Journal of Orthopaedic Surgery and Research最新文献

{"title":"Letter: effects of dexamethasone combined with vitamin B12 on percutaneous endoscopic interlaminar discectomy early outcomes: a randomized controlled trial.","authors":"Yinjie Zheng, Fei Gao, Xiaochun Zheng","doi":"10.1186/s13018-025-05462-3","DOIUrl":"10.1186/s13018-025-05462-3","url":null,"abstract":"<p><p>Cheng He et al. evaluated the effect of dexamethasone combined with vitamin B12 on early outcomes following percutaneous endoscopic interlaminar discectomy (PEID). While the study offers valuable insights, we have several constructive suggestions. The lack of a standardized anesthesia protocol (local vs. general anesthesia) may have influenced the results, as patients under local anesthesia were awake during the procedure. Previous studies suggest intraoperative communication and patient awareness can impact pain levels and recovery. To clarify the effect of anesthesia type on recovery, we recommend conducting a subgroup analysis based on the anesthesia method. Although the CT group(combined treatment) showed satisfactory pain control (VAS < 3.3), the observed VAS score between days 1 and 3 may not reflect the actual patient experience. Except for the VAS score for leg pain on the third day after surgery, the net intergroup differences at other time points were less than the minimal clinically important differences recommended in the literature(a change of 10 for the 100 mm pain VAS). Furthermore, the study does not assess patient satisfaction with pain management, making it difficult to determine the clinical importance of the treatment effect.</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":"20 1","pages":"269"},"PeriodicalIF":2.8,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11905597/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143615703","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":"Comparative analysis of dynamic external fixation, static external fixation, and internal fixation in interphalangeal joint fractures: outcomes, complications, and clinical implications.","authors":"Chengjing Wang, Changqing Li","doi":"10.1186/s13018-025-05644-z","DOIUrl":"10.1186/s13018-025-05644-z","url":null,"abstract":"<p><strong>Background and objective: </strong>Proximal interphalangeal joint (PIPJ) fractures present significant therapeutic challenges in hand surgery. This systematic review evaluated the comparative efficacy of dynamic external fixation against traditional treatment modalities, integrating machine learning analysis to enhance outcome prediction and treatment selection.</p><p><strong>Methods: </strong>We systematically reviewed 43 clinical studies published between January 2014 and January 2024, including 26 dynamic external fixations, 6 traditional internal fixations, and 11 static external fixations. Studies were included if they reported quantitative outcomes of PIPJ fracture treatment, had a minimum follow-up of 4 weeks, and included at least 20 patients. Case series with fewer than 5 patients and non-English publications without available translations were excluded. The analysis focused on four key outcomes: range of motion (ROM), recovery time, complication rates, and functional results. We developed a neural network model to predict treatment outcomes, achieving 89.7% accuracy (95% CI 87.3-92.1%). Methodological quality was assessed using the Newcastle-Ottawa Scale and Cochrane Risk of Bias tool.</p><p><strong>Results: </strong>Dynamic external fixation demonstrated superior outcomes across multiple domains. ROM analysis revealed a median of 86.12° (range: 70°-95°) for dynamic fixation compared to 72.30° (range: 56°-88°) for traditional approaches (mean difference: 13.82°, 95% CI 10.24-17.40°). Dynamic fixation significantly reduced recovery duration (9.68 weeks vs. 20.47 weeks, p < 0.001). Complication profiles favored dynamic fixation, with pin tract infection rates of 2.4% versus 3.8% for traditional fixation. Functional assessment using the Ishida scoring system showed favorable outcomes in the dynamic fixation group, with a mean score of 85.3 points and 78% of cases achieving scores above 80 points.</p><p><strong>Discussion: </strong>This comprehensive systematic review provides evidence supporting the efficacy of dynamic external fixation for PIPJ fracture treatment. The findings demonstrate improved functional outcomes, accelerated rehabilitation, and reduced complication rates. The integration of machine learning analysis shows promise for optimizing patient-specific treatment selection. Further validation through large-scale, multicenter randomized controlled trials with extended follow-up periods is warranted.</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":"20 1","pages":"265"},"PeriodicalIF":2.8,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11899099/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143605153","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":"Classification in 157 patients with Lisfranc injuries using three-dimensional fracture lines and heat map.","authors":"Lei Zhang, Songtao Jiang, Ruihan Wang, Xi Cheng, Wangyu Wu, Guoyou Wang","doi":"10.1186/s13018-025-05663-w","DOIUrl":"10.1186/s13018-025-05663-w","url":null,"abstract":"<p><strong>Background: </strong>Recently Lisfranc fractures have increased due to increased high-energy injuries from various causes. However, due to incomplete traditional classification, the pattern and distribution of fractures cannot be analyzed in three dimensions. This study examines a novel fracture pattern based on the fracture line and heat map for Lisfranc injuries.</p><p><strong>Methods: </strong>We retrospectively analyzed data from CT scans of 157 patients diagnosed with Lisfranc injuries. We extracted the CT data of a healthy adult and created a standard foot model. We performed 3D reconstruction using patients' CT images and superimposed the fracture model onto the standard model for drawing fracture lines. Subsequently, we converted the fracture lines into a heat map for visualization.</p><p><strong>Results: </strong>The novel classification identifies high-density fracture sites within the tarsometatarsal joint, predominantly localized in the medial and lateral columns. The fracture lines not involving the TMT joint are mainly located in the medial aspect of the first metatarsal trunk and the fifth metatarsal trunk. Additionally, we develop an assessment protocol for Lisfranc injury that incorporates ligament injury, displacement, and fracture.</p><p><strong>Conclusion: </strong>The new classification accurately identifies the different types of fractures in Lisfranc injuries, enabling clinicians to more fully and accurately understand their patients' injuries and assisting them in efficiently making sound decisions to avoid diagnostic delays that can negatively impact postoperative outcomes.</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":"20 1","pages":"266"},"PeriodicalIF":2.8,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11900351/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143605230","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 pregabalin for postoperative pain after total hip and knee arthroplasty: a systematic review and meta-analysis.","authors":"Miguel Ángel Ruiz Ibán, Ángel Oteo-Álvaro, Xoán Miguéns Vázquez, José Luís Ávila, Hermann Ribera, María Pérez-Páramo","doi":"10.1186/s13018-025-05675-6","DOIUrl":"10.1186/s13018-025-05675-6","url":null,"abstract":"<p><strong>Introduction: </strong>The prevalence of osteoarthritis and postoperative neuropathic pain after arthroplasty highlights the necessity for improved pain management. Many patients develop chronic neuropathic pain, necessitating targeted interventions. Research on pregabalin's effectiveness in pain relief has yielded conflicting findings, necessitating further exploration to determine its therapeutic value. This study sought to assess pregabalin's efficacy and safety in postoperative pain management, reconcile inconsistent literature, and enhance understanding of its clinical use.</p><p><strong>Methods: </strong>This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A systematic search was conducted across four major databases to select clinical trials. Statistical analysis was performed using Review Manager 5.4.1, applying fixed- or random-effects models depending on heterogeneity (I²). Subgroup analyses were conducted based on the type, timing, and dosage of pregabalin administered.</p><p><strong>Results: </strong>Pregabalin was associated with significantly reduced pain during movement at 24 h (MD -0.62, 95%CI -1.02 to -0.23), 48 h (MD -0.53, 95%CI -0.90 to -0.15), and 72 h (MD -0.59, 95%CI -1.05 to -0.12) post-surgery. Opioid consumption was also significantly lower at 24 h (SMD - 0.50, 95%CI -0.80 to -0.20), 48 h (SMD - 0.76, 95%CI -1.34 to -0.19), and 72 h (SMD - 1.33, 95%CI -2.16 to -0.49). While there were no significant improvements in the range of motion at 24 and 48 h, pregabalin was associated with significantly enhanced range of motion at 72 h (SMD 1.11, 95%CI 0.12, 2.09). Treatment with pregabalin was associated with a significant decrease in the odds of nausea (OR 0.30, 95%CI 0.09 to 0.99) and vomiting after total knee arthroplasty (TKA) (OR 0.17, 95%CI 0.04 to 0.65). Additionally, pregabalin exposure was associated with increased sedation after TKA (OR 2.27, 95%CI, 1.13 to 4.56) and total hip arthroplasty (THA) (OR 2.54, 95%CI 1.11 to 5.79), as well as blurred vision at 24 h in TKA/THA patients (OR 4.68, 95%CI 1.37 to 15.99; n = 95; I2 = 34). There was no significant association with other adverse events. The administration of pregabalin for more than 24 h before surgery was associated with maximal reductions in pain and opioid use at 72 h post-surgery.</p><p><strong>Conclusion: </strong>Pregabalin was associated with significantly reduced postoperative pain and opioid use following total joint arthroplasty while enhancing mobility on the third day, with acceptable tolerability and safety.</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":"20 1","pages":"261"},"PeriodicalIF":2.8,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11895303/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143605154","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":"Therapeutic potential of total flavonoids of Rhizoma Drynariae: inhibiting adipogenesis and promoting osteogenesis via MAPK/HIF-1α pathway in primary osteoporosis.","authors":"Hui Su, Luyao Liu, Zechen Yan, WenXuan Guo, Guangxin Huang, Rujie Zhuang, Yu Pan","doi":"10.1186/s13018-025-05665-8","DOIUrl":"10.1186/s13018-025-05665-8","url":null,"abstract":"<p><strong>Aim: </strong>This study seeks to confirm the therapeutic effectiveness of TRFD in inhibiting adipogenesis and promoting osteogenesis in primary osteoporosis through the MAPK/HIF-1α signaling pathway. C57BL/6J mice underwent ovariectomy (OVX) to induce osteoporosis. Mice were administered TRFD (Low and high doses)estradiol for a duration of 12 weeks. Bone microarchitecture evaluated using Micro-CT, while serum biomarkers and protein expressions were analyzed through enzyme-linked immunosorbent assay, Western blotting, and immunohistochemistry. Furthermore, BMSC were isolated to show differentiation, Osteogenic and adipogenic induction were performed, including ALP activity and Oil Red O staining. Bioinformatics analysis of RNA sequencing data was conducted to identify differentially expressed genes.</p><p><strong>Results: </strong>Total flavonoids of Rhizoma Drynariae treatment significantly improved bone microarchitecture and reversed histopathological damage in OVX mice. It increased serum levels of osteogenesis markers (RUNX2, BMP-2) and enhanced MAPK and HIF-1α signaling pathways, The results also showed a significant dose, TFDR enhanced the osteogenic differentiation of BMSCs while suppressing adipogenic differentiation, as demonstrated by increased ALP activity and mineralization, alongside, the expression of lipid markers (PPAR-γ, C/EBPα) was inhibited. Furthermore, MAPK/HIF-1α pathway was confirmed be crucial in mediating these effects.</p><p><strong>Conclusion: </strong>TRFD exhibits significant therapeutic potential in treating primary osteoporosis by promoting osteogenesis and inhibiting adipogenesis through the MAPK/HIF-1α pathway. These establish an investigation of TRFD as a natural treatment option for managing osteoporosis.</p><p><strong>Clinical trial number: </strong>Not applicable.</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":"20 1","pages":"260"},"PeriodicalIF":2.8,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11895304/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143605160","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":"Ultrasonography for diagnosing medial sided ankle instability in supination external rotation ankle fracture.","authors":"Jirawat Saengsin, Pongpanot Sornsakrin, Pichitchai Atthakomol, Go Sato, Bart Lubberts, Gregory Waryasz, Christopher W DiGiovanni, Daniel Guss","doi":"10.1186/s13018-025-05645-y","DOIUrl":"10.1186/s13018-025-05645-y","url":null,"abstract":"<p><strong>Background: </strong>Destabilizing injuries to the deltoid ligament have relied on radiographic stress examination for diagnosis, with a focus on medial clear space widening. Increasingly, Portable ultrasound has also been used in the clinical setting, allowing dynamic and non-invasive evaluation at the point of care. The aim of this study was to determine whether portable ultrasound can detect medial sided instability associated with supination-external rotation type ankle injuries during the gravity stress, weightbearing, and external rotation stress.</p><p><strong>Methods: </strong>Ten fresh-frozen cadaveric ankles were used in this study. Assessment of medial clear space distances with portable ultrasound was first performed with all structures intact, and later with sequential transection of the anterior inferior tibiofibular ligament (Stage I), Weber B fibular fracture (Stage II), posterior inferior tibiofibular ligament (Stage III), superficial deltoid ligament (Stage IVa), and the deep deltoid ligament (Stage IVb). In all scenarios, four loading conditions were considered; (1) a gravity stress test with the ankle positioned in a neutral position; (2) a gravity stress test with the ankle positioned in a plantarflexed position; (3) an external rotation stress test; and (4) simulated weightbearing condition.</p><p><strong>Results: </strong>Among all four loading conditions, all medial clear space values increased as the supination-external rotation ankle injury stage progressed (Spearman's rank correlation ranged from 0.43 to 0.90, P <.001). The medial clear space values measured with the portable ultrasound during; (1) gravity stress test in neutral ankle position, (2) gravity stress test in plantarflexed ankle position, (3) weightbearing, and (4) external rotation stress test were significantly increased between intact stage vs. stage IVb (P =.036), as well as between stage III vs. IVb (P ranged from 0.015 to 0.047).</p><p><strong>Conclusions: </strong>Portable ultrasonography is a feasible tool for diagnosing medial ankle instability in supination-external rotation ankle injury. The medial clear space measurements assessed with portable ultrasound during the gravity stress test, weightbearing, and the external rotation stress test well correlated with the supination-external rotation ankle injury staging. Besides, the portable ultrasound method can differentiate the supination-external rotation ankle injury stage IVb from the intact stage, as well as differentiating the supination-external rotation ankle fracture without deltoid ligament injury (III) from the supination-external rotation stage with complete deltoid ligament injury (IVb).</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":"20 1","pages":"254"},"PeriodicalIF":2.8,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11892171/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143585998","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":"Effects of TGF-β3 on meniscus repair using human amniotic epithelial cells.","authors":"Yupeng He, Ya Li, Xiaodong Zhi, Yuqiang Zhang, Wei Wang","doi":"10.1186/s13018-025-05640-3","DOIUrl":"10.1186/s13018-025-05640-3","url":null,"abstract":"<p><strong>Background: </strong>Meniscus injury is one of the most common knee diseases, which is managed through conservative and surgical treatments. In recent years, biotherapy has shown great potential to treat various symptoms caused by meniscus injury repair. Human amniotic epithelial cells (hAECs), which are easy to acquire, non-tumorigenic, and high tri-lineage differentiation potential, are a promising cell source for biotherapy and tissue engineering applications. Studies have demonstrated that the Transforming Growth Factor-β3 (TGF-β3) can facilitate chondrocyte differentiation and maturation.</p><p><strong>Methods: </strong>Both in vitro test and in vivo test were employed. In the in vitro test, human amniotic epithelial cells (hAECs), human amniotic mesenchymal stem cells (hAMCs), and fibrochondrocytes (FCs) were extracted and identified by flow cytometry and immunohistochemistry (IHC). These cells were treated with TGF-β3 for one week, followed by IHC staining and qPCR to explore TGF-β3-induced fibrocartilage formation in hAECs. In the in vivo tests, a meniscus injury model was established based on rabbits, and the Sham, the control (normal saline), and the hAECs + TGF-β3 groups were used. Additionally, the meniscus was collected and checked through general examination and IHC analysis 90 d after surgery.</p><p><strong>Results: </strong>Routine transcriptome analysis confirmed that TGF-β3 induced the differentiation of amniotic epithelial cells (hAECs) into fibrochondrocytes through the Wnt signaling pathway. This finding was corroborated using Western blot (WB) and quantitative PCR (QPCR). Among the five experimental groups, the highest expression of target proteins and genes was detected in hAECs + TGF-β3 group, followed by the hAECs + hAMCs + TGF-β3 group, the hAMCs + TGF-β3 group, the hAECs + FCs group, and the FCs group. The observed differences were statistically significant (P < 0.05). In vivo, treatment with hAECs + TGF-β3 facilitated effective repair of damaged menisci.</p><p><strong>Conclusions: </strong>hAECs + TGF-β3 can potentially promote the healing of meniscus injuries, laying the foundation for further research to promote its clinical translation.</p><p><strong>Trial registration: </strong>Not applicable.</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":"20 1","pages":"255"},"PeriodicalIF":2.8,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11892189/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143585922","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":"A retrospective comparative analysis of anterior cervical discectomy and fusion using stand-alone titanium cage versus cage and plate fixation in two-level cervical disc herniation.","authors":"Cem Sever, Bekir Eray Kilinc, Ahmet Onur Akpolat, Tayfun Bozkaya, Akif Kurtan, Abdulhamit Misir","doi":"10.1186/s13018-025-05654-x","DOIUrl":"10.1186/s13018-025-05654-x","url":null,"abstract":"<p><strong>Background: </strong>This study aims to compare the outcomes of two-level anterior cervical discectomy and fusion (ACDF) procedures using stand-alone cages versus cage and plate fixation in patients diagnosed with cervical disc herniation (CDH).</p><p><strong>Materials and methods: </strong>This retrospective analysis included 60 patients who underwent two-level ACDF procedures. Patients were divided into two groups: one treated with stand-alone cages and the other with cage and plate fixation. Data on surgical duration, blood loss, fusion stability, and complication rates were collected. Clinical outcomes, including neck pain and functional status, were assessed using standard scoring systems.</p><p><strong>Results: </strong>Plate fixation provided superior fusion stability but was associated with longer surgery durations, higher intraoperative blood loss, and increased complication rates. Stand-alone cages reduced intraoperative trauma but demonstrated higher subsidence rates and prolonged fusion times. Both techniques resulted in significant improvements in neck pain and disability scores.</p><p><strong>Discussion: </strong>While both approaches are effective for managing cervical disc herniation, each has distinct advantages and limitations. Surgical technique selection should be individualized, considering patient-specific anatomical factors, functional demands, and the risk-benefit profile of each approach.</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":"20 1","pages":"256"},"PeriodicalIF":2.8,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11892192/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143596918","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":"CT-based vertebral three-dimensional Hounsfield unit can predict the new vertebral fracture after percutaneous vertebral augmentation in postmenopausal women: a retrospective study.","authors":"Rongkun Chang, Feng Chang, Yang You, Zhaowei Wang, Zhen Geng, Rongcan Liu, Ruopeng Mai, Yinbin Wang, Lijun Cai","doi":"10.1186/s13018-025-05651-0","DOIUrl":"10.1186/s13018-025-05651-0","url":null,"abstract":"<p><strong>Background: </strong>Vertebral Hounsfield unit (HU) were regarded as a new way to predict fragility fracture. However, HU values were measured in a single plane, which is not accurate for the entire vertebral body. This study aimed to create a new CT-based metric for assessing bone mineral density, three-dimensional Hounsfield unit value (3D-HU), and to evaluate its effect in independently predicting new vertebral fracture (NVF) after percutaneous vertebral augmentation (PVA) in postmenopausal women.</p><p><strong>Methods: </strong>This study reviewed female patients with osteoporotic vertebral compression fracture (OVCF) who were treated at our hospital. Patients were divided into NVF and control groups according to whether they had NVF. 3D-HU of the L1-4 vertebrae was measured using preoperative computed tomography (CT) scanning of the lumbar spine. Demographics, procedure-related data, and radiological data were collected. Pearson correlation test was used to determine the correlation between 3D-HU and BMD T-score. The independent risk factors of NVF were determined by multivariate logistic regression analyses. Receiver operating characteristic curve (ROC) was used to evaluate the predictive performance of 3D-HU.</p><p><strong>Results: </strong>This study involved 349 postmenopausal women who were treated with PVA between January 2017 and August 2022. Among them, 61 people suffered the NVF following PVA. The mean 3D-HU was 40.64 ± 22.43 in the NVF group and 79.93 ± 25.69 in the without NVF group (p < 0.001). Multivariate analysis showed that lower 3D-HU (OR = 0.927; 95%CI = 0.906-0.945; p < 0.001) was the only independent predictor of NVF following PVA. The predictive accuracy of 3D-HU was 87.7%, which was higher than that of the HU value (82.3%), and it was highly positively correlated with BMD T-score (r = 0.628, p < 0.001).</p><p><strong>Conclusions: </strong>Lower 3D-HU was significantly associated with NVF following PVA in postmenopausal women. In addition, vertebral 3D-HU had better predictive power than HU values. 3D-HU assessment prior to PVA may provide insight into a patient' s risk for NVF.</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":"20 1","pages":"257"},"PeriodicalIF":2.8,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11892133/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143596931","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":"How to prevent preoperative adjacent segment degeneration L5/S1 segment occuring postoperative adjacent segment disease? A retrospective study of risk factor analysis.","authors":"Yan Liu, Hua-Peng Guan, Juan Yu, Nian-Hu Li","doi":"10.1186/s13018-024-05439-8","DOIUrl":"10.1186/s13018-024-05439-8","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;L5/S1 segment is one of the most common lumbar degenerative segments with high clinical failure rate. When the clinically responsible segment consists of one or more segments including L4/L5 segment, whether to merge the severely degraded L5/S1 segment together is a common problem plaguing clinicians. Therefore, the purpose of this study was to explore the risk factors for preoperative adjacent segment degeneration L5/S1 segment occuring Postoperative adjacent segment disease(ASDis), analyze the correlation between the high risk factors and the occurrence of adjacent segment disease, clarify the preventive measures and direction, and provide references for clinical selection of personalized treatment.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;The data of 119 patients with L5/S1 segment degeneration who underwent fixed to L4/5 posterior lumbar fusion surgery and were followed up in the orthopedic ward of Shandong Hospital of Traditional Chinese Medicine from January 2016 to January 2018 were retrospectively analyzed. According to the occurrence of ASDis at the last follow-up, all patients were divided into ASDis group (17 cases) and asymptomatic group (102 cases). The age, gender, BMI, bone mineral density and underlying diseases of the two groups were analyzed and compared. Perioperative time, intraoperative blood loss, incision length, number of surgical fusion segments, postoperative time on the ground, and hospital stay were recorded and compared. The improvement of VAS score and ODI index before and after operation were recorded and compared. X-ray and CT measurements were used to compare preoperative L5/S1 intervertebral space height, endplate Modic changes, gas in articular process, disc herniation calcification, sacral vertebrae lumbalization of patients, intraoperative L4/5 immediately corrected intervertebral space height, and sagittal position parameters of L5/S1 segment Segmental lordosis (SL), Pelvic incidence (PI), sacral slope (SS),lumbar lordosis (LL), pelvic tilt (PT), PI-LL and so on. Pfirmann grade, paravertebral muscle CSA, fat infiltration FI, paravertebral muscle rFCSA, psoas major CSA, and vertebral body area were measured and compared by MRI before surgery. The relative paravertebral cross-sectional area (rCSA), relative psoas major cross-sectional area (rCSA) and relative functional paravertebral cross-sectional area (rFCSA) were calculated. logistic regression analysis was used to determine the risk factors for preoperative adjacent segment degeneration L5/S1 segment occuring Postoperative ASDis, and the receiver operating characteristic (ROC) curve was described and the area under the curve was calculated.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;All patients successfully completed the operation. Proportion of patients with osteoporosis combined with ASDis [yes/no, (9/8) vs. (21/81), P = 0.004], BMI [(27.55 ± 3.99) vs. (25.18 ± 3.83), P = 0.021], the number of fusion segments [(1.76 ± 0.75) vs. (1.28 ± 0.52),","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":"20 1","pages":"259"},"PeriodicalIF":2.8,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11895260/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143596955","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}