Efort Open Reviews最新文献

Background: The efficacy and safety of robot-assisted pedicle screw placement versus freehand and computer-assisted navigation techniques remain debatable. This umbrella review synthesizes meta-analytic evidence on the associated accuracy, safety, and clinical outcomes.

Methods: A comprehensive search was performed in PubMed, Embase, Scopus, Web of Science, Ovid, and Cochrane databases, from inception to October 2025, with no language restrictions. Researchers independently assessed meta-analyses that compared robot-assisted with freehand and computer-assisted navigation techniques. Methodological quality was assessed using the AMSTAR-2 tool, and evidence was graded using the GRADE framework. The primary outcomes included accuracy metrics (acceptable and perfect screw placement) and safety indicators (intraoperative blood loss, radiation exposure, and hospital stay). The protocol was registered with PROSPERO (registration number: CRD42024556304).

Results: A total of 38 meta-analyses comprising 414 primary studies were included. Convincing evidence (class I) supported robotic superiority for acceptable placement versus freehand (eOR = 2.74; 95% CI: 2.33-3.22) and versus navigation (eOR = 2.36; 95% CI: 1.73-3.22), and for perfect placement versus navigation (eOR = 2.47; 95% CI: 1.84-3.32). Highly suggestive evidence (class II) supported superior perfect placement (vs freehand) and shorter hospital stays. Suggestive evidence (class III) indicated reductions in intraoperative blood loss and radiation exposure.

Conclusion: Robot-assisted pedicle screw placement demonstrates superior accuracy versus freehand and navigation-guided methods, supported by convincing (class I) evidence. Highly suggestive (class II) evidence also supports its superiority in perfect placement and shortening hospital stays, while suggestive (class III) evidence indicates reduced blood loss and radiation. These findings, supported by a robust evidence base, underscore the need for standardized clinical guidelines to maximize impact on patient outcomes.

Valgus accounts for 18.5% of patients undergoing a total knee arthroplasty (TKA). Following a mechanical alignment (MA) surgical technique, these patients have historically been more challenging than their varus counterparts. In valgus knees, conventional MA-TKA frequently distalizes and posteriorizes the lateral femoral condyle, increasing lateral patellar retinaculum tension and flexion space imbalance and instability. Personalized arthroplasty is gaining popularity for varus knees, but its value remains debated for valgus knees. This reluctance stems from outdated misconceptions about valgus knee anatomy and biomechanics and limited awareness of advancements in implant survivorship and outcomes. Patients with valgus HKA may present with various knee laxities. While medial collateral ligament (MCL) pseudo-laxity and generalized hyperlaxity are easy to manage, true MCL elongation requires careful evaluation and may necessitate surgical modifications. A surgical approach favoring patellar tracking and avoiding increasing medial compartment gaps is of paramount importance. Joint laxity assessment should guide surgical decisions, from tibial undercutting for mild laxity to soft tissue releases or constrained implants for severe instability. In the presence of a pathological patellofemoral joint, the surgical technique should be adapted with trochlear position/orientation modifications, patellar resurfacing medializing the implant, lateral retinacular release, or a tibial tuberosity osteotomy. Long-term studies show high patient satisfaction with restricted kinematic alignment, TKA in valgus knees, with outcomes comparable to varus knees.

Purpose: Telemedicine has emerged as a valuable tool in spinal surgery, enabling remote consultations, preoperative assessments, and postoperative care. This systematic review evaluates its impact on clinical outcomes, patient satisfaction, and healthcare resource use from 2020 to 2024, highlighting key benefits, challenges, and future research directions.

Methods: A systematic search of PubMed/MedLine, Scopus, Web of Science, and Embase identified studies assessing telemedicine in patients undergoing spinal surgery. Covidence (Covidence, Melbourne, Australia) was used for screening and selection. Risk of bias was evaluated, and a qualitative synthesis was conducted following SWiM guidelines due to study heterogeneity. Data were standardised to one decimal place, except for reported P-values.

Results: In total, 37 studies comprising 91,139 patients met inclusion criteria. Telemedicine demonstrated high diagnostic accuracy, with concordance rates exceeding 90% in most studies. Patient satisfaction remained consistently high (86.9-96.4%). It improved treatment adherence, pain management, and functional outcomes. Key advantages included cost-effectiveness and increased accessibility, though challenges such as bias and technological limitations persist.

Conclusion: Telemedicine plays a significant role in spinal surgery, offering high diagnostic accuracy, patient satisfaction, and improved clinical outcomes, including reduced pain and disability. It enhances compliance, reduces costs, and improves access to care. However, technological barriers, regulatory concerns, and study heterogeneity underscore the need for further research. Telemedicine holds promise for transforming spinal surgery care.

Purpose: The purpose of this systematic review and meta-analysis was to synthesise available evidence on functional outcomes, knee stability, and complications between quadriceps tendon with patellar bone block (B-QT) and quadriceps soft-tissue (S-QT) autografts for primary anterior cruciate ligament reconstructions (ACLR).

Methods: A systematic search (PROSPERO ID: CRD42023472220) was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and was performed on PubMed/MEDLINE, EMBASE, and WoS. The data concerning functional outcomes, knee stability, and complications were analysed.

Results: There were 5,898 B-QT patients (67.5% male) and 1,849 S-QT patients (51.5% male) included, with a mean age of 27.4 ± 9.3 and 24.7 ± 9.2 years and mean follow-up of 28.9 months (5.3-123.6 months) and 25.3 months (6.0-69.9 months), respectively. In a meta-analysis, the B-QT had higher KOOS subscales scores: activity-of-daily-living 95.98 (95% CI: 94.09-97.88) vs 93.88 (95% CI: 93.66-94.11), P = 0.028; pain 91.99 (95% CI: 89.48-94.49) vs 88.51 (95% CI: 88.21-88.81), P = 0.005; sports & recreation 84.26 (95% CI: 79.20-89.31) vs 79.21 (95% CI: 78.69-79.73), P = 0.041; symptoms 87.82 (95% CI: 84.75-90.90) vs 81.26 (95% CI: 80.71-81.82), P < 0.001; quality-of-life 78.28 (95% CI: 73.68-82.89) vs 65.37 (95% CI: 60.59-70.15), P < 0.001; and a higher Marx score: 11.90 (95% CI: 10.92-12.87) vs 9.65 (95% CI: 8.21-11.09), P = 0.006. B-QT had higher side-to-side difference in anteroposterior tibial translation: 1.55 mm (95% CI: 1.33-1.77) vs 1.15 mm (95% CI: 0.85-1.33 mm), P = 0.026.

Conclusion: A QT autograft, with or without a bone block, provides satisfactory functional outcomes, knee stability, and few complications in primary ACLR. B-QT may result in higher patient-reported outcomes, while S-QT may potentially result in slightly improved knee stability.

Malignant bone tumors, including primary bone tumors, such as osteosarcoma (OS), Ewing's sarcoma (ES), and multiple myeloma, and secondary bone tumors from prostate and breast cancers, pose significant mortality risks. Osteoblasts (OBs) and their derivatives play critical roles in the development, recurrence, and metastasis of these tumors. OBs promote metastasis-related events, including osteoclast differentiation and proliferation. Their derivatives, including extracellular vesicles and cytokines, modulate bone remodeling and tumor development through various signaling pathways. Recent in vivo and in vitro studies highlight the involvement of OBs in tumor progression, recurrence, and metastasis. Emerging therapies targeting OBs and their derivatives show promise in improving patient outcomes. The review emphasizes the importance of understanding the specific roles of OBs and their derivatives in malignant bone tumors. This knowledge can lead to the development of new therapeutic strategies aimed at improving patient survival rates and quality of life. Key findings include the regulatory effects of OBs on tumor dormancy, the vicious cycle of bone metastasis, and the potential for targeted therapies to disrupt these processes. Future research should focus on developing experimental models that more closely mimic the human tumor microenvironment and integrating multiple signaling pathways to create comprehensive treatment strategies.

Purpose: Phosphaturic mesenchymal tumors (PMTs) are rare neoplasms causing tumor-induced osteomalacia (TIO), usually through fibroblast growth factor 23 (FGF-23) secretion. They arise in bone or soft tissue and present with non-specific symptoms, often leading to delayed diagnosis. This study evaluates tumor characteristics, the role of surgical therapy, and its impact on outcomes while highlighting key aspects of PMT management.

Methods: A systematic review was conducted according to PRISMA guidelines, including 188 studies and 584 PMT cases, focusing on clinical presentation, treatment modalities, and outcomes. In addition, we retrospectively analyzed four patients treated at our institution.

Results: The mean patient age was 49 ± 15 years, with a slight male predominance (56%). Tumors were evenly distributed between bone and soft tissue, most commonly affecting the lower extremities. Frequent symptoms included pain (90%) and pathological fractures (69%). Elevated FGF-23 levels were detected preoperatively in over 90% of cases. Complete remission was achieved in 66.2% of surgically treated patients compared to 29.4% of non-operatively managed patients (P < 0.001). Complete resection was associated with significantly higher remission rates (55.7 vs 6.6%, P = 0.001), particularly in bone-localized PMT. In our case series, all patients undergoing complete resection showed no evidence of disease and relief of TIO-associated symptoms.

Conclusions: PMTs often lead to diagnostic delays due to non-specific symptoms. Complete surgical resection is the strongest predictor of favorable outcomes, especially for bone-localized tumors. An interdisciplinary approach is critical for early diagnosis, optimal treatment, and maximizing favorable clinical outcomes.

Background: Metastatic disease frequently causes pathological fractures, particularly in the proximal femur, significantly impacting patient prognosis and quality of life. With the advancements in cancer treatment leading to longer survival, there is a pressing need to evaluate the outcomes of surgical interventions aimed at managing proximal femoral metastases. This study compares the outcomes of internal fixation (IF) versus prosthesis (P) in the treatment of proximal femoral metastases, focusing on survival times, complication rates, functional outcomes, and reoperation rates.

Method: A systematic review and meta-analysis were conducted, searching PubMed, Embase, and Cochrane databases for studies published up to December 31, 2023. The PRISMA guidelines were followed. Studies comparing IF and P for proximal femoral metastases were included. Data on survival times, blood loss, reoperation rates, and functional scores were extracted and analyzed using the forest plot technique and inverse variance method. The quality of included studies was assessed using the Newcastle-Ottawa scale.

Results: In total, 19 studies (16 retrospective and three prospective) involving 4,126 patients were included. The P group demonstrated significantly longer survival times compared with the IF group, with no significant difference in complication and reoperation rates between the two methods. However, IF was associated with shorter operative times and less blood loss.

Conclusion: P may provide superior long-term functional outcomes and extended survival compared with IF, with similar rates of complications and reoperations. However, selection bias - where healthier patients with better baseline physiology are more likely to undergo prosthetic reconstruction - significantly impacts the interpretation of these findings, underscoring the need for further prospective studies.

The subacromial bursa is located below the acromion, coracoacromial ligament, and deltoid deep fascia, above the rotator cuff and greater tuberosity of the humerus, and plays a crucial role in physiological processes such as exercise and pathological processes of rotator cuff diseases. The subacromial bursa is associated with inflammatory pain in patients with rotator cuff disease. Removing the bursa during surgery and intra-articular drug injection can both relieve this pain to some degree. Resection of the subacromial bursa improves intraoperative visualization and may loosen an already stiff shoulder joint; however, excessive resection appears to result in more severe adhesion. Current evidence suggests that the subacromial bursa is a source of reparative cytokines and mesenchymal stem cells that may contribute to and enhance the healing of the injured rotator cuff and improve prognosis. Research studies related to the utilization of the subacromial bursa for bioaugmentation is ongoing and shows potential to promote patient recovery. Preservation or bioaugmentation with the subacromial bursa during rotator cuff surgery might lead to a better prognosis, but there is not yet sufficient evidence to prove this.

In patients with knee osteoarthritis, tibial stress fractures are mostly associated with osteoporosis and lower limb malalignment. Nonoperative management may lead to knee stiffness (due to prolonged immobilization), persistence of pain (due to the underlying knee osteoarthritis), and fracture nonunion. Acute unstable tibial stress fractures can be managed with long-stem total knee arthroplasty. Exposing the fracture site should be avoided as much as possible because it may be associated with skin necrosis and delayed union. In irreducible cases or fractures with persistent gaps, fibular osteotomy, by increasing the mobility and compression across the fracture site, may help with fracture reduction and decrease the rate of nonunion.

Purpose: This study aimed to systematically evaluate the efficacy and safety of oral versus intravenous tranexamic acid (TXA) in total knee arthroplasty (TKA).

Methods: The review process was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. PubMed, EMBASE, Web of Science, and the Cochrane Library were searched. Data extraction and quality assessment were performed independently by two investigators. The primary outcomes were hemoglobin (Hb) decrease and blood loss, while secondary outcomes included transfusion rate, operation time, hospital stay, and complications. The analysis used random-effects models and assessed heterogeneity with I 2 values.

Results: Nine studies were included in the meta-analysis, comprising a total of 1,227 participants. Across the included studies, oral TXA was most commonly administered as 1.95-2 g given 1-2 h before surgery, with some regimens including postoperative doses. Intravenous TXA was typically given as 1 g before surgery, sometimes with additional doses before wound closure or after surgery. The results showed no significant difference between oral and intravenous TXA in terms of Hb decrease and transfusion rates. Similarly, there was no significant difference in complications, operation time, and length of hospital stay. Comparable findings were observed in both RCTs and non-RCTs. Sensitivity analysis demonstrated that the overall results remained robust, with no single study exerting a substantial influence on the pooled estimates.

Conclusions: Based on available evidence, there is no significant difference observed between oral and intravenous TXA in patients undergoing TKA. However, the wide confidence intervals for several outcomes indicate important uncertainty, and further high-quality studies are needed to confirm the comparative effectiveness and safety.