Joint diseases and related surgery最新文献

Intraosseous schwannomas are extremely rare benign tumors originating from Schwann cells of the peripheral nervous system. While these tumors are commonly found in the mandible and sacrum, their occurrence in long bones, particularly the ulna, is uncommon. A 59-year-old female patient was admitted with a two-year history of pain and swelling in her right elbow. Radiographic imaging revealed a lytic lesion with cortical expansion and thinning in the proximal ulna metaphysis, while magnetic resonance imaging showed a lesion with irregular borders extending into the joint via cortical erosion. Differential diagnoses included a simple bone cyst, enchondroma, giant cell tumor, and metastasis. Surgical procedure involved curettage and bone grafting, and the lesion was diagnosed histologically as an intraosseous schwannoma. Immunohistochemical staining showed positive expression of SOX10 and S100, confirming the diagnosis. Postoperative recovery was uneventful, and the patient regained a full range of motion without pain at her six-month follow-up. In conclusion, this case underscores the importance of considering intraosseous schwannoma in the differential diagnosis of benign bone lesions, particularly in rare locations such as the ulna. Histopathological examination remains essential for an accurate diagnosis.

Objectives: This study aims to evaluate the interobserver reliability and interobserver reproducibility of radiographic acetabulotrochanteric distance (ATD) measurement and to investigate its accuracy by comparing it with conventional radiographic methods used in leg length discrepancy (LLD) measurement.

Patients and methods: Between January 2017 and January 2022, a total of 97 patients (39 males, 58 females; mean age: 77.8±7.1 years; range, 61 to 91 years) who underwent pelvic radiographic evaluation and hemiarthroplasty (HA) due to femoral neck fracture were retrospectively analyzed. For ATD measurement, the distance between the line connecting the upper cartilage of the acetabulum (AC) and the extreme point of the greater trochanter (GT) was used. The AC-GT measurement on both sides was compared with bottom of the ischial tuberosities-lesser trochanter (BI-LT), center of the femoral head-BI (CH-BI), inferior acetabular teardrops-LT (IT-LT) measurements. The agreement between the methods was examined with the intraclass correlation coefficient (CCI).

Results: According to the AC-GT & BI-LT, AC-GT & BI-CH methods, there were very strong (ICC: 0.75), moderate (ICC: 0.69) and acceptable (ICC: 0.33) agreements, respectively. Significant agreement was found between all measurements (p<0.001). A positive correlation was detected in the correlation analysis of all measurements (p<0.001). Intra- and interobserver agreement for ATD measurement (AC-GT) was excellent (ICC: >0.8).

Conclusion: The ATD measurement correlates well with known measurement techniques on pelvic radiography and can be used as an alternative to this method. It has excellent intra- and interobserver agreements. This method can predict LLD after HA, but does not consider other length differences in the lower limbs.

Objectives: In this systematic review and meta-analysis, we evaluate and compare the clinical efficacy and safety of proximal femoral nail antirotation (PFBN) and proximal femoral bionic nail (PFNA) for treating intertrochanteric fractures in elderly patients, with the goal of providing evidence-based recommendations for clinicians to select the most suitable internal fixation method.

Materials and methods: We conducted a literature search in the CNKI, PubMed, Cochrane, and Embase databases for studies on PFBN and PFNA in treating elderly intertrochanteric femoral fractures, with a search timeframe from database inception to November 2024. Two reviewers independently screened the literature according to the inclusion and exclusion criteria and extracted relevant data.

Results: A total of eight studies were included, involving 506 patients with intertrochanteric femoral fractures, with 225 in the PFBN group and 281 in the PFNA group. The meta-analysis results indicated that the PFBN group had a significantly shorter fracture healing time compared to the PFNA group (mean difference [MD]=-0.61, 95% confidence interval [CI]: -1.12 to -0.10, p<0.01), an earlier postoperative weight-bearing time (MD=-13.51, 95% CI: -22.38 to -4.64, p<0.01), and a higher Harris Hip Score postoperatively (MD=0.93, 95% CI: 0.01 to 1.86), p<0.05). However, the surgical time in the PFNA group was significantly shorter than that in the PFBN group (MD=6.19, 95% CI: 2.35 to 10.03, p<0.01), and the intraoperative blood loss was also significantly less (MD=9.61, 95% CI: 0.57 to 18.65, p<0.01). There was no significant statistically significant difference in complication rates between the two groups.

Conclusion: The PFBN group exhibited a significantly shorter fracture healing time, earlier postoperative weight-bearing time, and better hip function after surgery in treating elderly intertrochanteric femoral fractures. However, the surgical time and intraoperative blood loss in the PFBN group were significantly greater than those in the PFNA group. Nonetheless, there were no significant differences in complication rates between the two groups. Therefore, PFBN remains an ideal internal fixation method for treating elderly intertrochanteric femoral fractures.

Objectives: This study aims to investigate the effect of Kirschner wires (K-wires) placed in the lateral hinge on lateral cortical fractures occurring during medial opening wedge high tibial osteotomy (MOWHTO) technique.

Patients and methods: The mechanics of different models were compared using the finite element analysis and mathematical simulations. The first model is without K-wire control model, the second and third models are with one and two K-wires, respectively. The gap displacement (mm), gap distance (mm), correction angle (°), cortical-cancellous bone stresses (MPa), and stiffness (N/mm) of the hinge were used as outputs to compare the models. The effect of the position of the K-wire in the lateral hinge on the hinge stress and opening angle was also examined.

Results: The K-wires applied to the lateral hinge to prevent lateral cortex fracture reduced the hinge stress and increased the hinge stiffness. Higher force values were required to open the same amount of osteotomy compared to osteotomies without K-wires, which was a direct effect of increased hinge stiffness. Getting closer to the hinge for the K-wire position decreased the maximum stress value at the hinge and caused lower opening angles.

Conclusion: The higher force requirement for opening the osteotomy with K-wire application may reduce the risk of lateral hinge fracture by providing a more controlled and safer osteotomy opening, particularly for less experienced surgeons. Additionally, getting closer to the hinge for the K-wire position plays a positive role in preventing lateral hinge fractures. However, the opening angle decreases as the K-wire gets closer to the hinge.

Objectives: This experimental study aims to investigate the effects of angiotensin (1-7) (Ang-[1-7]) on the microstructural, biomechanical, and biophysicochemical properties of bone tissue in diabetic rats.

Materials and methods: Forty-eight male Wistar rats, aged three months and weighing between 280 and 330 g, were used in this study. Four groups, each containing 12 rats, were established: Control, diabetes mellitus (DM), DM-Ang-(1-7), and Ang-(1-7). The samples underwent analysis through micro-computed tomography (CT), Raman spectroscopy, and three-point bending biomechanical test.

Results: Diabetes significantly impaired bone quality, with reduced cortical thickness, maximum load, and flexural strength (p<0.05). The Ang-(1-7) treatment improved flexural strength (p<0.05), but did not fully restore mechanical function. Micro-CT showed decreased bone volume and trabecular thickness in both diabetic groups (p<0.05), with no significant recovery by Ang-(1-7). Raman spectroscopy revealed lower mineral-to-matrix ratio and disrupted collagen quality in diabetic bone (p<0.05), while Ang-(1-7) partially restored collagen-related parameters.

Conclusion: These findings highlight that Ang-(1-7) has minimal impact on bone minerals in DM rats. However, it may have a potential preventive effect on the triple-helix structural impairment within the bone organic matrix in this model.

Objectives: The aim of this study was to evaluate hidden blood loss (HBL) and to identify its possible risk factors after percutaneous vertebroplasty (PVP) in patients with spinal metastases from breast cancer.

Patients and methods: Between January 2020 and January 2024, a total of 54 female patients (mean age: 65.3±7.9 years, range, 47 to 79 years) with breast cancer and vertebral metastases who underwent PVP were retrospectively analyzed. Patient data were collected including demographic characteristics, oncological profiles, laboratory parameters, particularly pre- and postoperative hematocrit (Hct) levels, and clinical variables. The Sehat equation was employed to quantify HBL based on Hct alterations. To identify significant predictors of HBL, a multiple linear regression analysis of potential risk factors was carried out.

Results: The mean surgical time was 32.0±8.5 min. Cement leakage occurred in 44.4% of cases. The mean hemoglobin (Hb) loss and Hct loss were 0.9±0.4 g/dL and 2.8±0.6%, respectively. The mean HBL was 287.2±57.4 mL. Multiple linear regression analysis showed that HBL was positively correlated with bone metastasis (p=0.010), surgical time (p=0.009), number of punctures (p=0.036), cement leakage (p=0.026), Hct loss (p=0.020), and TBL (p<0.001), while it was negatively correlated with postoperative Hct (p=0.024).

Conclusion: Bone metastasis, surgical time, number of punctures, cement leakage, Hct loss, and TBL are independent risk factors for HBL. Therefore, HBL warrants clinical attention in patients with spinal metastases from breast cancer undergoing PVP, particularly those with these risk factors.

Objectives: This study aims to evaluate the hidden blood loss (HBL) and its possible risk factors after anterior cervical discectomy and fusion (ACDF) with zero-profile anchored spacer (ZPAS) in patients with cervical radiculopathy.

Patients and methods: Between January 2017 and January 2024, a total of 92 patients (44 males, 48 females; mean age: 73.2±10.0 years; range, 44 to 85 years) who underwent ACDF with ZPAS were retrospectively analyzed. Data collection encompassed baseline demographics including age, sex, height, weight, body mass index (BMI), disease duration, symptomatic laterality, and comorbidities and perioperative parameters such as the American Society of Anesthesiologists (ASA) score, operative levels, surgical time, intraoperative blood loss, and postoperative drainage volume. The HBL was quantified using the Sehat formula. Subsequent multivariate linear regression modeling was employed to identify independent predictors of HBL.

Results: The mean surgical time was 152.6±27.6 min. The mean total blood loss (TBL) and HBL were 334.6±67.7 mL and 268.1±69.0 mL, respectively. Correlation analyses revealed significant associations between HBL and symptomatic laterality, hematocrit (Hct) loss, surgical levels, and surgical time (p<0.05). Multivariate linear regression further confirmed Hct loss, surgical levels, and surgical time as positive predictors of HBL (p<0.05).

Conclusion: Patients with cervical radiculopathy who underwent ACDF with ZPAS perioperatively had significant HBL. More Hct loss, more surgical levels, and longer surgical time were independent risk factors for increased HBL.

Objectives: This study aims to evaluate the clinical effectiveness of platelet-rich fibrin (PRF) therapy in combination with core decompression (CD) and grafting in patients with femoral head avascular necrosis (AVNFH).

Patients and methods: Between February 2015 and February 2020, a total of 63 patients (45 males, 18 females; mean age: 45.8±11.7 years; range, 21 to 65 years) with early-stage AVNFH (Ficat-Arlet Stages I-II) who underwent treatment were retrospectively analyzed. The patients were divided into two groups: those treated with CD and grafting (CD+grafting; n=32) and those receiving additional PRF augmentation (CD+grafting+PRF; n=31). Demographic characteristics, including age, sex, and affected side, were comparable between the groups. Clinical assessments included pre- and postoperative Visual Analog Scale (VAS) for pain, Harris Hip Score (HHS), and Merle d'Aubigné Hip Score.

Results: No significant differences were observed between the groups preoperatively regarding HHS, Merle d'Aubigné scores, and VAS scores (p>0.05). Postoperatively, the PRF group demonstrated significantly improved outcomes in HHS (83.70±14.30 vs. 65.90±16.72, p=0.001), Merle d'Aubigné Hip Score (15.29±2.78 vs. 11.94±4.31, p=0.001), and VAS (2.06±1.50 vs. 4.69±2.08, p=0.001). Both groups showed significant clinical improvement, but PRF augmentation was associated with superior functional recovery and pain reduction.

Conclusion: Compared to CD+grafting alone, adding PRF to CD+grafting resulted in more favorable clinical outcomes with minimal complications. These findings suggest that PRF is a promising, minimally invasive adjunct therapy for joint preservation in early-stage AVNFH.

Objectives: In this study, we aimed to investigate whether there was a relationship between deformity at the fracture line/eccentric placement of the nail, and union time (UT) in isthmal diaphyseal femoral fractures treated with intramedullary nails.

Patients and methods: Between September 2017 and December 2020, a total of 61 patients (38 males, 23 females; median age: 47 years; range, 23 to 62 years) with closed femoral shaft fractures who underwent antegrade nailing were retrospectively analyzed. The following parameters were examined: (i) amount of angulation in the fracture line (AFL), (ii) varus/valgus of the fracture line (VAFL), (iii) amount of deviation of the distal tip of the nail from the femoral notch (DDT), (iv) medial lateral orientation of the distal nail relative to the notch (MLON), (v) number of fracture parts (NFP), and (vi) UT.

Results: The causes of injury were high-velocity traffic accidents in 42 patients and falls in 19 patients. The median surgical delay was 4.5 (range, 2 to 8 days). The median follow-up time was 37 (range, 12 to 57) months. There was a moderate, statistically significant and positive correlation between UT and AFL, DDT, and NFP (r=0.486, p<0.001). The difference in UT according to MLON (p=0.002) was statistically significant.

Conclusion: Our study results suggest that impaired weight-bearing force and translational force may cause impaired healing. Thus, angulation of the fracture line and eccentric nail placement may delay fracture union. We recommend using bold screws to ensure that there is no deformity in the fracture line and to fully center the nail inside the distal bone.

Periprosthetic joint infection (PJI) remains a challenging complication following total hip arthroplasty (THA), commonly managed through a two-stage revision which can lead to significant morbidity. In this article, we present a rare case of Salmonella enteritidis PJI, initially presenting as prosthetic hip dislocation. Preoperative hip aspiration utilizing blood culture bottles enabled early identification of the organism and guided targeted antimicrobial therapy. The patient underwent revision THA using a well-fixed custom-made articulating spacer (CUMARS) construct, with targeted antibiotic-loaded bone cement. One-year follow-up demonstrated successful eradication of the infection, stable implant fixation, and good functional outcomes. In conclusion, this case underscores the importance of diagnostic hip aspiration and highlights the potential of the CUMARS technique as an effective and durable solution for managing rare PJIs caused by atypical organisms such as Salmonella enteritidis.