World Journal of Orthopedics最新文献

The field of orthopedic and regenerative medicine is rapidly evolving with the increasing utilization of orthobiologic. These biologically derived therapies, including platelet-rich plasma, mesenchymal stem cells, bone marrow aspirate concentrate, stromal vascular fraction (SVF), and autologous chondrocyte implantation, are gaining traction for their potential to enhance the body's natural healing processes. They offer a promising alternative to traditional surgical interventions for musculoskeletal injuries and degenerative conditions. Current evidence suggests significant benefits of orthobiologics in treating conditions like osteoarthritis, tendon injuries, and spinal disorders, yet inconsistencies in treatment protocols and outcomes persist. The global market for orthobiologics is projected to grow substantially, driven by advancements in biologic therapies such as adipose-derived stem cells and SVF, and the demand for minimally invasive treatments. Despite their promise, regulatory and ethical challenges, as well as the need for high-quality, standardized research, remain significant obstacles. Future directions in the field include advancements in delivery systems, personalized medicine approaches, and the exploration of novel sources like induced pluripotent stem cells, aiming for more targeted and effective treatments. Collaborative efforts are crucial to overcoming these challenges and ensuring the safe and effective application of orthobiologics in clinical practice.

Background: Extracorporeal shock wave therapy (ESWT) is increasingly being recognized as an advantageous alternative for treating non-union due to its efficacy and minimal associated complications. Non-union following Bernese periacetabular osteotomy (PAO) is particularly challenging, with a reported 55% delayed union and 8% non-union. Herein, we highlight a unique case of ischial non-union post-PAO treated successfully with a structured ESWT regimen.

Case summary: A 50-year-old patient, diagnosed with left ischial non-union following the PAO, underwent six cycles of ESWT treatment across ten months. Each cycle, spaced four weeks apart, consisted of five consecutive ESWT sessions without anesthesia. Regular X-ray follow-ups showed progressive disappearance of the fracture line and fracture union. The patient ultimately achieved a satisfactory asymptomatic recovery and bone union.

Conclusion: The results from this case suggest that this ESWT regimen can be a promising non-invasive treatment strategy for non-union following PAO.

Background: Extensive research revealed the absence of reports documenting hypertensive emergencies precipitated by changes in the cervical spine posture.

Case summary: We here present a 57-year-old woman diagnosed as having cervical spondylotic radiculopathy (CSR) who was scheduled for anterior cervical decompression and fusion. During post-anesthetic positioning, a sudden hypertensive surge was observed when the patient was in a supine position with the neck being slightly extended. This surge was promptly reversed through cervical flexion and head elevation. This event however required an alternate surgical approach for recovery-posterior laminoplasty and endoscopy-assisted nucleus pulposus removal. Following the 6-month outpatient follow-up period, cervical flexion and extension activities substantially improved in the patient without any episodes of increase in acute blood pressure.

Conclusion: Maintaining a safe hypotensive posture and performing rapid, thorough decompression surgery may serve as effective interventions for patients presenting symptoms similar to those of CSR accompanied by hypertensive emergencies (HE). This would mitigate the underlying causes of these HEs.

Background: Percutaneous endoscopic lumbar decompression (PELD) shows promise for lumbar spinal stenosis (LSS) treatment, but its use is limited by the disease's complexity and procedural challenges.

Aim: In this study, the effects of preoperative planning and intraoperative guidance with computed tomography (CT)/magnetic resonance imaging (MRI) registration techniques on PELD for LSS and postoperative rehabilitation outcomes were evaluated.

Methods: This retrospective study was conducted with data from patients who underwent PELD for LSS between January 2021 and December 2023. Patients were assigned to preoperative CT/MRI registration and control groups. Data collected included the operative time, length of hospital stay, visual analog scale (VAS) scores for low back and leg pain, and the Japanese Orthopaedic Association (JOA) lumbar spine score. Differences between groups were assessed using Student's t test.

Results: Data from 135 patients (71 in the CT/MRI registration group, 64 in the control group) were analyzed. The operative time was significantly shorter in the CT/MRI registration group (P = 0.007). At 2 months postoperatively, both groups showed significant reductions in VAS leg and low back pain scores (all P < 0.001) and improvements in the JOA score (both P < 0.001). No complication or death occurred. Preoperatively, pain and JOA scores were similar between groups (P = 0.830, P = 0.470, and P = 0.287, respectively). At 2 months postoperatively, patients in the CT/MRI registration group reported lower leg and low back pain levels (P < 0.001 and P = 0.001, respectively) and had higher JOA scores (P = 0.004) than did patients in the control group.

Conclusion: Preoperative CT/MRI registration for PELD for LSS reduced the operative time and VAS pain scores at 2 months and improved JOA scores, demonstrating enhanced effectiveness and safety.

Recognizing the mechanical origin of enthesitis/enthesopathy and the avulsion-nature of what had previously been considered erosions, it seems inappropriate to attribute it to stresses related to a person's normal activities. Conversely, sudden or unconditioned repetitive stresses appears the more likely culprit. Studies of enthesial reaction have lacked standardization as to findings present among individuals who appear to be healthy. Clinical evaluation by palpation and manipulation may be as effective as application of radiologic techniques. Recognition of the mechanical nature of the disease, including individuals with inflammatory arthritis suggests prescription of mechanical solutions that reduce stresses across the involved enthesis.

Background: Severe skeletal class II malocclusion is the indication for combined orthodontic and orthognathic treatment.

Case summary: A woman with a chief complaint of a protruding chin and an inability to close her lips requested orthodontic camouflage. The treatment plan consisted of extracting the right upper third molar, right lower third molar, left lower second molar, and left upper third molar and moving the maxillary dentition distally using a convenient method involving microimplant nail anchors, push springs, long arm traction hooks, and elastic traction chains. After 52 months of treatment, her overbite and overjet were normal, and her facial profile was favorable.

Conclusion: This method can be used for distal movement of the maxillary dentition and to correct severe skeletal class II malocclusion in adults.

In this editorial, I present my comments on the article by Solarino et al. Conversion hip arthroplasty, which is an optional salvage procedure performed following unsuccessful fixation of intertrochanteric femur fractures in elderly patients, entails more complex processes and higher rates of operative complications than primary arthroplasty. Hence, it is important to consider the appropriateness of the primary treatment choice, as well as the adequacy of nailing fixation for intertrochanteric fractures. This article briefly analyzes the possible factors contributing to the nailing failure of intertrochanteric fractures and attempts to find corresponding countermeasures to prevent fixation failures. It also analyzes the choice of treatment between nailing fixation and primary arthroplasty for intertrochanteric fractures.

This review summarizes the latest progress in orthopedic nanotechnology, explores innovative applications of nanofibers in tendon repair, and evaluates the potential of selenium and cerium oxide nanoparticles in osteoarthritis and osteoblast differentiation. This review also describes the emerging applications of injectable hydrogels in cartilage engineering, emphasizing the critical role of interdisciplinary research and highlighting the challenges and future prospects of integrating nanotechnology into orthopedic clinical practice. This comprehensive approach provides a holistic perspective on the transformative impact of nanotechnology in orthopedics, offering valuable insights for future research and clinical applications.

Background: Postmenopausal osteoporosis (PMOP) is the most common form of primary osteoporosis among women, and the associated pain often drives patients to seek clinical intervention. Numerous studies have highlighted the unique clinical benefits of exercise therapy (ET) in alleviating PMOP-related pain. However, bibliometric analyses examining collaboration, development trends, and research frontiers in the field of ET for PMOP pain remain scarce.

Aim: To explore the research trends in ET for pain treatment in PMOP patients over the past decade.

Methods: All scholarly works were meticulously sourced from the Science Citation Index-Expanded within the prominent Web of Science Core Collection. Utilizing the capabilities of CiteSpace 6.2.R5, we conducted a thorough analysis of publications, authors, frequently cited scholars, contributing nations, institutions, journals of significant citation, comprehensive references, and pivotal keywords. Additionally, our examination explored keyword cooccurrences, detailed timelines, and periods of heightened citation activity. This comprehensive search, from 2014 through 2023, was completed within a single day, on October 11, 2023.

Results: In total, 2914 articles were ultimately included in the analysis. There was a rapid increase in annual publication output in 2015, followed by stable growth in subsequent years. Boninger, Michael L, is the most prolific author, whereas Ware JE has the most citations. The United States' global influence is significant, surpassing all other nations. The University of California System and Harvard University are the most influential academic institutions. J Bone Joint Surg Am is the most influential journal in this field. "Spinal cord injury" is the keyword that has garnered the most attention from researchers. The developmental pattern in this field is characterized by interdisciplinary fusion, with different disciplines converging to drive progress.

Conclusion: The academic development of the field of ET for pain in PMOP has matured and stabilized. Clinical management and rehabilitation strategies, along with the mechanisms underlying the relationship between ET and bone resorption analgesia, continue to be the current and future focal points of research in this field.

Background: This article presents a rare case of a complex hip fracture involving the ipsilateral femoral neck, trochanter, and femoral head, that was accompanied by hip dislocation. Currently, there is no established standard treatment method for this specific type of fracture. Therefore, it is crucial to comprehensively consider factors such as patient age, fracture type, and degree of displacement to achieve a successful outcome.

Case summary: A 38-year-old man sustained a comminuted fracture of his right hip as a result of a car accident. The injuries included a fracture of the femoral head, a fracture of the femoral neck, an intertrochanteric fracture of the femur, and a posterior dislocation of the hip on the same side. We opted for a treatment approach combining the use of a proximal femoral locking plate, cannulated screws, and Kirschner wires. Following the surgery, we developed an individualized rehabilitation program to restore patient limb function.

Conclusion: For this complex fracture, we selected appropriate internal fixation and formulated individualized rehabilitation, which ultimately achieved good results.