Orthopaedic Surgery最新文献

{"title":"Is Percutaneous Kyphoplasty the Better Choice for Treatment of Stage III Kümmell's Disease Without Neurological Symptoms? A Retrospective Study of Two Invasive Procedures.","authors":"Yijie Liu, Tangyiheng Chen, Haoyun Yu, Xiaohui Zhou, Runjia Hua, Yudong Wang, Qiang Wei, Yong Gu, Genglei Chu","doi":"10.1111/os.14313","DOIUrl":"https://doi.org/10.1111/os.14313","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective analysis.</p><p><strong>Objective: </strong>Kümmell's disease is an uncommon and complicated spinal condition first described in 1891. Treatment of this disease must be individualized according to the stage of disease and the experience and preference of the surgeon. Nevertheless, the surgical option in Stage III Kümmell's disease without neurological deficits remains controversial. The purpose of this study is to determine whether PKP or pedicle subtraction osteotomy (PSO) combined with long-segment fixation (LSF) is more effective in treating Kümmell's disease at Stage III without neurological impairments.</p><p><strong>Methods: </strong>Between January 2017 and June 2020, 89 patients were treated with PKP or PSO + LSF. The outcomes, including operative time, blood loss, Oswestry Disability Indexes (ODIs), heights of fractured vertebrae, visual analog scale (VAS) scores, and kyphosis Cobb angles, were measured at the follow-up time for the PKP group and PSO + LSF group. Fisher's exact test or chi-square test for number and percentage data was employed to compare statistical analyses between two groups.</p><p><strong>Results: </strong>Forty-six patients underwent PKP and 43 patients who treated by PSO + LSF. Postoperative measurements showed substantial improvements in kyphosis Cobb angle and vertebral height in the PKP group compared to preoperative measurements. Operating time, estimated blood loss, and duration of stay were all reduced in the PKP group compared to the PSO + LSF group. The PSO + LSF group had better correction of a kyphotic Cobb angle than the PKP group. Short-term monitoring showed that the PKP group had fewer ODI and VAS scores than the PSO + LSF group. In addition, no significant neurological symptoms were found after operation in both groups. The complication rates of PKP and PSO + LSF groups were 10.87% and 9.30%, respectively.</p><p><strong>Conclusions: </strong>Kümmell's disease in Stage III without neurological symptoms responded to both PKP and PSO + LSF as safe and efficient treatments. Despite limited correction of kyphotic Cobb angle, PKP patients had better early clinical outcomes, increased fractured vertebral height, decreased blood loss, and less surgical trauma compared with the PSO + LSF group.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142829489","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":"Distinguishing Characteristics of Benign Versus Malignant Intraosseous Schwannomas: A Comparative Study.","authors":"Jiangchao Zhang, Ge Xiong, Wei Zheng, Jing Sun","doi":"10.1111/os.14321","DOIUrl":"https://doi.org/10.1111/os.14321","url":null,"abstract":"<p><strong>Objectives: </strong>Benign and malignant intraosseous schwannomas are rare, and primarily documented in case reports. This study aims to elucidate the differences in clinical features and imaging manifestations between these tumors. This will help clinicians identify malignant lesions at an early stage, reliable guide treatment decisions, and accurately predict outcomes.</p><p><strong>Methods: </strong>Eighteen patients who underwent surgery and got pathological examinations in our hospital from 2012 to 2023 were retrospectively reviewed. Among them, 14 cases were found benign with 4 malignant. In the benign group, patients underwent curettage followed by bone grafting, whereas the malignant group was treated with extensive resection or amputation. Patients' demographics and radiographic features, including gender, age at diagnosis, symptom duration, tumor location, tumor margin, and the ratio of sclerotic margins were documented and compared between these tumors. All imaging was reviewed by two fellowship-trained musculoskeletal radiologists, who also quantified the sclerotic margin ratio. The intraclass correlation coefficient was used to determine inter-observer agreement. The Mann-Whitney U test was applied for continuous clinical variables, and the chi-square test or Fisher's exact test for categorical variables.</p><p><strong>Results: </strong>In our series, the mean age of these patients was 43.1 ± 14.0 years, six patients were male and 12 were female. Pain was the predominant preoperative symptom. The average duration from symptom onset to initial physician visit was 28.5 ± 25.3 months for benign schwannomas and 8.3 ± 4.3 months for malignant schwannomas (p = 0.012). On plain radiographs, 13 (13/14) of benign schwannomas exhibited well-defined margins of bone destruction, compared to 1 (1/4) of malignant schwannomas (p = 0.019). Furthermore, benign schwannomas had a significantly higher sclerotic margin ratio (75.5%) than malignant ones (16.7%) (p = 0.001). No statistically significant difference was found between the two groups in terms of cortical bone destruction (p = 1.0). On MRI, both tumors demonstrated intermediate to slightly hypointense signal intensity on T1-weighted images and heterogeneous high signal intensities on T2-weighted images.</p><p><strong>Conclusions: </strong>Despite their rarity, benign and malignant intraosseous schwannomas should be considered in the differential diagnosis for patients presenting with painful and radiographically lytic bone lesions, especially in the mandible, sacrum, and vertebrae. The ratio of sclerotic margins, which we proposed for the first time, in combination with symptom duration and the clarity of tumor margins, provide valuable diagnostic clues for distinguishing the malignancy of the tumors.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142829488","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":"Efficacy of Different Doses of Intra-Articular Tranexamic Acid for Reducing Blood Loss and Lower Limb Swelling After Total Knee Arthroplasty: A Prospective, Randomized, Controlled Trial.","authors":"Shuwei Ye, Yue Luo, Qianhao Li, Lijun Cai, Pengde Kang","doi":"10.1111/os.14317","DOIUrl":"https://doi.org/10.1111/os.14317","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;Both blood loss and lower extremity swelling after total knee arthroplasty (TKA) can affect a patient's postoperative recovery. The aim of this trial was to investigate whether different doses of intra-articular tranexamic acid (TXA) can reduce blood loss and postoperative lower limb swelling.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;In a prospective, randomized-controlled trial, a total of 225 patients were randomly assigned to three groups from September 2020 through January 2021: intra-articular injections of 3 g, 1 g of TXA, or placebo (saline solution). The primary outcome indicators were perioperative blood loss and decreased hemoglobin levels. The secondary outcome indicators were lower extremity swelling, functional recovery indicators (hospital for special surgery [HSS] scores, range of motion), visual analog scale [VAS] scores, and transfusion rates and safety outcomes, including thromboembolic events, incidence of wound-related complications, and length of hospital stay. One-way analysis of variance (ANOVA), post hoc Bonferroni correction, Pearson chi-square test and Fisher exact test were used for statistical analysis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Postoperative blood loss was lower in the 1 and 3 g TXA groups (754.00 ± 409.67 mL and 568.70 ± 408.27 mL, respectively) than in the placebo group (977.32 ± 418.69 mL) (p &lt; 0.001). The maximum postoperative decrease in hemoglobin was lower in the 1 and 3 g TXA groups (2.4 ± 0.9 and 1.8 ± 0.9 g/dL, respectively) than in the placebo group (3.1 ± 1.2 g/dL) (p &lt; 0.001). On postoperative Days 1, 2, and 3, the TXA group presented significantly reduced thigh, suprapatellar, and calf swelling and significantly reduced pain scores during exercise. Compared with that in the low-dose group, perioperative blood loss was further reduced in the high-dose TXA group (p = 0.006). However, while patients in the TXA group had improved pain scores, Hospital for Special Surgery scores, and joint range of motion at postoperative rest, these differences were not statistically significant. There were no significant differences in thromboembolic events or complication rates among the three groups.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Topical TXA in total knee arthroplasty was effective in reducing postoperative blood loss by 24%-43% and in reducing postoperative lower extremity swelling and pain during exercise. Higher doses (3 g) of TXA further controlled perioperative blood loss without affecting postoperative lower extremity swelling, and there was no increase in the incidence of related complications during follow-up.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Trial registration: &lt;/strong&gt;This study was a single-center, prospective, randomized controlled trial (RCT). The trial was approved by the Clinical Trials and Biomedical Ethics Committee at our institution (number: 2018.676), all participants provided written informed consent, and the trial was prospectively registered in the Chinese Clinical Trial Registry (Chi","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2024-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142824103","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":"Learning Curve of Uniportal Compared With Biportal Endoscopic Techniques for the Treatment of Lumbar Disc Herniation.","authors":"Yuquan Liu, Xiang Li, Haining Tan, Xinyi Hao, Bin Zhu, Yong Yang, Lingjia Yu","doi":"10.1111/os.14312","DOIUrl":"https://doi.org/10.1111/os.14312","url":null,"abstract":"<p><strong>Objectives: </strong>Currently, unilateral biportal endoscopic (UBE) and uniportal full-endoscopic (UFE) techniques for the treatment of lumbar disc herniation (LDH) are gaining popularity. However, studies investigating the number of surgeries needed for surgeons to achieve proficiency in these procedures are lacking. This study aims to compare the early learning curve for UBE and UFE when treating LDH.</p><p><strong>Methods: </strong>The learning curve for two fellowship-trained surgeons at our institution was retrospectively assessed for 160 consecutive patients (UFE: n = 100, UBE: n = 60) who underwent procedures between September 2020 and May 2023. Surgeon 1 first learned UBE, followed by UFE (S1BF), while Surgeon 2 first learned UFE and then UBE (S2FB). Operation time was evaluated as the primary outcome for determining the learning curve using cumulative sum (CUSUM) analysis. Secondary outcomes assessing endoscopic prowess include surgical outcomes, such as fluoroscopy usage times, postoperative hospital stays, the incidence of complications, and clinical outcomes, including visual analog scale (VAS) scores for back and leg pain, Oswestry disability index (ODI) score and modified MacNab criteria.</p><p><strong>Results: </strong>The learning curve analysis identified the cutoff point in UBE at 14 cases and 11 cases for S1BF and S2FB, respectively, and in UFE at 31 cases and 27 cases, respectively. Without UFE or UBE experience, at the last follow-up, both the VAS back and leg pain in UFE were significantly higher than that in UBE (p < 0.05). Furthermore, the incidence of complications of UFE was also higher than that of UBE (29.0% vs. 7.1%). When surgeons have previous UFE or UBE experience, there was no significant difference in the clinical outcomes between UFE and UBE, and the complication rates were also similar (p > 0.05). After gaining UBE experience, the UFE performed by S1BF showed significantly better outcomes in fluoroscopy usage times (p = 0.024), surgical complications (p = 0.036), last follow-up VAS back pain (p = 0.003), and leg pain (p < 0.001) compared to S2FB. However, after gaining UFE experience, the S2FB only showed significant improvement in operation time (p = 0.041) during the process of learning UBE compared to S1BF.</p><p><strong>Conclusions: </strong>Regardless of whether UBE or UFE is learned first, both techniques can significantly shorten the learning curve for the other technique. We recommend prioritizing the learning of UBE. Compared with UBE, the learning curve for UFE was significantly steeper and longer with higher incidence of complications in the early stage.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2024-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142824173","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":"Whether the Indications for Reverse Shoulder Arthroplasty Should Continue to Be Expanded? A Systematic Review and Meta-Analysis.","authors":"Huankun Li, Hangsheng Bao, Zhidong Yang, Baijun Hu, Yaocheng Pan, Yi Wang, Jiayi Chen, Hongjun Chen, Bisheng Shen, Yonggen Zou","doi":"10.1111/os.14311","DOIUrl":"https://doi.org/10.1111/os.14311","url":null,"abstract":"<p><strong>Background: </strong>It is still unclear whether reverse total shoulder arthroplasty (RTSA) has advantages over traditional hemiarthroplasty (HA) and anatomic total shoulder arthroplasty (ATSA) in the treatment of complex shoulder joint diseases. Therefore, this study aims to evaluate the clinical effectiveness of RTSA in the treatment of complex shoulder joint diseases and further determine whether it is necessary to expand the indications of RTSA.</p><p><strong>Method: </strong>We conducted a systematic search of studies published between January 1, 2012 and May 31, 2023 in PubMed, Embase, and Cochrane databases. The experimental group included patients who underwent primary reverse total shoulder arthroplasty (RTSA), while the control group consisted of patients who underwent primary hemiarthroplasty (HA) or anatomic total shoulder arthroplasty (ATSA). The minimum follow-up period was 1 year, and a random-effects model was utilized for data synthesis.</p><p><strong>Results: </strong>A total of 45 studies were included in the meta-analysis. Compare to HA, RTSA showed significant advantages in postoperative ASES scores (p = 0.004), forward flexion (p < 0.0001), and abduction (p < 0.0001). Compare to ATSA, RTSA showed significantly lower postoperative Constant scores (p = 0.004), ASES scores (p = 0.001), SST scores (p < 0.0001), forward flexion (p < 0.0001), abduction (p = 0.011), internal rotation (p < 0.0001), and external rotation (p < 0.0001). Further meta regression analysis was conducted, considering factors such as region, age, gender ratio, and follow-up time, excluding the influence of relevant factors. Overall, RTSA did not demonstrate advantages in postoperative functional scores and range of motion. In terms of complication and revision rates, RTSA had lower rates compared to HA and ATSA, except for the complication rate, where there was no significant difference between RTSA and ATSA (p = 0.521), but statistically significant differences were observed in other measures.</p><p><strong>Conclusion: </strong>RTSA demonstrates better clinical efficacy compared to HA but is inferior to ATSA. It can be considered for expanding treatment options for elderly patients with 3 or 4-part proximal humeral fractures, but it is not suitable for treating end-stage shoulder arthritis and humeral head necrosis. Overall, the decision to use RTSA should be carefully evaluated based on the extent of the patient's rotator cuff injury.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142818762","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":"Anterior Controllable Antedisplacement and Fusion (ACAF) for Cervical Stenosis Patients With Hyperextension Injury: A Retrospective Study.","authors":"Shuangxi Sun, Yingying Miao, Tao Xu, Kaiqiang Sun, Yijuan Lu, Jingchuan Sun, Jiuyi Sun, Jiangang Shi","doi":"10.1111/os.14319","DOIUrl":"https://doi.org/10.1111/os.14319","url":null,"abstract":"<p><strong>Objective: </strong>Central cord syndrome (CCS) is an incomplete spinal cord injury (SCI) causing severe motor weakness, and timely decompression via surgical intervention facilitates better recovery. Anterior controllable antedisplacement and fusion (ACAF) is a novel decompression technique and achieved satisfactory outcomes in treating cervical degenerated diseases. However, the clinical effects of ACAF on CCS remains unknown. This present study aimed to investigate the clinical outcomes of ACAF for cervical stenosis patients with CCS due to hyperextension injury.</p><p><strong>Methods: </strong>This is a retrospective study, and patients who underwent ACAF due to CCS in our institution from July 2021 to December 2022 were enrolled based on the inclusion and exclusion criteria. All patients underwent x-ray, computed tomography (CT), and magnetic resonance imaging (MRI) before and after surgery. The duration of follow-up was at least 12 months. The radiological parameters included associated pathologies, prevertebral hyperintensity (HI), intramedullary signal intensity (ISI), and Torg-Pavlov ratio (TPR). The cervical stability was also evaluated. Neurological function was assessed using the American Spinal Injury Association (ASIA) grading system and Japanese Orthopaedic Association (JOA) score. The Mann-Whitney U test was used to compare the clinical outcomes preoperatively and postoperatively.</p><p><strong>Results: </strong>Finally, 13 patients (7 male and 6 female) with the minimum of 12-month follow-up were finally enrolled in this study, with the mean age of 56.6 ± 12.5 years (range, 39-74 years). There were eight patients suffered CCS due to fall, three due to vehicle accident, and two due to diving injuries. The average delay from injury to surgery was 2.23 days (range, 1-4 days), and the mean duration of follow-up was 16.1 ± 3.5 months. In terms of prevertebral HI and ISI, C4-C6 were the most affected region. In addition, 76.9% (10 of 13) patients were observed to have cervical stenosis indicated by TPR. Associated pathologies were herniated nucleus pulposus (HNP) in five patients, OPLL in three cases, and HNP-osteophyte complexes (HNP-OC) in six patients. At the final follow-up, 13 patients were improved to E. The mean JOA score improved to 15.4 ± 1.0, with the recovery rate of 77.0% ± 12.0%. Two patients experienced postoperative dysphagia, two patients had hoarseness, and one patient suffered postoperative hematoma.</p><p><strong>Conclusions: </strong>ACAF can be a good option for treating CCS patients due to hyperextension injury with underlying cervical spondylosis and stenosis.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142818722","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":"Management of Bone Defects and Complications After Bone Tumor Resection Using Ilizarov Method.","authors":"Kai Zheng, Xiu-Chun Yu, Jinfang Cai, Ming Xu, Haocheng Cui, Qian Chen, Jing-Yu Zhang","doi":"10.1111/os.14318","DOIUrl":"https://doi.org/10.1111/os.14318","url":null,"abstract":"<p><strong>Objective: </strong>Ilizarov technology is highly effective in addressing complex orthopedic challenges. This study aims to describe our experience with distraction osteogenesis in managing bone tumors in the lower extremity, focusing on composite bone defects and associated complications.</p><p><strong>Methods: </strong>A retrospective clinical study was conducted to analyze patients with primary bone tumors who underwent distraction osteogenesis using the Ilizarov method from 2010 to 2020. Some young children received epiphyseal distraction and bone transport as part of their sarcoma surgical treatment. Additionally, external fixation, bone transport, or limb lengthening were employed to address complex postoperative complications associated with bone tumors. The clinical outcomes assessed included the patient's general information, the location of bone defects, the length of bone repair, the status of bone healing, and limb function.</p><p><strong>Results: </strong>Eleven patients were followed up for an average of 66 months (range, 24-132 months). The average length of repaired bone defects was 13 cm (range, 2.5-32 cm). The cohort comprised three females and eight males, with ages at presentation ranging from 6 to 42 years (mean, 18 years). The sites of involvement included the distal femur (n = 4), femoral diaphysis (n = 3), proximal tibia (n = 2), and the distal tibia (n = 2). Nine patients were diagnosed with osteosarcoma, while one presented with Ewing's sarcoma and another with a giant cell tumor of bone. Three young children were successfully treated with epiphyseal stretching; however, one patient experienced treatment failure. Additionally, seven patients underwent external fixation to address complex postoperative complications, including infection, bone defects, and limb shortening. At the last follow-up, with the exception of one failure, the average Musculoskeletal Tumor Society (MSTS) limb function scores for the remaining 10 patients were 25 (range, 21-30). Three months post-fixator removal, the Asociación Latinoamericana de Oncología (ASAMI) bone score was rated as excellent in 63.6% (7/11) of patients, whereas the ASAMI function score was excellent in 36.4% (4/11) and good in 54.5% (6/11) of cases.</p><p><strong>Conclusion: </strong>The Ilizarov method demonstrates some clinical value in the resection and reconstruction of bone tumors, as well as in the management of postoperative complications associated with such tumors.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142818726","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":"Strategizing Simultaneous Spinal Osteotomy and Total Hip Replacement in Ankylosing Spondylitis.","authors":"Chen Guo, Yan Liang, Zhenqi Zhu, Shuai Xu, Haiying Liu","doi":"10.1111/os.13974","DOIUrl":"https://doi.org/10.1111/os.13974","url":null,"abstract":"<p><strong>Objective: </strong>Ankylosing spondylitis (AS) is a debilitating rheumatic condition that significantly impairs mobility and quality of life through chronic inflammation and spinal fusion. The aim of this study is to investigate the optimal sequencing of spinal osteotomy and total hip replacement (THR) as treatment options, a topic that remains a subject of debate among medical professionals.</p><p><strong>Methods: </strong>In a retrospective cohort study spanning from 2017 to 2021, we assessed adult patients with AS who underwent both spinal osteotomy and THR, outcome measures involved radiographic assessments like Global Cobb angle, thoracolumbar kyphosis (TLK), lumbar lordosis (LL), pelvic incidence (PI), pelvic tilt (PT), and sacral slope (SS), as well as clinical metrics such as the Harris hip score. For the same surgical group, paired t-tests were performed for pre- and postoperative data, while independent sample t-tests were used for comparing different surgical groups. The study aims to elucidate the optimal sequencing of these surgical procedures based on these comprehensive metrics.</p><p><strong>Results: </strong>Among the 14 patients included, demographic and clinical variables were comparable between the two procedural groups. At the 3-month follow-up, all major metrics showed significant postoperative improvements. Specifically, the Global Cobb angle reduced from 98.88 ± 38.54 to 54.48 ± 18.14 (p = 0.018), and the Harris hip scores, evaluated at the 3-month follow-up, dramatically increased from 15.14 ± 10.12 to 72.57 ± 14.12 (p = 0.001). Furthermore, the Spine First Group exhibited more pronounced changes in pelvic parameters (p = 0.009), albeit at the expense of longer operation times and increased blood loss. No major complications were encountered.</p><p><strong>Conclusions: </strong>Contrary to the prevalent belief that spinal osteotomy should precede THR, our study argues that under certain conditions, opting for hip surgery first can be both viable and advantageous. This approach may mitigate the risk of complications and even facilitate subsequent spinal surgery. Surgical decisions must be highly tailored, focusing on patient-specific needs and anatomical considerations. The ultimate goal remains consistent: to improve patients' functional abilities in daily activities and thereby enhance their overall quality of life.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2024-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142813907","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":"Removal of Forearm Plate Leads to a Higher Risk of Refracture-A Systematic Review and Meta-Analysis.","authors":"Renwei Cao, Jianyu Zhang, Weitong Sun, Xieyuan Jiang, Kehan Hua, Dan Xiao, Chen Chen, Yejun Zha, Maoqi Gong","doi":"10.1111/os.14307","DOIUrl":"https://doi.org/10.1111/os.14307","url":null,"abstract":"<p><strong>Objective: </strong>Plate fixation is the preferred method for treating forearm shaft fractures. However, it remains controversial regarding the necessity of implant removal after bone union. This review aims to assess refracture risk after plate removal.</p><p><strong>Methods: </strong>We searched various data sources, including PubMed, Embase, Web of Science, and Cochrane Library. A total of 6749 papers were identified, of which 23 studies were eligible for final quantitative syntheses. Subgroup analyses and sensitivity analyses were conducted to reduce heterogeneity and make the results more reliable.</p><p><strong>Results: </strong>The total risk difference (RD) was 0.06 (0.04-0.09), indicating that the difference was significant. In the \"Reasons for Removal\" subgroup analysis, the RD of the \"No Symptom\" subgroup was 0.07 (95% CI = 0.04-0.11), while the RD of the \"Symptoms\" subgroup was 0.04 (95% CI = -0.02 to 0.10). In the \"Plate Type\" subgroup analysis, the RD of the \"LCP\" subgroup was 0.07 (95% CI = 0.02-0.13), while the RD of the \"DCP\" subgroup was 0.07 (95% CI = 0.01-0.13). After omitting each study one by one, the RDs were all significant.</p><p><strong>Conclusions: </strong>Plate retention is significantly associated with a lower rate of refracture than plate removal. Consequently, it is not recommended to remove implants, especially for patients without implant-related symptoms, but more reliable evidence is still needed.</p><p><strong>Trial registration: </strong>The review was registered on PROSPERO and the registration ID is CRD42023424743, and a protocol was not prepared.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2024-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142807697","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":"Vertebral Column Decancellation for Correcting Cervicothoracic Kyphotic Deformity in Patients With Ankylosing Spondylitis.","authors":"Han Yu, Qi Wang, Yiming Fan, Dengbin Qi, Tianhao Wang, Bing Li, Yi Huang, Ze Wang, Chao Xue, Guoquan Zheng","doi":"10.1111/os.14306","DOIUrl":"https://doi.org/10.1111/os.14306","url":null,"abstract":"<p><strong>Objective: </strong>Surgery to correct the cervicothoracic kyphotic deformity in ankylosing spondylitis (AS) can be associated with serious neurovascular risks. According to the literature, there are no clinical reports documenting the use of vertebral column decancellation (VCD) in the treatment of cervicothoracic kyphotic deformity in patients with AS. The purpose of the present study was to retrospectively analyze and evaluate the effect of VCD on cervicothoracic kyphotic deformity in patients with AS.</p><p><strong>Methods: </strong>Records of eight patients with cervicothoracic kyphotic deformity who underwent VCD at C7 in our institution were retrospectively reviewed. The mean duration of clinical follow-up after surgery was 19 months. The cervical lordosis (CL) and C2-C7 sagittal vertical axis (SVA) were meticulously measured on full-length spine radiographs. The chin-brow vertical angle (CBVA) was measured on clinical photographs. Outcome measures utilized included the Neck Disability Index (NDI), the Japanese Orthopaedic Association (JOA) Score, and a Visual Analog Scale (VAS) for neck pain. The data analysis was performed using SPSS version 26.0 for Windows. For paired data adhering to a normal distribution, we utilized paired sample t-tests to analyze preoperative and postoperative imaging parameters. Statistical significance was established at a p value threshold of < 0.01.</p><p><strong>Results: </strong>All eight patients successfully completed the surgery. With an average VCD osteotomy angle of 47.6° ± 8.1° (±SD), the mean preoperative CBVA was 81.1° ± 17.6° (±SD), while the immediate postoperative value was 19.9° ± 5.7° (±SD). The overall average correction was 61.2° ± 18.9°. The mean preoperative cervical sagittal imbalance was 93.4 ± 27.3 mm (±SD), while the immediate postoperative value was 40.2 ± 18.9 mm (±SD). The overall average correction was 53.2 ± 28.1 mm. None of the eight patients experienced intraoperative complications, including nerve or vascular injury, cerebrospinal fluid leakage, or any other related complications. In the cohort of eight patients, the mean values for estimated blood loss, surgical time, and hospital stay were 1313 mL, 248 min, and 18 days, respectively. In comparison to preoperative scores, statistically significant improvement was noted in all patients in the postoperative period with regard to NDI, JOA, and VAS (p < 0.01, using a paired t-test).</p><p><strong>Conclusion: </strong>The VCD procedure proves to be a dependable and efficient approach for addressing cervicothoracic kyphotic deformities. It achieves remarkable corrections in cervical kyphosis and CBVA.</p><p><strong>Trial registration: </strong>Chinese Clinical Trial Registry: 2400090375.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2024-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142807713","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}