tsirikos, Guillaume Blin

The spine is a fascinating structure originating from just a few embryonic precursors appearing early during embryo implantation and developing into a complex multi-component architecture, evolutionary selected to ensure structural support, protect the spinal cord and enable bipedal mobility in humans. A broad range of developmental disorders can affect the spine leading to malformed vertebrae, neurological impairments and premature degeneration. The developmental mechanisms causing these disorders remain poorly understood, thus limiting therapeutic interventions to palliative treatments. In this short review, we cover the fundamentals of spinal embryogenesis and highlight developmental mechanisms associated with selected spinal developmental disorders observed in the clinic in the hope that the reader will gain a better grasp of the origins of complex spinal developmental abnormalities.

脊柱是一种迷人的结构，起源于胚胎着床早期出现的几个胚胎前体，并发展成一个复杂的多组分结构，进化选择以确保结构支持，保护脊髓并使人类能够两足行走。广泛的发育障碍会影响脊柱，导致脊椎畸形、神经损伤和过早变性。引起这些疾病的发育机制仍然知之甚少，因此限制了治疗干预的姑息治疗。在这篇简短的综述中，我们涵盖了脊柱胚胎发生的基本原理，并强调了与临床观察到的特定脊柱发育障碍相关的发育机制，希望读者能更好地掌握复杂脊柱发育异常的起源。

引用次数: 0

Minimally invasive foot surgery: what is it and what are the gains and pitfalls? 微创足部手术：什么是微创足部手术？它的优点和缺点是什么？

Q4 Medicine

Orthopaedics and Trauma

Pub Date : 2025-10-01 DOI: 10.1016/j.mporth.2025.08.003

Chi Fung Antony Yiu, Catherine Flood, Joël Vernois, Stephen Bendall

Minimally invasive surgery (MIS) describes surgery performed using specialized equipment through small incisions. It includes a wide range of surgery such as arthroscopy as well as percutaneous soft tissue or bony corrective surgery. MIS has been associated with a high complication rate historically from a lack of understanding the importance of appropriate equipment, intraoperative imaging and appropriate fixation. These have been addressed with better instruments, better osteotomy techniques with internal fixation which have improved the outcomes of MIS. Recent systematic reviews comparing MIS with open surgery show similar outcomes with the added benefit of lower wound complication rate and shorter hospital stays in both the trauma and elective settings. Overall evidence is still relatively poor and long-term outcome studies are still needed. The main pitfalls with MIS include a steep learning curve as well as higher metal work removal rate compare to open techniques. There are also technical pitfalls especially when performing hallux valgus surgery.

微创手术（MIS）是指使用专门的设备通过小切口进行的手术。它包括范围广泛的手术，如关节镜以及经皮软组织或骨矫正手术。由于缺乏对适当设备、术中成像和适当固定重要性的认识，MIS历来与高并发症发生率相关。这些问题已经通过更好的器械，更好的内固定截骨技术得到解决，从而改善了MIS的预后。最近的系统综述将MIS与开放手术进行了比较，结果相似，并且在创伤和择期情况下都具有更低的伤口并发症发生率和更短的住院时间。总体证据仍然相对缺乏，仍然需要长期的结果研究。与开放式技术相比，MIS的主要缺陷包括陡峭的学习曲线以及更高的金属工件去除率。也有技术上的陷阱，特别是在进行外翻手术时。

引用次数: 0

An overview of tendon physiology: the impact of injury and disease on structure, function and healing 肌腱生理学综述：损伤和疾病对结构、功能和愈合的影响

Q4 Medicine

Orthopaedics and Trauma

Pub Date : 2025-10-01 DOI: 10.1016/j.mporth.2025.08.006

Rianna Graham, Chido Donald Nwankwo

Tendons are vital structures that connect muscle to bone, enabling movement while maintaining joint stability. Their highly specialized architecture, comprising aligned type I collagen, proteoglycans, glycoproteins, elastin and a unique extracellular matrix ensures a balance between mechanical strength and flexibility. When disrupted by acute trauma, chronic overuse, or systemic diseases, tendon integrity is compromised, leading to pain, functional deficits, and a significant healthcare burden. This review synthesizes current knowledge on tendon anatomy, cellular and molecular regulation, and the multi-phase repair process following injury. It also explores contemporary diagnostic methods, management strategies, from conservative treatments and rehabilitation to advanced surgical interventions. As well as emerging biological therapies such as platelet-rich plasma (PRP), stem cell applications and gene modulation. Furthermore, this review highlights the challenges inherent in tendon regeneration, the impact of systemic conditions like diabetes, rheumatoid arthritis and chronic kidney disease (CKD) on tendon integrity. By bridging laboratory findings with clinical practice, this article offers a comprehensive resource intended to support informed decision-making and enhance patient outcomes in orthopaedic care.

肌腱是连接肌肉和骨骼的重要结构，在保持关节稳定的同时使运动成为可能。它们高度专业化的结构，包括排列整齐的I型胶原蛋白、蛋白聚糖、糖蛋白、弹性蛋白和独特的细胞外基质，确保了机械强度和柔韧性之间的平衡。当因急性创伤、慢性过度使用或全身性疾病而破坏时，肌腱完整性受损，导致疼痛、功能缺陷和严重的医疗负担。本文综述了肌腱解剖、细胞和分子调控以及损伤后多阶段修复过程的最新知识。它还探讨了当代的诊断方法，管理策略，从保守治疗和康复到先进的手术干预。以及新兴的生物疗法，如富血小板血浆（PRP）、干细胞应用和基因调节。此外，本综述强调了肌腱再生所固有的挑战，以及糖尿病、类风湿性关节炎和慢性肾脏疾病（CKD）等系统性疾病对肌腱完整性的影响。通过将实验室研究结果与临床实践相结合，本文提供了一个全面的资源，旨在支持知情决策，提高骨科护理患者的预后。

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引用次数: 0

The gait cycle and its disorders 步态周期及其紊乱

Q4 Medicine

Orthopaedics and Trauma

Pub Date : 2025-10-01 DOI: 10.1016/j.mporth.2025.08.004

Simon John Federer

Movement is an important component of daily life. In the absence of pathology, walking enables the body to move through space with energy conservation. An understanding of the gait cycle is essential in the assessment of patients with musculoskeletal or neuromuscular pathology affecting walking. This article will review the gait cycle and disorders relevant to the orthopaedic surgeon.

运动是日常生活的重要组成部分。在没有病理的情况下，行走使身体能够在空间中移动，并节约能量。步态周期的理解是必不可少的评估患者的肌肉骨骼或神经肌肉病理影响步行。这篇文章将回顾步态周期和疾病相关的骨科医生。

引用次数: 0

A review of the basic science of the diabetic foot and its complications 糖尿病足及其并发症的基础科学综述

Q4 Medicine

Orthopaedics and Trauma

Pub Date : 2025-10-01 DOI: 10.1016/j.mporth.2025.08.002

Catherine Flood, David Okata, Valliammai Muthuganesan, Chi Fung Antony Yiu, Stephen Bendall

Diabetes mellitus (DM) is a chronic metabolic disorder of impaired glucose metabolism, leading to widespread systemic complications. Among these, diabetic foot pathology contributes to severe morbidity. This review explores the underlying mechanisms of diabetic foot complications, including diabetic neuropathy, diabetic foot ulcer (DFU), infection, impaired wound healing, fracture healing, and Charcot neuroarthropathy (CNA). Diabetic neuropathy contributes to loss of protective sensation, balance impairment, ulcer formation, and an increased risk of lower limb amputations. DFUs arise from synergistic ischemia, neuropathy, and infection, often progressing to chronic wounds with poor healing capacity. Infections in diabetic feet are frequently caused by Staphylococcus aureus and other pathogens, often leading to severe complications, including osteomyelitis and amputations. Diabetes adversely affects bone health, resulting in delayed fracture healing through disrupted osteoblast activity, chronic inflammation, and oxidative stress. CNA remains a challenging condition, characterized by excessive local inflammation, bone resorption, and progressive joint destruction, leading to deformity and ulceration. Currently, management of diabetic foot complications is preventative, including glycaemic control, pressure offloading, infection management, and surgical interventions when necessary. Despite advancements in understanding pathology, there remain significant gaps in treatment strategies, necessitating further research into targeted therapies to mitigate neuropathy, enhance wound healing, and preserve limb function.

糖尿病（DM）是一种糖代谢受损的慢性代谢紊乱，可导致广泛的全身并发症。其中，糖尿病足病理导致严重的发病率。本文综述了糖尿病足并发症的潜在机制，包括糖尿病神经病变、糖尿病足溃疡（DFU）、感染、伤口愈合受损、骨折愈合和Charcot神经关节病（CNA）。糖尿病性神经病变可导致保护性感觉丧失、平衡障碍、溃疡形成和下肢截肢风险增加。DFUs由协同缺血、神经病变和感染引起，通常进展为愈合能力差的慢性伤口。糖尿病足的感染通常是由金黄色葡萄球菌和其他病原体引起的，通常会导致严重的并发症，包括骨髓炎和截肢。糖尿病对骨骼健康有不利影响，通过破坏成骨细胞活性、慢性炎症和氧化应激导致骨折愈合延迟。CNA仍然是一种具有挑战性的疾病，其特征是局部过度炎症、骨吸收和进行性关节破坏，导致畸形和溃疡。目前，糖尿病足并发症的管理是预防性的，包括血糖控制、减压、感染管理和必要时的手术干预。尽管对病理学的理解有了进步，但在治疗策略上仍有很大的差距，需要进一步研究靶向治疗来减轻神经病变，促进伤口愈合，并保持肢体功能。

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引用次数: 0

CME questions on Principles of Orthopaedics 关于骨科原理的CME问题

Q4 Medicine

Orthopaedics and Trauma

Pub Date : 2025-10-01 DOI: 10.1016/j.mporth.2025.08.008

引用次数: 0

Answers to the CME questions on The Wrist 关于the Wrist的CME问题解答

Q4 Medicine

Orthopaedics and Trauma

Pub Date : 2025-10-01 DOI: 10.1016/j.mporth.2025.08.007

引用次数: 0

Diabetes and obesity in orthopaedic patients 骨科患者的糖尿病和肥胖

Q4 Medicine

Orthopaedics and Trauma

Pub Date : 2025-10-01 DOI: 10.1016/j.mporth.2025.08.001

Danilo Vukanic, Sam Vollans

Diabetes and obesity are becoming more prevalent globally. The burden of these diseases on modern healthcare systems is projected to rise. Diabetes has multiple effects on the trauma workload, with patients being more likely to sustain injuries and exhibit a disordered physiological response. When these patients require surgical intervention, they face a higher risk of postoperative infection and mortality. Hyperglycaemia, even without pre-existing diabetes, is associated with worse trauma and surgical outcomes, including increased mortality. Authors therefore advocate for aggressive blood glucose control both preoperatively and postoperatively. There is an elevated risk of complications for patients with shoulder and elbow conditions, but not for those with wrist and hand conditions. Patients undergoing spinal, hip, knee, and especially foot and ankle procedures have a greater risk of prolonged surgical time, non-union, infection, and amputation. Medical interventions aimed at managing obesity appear to reduce the risk of complications, and certain medications are thought to influence bone healing. Bariatric surgery is advantageous, but the timing of orthopaedic surgery must be carefully planned to minimize risks. Research into the impact of diabetes and obesity in orthopaedics is expanding as the anticipated costs associated with managing diabetic patients have increased the pressure on healthcare systems.

糖尿病和肥胖症在全球变得越来越普遍。预计这些疾病给现代卫生保健系统带来的负担将会增加。糖尿病对创伤负荷有多重影响，患者更容易遭受伤害，并表现出紊乱的生理反应。当这些患者需要手术干预时，他们面临着更高的术后感染和死亡风险。高血糖，即使没有先前存在的糖尿病，也与更严重的创伤和手术结果相关，包括死亡率增加。因此，作者提倡术前和术后积极控制血糖。肩关节和肘关节有并发症的风险增加，但腕部和手部没有并发症。接受脊柱、髋关节、膝关节，特别是足部和踝关节手术的患者有更大的手术时间延长、不愈合、感染和截肢的风险。旨在控制肥胖的医疗干预似乎可以降低并发症的风险，某些药物被认为可以影响骨愈合。减肥手术是有利的，但骨科手术的时机必须仔细计划，以尽量减少风险。随着与糖尿病患者管理相关的预期成本增加了医疗保健系统的压力，对糖尿病和肥胖对骨科影响的研究正在扩大。

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