Orthopaedic Surgery最新文献

{"title":"Predicting the Nonunion of the Acute Osteoporotic Vertebral Compression Fracture Following Low-Energy Injuries by Quantifying Vertebral Marrow Fat Fraction on T₂-Weighted Dixon Sequences.","authors":"Pengguo Gou, Rui Wang, Zhihui Zhao, Yunguo Wang, Yuan Xue","doi":"10.1111/os.70098","DOIUrl":"https://doi.org/10.1111/os.70098","url":null,"abstract":"<p><strong>Objective: </strong>Increased marrow fat fraction (MFF) of vertebrae was detected in patients with osteoporosis. However, MFF of the fractured vertebrae decreased significantly following the fracture. The aim of this study was to assess the predictive value of fractured vertebrae MFF quantified on T₂-weighted Dixon sequences for the prediction of nonunion risk of acute OVCF.</p><p><strong>Materials and methods: </strong>Medical records of 39 patients with OVCF, including a total of 60 fractured vertebrae, were reviewed retrospectively. Fractured vertebrae in the acute phase were grouped into the nonunion group (20 vertebrae) and the union group (40 vertebrae), based on the OVCF prognosis confirmed by computer tomography (CT). MFF of the fractured vertebrae was quantitatively assessed with the software Matlab on T₂-weighted Dixon sequences. Interclass correlation coefficients (ICC) were analyzed to assess the repeatability of MFF measurement. Binary logistic regression analysis was performed to determine the relative contribution of the MFF for predicting the prognosis of OVCF. Receiver operating characteristic (ROC) curve analysis was performed to determine the diagnostic performance of MFF.</p><p><strong>Results: </strong>The ICC indicated that the repeatability of MFF measurement was excellent (all p < 0.001). The MFF (42.25% ± 26.61%) decreased significantly compared to the value before OVCF (79.84% ± 9.65%) (p < 0.001). The MFF of the fractured vertebrae was lower in the nonunion group (16.40% ± 15.65%) than in the union group (55.18% ± 20.93%) (p < 0.001). Binary logistic regression analysis indicated that MFF of fractured vertebrae could independently predict the prognosis of acute OVCF (p < 0.001). ROC analysis indicated the area under the curve was 0.928 (95% CI, 0.831-0.979, p < 0.0001).</p><p><strong>Conclusions: </strong>The MFF quantified on T₂-weighted Dixon sequences was a useful marker for assessing the nonunion risk of acute OVCF. The fractured vertebra with low MFF should be carefully monitored for nonunion.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144333643","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction to \"Enhanced Biomechanical Stability in Proximal Humeral Fractures: Finite Element Analysis of a Novel Endosteal Anatomical Support Nail for Improved Fixation in Elderly Patients\".","authors":"","doi":"10.1111/os.70106","DOIUrl":"https://doi.org/10.1111/os.70106","url":null,"abstract":"","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144317557","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring Appropriate Positioning of the Spiral Blade in Treatment of Subtrochanteric Fractures of the Femur Using Proximal Femoral Nail Antirotation.","authors":"Qingyan Zhang, Xiaogang Wang, Longhui Su, Qiang Xu","doi":"10.1111/os.70051","DOIUrl":"https://doi.org/10.1111/os.70051","url":null,"abstract":"<p><strong>Objectives: </strong>Subtrochanteric fractures have anatomic characteristics distinct from intertrochanteric fractures that may affect the positioning of the spiral blade during surgical treatment. Tip-apex distance (TAD) and calcar-referenced tip-apex distance (Cal-TAD) were measured to determine if these measures are reliable indicators to assist in the accurate placement of intramedullary nails and minimize postoperative complications.</p><p><strong>Methods: </strong>For patients treated with proximal femoral nail antirotation (PFNA) internal fixation between 2016 and 2020, we analyzed the TAD, Cal-TAD, and postoperative complications. Fracture healing was assessed radiographically at 6-week intervals until union. The incidences of axial cut-off, cephalad cut-off, and non-union were also examined. Analysis of variance and Fisher's exact test were performed to evaluate differences in complications between the TAD and Cal-TAD groups.</p><p><strong>Results: </strong>Data from 104 patients (58 males, 46 females) with a mean age of 56.9 years were analyzed. Fracture healing was observed in 90 (86.5%) patients at an average time of 14.92 ± 1.81 weeks. The healing rate was significantly higher when the TAD and Cal-TAD were controlled within the 20-25 mm range (p < 0.05). Postoperative complications occurred in 14 (13.5%) cases [cephalad cut-off, n = 5 (4.8%); axial cut-off, n = 4 (3.8%); non-union, n = 5 (4.8%)]. Five (4.8%) complications occurred without internal fixation failure. The fracture healing time and incidence of complications differed among groups defined by TAD and Cal-TAD measurements, and were shortest and lowest, respectively, in the 20 mm < TAD/Cal-TAD < 25 mm group.</p><p><strong>Conclusions: </strong>In our cohort, use of PFNA internal fixation for treatment of unstable femoral subtrochanteric fractures and placement of the spiral blade in the middle or lower 1/3 of the femoral neck did not increase the incidence of complications. Therefore, we propose that the TAD rule of 20-30 mm should not apply to subtrochanteric fractures, and TAD and Cal-TAD should be controlled within the range of 20-25 mm to reduce the incidence of complications.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144317558","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of Biportal Endoscopic Technique and Conventional Unilateral Laminectomy for Bilateral Decompression (ULBD) for Multi-Level Degenerative Lumbar Spinal Stenosis in Elderly People.","authors":"Chenhao Dou, Qingsong Yu, Wei Zhang, Lei Ma, Xianzhong Meng","doi":"10.1111/os.70084","DOIUrl":"https://doi.org/10.1111/os.70084","url":null,"abstract":"<p><strong>Objective: </strong>The object of this retrospective study was to compare the clinical, radiological, and spinal stability outcomes of biportal endoscopic Unilateral Laminectomy for Bilateral Decompression (BE-ULBD) and traditional Unilateral Laminectomy for Bilateral Decompression (ULBD) for multi-segmental lumbar spinal stenosis in elderly patients with osteoporosis.</p><p><strong>Methods: </strong>We retrospectively identified 41 and 47 patients who underwent BE-ULBD and ULBD, respectively, who were diagnosed with multi-level lumbar stenosis and underwent double-segmental surgery in elderly patients. The clinical outcomes were evaluated using visual analogue scale (VAS) score for both back and leg pain, Oswestry Disability Index (ODI) score, and Zurich Claudication Questionnaire score during the two-year follow-up. The radiological changes of cross-sectional dural area (DCSA), facet joint preservation rate (PFJR) and cross-sectional fat infiltration ratio (FI) on the surgical side were evaluated by MRI before and after operation. At 2 years after operation, progressive spondylolisthesis and instability were evaluated in the X-ray of the lumbar spine.</p><p><strong>Results: </strong>After 24 months of follow-up, the VAS scores for both back and leg pain, ODI, and Zurich Claudication Questionnaire in both groups were recovered compared to pre-operation. The postoperative VAS score for lower back pain in the BE-ULBD group was lower than in the ULBD group (1.00 ± 0.95 vs. 1.91 ± 1.07, p < 0.001), and the postoperative VAS score for lower limbs was similar (0.49 ± 0.51 vs. 0.46 ± 0.72, p < 0.001). The postoperative ODI score was lower than that of the ULBD group (9.05 ± 5.01 vs. 12.09 ± 6.18, p < 0.001), and the postoperative ZCQ score of the BE-ULBD group was lower than that of the ULBD group (10.59 ± 2.18 vs. 8.85 ± 1.59, p < 0.001; 7.00 ± 1.12 vs. 7.87 ± 1.63, p = 0.012; 8.95 ± 2.11 vs. 10.74 ± 2.47, p < 0.001). In terms of radiological evaluation, the DCSA of patients in both groups was effectively improved after surgery. Compared with the ULBD group, the BE-ULBD group had a tiny improvement in DCSA (195.04 ± 34.54 vs. 180.93 ± 31.07, p = 0.048) and a better FI (43.48 ± 10.24 vs. 53.93 ± 7.62, p < 0.001). The PFJR was higher (85.90 ± 4.03 vs. 81.26 ± 4.56, p < 0.001) in the BE-ULBD group. Two years after surgery, fewer patients in the BE-ULBD group had spondylolisthesis than in the ULBD group (1/41 vs. 7/46, p = 0.043). The results of complications were similar between the two groups.</p><p><strong>Conclusion: </strong>BE-ULBD is a safe and effective technique for multilevel decompression surgery in elderly patients, which can better protect spinal stability and has better long-term follow-up than traditional surgery.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144317556","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Modular Femoral Stem for Hartofilakidis Type C Hip Dysplasia: Is It Necessary for 1-mm Increment of Distal Stem Diameter?","authors":"Jiafeng Yi, Hongbin Xie, Yubo Liu, Yijian Huang, Wei Chai, Xiangpeng Kong","doi":"10.1111/os.70092","DOIUrl":"https://doi.org/10.1111/os.70092","url":null,"abstract":"<p><strong>Background: </strong>S-ROM prosthesis, one well-used femoral prosthesis in the patients with developmental dysplasia of the hip (DDH), has a skipping size of the distal stem diameter. The purpose of this study was to investigate whether its 2-mm incremental diameter could meet clinical needs for high-riding DDH patients.</p><p><strong>Methods: </strong>Between July 2018 and December 2022, the Hartofilakidis type C DDH patients with S-ROM stem (9 or 11 mm) were retrospectively enrolled according to the inclusion criteria and exclusion criteria in our institute. The intraoperative femur fractures, the diameter of the femoral medullary cavity, the canal filling ratio of the S-ROM stem, the closure conditions of the stem slot, and the healing rate of subtrochanteric osteotomy were analyzed to evaluate the effect of stem design on clinical outcomes. Statistical analyses were conducted using independent samples t-tests, chi-square test, and logistic regression analysis with a significance threshold of p < 0.05.</p><p><strong>Results: </strong>A total of 95 patients (109 hips) were included in this study, including 60 hips with 9 mm S-ROM and 49 hips with 11 mm S-ROM. Compared with the 9 mm S-ROM group, the 11 mm S-ROM group presented nearly 5 times the intraoperative fracture rate (16.3%, 3.3%, p < 0.05). The mean diameter of the femoral medullary cavity in the 9 mm S-ROM group was 0.84 ± 0.20 mm and in the 11 mm S-ROM group was 1.03 ± 0.18 mm. The canal filling ratio in the 9 mm S-ROM group is significantly lower than that of the 11 mm S-ROM group. In the 11 mm S-ROM group, the filling ratio of the femoral medullary cavity of fracture hips was significantly higher than that in non-fracture hips.</p><p><strong>Conclusion: </strong>The S-ROM design with a distal stem diameter increment of every 2 mm would increase the risk of intraoperative periprosthetic femoral fractures in high-riding DDH patients. It is necessary for a 1-mm increment of distal stem diameter in such patients.</p><p><strong>Level of evidence: </strong>Level III, retrospective comparative study.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144317559","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Noninvasive Compartmental Pressure Assessment With iCare in Healthy Individuals of Different Ages.","authors":"Jialiang Guo, Jianfeng Zhang, Kezheng Du, Bo Shi, Weichong Dong, Yingze Zhang, Zhiyong Hou","doi":"10.1111/os.70078","DOIUrl":"https://doi.org/10.1111/os.70078","url":null,"abstract":"<p><strong>Objective: </strong>Acute compartment syndrome is a major orthopedic emergency due to elevated pressure in the closed muscle compartment, and prompt evaluation and fasciotomy are always needed. However, the gold standard indicator of fasciotomy is still under debate. To date, few studies have investigated the variations in compartmental pressure at different locations in people of different ages. The aim of the research was to compare compartmental pressure among different age groups and measurement locations.</p><p><strong>Methods: </strong>A total of 154 healthy individuals including 106 males and 48 females over 18 years (46.8 ± 14.0 years) were enrolled between January 2020 and December 2021, and classified into five age groups: Group I = 18-30 years; Group II = 31-40 years; Group III = 41-50 years; Group IV = 51-60 years; and Group V ≥ 61 years. Six measurement locations (lower, middle, and upper points, 6 points) were selected to assess pressure variations in the anterior compartment and posterior superficial compartment with the iCare device, which calculates biomechanical properties based on the tissue's inherent response. Differences in pressure among the five age groups and six measurement locations (three for anterior compartment, three for posterior superficial compartment) were examined. One-way ANOVA and LST tests were used to conduct comparisons among five independent age groups.</p><p><strong>Results: </strong>In the same measurement location, the compartmental pressure in Group V at the upper anterior (anterior fascial compartment) measurement location was increased compared with that in Groups I, III, and IV. However, the compartmental pressures at the middle anterior and posterior measurement locations were almost comparable among the five different age groups. In the same age group, the compartmental pressure was more inclined to be lower at the upper anterior measurement location in Groups I-IV. However, no significant differences were observed for other measurement locations.</p><p><strong>Conclusions: </strong>The measurement results demonstrated comparable compartmental pressure in the fascial compartment at most measurement locations. The fascia, which forms the limb compartment, may play a role in pressure release or redistribution after injury or fracture due to its function and unique or interconnected structure.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144302624","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Decrease in Global Offset Leads to Complaints of Worsening of Valgus Knee Deformity After Total Hip Arthroplasty in Patients With Crowe Type IV Developmental Dysplasia of the Hip.","authors":"Minzhi Yang, Xiangpeng Kong, Ping Song, Zheng Cao, Wei Chai","doi":"10.1111/os.70091","DOIUrl":"https://doi.org/10.1111/os.70091","url":null,"abstract":"<p><strong>Background: </strong>Conflicting evidence exists regarding the impact of total hip arthroplasty (THA) on valgus knee deformities in patients with developmental dysplasia of the hip (DDH). The aim of this retrospective study was to identify the factors potentially contributing to the worsening of valgus knee deformities in DDH patients after THA.</p><p><strong>Methods: </strong>This retrospective case-control study included 51 patients (69 hips) with Crowe type IV DDH who underwent primary THA between January 2018 and January 2020. The anatomic lateral distal femoral angle (aLDFA), mechanical lateral distal femoral angle (mLDFA), anatomic medial proximal tibial angle (MPTA), hip-knee-ankle (HKA) angle, anatomic tibiofemoral angle (TFA), joint line convergence angle (JLCA), tibial joint line angle (TJLA), femoral offset (FO), acetabular offset (AO), global offset (GO), and extent of leg lengthening were measured before and after THA. The case group comprised patients who complained that their valgus knee deformity worsened after THA, and the control group comprised those who did not. Hip-level data were compared using generalized linear mixed effects models for proportions/rates and linear mixed models for means.</p><p><strong>Results: </strong>The case group has 19 hips, and the control group has 50 hips. Both groups showed improvement in the HKA after THA (p < 0.05), but the case group presented with a smaller HKA (177.4 ± 2.4 vs. 175.2 ± 2.7, p < 0.001) and greater AO (5.8 ± 1.0 vs. 5.0 ± 1.0, p = 0.011) and GO (7.9 ± 0.7 vs. 7.0 ± 1.1, p = 0.003) values before THA. After THA, GO decreased in both groups, and the TJLA increased in the case group (0.6 ± 2.6 to 2.3 ± 3.5, p = 0.011).</p><p><strong>Conclusions: </strong>THA improved the HKA in DDH patients. However, a decrease in GO could lead to an increase in the TJLA, suggesting pseudoprogression of the valgus knee deformity and therefore lead to complaints of worsening of valgus knee deformities. GO restoration during surgery may reduce the impact on the TJLA.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144294202","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Efficacy of Intravenous Analgesia and Various Nerve Blocks for Pain Management in Elderly Patients With Hip Fractures: A Meta-Analysis.","authors":"Yuping Liu, Li Zhou, Xin Wang","doi":"10.1111/os.70090","DOIUrl":"https://doi.org/10.1111/os.70090","url":null,"abstract":"<p><p>Pain management in elderly patients with hip fractures has received more and more attention, which is crucial for promoting recovery and reducing complications. At present, there are various and controversial analgesic methods for this population. This meta-analysis evaluated the analgesic effects and side effects of intravenous analgesia compared to different nerve block techniques, including femoral nerve block, fascia iliaca block or pericapsular nerve group block, in this patient group. The study was conducted following the PRISMA 2020 guidelines. A search was performed in October 2024 across PubMed, Web of Science, Cochrane Library, and Embase. Pain scores at different time points, supplemental analgesic morphine consumption, and adverse reactions were compared between intravenous analgesia and nerve blocks. Data were collected from 12 studies and 1157 elderly patients using intravenous analgesia and nerve block after hip fracture, with no differences in sample size, mean age, or percentage of females between the two groups at baseline. Compared to intravenous analgesia, nerve blocks showed significant advantages in the pain score of 2 h after block (SMD-0.80; 95% CI: -1.23 to -0.38; I² = 90%) and the supplemental analgesic morphine consumption (SMD = -0.46; 95% CI: -0.73 to -0.19; I² = 59%). The incidence of adverse reactions and the pain scores at various time points also demonstrated significant differences between the two groups. The application of nerve blocks in elderly patients with hip fractures demonstrates significant clinical advantages, particularly in postoperative pain management, decreasing opioid use, and reducing postoperative complications.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144258655","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Immediate Effects of the Schroth Method on Spinal Curvature and Paravertebral Muscle Activation in Adolescent Idiopathic Scoliosis.","authors":"Xiaohui Zhang, Jinmiao Lv, Xianglan Li, Baiyan Lin, Yinzi Huang, Yan Lin, Min Hu, Bagen Liao","doi":"10.1111/os.70096","DOIUrl":"https://doi.org/10.1111/os.70096","url":null,"abstract":"<p><strong>Objectives: </strong>The Schroth method is considered potentially valuable as an alternative intervention to control curve progression in mild to moderate adolescent idiopathic scoliosis. However, patients are often dependent on the subjective experience of the physiotherapist when practicing, as changes in spinal alignment and muscle activation are unknown. The aim of this study was to evaluate the effectiveness of the Schroth method for spinal alignment and muscle activation in adolescents with idiopathic scoliosis (AIS).</p><p><strong>Methods: </strong>This prospective cross-sectional study, conducted at the Scoliosis Engineering Center of Guangzhou Sport University (January 2020-October 2022), enrolled 36 AIS (4 males, 32 females; age 13.2 ± 1.8 years) presenting major thoracic curvature (Cobb angle: 10°-40°, Risser stage 0-4). Participants underwent a standardized 1-week pretraining protocol before performing four Schroth exercises (\"50 × Pezziball,\" sail, muscle cylinder, and corrected standing). Real-time spinal ultrasound angles (SUAs) and paraspinal muscle activation (via surface electromyography, sEMG) were quantified during habitual standing (baseline) and exercise conditions. Normality was verified using Kolmogorov-Smirnov tests. Within-group comparisons employed paired t-tests (effect sizes: Cohen's d; 95% CIs), while proximal thoracic (PT) compensation frequencies were assessed via chi-squared tests.</p><p><strong>Results: </strong>All four Schroth exercises significantly reduced the SUA of the primary thoracic curve compared to habitual standing (p < 0.05). The lumbar curve SUA decreased specifically after \"50 × Pezziball\" and muscle cylinder exercises (p < 0.05). PT curve compensation frequency rose from 16.7% (6/36) in habitual standing to 33.3% (12/36) and 30.6% (11/36) during \"50 × Pezziball\" and sail exercises, respectively (p < 0.05). sEMG demonstrated reduced paravertebral muscle (PSM) activation asymmetry at the thoracic apex (T8) during corrective standing, \"50 × Pezziball,\" and sail exercises (p < 0.05). However, \"50 × Pezziball\" and sail exercises triggered compensatory left-dominant PSM imbalance at T2 (p < 0.05). At lumbar levels (L2-L5), performing 50 × Pezziball exercise exacerbated asymmetry (p < 0.05), whereas muscle cylinder exercises reversed the activation patterns of the PSM (p < 0.05).</p><p><strong>Conclusion: </strong>While Schroth exercises effectively reduced thoracic curvature and improved T8 muscle symmetry, caution is warranted during \"50 × Pezziball\" and sail exercises due to increased PT compensation and lumbar/T2 muscle imbalances. Muscle cylinder exercises may mitigate adverse lumbar effects.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144258654","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treatment of L5-S1 Spondyloptosis via Posterior-Only L5 Partial Spondylectomy and Reduction of L4 Onto S1: Surgical Technique and Case Series.","authors":"Xinhu Guo, Weishi Li","doi":"10.1111/os.70089","DOIUrl":"https://doi.org/10.1111/os.70089","url":null,"abstract":"<p><strong>Objective: </strong>Spondyloptosis (Grade-V spondylolisthesis) is the most severe form of spondylolisthesis and presents significant surgical challenges due to its rarity and complexity. This study aimed to outline the key aspects of posterior-only L5 partial spondylectomy and reduction of L4 onto S1 for spondyloptosis, as well as evaluate the clinical outcomes and prospects of this technique.</p><p><strong>Methods: </strong>Three patients diagnosed with L5/S1 spondyloptosis between July 2022 and June 2023 were assessed. All these patients underwent posterior-only L5 partial spondylectomy with L4-S1 reduction, using a modified Kebaish's technique. The surgical approach was described in detail, and patient outcomes were assessed through postoperative imaging and clinical measures.</p><p><strong>Results: </strong>The mean age of the patients was 28.7 years (range, 13-41). Preoperative assessments showed a mean Visual Analog Scale (VAS) score for low back or lower limb pain of 5.3 (range 5-6), an Oswestry Disability Index (ODI) of 57.3% (40%-74%), and a Japanese Orthopedic Association-29 (JOA-29) score of 15.7 (13-19). The mean operative time was 469 min (455-483), with a mean estimated blood loss of 1400 mL (1200-2000). The average follow-up duration was 14 months (12-18). At the final follow-up, all the patients achieved solid fusion, confirmed via computed tomography. Postoperative VAS, ODI, and JOA-29 scores improved to 2 (0-3), 17.3% (6%-26%), and 23 (22-25), respectively. All the patients reported high satisfaction with the treatment.</p><p><strong>Conclusions: </strong>Posterior-only L5 partial spondylectomy with L4-S1 reduction is a feasible and effective treatment for lumbar spondyloptosis. Although technically demanding and associated with a high risk of nerve palsy, this approach can yield favorable clinical outcomes when applied appropriately in these challenging cases.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144258656","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}