Revista Espanola de Cirugia Ortopedica y Traumatologia最新文献

Santiago Ramón y Cajal (1852-1934), a distinguished histologist and Nobel Laureate in Physiology or Medicine in 1906, is considered the father of Neuroscience. However, his legacy also extended to the study of various tissues, including hyaline cartilage, an area in which he was a pioneer. Throughout his work Elements of Normal Histology and Micrographic Technique, Cajal developed fundamental concepts that, when reviewed in light of molecular biology, resonate with current ideas about cellular communication and macromolecular interactions. In particular, his observations on hyaline cartilage, such as stellate chondrocytes, were largely overlooked in the scientific literature until today. In this paper, four hypotheses based on his discoveries are proposed: the architecture of chondrocyte columns, the role of the perichondrium in endochondral ossification, cartilage nutrition, and the role of the Golgi apparatus in the resting zone. Nearly a century later, research on hyaline cartilage continues to confirm Cajal's pioneering ideas.

The Latarjet technique is a procedure used to treat anterior glenohumeral instability with glenoid bone loss. Various fixation systems for the coracoid have been described in the literature. This study aims to compare the results in quality of life and complications between patients treated with plate and screws (GP) and those with screws only (GSP) for coracoid fixation.

Material and methods: A retrospective study including patients with anterior glenohumeral instability and glenoid bone loss treated with Latarjet at the same center between October 2009 and February 2021. A total of 85 shoulders were analyzed, of which 64 completed at least one year of follow-up. Patients with previous surgical history in the same shoulder, bone loss <10%, ligamentous hyperlaxity (Beighton score >6), and previous infections were excluded. Complications were recorded, and the WOSI and Rowe tests were used to assess quality of life and return to sports activity.

Results: Of the 64 patients, 35 were treated with a plate (GP) and 29 with screws (GSP). The mean age was 30±8.78years. Both groups were statistically comparable. No significant differences were found in the WOSI test (P=.140), the Rowe test (P=.380) or in complications (P=.692). A higher percentage of the GP group returned to sports activity (77.1% GP vs. 51.7% GSP, P=.039).

Conclusions: No statistically differences were observed in quality of life, complications, or re-dislocations. However, the use of a plate showed a greater predisposition to return to sports activity (P=.039) in patients with anterior glenohumeral instability.

Purpose: The SL-Plus cementless stem was introduced in 1993 as an evolution of the Alloclassic stem with some modifications. The aim of this study was to analyse if these modifications have any influence in clinical and radiological outcomes at minimum 10-year follow-up.

Methods: Sixty-eight consecutive implants (64 patients) were retrospective evaluated. The mean duration of clinical and radiographic follow-up was 12.2 years. There were 41 female and 23 male patients with a median age of 73.5 years. All complications and reinterventions were collected. Functional outcomes were assessed using the modified Harris Hip Score (mHHS). Radiographs were evaluated immediately after the operation, after a minimum 2-year follow-up and by the end of follow-up (time A, B and C, respectively).

Results: Two stems were revised, one due to periprosthetic fracture and one due to aseptic loosening with a cumulative probability of not having a stem revision for any reason of 97.2% at 12.2 years. Mean mHHS was 76.7 points at the latest follow-up. Significant differences were found in distal migration (time A: 5.9mm±6.7, B: 6.9mm±7.1 and C: 8.2mm±6.3; p=0.000) and varus angulation (time A: 0.0° ±2, B: 0.0° ±2 and C: 1.0° ±3; p<0.001), although these stems showed radiographic signs of osseointegration. Thirty-three hips (48.5%) showed any radiolucent line around the stem, most of them located the proximal femur (Gruen 1 and 7). Multivariate regression analysis showed lower mHHS scores in older patients (p=0.004) and female (p=0.00).

Conclusions: The modifications of the SL-Plus stem influence the long-term outcome of the implant regarding radiological results, particularly in progressive varus angulation and distal migration. However, our study has not been able to demonstrate any clinical repercussions: functional scores and survival free of all cause revision were favorable and comparable to previous reports.

Level of evidence: Therapeutic Level IV (Case Series).

Introduction: Reported prevalence for reamputation in diabetic foot is diverse, risk factors are not clear for minor amputations. This study aims to determine the prevalence for reamputation in diabetic foot from minor amputations and to evaluate associated factors for such outcome.

Methods: Cross sectional study developed in 2 hospitals. Patients hospitalized for diabetic foot ulcer requiring a minor amputation were included. A descriptive analysis of all variables is presented, as well as prevalence ratios (PR) and a multivariate logistic regression.

Results: The prevalence was of 48% for 15 years. Toes were the most frequent minor amputation that required reamputation and above the knee amputation was the most frequent reamputation level (45%). Variables whose PR was associated to reamputation risk were: smoking history (PR 1.32, CI 95%: 1.02-1.67, p=0.03), vascular occlusion in doppler (PR 1.47, CI 95%: 1.11-1.73, p=0.01), revascularization (PR 1.73, CI 95%: 1.31-2.14, p=0.00002), Wagner>3 (PR 1.75, CI 95%: 1.16-1.84, p=0.01) and leucocytosis>11,000 (PR 1.39, CI 95%: 1.07-1.68, p=0.01). Leucocytosis>11,000, Wagner>3, vascular occlusion in doppler and revascularization were the variables that best predicted the outcome. Furthermore, leucocytosis was the best variable for predicting reamputation (OR 2.4, CI 95%: 1.1-5.6, p=0.04).

Conclusions: Reamputation prevalence was 48%. The toes were the minor amputation more frequently requiring reamputation and above the knee was the most frequent reamputation level. Risk for reamputation was associated with variables related to vascular compromise and infection.

Introduction: Greater trochanteric pain syndrome (GTPS) is a multifactorial clinical condition affecting the lateral area of the hip. Although conservative treatment shows good results, some patients may still require surgical bursectomy, which can be performed either openly or endoscopically. One of the main technical difficulties of the endoscopic procedure is intraoperative bleeding, which can hinder the medical team's vision and increase the operation time for endoscopic treatment of GTPS.

Hypothesis: An instillation of vasoconstrictors and local anaesthetics before endoscopy will cause less intraoperative bleeding, which will translate into shorter surgical time.

Materials and methods: A prospective cohort was retrospectively divided based on the use or absence of a preoperative instillation of physiological saline solution with epinephrine and lidocaine. Surgical time was measured in each procedure and compared between the two groups.

Results: One hundred thirty-nine hips from 139 patients were included in the analysis. One hundred two patients were included in the instillation group versus 37 in the control group. The surgical time was significantly shorter in the instillation group than in the control group, with an average (standard deviation) of 52.01 (14.71) and 72.30 (11.70)min, respectively (p<.001).

Conclusion: The instillation of a physiological saline solution with epinephrine and lidocaine prior to the surgical treatment of GTPS is effective in reducing surgical times, likely due to a reduction in intraoperative bleeding. Future research should focus on more direct outcomes such as intraoperative blood loss and between different instillation protocols.

Introduction: There is no generalised consensus regarding perioperative prophylaxis of venous thromboembolism (VTE), either on using or timing it in patients undergoing spine surgery. VTE is a current concern because, even though being an uncommon event, it can cause serious complications. The aim of the present study is to propose guidelines for the prevention of thrombotic events in posterior spinal surgery, either as deep vein thrombosis or pulmonary thromboembolism. If the number of patients getting prophylaxis drugs is reduced a subsequent reduction of the incidence of epidural haematoma can be expected.

Materials and methods: A number of 235 patients who had undergone posterior spinal arthrodesis in the previous five years were studied. Mechanical thromboprophylaxis measures consisting of compression stockings were applied in all of them. Anticoagulant drugs were also applied whenever risk factors for thrombosis were observed. Early weight-bearing was resumed immediately after surgery. Demographic, clinical, and surgical variables were collected, as well as complications appearing during the follow-up period, that was scheduled at one, two, four, six and twelve months after the surgery. Thrombotic events, if present, were diagnosed by clinical and imaging tests such as ultrasound and CT angiography.

Results: From the total 235 patients of this series, one hundred and fifty-three cases met the study inclusion criteria. A total of four thrombotic events appeared, one in the form of deep vein thrombosis and other three in the form of pulmonary thromboembolism. These last patients suffering an embolism died because of it. None of the variables studied had statistical significance for the occurrence of a thrombotic event. All four patients who suffered thrombotic events were receiving anticoagulant drugs, in addition to mechanical compression stockings, because of the presence of risk factors for thrombosis.

Conclusions: By applying the fore mentioned protocol, adequate prevention of thromboembolic events was achieved in this study population of patients undergoing posterior spinal surgery.

Introduction: Although conservative treatment of calcific tendinopathy has a high success rate, arthroscopic excision of the calcific deposit is occasionally necessary. Controversy exists as to whether the remaining rotator cuff defect can be left in situ or should be repaired to achieve better functional outcomes. This study aimed to compare the results of debridement versus debridement combined with suturing in arthroscopic surgery for calcific tendinopathy.

Methodology: MEDLINE, EMBASE, Cochrane Library, and Web of Science were searched from inception to February 2023 for articles on arthroscopic treatment of calcific tendinopathy. Functional outcomes (VAS, ASES, UCLA, and Constant) and the number of complications were analyzed. The effect size was calculated using Cohen's d-index.

Results: Twenty-one studies were included, including a total of 1172 patients aged between 44.7 and 55 years. The mean follow-up time was 24.7 months. The combined ES estimates for the total score of the VAS, ASES, UCLA, and Constant scales were very strong (>1.0) for both debridement and combined debridement with suture. The ES estimates for the number of total complications were 1.75 (95% CI: 0.08-3.43, I² = 0%) for debridement and 9.07 (95% CI: -0.03-18.17, I² = 50.4%) for combined debridement with suture.

Conclusions: Both arthroscopic procedures improve the total score significantly on the EVA, ASES, UCLA, and Constant scales. However, a higher proportion of complications was observed in the group that performed suturing. In this regard, we must consider whether it is really necessary to repair all partial tears after the calcified deposits removal.