Pub Date : 2025-01-01DOI: 10.1016/j.recot.2024.11.016
M. Herrera-Pérez
{"title":"[Translated article] New times, same objectives","authors":"M. Herrera-Pérez","doi":"10.1016/j.recot.2024.11.016","DOIUrl":"10.1016/j.recot.2024.11.016","url":null,"abstract":"","PeriodicalId":39664,"journal":{"name":"Revista Espanola de Cirugia Ortopedica y Traumatologia","volume":"69 1","pages":"Page T1"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142693780","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.recot.2024.11.013
R. Seijas Vazquez , F. Montaña I Pararols , A. Ferré-Aniorte , P. Laiz Boada , M. Vázquez Gómez , R. Cugat
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.
{"title":"[Translated article] Preoperative instillation of epinephrine and lidocaine can reduce surgical time in the endoscopic treatment of GTPS","authors":"R. Seijas Vazquez , F. Montaña I Pararols , A. Ferré-Aniorte , P. Laiz Boada , M. Vázquez Gómez , R. Cugat","doi":"10.1016/j.recot.2024.11.013","DOIUrl":"10.1016/j.recot.2024.11.013","url":null,"abstract":"<div><h3>Introduction</h3><div>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. <em>Hypothesis</em>: An instillation of vasoconstrictors and local anaesthetics before endoscopy will cause less intraoperative bleeding, which will translate into shorter surgical time.</div></div><div><h3>Materials and methods</h3><div>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.</div></div><div><h3>Results</h3><div>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 (<em>p</em> <!--><<!--> <!-->.001).</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":39664,"journal":{"name":"Revista Espanola de Cirugia Ortopedica y Traumatologia","volume":"69 1","pages":"Pages T77-T82"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142630268","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.recot.2024.11.004
J. Lixa, P. Vieira, P. Pereira, A. Pinho, M. Seara, A. Sousa, L. Vieira
Introduction and objectives
Periprosthetic hip fractures show increasing incidence and complexity, representing a challenge for the surgeon. We aimed to evaluate the survival of uncemented modular tapered stems in the treatment of periprosthetic Vancouver B2 and B3 type fractures and review the main complications and factors associated with decreased survival.
Materials and methods
We performed a retrospective study of patients submitted to revision arthroplasty for treatment of periprosthetic femoral stem Vancouver B2 and B3 type fractures with an uncemented modular fluted tapered stem (MRP-Titan). Demographic and radiographic parameters were analyzed. The survival rate (free of reoperation) was calculated at 2- and 5-years using the Kaplan–Meier survivorship analysis.
Results
Thirty-nine patients were included with a mean age of 73.5 years and a mean follow-up of 5 years. Arthroplasty survivorship at 2 years was 73.7% and at 5 years was 67.5% (mean 8.4 years; range 6.7–10.2). Survivorship was inferior in the patients with episodes of instability (mean 2.5 years; range 0–5.42) (p < 0.001). At least one episode of instability occurred in 26.3% of patients and 60% of these patients had a femoral head size 32 mm or lower. At least one episode of instability occurred in 71.4% of patients with a greater trochanter fracture (p = 0.008). The consolidation rate was 90.6% and the mortality rate was 23.7%. In the group of patients that died, 55.6% were submitted to at least one revision surgery (p = 0.044).
Conclusion
Survivorship of an uncemented modular stem (MRP-Titan) in revision for PHF is significantly reduced by episodes of instability.
{"title":"[Artículo traducido] Análisis retrospectivo de supervivencia del uso de vástagos modulares cónicos no cementados para la revisión en fracturas periprotésicas tipo B de Vancouver. ¿Es la inestabilidad una amenaza para la supervivencia?","authors":"J. Lixa, P. Vieira, P. Pereira, A. Pinho, M. Seara, A. Sousa, L. Vieira","doi":"10.1016/j.recot.2024.11.004","DOIUrl":"10.1016/j.recot.2024.11.004","url":null,"abstract":"<div><h3>Introduction and objectives</h3><div>Periprosthetic hip fractures show increasing incidence and complexity, representing a challenge for the surgeon. We aimed to evaluate the survival of uncemented modular tapered stems in the treatment of periprosthetic Vancouver B2 and B3 type fractures and review the main complications and factors associated with decreased survival.</div></div><div><h3>Materials and methods</h3><div>We performed a retrospective study of patients submitted to revision arthroplasty for treatment of periprosthetic femoral stem Vancouver B2 and B3 type fractures with an uncemented modular fluted tapered stem (MRP-Titan). Demographic and radiographic parameters were analyzed. The survival rate (free of reoperation) was calculated at 2- and 5-years using the Kaplan–Meier survivorship analysis.</div></div><div><h3>Results</h3><div>Thirty-nine patients were included with a mean age of 73.5 years and a mean follow-up of 5 years. Arthroplasty survivorship at 2 years was 73.7% and at 5 years was 67.5% (mean 8.4 years; range 6.7–10.2). Survivorship was inferior in the patients with episodes of instability (mean 2.5 years; range 0–5.42) (<em>p</em> <!--><<!--> <!-->0.001). At least one episode of instability occurred in 26.3% of patients and 60% of these patients had a femoral head size 32<!--> <!-->mm or lower. At least one episode of instability occurred in 71.4% of patients with a greater trochanter fracture (<em>p</em> <!-->=<!--> <!-->0.008). The consolidation rate was 90.6% and the mortality rate was 23.7%. In the group of patients that died, 55.6% were submitted to at least one revision surgery (<em>p</em> <!-->=<!--> <!-->0.044).</div></div><div><h3>Conclusion</h3><div>Survivorship of an uncemented modular stem (MRP-Titan) in revision for PHF is significantly reduced by episodes of instability.</div></div>","PeriodicalId":39664,"journal":{"name":"Revista Espanola de Cirugia Ortopedica y Traumatologia","volume":"69 1","pages":"Pages T2-T8"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142630274","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.recot.2024.05.004
F. Canillas del Rey , M. Canillas Arias
Introduction
Generative Artificial Intelligence is a technology that provides greater connectivity with people through conversational bots («chatbots»). These bots can engage in dialogue using natural language indistinguishable from humans and are a potential source of information for patients.The aim of this study is to examine the performance of these bots in solving specific issues related to orthopedic surgery and traumatology using questions from the Spanish MIR exam between 2008 and 2023.
Material and methods
Three «chatbot» models (ChatGPT, Bard and Perplexity) were analyzed by answering 114 questions from the MIR. Their accuracy was compared, the readability of their responses was evaluated, and their dependence on logical reasoning and internal and external information was examined. The type of error was also evaluated in the failures.
Results
ChatGPT obtained 72.81% correct answers, followed by Perplexity (67.54%) and Bard (60.53%).Bard provides the most readable and comprehensive responses. The responses demonstrated logical reasoning and the use of internal information from the question prompts. In 16 questions (14%), all 3 applications failed simultaneously. Errors were identified, including logical and information failures.
Conclusions
While conversational bots can be useful in resolving medical questions, caution is advised due to the possibility of errors. Currently, they should be considered as a developing tool, and human opinion should prevail over Generative Artificial Intelligence.
{"title":"Explorando el potencial de la inteligencia artificial en traumatología: respuestas conversacionales a preguntas específicas","authors":"F. Canillas del Rey , M. Canillas Arias","doi":"10.1016/j.recot.2024.05.004","DOIUrl":"10.1016/j.recot.2024.05.004","url":null,"abstract":"<div><h3>Introduction</h3><div>Generative Artificial Intelligence is a technology that provides greater connectivity with people through conversational bots («chatbots»). These bots can engage in dialogue using natural language indistinguishable from humans and are a potential source of information for patients.The aim of this study is to examine the performance of these bots in solving specific issues related to orthopedic surgery and traumatology using questions from the Spanish MIR exam between 2008 and 2023.</div></div><div><h3>Material and methods</h3><div>Three «chatbot» models (ChatGPT, Bard and Perplexity) were analyzed by answering 114 questions from the MIR. Their accuracy was compared, the readability of their responses was evaluated, and their dependence on logical reasoning and internal and external information was examined. The type of error was also evaluated in the failures.</div></div><div><h3>Results</h3><div>ChatGPT obtained 72.81% correct answers, followed by Perplexity (67.54%) and Bard (60.53%).Bard provides the most readable and comprehensive responses. The responses demonstrated logical reasoning and the use of internal information from the question prompts. In 16 questions (14%), all 3 applications failed simultaneously. Errors were identified, including logical and information failures.</div></div><div><h3>Conclusions</h3><div>While conversational bots can be useful in resolving medical questions, caution is advised due to the possibility of errors. Currently, they should be considered as a developing tool, and human opinion should prevail over Generative Artificial Intelligence.</div></div>","PeriodicalId":39664,"journal":{"name":"Revista Espanola de Cirugia Ortopedica y Traumatologia","volume":"69 1","pages":"Pages 38-46"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141088915","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.recot.2024.06.013
R. Seijas Vazquez , F. Montaña I Pararols , A. Ferré-Aniorte , P. Laiz Boada , M. Vázquez Gómez , R. Cugat
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 anesthetics 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) minutes, 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.
{"title":"La instilación preoperatoria de epinefrina y lidocaína puede reducir el tiempo quirúrgico del tratamiento endoscópico del SDTM","authors":"R. Seijas Vazquez , F. Montaña I Pararols , A. Ferré-Aniorte , P. Laiz Boada , M. Vázquez Gómez , R. Cugat","doi":"10.1016/j.recot.2024.06.013","DOIUrl":"10.1016/j.recot.2024.06.013","url":null,"abstract":"<div><h3>Introduction</h3><div>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. <em>Hypothesis</em>: An instillation of vasoconstrictors and local anesthetics before endoscopy will cause less intraoperative bleeding, which will translate into shorter surgical time.</div></div><div><h3>Materials and methods</h3><div>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.</div></div><div><h3>Results</h3><div>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) minutes, respectively (<em>P</em><.001).</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":39664,"journal":{"name":"Revista Espanola de Cirugia Ortopedica y Traumatologia","volume":"69 1","pages":"Pages 77-82"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141724665","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.recot.2023.08.015
D. González-Martín , M. Garrido-Miguel , G. de Cabo , J.M. Lomo-Garrote , M. Leyes , L.E. Hernández-Castillejo
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.
{"title":"Desbridamiento frente a reparación asociada del manguito rotador en el tratamiento artroscópico de la tendinitis calcificante del hombro: una revisión sistemática y metaanálisis","authors":"D. González-Martín , M. Garrido-Miguel , G. de Cabo , J.M. Lomo-Garrote , M. Leyes , L.E. Hernández-Castillejo","doi":"10.1016/j.recot.2023.08.015","DOIUrl":"10.1016/j.recot.2023.08.015","url":null,"abstract":"<div><h3>Introduction</h3><div>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.</div></div><div><h3>Methodology</h3><div>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.</div></div><div><h3>Results</h3><div>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, I<sup>2</sup> = 0%) for debridement and 9.07 (95% CI: –0.03-18.17, I<sup>2</sup> = 50.4%) for combined debridement with suture.</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":39664,"journal":{"name":"Revista Espanola de Cirugia Ortopedica y Traumatologia","volume":"69 1","pages":"Pages 91-103"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10603718","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.recot.2024.05.006
M. Desviat Ruiz, P. Jordà Gómez, K. Ramón López, J.M. Romero Martínez, J.J. Valls Vilalta, N. Fernández Fernández, Á. Chulvi Gimeno, L. Cuñat Navarro, J. Poyatos Campos
<div><h3>Introducción</h3><div>En la actualidad, la tromboprofilaxis en cirugía de columna es motivo de estudio ya que a pesar de ser un evento poco frecuente, puede causar complicaciones graves. El objetivo del presente estudio es proponer un protocolo de prevención de eventos trombóticos en cirugía de columna por vía posterior que reduzca la aparición de estos eventos, ya sea en forma de trombosis venosa profunda o tromboembolismo pulmonar, limitando el número de pacientes en los que se emplea profilaxis farmacológica para intentar evitar la aparición de hematoma epidural.</div></div><div><h3>Material y método</h3><div>Se estudió de manera retrospectiva a los 235 pacientes del centro a los que se les había practicado una cirugía de artrodesis de columna por vía posterior en los cinco años previos, encontrándose el protocolo en vigencia. En todos ellos se aplicaron medidas mecánicas de tromboprofilaxis, consistentes en medias de compresión y, en aquellos con factores de riesgo de trombosis, se aplicaron también medidas farmacológicas. En todos se inició la deambulación precoz tras la cirugía. Se recogieron variables demográficas, clínicas, quirúrgicas, así como las complicaciones aparecidas a lo largo del seguimiento que se realizaba al mes uno, dos, cuatro, seis y 12 tras la cirugía. Los eventos trombóticos, en caso de aparecer, se diagnosticaban mediante la clínica y pruebas de imagen, como la ecografía Doppler y el angioTAC.</div></div><div><h3>Resultados</h3><div>De los 235 pacientes, 153 cumplieron con los criterios de inclusión del estudio. Aparecieron un total de cuatro eventos trombóticos, uno en forma de trombosis venosa profunda y tres en forma de tromboembolismo pulmonar, acabando estos últimos en éxitus. Ninguna de las variables estudiadas tuvo significación estadística para la aparición de evento trombótico. Estos pacientes estaban recibiendo medidas farmacológicas adicionales a las mecánicas por presentar factores de riesgo de trombosis.</div></div><div><h3>Conclusiones</h3><div>Mediante la aplicación de dichas medidas se consigue realizar una adecuada prevención de eventos tromboembólicos en la población estudiada de pacientes intervenidos de cirugía de columna por vía posterior.</div></div><div><h3>Introduction</h3><div>There is no generalized 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 hematoma can be expected.</div></div><div><h3>Materials and methods</h3><div>A number of 235 patients who had undergone posterior spinal arthrodesi
{"title":"Prevención de eventos trombóticos en pacientes sometidos a cirugía de artrodesis lumbar por vía posterior: experiencia en nuestro centro. Estudio retrospectivo de casos","authors":"M. Desviat Ruiz, P. Jordà Gómez, K. Ramón López, J.M. Romero Martínez, J.J. Valls Vilalta, N. Fernández Fernández, Á. Chulvi Gimeno, L. Cuñat Navarro, J. Poyatos Campos","doi":"10.1016/j.recot.2024.05.006","DOIUrl":"10.1016/j.recot.2024.05.006","url":null,"abstract":"<div><h3>Introducción</h3><div>En la actualidad, la tromboprofilaxis en cirugía de columna es motivo de estudio ya que a pesar de ser un evento poco frecuente, puede causar complicaciones graves. El objetivo del presente estudio es proponer un protocolo de prevención de eventos trombóticos en cirugía de columna por vía posterior que reduzca la aparición de estos eventos, ya sea en forma de trombosis venosa profunda o tromboembolismo pulmonar, limitando el número de pacientes en los que se emplea profilaxis farmacológica para intentar evitar la aparición de hematoma epidural.</div></div><div><h3>Material y método</h3><div>Se estudió de manera retrospectiva a los 235 pacientes del centro a los que se les había practicado una cirugía de artrodesis de columna por vía posterior en los cinco años previos, encontrándose el protocolo en vigencia. En todos ellos se aplicaron medidas mecánicas de tromboprofilaxis, consistentes en medias de compresión y, en aquellos con factores de riesgo de trombosis, se aplicaron también medidas farmacológicas. En todos se inició la deambulación precoz tras la cirugía. Se recogieron variables demográficas, clínicas, quirúrgicas, así como las complicaciones aparecidas a lo largo del seguimiento que se realizaba al mes uno, dos, cuatro, seis y 12 tras la cirugía. Los eventos trombóticos, en caso de aparecer, se diagnosticaban mediante la clínica y pruebas de imagen, como la ecografía Doppler y el angioTAC.</div></div><div><h3>Resultados</h3><div>De los 235 pacientes, 153 cumplieron con los criterios de inclusión del estudio. Aparecieron un total de cuatro eventos trombóticos, uno en forma de trombosis venosa profunda y tres en forma de tromboembolismo pulmonar, acabando estos últimos en éxitus. Ninguna de las variables estudiadas tuvo significación estadística para la aparición de evento trombótico. Estos pacientes estaban recibiendo medidas farmacológicas adicionales a las mecánicas por presentar factores de riesgo de trombosis.</div></div><div><h3>Conclusiones</h3><div>Mediante la aplicación de dichas medidas se consigue realizar una adecuada prevención de eventos tromboembólicos en la población estudiada de pacientes intervenidos de cirugía de columna por vía posterior.</div></div><div><h3>Introduction</h3><div>There is no generalized 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 hematoma can be expected.</div></div><div><h3>Materials and methods</h3><div>A number of 235 patients who had undergone posterior spinal arthrodesi","PeriodicalId":39664,"journal":{"name":"Revista Espanola de Cirugia Ortopedica y Traumatologia","volume":"69 1","pages":"Pages 55-60"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141199789","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.recot.2024.11.014
T. Fernández-Fernández , L. Mediavilla-Santos , M. Cuervo-Dehesa , E. Gómez-Larrén , R. Pérez-Mañanes , J. Calvo-Haro
Background and objectives
3D-printed patient-specific instruments (PSIs), also known as 3D guides, have been shown to improve accuracy in resection of pelvic tumors in cadaver studies and achieve better surgical margins in vivo. This study evaluates the clinical impact of 3D-printed guides on medium-term local and distant disease control, as well as disease-free and overall survival in patients.
Material and methods
A cohort study included 25 patients with primary pelvic or sacral sarcomas: 10 in the 3D group and 15 in the control group, with a median follow-up of 47 months. Demographic and clinical data, including tumor histology, stage, resection technique, associated reconstruction, adjuvant therapies, and complications, were evaluated. Surgical margins (free, marginal, and contaminated) and relapse-free and overall survival curves were analyzed.
Results
The 3D group achieved a higher rate of free margins (80% vs. 66.7%, p = .345). Local recurrence (50% vs. 60%, p = .244) and distant disease relapse (20% vs. 47%, p = .132) rates were lower in the 3D group. At the end of the follow-up, the 3D group had a higher overall survival rate (60% vs. 40%, p = .327). The complication rate was similar in both groups, with a deep infection rate of 40%.
Conclusions
The use of 3D guides in resecting primary pelvic tumors not only achieves a higher rate of free margins compared to conventional techniques but also shows a trend towards higher local, distant, and overall disease-free survival. Further studies with larger sample sizes and higher levels of evidence are necessary to validate these clinical trends.
背景和目的 3D打印患者特异性器械（PSI）又称3D导板，在尸体研究中已被证明可提高盆腔肿瘤切除的准确性，并在体内获得更好的手术切缘。本研究评估了三维打印导板对患者中期局部和远处疾病控制以及无病生存和总生存的临床影响。材料和方法 一项队列研究纳入了 25 例原发性盆腔或骶骨肉瘤患者：3D 组 10 例，对照组 15 例，中位随访时间为 47 个月。研究评估了人口统计学和临床数据，包括肿瘤组织学、分期、切除技术、相关重建、辅助治疗和并发症。分析了手术切缘（游离切缘、边缘切缘和污染切缘）、无复发生存率和总生存率曲线。结果 三维组的游离边缘率更高（80% vs 66.7%，P = 0.345）。三维组的局部复发率（50% vs 60%，P=0.244）和远处疾病复发率（20% vs 47%，P=0.132）更低。在随访结束时，三维组的总生存率更高（60% 对 40%，P=0.327）。两组的并发症发生率相似，深部感染率均为 40%。结论 与传统技术相比，使用三维导板切除原发性盆腔肿瘤不仅能获得更高的游离缘率，而且还显示出更高的局部、远处和总体无病生存率趋势。要验证这些临床趋势，有必要进行样本量更大、证据级别更高的进一步研究。
{"title":"[Translated article] Can 3D-printed patient-specific instruments improve local control and overall survival in pelvic sarcoma? A clinical validation study","authors":"T. Fernández-Fernández , L. Mediavilla-Santos , M. Cuervo-Dehesa , E. Gómez-Larrén , R. Pérez-Mañanes , J. Calvo-Haro","doi":"10.1016/j.recot.2024.11.014","DOIUrl":"10.1016/j.recot.2024.11.014","url":null,"abstract":"<div><h3>Background and objectives</h3><div>3D-printed patient-specific instruments (PSIs), also known as 3D guides, have been shown to improve accuracy in resection of pelvic tumors in cadaver studies and achieve better surgical margins in vivo. This study evaluates the clinical impact of 3D-printed guides on medium-term local and distant disease control, as well as disease-free and overall survival in patients.</div></div><div><h3>Material and methods</h3><div>A cohort study included 25 patients with primary pelvic or sacral sarcomas: 10 in the 3D group and 15 in the control group, with a median follow-up of 47 months. Demographic and clinical data, including tumor histology, stage, resection technique, associated reconstruction, adjuvant therapies, and complications, were evaluated. Surgical margins (free, marginal, and contaminated) and relapse-free and overall survival curves were analyzed.</div></div><div><h3>Results</h3><div>The 3D group achieved a higher rate of free margins (80% vs. 66.7%, <em>p</em> <!-->=<!--> <!-->.345). Local recurrence (50% vs. 60%, <em>p</em> <!-->=<!--> <!-->.244) and distant disease relapse (20% vs. 47%, <em>p</em> <!-->=<!--> <!-->.132) rates were lower in the 3D group. At the end of the follow-up, the 3D group had a higher overall survival rate (60% vs. 40%, <em>p</em> <!-->=<!--> <!-->.327). The complication rate was similar in both groups, with a deep infection rate of 40%.</div></div><div><h3>Conclusions</h3><div>The use of 3D guides in resecting primary pelvic tumors not only achieves a higher rate of free margins compared to conventional techniques but also shows a trend towards higher local, distant, and overall disease-free survival. Further studies with larger sample sizes and higher levels of evidence are necessary to validate these clinical trends.</div></div>","PeriodicalId":39664,"journal":{"name":"Revista Espanola de Cirugia Ortopedica y Traumatologia","volume":"69 1","pages":"Pages T83-T90"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142630271","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.recot.2024.11.005
F. Canillas del Rey , M. Canillas Arias
Background and objective
Generative artificial intelligence is a technology that provides greater connectivity with people through conversational bots (“chatbots”). These bots can engage in dialogue using natural language indistinguishable from humans and are a potential source of information for patients. The aim of this study is to examine the performance of these bots in solving specific issues related to orthopedic surgery and traumatology using questions from the Spanish MIR exam between 2008 and 2023.
Material and methods
Three “chatbot” models (ChatGPT, Bard and Perplexity) were analyzed by answering 114 questions from the MIR. Their accuracy was compared, the readability of their responses was evaluated, and their dependence on logical reasoning and internal and external information was examined. The type of error was also evaluated in the failures.
Results
ChatGPT obtained 72.81% correct answers, followed by Perplexity (67.54%) and Bard (60.53%). Bard provides the most readable and comprehensive responses. The responses demonstrated logical reasoning and the use of internal information from the question prompts. In 16 questions (14%), all three applications failed simultaneously. Errors were identified, including logical and information failures.
Conclusions
While conversational bots can be useful in resolving medical questions, caution is advised due to the possibility of errors. Currently, they should be considered as a developing tool, and human opinion should prevail over generative artificial intelligence.
{"title":"[Translated article] Exploring the potential of artificial intelligence in traumatology: Conversational answers to specific questions","authors":"F. Canillas del Rey , M. Canillas Arias","doi":"10.1016/j.recot.2024.11.005","DOIUrl":"10.1016/j.recot.2024.11.005","url":null,"abstract":"<div><h3>Background and objective</h3><div>Generative artificial intelligence is a technology that provides greater connectivity with people through conversational bots (“chatbots”). These bots can engage in dialogue using natural language indistinguishable from humans and are a potential source of information for patients. The aim of this study is to examine the performance of these bots in solving specific issues related to orthopedic surgery and traumatology using questions from the Spanish MIR exam between 2008 and 2023.</div></div><div><h3>Material and methods</h3><div>Three “chatbot” models (ChatGPT, Bard and Perplexity) were analyzed by answering 114 questions from the MIR. Their accuracy was compared, the readability of their responses was evaluated, and their dependence on logical reasoning and internal and external information was examined. The type of error was also evaluated in the failures.</div></div><div><h3>Results</h3><div>ChatGPT obtained 72.81% correct answers, followed by Perplexity (67.54%) and Bard (60.53%). Bard provides the most readable and comprehensive responses. The responses demonstrated logical reasoning and the use of internal information from the question prompts. In 16 questions (14%), all three applications failed simultaneously. Errors were identified, including logical and information failures.</div></div><div><h3>Conclusions</h3><div>While conversational bots can be useful in resolving medical questions, caution is advised due to the possibility of errors. Currently, they should be considered as a developing tool, and human opinion should prevail over generative artificial intelligence.</div></div>","PeriodicalId":39664,"journal":{"name":"Revista Espanola de Cirugia Ortopedica y Traumatologia","volume":"69 1","pages":"Pages T38-T46"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142630272","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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