Journal of Orthopaedic Surgery and Research最新文献

{"title":"Texture analysis of T1- and T2-weighted images identifies myofiber atrophy and grip strength decline in streptozotocin-induced type 1 diabetic sarcopenia rats.","authors":"Dong Xing, Fang Liu, Yufan Gao, Ziyan Fei, Yunfei Zha","doi":"10.1186/s13018-025-05556-y","DOIUrl":"https://doi.org/10.1186/s13018-025-05556-y","url":null,"abstract":"<p><strong>Background: </strong>Type 1 diabetes mellitus is associated with accelerated skeletal muscle aging and sarcopenia, a condition characterized by muscle mass and function loss. Early and noninvasive evaluation of muscle microstructural damage is critical for managing sarcopenia in diabetes. This study evaluated the potential of MRI texture analysis as a noninvasive imaging tool to assess myofiber size and grip strength alterations in a rat model of diabetic sarcopenia.</p><p><strong>Materials and methods: </strong>Twenty SD rats were randomly and evenly allocated to the control (CON) and diabetic sarcopenia (DS) groups. Blood glucose, body weight, and forelimb grip strength were measured weekly. In the eighth week, axial T₁WI and T₂WI scans were performed to extract 16 texture features of the gastrocnemius muscle. The size of the fibers, including the cross-sectional area, perimeter, and minFeretDiam, was calculated from the HE-stained images. Differences between the two groups were analyzed via t tests or Mann‒Whitney U tests. Receiver operating characteristic (ROC) analysis was conducted to evaluate the diagnostic performance of MRI texture features. Associations between MRI texture features, grip strength, and myofiber size were assessed via Spearman correlation analysis.</p><p><strong>Results: </strong>The DS group presented significant reductions in body weight, grip strength, and myofiber size (p < 0.001). Seven texture features demonstrated high repeatability. Among them, T₁WI_Entropy and T₂WI_Entropy were significantly lower, whereas T₁WI_Mean, T₂WI_Mean, and T₂WI_Variance were greater in the DS group than in the control group (p < 0.05 to p < 0.001). ROC analysis revealed that the MRI texture features performed well in differentiating the DS and CON groups (AUC 0.830 ~ 1.000). Strong correlations were found between MRI texture parameters and muscle strength and myofiber size.</p><p><strong>Conclusion: </strong>Muscle texture analysis based on T₁WI and T₂WI effectively differentiated type 1 diabetic sarcopenic rats from normal controls and revealed strong associations with muscle strength and myofiber size. These findings indicate that MRI texture parameters serve as potential biomarkers for diagnosing muscle damage in type 1 diabetic sarcopenia patients, suggesting that MRI texture parameters are promising noninvasive tools for early detection and monitoring of myofiber atrophy in diabetic sarcopenia.</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":"20 1","pages":"155"},"PeriodicalIF":2.8,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143399023","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Application of an enhanced recovery after surgery care protocol in patients undergoing lumbar interbody fusion surgery: a meta-analysis.","authors":"Jianghong Luo, Yixin Tang, Jing Cao, Wei Li, Liu Zheng, Haomin Lin","doi":"10.1186/s13018-025-05523-7","DOIUrl":"https://doi.org/10.1186/s13018-025-05523-7","url":null,"abstract":"<p><strong>Background: </strong>Enhanced recovery after surgery (ERAS) has been widely used in several surgical fields. This meta-analysis compared the clinical outcomes of the ERAS protocol and standard care (SC) in patients who underwent lumbar interbody fusion surgery.</p><p><strong>Materials and methods: </strong>The PubMed, Web of Science, Cochrane Library, and Embase databases were systematically searched to identify studies reporting the effects of the ERAS protocol on clinical outcomes in patients who underwent lumbar interbody fusion surgery.</p><p><strong>Results: </strong>Overall, 15 studies involving 17 865 patients were included in the final analysis. With the ERAS protocol, the length of hospitalization (SMD: - 0.47, 95% CI - 0.56 to -0.38), postoperative complications (OR = 0.62; 95% CI 0.50 to 0.77), operation time (SMD = - 0.26; 95% CI - 0.44 to -0.09), postoperative pain (SMD = - 0.35; 95% CI - 0.64 to -0.07) and duration of ambulation (SMD = - 0.80; 95% CI - 1.02 to - 0.58) were significantly reduced. The rates of readmission (OR = 0.63; 95% CI 0.38 to 1.04), estimated blood loss (SMD = - 0.31; 95% CI - 0.69 to 0.06) and hospitalization costs (SMD: - 0.56, 95% CI - 1.27 to 0.14) did not significantly differ between the ERAS and SC groups.</p><p><strong>Conclusions: </strong>The present meta-analysis indicated that the ERAS protocol could be safely and feasibly implemented in the perioperative management of patients receiving lumbar interbody fusion surgery. The protocol significantly reduced the length of hospitalization, incidence of postoperative complications, operation time, duration of 1st ambulation and duration of postoperative pain. However, no differences were observed in estimated blood loss, readmission rates or hospitalization costs.</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":"20 1","pages":"154"},"PeriodicalIF":2.8,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143398330","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical efficacy of cell-free fat extract and its effects on bone marrow edema in patients with early to mid-stage knee osteoarthritis: a clinical trial in comparison with hyaluronic acid.","authors":"Changchun Zhang, Yuanshi Lu, Yuanxia Huang","doi":"10.1186/s13018-025-05543-3","DOIUrl":"10.1186/s13018-025-05543-3","url":null,"abstract":"<p><strong>Background: </strong>Previous studies have shown that hyaluronic acid can delay the progression of knee osteoarthritis. Existing research has extracted a bright red fluid called cell-free fat extract from human adipose tissue, which may play an important role in delaying the progression of osteoarthritis. By comparing with intra-articular injection of hyaluronic acid, this study aimed to evaluate the effects of intra-articular injection of CEFFE on both clinical efficacy and the reduction of bone marrow edema in patients with early to mid-stage knee osteoarthritis.</p><p><strong>Methods: </strong>A total of 48 patients with KOA (Kellgren-Lawrence grade II-III) symptoms were randomly divided into CEFFE group (24 cases) and HA group (24 cases). The patients in the CEFFE group received five injections of CEFFE (2 ml, 1 time/week), and the patients in the HA group received five injections of HA (2 ml, 1 ml/10 mg, 1 time/week). All the patients underwent clinical assessments using rating scales, including VAS, WOMAC and Lysholm Knee Score. These assessments were conducted at pre-treatment and at 3-week, 6-week, 3-month, and 6-month follow-up timepoints post-treatment. The clinical efficacy was evaluated at the 6-month follow-up after the treatment. The changes in subchondral bone marrow edema before and 6 months after treatment were assessed by grading BME on MRI of the affected knees.</p><p><strong>Results: </strong>A total of 52 knees from 46 patients were included in the final analysis. Comparison of VAS score, WOMAC score, and Lysholm score between the two groups revealed that the differences between pre-treatment and 3 weeks post-treatment were not statistically significant (P > 0.05). For the VAS score and WOMAC score at 6 weeks, 3 months, and 6 months post-treatment, the CEFFE group was lower than the HA group (P < 0.05). For the Lysholm score, the CEFFE group was higher than the HA group (P < 0.05). Compared with pre-treatment, VAS scores and WOMAC scores were lower and Lysholm scores were higher at all post-treatment time points (P < 0.05). At 6 months post-treatment, the clinical efficacy of the CEFFE group was significantly better than that of the HA group (P < 0.05). At 6 months post-treatment, MRI grading showed that subchondral BME was reduced to different degrees in both groups, with the reduction being more pronounced in the CEFFE group (P < 0.05).</p><p><strong>Conclusion: </strong>This study demonstrated that intra-articular injection of CEFFE into the knee joint could enhance the durability of tissue-specific cells (especially chondrocytes) and improve cellular metabolic processes, preventing the continued progression of osteoarthritis. Both CEFFE and HA were found to improve clinical symptoms and reduced subchondral bone marrow edema in the treatment of early to mid-stage knee osteoarthritis. However, CEFFE was more effective than HA in achieving these outcomes.</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":"20 1","pages":"153"},"PeriodicalIF":2.8,"publicationDate":"2025-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11809086/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143382427","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}

{"title":"Evaluation and testing of polymethylmetacrylic (PMMA) bone cements with admixed Amphotericin B.","authors":"Florian A Frank, Barbara Krampitz, Julia Steiner, Rainer Strathausen, Mario Morgenstern, Martin Clauss, Klaus-Dieter Kühn","doi":"10.1186/s13018-025-05565-x","DOIUrl":"10.1186/s13018-025-05565-x","url":null,"abstract":"<p><strong>Background: </strong>Amphotericin is admixed to Polymethylmethacrylic (PMMA) spacers for fungal periprosthetic joint infections (PJI) during two-stage exchanges. We aimed to analyse the mechanical properties of PMMA cement with admixed Amphotericin B.</p><p><strong>Materials and methods: </strong>We tested Amphotericin in PMMA cement mechanically, its elution properties in vitro and present two cases of fungal PJI treated with Amphotericin B powder in Copal cement in vivo.</p><p><strong>Results: </strong>Sterile Amphotericin B is not available as a pure substance but only as powder for infusions. PMMA mixed with such pharmaceutical Amphotericin B formulations colored the cement orange. Compression strength was slightly decreased, bending and impact strength significantly decreased whereas bending modulus was increased. Drug elution was high within the first 24 h and decreased over time until day 5. Amphotericin B in combination with Copal was successfully used in two cases with Candida ssp.</p><p><strong>Infections: </strong>No negative side effects, especially no nephrotoxic effects, were observed. Sterile Amphotericin B powder for preparing an infusion solution contains only small amounts of pure drug. In vivo polymicrobial Candida-infections with bacterial co-infection were successfully treated using the combination of Copal cements with added Amphotericin B without systemic nephrotoxic impact.</p><p><strong>Conclusions: </strong>The addition of Amphotericin B to PMMA cement affects the cement's properties in vitro whereas in vivo the combination with Copal is clinically successful in treating complex cases of fungal PJI.</p><p><strong>Level of evidence: </strong>Level IV.</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":"20 1","pages":"151"},"PeriodicalIF":2.8,"publicationDate":"2025-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11806800/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143370754","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}

{"title":"Radiological assessment of cup anteversion with a novel 3D-printed highly-porous titanium dual mobility cup.","authors":"Nicole Puteo, Edoardo Matteo Valentino, Vittorio Davidoni, Domenico Tigani","doi":"10.1186/s13018-025-05555-z","DOIUrl":"10.1186/s13018-025-05555-z","url":null,"abstract":"<p><strong>Background: </strong>Cup anteversion after primary total hip arthroplasty (THA) with monobloc dual mobility cups (DMC) is difficult to measure on anterior-posterior (AP) pelvic radiographs because of the implant radiopacity and cup design which do not allow for an accurate visualization of the radiographic projection of the cup equatorial rim and the femoral head. This study aims to radiographically investigate on the reliability and accuracy of different measurement methods for cup anteversion in monobloc DMC THA, by comparing a novel titanium cup with conventional cup designs.</p><p><strong>Methods: </strong>97 THAs with a monobloc 3D-printed titanium DMC were radiographically assessed for cup radiographic anteversion (RA) one month postoperatively. RA were measured by three blinded observers through Lewinnek, Woo-Morrey methods and an open access mathematical software (GeoGebra), used as reference method. Intra- and interobserver reliability of RA measurements were evaluated for each method using intraclass correlation coefficient (ICC). Accuracy was assessed comparing Lewinnek and Woo-Morrey methods with GeoGebra. Moreover, further 98 THAs with conventional different brand DMC were radiographically assessed as control group by using the same methods.</p><p><strong>Results: </strong>ICC for intra- and interobserver reliability for RA measurements with GeoGebra, Lewinnek and Woo-Morrey methods were 0.975-0.980, 0.978 - 0.965, and 0.979 - 0.958, respectively, for the titanium DMC group. Lewinnek resulted more accurate for RA than Woo-Morrey, differing by + 0.4° (p = 0.06) and + 4.4° (p < 0.001) from GeoGebra, respectively. ICC for intra- and interobserver reliability for GeoGebra, Lewinnek and Woo-Morrey methods were 0.848 - 0.756, 0.843 - 0.801, and 0.965 - 0.958, respectively, for the control DMC group. Lewinnek and Woo-Morrey methods differed by -2.3° and + 5.1° from GeoGebra, respectively (p < 0.001).</p><p><strong>Conclusions: </strong>RA measurements are more consistent, repeatable and accurate with a titanium DMC than standard DMC, due to the minor radiopacity of the former cup which enable RA measurements on AP radiographs. Conversely, RA measurements of conventional DMC are more consistent but less accurate if performed on cross-table lateral radiographs by Woo-Morrey method than AP radiographs.</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":"20 1","pages":"150"},"PeriodicalIF":2.8,"publicationDate":"2025-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11806696/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143370758","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}

{"title":"The role of sex, age, and BMI in treatment decisions for knee osteoarthritis: conservative management versus total knee replacement.","authors":"Fabiola Ojeda, Laura Tío, Francisco Castro-Domínguez, Simone Tassani, Jerome Noailly, Jordi Monfort","doi":"10.1186/s13018-025-05552-2","DOIUrl":"10.1186/s13018-025-05552-2","url":null,"abstract":"<p><strong>Background: </strong>Knee osteoarthritis (KOA) has a complex, multifactorial nature with well-established risk factors which may influence treatment decisions. Here we want to identify distinctive characteristics between patients receiving conservative treatment versus total knee replacement (TKR), analyzing both patient-specific and knee-specific features.</p><p><strong>Methods: </strong>This case-control study compared patients assigned to TKR versus conservative management, examining subjects aged 60-75 years with radiographically confirmed KOA (Kellgren-Lawrence grades 2-3), with all participants evaluated by blinded clinicians using validated assessment tools including Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Hospital Anxiety and Depression Scale (HADs), Pain Catastrophizing Scale (PCS) and Daily physical activity (DPA) questionnaires. The study employed multivariate analysis of variance for continuous variables at both patient and knee levels, followed by univariate analysis of variance for significant factors, while logistic and linear regression analyses were used to calculate odds ratios, with Bonferroni corrections applied to adjust p-values for multiple comparisons.</p><p><strong>Results: </strong>Between 2016 and 2020, the study included 87 patients (51 women and 36 men) with a mean age of 67.7 years in both treatment groups, with a slightly higher body mass index (BMI) of 31.9 kg/m² in the TKR group vs 30.5 kg/m² in the conservative management group. TKR patients demonstrated significantly worse scores in WOMAC, HADS, and PCS compared to the conservative management group, though DPA levels remained similar between both groups. At the knee level, women demonstrated significantly higher pain sensitivity and central sensitization compared to men, with no differences between conservative and TKR groups.</p><p><strong>Conclusions: </strong>Patients undergoing TKR exhibited significantly worse baseline clinical outcomes, particularly in WOMAC scores, despite having similar radiographic severity to those receiving conservative treatment, suggesting that functional and symptomatic measures may be more valuable than radiographic findings in determining surgical intervention.</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":"20 1","pages":"152"},"PeriodicalIF":2.8,"publicationDate":"2025-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11806564/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143373980","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}

{"title":"The utility of robotic-assisted surgery in total knee arthroplasty for moderate and severe valgus deformities: a case series.","authors":"Charles Poh Thean Ang, Kunalan Ganthel, Jade Pei Yuik Ho, Khanchana Devi, Juliet Kar Yan Cheong","doi":"10.1186/s13018-024-05443-y","DOIUrl":"10.1186/s13018-024-05443-y","url":null,"abstract":"<p><strong>Background: </strong>Achieving soft tissue balance is challenging in valgus arthritic knee because of a combination of anomalies in the soft tissues and bones. It has been stipulated that contemporary robotic systems are more precise than traditional instrumentation. Its advantage lies in the soft tissue algorithms. Presently, there is paucity of information on the use of robotic-assisted TKA in addressing moderate and severe valgus deformities. The aim of this series is to demonstrate the utility of robotic-assisted surgery in TKA for arthritic knees with moderate and severe valgus deformities, including accuracy, soft tissue releases performed and level of constraint required.</p><p><strong>Methods: </strong>This is a single surgeon series of 14 cases of moderate and severe valgus osteoarthritic knees who underwent robotic-assisted TKA, utilizing the robotic surgical assistant ROSA^® System.</p><p><strong>Results: </strong>All patients were restored to within 3° of the planned alignment. 8 patients were implanted with cruciate retaining implants, 2 had ultracongruent implants, 3 had posterior stabilized implants, and 1 had a constrained posterior stabilized implant. No patients required release of the popliteus tendon or origin of the lateral collateral ligament. No perioperative complications were encountered in all cases. All patients reported an improvement in the Forgotten Joint Score of > 10.8 at 1year follow up with a 100% satisfaction rate.</p><p><strong>Conclusion: </strong>In this case series, the utilization of robotic assisted the surgeon to achieve a final limb alignment to within 3° of the planned alignment with minimal use of constrained prostheses and good patient-reported outcomes in moderate and severe valgus deformities.</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":"20 1","pages":"145"},"PeriodicalIF":2.8,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11803977/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143370768","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}

{"title":"External validation and revision of the Lafontaine criteria for unstable distal radius fractures: a retrospective study.","authors":"Pornpanit Dissaneewate, Phatklao Thanavirun, Yanin Tangjaroenpaisan, Kantapon Dissaneewate","doi":"10.1186/s13018-025-05558-w","DOIUrl":"10.1186/s13018-025-05558-w","url":null,"abstract":"<p><strong>Background: </strong>The Lafontaine criteria are the most commonly cited criteria for predicting unstable distal radius fractures. However, formal validation of the performance of these criteria remains limited. Therefore, we aimed to evaluate the Lafontaine criteria as a diagnostic prediction rule for distal radius fractures, assess the inter-rater reliability and predictive ability of various parameters for distal radius instability, and develop new criteria for fracture instability using reliable and highly predictive factors.</p><p><strong>Methods: </strong>This retrospective study included 274 adult patients with acute distal radius fractures treated with closed reduction and immobilisation between January 2019 and December 2022. Patients who underwent immediate surgery, were lost to follow-up before 4 weeks, or had unacceptable alignment after reduction were excluded. The Lafontaine criteria were validated using the area under the receiver operating characteristic curve (AUROC). Criteria with an AUROC > 0.7 were considered acceptable. The criteria were updated using risk factors with stronger associations in the multivariable logistic regression analysis, and the inter-rater reliability of potential predictors was evaluated.</p><p><strong>Results: </strong>The median age of the patients was 63 years; 78% were female. Redisplacement occurred in 39% of the cases. The AUROC for the Lafontaine criteria was 0.65 (95% confidence interval [CI] 0.57-0.74). Multivariable logistic regression showed that age 56-74 years (odds ratio [OR] 3.92, 95% CI 1.82-9.16, p < 0.001) age > 74 years (OR 6.34, 95% CI 2.66-16.2, p < 0.001), associated ulna fracture (OR 1.61, 95% CI 0.92-2.84, p = 0.10), and initial radial shortening > 3 mm (OR 5.78, 95% CI 3.11-11.2, p < 0.001) were the strongest predictive factors of fracture instability. These predictors demonstrated substantial inter-rater reliability, making them suitable for clinical use. Updating the model with these risk factors resulted in an AUROC of 0.74 (95% CI 0.66-0.82).</p><p><strong>Conclusions: </strong>The performance of the Lafontaine criteria in discriminating unstable distal radius fractures was unacceptable in our study cohort. The updated criteria using age group (< 56 years, 56-74 years, and > 74 years), associated ulnar fractures, and initial radial shortening > 3 mm was found to have moderate discrimination; however, further research is warranted to improve the prediction and measurement reliability of fracture instability.</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":"20 1","pages":"146"},"PeriodicalIF":2.8,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11804089/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143370757","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}

{"title":"Comparison of long-term ankle joint function after one-stage and staged microsurgical repair of open achilles tendon defects.","authors":"Jianjie Mao, Yang Xiang, Hui Chu, GenYang Jin, Guangyan Su, Chang Zeng Liu, Feng Zhu","doi":"10.1186/s13018-025-05548-y","DOIUrl":"10.1186/s13018-025-05548-y","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;To explore the differences in long-term ankle joint function between one-stage and staged microsurgical repair of open Achilles tendon defects.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A retrospective analysis of the surgical treatment and follow-up data of 147 patients with open Achilles tendon defects from January 2007 to September 2023 was conducted. Patients were divided into a one-stage reconstruction group (n = 81) and a staged reconstruction group (n = 66) on the basis of whether one-stage microsurgical repair was used. In the one-stage reconstruction group, 43 patients underwent vascular anastomosed fascia lata free anterolateral thigh perforator flap transplantation for repair, and 38 patients underwent descending genicular artery free flap transplantation with the adductor magnus tendon. In the staged reconstruction group, the sural neurovascular flap was used to repair the soft tissue defect in the heel area in the first stage. In the second stage, 31 patients underwent flexor hallucis longus tendon transfer, and 35 patients underwent peroneus longus muscle tendon transfer with the lateral calcaneal artery. Observations included evaluation of the continuity and healing of the Achilles tendon via colour Doppler ultrasound 3 months postoperatively and assessment of ankle joint function 2 years postoperatively using the American Orthopedic Foot and Ankle Society ankle-hindfoot score (AOFAS) and the Achilles tendon total rupture score (ATRS).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Three months after surgery, colour Doppler ultrasound revealed good continuity of the Achilles tendon in all patients, with slight thickening and irregular fibre orientation. Two years after surgery, the ATRS and AOFAS scores of the one-stage reconstruction group were superior to those of the staged group (P&lt;sub&gt;ATRS&lt;/sub&gt; &lt; 0.05, P&lt;sub&gt;AOFAS&lt;/sub&gt; &lt; 0.05). Among the one-stage reconstruction group, patients who underwent descending genicular artery-free flap transplantation with the adductor magnus tendon presented better performance in walking on uneven surfaces, fast stair climbing, abnormal gait, plantar flexion and dorsiflexion, and inversion and eversion than did those who underwent vascular anastomosed fascia lata free anterolateral thigh perforator flap transplantation, although there was no overall functional difference (P&lt;sub&gt;AOFAS&lt;/sub&gt; = 0.792; P&lt;sub&gt;ATRS&lt;/sub&gt; &lt; 0.001). In the staged repair group, patients who underwent peroneus longus muscle tendon transfer with the lateral calcaneal artery in the second stage had better postoperative follow-up ankle joint function than did those who underwent flexor hallucis longus tendon transfer (P&lt;sub&gt;AOFAS&lt;/sub&gt; &lt; 0.001; P&lt;sub&gt;ATRS&lt;/sub&gt; &lt; 0.001). Preoperative injury classification of the heel region (P &lt; 0.001), size of the defect area in the heel region (P&lt;sub&gt;AOFAS&lt;/sub&gt; &lt; 0.001, R&lt;sub&gt;AOFAS&lt;/sub&gt; = -0.397; P&lt;sub&gt;ATRS&lt;/sub&gt; &lt; 0.001, R&lt;sub&gt;ATRS&lt;/sub&gt; = -0.436), and length of the Achilles tendon de","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":"20 1","pages":"149"},"PeriodicalIF":2.8,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11804006/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143370667","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}

{"title":"Efficacy and safety of sequential therapy for primary osteoporosis with bone formation promoters followed by bone resorption inhibitors: a meta-analysis.","authors":"Yuxin Liu, Xin Liu, Yuefeng Wu, Tao Luo","doi":"10.1186/s13018-025-05545-1","DOIUrl":"10.1186/s13018-025-05545-1","url":null,"abstract":"<p><strong>Objective: </strong>Through this study we aimed to present the latest and most comprehensive pooled analysis, providing an updated evaluation of the efficacy and safety of sequential therapy for primary osteoporosis, using bone formation promoters followed by bone resorption inhibitors.</p><p><strong>Methods: </strong>PubMed, the Cochrane Library, Web of Science, and Embase databases were retrieved to identify pertinent studies. Randomized controlled trials (RCTs) on the sequential therapy of primary osteoporosis with bone formation promoters followed by bone resorption inhibitors were included. Data from clinical studies that met the eligibility criteria were extracted, and quality assessment and meta-analysis were performed using RevMan v5.4 and Stata v15.0. Sensitivity and subgroup analyses were performed to find the source of heterogeneity and discover more findings.</p><p><strong>Results: </strong>A total of 10 eligible articles involving 14,510 patients (7171 in the intervention group versus 7339 in the comparator group) were included for the evidence synthesis. The baseline characteristics of the two groups were similar. Pooled analysis showed that the intervention group (bone formation promoters followed by bone resorption inhibitors) increased BMD at the spine (SMD:1.64; 95% CI: 0.97, 2.31; P < 0.00001; I² = 99%), femoral neck (SMD: 0.57; 95% CI: 0.16, 0.99; P = 0.007; I² = 96%), and total hip (SMD: 0.82; 95% CI: 0.16, 1.48; P = 0.02; I² = 97%) compared with the comparator group (monotherapy or combination therapy using two drugs)for postmenopausal osteoporosis patient; however, there was no statistically significant difference observed in the increase of BMD at the 1/3 distal radius comparing the intervention group and comparator group (SMD: -0.25; 95% CI: -1.49, 0.99; P = 0.069; I² = 92%). The incidence of new fractures was reduced in the intervention group relative to the comparator group (RR: 0.60; 95% CI: 0.43, 0.82; P = 0.001; I² = 75%). The incidence of adverse events differed statistically between the two groups (RR: 0.85; 95% CI: 0.76, 0.95; P = 0.004; I² = 97%), but the difference in adverse event incidence was not statistically significant among subgroups within the intervention and comparator groups. The intervention group had a superiority of Clinical efficacy.</p><p><strong>Conclusion: </strong>Among patients with primary osteoporosis, sequential therapy with bone formation promoters followed by bone resorption inhibitors substantially increased BMD at sites such as the spine, femoral neck, and total hip while concurrently mitigating fracture risks. However, benefits regarding BMD at the 1/3 distal radius and the incidence of adverse events have not yet been established.</p><p><strong>Study registration: </strong>Registered on PROSPERO (ID: CRD42023437188).</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":"20 1","pages":"147"},"PeriodicalIF":2.8,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11803957/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143370634","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}