Archives of Orthopaedic and Trauma Surgery最新文献_第9页

Understanding the long-term clinical effectiveness of L'Episcopo procedure in restoring external rotation & abduction in patients suffering from brachial plexus birth injury: a systematic review & meta-analysis. 了解L'Episcopo手术在臂丛出生损伤患者恢复外旋和外展的长期临床效果：一项系统回顾和荟萃分析。

IF 2.1 3区医学 Q2 ORTHOPEDICS

Archives of Orthopaedic and Trauma Surgery

Pub Date : 2026-02-02 DOI: 10.1007/s00402-026-06191-w

Kunal P Shah, Jonathan Elias, Ryan St John, Mario Salah, Kunal Damaraju, Sean McMillan

引用次数: 0

Preoperative flexion contracture influences magnitude of planned resections in robotic-assisted total knee arthroplasty. 术前屈曲挛缩影响机器人辅助全膝关节置换术中计划切除的大小。

IF 2.1 3区医学 Q2 ORTHOPEDICS

Archives of Orthopaedic and Trauma Surgery

Pub Date : 2026-02-02 DOI: 10.1007/s00402-025-06184-1

Catherine Di Gangi, Saloni Haruray, David Novikov, Patrick Meere, Morteza Meftah, Matthew S Hepinstall

Background: Varying degrees of flexion contracture appear commonly in total knee arthroplasty (TKA) patients and can be corrected using increasing distal femoral bone resection. Robotic-assisted (RA) technology aims to avoid ligament release through optimized bony resections. This study evaluated the influence of preoperative flexion contracture on the magnitude of resections surgeons perform to balance knees in RA-TKA.

Materials and methods: We reviewed 789 primary RA-TKAs from 2023 to 2024 using cruciate-retaining (CR) implants. The cohort was divided by native flexion deformity into three groups: <0° flexion ("hyperextension", n = 157), 0-9.9° flexion ("minimal contracture", n = 457), and ≥ 10° flexion ("clinically important contracture", n = 175). Mean preoperative flexion contracture was - 3.8, 4.1, and 13.5° for the hyperextension, minimal contracture, and clinically important contracture cohorts, respectively. Demographics, implants, and intraoperative data were collected and analyzed. The arithmetic hip-knee-ankle (aHKA) angle was used to determine native deformity groups for additional subanalyses.

Results: Significant differences were found between cohorts for mean distal femur and proximal tibia resections, with the clinically important contracture group having the largest resections. After accounting for implanted polyethylene thickness, differences in mean tibia resections were quite small, varying by 0.9 millimeters (mm) laterally and 0.7 mm medially. Similarly, the mean distal femoral resection varied by only 1.4 mm laterally and 0.7 mm medially between the hyperextension and clinically important contracture cohorts. Indeed, 85% of cases with clinically important contractures were managed with less than 2 mm of additional distal femoral resection compared to the minimal contracture cohort.

Conclusion: With robotic-assisted TKA, bone resections can be guided by collateral ligament tension in flexion and extension. Our data suggest that surgeons can follow this strategy and successfully address flexion contractures with very small increases in resection magnitudes, which may help to maintain the joint line.

背景：不同程度的屈曲挛缩在全膝关节置换术（TKA）患者中常见，可以通过增加股骨远端切除来纠正。机器人辅助（RA）技术旨在通过优化的骨切除来避免韧带释放。本研究评估术前屈曲挛缩对RA-TKA手术中平衡膝关节切除大小的影响。材料和方法：我们回顾了2023年至2024年789例使用cross -挽留（CR）种植体的ra - tka。根据自身屈曲畸形将队列分为三组：结果：队列之间股骨远端和胫骨近端平均切除量有显著差异，临床上重要的挛缩组切除量最大。考虑到植入的聚乙烯厚度，平均胫骨切除的差异非常小，侧向变化0.9毫米（mm），内侧变化0.7毫米。同样，在过伸组和临床上重要的挛缩组之间，股骨远端切除的平均横向差异仅为1.4 mm，内侧差异为0.7 mm。事实上，与最小挛缩组相比，85%的临床重要挛缩病例采用了小于2mm的股骨远端额外切除。结论：机器人辅助TKA可以通过侧副韧带屈伸张力指导骨切除。我们的数据表明，外科医生可以遵循这一策略，并成功地解决屈曲挛缩，切除幅度很小，这可能有助于维持关节线。

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引用次数: 0

Knowledge, training, and practice patterns in pneumatic tourniquet use among orthopedic physicians: a national cross-sectional survey. 骨科医生使用气动止血带的知识、培训和实践模式：一项全国横断面调查。

IF 2.1 3区医学 Q2 ORTHOPEDICS

Archives of Orthopaedic and Trauma Surgery

Pub Date : 2026-02-02 DOI: 10.1007/s00402-025-06176-1

Mert Gündoğdu, Deniz Gülabi, Özgür Baysal

引用次数: 0

Leg length and offset in short-stem total hip arthroplasty: is a single offset-implant sufficient to restore the hip rotation centre within a range of 5 mm? 短柄全髋关节置换术中的腿长和偏移量：单个偏移植入物是否足以在5mm范围内恢复髋关节旋转中心？

IF 2.1 3区医学 Q2 ORTHOPEDICS

Archives of Orthopaedic and Trauma Surgery

Pub Date : 2026-02-02 DOI: 10.1007/s00402-026-06194-7

Felix Olk, Bernd Bittersohl, Jürgen Babisch, Hagen Mittelstädt, Marcus Jäger, Rüdiger Krauspe, Christoph Zilkens

Introduction

Short-stem total hip arthroplasty (THA) has gained popularity due to its bone-preserving properties and improved physiological load transmission to the proximal femur. Despite these advantages, the ability of short-stem implants to reliably restore leg length and offset remains debated. This study evaluates whether a single offset implant is sufficient for accurate anatomical reconstruction or if multiple offset options are necessary.

Material and methods

A total of 148 anteroposterior pelvic radiographs of patients scheduled for short-stem THA were analysed using MediCAD^® software. Femoral offset and leg length were measured, and the accuracy of anatomical reconstruction was assessed within a 5-mm target range. Comparisons were made between a single offset (130°) implant and a dual-offset system (130° and 119°) using the McNemar-Bowker test.

Results

With a single 130° CCD (Caput-collum-diaphyseal) offset implant, 55.7% (82/148) of cases achieved satisfactory leg length and offset restoration. The use of a dual-offset system improved accuracy to 79.1% (117/148), demonstrating a statistically significant advantage (p < 0.001).

Discussion

The study highlights the need for at least two CCD-angle-offset combinations in short-stem THA to address anatomical variability. A dual-offset system enhances accuracy, reduces biomechanical imbalances, and therefore we expect improvements in clinical outcomes, particularly in teaching hospitals where standardization is essential.

短柄全髋关节置换术（THA）由于其保骨特性和改善股骨近端生理负荷传递而越来越受欢迎。尽管有这些优点，短柄假体是否能够可靠地恢复腿长和偏置仍存在争议。本研究评估单一偏移种植体是否足以进行准确的解剖重建，或者是否需要多个偏移选择。材料和方法使用MediCAD®软件对148例计划行短茎全髋关节置换术的患者骨盆正位x线片进行分析。测量股骨偏移量和腿长，并在5毫米目标范围内评估解剖重建的准确性。采用McNemar-Bowker试验对单偏移（130°）种植体和双偏移系统（130°和119°）进行比较。结果单颗130°CCD（头柱-骨干）偏位种植体，55.7%（82/148）的患者获得满意的腿长和偏位修复。双偏置系统的使用将精度提高到79.1%(117/148)，显示出统计学上显著的优势（p < 0.001）。该研究强调了在短杆THA中至少需要两种ccd -角度偏移组合来解决解剖变异性。双偏移系统提高了准确性，减少了生物力学不平衡，因此我们期望临床结果得到改善，特别是在标准化至关重要的教学医院。

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引用次数: 0

Understanding the role of diabetes mellitus on symptomatic neuroma development and identifying the ideal patient for prophylactic surgical management. 了解糖尿病在症状性神经瘤发展中的作用并确定预防性手术治疗的理想患者。

IF 2.1 3区医学 Q2 ORTHOPEDICS

Archives of Orthopaedic and Trauma Surgery

Pub Date : 2026-02-02 DOI: 10.1007/s00402-025-06140-z

Casey A Hamlet, Tiam Mana Saffari, Varoon T Phondge, Sheldon S Lin, J Patrick O'Connor, Edward S Lee

Introduction: Symptomatic neuromas result from disorganized nerve growth at the site of amputation, causing pain that affects recovery and quality of life. In patients with diabetes mellitus (DM), nerve regeneration is impaired, compounded by comorbidities such as obesity, hypertension, and hyperlipidemia. Surgical approaches including targeted muscle reinnervation (TMR) and regenerative peripheral nerve interface (RPNI) have shown promise for managing symptomatic neuroma, but their effectiveness in diabetic patients is uncertain due to unique challenges in nerve regeneration. This narrative review explores the protective effects of DM on symptomatic neuroma formation and to evaluate the implications for surgical intervention.

Materials and methods: A systematic search of PubMed was conducted, and relevant studies discussing symptomatic neuroma formation in amputees were included.

Results: Symptomatic neuromas were reported in 9.5-50% of amputees involving 9.5% of upper extremity, and 3.8% of lower extremity amputees. Younger age and proximal amputations were identified as significant risk factors. While it is suggested that Interleukin (IL)-10 and brain-derived neurotropic factor (BDNF) levels are involved in protecting against symptomatic neuroma formation, IL-1β and IL-6 promote neuroma formation. Although evidence is mixed, some evidence suggests that DM and diabetic peripheral neuropathy decrease symptomatic neuroma formation by impairing axonal regeneration, altering the extracellular matrix and modulating inflammatory responses.

Conclusions: Although surgical approaches such as TMR and RPNI have shown potential in reducing neuroma-related pain, further studies are needed to ensure that this benefit extends to diabetic patients whose disease puts them at increased risk of postoperative complications. Additional studies are required to confirm these findings and optimize surgical strategies for high-risk patient populations.

症状性神经瘤是由截肢部位神经生长紊乱引起的，引起疼痛，影响康复和生活质量。在糖尿病（DM）患者中，神经再生受损，并发肥胖、高血压和高脂血症等合并症。包括靶向肌肉神经再生（TMR）和再生周围神经界面（RPNI）在内的手术方法已显示出治疗症状性神经瘤的希望，但由于神经再生方面的独特挑战，它们在糖尿病患者中的有效性尚不确定。这篇叙述性综述探讨了DM对症状性神经瘤形成的保护作用，并评估手术干预的意义。材料与方法：系统检索PubMed，纳入截肢者症状性神经瘤形成的相关研究。结果：9.5 ~ 50%的截肢者报告有症状性神经瘤，其中上肢9.5%，下肢3.8%。年龄较小和近端截肢被认为是重要的危险因素。白细胞介素(IL)-10和脑源性神经营养因子（BDNF）水平参与预防症状性神经瘤的形成，而IL-1β和IL-6则促进神经瘤的形成。尽管证据不一，但一些证据表明，糖尿病和糖尿病周围神经病变通过损害轴突再生、改变细胞外基质和调节炎症反应来减少症状性神经瘤的形成。结论：虽然手术入路如TMR和RPNI已经显示出减少神经瘤相关疼痛的潜力，但需要进一步的研究来确保这种益处延伸到糖尿病患者，因为糖尿病患者的疾病使他们术后并发症的风险增加。需要进一步的研究来证实这些发现，并优化高危患者的手术策略。

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引用次数: 0

Intraoperative torsion control with radiological cortical thickness parameters in distal tibial shaft fractures: a cadaveric study 胫骨远端骨折术中扭转控制与放射学皮质厚度参数：一项尸体研究。

IF 2.1 3区医学 Q2 ORTHOPEDICS

Archives of Orthopaedic and Trauma Surgery

Pub Date : 2026-02-02 DOI: 10.1007/s00402-025-06178-z

Lena Keppler, Richard Zaccaria, Christian Zeckey, Konstantin Küßner, Eduardo M. Suero, Carl Neuerburg, Maximilian Weigert, Wolfgang Böcker, Alexander M. Keppler

Aim

Intramedullary nailing is a common and safe procedure in the treatment of distal tibial shaft fractures. It is often accompanied with maltorsion of the tibia due to insufficient intraoperatively available and objective diagnostic tools. Therefore there´s high need for reliable tools for intraoperative torsional control. Radiographic parameters such as the Cortical Step Sign (CSS) and the Diameter Difference Sign (DSS) may serve for diagnosing relevant maltorsion intraoperatively.

The aim of this study was to investigate the effect of maltorsion on CSS and DSS parameters in a distal tibial fracture model and to construct a prognostic model to detect maltorsion.

Methods

A distal tibial shaft fracture (AO/OTA type “A”) was set on 19 human tibias. Torsion was gradually adjusted from 0° to 30° in external and internal torsion. Images were acquired with a C-arm in two planes and transferred to a PC for measurement of medial cortical thickness (MCT), lateral cortical thickness (LCT), tibial diameter (TD) in a.p., and anterior cortical thickness (ACT), posterior cortical thickness (PCT), and transverse diameter (TD lat.) in lateral view of the proximal and distal fragment.

Results

For the various levels of torsion significant differences for each of the values of the examined variables could be shown. Highest visibility was found for ACT, TD a.p. and TD lat. Highest correlation of radiographic difference and maltorsion was found in internal torsion (TD lat./ TD a.p.). A threshold of less than 2 mm led to a probability to detect maltorsion of 0.7. ROC for the lateral model was better than for the a.p. model (0.866 vs. 0.829). TD lat. performed best regarding ROC in single parameter evaluation (0.778). Best prediction for relevant maltorsion was obtained with TD a.p. and TD lat.

Conclusion

CSS and DSS are useful tools for detection of maltorsion in distal tibial shaft fractures. The parameters can be easily collected and therefore represent promising parameters for intraoperative torsional control.

目的髓内钉是治疗胫骨远端骨折的一种常见且安全的方法。由于术中可用的客观诊断工具不足，常伴有胫骨畸形。因此对术中扭转控制的可靠工具有很高的需求。影像学参数如皮质步征（CSS）和直径差征（DSS）可用于术中相关畸形的诊断。本研究的目的是探讨畸形对胫骨远端骨折模型中CSS和DSS参数的影响，并建立一个检测畸形的预后模型。方法对19例人胫骨进行AO/OTA型“A”型远端胫骨干骨折。外扭和内扭从0°逐渐调整到30°。用c臂在两个平面上获取图像，并传输到PC上测量内侧皮质厚度（MCT），外侧皮质厚度（LCT）， a.p.胫骨直径（TD），以及近端和远端碎片侧面的前皮质厚度（ACT），后皮质厚度（PCT）和横向直径（TD lat）。结果对于不同水平的扭转，可以显示出每个被检查变量的值的显著差异。ACT、TD、ap和TD的能见度最高。x线影像差异与扭曲的相关性最高的是内扭转（TD）。/ d.d.a.p.)。小于2mm的阈值导致检测到扭曲的概率为0.7。横向模型的ROC优于a.p.模型（0.866比0.829）。TD lat。单参数评价的ROC最佳（0.778）。TD ap和TD lt对相关畸形的预测效果最好。结论css和DSS是检测胫骨远端骨折畸形的有效工具。这些参数易于收集，因此为术中扭转控制提供了有希望的参数。

{"title":"Intraoperative torsion control with radiological cortical thickness parameters in distal tibial shaft fractures: a cadaveric study","authors":"Lena Keppler, Richard Zaccaria, Christian Zeckey, Konstantin Küßner, Eduardo M. Suero, Carl Neuerburg, Maximilian Weigert, Wolfgang Böcker, Alexander M. Keppler","doi":"10.1007/s00402-025-06178-z","DOIUrl":"10.1007/s00402-025-06178-z","url":null,"abstract":"<div><h3>Aim</h3><p>Intramedullary nailing is a common and safe procedure in the treatment of distal tibial shaft fractures. It is often accompanied with maltorsion of the tibia due to insufficient intraoperatively available and objective diagnostic tools. Therefore there´s high need for reliable tools for intraoperative torsional control. Radiographic parameters such as the Cortical Step Sign (CSS) and the Diameter Difference Sign (DSS) may serve for diagnosing relevant maltorsion intraoperatively. </p><p>The aim of this study was to investigate the effect of maltorsion on CSS and DSS parameters in a distal tibial fracture model and to construct a prognostic model to detect maltorsion.</p><h3>Methods</h3><p>A distal tibial shaft fracture (AO/OTA type “A”) was set on 19 human tibias. Torsion was gradually adjusted from 0° to 30° in external and internal torsion. Images were acquired with a C-arm in two planes and transferred to a PC for measurement of medial cortical thickness (MCT), lateral cortical thickness (LCT), tibial diameter (TD) in a.p., and anterior cortical thickness (ACT), posterior cortical thickness (PCT), and transverse diameter (TD lat.) in lateral view of the proximal and distal fragment.</p><h3>Results</h3><p>For the various levels of torsion significant differences for each of the values of the examined variables could be shown. Highest visibility was found for ACT, TD a.p. and TD lat. Highest correlation of radiographic difference and maltorsion was found in internal torsion (TD lat./ TD a.p.). A threshold of less than 2 mm led to a probability to detect maltorsion of 0.7. ROC for the lateral model was better than for the a.p. model (0.866 vs. 0.829). TD lat. performed best regarding ROC in single parameter evaluation (0.778). Best prediction for relevant maltorsion was obtained with TD a.p. and TD lat.</p><h3>Conclusion</h3><p>CSS and DSS are useful tools for detection of maltorsion in distal tibial shaft fractures. The parameters can be easily collected and therefore represent promising parameters for intraoperative torsional control.</p></div>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"146 1","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12864369/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146103634","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Tibiofemoral rotation is significantly higher in patients with patellofemoral maltracking and torsional deformity 髌股畸形和扭转畸形患者的胫股旋转明显更高。

IF 2.1 3区医学 Q2 ORTHOPEDICS

Archives of Orthopaedic and Trauma Surgery

Pub Date : 2026-02-02 DOI: 10.1007/s00402-026-06198-3

Sina Gräber, Felix Hüttner, Andrzej Jasina, Parisa Pourostad, Turgay Efe, Thomas Tischer, Jörg Harrer, Christoph Lutter, Felix Ferner

Introduction

Tibiofemoral (TF) rotation, the relative rotational alignment between femur and tibia in the axial plane at the level of the knee has been investigated as a parameter of joint alignment. Its influence on patellofemoral pathologies is largely unknown. Within this cross sectional study, it was hypothesized that TF rotation is increased in patients with symptomatic torsional femoral or tibial deformity and associated patellofemoral maltracking compared to healthy individuals.

Methods

This single-center-study included patients with patellofemoral maltracking, including patellofemoral instability, who underwent tibial and/or femoral derotational osteotomy (surgery 2019–2024) and for whom preoperative torsional MRI was available. Torsion was measured according to Waidelich et al. and TF rotation defined as the angle between a tangent on the dorsal femoral condyles and a tangent on the dorsal tibial plateau. Positive values indicating external, negative values internal rotation. Tibial-tuberosity-trochlea-groove (TT-TG) distance was measured additionally. Interrater reliability was calculated between measurements of orthopaedic surgeons and musculoskeletal radiologists. Results were compared with those of a healthy control group that had previously been published.

Results

86 cases were included (age 25.0 ± 9.0, 78% females). Level of derotational osteotomy was femoral in 36% (n = 31), tibial in 26% (n = 22), double-level in 38% (n = 33). Interrater reliability was good to excellent for all parameters measured. TF rotation (5.6 ± 6.7°) was significantly increased (P < .001) compared to healthy subjects (1.3 ± 3.9°). 50% of the cases suffered from patellofemoral instability. Among these, TF rotation was significantly increased compared to cases without instability (7.5 ± 7.3° vs. 3.8 ± 5.5°; P = .011). TF rotation correlated moderately negative with tibial torsion (r_s=-0.284; P = .008) and moderately positively with TT-TG-distance (r_s=0.487, P < .001). There was no significant difference in TF rotation between different osteotomy levels.

Conclusion

TF rotation is significantly increased in patients with symptomatic torsional deformity and associated patellofemoral maltracking and should therefore be included in future investigations for establishing further treatment recommendations.

胫骨股骨（TF）旋转，股骨和胫骨在膝关节水平的轴向平面上的相对旋转对齐已被研究作为关节对齐的一个参数。其对髌股病理的影响在很大程度上是未知的。在这项横断面研究中，假设与健康个体相比，有症状性扭转股骨或胫骨畸形和相关髌骨股骨畸形的患者TF旋转增加。方法该单中心研究纳入了髌股追踪不良（包括髌股不稳定）的患者，这些患者接受了胫骨和/或股骨旋转截骨术（手术2019-2024），术前进行了扭转MRI检查。根据Waidelich等人的方法测量扭转，TF旋转定义为股骨髁背侧切线与胫骨平台背侧切线之间的夹角。正值表示向外旋转，负值表示向内旋转。另外测量胫骨-结节-滑车-沟（TT-TG）距离。计算了骨科医生和肌肉骨骼放射科医生测量结果之间的相互信度。研究结果与之前发表的健康对照组的结果进行了比较。结果共纳入86例，年龄25.0±9.0岁，女性78%。旋转截骨水平为股骨36% (n = 31)，胫骨26% (n = 22)，双水平38% （n = 33）。所有测量的参数间信度均为良好至优异。与健康受试者（1.3±3.9°）相比，TF旋转（5.6±6.7°）显著增加（P < 0.001）。50%的病例出现髌骨不稳。其中，与没有不稳定的患者相比，TF旋转明显增加（7.5±7.3°vs 3.8±5.5°；P = 0.011）。TF旋转与胫骨扭转呈中度负相关(rs=-0.284; P =。与TT-TG-distance呈正相关（rs=0.487, P < .001）。不同截骨水平间TF旋转无显著差异。结论：有症状性扭转畸形和相关髌骨股骨畸形的患者tf旋转明显增加，因此应纳入未来的研究，以确定进一步的治疗建议。

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引用次数: 0

The role of the gastrocnemius flap in implant retention strategies for acute periprosthetic joint infection following total knee arthroplasty: a systematic review 腓肠肌瓣在全膝关节置换术后急性假体周围关节感染的植入物保留策略中的作用：一项系统综述。

IF 2.1 3区医学 Q2 ORTHOPEDICS

Archives of Orthopaedic and Trauma Surgery

Pub Date : 2026-01-28 DOI: 10.1007/s00402-026-06199-2

Daniele Grassa, Guido Bocchino, Cesare Stefanelli, Giacomo Capece, Rocco Maria Comodo, Alessandro El Motassime, Riccardo Totti, Giulio Maccauro, Raffaele Vitiello

Background

Acute periprosthetic joint infection (PJI) represents a major cause of early failure following total knee arthroplasty (TKA). In selected cases, implant retention strategies such as debridement, antibiotics, and implant retention (DAIR), including modified techniques such as debridement, antibiotic pearls, and retention of the implant (DAPRI), may be considered. However, the success of these approaches is strongly influenced by the condition of the surrounding soft tissues. In the presence of compromised or tenuous wound conditions, soft tissue reconstruction may play a critical adjunctive role. This review aims to evaluate the role of the gastrocnemius flap as an adjunct to implant retention strategies in the management of acute PJI following TKA.

Methods

A systematic review was conducted in accordance with PRISMA guidelines. After screening 27 studies, five retrospective case series met the inclusion criteria, comprising a total of 73 patients with a mean follow-up of 48.7 months.

Results

The medial gastrocnemius flap was the most used technique, accounting for approximately 70% of cases. Infection clearance rates ranged from 66% to 77%, while prosthesis retention was achieved in nearly 79% of patients. Gastrocnemius flap coverage was applied in conjunction with different PJI treatment strategies, including staged revision procedures and implant retention approaches. Early flap application, particularly when combined with debridement and implant retention in the presence of compromised soft tissues, was associated with improved wound healing and limb salvage, although the level of evidence remains limited.

Conclusions

Gastrocnemius flap reconstruction appears to be a useful adjunct in selected patients undergoing implant retention strategies for acute PJI following TKA, particularly in the presence of compromised soft tissue conditions. Nevertheless, the current evidence is based on low-level, non-comparative studies, and definitive conclusions regarding its routine or preventive use cannot be drawn. Further prospective and comparative studies are required to better define indications, timing, and expected outcomes.

背景：急性假体周围关节感染（PJI）是全膝关节置换术（TKA）后早期失败的主要原因。在选定的病例中，可以考虑采用诸如清创、抗生素和种植体保留（DAIR）等种植体保留策略，包括诸如清创、抗生素珍珠和种植体保留（DAPRI）等改良技术。然而，这些方法的成功与否很大程度上受到周围软组织状况的影响。在存在受损或脆弱的伤口条件下，软组织重建可能起关键的辅助作用。这篇综述旨在评估腓肠肌瓣作为一种辅助植入物保留策略在TKA后急性PJI治疗中的作用。方法按照PRISMA指南进行系统评价。筛选27项研究后，5个回顾性病例系列符合纳入标准，共73例患者，平均随访48.7个月。结果腓肠肌内侧皮瓣是最常用的修复方法，约占70%。感染清除率从66%到77%不等，而近79%的患者获得了假体保留。腓肠肌皮瓣覆盖与不同的PJI治疗策略相结合，包括分阶段翻修手术和种植体保留入路。尽管证据水平仍然有限，但早期皮瓣应用，特别是在存在受损软组织的情况下结合清创和种植体保留，与改善伤口愈合和肢体保留有关。结论腓肠肌皮瓣重建对于TKA后急性PJI的患者来说是一种有用的辅助手段，特别是在软组织受损的情况下。然而，目前的证据是基于低水平的非比较性研究，无法得出关于其常规或预防性使用的明确结论。需要进一步的前瞻性和比较研究来更好地确定适应症、时机和预期结果。

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引用次数: 0

Correction: Gastrocnemius release procedures in the treatment of mechanical metatarsalgia: a systematic review 矫正：腓肠肌松解术治疗机械性跖骨痛：系统回顾。

IF 2.1 3区医学 Q2 ORTHOPEDICS

Archives of Orthopaedic and Trauma Surgery

Pub Date : 2026-01-14 DOI: 10.1007/s00402-025-06177-0

Laura Langone, Antonio Mazzotti, Simone Ottavio Zielli, Alberto Arceri, Federico Sgubbi, Gianmarco Di Paola, Elena Artioli, Cesare Faldini

引用次数: 0

Current concepts of medial unicompartmental knee replacement: part 2—hot topics and further directions 内侧单室膝关节置换术的最新概念：第2部分——热点和未来发展方向。

IF 2.1 3区医学 Q2 ORTHOPEDICS

Archives of Orthopaedic and Trauma Surgery

Pub Date : 2026-01-07 DOI: 10.1007/s00402-025-06158-3

Simone Cerciello, Lorenzo Proietti, Fabrizio Mocini, Katia Corona, Michele Venosa, Michele Mercurio, Philippe Neyret

Although the results of medial unicompartmental knee arthroplasty (UKA) are extremely positive in most of the cases, several technical aspects are still discussed. Cementation or not is one of them and no clear advantage of one option over the other has emerged; similarly mobile and fixed designs have similar outcomes. Metal back implants although more common than all-poly implants do not have clearly superior outcomes. Similarly technological innovations are leading the research toward more accurate reproduction of unique patients’ anatomy and function with the surgical procedures. Robotics aim at reproducing the pre-arthritic individual joint line and lower limb alignment while custom implants would reproduce the anatomy of the articular surfaces. All these aspects will be discussed in the following article.

虽然内侧单室膝关节置换术（UKA）的结果在大多数情况下是非常积极的，几个技术方面仍在讨论。胶结与否是其中之一，目前还没有明显的优势；类似的移动和固定设计也有类似的结果。金属假体虽然比全聚假体更常见，但没有明显的好结果。同样，技术创新也在引导研究朝着更精确地复制独特患者的解剖结构和功能的方向发展。机器人技术的目标是重现患关节炎前的个体关节线和下肢排列，而定制植入物将重现关节表面的解剖结构。下面的文章将讨论所有这些方面。

引用次数: 0