Joint diseases and related surgery最新文献

Objectives: In our study, we aimed to evaluate the efficacy of prophylactic ozone therapy (OT) for heterotopic ossification (HO) development after hip surgery in a rat model.

Materials and methods: We randomly divided a total of 20 Wistar albino rats into two equal groups (n=10) as the control group (Group 1) receiving daily intraperitoneal injections of 1 mL of Ringer's lactate solution for a duration of two weeks after undergoing hip surgery and the group (Group 2) receiving OT daily at a dose of 1 mL of an ozone/oxygen combination via intraperitoneal route for a period of two weeks after hip surgery. Hip surgery was performed to mimic the formation of HO. After 12 weeks, the animals were evaluated functionally and sacrificed. Following sacrification, histopathological, and radiological assessments were performed.

Results: The modified Brooker staging method was used for radiological evaluation, and all animals in the control group showed at least Stage 1 HO formation. However, only three animals (30%) in the OT group showed HO formation (p=0.006). In histopathological evaluation, the median HO rates in the high power field were 42.5 (range, 30 to 55) in the control group and 0 (range, 0 to 25) in the OT group (p=0.003), and the median leukocyte count was 5.5 (range, 3 to 7) in the control group and 1 (range, 0 to 3) in the ozone group (p=0.006). Radiological HO, histopathological HO, and inflammation were significantly lower in the ozone group (p<0.05).

Conclusion: Our study results suggest that OT is effective in decreasing HO formation in rats following hip surgery.

Objectives: The aim of this study was to evaluate the clinical and radiological results of the combined use of distal closed wedge and proximal open wedge osteotomies in cases of recurrent hallux valgus (HV) with an increased distal metatarsal articular angle (DMAA).

Patients and methods: Between January 2019 and December 2022, a total of 10 female patients (mean age: 48.8±10.8 years; range, 28 to 63 years) who underwent surgical treatment for recurrent HV with an increased DMAA were retrospectively analyzed. Pre- and postoperative anterior-posterior and lateral radiographs of the patients were taken. The intermetatarsal angle (IMA), DMAA, and HV angle (HVA) were measured and compared before and after surgery. The clinical outcomes of the patients were evaluated using the American Orthopaedic Foot & Ankle Society (AOFAS) score, Manchester-Oxford Foot Questionnaire (MOXFQ) score, and Maryland Foot Score (MARYLAND).

Results: The median follow-up was 33.1 (range, 24 to 78) months. Seven (70%) of the patients underwent surgery on the right side and three (30%) of the patients underwent surgery on the left side. The median time to recovery of osteotomies was 8 (range, 6 to 10) weeks. There was no loss of correction at minimal two years of follow-up. None of the patients developed postoperative infections. The postoperative HVA, IMA, DMAA values of the patients were statistically significantly lower than the preoperative values (p<0.05). The AOFAS and MARYLAND scores of the patients at six and 24 months after surgery were statistically significantly higher compared to the baseline (p<0.05). Considering the MOXFQ scores, the scores at six months and 24 months after surgery were statistically significantly lower than the scores before surgery (p=0.005 for both). Similarly, MOXFQ scores at 24 months after surgery were statistically significantly lower than those at six months (p=0.013), indicating that the clinical improvement obtained at six months continued to increase until 24 months.

Conclusion: The combination of distal closed wedge and proximal open wedge osteotomies for HV recurrence seems to be an effective surgical technique for correction of the deformity. Plate and screw fixation can increase the rate of bone union and accelerate postoperative mobilization of the patients. Further large-scale, long-term studies are needed to provide more comprehensive findings on the effectiveness of HV surgery and elucidate the effects of postoperative rehabilitation processes on recovery in order to optimize the treatment protocols.

Objectives: This study aims to assess the effects of systemic medical ozone (O₃) application and to compare its effects with hyperbaric oxygen (HBO) therapy for preventing avascular necrosis of the femoral head in a rat model.

Materials and methods: A total of 50 male Wistar albino rats were divided into six groups including five rats in each control and sham-operated control group and 10 rats in the remaining four groups: (i) control group, (ii) sham-operated control group, (iii) avascular necrosis group, (iv) intraperitoneal ozone given avascular necrosis group, (v) HBO therapy given avascular necrosis group, and (vi) intraperitoneal ozone and HBO given avascular necrosis group. We surgically induced osteonecrosis by cutting the ligamentum teres and placing a tight ligature around the femoral neck. At Week 11, we harvested femoral heads bilaterally from each animal and performed a macroscopic, histological evaluation and histomorphometric, immunohistochemical analysis.

Results: The intertrabecular mesenchymal cell ratio was substantially higher in the O₃ group than that of all other groups in the histological evaluation (p<0.05). Group O3 had also significantly more CD31-positive stained new vasculature than other groups, with the exception of the HBO therapy group, according to the immunohistochemical analysis (p<0.05).

Conclusion: The results of this experimental study suggest that the application of medical ozone alone may have a positive effect on new vessel formation and the repair process and may be more beneficial than HBO therapy and HBO+O₃ therapy in the vascular deprivation of the rat femoral head model.

Severe old lumbar fractures and dislocations with associated cauda equina nerve transection are rare clinical presentations which pose significant management challenges. This case report highlights a unique instance of such an injury, emphasizing novel surgical strategies for reconstruction and recovery. A 30-year-old male patient was admitted after sustaining a severe open fracture and degree IV posterior dislocation of L3 vertebra, accompanied by cauda equina nerve transection, spinal cord injury and multiple organ injuries. Following initial stabilization, the patient underwent surgical reduction and internal fixation two months after the injury. The procedure involved cauda equina nerve reconstruction using sural nerve grafts. Postoperatively, the patient showed improved bladder function and regained some mobility. However, he later developed arachnoiditis ossificans of the cauda equina, resulting in severe pain, which required additional surgical intervention. In conclusion, this case underscores the importance of timely intervention in severe thoracolumbar injuries and presents a successful approach to nerve reconstruction.

Objectives: This study aims to investigate the causal relationship between genetically predicted blood metabolites and osteoporotic fracture risk in individuals aged over 60 years, focusing on their role in bone metabolism and osteoporosis (OP).

Materials and methods: Using Mendelian randomization (MR), we analyzed 1,400 blood metabolites selected for their involvement in metabolic and inflammatory pathways relevant to bone health. Bone mineral density (BMD) at the femoral neck served as a proxy for fracture risk, with reduced BMD defined as T-score ≤-1.0. Fourteen metabolites were associated with osteopenia, determined by T-score being lower than -1 at the femoral neck. The genome-wide association study (GWAS) data from the European Bioinformatics Institute (GCST005349) included 22,504 cases and 23.7 million SNPs from individuals of European ancestry aged ≥60 years. Genetic associations were evaluated using Inverse Variance Weighted (IVW), MR-Egger, and MR-Pleiotropy Residual Sum and Outlier (MR-PRESSO) methods.

Results: After stringent screening, 14 metabolites were significantly associated with OP risk (p<0.05, false discovery rate [FDR] <0.2). The AMP-to-alanine ratio (odds ratio [OR]=0.900, 95% confidence interval [CI]: 0.845-0.958) was protective, while tauro-beta-muricholate (OR=0.855), glycosyl-N-stearoylsphingosine (OR=1.065), and the mannose-to-glycerol ratio (OR=1.116) increased risk. Sensitivity analyses confirmed robust results without heterogeneity or pleiotropy.

Conclusion: This study identifies blood metabolites as potential causal markers for osteoporotic fracture risk, offering insights for risk assessment and prevention in the elderly.

Objectives: The aim of this study was to investigate whether proximal tibial cortex transverse distraction (PTCTD) could result in nerve regeneration in diabetic Charcot foot via electromyography (EMG).

Patients and methods: Between March 2015 and June 2021, a total of six patients (4 males, 2 females; mean age: 58.8±15.5 years; range, 32 to 75 years) with diabetic Charcot foot treated with PTCTD were retrospectively analyzed. Electromyography was performed preoperatively and six months postoperatively to evaluate nerve regeneration. Healing time, wound area and limb salvage rates were also recorded.

Results: The mean time to wound healing in all patients was 155.17±19.13 (range, 135 to 189) days. The mean wound area was 4.44±2.58 (range, 2.52 to 9.52) cm². No cases of low limb amputation occurred, with a limb salvage rate of 100%. The EMG revealed spontaneous potentials and decreased recruitment in all patients preoperatively. Motor unit potentials were found only in some of the tested muscles. At the final follow-up, the extensor digitorum brevis in four patients (67.7%) had a simple recruitment phase. Three patients (50%) and four patients (67.7%) had increased compound muscle action potential (CMAP) amplitudes in muscles innervated by the nervus peroneus communis and tibial nerve, respectively. In one patient (16.7%), the CMAP was found only at the peroneal head segment of the nervus peroneus communis, but not at the distal end.

Conclusion: Our results indicate that nerve regeneration can be confirmed by EMG after PTCTD in patients with diabetic Charcot foot. However, further multi-center, large-scale, long-term prospective studies are needed to draw more reliable conclusions on this subject.

Objectives: The aim of the study was to evaluate the relationships between common pathologies and anatomical variations in the foot & ankle using magnetic resonance imaging (MRI).

Patients and methods: Between January 2016 and December 2020, a total of 849 ankle MRIs (427 right foot, 422 left foot) in 738 patients (274 males, 464 females; mean age: 43.4±14.3 years; range, 15 to 70 years) were retrospectively analyzed. Among ankle pathologies, peroneal and flexor hallucis longus (FHL) tendinopathies were evaluated. Among the anatomical variations, retromalleolar fibular groove (RMFG) shape, os peroneum, os trigonum, peroneus quartus (PQ), flexor digitorum accessorius longus (FDAL), low-lying peroneus brevis (PB) and FHL muscles were examined. The distance of the PB and FHL musculotendinous junctions (MTJs) from designated reference points was measured. Cut-off values for PB and FHL musculotendinous junction distances were determined by receiver operating characteristic (ROC) analysis. For the reliability analysis of measurements performed by two researchers, intraclass correlation coefficient (ICC) values were calculated.

Results: Bilateral ankle MRIs of 111 patients were evaluated. The PB, PL, and FHL tenosynovitis were observed in 29.6%, 34.9%, and 38.8% of all ankles, respectively. The PB and PL tendon tears were found in 12.2% and 3.9%, respectively. A total of 47.1% of the RMFG shapes were concave, 36.7% were flat, 12.4% were convex, and 3.8% were irregular. The PQ, FDAL, os peroneum, and os trigonum were detected in 13.8%, 3.1%, 16.6%, and 20.5% of the ankles, respectively. The cut-off value of PB MTJ distance that would cause a PB tendon tear was 4.40 mm distal from reference point. The cut-off value of FHL MTJ distance that would cause FHL tendinopathy was 4.15 mm distal from reference point. The study had a statistically significantly high level of consistency between the experts (ICC=0.85).

Conclusion: The convex and irregular shapes of the RMFG, along with the anatomical variations of the os peroneum and low-lying PB muscle, constitute risk factors for peroneal tendon pathologies. The presence of the os trigonum and low-lying FHL muscle anatomical variations predispose individuals to FHL tendinopathies. The cut-off values that could lead to PB vertical tears and FHL tendinopathy were identified for the low-lying PB and FHL muscles, respectively.

Objectives: The aim of this study was to assess the diagnostic value of pre-treatment inflammatory markers, including neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and lymphocyte-to-monocyte ratio (LMR), in distinguishing frozen shoulder (idiopathic stiff shoulder) from secondary stiff shoulder caused by shoulder pathologies.

Patients and methods: Between February 2008 and August 2021, a total of 176 patients (64 males, 112 females; mean age: 54.0±9.9 years; range, 24 to 82 years) were retrospectively analyzed. The patients underwent analysis of surgical video recordings. Seventy-one patients with rotator cuff pathology were classified as having secondary stiff shoulders, while 105 patients without a history of trauma or cuff pathology were classified as having frozen shoulder (primary stiff shoulder). Demographic and preoperative laboratory data, including white blood cell count (WBC), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), neutrophil, lymphocyte, monocyte, platelet counts, along with NLR, PLR, and LMR values, were evaluated.

Results: Significantly higher levels of WBC, neutrophils, and NLR were observed in patients with secondary stiff shoulder (p<0.001 for all). In contrast, LMR (p=0.013) and platelet values (p=0.046) were found to be significantly higher in the frozen shoulder group. No statistically significant differences were observed between the groups regarding CRP, ESR, lymphocyte count, monocyte count, or PLR (p>0.05).

Conclusion: The NLR and LMR values have diagnostic utility in differentiating primary and secondary stiff shoulder. Elevated NLR values are associated with more acute inflammatory responses typical of secondary stiff shoulder, while higher LMR and platelet levels are linked to chronic and fibrotic processes observed in frozen shoulder.