Joint diseases and related surgery最新文献

Objectives: This study aims to investigate the clinical efficacy of managing far lateral lumbar disc herniation (FLLDH) through two surgical approaches: unilateral biportal endoscopy (UBE) and percutaneous endoscopic lumbar discectomy (PELD).

Patients and methods: Between December 2019 and September 2024, a total of 45 patients (18 males, 27 females; mean age: 59.76±11.82 years; range, 31 to 89 years) who were diagnosed with FLLDH were retrospectively analyzed. Based on the surgical technique used, the patients were randomly divided into two groups: the PELD group (n=17) and the UBE group (n=28). Perioperative indicators, including operative time, postoperative hospital stay and mean fluoroscopy times, were recorded. Pre- and postoperative assessments were conducted at the time of admission and at one, three, and six months after surgery, using the Visual Analog Scale (VAS) and the Oswestry Disability Index (ODI) scores. The modified MacNab criteria were used to assess patient satisfaction.

Results: Both groups demonstrated a reduction in VAS and ODI scores after surgery (p<0.05). However, no statistically significant differences were observed between the groups at one, three, or six months postoperatively. Operative times were also comparable, with the UBE group mean 97.39±26.78 min and the PELD group 88.18±27.52 min. The postoperative length of hospital stay was similar, with the UBE group staying a mean of 3.93±1.81 days and the PELD group 3.06±1.21 days (p>0.05). The mean fluoroscopy times were significantly lower in the UBE group, with 6.25±1.30 times compared to 16.76±6.02 times in the PELD group (p<0.05).

Conclusion: Our study results suggest that UBE is a viable alternative to PELD for treating FLLDH, offering comparable clinical outcomes with reduced radiation exposure.

Objectives: This study aims to compare ChatGPT (Generative Pre-Trained Transformer) and Google in addressing frequently asked questions (FAQs), answers, and online sources regarding robot-assisted total hip arthroplasty (RATHA).

Materials and methods: On December 15^th, 2024, the 20 most FAQs were identified by inputting the search term "Robot-Assisted Total Hip Replacement" into both Google Search and ChatGPT-4o. Twenty FAQs were independently identified using a clean Google search and a prompt to ChatGPT-4o. The FAQs on Google were sourced from the "People also ask" section, while ChatGPT was requested to generate the 20 most often asked questions. All questions, answers, and references cited were recorded. A modified version of the Rothwell system was used to categorize questions into 10 subtopics: special activities, timeline of recovery, restrictions, technical details, cost, indications/management, risks and complications, pain, longevity, and evaluation of surgery. Each reference was categorized into the following groups: commercial, academic, medical practice, single surgeon personal, or social media. Responses were also graded as "excellent response not requiring clarification" (1), "satisfactory requiring minimal clarification" (2), "satisfactory requiring moderate clarification" (3), or "unsatisfactory requiring substantial clarification" (4).

Results: Overall, 20% of the questions that Google and ChatGPT-4o considered as the most FAQ were similar to each other. Technical details (35%) were the most common categories of questions. The ChatGPT provided significantly more academic references than Google search (70% vs. 20%, p=0.0113). Conversely, Google web search cited more medical practice references (40% vs. 0%, p=0.0033), single surgeon websites (20% vs. 0%, p=0.1060), and government websites (10% vs. 0%, p=0.4872) more frequently than ChatGPT. In terms of response quality, 62% of answers were rated as Grade 1-2 (excellent or satisfactory with minimal clarification), while 38% required moderate or substantial clarification (Grades 3-4).

Conclusion: ChatGPT demonstrated comparable results to those of Google searches on information regarding RATHA, with a higher reliance on academic sources. While most responses were satisfactory, a notable proportion required further clarification, emphasizing the need for continued evaluation of these platforms to ensure accuracy and reliability in patient education. Taken together, these technologies have the capacity to enhance health literacy and provide enhanced shared decision-making for patients seeking information on RATHA.

Objectives: This study aims to evaluate hidden blood loss (HBL) and its determinants in elderly hip fracture patients undergoing this procedure via a posterolateral approach.

Patients and methods: Between January 2016 and June 2024, a total of 105 patients (52 males, 53 females; mean age: 78.5±5.6 years; range, 60 to 93 years) who underwent hip hemiarthroplasty through a posterolateral approach were retrospectively analyzed. Patient demographics and clinical data were obtained. Pre- and postoperative hematocrit (Hct), height, and weight were documented. Perioperative total blood loss (TBL) and HBL were quantified using the Gross and Sehat formulas, respectively. Risk factors linked to HBL were determined.

Results: The mean operative duration was 80.3±9.9 min. The mean HBL was 465.9±58.3 mL, accounting for 81.4% of TBL (571.1±149.6 mL). Multivariate linear regression revealed significant associations between increased HBL and lower preoperative albumin (β=-0.188, p=0.011), higher American Society of Anesthesiologists (ASA) classification (β=0.162, p=0.029), and perioperative blood transfusion (β=0.221, p=0.002).

Conclusion: Hidden blood loss constitutes a clinically significant consideration during hip hemiarthroplasty for geriatric hip fractures. Significantly greater HBL occurs in patients with preoperative hypoalbuminemia, elevated ASA classification, or perioperative transfusion. Recognizing and quantifying HBL enhances perioperative assessment precision and contributes to improved patient safety.

Objectives: The present meta-analysis aims to perform a comprehensive, evidence-based comparison of the effectiveness and safety of the unilateral extrapedicular approach (UEA) percutaneous vertebral augmentation and transpedicular approach percutaneous vertebral augmentation for osteoporotic vertebral compression fractures (OVCFs).

Materials and methods: Publications indexed up to May 2025 were interrogated across Cochrane Library, Web of Science, PubMed, Embase, and SpringerLink using the combined keywords "unilateral extrapedicular approach", "transpedicular approach", "percutaneous vertebral augmentation", "percutaneous vertebroplasty", "percutaneous kyphoplasty", and "osteoporotic vertebral compression fractures". Mean difference (MD) and risk difference (RD) served as summary metrics, each expressed with 95% confidence intervals (CIs).

Results: Eight clinical trials involving 830 patients were included. The UEA significantly shortened operative time (MD=-4.26; 95% CI:-6.15 ~ -2.37; p<0.00001), compared to unilateral transpedicular approach (UTA), while no statistically significant differences were observed in cement leakage (RD:-0.01; 95% CI:-0.09 ~ 0.07; p=0.88), cement injection volume (MD=0.20; 95% CI:-0.02 ~ 0.41; p=0.07), or intraoperative fluoroscopy times (MD=-1.15; 95% CI:-3.62 ~ 1.32; p=0.36). Notably, UEA demonstrated significant advantages over bilateral transpedicular approach (BPA) in reducing cement leakage rate (RD:-0.08; 95% CI:-0.14 ~ -0.02; p=0.01), decreasing cement injection volume (MD=-1.51; 95% CI:-2.98 ~ -0.04; p=0.04), shortening operative time (MD=-9.64; 95% CI:-13.25 ~ -6.04; p<0.00001), and minimizing intraoperative fluoroscopy times (MD=-8.12; 95% CI:-12.36 ~ -3.88; p=0.0002). However, no significant intergroup differences were found between UEA and BPA in postoperative Visual Analog Scale (VAS) (MD=-0.04; 95% CI:-0.24 ~ 0.17; p=0.73), postoperative Cobb angle (MD=-0.37; 95% CI:-0.54 ~ 1.28; p=0.42) or Oswestry Disability Index (ODI) (MD=-0.54; 95% CI:-2.81 ~ 1.72; p=0.64).

Conclusion: In the management of OVCFs, UEA offers shorter operative time compared with UTA. Additionally, UEA shows remarkable superiority over BPA in cement injection volume, cement leakage rate, intraoperative fluoroscopy frequency and operative time.

Objectives: This study aims to investigate the microstructural effects of distal bicortical screw placement in medial buttress plate (MBP) constructs using scanning electron microscopy (SEM).

Materials and methods: Ten synthetic femur models with standardized Pauwels type III fractures were divided into two groups. All specimens received fixation with three cannulated screws in an inverted triangle configuration. Group A received a MBP fixed with four unicortical screws. Group B received the same construct, except for the most distal screw was inserted bicortically. All specimens underwent combined axial and torsional cyclic loading, followed by load-to-failure testing. Plates were, then, analyzed under SEM to assess deformation and microdamage. A semi-quantitative scoring system was used to compare the severity of microstructural changes between groups.

Results: The SEM analysis revealed significantly more microdamage in Group B compared to Group A (median deformation scores: 4 vs. 2; p=0.0181). Plates with bicortical screw placement showed localized plastic deformation, microcracks, and in some cases, complete fractures, particularly at the bent midsection of the plate. In contrast, unicortical plates showed only mild surface irregularities without structural failure.

Conclusion: Although distal bicortical screw placement may enhance initial mechanical stability, it also increases the risk of microstructural damage in MBPs, potentially compromising long-term durability. These findings underscore the importance of optimizing screw configuration to balance stability with implant longevity in the treatment of vertically unstable femoral neck fractures.

Objectives: In this systematic review, we discuss the clinical efficacy and complications of unilateral biportal endoscopy (UBE) in the treatment of thoracic ossification of the ligamentum flavum (TOLF), providing surgeons with evidence-based guidance for optimal treatment decisions.

Materials and methods: We systematically searched the PubMed, EMBASE, Cochrane Library, CNKI, Wanfang, and VIP databases up to January 2025. Inclusion criteria encompassed studies reporting UBE outcomes for single/double-segment TOLF. Data on pain (Visual Analog Scores [VAS]), function (Oswestry Disability index [ODI] and Japanese Orthopaedic Association [JOA]), and complications were pooled using random-effects models. Minimal clinically important difference (MCID) was applied as the evaluative benchmark for clinical significance.

Results: Six studies (n=77) were analyzed. Significant improvements were observed in leg pain (p<0.001; 95% confidence interval [CI]: -6.63 to -3.57; I²=88%), back pain (p<0.0001; 95% CI: -6.36 to -3.83; I²=86%), ODI (p<0.00001; 95% CI: 31.00 to 53.53; I²=95%), and JOA scores (p<0.05; 95% CI: 2.80 to 3.70; I²=86%). The overall complication rate was 28% (2/6 reporting zero complications), predominantly mild (headache, hyperalgesia). Severe complications included dural tears (2.6%) and spinal cord injury (2.6%), with heterogeneity attributed to surgical technique evolution.

Conclusion: Preliminary evidence suggests UBE may be a promising minimally invasive approach for TOLF, potentially offering accelerated recovery and reduced perioperative morbidity. However, given the limited sample size and substantial heterogeneity, these findings require validation through large-scale prospective studies.

Objectives: In this meta-analysis, we aimed to evaluate systematically the effectiveness and safety of acupuncture combined with bone-setting in the treatment of cervical vertigo (CV).

Materials and methods: A systematic search was conducted across three English databases (PubMed, the Web of Science and the National Library of Medicine) and two Chinese databases (the China National Knowledge Infrastructure and the Wanfang Database). The search timeframe spanned from the inception of each database until 31 January 2025. The search terms were as follows: (i) 'Bone-setting' OR 'Bone Setting' OR 'Chinese Osteopathy' OR 'Chiropractic manipulation'; (ii) 'Acupuncture and Moxibustion' OR 'Acupuncture' OR 'Traditional Chinese acupuncture' OR 'Electroacupuncture' OR 'fire acupuncture' OR 'warm acupuncture'; (iii) 'Cervical Vertigo' OR 'Vertebral Artery Cervical Spondylosis' OR 'CV'.

Results: A total of 15 articles were included, all of which were randomized-controlled trials (RCTs), involving 2,320 participants. The meta-analysis results showed that, compared to using acupuncture alone or bone-setting alone for CV, the combined therapy demonstrated a significantly higher overall clinical efficacy rate (odds ratio [OR]=3.88, 95% confidence interval [CI]: 2.89, 5.19, p<0.001), significantly better symptoms and functional assessment scores for CV (mean difference [MD]=4.01, 95% CI: 3.19, 4.83, p<0.001), significantly better mean flow velocity (Vm) in the vertebral artery (MD=3.21, 95% CI: 1.58, 4.84, p<0.001), significantly better Vm in the basilar artery (MD=5.09, 95% CI: 0.78, 9.40, p=0.02) and better quality of life scores (MD=9.83, 95% CI: 5.89, 13.77, p<0.001).

Conclusion: Acupuncture combined with bone-setting may be superior to monotherapy in improving symptoms, function and cerebral blood flow in patients with CV, with fewer and milder adverse effects. However, due to the limited methodological quality of the included studies, more high-quality, large-sample RCTs are needed to further validate these results.

Objectives: The aim of this study was to evaluate the effect of patient characteristics, including middle glenohumeral ligament (MGHL) morphological types, on the risk of redislocation following arthroscopic labral repair.

Patients and methods: Between February 2018 and May 2020, a total of 138 patients (105 males, 33 females; mean age: 26.5±9.8 years; range, 13 to 65 years) who underwent arthroscopic Bankart repair for traumatic anterior shoulder instability were retrospectively analyzed. Demographic data, the presence of an anterior labroligamentous periosteal sleeve avulsion (ALPSA) lesion, and information regarding the morphology of the MGHL were collected. Clinical outcomes were assessed using the Oxford Shoulder Instability Score (OSIS) and the Visual Analog Scale (VAS). The morphology of MGHL was classified through the analysis of surgical video recordings.

Results: Among the patients, ALPSA lesions were observed in 40% of cases. Redislocation occurred in 18% of patients and was significantly associated with younger age and ALPSA lesions. Multivariate logistic regression revealed that younger age at the time of surgery (odds ratio [OR]=0.936, p=0.047) and the presence of ALPSA lesions (OR=2.953, p=0.027) were independent predictors of redislocation. The morphology of MGHL showed no significant association with recurrence. The OSIS and VAS scores improved significantly postoperatively (p<0.001), and stable patients had more favorable final patient-reported outcome measures compared to those with redislocation.

Conclusion: Although variations in MGHL morphology did not independently influence outcomes, younger age and presence of ALPSA lesions were identified as predictors of postoperative instability following arthroscopic Bankart repair. Based on these findings, the increased risk of redislocation in younger patients and those with ALPSA lesions should be carefully considered during treatment planning.