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A Review of the Biomechanical and Clinical Outcomes of Tibial-Sided Fixation for Anterior Cruciate Ligament Reconstruction. 前交叉韧带重建胫骨侧固定的生物力学和临床结果综述。
IF 2.4 Q2 SURGERY Pub Date : 2026-02-09 eCollection Date: 2026-02-01 DOI: 10.2106/JBJS.RVW.25.00186
Garrett R Jackson, Rhett Wakefield, Clayton W Nuelle, Steven F DeFroda

» Tibial fixation remains the biomechanically weaker site in ACL reconstruction due to lower bone density and directional loading forces, making fixation choice critical for graft stability.» Interference screws provide aperture fixation close to the joint line but are limited by graft slippage, tunnel widening, and progressive loss of tension over time.» Suspensory devices engage cortical bone and reduce graft damage during insertion; when supplemented with backup fixation, such as knotless suture anchors, they demonstrate greater fixation strength and reduced graft micromotion.» Internal suture augmentation offers promising biomechanical and early clinical benefits by protecting the graft during the vulnerable early healing period, especially in young athletes and revision cases, though long-term effects remain under investigation.» Fixation strategy should be individualized, balancing graft choice, bone quality, and rehabilitation demands to optimize outcomes and reduce risk of failure.

由于较低的骨密度和定向载荷力,胫骨固定仍然是ACL重建中生物力学较弱的部位,因此固定选择对移植物的稳定性至关重要。干涉螺钉提供接近关节线的孔径固定,但受移植物滑移、隧道加宽和随着时间的推移逐渐失去张力的限制。»悬吊装置接合皮质骨,减少植入时移植物损伤;当辅以后援固定时,如无结缝合锚钉,它们显示出更大的固定强度和减少移植物微动。»内缝合增强术通过在易受伤害的早期愈合期间保护移植物,提供了有希望的生物力学和早期临床益处,特别是在年轻运动员和翻修病例中,尽管长期效果仍在研究中。»固定策略应个体化,平衡移植物选择、骨质量和康复需求,以优化结果并降低失败风险。
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引用次数: 0
Impact of Social and Behavioral Determinants on Utilization and Outcomes of Total Ankle Arthroplasty: A Systematic Review. 社会和行为决定因素对全踝关节置换术的使用和结果的影响:一项系统综述。
IF 2.4 Q2 SURGERY Pub Date : 2026-02-09 eCollection Date: 2026-02-01 DOI: 10.2106/JBJS.RVW.25.00228
Alexander Tham, Megan Calton, Jared Rubin, Anaelie Mainville, Raymond Walls, Kevin A Schafer, Lew C Schon, John G Kennedy

Background: Total ankle arthroplasty (TAA) provides pain relief and motion preservation for end-stage ankle arthritis, yet outcomes and utilization vary widely. Social determinants of health (SDOHs) such as socioeconomic, demographic, and behavioral factors may contribute to these disparities, but their influence on TAA has not been systematically evaluated.

Methods: A systematic review was registered on PROSPERO (CRD420251156933) and performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines using the PROGRESS-Plus framework to identify studies examining the impact of SDOH on TAA utilization and outcomes. PubMed, Embase, and Scopus were searched through 2025. Study quality was assessed with the Risk Of Bias In Nonrandomized Studies of Interventions tool, and certainty of evidence for each domain was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation framework. Data were synthesized narratively with random-effects meta-analysis where feasible.

Results: Forty-four studies including more than 200,000 patients were analyzed. Social determinants were found to influence both access to TAA and postoperative outcomes. Men demonstrated slightly better postoperative function, whereas women reported more pain and higher rates of nonhome discharge. Older patients experienced more perioperative complications but achieved similar long-term implant survival compared with younger cohorts. Patients from minority racial and ethnic groups had higher complication rates and were less likely to receive TAA compared with arthrodesis. Lower income, public insurance, and treatment in rural or lower-volume hospitals were consistently linked with reduced access to TAA, longer hospital stays, and greater healthcare costs. Behavioral factors such as smoking and preoperative opioid use were strongly associated with wound complications, prolonged hospitalization, and poorer recovery.

Conclusion: SDOH significantly shape access to surgery, complication risk, and recovery after TAA. Recognition of these influences and targeted strategies such as preoperative optimization, equitable referral pathways, and improved access to rehabilitation may help reduce disparities and improve outcomes in ankle arthroplasty.

Level of evidence: Level III, systematic review of predominantly Level III studies.

背景:全踝关节置换术(TAA)为终末期踝关节关节炎提供疼痛缓解和运动保持,但结果和应用差异很大。健康的社会决定因素(SDOHs),如社会经济、人口和行为因素可能导致这些差异,但它们对TAA的影响尚未得到系统评估。方法:在PROSPERO (CRD420251156933)上注册了一项系统评价,并使用PROGRESS-Plus框架根据系统评价和荟萃分析指南的首选报告项目进行了系统评价,以确定SDOH对TAA利用和结果的影响的研究。PubMed, Embase和Scopus检索到2025年。使用干预措施的非随机研究的偏倚风险来评估研究质量,并使用推荐、评估、发展和评估框架的分级来评估每个领域证据的确定性。在可行的情况下,采用随机效应荟萃分析对数据进行叙述性综合。结果:共分析了44项研究,包括20多万例患者。发现社会决定因素影响TAA的获取和术后结果。男性表现出稍好的术后功能,而女性报告更多的疼痛和更高的非家庭出院率。老年患者经历了更多的围手术期并发症,但与年轻患者相比获得了相似的长期种植体生存。与关节融合术相比,少数民族患者并发症发生率较高,接受TAA的可能性较小。较低的收入、公共保险和在农村或规模较小的医院接受治疗,始终与较少获得TAA、较长的住院时间和较高的医疗费用有关。吸烟和术前使用阿片类药物等行为因素与伤口并发症、住院时间延长和恢复较差密切相关。结论:SDOH显著影响TAA术后的手术机会、并发症风险和康复。认识到这些影响和有针对性的策略,如术前优化、公平转诊途径和改善康复机会,可能有助于减少差异并改善踝关节置换术的结果。证据等级:III级,主要是III级研究的系统评价。
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引用次数: 0
Differences in Diagnosing Tarsal Tunnel Syndrome Across the Literature: A Systematic Review and a Call for Standardization. 不同文献诊断跗骨隧道综合征的差异:系统回顾和标准化的呼吁。
IF 2.4 Q2 SURGERY Pub Date : 2026-02-09 eCollection Date: 2026-02-01 DOI: 10.2106/JBJS.RVW.25.00222
Nadine Boers, Melanie Haverkamp, Anne Merijn Eligh, Manuel Castro Cabezas, J Henk Coert, Willem D Rinkel

Background: The lack of a gold standard in tarsal tunnel syndrome (TTS) diagnosis leads to diagnostic inconsistencies and variation in patient selection for treatment. Therefore, the aim of this review is to summarize the diagnostic criteria used in current studies on TTS based upon this best-evidence synthesis.

Methods: Three databases were searched to identify all studies on TTS. Studies were included when they included (1) diagnosis or treatment of TTS as the primary focus, (2) a description of the diagnosis of TTS, (3) an original data set of TTS cases, and (4) a minimum of 10 adult patients diagnosed with TTS. A best-evidence synthesis was used to summarize the results.

Results: In total, 4,213 patients were represented in 82 included studies. Among the varying diagnostic methods employed, aside from clinical symptoms, provocative testing was most often used (in 94% of studies, mandatory for diagnosis in 41% of studies) with the Tinel sign being the most prevalent (used in 89% of studies). Sensitivities of provocative tests, electrodiagnostic, and ultrasound measurements showed significant variability.

Conclusion: We provided an overview of the diagnostic tools and workups reported in the literature on TTS. Our findings show that the lack of a standardized diagnostic approach results in considerable variability in clinical practice. Alongside typical clinical symptoms, the Tinel sign is the most frequently used diagnostic test. The varying sensitivities reported in literature underscore the need for evidence-based diagnostic guidelines on TTS diagnosis.

Level of evidence: Diagnostic Level III. See Instructions for Authors for a complete description of levels of evidence.

背景:跗骨隧道综合征(TTS)诊断缺乏金标准,导致诊断不一致和患者选择治疗的变化。因此,本综述的目的是总结当前研究中基于最佳证据综合的TTS诊断标准。方法:检索三个数据库,确定所有关于TTS的研究。纳入的研究包括:(1)将TTS的诊断或治疗作为主要焦点,(2)对TTS诊断的描述,(3)TTS病例的原始数据集,以及(4)至少10名被诊断为TTS的成年患者。采用最佳证据综合来总结结果。结果:82项纳入的研究共纳入4213例患者。在所采用的各种诊断方法中,除了临床症状外,最常用的是刺激性检测(94%的研究中,41%的研究中诊断是强制性的),其中最普遍的是蒂内尔标志(89%的研究中使用)。刺激试验、电诊断和超声测量的敏感性显示出显著的可变性。结论:我们提供了文献中报道的TTS诊断工具和检查的概述。我们的研究结果表明,缺乏标准化的诊断方法导致临床实践中相当大的变异性。除了典型的临床症状外,Tinel征象是最常用的诊断测试。文献中报道的不同敏感性强调了对TTS诊断的循证诊断指南的必要性。证据等级:诊断级III。有关证据水平的完整描述,请参见作者说明。
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引用次数: 0
Shoulder-to-Elbow Humeral Malunions: Current Concepts and Review of the Literature. 肩关节-肘关节畸形连:目前的概念和文献综述。
IF 2.4 Q2 SURGERY Pub Date : 2026-02-09 eCollection Date: 2026-02-01 DOI: 10.2106/JBJS.RVW.25.00185
Jazmoné Kelly, Niaz Ahankoob, Emily Benson

» Proximal humeral malunions: Arthroscopic techniques are effective for mild malunions, osteotomy is suitable for more significant deformities, and shoulder arthroplasty is ideal for cases with severe damage or nonviable humeral heads.» Humeral shaft malunions: Rotational and angled deformities should be addressed with an osteotomy, though malunions are generally well tolerated and more likely to be cosmetic deformities.» Distal humerus malunions are complex, but corrective osteotomy or arthroplasty can improve function and pain, especially with 3-dimensional imaging enhancing surgical accuracy.

肱骨近端畸形愈合:关节镜技术对轻度畸形愈合有效,截骨术适用于更严重的畸形,肩关节置换术适用于严重损伤或无法存活的肱骨头。肱骨轴畸形连:旋转和角度畸形应该通过截骨术来解决,尽管畸形连通常是耐受良好的,更有可能是美容畸形。肱骨远端畸形愈合是复杂的,但矫正截骨或关节成形术可以改善功能和疼痛,特别是三维成像提高手术准确性。
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引用次数: 0
Understanding Sex-Based Differences in Anterior Cruciate Ligament Injury Risk and Management. 了解前交叉韧带损伤风险和处理的性别差异。
IF 2.4 Q2 SURGERY Pub Date : 2026-01-26 eCollection Date: 2026-01-01 DOI: 10.2106/JBJS.RVW.25.00174
Hanna H Sorensen, Kiera Little, Mitchell J Christiansen, Mary K Mulcahey

» Anterior cruciate ligament (ACL) tears are one of the most common severe injuries in sports medicine, with notable differences in incidence and outcomes between male and female athletes.» While anatomical, biomechanical, and hormonal sex-specific factors such as quadriceps angle, posterior tibial slope, and cyclic hormonal variation have been extensively evaluated, the influence of psychological and societal factors, including fear of reinjury, access to training, and disparities in access to care, remains less well understood.» This review aims to provide a comprehensive overview of intrinsic (anatomic, biomechanical, and hormonal) and extrinsic (psychological, social, and environmental) factors contributing to sex-based differences in ACL injury risk. In doing so, we seek to highlight both the breadth of current understanding and the relative lack of research addressing external, sex-based influences on injury incidence and recovery.» Recognizing sex-based differences in ACL injury risk, treatment, and recovery should guide the development of individualized prevention and rehabilitation strategies to optimize outcomes for all athletes.

前交叉韧带(ACL)撕裂是运动医学中最常见的严重损伤之一,在男女运动员的发病率和结局上存在显著差异。虽然解剖学、生物力学和激素性别特异性因素,如股四头肌角度、胫骨后斜度和周期激素变化已被广泛评估,但心理和社会因素的影响,包括对再损伤的恐惧、接受训练的机会和获得护理的差异,仍然知之甚少。»本综述旨在全面概述导致ACL损伤风险性别差异的内在因素(解剖学、生物力学和激素)和外在因素(心理、社会和环境)。在此过程中,我们试图强调当前理解的广度和相对缺乏的研究,解决外部的,基于性别的影响伤害发生率和恢复。认识到ACL损伤风险、治疗和恢复的性别差异,应该指导个性化预防和康复策略的发展,以优化所有运动员的结果。
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引用次数: 0
Optimizing Infection Prevention in Primary Shoulder Arthroplasty: Evidence-Based Strategies and Best Practices. 优化原发性肩关节置换术中的感染预防:循证策略和最佳实践。
IF 2.4 Q2 SURGERY Pub Date : 2026-01-26 eCollection Date: 2026-01-01 DOI: 10.2106/JBJS.RVW.25.00139
C Lucas Myerson, Brian O Molokwu, Jacquelyn J Xu, Sophia M Jacobi, Dennis A DeBernardis, Mandeep S Virk

» Based on the available evidence, there are numerous strategies that may reduce infection risk in primary shoulder arthroplasty. Preoperatively, optimization of iron deficiency anemia and smoking cessation are associated with lower rates of periprosthetic joint infection and perioperative complications. In addition, risk of infection may be mitigated by deferring shoulder arthroplasty for at least three months following a corticosteroid injection. Management of biologic and targeted immunosuppressive therapies should be coordinated with medical specialists and tailored to the specific agent's pharmacokinetics and surgical risk.» Preoperative skin preparation with agents such as benzoyl peroxide or chlorhexidine gluconate may decrease bacterial colonization. Antibiotic prophylaxis with a single preoperative dose of cefazolin administered within one hour of incision reduces infection risk, and in patients with true beta-lactam allergy, fully infused vancomycin prior to incision is an effective alternative. Intraoperatively, measures such as dilute betadine lavage, vancomycin powder, chlorhexidine wash, and antibiotic irrigation can reduce bacterial contamination. Additional intraoperative techniques including electrocautery after skin incision may further decrease bacterial burden, although higher level evidence for these latter interventions remains limited or conflicting.

根据现有的证据,有许多策略可以降低原发性肩关节置换术的感染风险。术前,优化缺铁性贫血和戒烟可降低假体周围关节感染和围手术期并发症的发生率。此外,在注射皮质类固醇后推迟至少三个月的肩关节置换术可以减轻感染的风险。生物和靶向免疫抑制治疗的管理应与医学专家协调,并根据具体药物的药代动力学和手术风险量身定制。术前皮肤准备剂如过氧化苯甲酰或葡萄糖酸氯己定可减少细菌定植。术前在切口一小时内给予单剂量头孢唑林的抗生素预防可降低感染风险,对于真正的β -内酰胺过敏的患者,切口前完全输注万古霉素是一种有效的替代方法。术中,稀倍他定灌洗、万古霉素粉剂、氯己定冲洗、抗生素冲洗等措施可减少细菌污染。其他术中技术,包括皮肤切口后的电灼,可能会进一步减少细菌负担,尽管后一种干预措施的高水平证据仍然有限或相互矛盾。
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引用次数: 0
Effects of Losartan on Musculoskeletal Tissues : Basic Science and Clinical Applications. 氯沙坦对肌肉骨骼组织的影响:基础科学和临床应用。
IF 2.4 Q2 SURGERY Pub Date : 2026-01-20 eCollection Date: 2026-01-01 DOI: 10.2106/JBJS.RVW.25.00156
Alan D Villegas Meza, Michael Nocek, Ioanna K Bolia, Alyson Speshock, Marc J Philippon, Johnny Huard

Background: Fibrosis is a prevalent impediment to musculoskeletal healing, which contributes to poor outcomes across orthopaedic procedures and remains largely underaddressed in orthopaedic care.

Purpose: To review the effects of losartan on fibrosis across musculoskeletal tissues, and to evaluate its mechanistic rationale, preclinical outcomes, delivery strategies, and translational potential in orthopaedic practice.

Content summary: Losartan inhibits transforming growth factor beta 1 signaling by antagonizing the angiotensin II type 1 receptor, thereby reducing myofibroblast activity, limiting extracellular matrix deposition, and preserving regenerative cell populations across musculoskeletal tissues. Preclinical models demonstrate histological and mechanical improvements in models of cartilage injury, joint capsule fibrosis, tendon-bone healing, and skeletal muscle regeneration. Therapeutic efficacy is strongly influenced by timing, delivery route, and the microenvironment of the injury. Biomaterial innovations such as nanofiber scaffolds and injectable angiotensin II receptor blocker (ARB) hydrogels may enhance delivery. Further studies stratifying outcomes by age and sex are warranted. Ongoing clinical trials are evaluating losartan for arthrofibrosis, skeletal muscle disorders, and comparative antifibrotic efficacy among ARBs.

Conclusion: Losartan offers a mechanistically targeted, clinically familiar antifibrotic therapy with strong potential to improve surgical and rehabilitative outcomes in orthopaedics.

背景:纤维化是肌肉骨骼愈合的普遍障碍,导致骨科手术预后不良,在骨科护理中仍未得到充分重视。目的:回顾氯沙坦对肌肉骨骼组织纤维化的影响,并评估其机制原理、临床前结果、输送策略和在骨科实践中的转化潜力。内容概述:氯沙坦通过拮抗血管紧张素II型1受体抑制转化生长因子β 1信号,从而降低肌成纤维细胞活性,限制细胞外基质沉积,并保持肌肉骨骼组织的再生细胞群。临床前模型显示软骨损伤、关节囊纤维化、肌腱-骨愈合和骨骼肌再生模型的组织学和力学改善。治疗效果受时间、递送途径和损伤微环境的强烈影响。生物材料的创新,如纳米纤维支架和可注射血管紧张素II受体阻滞剂(ARB)水凝胶可能会提高递送。根据年龄和性别对结果进行分层的进一步研究是有必要的。正在进行的临床试验正在评估氯沙坦治疗关节纤维化、骨骼肌疾病和arb的比较抗纤维化疗效。结论:氯沙坦提供了一种机械靶向、临床熟悉的抗纤维化治疗方法,具有改善骨科手术和康复效果的强大潜力。
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引用次数: 0
Human Growth Hormone as a Therapeutic Treatment Option in Orthopaedics: A Systematic Review of Dosing, Side Effects, and Clinical Outcomes. 人类生长激素作为矫形外科的治疗选择:剂量、副作用和临床结果的系统回顾。
IF 2.4 Q2 SURGERY Pub Date : 2026-01-20 eCollection Date: 2026-01-01 DOI: 10.2106/JBJS.RVW.25.00194
Ajay Shah, Nikhil Aman Patel, Rishab Udiaver, Bheeshma Ravi, Cari Whyne, David Wasserstein

Background: Administering recombinant human growth hormone (rHGH) in a medically directed fashion has emerged as an investigational therapeutic intervention in clinical research to improve orthopaedic and sports medicine-related outcomes. Literature suggests that rHGH administration may improve athletic performance and influence osteoporosis and hip fracture outcomes. The purpose of this systematic review is to examine dosage regimens, identify adverse events, and summarize published peer-reviewed data of clinical outcomes where rHGH has been used in orthopaedic surgery human clinical studies to identify potential patient population targets, gaps in knowledge, and risks of use.

Methods: Three databases (Embase, PubMed, and MEDLINE) were searched using search terms including but not limited to "human growth hormone," "muscle strength," and "bone healing." Duplicate studies were removed and were subsequently screened first by title and abstract, followed by full-text. The reference lists of included studies were also evaluated with title screen. Data were abstracted and underwent pooled analysis, including meta-analysis where possible.

Results: The initial search produced 2,047 unique studies. A total of 22 studies with moderate methodological quality were included, which comprised 1,157 total patients, with a mean age of 54.3 years and a mean daily rHGH dose of 1.49 mg/d. Administration of rHGH led to a dose-dependent increase in serum insulin-like growth factor 1 (mean increase +133.2%). Lean body mass increased in 15 of the 23 studies (mean difference of +3.63% vs. placebo). Leg extension strength increased for rHGH administration vs. placebo (mean difference +3.17%). The most common adverse events in GH patients were peripheral edema (odds ratio [OR] = 3.03), carpal tunnel symptoms (OR = 3.85), and arthralgias (OR = 2.94).

Conclusion: rHGH administration led to improvements in clinical outcomes; however, the noteworthy side effects should also be taken into consideration when designing a treatment regimen for orthopaedic-related pathologies.

Level of evidence: Therapeutic Level II, systematic review of Level I and II studies. See Instructions for Authors for a complete description of levels of evidence.

背景:在医学指导下使用重组人生长激素(rHGH)已经成为临床研究中的一种研究性治疗干预措施,以改善骨科和运动医学相关的结果。文献表明,rHGH可以改善运动表现,影响骨质疏松症和髋部骨折的结果。本系统综述的目的是检查剂量方案,确定不良事件,并总结已发表的同行评审的临床结果数据,其中rHGH已用于骨科外科人类临床研究,以确定潜在的患者人群目标,知识差距和使用风险。方法:检索三个数据库(Embase、PubMed和MEDLINE),检索词包括但不限于“人类生长激素”、“肌肉力量”和“骨愈合”。重复的研究被删除,然后首先通过标题和摘要进行筛选,然后是全文。纳入研究的参考文献列表也用标题屏幕进行评估。对数据进行抽象和汇总分析,并在可能的情况下进行meta分析。结果:最初的搜索产生了2047个独特的研究。共纳入22项方法学质量中等的研究,共纳入1157例患者,平均年龄54.3岁,平均每日rHGH剂量为1.49 mg/d。rHGH的使用导致血清胰岛素样生长因子1的剂量依赖性增加(平均增加133.2%)。23项研究中有15项的瘦体重增加(与安慰剂相比平均差异为+3.63%)。与安慰剂相比,rHGH组腿部伸展力量增加(平均差值+3.17%)。GH患者最常见的不良事件是外周水肿(优势比[OR] = 3.03)、腕管症状(OR = 3.85)和关节痛(OR = 2.94)。结论:rHGH可改善临床预后;然而,在设计骨科相关病理的治疗方案时,也应考虑到值得注意的副作用。证据水平:治疗性II级,对I级和II级研究进行系统评价。有关证据水平的完整描述,请参见作者说明。
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引用次数: 0
Medial Meniscal Ramp Lesions: Current Concepts in Diagnosis and Treatment. 内侧半月板斜坡病变:当前诊断和治疗的概念。
IF 2.4 Q2 SURGERY Pub Date : 2026-01-13 eCollection Date: 2026-01-01 DOI: 10.2106/JBJS.RVW.25.00220
Abdulhamit Misir, Ali Yuce

» Ramp lesions occur in up to 40% of anterior cruciate ligament (ACL) injuries and are easily missed without systematic posteromedial inspection.» Magnetic resonance imaging has 70% sensitivity; arthroscopic probing using the posteromedial portal remains the diagnostic gold standard.» Unstable ramp lesions require repair; stable lesions may heal spontaneously with ACL reconstruction.» Repair restores knee stability and yields excellent outcomes comparable with isolated ACL reconstruction.» Return-to-sport rates exceed 80%, with rehabilitation mirroring standard ACL reconstruction protocols.

斜坡病变发生在高达40%的前交叉韧带(ACL)损伤中,如果没有系统的后内侧检查,很容易被遗漏。»磁共振成像灵敏度70%;使用后内侧门静脉的关节镜探查仍然是诊断的金标准。不稳定斜坡病变需要修复;稳定的病变可以通过前交叉韧带重建自行愈合。修复可恢复膝关节稳定性,并产生与孤立前交叉韧带重建相当的优异结果。恢复率超过80%,康复与标准ACL重建方案一致。
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引用次数: 0
Fixation vs. Revision of Vancouver B2 Periprosthetic Fractures Around Polished Tapered Cemented Femoral Stems: A Meta-Analysis of Outcomes. 磨光锥形骨水泥股骨柄周围的Vancouver B2假体周围骨折的固定与翻修:结果的荟萃分析
IF 2.4 Q2 SURGERY Pub Date : 2025-12-26 eCollection Date: 2025-12-01 DOI: 10.2106/JBJS.RVW.25.00215
Zain Choudhary, Sachin Singal, Amr Selim, Abdelrahman Ibrahim, Ronald Hang Kin Nam, Abdul-Basit Rafi, Siddharth Govilkar, Geraint Thomas

Background: The management of periprosthetic femoral fractures (PFFs) around polished taper-slip (PTS) cemented femoral stems in total hip arthroplasty has seen a recent shift in practice from revision to open reduction and internal fixation (ORIF). While ORIF is the accepted standard for stable uncemented stems, evidence guiding optimal management of PFF around cemented stems remains inconclusive. This metanalysis aimed to compare the outcomes of ORIF vs. revision in patients with Vancouver B2 PFFs around cemented PTS femoral stems.

Methods: We systematically searched MEDLINE, Embase, CENTRAL, Scopus, and ClinicalTrials.gov from inception to May 2025, for studies comparing ORIF with revision arthroplasty in adults with Vancouver type B2 PFFs around cemented PTS stem. None of the included studies were randomized control trials (RCTs). The outcomes were 5-year implant survival, 2-year reoperation rate, 1-year mortality, infection, aseptic loosening, nonunion, and operative time.

Results: Eight studies involving 675 patients (318 ORIF, 357 revision) met eligibility criteria. The mean age was 82.2 years, and the mean follow-up was 2.8 years. Two-year reoperation was significantly lower with ORIF (odds ratio [OR] 0.28, 95% confidence interval [CI] 0.14-0.53, p < 0.001). Operative time was significantly shorter in the ORIF group (mean difference -42.28 minutes, 95% CI -71.27 to -13.29; p < 0.001). No significant differences were observed in 5-year implant survival (OR 0.64, 95% CI 0.26-1.60) or 1-year mortality (OR 2.05, 95% CI 0.71-5.89). Postoperative infection, aseptic loosening, and nonunion rates were also similar. Risk of bias was moderate overall.

Conclusion: For patients with Vancouver B2 PFFs around cemented PTS femoral stems, ORIF was associated with a significantly lower 2-year reoperation rate and shorter operative time compared with revision, while other outcomes were similar. These findings indicate comparable overall performance between ORIF and revision; however, given the heterogeneity and potential selection bias, uncertainty remains high, supporting the need for an RCT to evaluate both options.

Level of evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

背景:在全髋关节置换术中,围绕磨光锥形滑移(PTS)骨水泥股骨柄的假体周围股骨骨折(pff)的治疗最近从翻修转向切开复位内固定(ORIF)。虽然ORIF是稳定非骨水泥茎的公认标准,但指导骨水泥茎周围PFF最佳管理的证据仍然没有定论。本荟萃分析的目的是比较ORIF与翻修术对温哥华B2 pff患者骨水泥PTS股骨干周围的疗效。方法:我们系统地检索了MEDLINE、Embase、CENTRAL、Scopus和ClinicalTrials.gov从成立到2025年5月的研究,比较ORIF和翻修性关节置换术在成人温哥华B2型pff骨水泥PTS周围的疗效。纳入的研究均非随机对照试验(RCTs)。结果为5年种植体存活率、2年再手术率、1年死亡率、感染、无菌性松动、不愈合和手术时间。结果:8项研究涉及675例患者(318例ORIF, 357例修订)符合入选标准。平均年龄82.2岁,平均随访2.8年。ORIF组2年再手术率显著降低(优势比[OR] 0.28, 95%可信区间[CI] 0.14-0.53, p < 0.001)。ORIF组的手术时间明显缩短(平均差异为-42.28分钟,95% CI为-71.27 ~ -13.29;p < 0.001)。5年种植体存活率(OR 0.64, 95% CI 0.26-1.60)和1年死亡率(OR 2.05, 95% CI 0.71-5.89)无显著差异。术后感染、无菌性松动和不愈合率也相似。偏倚风险总体为中等。结论:对于骨水泥PTS股骨干周围的Vancouver B2 pff患者,与翻修术相比,ORIF可显著降低2年再手术率,缩短手术时间,其他结果相似。这些发现表明ORIF和修正之间的总体表现相当;然而,考虑到异质性和潜在的选择偏倚,不确定性仍然很高,因此需要随机对照试验来评估这两种选择。证据等级:治疗性III级。有关证据水平的完整描述,请参见作者说明。
{"title":"Fixation vs. Revision of Vancouver B2 Periprosthetic Fractures Around Polished Tapered Cemented Femoral Stems: A Meta-Analysis of Outcomes.","authors":"Zain Choudhary, Sachin Singal, Amr Selim, Abdelrahman Ibrahim, Ronald Hang Kin Nam, Abdul-Basit Rafi, Siddharth Govilkar, Geraint Thomas","doi":"10.2106/JBJS.RVW.25.00215","DOIUrl":"10.2106/JBJS.RVW.25.00215","url":null,"abstract":"<p><strong>Background: </strong>The management of periprosthetic femoral fractures (PFFs) around polished taper-slip (PTS) cemented femoral stems in total hip arthroplasty has seen a recent shift in practice from revision to open reduction and internal fixation (ORIF). While ORIF is the accepted standard for stable uncemented stems, evidence guiding optimal management of PFF around cemented stems remains inconclusive. This metanalysis aimed to compare the outcomes of ORIF vs. revision in patients with Vancouver B2 PFFs around cemented PTS femoral stems.</p><p><strong>Methods: </strong>We systematically searched MEDLINE, Embase, CENTRAL, Scopus, and ClinicalTrials.gov from inception to May 2025, for studies comparing ORIF with revision arthroplasty in adults with Vancouver type B2 PFFs around cemented PTS stem. None of the included studies were randomized control trials (RCTs). The outcomes were 5-year implant survival, 2-year reoperation rate, 1-year mortality, infection, aseptic loosening, nonunion, and operative time.</p><p><strong>Results: </strong>Eight studies involving 675 patients (318 ORIF, 357 revision) met eligibility criteria. The mean age was 82.2 years, and the mean follow-up was 2.8 years. Two-year reoperation was significantly lower with ORIF (odds ratio [OR] 0.28, 95% confidence interval [CI] 0.14-0.53, p < 0.001). Operative time was significantly shorter in the ORIF group (mean difference -42.28 minutes, 95% CI -71.27 to -13.29; p < 0.001). No significant differences were observed in 5-year implant survival (OR 0.64, 95% CI 0.26-1.60) or 1-year mortality (OR 2.05, 95% CI 0.71-5.89). Postoperative infection, aseptic loosening, and nonunion rates were also similar. Risk of bias was moderate overall.</p><p><strong>Conclusion: </strong>For patients with Vancouver B2 PFFs around cemented PTS femoral stems, ORIF was associated with a significantly lower 2-year reoperation rate and shorter operative time compared with revision, while other outcomes were similar. These findings indicate comparable overall performance between ORIF and revision; however, given the heterogeneity and potential selection bias, uncertainty remains high, supporting the need for an RCT to evaluate both options.</p><p><strong>Level of evidence: </strong>Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":47098,"journal":{"name":"JBJS Reviews","volume":"13 12","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145844266","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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