Acta orthopaedica et traumatologica turcica最新文献

Objective: This study aimed to examine the relationship between lumbosacral transitional vertebra (LSTV), classified by Castellvi's system, and lumbar disc degeneration, graded using Pfirrmann's classification, based on radiological assessment. Methods: This retrospective study analyzed 2516 patients (1548 females and 968 males) with a mean age of 51.83 ± 15.6 years with chronic low back pain who underwent lumbosacral magnetic resonance imaging and computed tomography scans at a single center between January 2018 and January 2021. Pfirrmann grading was used to assess L4-L5 intervertebral disc degeneration, and Castellvi classification determined the anatomical type of LSTV. Correlation analysis was performed to evaluate the association between LSTV presence and disc degeneration. Additionally, a proportional-odds ordinal logistic regression model was used to examine the relationship between Pfirrmann grade and patient-specific factors (age, gender, and LSTV presence). Results: According to Pfirrmann classification, 113 patients were grade I, 402 were grade II, 877 were grade III, 861 were grade IV, and 263 were grade V. A total of 771 patients (30.6%) did not have LSTV, while the remaining 1745 patients (69.4%) had LSTV. A statistically significant association was found between LSTV presence and Pfirrmann grade (P < .001, r=.200). Patients with LSTV had 0.75 times higher probability (95% CI: 0.58-0.90, P < .001) of exhibiting a higher Pfirrmann grade compared to those without LSTV. However, no significant correlation was observed between LSTV subtypes classified by Castellvi and Pfirrmann grade (P=.379). Additionally, age was significantly correlated with Pfirrmann classification, LSTV presence, and Castellvi classification (P < .001). Female patients had 1.34 times higher likelihood (95% CI: 1.19-1.49, P < .001) of exhibiting a higher Pfirrmann grade compared to male patients. Conclusions: This study highlights the significant association between LSTV and advanced disc degeneration, establishing LSTV as a potential risk factor for progressive spinal changes. It emphasizes the importance of early detection and targeted management, particularly for older adults and females who are more susceptible to severe degenerative changes. Level of Evidence: Level III, Prognostic Study.

Objective: This study aimed to compare the e!ects of local hyaluronic acid (HA) and autologous conditioned serum (ACS) on the repair of acute rotator cu! (RC) tears and their impact on functional outcomes, specifically on running performance. Methods: In this study, 25 male Wistar Albino rats, aged 16 weeks and weighing 350-400 g, were used. The rats were divided into 4 groups (n = 6 per group). Group A was the sham group, and the 3 treatment groups were as follows: group B (primary repair), group C (primary repair + ACS), and group D (primary repair + HA). A standardized procedure was used to create an acute tear-and-repair model of the RC in each treatment group. The rats in group B received no injections. Group C received ACS 24, 48, and 72 h after surgery. Patients in group D received a single dose of HA at the operative site. After a 4-week follow-up period, the rats were subjected to an exercise protocol using a computer-monitored motorized treadmill. For each treadmill run, shocks were recorded as one penalty point using a computer (one point per shock). Subsequently, the rats were sacrificed and bone-tendon healing in each group was assessed histopathologically. Results: Group A had the lowest penalty points in the final run and the highest penalty points. The best performance among the surgical groups was observed in group D. Groups C and D received fewer penalty points than group B. Group D received fewer penalty points than group C; however, there was no significant di!erence between them in pairwise comparisons (P = .132). When the statistical analysis of histological parameters was conducted, excluding the sham group, the least inflammation was observed in group D. Pairwise analysis between groups D and B revealed significantly fewer inflammatory cells in group D (P = .026). After pairwise analysis between groups, no significant di!erences were found in terms of fibroblastic proliferation, neovascularization, or fibrosis. Conclusion: This study has shown that HA application in an acute RC tear repair model significantly reduced inflammation, acceler- ated tendon healing, and markedly improved running performance by reducing pain. Additionally, immunohistochemical evaluations revealed that following HA application, collagen fibers were reorganized, forming a regular and tight connective tissue structure.

A 51-year-old female with a 10-year history of progressive low back pain presented with a 9 × 15 mm circular tumor adjacent to L1 on preoperative magnetic resonance imaging. The lesion was successfully removed by T12-L2 laminectomy and nail-rod fixation. Histopathological examination diagnosedmature intramedullary cystic teratoma. At 6-month follow-up, right lower limb numbness and pain were reduced.

Objective: Glenoid-version-measurement methods were initially defined for computed tomography (CT) but are now used for magnetic resonance imaging (MRI). However, their accuracy and reliability on MRI have not been thoroughly investigated. The aim was to determine the accuracy of these methods on MRI and compare their reliability, hypothesizing that MRI could provide accurate measurements similar to CT using all 3 methods, with the Matsumura method having the highest reliability. Methods: Glenoid-version measurements of 40 patients (14 female, 26 males; mean age 46.5 ± 17.9 years) with glenohumeral instability were performed using the Friedman, Poon and Ting, and Matsumura methods on MRI. These measurements were compared to those on 3-dimensional corrected slices of CT scans to evaluate accuracy. Reliability was assessed by 2 observers who repeated MRI measurements after 2 months. Results: All methods demonstrated favorable accuracy. The Friedman and Matsumura methods exhibited good interobserver reliability [intraclass correlation coefficient (ICC)=0.78 (0.58-0.88) and 0.89 (0.79-0.94)], while the Poon and Ting method showed moderate reliability [ICC=0.71 (0.44-0.84)]. Intraobserver reliability was excellent for the Matsumura method [Observer 1 ICC=0.96 (0.93-0.98), Observer 2 ICC=0.86 (0.95-0.99)], good for Friedman [Observer 1 ICC=0.77 (0.57-0.88), Observer 2 ICC=0.82 (0.67-0.91)], and moderate to good for Poon and Ting [Observer 1 ICC=0.68 (0.39-0.83), Observer 2 ICC=0.82 (0.65-0.9)]. Conclusion: All 3 methods can be used confidently for MRI measurements, matching the accuracy of CT scans. The Friedman and Matsumura methods demonstrated higher interobserver and intraobserver reliabilities. Level of evidence: Level III, diagnostic study.

Objective: This study aimed to investigate the synaptic plasticity of the spinal dorsal horn regulated by the Piezo2/P2X7/MG signaling pathway and elucidate its role in the analgesic effects of massage in Cervical Spondylotic Radiculopathy (CSR), with the goal of identifying potential therapeutic targets for effective treatment. Methods: This experimental animal study included 40 Sprague-Dawley rats (180 ± 20 g), randomly divided into four groups (control, model, sham-operated, and massage; n=10 per group) after a one-week acclimation period. The CSR model was established by spinal canal insertion. Blood and spinal cord tissues were collected post-intervention. Mechanical pain threshold (MPT), 50% paw withdrawal threshold (50% PWT), immunofluorescence, Western blot, and qRT-PCR assays were employed to evaluate synaptic plasticity and pathway expression. Results: The massage group demonstrated significantly higher MPT and 50% PWT values compared to the model group post-intervention (P < 0.05). Downregulation of the Piezo2/P2X7/MG signaling pathway was observed in the massage group, correlating with a reduction in CSR progression, while upregulation in the model group promoted CSR (P < 0.05). Conclusion: The Piezo2/P2X7/MG signaling pathway regulates the synaptic plasticity of the spinal dorsal horn in CSR. These findings suggest that massage therapy can effectively alleviate CSR-associated pain by modulating this pathway, offering a potential noninvasive therapeutic approach.

Objective: The aim of this experimental study in a rat model was to investigate the biomechanical and histological effects of subacromial corticosteroid injections on the healing of the tendon-bone junction after repair in the rotator cuff tear model. Methods: A total of 48 rats were divided into 3 groups: the control group, the single-dose steroid group, and the 4-dose steroid group. The supraspinatus tendon was completely dissected from the footprint attachment site and repaired. Saline was injected into the subacromial area in the control group, while 0.6 mL-4.8 mg/kg of single-dose methylprednisolone was applied to the single-dose group, and the same dose was applied 4 times at 1-week intervals to the 4-dose steroid group. All animals were allowed unrestricted movement during this period, and all animals were sacrificed by cervical dislocation 4 weeks after the last dose in the 4-dose steroid group. Cell shape and the number of apoptotic cells were assessed histopathologically, and the fracture load, maximum stress, and energy absorption were assessed biomechanically. Results: There were no significant differences in terms of cell shape between the groups. There was a significant difference in the mean number of apoptotic cells in the control group and in the single-dose and 4-dose steroid groups (P=.028). There was a 36% reduction in the mean number of apoptotic cells in the steroid groups compared to the control group. In the biomechanical evaluation, no differences were found between the groups in terms of maximum tension or breaking load (n.s.). A significant difference was found when the 3 groups were compared in terms of energy absorption (P=.001). There was a significant difference in energy absorption between the control group and the steroid-treated groups, but there was also a significant difference between the single-dose group and the 4-dose group (P=.038). Conclusion: The administration of corticosteroids was found to have a negative effect on healing at the tendon-bone junction, but this effect did not vary with the number of steroid injections. From a biomechanical perspective, it was observed that the energy absorption at the surgical repair site was lower with corticosteroid administration, and this negative effect increased with the increasing number of injections.

Objective: This study aimed to compare the biomechanical characteristics of conventional transosseous equivalent (TOE) techniques with those of the novel free independent double-row medial fixation method, using rigid polyurethane (PU) foam blocks to simulate osteoporotic humerus bone. Methods: In this biomechanical study, 4 groups were tested using rigid PU foam blocks with osteoporotic properties and bovine infraspinatus tendons to simulate the rotator cuff. Groups 1 and 2 employed conventional TOE techniques: medial row knotted repair and knotless repair, respectively. Groups 3 and 4 utilized the "free independent double-row medial fixation method," differing in the order of suture tying. Several biomechanical characteristic and pressure parameters were measured. Results: Groups 3 (0.16 ± 0.04 MPa) and 4 (0.17 ± 0.05 MPa) achieved significantly higher initial contact pressure compared to standard TOE techniques (P=.039). While contact area (Group 3: 102.4 ± 55.0 mm², Group 4: 110.4 ± 37.2 mm²) and ultimate failure force (Group 3: 212.0 ± 26.5 N, Group 4: 214.7 ± 30.2 N) were relatively higher, the differences were not statistically significant (P=.135 and P=.3, respectively). The overall failure types included medial anchor pullout (40%) and suture/tendon stripping (32.5%), with no significant differences among groups (P=.260). Conclusion: With superior contact pressure and comparable ultimate failure and contact area measurements, the novel independent double-row medial fixation technique may be a viable alternative to conventional TOE techniques for enhancing medial row stability in osteoporotic conditions. Level of Evidence: N/A.

Objective: This study aimed to evaluate the dose-dependent efficacy of tranexamic acid (TXA) in preventing epidural fibrosis in a rat laminectomy model and explore its potential as a therapeutic intervention for postoperative fibrosis in spinal surgery. Methods: In this experimental animal study, 32 female Wistar-Albino rats were randomized into four groups (control, 10 mg/kg TXA, 30 mg/kg TXA, and 100 mg/kg TXA; n=8 per group). Following a standardized laminectomy procedure, TXA was administered intravenously as a loading dose through the tail vein prior to surgery. The rats were sacrificed at the 4th-week post-surgery, the lumbar vertebrae were excised en bloc, and epidural fibrosis, inflammatory cell density, and fibroblast density were assessed histologically. Results: High-dose TXA (100 mg/kg) significantly reduced epidural fibrosis compared to the control (p=0.004), 10 mg/kg (p=0.002), and 30 mg/kg TXA groups (p=0.03). While the 30 mg/kg group showed lower epidural fibrosis grades compared to the control, the difference was not statistically significant. No significant differences were observed in inflammatory or fibroblast densities across groups. Conclusion: High-dose TXA (100 mg/kg) effectively reduced epidural fibrosis in a dose-dependent manner, demonstrating potential as a systemic therapeutic option to improve postoperative outcomes in spinal surgery.

Objective: The aim of this study was to evaluate and compare the performance of the artificial intelligence (AI) models ChatGPT-3.5, ChatGPT-4, and Gemini on the Turkish Specialization Training and Development Examination (UEGS) to determine their utility in medical education and their potential to improve patient care.

Methods: This retrospective study analyzed responses of ChatGPT-3.5, ChatGPT-4, and Gemini to 1000 true or false questions from UEGS administered over 5 years (2018-2023). Questions, encompassing 9 orthopedic subspecialties, were categorized by 2 independent residents, with discrepancies resolved by a senior author. Artificial intelligence models were restarted for each query to prevent data retention. Performance was evaluated by calculating net scores and comparing them to orthopedic resident scores obtained from the Turkish Orthopedics and Traumatology Education Council (TOTEK) database. Statistical analyses included chi-squared tests, Bonferroni-adjusted Z tests, Cochran's Q test, and receiver operating characteristic (ROC) analysis to determine the optimal question length for AI accuracy. All AI responses were generated independently without retaining prior information.

Results: Significant di!erences in AI tool accuracy were observed across di!erent years and subspecialties (P < .001). ChatGPT-4 consistently outperformed other models, achieving the highest overall accuracy (95% in specific subspecialties). Notably, ChatGPT-4 demonstrated superior performance in Basic and General Orthopedics and Foot and Ankle Surgery, while Gemini and ChatGPT-3.5 showed variability in accuracy across topics and years. Receiver operating characteristic analysis revealed a significant relationship between shorter letter counts and higher accuracy for ChatGPT-4 (P=.002). ChatGPT-4 showed significant negative correlations between letter count and accuracy across all years (r="0.099, P=.002), outperformed residents in basic and general orthopedics (P=.015) and trauma (P=.012), unlike other AI models.

Conclusion: The findings underscore the advancing role of AI in the medical field, with ChatGPT-4 demonstrating significant potential as a tool for medical education and clinical decision-making. Continuous evaluation and refinement of AI technologies are essential to enhance their educational and clinical impact.