Orthopaedic Surgery最新文献

{"title":"Effect of Spinal Versus General Anesthetic on 30-Day Outcomes in Patients With Chronic Obstructive Pulmonary Disease Undergoing Hip Arthroplasty for Femoral Neck Fracture.","authors":"David R Christian, Mark A Plantz, Manasa Pagadala, Isaac SontagMilobsky, Michael Peabody, Erik B Gerlach, David W Manning","doi":"10.1111/os.70181","DOIUrl":"https://doi.org/10.1111/os.70181","url":null,"abstract":"<p><strong>Introduction: </strong>Patients with chronic obstructive pulmonary disease (COPD) and femoral neck fractures are at high risk for postoperative complications and mortality. One consideration to reduce risk is the type of anesthesia, although this has not been investigated. The purpose of this study was to compare 30-day complications between use of general and spinal anesthetic in patients with COPD and femoral neck fractures who underwent hip arthroplasty.</p><p><strong>Methods: </strong>Patients with COPD treated with hip arthroplasty for femoral neck fractures were identified on the American College of Surgeons' National Surgical Quality Improvement Program (ACS-NSQIP) database between January 1, 2015 and December 31, 2020. Demographics, patient variables, and surgical variables were recorded. Patients were divided into cohorts based on general or spinal anesthetic. Propensity score matching was used to match the two groups. Thirty-day outcome measures were compared between groups using chi-squared test. Logistic regression was used to assess for risk factors for 30-day complications.</p><p><strong>Results: </strong>Five thousand and forty patients with COPD were identified who underwent arthroplasty for femoral neck fracture-3800 with general anesthesia and 1240 patients with spinal anesthesia. The general anesthesia cohort had higher rates of diabetes (18.4% vs. 15.1%, p = 0.007), congestive heart failure (10.7% vs. 6.7%, p < 0.001), and chronic kidney disease requiring dialysis (2.6% vs. 1.5%. p = 0.019). After matching, the general anesthesia cohort had higher rates of mortality (8.4% vs. 5.8%, p = 0.042), nonhome discharge (85.5% vs. 79.2%, p < 0.001), and unplanned intubation (1.9% vs. 0.7%, p = 0.048). Logistic regression identified general anesthesia to be an independent risk factor for 30-day mortality (RR 1.514 [1.022-2.245]), nonhome discharge (1.626 [1.237-2.138]), and unplanned intubation (RR 1.488 [1.012-2.187]).</p><p><strong>Conclusions: </strong>General anesthesia is an independent risk factor for 30-day mortality, nonhome discharge, and unplanned intubation in patients with COPD undergoing arthroplasty procedures for femoral neck fractures. If possible, spinal anesthetic should be considered as it may reduce the risk of complications in this patient population.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145302384","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":"Effectiveness of Microscopic Tubular Discectomy for Improved Pain and Mobility in Far Lateral Lumbar Disc Herniation: A Systematic Review.","authors":"Chamath Jagoda, Samantha Spanos, Timothy L Siu","doi":"10.1111/os.70187","DOIUrl":"https://doi.org/10.1111/os.70187","url":null,"abstract":"<p><p>Far lateral lumbar disc herniation (FLLDH) is a subtype of lumbar disc herniation marked by severe radicular and lower back pain, often accompanied by sensory and motor dysfunction. Microscopic tubular discectomy (MTD) is a contemporary minimally invasive approach for treating FLLDH, yet its superiority over conventional discectomy remains inconclusive. The purpose of this systematic review was to assess the effectiveness of MTD in improving pain and mobility for FLLDH patients. A secondary aim was to assess the safety of MTD. Primary outcome measures were patient-reported pain, assessed using a visual analog scale (VAS), patient-reported mobility, assessed using the Oswestry Disability Index (ODI), and scores on the Modified MacNab criteria clinical assessment. Secondary outcome measures were mean blood loss, operation duration, hospital stay, reherniation rate, reoperation rate, and any peri- or postoperative complications. MEDLINE, Embase, and Scopus were searched for empirical studies on MTD for FLLDH, reporting pain or mobility outcomes. Data extracted included study design, participant characteristics, pre- and postmean scores for pain and mobility, blood loss, operation time, hospitalization duration, reherniation rate, and complications. Articles were quality appraised using Joanna Briggs Institute (JBI) quality appraisal tools. Of 271 articles identified, 15 were included. Preoperative leg pain scores ranged from 5.5 to 8.6, and postoperative scores ranged from 1.2 to 3.8. For lower back pain, preoperative scores ranged from 2.4 to 7.6, with postoperative scores from 1 to 4.8. Seven studies assessed mobility using the ODI, reporting significant improvements; pre-operative scores ranged from 30.6 to 56.7, and postoperative scores ranged from 5.5 to 30.3. Seven studies used the Modified MacNab criteria, reporting excellent outcomes in 18.2%-71% of patients, good in 23%-54.5%, fair in 0%-18.2%, and poor in 0%-18%. Mean blood loss ranged from 30 to 70 mL, mean operation times from 43 to 126 min, and average hospital stays were, on average, ≤ 4 days. Reherniation was minimal, and the reoperation rate was low. Complications were rare, primarily transient neuropraxic symptoms. This review comprehensively synthesized empirical research on the effectiveness and safety of MTD for treating FLLDH. Overall, the findings indicate that MTD can reduce pain and improve mobility in patients with FLLDH, but limited sample sizes, variable follow-up periods, and a lack of controlled studies constrain definitive conclusions about MTD's superiority over other discectomy techniques. PROSPERO registration number: CRD42023443900.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145280789","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 Impact of Lower Extremity Mechanical Axis Alignment on the Success of Platelet-Rich Plasma Injections in Knee Osteoarthritis Patients.","authors":"Alparslan Yurtbay, Furkan Erdoğan, Ferhat Say","doi":"10.1111/os.70185","DOIUrl":"https://doi.org/10.1111/os.70185","url":null,"abstract":"<p><strong>Objectives: </strong>Knee osteoarthritis (OA) is a common cause of pain and disability, and conventional conservative treatments often provide only limited and temporary relief. Platelet-rich plasma (PRP) injections have emerged as a promising biological therapy; however, patient response is highly variable, and biomechanical factors such as lower extremity malalignment may influence treatment outcomes. This study aimed to evaluate the effect of the lower extremity mechanical axis angle (MAA) on the clinical efficacy of PRP injection therapy in improving knee function and pain in patients with OA.</p><p><strong>Methods: </strong>A total of 210 patients with knee OA who consented to PRP treatment between January 1, 2018, and January 1, 2023, were enrolled. Patients were stratified into three groups according to baseline varus angle: Group 1, 0°-5° (n = 70); Group 2, 6°-10° (n = 70); and Group 3, 11°-15° (n = 70). Clinical evaluations were performed at baseline and at 1, 3, 6, 12, and 24 months post-treatment using the Knee Injury and Osteoarthritis Outcome Score (KOOS), Kujala Patellofemoral Score, knee joint range of motion (ROM), MAA measurement, and a Visual Analogue Scale (VAS) for pain.</p><p><strong>Results: </strong>All groups demonstrated significant improvements in pain and functional scores over the 24-month follow-up compared to baseline (p < 0.001), with the most notable gains observed at 3 and 6 months. At 3, 6, and 12 months, Group 1 achieved significantly better VAS and KOOS Pain subscale scores than Group 3 (p < 0.05). Both Groups 1 and 2 had higher KOOS Total scores than Group 3 at these time points (p < 0.05). Spearman correlation analysis revealed moderate negative associations between baseline MAA and changes from baseline to 6 months in VAS (ρ = -0.58), KOOS Total (ρ = -0.54), and Kujala scores (ρ = -0.53) (all p < 0.001). Statistical analyses were conducted using ANOVA or Kruskal-Wallis tests as appropriate, and effect sizes (Cohen's d) with 95% confidence intervals were calculated.</p><p><strong>Conclusion: </strong>PRP injection therapy yields significant improvements in pain and functional outcomes in patients with knee OA. However, increased MAA is associated with reduced clinical benefit, indicating that baseline lower extremity alignment should be considered in treatment planning.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145280860","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":"Effects and Complications of Hip Arthroplasty After Failure of Internal Fixation in Stable and Unstable Intertrochanteric Femoral Fractures.","authors":"Juncheng Li, Canhong Zhang, Lan Lin, Nanxin Zhang, Jiexin Huang, Zida Huang, Huangfeng Lin, Hongxiang Wei, Haiqi Ding, Shaopeng Lin, Wenming Zhang, Xinyu Fang, Jiagu Huang","doi":"10.1111/os.70184","DOIUrl":"https://doi.org/10.1111/os.70184","url":null,"abstract":"<p><strong>Objective: </strong>Conversion to hip arthroplasty (cHA) is a widely utilized and effective surgical intervention for addressing the failure of internal fixation in intertrochanteric femoral fractures (FIF-INF). Although previous studies have confirmed that the failure rate of internal fixation is higher in unstable intertrochanteric femoral fractures, but whether the efficacy and complications of cHA after failure differ from those in stable fractures remains unclear. This study aimed to evaluate and compare the clinical and radiological outcomes, as well as the incidence of complications associated with hip arthroplasty over a minimum follow-up period of 3 years after the failure of internal fixation in both stable and unstable intertrochanteric femoral fractures.</p><p><strong>Methods: </strong>This multicenter study retrospectively analyzed patients who underwent hip arthroplasty subsequent to the failure of FIF-INF from December 2012 to December 2020 at various participating research centers. Cases demonstrating excellent and acceptable quality fracture reduction, as defined by the criteria established by Chang et al., were included. According to AO/OTA classification criteria of intertrochanteric fractures, the fractures were classified into stable fractures (31-A1) and unstable fractures (31-A2, A3). There were 47 patients with stable fractures and 56 patients with unstable fractures. Clinical and radiological evaluations were conducted for all patients. This study employed independent samples t-tests, χ² tests or Fisher's exact test, and both univariate and multivariate logistic regression analyses.</p><p><strong>Results: </strong>A total of 103 patients were analyzed. The HHS in the stable group improved from a preoperative mean of 47.08 ± 5.50 to 89.13 ± 4.75 at the final follow-up, whereas that in the unstable group increased from 45.43 ± 6.36 to 83.87 ± 4.67. The improvement scores for the stable and unstable groups were 42.05 ± 4.69 and 38.81 ± 3.06, respectively, with a statistically significant difference (p < 0.0001). VAS scores decreased from the preoperative levels of 7.13 ± 0.92 and 7.61 ± 0.82 to 2.36 ± 0.87 and 2.91 ± 0.79, respectively, indicating a significant reduction in pain in both groups; however, the unstable group reported more severe postoperative pain (p = 0.001). The incidence of postoperative complications following cHA was significantly greater in the unstable group (28.57%) than in the stable group (10.64%) (p = 0.047).</p><p><strong>Conclusion: </strong>cHA is an effective treatment modality for the failure of internal fixation in intertrochanteric femoral fractures. Compared with stable fractures, patients with initial unstable fractures that have failed experience a greater incidence of postoperative complications, relatively poorer joint function, and more pronounced pain following cHA.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145280740","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":"Robot-Assisted, Conventional Fluoroscopy (C-Arm), O-Arm Navigation, and Freehand Pedicle Screw Fixation in Thoracolumbar Spine Fracture Surgery: A Network Meta-Analysis.","authors":"Yankun Zhu, Shuaiqi Zhu, Yanan Li, Kun Wang","doi":"10.1111/os.70189","DOIUrl":"https://doi.org/10.1111/os.70189","url":null,"abstract":"<p><p>Thoracolumbar fractures are a prevalent clinical disease, with several surgical techniques, including traditional freehand pedicle screw fixation (TFPSF), conventional fluoroscopy (C-arm) percutaneous pedicle screw fixation (CPPSF), O-arm-assisted percutaneous pedicle screw fixation (OPPSF), and robot-assisted percutaneous pedicle screw fixation (RPPSF), being currently applied. However, a comprehensive comparison of their relative efficacy across multiple perioperative and functional outcomes is lacking, leading to uncertainty in optimal technique selection. This network meta-analysis (NMA) evaluates and compares the clinical efficacy of these four surgical techniques to identify the most effective intervention and guide clinical decision-making. Researchers independently searched PubMed, Embase, the Cochrane Central Register of Controlled Trials, and Web of Science for studies published before September 20, 2024. Studies were selected based on stringent eligibility criteria. Randomized controlled trials (RCTs) were assessed using RoB 2.0, while cohort studies were evaluated with the Newcastle-Ottawa Scale (NOS). After data extraction, Bayesian network analysis was executed using R 4.2.2 and Stata 16.0. Nineteen studies were included, encompassing 1344 patients with thoracolumbar fractures. For screw accuracy, OPPSF ranked highest (SUCRA = 92.7%), significantly outperforming TFPSF (RR 1.12; 95% credible intervals [CrI] [1.04, 1.23]) and CPPSF (RR 1.12; 95% CrI [1.04, 1.22]), with RPPSF also surpassing both. OPPSF showed superior intraoperative blood loss reduction (SUCRA = 79.8%) while TFPSF had significantly more bleeding than others. For hospitalization, RPPSF ranked highest (SUCRA = 65.0%) but CPPSF significantly shortened stays versus TFPSF (MD -2.24; 95% CrI [-4.48, -0.03]). CPPSF also showed better pain control (SUCRA = 77.9%) with significantly lower VAS scores versus TFPSF (MD -1.02; 95% CrI [-1.71, -0.37]). RPPSF demonstrated the lowest complication risk (SUCRA = 94.9%), with both CPPSF and RPPSF showing significant reductions versus TFPSF. Additionally, although CPPSF ranked first in SUCRA for both operative time (SUCRA = 81.6%) and Cobb angle (SUCRA = 72.4%), the pairwise comparisons did not demonstrate statistical significance, necessitating cautious interpretation. In summary, OPPSF tends to demonstrate superior precision and blood loss control, CPPSF may optimize rehabilitation efficiency, while RPPSF appears to be the safest technique. Technique selection should balance clinical outcomes, economic feasibility, and patient-specific priorities.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145275363","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":"Three-Dimensional-Printed Porous Tantalum Wedge Shows Promising Early Results for Opening-Wedge High Tibial Osteotomy: A Retrospective Comparative Study With Mean 50-Month Follow-Up.","authors":"Zhenlan Fu, Huaquan Fan, Xin Ju, Ran Xiong, Xin Chen, Jiayi Ma, Junjun Yang, Xiaojun Duan, Guangxing Chen, Fuyou Wang, Liu Yang","doi":"10.1111/os.70173","DOIUrl":"https://doi.org/10.1111/os.70173","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;Bone void fillers are essential for successful outcomes in opening-wedge high tibial osteotomy (OWHTO), a procedure that corrects varus knee misalignment and alleviates medial compartment pain. However, the best filler for OWHTO is still uncertain. This study compared the clinical and radiographic results of using three-dimensional-printed (3DP) porous tantalum wedges versus allogeneic chip bone as fillers in OWHTO, aiming to provide a reference for clinical decision-making.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This exploratory-retrospective matched-cohort consecutively enrolled study included 20 patients (10 per group) who were treated between January 2020 and December 2022, with Group A (3DP porous tantalum) selected from a large trial and Group B (allogeneic chip bone) matched by age, gender, and varus severity.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Inclusion criteria: &lt;/strong&gt;young, active patients with tibial varus and complete follow-up; exclusions: knee infection, instability, contracture, dislocation, or pan-compartmental osteoarthritis. Postoperatively, early full-weight-bearing rehabilitation was applied, with follow-ups at 6 weeks, 3 months, 6 months, 12 months, and annually.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Primary outcome: &lt;/strong&gt;bone healing (modified van Hemert score, standing radiographs).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Secondary outcomes: &lt;/strong&gt;hospital for special surgery knee score (HSS), visual analogue scale (VAS), time to full-weight-bearing walking, and radiographic parameters (joint line convergence angle [JLCA], femur-tibia angle [FTA], hip-knee-ankle angle [HKA], mechanical medial proximal tibial angle [mMPTA], mechanical axis deviation [MAD], weight-bearing line [WBL] ratio, posterior tibial slope [PTS]). Postoperative complications were recorded and compared between both groups. Statistical analyses used the Mann-Whitney U test for continuous data and the chi-square test for categorical data.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Mean age was 48.7 ± 3.9 years, with a mean follow-up of 50.0 ± 7.0 months (range: 29.4-59.0). Group A had significantly higher bone healing scores at 6 weeks, 3 and 6 months (3.0 ± 0.8 vs. 1.6 ± 1.0, 3.4 ± 0.5 vs. 2.0 ± 0.9, 4.3 ± 0.5 vs. 2.9 ± 0.9, respectively, all p &lt; 0.01), with no difference at 1 year (4.8 ± 0.4 vs. 4.4 ± 0.5, p = 0.075). Time to full-weight-bearing walking was significantly shorter in Group A (18.7 ± 3.2 vs. 54.4 ± 15.3 days; p &lt; 0.001). Both groups showed significant postoperative improvements in VAS, HSS scores, and radiographic parameters (MAD, WBL ratio, mMPTA, HKA; all p &lt; 0.01 vs. preoperative values), with no intergroup differences in these metrics (preoperative or postoperative). Overall complication rates were similar (20% vs. 60%; p = 0.074), but Group A had a lower incidence of delayed union (0% vs. 40%; p = 0.011). The statistical power for 1-year bone union grades was 0.65 (G*Power, effect size = 0.883).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;3DP porous tantalum wedges in OWHTO accelerate bone hea","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145275433","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":"Implantation Accuracy of Custom-Made Acetabular Components With Iliac Stem Fixation for Large Bone Defects in Hip Revision Surgery.","authors":"Timo A Nees, Mustafa Hariri, Christian T Müller, Moritz M Innmann, David M Spranz, Fabian Westhauser, Tilman Walker, Tobias Reiner","doi":"10.1111/os.70186","DOIUrl":"https://doi.org/10.1111/os.70186","url":null,"abstract":"<p><strong>Objectives: </strong>The treatment of extensive acetabular bone defects presents significant challenges in revision total hip arthroplasty (rTHA). Custom-made implants, tailored to patient-specific anatomy via 3D printing, offer potential advantages regarding implant stability and alignment. Precise positioning of these large-volume implants is crucial for primary stability and long-term fixation, but can be surgically demanding, especially when intramedullary iliac press-fit stems are used. In contrast to triflange custom-made implants, data on the implantation accuracy of custom-made acetabular components with iliac stem fixation remain limited. This study aimed to assess the accuracy of implant positioning by comparing preoperatively planned component positions with postoperative radiographic outcomes, focusing on anteversion (AV), inclination (INCL), and the center of rotation (CoR).</p><p><strong>Methods: </strong>In this retrospective cohort study, 24 patients with large acetabular defects (Paprosky ≥ 3A) underwent rTHA with custom-made acetabular components with intramedullary press-fit iliac stem fixation between November 2022 and April 2024. Implantation accuracy was evaluated by comparing the planned positions on preoperative CT scans with the actual implant positions observed on 6-week postoperative radiographs using a previously validated methodology. Discrepancies in AV, INCL, and the CoR were analyzed.</p><p><strong>Results: </strong>A high degree of alignment with preoperative plans was observed. The mean postoperative AV was 9.96° ± 6.4° (planned: 10.2°), and the mean INCL was 46.3° ± 3.2° (planned: 44.6°). The deviations were minor (Δ AV: -0.25°, Δ INCL: 1.7°), confirming the precision of implant placement. Four implants had CoR deviations exceeding 5 mm cranially (mean cranial shift: 1.77 ± 3.97 mm), and five exceeded 5 mm laterally. Most deviations were within clinically acceptable ranges.</p><p><strong>Conclusions: </strong>Our findings demonstrate that custom-made acetabular components with iliac stem fixation can be implanted with high accuracy. Moreover, our results support the use of standard radiographs for the postoperative assessment of implant positioning precision. This study provides valuable insights into the accuracy of implant placement in complex rTHA cases, highlighting the role of patient-specific implant technologies in enhancing surgical outcomes.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145275374","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":"Long-Term Outcomes of Triple Cannulated Compression Screws Combined With Bone Graft Sleeve Parallel Implantation of DBM Crunch Internal Fixation for the Treatment of Femoral Neck Fractures in Middle-Aged and Young Adults.","authors":"Peiyuan Wang, Zhiang Zhang, Zihang Zhao, Ziping Li, Lin Liu, Kuo Zhao, Lin Jin, Wei Chen, Shiqiang Zhang, Zhiyong Hou","doi":"10.1111/os.70169","DOIUrl":"https://doi.org/10.1111/os.70169","url":null,"abstract":"<p><strong>Objective: </strong>If the appropriate internal fixation surgical method is not adopted for femoral neck fractures in young people, it may lead to serious consequences such as poor fracture healing and femoral head necrosis, affecting the quality of life and working ability of young people. Therefore, it is crucial to conduct in-depth research on the internal fixation surgical methods. This study compared the therapeutic effects of triple cannulated screws combined with a bone graft sleeve for parallel implantation of DBM Crunch internal fixation (CCSBGS) and cannulated compression screws (CCS).</p><p><strong>Methods: </strong>Medical records on the young and middle-aged patients with femoral neck fracture treated with two different internal fixation methods from January 2020 to June 2023 were collected and retrospectively analyzed in the Trauma Emergency Center of the Third Hospital of Hebei Medical University. Two internal fixation groups are: CCSBGS group with 50 patients, 35 males and 15 females, aged (42.44 ± 14.07) years; CCS group with 80 males and 39 females, aged (41.5 ± 13.48) years. This study compared the outcome measures of two groups of patients, including Garden alignment index, Operation duration time, Intraoperative blood loss, Length of hospital stay, Postoperative complications, Femoral neck shortening, Postoperative ambulation time, Walking with sticks, Barthel score, and Harris score.</p><p><strong>Results: </strong>There was a statistically significant difference in blood loss between the CCS group and the CCSBGS group; at the same time, the amount of bleeding in the CCS group was lower than that in the CCSBGS group (p < 0.01). During the follow-up period, there was a statistically significant difference in the incidence of osteonecrosis of the femoral head among the two groups (p < 0.05), 20 patients in the CCS group and 2 patients in the CCSBGS group developed osteonecrosis of the femoral head. At the last follow-up, the average degree of femoral neck shortening in the CCSBGS group [(0.49 ± 0.28) cm] was significantly lower than that in the CCS group [(0.87 ± 0.35) cm] (p < 0.05). Meanwhile, the postoperative ambulation time of the CCSBGS group is earlier than that of the CCS group (p < 0.05). In addition, the CCSBGS group had the highest Barthel scores [(95.50 ± 2.90)] (p < 0.05). The average Harris score in the CCSBGS group [(92.52 ± 2.41)] was higher than that in the CCS group [(90.47 ± 2.88)] (p < 0.05).</p><p><strong>Conclusions: </strong>Compared with CCSBGS and CCS, CCSBGS shows better efficacy in terms of quicker return to weight-bearing activities, preservation of femoral neck length, reduction of the rate of osteonecrosis of the femoral head, and overall enhancement of hip function.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145252263","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":"Multisensory Integration for Identifying the Milling States in Robot-Assisted Cervical Laminectomy.","authors":"Chao Sun, Yingjie Zheng, Junfei Hu, Weixiang Ke, Fei Zhao, Guangming Xia, Yu Dai, Yuan Xue, Rui Wang","doi":"10.1111/os.70182","DOIUrl":"https://doi.org/10.1111/os.70182","url":null,"abstract":"<p><strong>Objective: </strong>In spinal surgery, precise identification of high-speed bur milling states is crucial for patient safety. This study investigates whether integrating tactile and auditory perception can enhance the accuracy of milling state detection in robot-assisted cervical laminectomy.</p><p><strong>Methods: </strong>Based on the mathematical and physical model of vibration and sound in high-speed bur milling bone, the feasibility of employing vibration and sound characteristics to identify the milling states of high-speed bur is studied systematically. Cervical laminectomy was performed on the cervical spine of the sheep. During the signal acquisition process, acceleration sensors and microphones were installed to collect vibration and sound signals, respectively. Seven milling states were set up in the experiment: (1) Milling depths of cortical bone (CTB): 0.5, 1.0, and 1.5 mm; (2) Milling depths of milling of cancellous bone (CCB): 0.5, 1.0, and 1.5 mm; (3) Boundary conditions: high-speed bur idling or complete penetration of bone (PT). The milling speed was set at 0.5 mm/s, the milling angle was 45°, and the bur diameter was 4 mm. The vibration or sound was extracted by Fast Fourier Transform (FFT) in the frequency domain of the first nine harmonics to generate the feature vector in 9 dimensions (9-D) space. These vibration and sound features were combined to form an 18-D multi-perception spatial vector for subsequent analysis, including five machine learning algorithms: Support Vector Machine (SVM), K Nearest Neighbors (KNN), Naive Bayes (NB), Linear Discriminant Analysis (LDA), and Decision Tree (DT), and deep learning models: Long Short-Term Memory networks (LSTM).</p><p><strong>Results: </strong>Based on the 18-D features of tactile and auditory multisensory fusion, the LSTM model is trained using 6600 sets of high-speed bur milling data. In order to achieve the best performance, a layer-by-layer parameter optimization strategy was used to determine the optimal parameter configuration, and finally, a single-layer LSTM with 12 memory units was constructed. In terms of accuracy and stability, the model is significantly superior to the machine learning algorithms (SVM, KNN, NB, LDA, and DT), and the accuracy of LSTM is 99.32% in the milling states identification of cervical lamina milling with high-speed bur.</p><p><strong>Conclusion: </strong>Through theoretical analysis and experimental verification, the study built a multi-perception fusion framework based on tactile and auditory perception and accurately identified the cervical vertebra milling states through the LSTM model, which can provide perception means for operational spinal surgery robots in the future.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145258578","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":"Adjacent Vertebral BMD Decline After Lateral Lumbar Interbody Fusion.","authors":"Kai Sun, Bo Zhang, Mingyuan Di, Yuanzhi Weng, Weijia William Lu, Chao Chen, Jiaguo Zhao, Meng Fan, Qiang Yang","doi":"10.1111/os.70183","DOIUrl":"https://doi.org/10.1111/os.70183","url":null,"abstract":"<p><strong>Objective: </strong>Lateral lumbar interbody fusion technology may have a protective effect on the paravertebral and spinal ligaments during surgery, resulting in positive effects on bone mineral density (BMD). However, evidence is lacking on the change in vertebral bone density of patients. The changes in bone density in patients after lumbar fusion surgery are closely related to the occurrence of mechanical complications such as proximal border kyphosis, screw extraction, and adjacent vertebral fractures. Therefore, the aim is to investigate the changes in the volumetric bone mineral density (vBMD) of the adjacent vertebral cancellous bone and endplate at the fusion level in patients undergoing lateral lumbar interbody fusion (LLIF).</p><p><strong>Methods: </strong>The medical records of patients with lumbar degenerative diseases who underwent LLIF surgery in our hospital from March 2018 to October 2021 were retrospectively examined. The volumetric BMD of the cancellous bone and endplate adjacent to the lumbar fusion segment was measured before the operation and during postoperative follow-up. The measured volumetric BMD included the level of the upper/lower instrumented vertebra and the endplate (UIV + 1; LIV + 1; UIV + 1e; and LIV + 1e). Shapiro-Wilk test, one-way ANOVA, Mann-Whitney test, Fisher exact test, univariable, and receiver operating characteristic (ROC) curve analysis were executed in this study.</p><p><strong>Results: </strong>A total of 32 patients were included in the study, including 27 women and 5 men, with a mean age of 60.1 ± 7.1 years. The preoperative vBMD values in the UIV + 1, LIV + 1, UIV + 1e, and LIV + 1e groups were greater than those at the postoperative follow-up (131.9 ± 34.8 vs. 115.8 ± 30.8; 134.8 ± 37.0 vs. 117.2 ± 32.1, p < 0.001; 312.9 ± 79.3 vs. 287.7 ± 85.2, p = 0.007; 314.7 ± 71.4 vs. 296.1 ± 59.8, p = 0.042). The vBMD changes and rates of change in the cancellous and endplate regions were 16.1% ± 17.7% (11.4% ± 13.0%), 12.2% ± 12.1% (17.3% ± 17.5%), 11.4% ± 18.3% (-25.2% ± 49.2%), and 7.2% ± 18.5% (-18.6% ± 49.8%) in the UIV + 1, LIV + 1, UIV + 1e, and LIV + 1e groups, respectively. There was no significant difference in the preoperative vBMD, postoperative vBMD, or percent vBMD change between UIV + 1 and LIV + 1. However, there was a significant difference in the endplate vBMD at follow-up (p = 0.035).</p><p><strong>Conclusion: </strong>We evaluated the changes of vBMD of the cancellous bone and endplates adjacent to the vertebral body, cephalad or caudal to the fused level in LLIF patients through QCT, and can provide a new approach for reducing the occurrence of mechanically related complications after vertebral fusion surgery.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145258631","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}