Joint diseases and related surgery最新文献

Objectives: This study aimed to compare the clinical efficacy and complication rates of decompression with unilateral biportal endoscopy (UBE) and percutaneous endoscopy (PE) in cervical spondylotic radiculopathy (CSR).

Materials and methods: A comprehensive literature review was conducted up to April 2024 across multiple databases, including EMBASE, PubMed, Cochrane Library, China National Knowledge Infrastructure, and Wanfang Data, focusing on clinical studies that compare UBE with PE for posterior foraminotomy and discectomy decompression in CSR. The meta-analysis was performed with an emphasis on evaluating clinical outcomes such as operation time, blood loss, incision length, Neck Disability Index (NDI), Visual Analog Scale (VAS) for neck pain and arm pain, and complications.

Results: Out of an initial 1,041 studies identified from electronic databases, eight were deemed eligible based on title, abstract, and full-text screening. These studies involved 552 patients (269 males, 283 females; mean age: 53.9±11.4 years; range, 30 to 79 years), with 287 in the UBE group and 265 in the PE group. Meta-analysis indicated no significant difference in operation time between UBE and PE (mean difference [MD]=-3.68; 95% confidence interval [CI]:-19.38, 12.02; p=0.65). However, both blood loss (MD=17.01; 95% CI: 2.61, 31.41; p=0.02) and incision length (MD=11.62; 95% CI: 9.23, 14.01; p<0.00001) were significantly lower in the PE group compared to the UBE group. Regarding clinical outcomes, no significant differences were observed between the two groups in terms of NDI (MD=0.12; 95% CI:-0.10, 0.34; 0.28), VAS for neck pain (MD=-0.06; 95% CI:-0.19, 0.06; p=0.32), VAS for arm pain (MD=-0.14; 95% CI:-0.26, -0.01; p=0.84), or complications (OR=1.07; 95% CI: 0.54, 2.10; p=0.85).

Conclusion: Our findings suggest that there are no significant disparities in clinical outcomes between UBE and PE, encompassing NDI, VAS for arm pain, and VAS for neck pain, as well as complication rates. Notably, compared to PE, UBE results in increased bleeding and longer incision lengths when treating CSR, without substantially reducing operation time.

Objectives: This study aimed to investigate the infections following musculoskeletal injuries in earthquake survivors, offering a future clinical point of reference for the handling of musculoskeletal injuries resulting from earthquakes.

Patients and methods: In this single-center retrospective observational study, 225 earthquake survivors (120 females, 105 males; median: 39 years; range, 18 to 94 years) admitted between February 2023 and April 2023 were evaluated. Patients with musculoskeletal injuries and patients who had at least one month of follow-up data were included in the study. Diagnosis of healthcare-associated infections was verified by an infection control physician in accordance with the Centers for Disease Control and Prevention.

Results: Among all cultures, the most isolated pathogen was Acinetobacter baumannii (49.4%), followed by enterococci (28.6%). Colistin sensitivity of A. baumannii was 36 (94.7%). However, sensitivity rate was 5.3% for ciprofloxacin, 10.5% for piperacillin-tazobactam, and 26.4% for carbapenems, which are frequently used for skin and soft tissue infections. Among all, 76% of the microorganisms isolated from wound culture and 58% of the microorganisms isolated from deep tissue culture were found to be multidrug-resistant pathogens. During the follow-up, 12 (5.3%) patients had hospital-acquired urinary tract infections, 13 (5.7%) patients had hospitalacquired bloodstream infections, one (0.4%) patient had hospital-acquired pneumonia, and 74 (32.8%) patients had surgical site infections. Eighty (35.6%) of the patients were followed up in the intensive care unit, and the overall mortality rate was 2.7%.

Conclusion: While gram-positive microorganisms are frequently the causative microorganisms in infections after traumatic injuries, this study revealed that gram-negative microorganisms could be observed more frequently in postearthquake traumatic injuries. Most causative microorganisms are resistant to commonly prescribed antibiotics in clinical settings, which makes them more challenging to treat.

Objectives: The aim of this study was to investigate the efficacy of three-dimensional (3D) printing-assisted treatment for acetabular fractures (AFs) and to compare with conventional surgical methods.

Patients and methods: Between May 2019 and May 2022, a total of 44 patients (33 males, 11 females; mean age: 40.6±11.8 years; range, 20 to 68 years) who were diagnosed with AFs based on clinical symptoms, X-ray and computed tomography (CT) and underwent open reduction and internal fixation in Hospital of Xinjiang Production and Construction Corps were retrospectively analyzed. The patients were divided into two groups based on whether 3D printing was applied as the experimental group (n=24) and control group (n=20). In the experimental group, pelvic and acetabular data were imported into a 3D printer, and an equal-scale highly simulated model was printed using photosensitive resin as the 3D printing material. The model was used to develop more specific personalized surgical plans, to determine the optimal sequence of surgical procedures for fracture reduction, and simulate surgery in vitro.

Results: In the experimental group, the mean surgical duration was shorter (123.57±22.05 vs. 163.57±26.20 min, p<0.001), the mean intraoperative bleeding loss was lower (557.14±174.15 vs. 885.71±203.27 mL, p<0.001), and the frequency of intraoperative fluoroscopy was lower (8.64±1.65 vs. 12.07±2.76, p<0.001) than in the control group. No statistically significant differences were found between the two groups in the Visual Analog Scale scores after surgery or the hip function score after treatment (p>0.05). No major postoperative complications were observed in any of the patients.

Conclusion: Compared to conventional surgical treatment, preoperative 3D printing-assisted treatment for adult patients with AFs can significantly reduce surgical duration, intraoperative bleeding loss and frequency of intraoperative C-arm fluoroscopy, reducing surgical difficulty and improving surgical safety.

Objectives: The study focused on the ability to predict the need and size of femoral and tibial augmentation using standard two-dimensional (2D) templates and models created with three-dimensional (3D) printing in surgical planning.

Patients and methods: This observational cohort study included 28 consecutive patients (22 females, 6 males; mean age: 71±7.3 years; range, 54 to 82 years) with periprosthetic joint infection recruited between March 2021 and September 2023 undergoing revision total knee arthroplasty revision (TKA). Standard planning was made using calibrated X-ray images. The 3D planning started with computed tomography scans to generate a 3D template of the distal femur and proximal tibia. The model was exported to a 3D printer to produce a patient-specific phantom. The surgery was then simulated on the 3D phantom using revision knee arthroplasty instrumentation to evaluate the appropriate augmentation to use until a correct alignment was obtained.

Results: Three-dimensional planning predicted the need for femoral and tibial augments in 22 (78.6%) cases at both the tibial and femoral components, while 2D planning correctly predicted the need for augmentation in 17 (60.7%) for the tibial side and 18 (64.3%) for the femoral side. The Cohen's kappa demonstrated a significant agreement between the 3D planning for the femoral metal block and the intraoperative requirement (kappa=0.553), whereas 2D planning showed only nonsignificant poor agreement (kappa=0.083). In contrast, the agreement between 2D or 3D preoperative planning for tibial augment and the intraoperative requirement was nonsignificant (kappa=0.130 and kappa=0.158, respectively). On the femoral side, 2D planning showed only a fair nonsignificant correlation (r=0.35, p=0.069), whereas 3D planning exhibited substantial agreement with the actual thickness of the implanted augment (r=0.65, p<0.001). On the tibial side, 3D and 2D planning showed substantial agreement with the actual size of implanted augments (3D planning, r=0.73, p<0.001; 2D planning, r=0.69, p<0.001).

Conclusion: Prediction based on 3D computed tomography segmentation showed significant agreement with the intraoperative need for augmentations in revision TKA. The results suggest that planning with 3D printed models represents a stronger aid in this kind of surgery rather than standard 2D planning, providing greater accuracy in the prediction of the required augmentation in revision TKA.

Objectives: This study aimed to investigate the relationship between the severity of preoperative valgus deformity and clinical outcomes of neutrally aligned total knee arthroplasty (TKA).

Patients and methods: A total of 376 knees with valgus deformity who underwent TKA from January 2006 to March 2014 were retrospectively screened, and 287 knees (242 patients; 32 males, 210 females; mean age: 64.5±8.8 years; range, 35 to 83 years) aligned neutrally after the operation were included. Patients were divided into four groups based on the preoperative hip-knee-ankle (HKA): mild (0°< HKA ≤5°, n=94), moderate (5°< HKA ≤10°, n=74), severe (10°< HKA ≤15°, n=75), and very severe (HKA >15°, n=44) groups. Range of motion (ROM), Knee Society Score (KSS), Visual Analog Scale (VAS) dynamic pain scores, and Forgotten Joint Score (FJS) were evaluated. Mechanical failures were recorded to assess prosthesis survival. A survival rate analysis was performed using Kaplan-Meier survival analysis.

Results: The degree of preoperative valgus deformity did not have a significant impact on the postoperative ROM, KSS, VAS dynamic pain scores, or FJS at the last follow-up. There were no significant differences in cumulative survival rates of neutrally aligned TKAs at 10 years between the four groups (p=0.513).

Conclusion: The severity of preoperative valgus deformity did not affect the clinical outcomes of neutrally aligned TKAs in the minimum five-year follow-up. Additionally, it did not impact the survival rates of neutrally aligned TKAs over 10 years.

Objectives: The aim of this study was to evaluate the longterm outcomes of open tibia fractures treated using the Ilizarov external circular fixation (ECF) technique in the Military Medical Academy.

Patients and methods: Between January 1992 and December 2011, a total of 134 male military personnel (median age: 22.5 years; range, 18 to 36 years) with Gustilo-Anderson type 3 open tibia fractures treated with ECF were retrospectively analyzed. All patients underwent multiple surgeries and eventually Ilizarov fixation surgery. The radiological and functional outcomes were evaluated using the Association for the Study and Application of Methods of Ilizarov (ASAMI) criteria, and complications were noted.

Results: The median follow-up was 17.7 (range, 10 to 29) years. The median time to union was 4.7 (range, 3 to 8) months. All frames were removed from the limb, when union was observed. No re-fracture, limb length discrepancy more than 2.5 cm, or below-knee amputation after Ilizarov treatment was seen in any patient. Chronic osteomyelitis was observed at in 40% (n=54) of the patients at a median time ranging from 17 to 148 months. The overall ASAMI bone scores were excellent in 40 (30%), good in 20 (15%), fair in 20 (15%), and poor in 54 (40%) patients with osteomyelitis. The ASAMI functional scores were excellent in 40 (30%), good in 40 (30%), and fair in 54 patients (40%). No poor score was observed. Minor pin site infections were observed in 63 patients (47%).

Conclusion: Our long-term study results showed that all patients returned to their social life and were mobilized without support after treatment with the use of Ilizarov ECF method of open tibia fractures caused by high-energy ballistic injuries. However, complications such as pin tract infections and osteomyelitis after several years must be kept in mind in the treatment of comminuted bone fractures caused by firearms and ballistic missiles injuries.

Objectives: The purpose of this study was to investigate the relationship between patient demographics and potential intraoperative factors and delayed bone union in opening wedge high tibial osteotomy (OWHTO).

Patients and methods: A retrospective review of 65 patients (37 females, 28 males; mean age: 60.1±10.1 years; range, 44 to 77 years) who underwent OWHTO using an angle-stable implant with beta-tricalcium phosphate gap filling between September 2016 and October 2019 was conducted. The osteotomy site was divided into five zones from the lateral hinge on anteroposterior radiographs, and we defined the zone in which bone healing was observed. The bone union area was assessed according to this definition at three, six, nine, and 12 months after surgery, and bone union was defined as union at the fourth zone or greater. A generalized estimating equations approach was employed to investigate longitudinal data pertaining to bone union area as a dependent variable. In addition, the association of bone union at six months postoperatively and predictors were evaluated using cross-sectional statistical methods. The categorical predictors included in the models were smoking, diabetes, hinge fracture, and autologous osteophyte grafting. The continuous variables included in the models were age, body mass index, opening gap width, and plate position.

Results: Smoking (odds ratio [OR]=0.478, p<0.01), large opening gap width (OR=0.941, p=0.014), and anterior plate placement (OR=0.971, p<0.01) were significantly associated with decreased bone union area. Union rate at six months in smokers was significantly lower compared to nonsmokers (16.6% and 67.8%, respectively; OR=0.10, p=0.023). Area under the curve in the receiver operating characteristic analysis for bone union at six months was 0.60 for gap width and 0.63 for plate placement.

Conclusion: Smoking, large opening gap width, and anterior plate placement are risk factors for delayed bone union after OWHTO. Surgeons should avoid anterior placement of the plate and carefully consider other options for smokers and those who require a large correction.

Dislocations of the fourth and fifth carpometacarpal joints (CMCJs) are rare and often misdiagnosed via radiography. Moreover, treatment strategies have not yet been standardized. Herein, we report a case of chronic dislocations of the fourth and fifth CMCJs with delayed diagnosis and successful treatment via ligament repair. A 29-year-old male patient who was initially diagnosed with contusion at another center following a fall on the stairs was referred to our hospital one month later due to persistent pain and swelling. Fourth and fifth CMCJ dislocations were diagnosed using radiography and computed tomography. Closed reduction attempts were unsuccessful, prompting open reduction. The operative findings included rupture of the dorsal carpometacarpal ligament and hamate cartilage injury. Using two mini anchors, the fourth and fifth dorsal carpometacarpal ligaments were repaired, and Kirschner-wire (K-wire) pinning was performed. The K-wire was extracted after four weeks. At the eight-month follow-up, the only remaining symptom was mild discomfort, and the range of motion and grip strength was fully recovered. Our findings highlight the difficulties in diagnosing CMCJ dislocation and suggest ligament repair as a treatment option for chronic cases of CMCJ dislocation.

Brucella disease is an infectious disease caused by Brucella bacteria. It is transmitted through the consumption of unpasteurized dairy products and undercooked meat and penetration through the skin of individuals in contact with farm animals. A detailed medical history is of utmost importance in the diagnosis. Headache, cyclical fever, sweating, vomiting, abdominal pain, and wandering arthralgia are among the main clinical symptoms. Brucella infection is usually characterized by inflammation in the musculoskeletal system, and osteomyelitis is rarely seen. In this article, we report a case of osteomyelitis after neglected brucellosis.

Objectives: This study aims to investigate the etiological distribution of primary and metastatic malignancies around the elbow and the effect of surgical and adjuvant treatments on clinical outcome.

Patients and methods: Between January 2006 and December 2020, medical records of a total of 33 patients with elbow neoplasm (15 males, 18 females; median age: 55 years; range, 39 to 71 years) who underwent surgical treatment and with or without clinical treatment were retrospectively analyzed. The outcomes and frequencies of the elbow metastatic and primary malignancies were evaluated. Data were collected from patients' medical and radiological documents, and a dedicated archive was created for this study.

Results: Most tumors occurred on the right side and were intra-articular or distal to the humerus. A total of 75.8% (25/33) of the patients had tumors of any diameter ≥5 cm. Most patients were treated with extensive resection. A total of 81.8% (27/33) of the patients had wide resected tumor margins, and 18.2% (6/33) had intralesional tumor margins. The median follow-up was 42 (range, 1 to 83) months. Synovial sarcoma and malignant peripheral nerve sheath tumors were the most common soft tissue sarcomas, and pulmonary adenoma and multiple myeloma were found in metastatic lesions.

Conclusion: Elbow surgery is particularly challenging due to the interrelationship of major neurovascular structures. Synovial sarcoma and malignant peripheral nerve sheath tumors are the most common soft tissue sarcomas, and pulmonary adenoma and multiple myeloma are found in metastatic lesions. Limb-sparing surgery is the gold-standard method recently.