Journal of Orthopaedic Surgery and Research最新文献

{"title":"Three-column osteotomy versus Halo-gravity traction combined with posterior column osteotomy in the treatment of dystrophic neurofibromatosis type 1 kyphoscoliosis: a retrospective comparative cohort study.","authors":"Yuan-Shun Lo, Yu-Tong Dai, Yong Qiu, Erh-Ti Ernest Lin, Hung-Lun Hsieh, Xue-Peng Wei, Chun-Hao Tsai, Yi-Chin Fong, Hsien-Te Chen, Shiau-Tzu Tzeng, Ben-Long Shi","doi":"10.1186/s13018-025-05842-9","DOIUrl":"10.1186/s13018-025-05842-9","url":null,"abstract":"<p><strong>Background: </strong>Dystrophic neurofibromatosis type I (NF1) kyphoscoliosis presents unique challenges for corrective spinal surgery due to anatomical abnormalities. To compare the radiographic and clinical outcomes of dystrophic neurofibromatosis type 1 (NF1) kyphoscoliosis patients undergoing three-column osteotomy (3CO), halo-gravity traction (HGT), or posterior column osteotomy (PCO) and to evaluate their efficacy and safety in this cohort, different treatment strategies and their associated complication rates warrant further comprehensive investigation.</p><p><strong>Methods: </strong>Dystrophic NF1 kyphoscoliosis were divided into 3CO, HGT, and PCO groups based on the surgical strategy. Radiographic parameters were measured preoperatively, postoperatively, and at each follow-up. Intraoperative and postoperative complications were recorded for each patient, and patient-reported outcomes were assessed using the Scoliosis Research Society-22 (SRS-22) questionnaire. Differences among the three groups were analyzed.</p><p><strong>Results: </strong>A total of 9 patients were included in the 3CO, 22 in HGT group, 95 in PCO groups, respectively. Significant differences among the three groups were found in terms of operation time (p = 0.011), estimated blood loss (p = 0.003), and number of satellite rod techniques (p = 0.013). At pre-operation, the Cobb angles of main curves were 84.3 ± 24.6° in 3CO group, 99.1 ± 24.3° in HGT group, 60.0 ± 16.8° in PCO group. At post-operation, significant post-operative improvements were found in the Cobb angles of the main curves, apical vertebral translation (AVT), segmental kyphosis (SK), and deformity angular ratio (DAR) in all three groups (p < 0.001). No significant correction loss was observed during the follow-up. Six complications were found in the 3CO group, 13 in the HGT group, and 40 in the PCO group.</p><p><strong>Conclusions: </strong>PCO, 3CO, and HGT could be applied to dystrophic NF1 patients. The 3CO is also associated with increased perioperative complications.</p><p><strong>Level of evidence: </strong>IV.</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":"20 1","pages":"470"},"PeriodicalIF":2.8,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12082947/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144086343","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":"Secondary surgery and mortality following primary treatment for acetabular fractures - an observational study from Swedish national quality registers.","authors":"Madelene Albrektsson, Michael Möller, Mikael Sundfeldt, David Wennergren, Olof Wolf","doi":"10.1186/s13018-025-05796-y","DOIUrl":"10.1186/s13018-025-05796-y","url":null,"abstract":"<p><strong>Background: </strong>The treatment of acetabular fractures ranges from non-operative with no restrictions in mobilisation to some of the more complex operative treatments in orthopaedics. Treatment strategies are developing, and outcomes need to be studied continuously. The study's primary aim was to assess the rate of secondary treatment in patients with acetabular fractures treated non-operatively or operatively. A secondary aim was to study mortality.</p><p><strong>Methods: </strong>Data were retrieved from the Swedish Fracture Register and cross-referenced with the Swedish Arthroplasty Register for all patients aged ≥ 18 years with an acetabular fracture between 2014 and 2023. Patients were divided into three primary treatment groups: non-operative treatment, open reduction and internal fixation (ORIF), and total hip arthroplasty (THA) with/without combined ORIF (THA/combined hip procedure, CHP). The study examined mortality rates within each treatment group.</p><p><strong>Results: </strong>Of the 3318 patients included in the study, 74% were treated non-operatively, 18% with ORIF, and 8% with THA/CHP. 4% of non-operatively treated patients and 17% of patients treated with ORIF had been converted to THA at 5 years, 12% of patients with THA as primary treatment had been revised. Patients who underwent THA as their initial treatment were more likely to undergo secondary treatment early. However, in those initially treated with ORIF the prevalence of secondary treatment increased after the first year. The non-operatively treated group had the highest mortality rate (19% at 1 year), followed by the THA group (14% at 1 year).</p><p><strong>Conclusions: </strong>This observational nationwide register study on acetabular fractures shows that surgically treated patients have a relatively high reoperation rate. Younger patients are predominately treated with ORIF and display low mortality rates. Older patients with complex fracture patterns may benefit from primary treatment with THA/CHP being more frequently performed compared to prevailing practice.</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":"20 1","pages":"465"},"PeriodicalIF":2.8,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12083103/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144086340","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":"Accuracy of diagnosis and evaluation of first ray hypermobility in symptomatic and asymptomatic hallux valgus patients using ultrasonography.","authors":"Jirawat Saengsin, Pichitchai Atthakomol, Nuttaya Pattamapaspong, Tanawat Vaseenon","doi":"10.1186/s13018-025-05856-3","DOIUrl":"10.1186/s13018-025-05856-3","url":null,"abstract":"<p><strong>Background: </strong>Hypermobility of the first ray is related to many foot problems. Existing methods to assess this condition have diverse advantages and disadvantages. The aims of this study were 1) to define the optimal cutoff points for ultrasound evaluation of first ray hypermobility reliant on Klaue device and 2) to evaluate the relationship between the demographic or radiological factors, and hypermobility or forefoot symptoms in patients with hallux valgus.</p><p><strong>Methods: </strong>Thirty-two hallux valgus patients were enrolled. Patient's demographic and radiographic data were taken. Hypermobility of the first ray was assessed in all patients using both the Klaue device and ultrasound. Ultrasonographic evaluation, including dorsal translation, plantar and medial gapping of the first metatarsal cuneiform joint, was accomplished. Youden's J statistic was calculated for each sensitivity/ specificity pair to determine the optimal cutoff value for the ultrasound measurements to distinguish hypermobile from non-hypermobile group. Continuous outcome data were analyzed using the two-sample t-test. Categorical outcome data were analyzed using Fisher's exact tests. A separate multivariable logistic regression was used to re-evaluate individual variables that were significant on the univariate analysis while controlling for age, sex, and body mass index.</p><p><strong>Results: </strong>The cutoff points for each ultrasound parameter to diagnose hypermobility of the first ray were determined to be ≥ 1 mm increase in dorsal translation (sensitivity = 96.97%, specificity = 82.61%) or ≥ 0.8 mm increase in medial gapping (sensitivity = 72.73%, specificity = 86.96%) or > 1.1 mm increase in plantar gapping of the first metatarsocuneiform joint (sensitivity = 81.82%, specificity = 91.30%). The increase in width of the foot and the increase in hallux valgus angle were correlated with hypermobility of the first ray, while the increase in hallux valgus angle and the first-second intermetatarsal angle were correlated with symptoms in hallux valgus patients.</p><p><strong>Conclusions: </strong>The ultrasound technique measuring three parameters of the first ray motion provides acceptable accuracy for the first ray mobility assessment. Width of the feet and hallux valgus angle were associated with hypermobility of the first ray while an increase in the hallux valgus angle and the first-second intermetatarsal angle were associated with symptoms among hallux valgus patients.</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":"20 1","pages":"463"},"PeriodicalIF":2.8,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12083005/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144078553","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":"Correction: Inhibition of cc chemokine receptor 10 ameliorates osteoarthritis via inhibition of the phosphoinositide-3-kinase/Akt/mammalian target of rapamycin pathway.","authors":"Yan Luo, Feng Zhou, Xiaojing Wang, Runwei Yang, Yi Li, Xiaochun Wu, Bin Ye","doi":"10.1186/s13018-025-05807-y","DOIUrl":"https://doi.org/10.1186/s13018-025-05807-y","url":null,"abstract":"","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":"20 1","pages":"462"},"PeriodicalIF":2.8,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12080170/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144078557","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":"Radiographic comparison of weight-bearing and non-weight-bearing positions in evaluating the distal tibiofibular syndesmosis: a single-center study of 72 ankles.","authors":"Javid Mohammadzadeh Azarabadi, Neveen Shalalfa, Kemal Gökkuş, Saleh Shalalfa","doi":"10.1186/s13018-025-05886-x","DOIUrl":"https://doi.org/10.1186/s13018-025-05886-x","url":null,"abstract":"<p><strong>Introduction: </strong>The distal tibiofibular syndesmosis is a key structure for the ankle joint's stability and function, especially when the body is weight-bearing. Recent literature indicates that weight-bearing radiographs demonstrate superior diagnostic yield compared to non-weight-bearing radiographs. This study aimed to determine the diagnostic yield of the weight-bearing compared to the non-weight-bearing radiographs.</p><p><strong>Materials and methods: </strong>A total of thirty-six healthy adult individuals, with an age group ranging from 18 to 65 years, who had never experienced any trauma, were selected for this study. We performed radiographic imaging in three planes of view: anterior-posterior, lateral, and mortise, for both ankles under both weight-bearing and non-weight-bearing conditions. The tibiofibular clear space, tibiofibular overlap, medial clear space, tibiofibular distance-lateral, anteroposterior tibiofibular ratio, and Lateral Tibial (LT) width were measured.</p><p><strong>Results: </strong>Tibiofibular clear space and anteroposterior tibiofibular ratio were higher in the weight-bearing position, while tibiofibular overlap, medial clear space, and lateral tibiofibular distance were higher in the non-weight-bearing position. There was a gender effect, as males had higher values for most of the parameters; however, no significant difference was seen in the anteroposterior tibiofibular ratio and tibiofibular distance lateral. The results of this study demonstrate that X-rays of the distal tibiofibular syndesmosis reveal very different outcomes when the person is bearing weight or not pulling weight. These clinically significant differences suggest that weight-bearing radiographs may enhance the identification and diagnosis of syndesmotic injuries. Further studies will be necessary to help with the refinement of the imaging protocols and to improve diagnostic accuracy based on various types of patient demographics.</p><p><strong>Conclusion: </strong>WB radiographs provide a more functionally accurate assessment of syndesmotic integrity than NWB imaging. They should be incorporated into routine diagnostic protocols, especially for active individuals and those with higher BMI. These findings support the need for demographic-specific imaging strategies to improve diagnostic precision.</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":"20 1","pages":"461"},"PeriodicalIF":2.8,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12076814/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144078560","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":"Dysregulation of miR-106a-5p/PTEN axis associated with progression and diagnostic of postmenopausal osteoporosis.","authors":"Xiangjie Liu, Xiaogang Zhang, Meini Cen","doi":"10.1186/s13018-025-05872-3","DOIUrl":"10.1186/s13018-025-05872-3","url":null,"abstract":"<p><strong>Objective: </strong>Postmenopausal osteoporosis (PMOP) is a bone disorder in postmenopausal women and a significant risk factor for fragility fractures. This study aims to explore the role of miR-106a-5p in the pathogenesis of PMOP and its potential as a diagnostic biomarker.</p><p><strong>Methods: </strong>220 postmenopausal women were recruited. The levels of miR-106a-5p, PTEN, and osteogenic-related genes were quantified using qRT-PCR. The relative protein of PTEN was detected using Western blotting. ROC curve and Pearson correlation were employed to evaluate the diagnostic value and relationships between variables. To model iron accumulation, hFOB1.19 osteoblasts were treated with ferric ammonium citrate (FAC). Cell proliferation and apoptosis were assessed using the CCK-8 and flow cytometry. The target relationship was verified using dual-luciferase assays.</p><p><strong>Results: </strong>miR-106a-5p levels were reduced, while PTEN levels were increased in PMOP. miR-106a-5p was positively correlated with bone mineral density and negatively correlated with ferritin. In the FAC-treated cells, miR-106a-5p decreased, and PTEN increased. Dual-luciferase assays confirmed that miR-106a-5p targets PTEN. Successful transfection was confirmed by observing the corresponding changes in miR-106a-5p and PTEN expression. Up-regulated miR-106a-5p increased the PTEN protein level, mRNA expression of RUNX2, OPN, and OCN, promoted cell proliferation, and decreased cell apoptosis under iron accumulation conditions. These effects were reversed by the upregulation of PTEN.</p><p><strong>Conclusion: </strong>miR-106a-5p has the potential to diagnose osteoporosis in postmenopausal women and is linked to ferritin levels. miR-106a-5p plays a protective role in PMOP by regulating PTEN under conditions of iron accumulation, suggesting its potential as a promising biomarker for PMOP.</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":"20 1","pages":"456"},"PeriodicalIF":2.8,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12070524/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144014322","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":"¹⁸F-fluoride PET/CT as an early predictor of bony fusion after posterior lumbar interbody fusion- a prospective study.","authors":"Marloes J M Peters, Roel Wierts, Elisabeth M C Jutten, Wouter A M Broos, Mariel P Ter Laak, Paul C Willems","doi":"10.1186/s13018-025-05814-z","DOIUrl":"10.1186/s13018-025-05814-z","url":null,"abstract":"<p><strong>Purpose: </strong>Posterior Lumbar Interbody Fusion (PLIF) is a surgical procedure in which stabilization of spinal segments is achieved by inserting interbody cages filled with bone graft. Positron Emission Tomography (PET) is an imaging modality to assess physiological processes at cellular level, well before manifestation of morphological changes on computed tomography (CT). The goal was to determine whether ¹⁸F-fluoride PET/CT findings six weeks after PLIF, can predict bony fusion one year postoperatively on CT.</p><p><strong>Materials and methods: </strong>20 consecutive PLIF patients (21 levels) were prospectively included. Based on diagnostic CT one year postoperatively, operated segments were classified as pseudarthrotic or fused. ¹⁸F-fluoride PET/CT scanning was performed at six weeks and one year, yielding parameters related to overall bone metabolism, bone blood flow and bone mineral incorporation. Differences in PET parameters between groups and follow-up moments were assessed. The area under the curve from the receiver operating characteristic was calculated for each PET parameter as a measure of diagnostic accuracy.</p><p><strong>Results: </strong>11 segments were classified as pseudarthrotic and 10 as fused. Pseudarthrotic segments showed lower intervertebral overall bone metabolism values compared to fused segments at six weeks. Pseudarthrotic segments showed lower intervertebral bone blood flow at six weeks and lower intervertebral bone mineral incorporation at one year compared to fused segments. Overall bone metabolism of the operated intervertebral disc space at six weeks had the highest diagnostic accuracy for predicting the fusion status at one year.</p><p><strong>Conclusions: </strong>¹⁸F-fluoride PET/CT six weeks after PLIF provides prognostic information on bony fusion at one year.</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":"20 1","pages":"458"},"PeriodicalIF":2.8,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12070508/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144009889","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":"Perioperative blood loss of sequential administration of hemocoagulase Agkistrodon and Tranexamic acid for primary total knee arthroplasty: a randomized controlled trial.","authors":"Yucan Ju, Huansheng Liu, Wenyu Jiang, Qiang Huang, Zongke Zhou, Fuxing Pei","doi":"10.1186/s13018-025-05867-0","DOIUrl":"10.1186/s13018-025-05867-0","url":null,"abstract":"<p><strong>Purpose: </strong>Total knee arthroplasty (TKA) has significant perioperative blood loss and a high transfusion rate. Tranexamic acid (TXA) has widely recognized hemostatic efficacy in TKA. Hemocoagulase Agkistrodon (HCA) enhances coagulation by hydrolyzing fibrinogen into fibrin, complements the hemostatic effect of TXA. Our aim was to investigate the hemostatic potential of sequential administration of HCA and TXA in TKA.</p><p><strong>Methods: </strong>Patients who underwent cemented total knee arthroplasty at our hospital were randomized to receive the sequential administration of HCA and TXA (n = 29) or TXA-only (n = 30. All patients received mechanical and chemical thromboprophylaxis protocol. The primary outcome was perioperative blood loss, while secondary outcomes were postoperative coagulation function and arterio-venous thrombosis, transfusion, and complications.</p><p><strong>Results: </strong>Total blood loss was not different between sequential administration of HCA and TXA group (1,025.3 ± 305.3 mL) and TXA-only group (892.4 ± 306.4 mL, P = 0.079). Intermuscular vein thrombosis was reported in one case in the sequential administration group and three cases in the TXA-only group. No deep vein thrombosis was reported in any of the patients. The two groups had no perioperative transfusion.</p><p><strong>Conclusion: </strong>The sequential administration of HCA and TXA does not demonstrate superior efficacy in reducing blood loss compared to TXA-only. However, the HCA and TXA group has a lower incidence of intermuscular thrombosis and may demonstrate superiority in postoperative thromboprophylaxis.</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":"20 1","pages":"457"},"PeriodicalIF":2.8,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12070700/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144026320","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":"Anterior tuberculosis lesion debridement and bone grafting combined with short-segment internal fixation in the treatment of thoracolumbar tuberculosis.","authors":"Zhengting Lei, Ming Wang, Zhun Xu, Wang Cheng, Yiguo Yan, Jingbo Xue","doi":"10.1186/s13018-025-05861-6","DOIUrl":"10.1186/s13018-025-05861-6","url":null,"abstract":"<p><strong>Study design: </strong>This was a retrospective study.</p><p><strong>Objective: </strong>To retrospectively analyze the safety and efficacy of anterior lesion debridement and bone grafting combined with short-segment internal fixation for the treatment of patients with thoracolumbar tuberculosis. There is currently no unified standard in the academic community for surgical treatment of spinal tuberculosis. This study proposes a new surgical approach for specific thoracolumbar tuberculosis.</p><p><strong>Methods: </strong>Patients (n = 65) who underwent anterior lesion debridement and bone grafting combined with short-segment internal fixation at our institution between January 2011 and January 2021 were included in this study. The patients were followed up for at least 2 years. During each follow-up, patients were graded using the American Spinal Injury Association (ASIA) neurologic deficit grading system, and postoperative conditions were evaluated using the Oswestry Disability Index (ODI) and pain visual analog scale (VAS).</p><p><strong>Results: </strong>All patients successfully completed the surgery without serious complications.Four patients had unstable vital signs during the operation, 3 patients had a water-electrolyte imbalance in the postoperative period, 5 patients had transient neurological symptoms in the postoperative period, 1 patient had cerebrospinal fluid leakage after the operation, 1 patient had a transient nerve injury, and 1 patient had delayed healing. The patient with recurrence was treated regularly with quadruple antituberculosis drugs for three months after surgery and then maintained with two oral antituberculosis drugs for the following period. The CT examination was repeated half a year later, and all the indexes showed that the prognosis was good. The patients' mean postoperative VAS and ODI scores were significantly better than the preoperative scores.</p><p><strong>Conclusion: </strong>Anterior tuberculosis lesion debridement and bone grafting combined with short-segment internal fixation in the treatment of thoracolumbar tuberculosis has certain advantages over other Surgical Procedures, and can achieve corresponding clinical results.</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":"20 1","pages":"460"},"PeriodicalIF":2.8,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12070778/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143987680","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":"Optimizing surgical field visualization in total knee arthroplasty: a randomized controlled trial comparing esmarch bandages and simple leg elevation.","authors":"Sirisak Chaitantipongse, Natthapong Hongku, Satit Thiengwittayaporn","doi":"10.1186/s13018-025-05853-6","DOIUrl":"10.1186/s13018-025-05853-6","url":null,"abstract":"<p><strong>Background: </strong>This prospective randomized controlled study explores the effectiveness of two exsanguination techniques in total knee arthroplasty (TKA), comparing Esmarch bandages and simple leg elevation concerning surgical field visualization, intra-operative metrics, and post-operative outcomes.</p><p><strong>Methods: </strong>Patients who underwent primary unilateral TKA (n = 100) were randomized and equally divided into the Esmarch bandage (EM group) and simple leg elevation (LE group) groups. Surgical field visualization was assessed using the Fromme-Boezaart grading scale. The operative time, intra-operative blood loss, total blood loss, post-operative pain, leg swelling, and post-operative complications were also assessed.</p><p><strong>Results: </strong>Surgical field visualization was significantly better in the EM group for all steps except for wound closure. The overall surgical field scales were 1.16 ± 0.29 and 1.46 ± 0.34 in the EM and LE groups, respectively (p < 0.001). The operative time and intra-operative blood loss were not significantly different between the two groups. Post-operative pain levels on days 1 and 3, and total blood loss were comparable between the groups. The knee circumference significantly increased in the EM group compared to the LE group (4.6% vs. 2.9%; p = 0.04).</p><p><strong>Conclusions: </strong>Although Esmarch bandages enhance surgical field visualization, they do not reduce operative time or blood loss compared to simple leg elevation. However, the improved visualization is associated with increased post-operative knee swelling.</p><p><strong>Trial registration: </strong>Clinical Trials Gov (NCT03989648) (18/06/2019).</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":"20 1","pages":"455"},"PeriodicalIF":2.8,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12070622/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144031231","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}