Joint diseases and related surgery最新文献

Objectives: This study aimed to identify predictors of sepsis in earthquake survivors who underwent either amputation or fasciotomy and to compare these two patient groups across many clinical outcomes, including sepsis.

Patients and methods: In this retrospective study, a total of 1,608 patients who presented to our hospital following the February 6, 2023, Kahramanmaraş earthquakes were evaluated between February 2023 and March 2023. Of these, 138 patients (65 males, 73 females; median age: 35 years; range, 18 to 74 years) who underwent either fasciotomy or amputation were included in the study. Patients managed solely with fasciotomy were included in the fasciotomy group, while those who underwent amputation in at least one area were included in the amputation group. Sepsis predictors were investigated in this population. Additionally, the two groups were compared in terms of clinical outcomes, including bacteremia, sepsis, septic shock and mortality.

Results: Of the 138 earthquake survivors, 59 (42.8%) were in the amputation group, and 79 (57.2%) were in the fasciotomy group. There were no significant differences between the groups in terms of the development of crush syndrome or the need for renal replacement therapy (p=0.781 and p=0.411, respectively). The duration of entrapment under rubble was higher in the amputation group (p=0.030). While bacteremia was more common in the amputation group, there was no significant difference in relation to sepsis (p=0.002 and p=0.106, respectively). Septic shock and mortality rates were higher in the amputation group (p=0.001 and p=0.009, respectively). Multivariate analysis revealed that the number of traumatized sites (odds ratio [OR]=3.68, 95% confidence interval [CI]: 2.13-6.33, p<0.001), amputation at more than two sites (OR=4.27, 95% CI: 1.15-15.9, p=0.022), and fasciotomy at more than two sites (OR=2.71, 95% CI: 1.10-6.69, p=0.021) were significant predictors of sepsis.

Conclusion: Patients undergoing fasciotomy and amputation should be comprehensively evaluated for potential benefits and risks. Close monitoring for sepsis is particularly recommended for patients who have amputation or fasciotomy procedures at more than two sites.

Objectives: This study evaluated the impact of different doses of gabapentin and pregabalin on fracture healing in a rat femoral shaft model, with histological, radiological, and biomechanical assessments.

Materials and methods: Seventy male Wistar albino rats were divided into five groups: control, low-dose gabapentin (GBP-L, 300 mg/day), high-dose gabapentin (GBP-H, 3600 mg/day), low-dose pregabalin (PRG-L, 150 mg/day), and high-dose pregabalin (PRG-H, 600 mg/day), based on human equivalent doses. Bilateral femoral fractures were induced; the right femurs were prepared for radiological examination using microtomography, followed by histological analysis, whereas the left femurs were allocated for biomechanical testing. Drug administration began three weeks preoperatively and continued until sacrifice at either two or four weeks. Histological assessments included inflammation and transformation scoring and microtomography-measured callus volume. Biomechanical testing assessed maximum force and stiffness.

Results: At the fourth week, inflammation levels were significantly higher in the GBP-H, PRG-L, and PRG-H groups compared to control (p<0.01, p<0.05, and p<0.01), while transformation scores were significantly lower in these groups (p<0.01, p<0.05, and p<0.001). Low-dose pregabalin showed a borderline transformation difference (p=0.051). Microtomography analysis showed that the GBP-H group had significantly reduced callus volume versus control by the second week (p<0.01), persisting at a lower significance by week four (p<0.05). By the fourth week, PRG-H also had reduced callus volume (p<0.05). Maximum force values by the fourth week were significantly lower in the GBP-L, GBP-H, and PRG-H groups compared to control (p<0.05 for GBP-L; p<0.01 for GBP-H and PRG-H).

Conclusion: These findings suggest that these drugs, particularly with their high-dose applications, may lead to prolonged inflammation and hinder fracture healing by reducing callus volume and biomechanical integrity, potentially disrupting the transition from the inflammatory to reparative phases of healing.

Objectives: This study aimed to radiologically evaluate the possible relationship between the body mass index (BMI) and recurrence of varus deformity during the mid-term follow-up of patients treated for medial gonarthrosis.

Patients and methods: Fifty-six patients (11 males, 45 females; mean age: 53.8±7.2 years; range, 29 to 64 years) who underwent medial opening wedge osteotomy for the treatment of isolated medial varus gonarthrosis between January 1, 2020, and June 1, 2021, were retrospectively reviewed. Patients were categorized according to BMI values as having a healthy weight (18.5-24.9 kg/m²), being overweight (25.0-29.9 kg/m²), or being obese (≥30 kg/m²). Mechanical medial proximal tibial angle, hip-knee-ankle angle, joint line convergence angle, and knee adduction moment calculations were performed based on radiographs.

Results: Among the 56 patients, the mean age of those with healthy weight was 42.5±13.2 years, that of the overweight group was 53.3±6.4 years, and that of the obese group was 54.0±5.8 years. Radiological evaluations were statistically improved postoperatively compared to preoperative scores across BMI groups (p<0.05). There were no correlations between age and radiological scores or BMI (p>0.05). Similarly, no correlation was found between BMI and radiological scores (p>0.05).

Conclusion: Body mass index is not of significance in medial opening wedge osteotomy radiological scores in short- and mid-term follow-up.

This case report highlights a rare complication of arthroscopic meniscal tear which is an arteriovenous fistula and pseudoaneurysm of the superior medial geniculate artery. A 14-year-old male patient presented with persistent hemarthrosis following arthroscopic repair of a bucket handle medial meniscal tear. The patient was investigated due to suspicion of vascular damage. After obtaining computed tomography arteriogram, the patient was diagnosed with an arteriovenous fistula and pseudoaneurysm of the superior medial geniculate artery. Conservative management was pursued following consultation with cardiovascular surgery. At three months, the arteriovenous fistula was observed to be in remission. In conclusion, orthopedic surgeons performing knee arthroscopy should be vigilant about potential vascular complications, although rare, and consider early diagnosis and treatment in cases of persistent postoperative hemarthrosis.

Objectives: This study aims to investigate the frequency of recurrence and prolonged postoperative symptoms in patients undergoing open A1 pulley release for trigger finger and to identify potential associated factors.

Patients and methods: Between October 2021 and December 2023, a total of 72 patients (30 males, 42 females; mean age: 58.0±11.6 years; range, 32 to 84 years) who underwent trigger finger surgery with at least six months of follow-up were retrospectively analyzed. Patients were followed prospectively and relevant data were collected from patient files retrospectively. Demographics, finger symptoms, associated pathologies, clinical grades, Quinnell scores, Disabilities of the Arm, Shoulder and Hand (DASH) scores, grip strength, and surgeon experience were evaluated. Prolonged symptoms lasting over eight weeks postoperatively were also assessed.

Results: Comorbidities included carpal tunnel syndrome (13.89%), De Quervain tenosynovitis (13.89%), diabetes (8.33%), Bouchard's node (2.78%), ganglion cyst (8.33%), and calcium deposition (2.86%). Fourteen patients (19.44%) had additional trigger fingers. Loupe was used in 32 surgeries, resulting in significantly fewer prolonged symptoms (12.50% vs. 35.00%, p=0.028). The mean DASH scores significantly improved after surgery (53.07±13.43 vs. 18.41±11.26, p=0.000), with a greater improvement in the loupe group (46.52±6.50 vs. 25.18±13.96, p=0.0000). The mean grip strength did not significantly differ between the surgical and control sides in the loupe group (27.29±7.58 vs. 26.36±7.85 lb, p=0.0887); however, it was weaker on the surgical side in the nonloupe group (23.87±7.81 vs. 25.28±6.96 lb, p=0.0067). Loupe usage was the sole significant factor which was absent in 77.78% of the patients with prolonged symptoms.

Conclusion: Trigger finger surgery, though typically simple and routine, may benefit from loupe-assisted procedures due to reduced postoperative symptoms and improved functional outcomes. Consideration of loupe use is warranted in such surgeries.

Objectives: The study aimed to evaluate the hidden blood loss (HBL) and its possible risk factors in patients undergoing percutaneous endoscopic cervical discectomy (PECD) via posterior approach to better guide the management of perioperative anemia in patients.

Patients and methods: The study retrospectively analyzed the clinical data of 60 patients (33 males, 27 females; mean age: 55.3±7.9 years; range, 40 to 69 years) treated with PECD between March 2019 and January 2023. All patients had cervical disc herniation or radiculopathy. General information (age, sex, height, weight, body mass index, Visual Analog Scale pain score, and comorbidities), surgery-related data (surgical time, number of surgical segments, American Society of Anesthesiologists score, and blood transfusions), and laboratory-related results (hemoglobin, hematocrit, albumin, and blood glucose) of the patients were collected from the hospital database. The patients' HBL was calculated based on the patients' height, weight, and hematocrit levels, and then the risk factors were analyzed by multiple linear regression.

Results: Only five patients underwent two-segment PECD via a single channel. The mean surgical time and HBL were 110.3±34.0 min and 114.5±50.2 mL, respectively. Six patients who were not anemic preoperatively developed anemia postoperatively, and the difference in the incidence of anemia between preoperative and postoperative periods was statistically significant (p=0.013). Multiple linear regression analysis showed that HBL was associated with surgical time and the number of surgical segments (p<0.001).

Conclusion: Hidden blood loss after PECD may represent a significant issue, with a risk of causing anemia. The number of surgical segments and surgical time are independent risk factors for HBL. Spine surgeons should emphasize the adverse effects of HBL to ensure the safety of patients in the perioperative period.

Objectives: This study aimed to evaluate clinical outcome, prevalence, severity, location, range of motion, and possible risk factors of heterotopic ossification (HO) following severe radial head fractures.

Patients and methods: In this retrospective study, 73 patients (40 males, 33 females; mean age: 51.4±15 years; range, 20 to 82 years) with Mason-Johnston type 3 and 4 radial head fractures were surgically treated with osteosynthesis or radial head arthroplasty (RHA) between September 2014 and February 2021. Fifty-one were examined in person, while 22 participated via questionnaire. The clinical outcome was assessed by the range of motion, the Disabilities of the Arm, Shoulder, and Hand questionnaire (DASH), and the 36-item Short-Form Health Survey (SF-36). Operative and postoperative details and the intake of HO prophylaxis were reviewed. Heterotopic ossification severity and location was evaluated on radiographs.

Results: Heterotopic ossification was present in 52.1%, while in 31.5% of all participants, RHA was needed. Overall, 46.6% received additional ligamental refixation. The mean time to surgery was 8.9±11.9 days, and the mean DASH was 13.7±16.6. In patients treated with osteosynthesis, more HO was observed for Mason-Johnston type 4 injuries compared to Mason-Johnston type 3 injuries (p=0.028). Overall, more HO was present in Mason-Johnston type 4 injuries (63.6%) compared to Mason-Johnston type 3 injuries (42.5%), without reaching significance (p=0.072). No significant association between HO and time to surgery (p=0.716), implantation of RHA (p=0.127), or ligamental refixation (p=0.121) was detected. Regardless of intake of HO prophylaxis, nearly the same amount of HO (51.7% vs. 53.8%) was present. No differences between the HO and non-HO group were detected in the DASH (p=0.553) and the SF-36 (physical component, p=0.728; mental component, p=0.275).

Conclusion: Over 50% surgically treated radial head fractures classified as Mason-Johnston types 3 and 4 developed HO, while more severe injuries led to a higher prevalence of HO. No increased rates of HO were determined for delayed surgery, surgical treatment methods, and use of HO prophylaxis. Therefore, regular HO prophylaxis might not be needed. Additionally, no significant differences in functional scores and quality of life were detected between patients with and without HO.

Objectives: This study aims to investigate the relationship between the expression of lipid metabolism and cartilage degeneration-related factors and Modic changes (MCs) of lumbar vertebral.

Patients and methods: This prospective study included a total of 10 patients (6 males, 4 females; mean age: 60.4±8.7 years; range 51 to 82 years) who underwent lumbar interbody fusion surgery due to degenerative lumbar diseases (MC group), and 10 control patients (4 males, 6 females; mean age: 49.7±9.8 years; range, 42 to 76 years) with lumbar burst fractures (nonMC group) between January 2020 and December 2022. Clinical imaging data and cartilage tissues were collected to observe cartilage characteristics and pathological changes. The relative expression levels of lipid metabolism-related inflammatory factors matrix metalloproteinase-1 (MMP-1), a disintegrin and metalloproteinase with thromboSpondin motifs-5 (ADAMTS-5), and aggrecan in cartilage were detected by quantitative polymerase chain reaction (qPCR). The relative expression levels of MMP-1 and ADAMTS-5 proteins in cartilage tissues were detected by Western blotting.

Results: There were no significant differences in the baseline characteristics between the two groups. The color and transparency of the endplate cartilage in the control group were significantly better than those in the MCs group. Radiographic and hematoxylin-eosin staining of the endplate cartilage tissues showed that the extracellular matrix was higher in the control group than in the MCs group (p<0.05). Compared to the control group, qPCR analysis showed higher expression of MMP-1 and ADAMTS-5 in the MCs group, while aggrecan expression was lower (p<0.05). Western blot analysis showed that both MMP-1 and ADAMTS-5 expression were higher in the MCs group than in the control group (p<0.05).

Conclusion: Lipid metabolism and cartilage degeneration-related inflammatory factors exist in the vertebral endplate of the patients with degenerative lumbar diseases, and the upregulation of MMP-1 and ADAMTS-5 may be related to MCs and endplate degeneration.

Objectives: This study aims to evaluate the clinical outcomes of an anatomical medial patellofemoral ligament (MPFL) reconstruction and the effects of concomitant patellofemoral joint injuries and radiological findings on outcomes in adolescents with recurrent patellar dislocation (RPD).

Patients and methods: Between January 2011 and January 2020, a total of 34 patients (19 males, 15 females; median age: 15.6 years; range, 13 to 17 years) with RPD who underwent anatomic MPFL reconstruction were retrospectively analyzed. Lateral release was performed as indicated. Clinical outcomes were evaluated preoperatively and at the final follow-up using the Visual Analog Scale (VAS), Lysholm, Kujala, and Tegner activity rating scales. Magnetic resonance imaging was performed to detect concomitant injuries such as bone, cartilage, and soft tissue injuries.

Results: The mean follow-up was 5±2 years. All postoperative knee functions and activity levels were statistically significantly improved without re-dislocation (p<0.001). There was no statistically significant relationship between the presence and location of cartilage lesions and clinical outcomes (p>0.05). Patients with cartilage lesions had a significantly higher CatonDeschamps index and a higher incidence of bone edema in both the patella and femur than patients without.

Conclusion: Anatomic MPFL reconstruction with meticulous physical therapy has successful clinical outcomes, prevents re-dislocation, and increases participation in sports and activity levels in adolescent patients with RPD. Although cartilage injuries are common after RPD, it has no adverse effect on clinical outcomes in the mid-term.