Orthopaedic Surgery最新文献

{"title":"Total Hip Arthroplasty for Crowe III/IV Hip Dysplasia With Oblique Subtrochanteric Shortening Osteotomy and S-ROM-A Modular Stem: 10-Year Outcomes.","authors":"Tetsuo Hayama, Motoi Takahashi, Takuya Otani, Hideki Fujii, Yasuhiko Kawaguchi, Toshiomi Abe, Mitsuru Saito","doi":"10.1111/os.70154","DOIUrl":"10.1111/os.70154","url":null,"abstract":"<p><strong>Background: </strong>High dislocation due to developmental dysplasia of the hip (DDH), classified as Crowe type III or IV, presents significant challenges in total hip arthroplasty (THA), particularly in preventing nerve complications while restoring leg length.</p><p><strong>Aim: </strong>This study aimed to evaluate the clinical and radiographic outcomes of primary THA using an S-ROM-A modular stem with oblique subtrochanteric shortening osteotomy in patients with high hip dislocation; to identify the advantages, limitations, and possible countermeasures of this surgical approach.</p><p><strong>Patients and methods: </strong>Subjects were 45 hips (37 patients) with high hip dislocation (Crowe III/IV) treated by primary THA using an S-ROM-A stem, with femoral shortening osteotomy performed at our institution. Outcomes 3 years after surgery were examined in 100% of the subjects. Postoperative complications and functional and radiographic outcomes were investigated.</p><p><strong>Results: </strong>The mean age at surgery was 65 years and the mean duration of postoperative follow-up was 10.7 ± 3.4 years. There were no cases of postoperative infection, symptomatic pulmonary embolism, or neurological complications in the legs. Early postoperative dislocation occurred in two hips (4%, resolved conservatively) and osteotomy site nonunion in one hip (2%). Repeat surgery was required in only this case of nonunion (2%). The hip function score was significantly improved postoperatively. Leg lengthening after surgery was 0-56 mm (mean, 28 mm). Examination of radiographs revealed that it took 12 weeks for bone union at the osteotomy site in all hips except for the one hip with nonunion. No stem subsidence was found postoperatively, and \"fixation by bone ingrowth\" was achieved at the final follow-up examination in all hips (100%), including the one that required repeat surgery.</p><p><strong>Conclusion: </strong>THA using an S-ROM-A modular stem with oblique subtrochanteric shortening osteotomy provided favorable mid-term outcomes in patients with Crowe III/IV DDH. No neurological complications occurred, and functional and radiographic improvements were substantial. Our method, which emphasizes intraoperative sciatic nerve palpation for individualized leg lengthening, may serve as a practical and safe alternative to more complex monitoring systems. Further research incorporating objective intraoperative monitoring may help standardize this approach.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":"2895-2902"},"PeriodicalIF":2.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12497549/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144883387","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Classification and Bundle-Weaving Fixation for Posterior Cruciate Ligament Tibial Avulsion Fractures: Innovations and Applications of Key Techniques.","authors":"Guangdong Chen, Weiguo Xu, Yibing Chen, Wei Wang, Chengyue Yu","doi":"10.1111/os.70135","DOIUrl":"10.1111/os.70135","url":null,"abstract":"<p><strong>Objective: </strong>Posterior cruciate ligament tibial avulsion fractures (PCLTAF) are characterized by complex injury mechanisms and treatment difficulties, with no standardized diagnostic or therapeutic guidelines currently available. This study aims to establish a classification-based Bundle-Weaving Zonal Fixation system to facilitate the precise treatment of PCLTAF.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on 100 patients with PCLTAF treated across multiple centers between 2016 and 2022. Based on fracture morphology, fragment characteristics, bone quality, and the extent of posterior ligamentous complex involvement, a novel classification system-Xu-Chen concise classification-was developed using an inductive approach, categorizing PCLTAF into nine subtypes. Guided by this classification, four bundle-weaving fixation techniques were designed, along with the development of a novel fixation system with tendon-weaving holes. One representative case from each subtype (n = 9) underwent open reduction and subtype-guided individualized fixation. Surgical time, intraoperative blood loss, complications, fracture healing, and functional outcomes (Lysholm and Tegner scores) were assessed.</p><p><strong>Results: </strong>According to the Xu-Chen concise classification, nine patients (six males and three females; mean age, 45 years) underwent open reduction and individualized bundle-weaving fixation. The average surgical duration was 77.2 min (range, 60-95 min), and the average intraoperative blood loss was 23.3 mL (range, 15-40 mL). The mean follow-up period was 17.89 months (range, 12-22 months). The Lysholm knee score improved from 26.78 preoperatively to 97.22 postoperatively, while the Tegner activity score increased from 2.89 to 9.56. No complications such as deep vein thrombosis, joint stiffness, postoperative swelling, hematoma, infection, fixation failure, joint instability, or refracture were observed during follow-up. Only one elderly patient experienced superficial wound necrosis, which healed with conservative wound care.</p><p><strong>Conclusion: </strong>The Xu-Chen concise classification and its corresponding tendon-bundled intraosseous fixation system offer a structured and standardized treatment pathway for PCLTAF. Preliminary results demonstrate promising outcomes in anatomical reduction, functional recovery, and surgical safety. This strategy shows clinical value in managing complex cases, such as comminuted fractures and osteoporotic bone.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":"2943-2959"},"PeriodicalIF":2.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12497554/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144963698","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Approach to Patellar Dislocation Treatment: Review and Prospects.","authors":"Djovensky Gateau, Dereje Gobena Alemayehu, Zhi Zhang, Hanyu Wang, Bygrage Mayendesa, Elena Tahir, Xing Ma","doi":"10.1111/os.70105","DOIUrl":"10.1111/os.70105","url":null,"abstract":"<p><p>Lateral patellar dislocation (LPD) is a musculoskeletal condition characterized by a complex etiology. Despite significant advancements in management strategies, it continues to pose considerable challenges. Critical anatomic risk factors previously identified include trochlear dysplasia (TD), patella alta, and elevated tibial tubercle-trochlear groove (TT-TG) distance, with TD being the most significant. A thorough risk assessment using predictive models is primarily recommended to assist in patient counseling and to identify high-risk cases, for whom early surgical intervention may be considered. Controversies persist regarding the indications for combined surgical procedures, including tibial tubercle osteotomy (TTO), derotational distal femoral osteotomy (DDFO), and lateral retinacular release (LRR) with medial patellofemoral reconstruction (MPFLR). Moreover, emerging evidence suggests that a deeper understanding of the interplay between anatomic factors may optimize surgical prioritization and improve clinical outcomes. The combined surgical approach should be reserved for meticulously selected cases with substantial anatomic risk factors, while isolated MPFLR may prove adequate for cases with milder grade risk factors. To enhance individualized treatment strategies and improve outcomes for patients with LPD, deeper insights into the interaction of anatomical factors, supported by higher-quality clinical research and advancements in biomechanical modeling, are essential.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":"2771-2783"},"PeriodicalIF":2.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12497552/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145001064","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of Dexamethasone on Nausea, Vomiting, and Inflammatory Indexes After Total Knee Arthroplasty.","authors":"Jiazheng Chen, Yizhen He, Ting Deng, Yang Li, Xinguang Wang, Minwei Zhao, Feng Li, Cheng Wang, Hua Tian","doi":"10.1111/os.70139","DOIUrl":"10.1111/os.70139","url":null,"abstract":"<p><strong>Objective: </strong>Postoperative nausea and vomiting (PONV) and abnormal inflammatory markers frequently complicate recovery following total knee arthroplasty (TKA), posing diagnostic challenges in distinguishing between transient inflammatory responses and early infections. This study aimed to evaluate the specific effects of dexamethasone (DXM) on PONV incidence and inflammatory markers after TKA.</p><p><strong>Methods: </strong>This was a retrospective cohort study including 1853 patients who underwent unilateral TKA from January 2020 to August 2021. Patients were divided into a dexamethasone group (n = 756) and a control group (n = 1097) based on postoperative DXM use. All other perioperative management was consistent between groups. Data collected included PONV incidence, white blood cell count (WBC), C-reactive protein (CRP), and postoperative clinical outcomes. Statistical analysis included the χ² test, t test, and multivariate logistic regression to control for confounding factors.</p><p><strong>Results: </strong>The DXM group showed significantly lower incidences of PONV and lower postoperative CRP levels. WBC counts and neutrophil percentages were transiently elevated postoperatively in the DXM group without corresponding increases in postoperative complications.</p><p><strong>Conclusion: </strong>DXM administration after TKA reduces PONV and inflammatory markers but leads to transient leukocytosis, which is not associated with an increased incidence of complications.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":"2862-2868"},"PeriodicalIF":2.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12497572/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144848228","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk Factors for Neurological Complications in Severe Spinal Deformity Surgery.","authors":"Xinwei Wang, Haoran Zhang, Chenkai Li, Xiaohan Ye, Yiwei Zhao, You Du, Shengru Wang, Jianguo Zhang","doi":"10.1111/os.70158","DOIUrl":"10.1111/os.70158","url":null,"abstract":"<p><strong>Objective: </strong>Severe spinal deformities, including scoliosis and kyphosis, present significant challenges in corrective surgery due to the elevated risk of neurological complications. The identification of preoperative risk factors is of paramount importance for the optimization of outcomes and the prevention of complications.</p><p><strong>Methods: </strong>This retrospective cohort study analyzed 130 patients with severe spinal deformities who underwent surgical treatments from January 2002 to May 2022. A comprehensive collection and analysis of preoperative clinical, imaging, and surgical data were conducted with the objective of identifying risk factors for neurological complications. Univariate and multivariate logistic regression analyses were conducted to ascertain the independent predictors.</p><p><strong>Results: </strong>A total of 130 patients were included in the study, with a female ratio of 50% and a mean age of 21.4 ± 15.3 years, and 18 (13.8%) of them experienced postoperative neurological complications. Significant factors included preoperative spinal cord anomalies (38.9% in the complication group vs. 8.9% in the non-complication group, p = 0.001) and a higher kyphosis angle (112.4° in the complication group vs. 98.2° in the non-complication group, p = 0.018). The incidence of intraoperative neuromonitoring alarms was significantly higher in the complication group (38.9% vs. 15.9%, p = 0.022). No significant differences were observed in operative time (p = 0.095) or blood loss (p = 0.179). A higher angle of kyphosis (OR = 1.027, 95% CI: 1.001-1.055, p = 0.045) and the occurrence of spinal cord anomalies (OR = 6.715, 95% CI: 1.694-26.615, p = 0.007) were independent predictors of surgical neurological complications.</p><p><strong>Conclusions: </strong>Preoperative spinal cord anomalies and a higher kyphosis angle are independent risk factors for postoperative neurological complications. A comprehensive preoperative evaluation is essential for optimizing surgical strategies in these high-risk patients.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":"2914-2926"},"PeriodicalIF":2.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12497570/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144963777","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy and Safety of Unilateral Interlaminar Endoscopic Decompression for Lumbar Spinal Stenosis: A Retrospective Study of 176 Cases With a 3-6 Year Follow-Up.","authors":"Zhifa Zhang, Zhiyong Yin, Rongqiang Bu, Xiangyu Wang, Benzhang Tao, Leiming Zhang, Xifeng Zhang, Jianning Zhang","doi":"10.1111/os.70131","DOIUrl":"10.1111/os.70131","url":null,"abstract":"<p><strong>Objective: </strong>Spinal endoscopic surgery is widely acknowledged as an effective and minimally invasive approach for treating lumbar disc herniation. Comprehensive descriptions of the endoscopic decompression technique for lumbar spinal stenosis (LSS) are limited in existing literature. With a focus on long-term follow-up outcomes, this study investigates the safety and efficacy of endoscopic decompression using a unilateral interlaminar approach.</p><p><strong>Methods: </strong>Between August 1, 2018, and December 1, 2020, a total of 316 consecutive cases underwent endoscopic decompression for LSS following conservative treatment. Based on specific selection criteria, 176 of these cases were retrospectively included in this study. The minimally invasive decompression was performed using a percutaneous uniportal and lateral interlaminar endoscopic approach under local anesthesia. This endoscopic procedure involved comprehensive decompression of the central canal and unilateral recess, addressing the lamina, hypertrophic ligamentum flavum (LF), and medial osteophytes of the facet joint. Clinical outcomes were assessed using the single continuous walking distance (SCWD) without pain, the modified MacNab criteria, the Oswestry Disability Index (ODI), and the visual analogue scale (VAS). Radiographic changes, both preoperative and postoperative, were documented and analyzed. This analysis included evaluating the stability of the lumbar spine through lumbar hyper-flexion and hyper-extension X-rays, as well as determining the lumbar canal cross-sectional area (CCA) using CT scans.</p><p><strong>Results: </strong>The mean follow-up period was 47.4 ± 7.1 months. The average operative duration was 65.3 ± 12.6 min, and the mean estimated blood loss was 10.4 ± 8.5 mL. The average length of postoperative hospital stay was 2.2 ± 1.3 days. There was a significant improvement in SCWD without pain (p < 0.05). Postoperatively, the ODI and VAS scores for both back and leg pain showed significant reductions (p < 0.05). Based on the modified MacNab criteria, the overall rate of good-to-excellent outcomes was 95.45%. The CCA increased significantly from 52.0 ± 11.0 to 122.5 ± 12.1 mm² (p < 0.05). The stability of the spine did not exhibit significant changes compared to the preoperative state.</p><p><strong>Conclusions: </strong>The unilateral interlaminar approach for bilateral endoscopic decompression in the treatment of LSS demonstrated both safety and efficacy, as evidenced by clinical and radiographic outcomes.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":"2992-3001"},"PeriodicalIF":2.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12497534/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144963814","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Influence of Alignment Changes in Different Planes During Supra-Tubercular Biplanar Medial Opening Wedge High Tibial Osteotomy on Tibial Tubercle-Trochlear Groove Distance.","authors":"Lizhong Jing, Weiguo Wang, Yulian Ren, Yanrong Chen, Xia Zhang, Meifeng Shen, Jiushan Yang, Jian Wang","doi":"10.1111/os.70119","DOIUrl":"10.1111/os.70119","url":null,"abstract":"<p><strong>Objective: </strong>Changes in the coronal, sagittal, and axial alignments during supra-tubercular biplanar medial opening wedge high tibial osteotomy (STB-MOWHTO) may have different influences on tibial tubercle-trochlear groove (TT-TG) distance, but few pieces of literature have addressed this specific concern. We aimed to analyze the impacts of changes in alignments in different planes during STB-MOWHTO on the TT-TG distance.</p><p><strong>Methods: </strong>Patients who underwent STB-MOWHTO for varus knee deformity at our hospital were reviewed retrospectively from January 2020 to December 2022. Radiographic parameters, including opening width (OW), distal tibial rotation (DTR), posterior tibial slope (PTS), and TT-TG distance, were assessed before operation and directly postoperatively. Multivariate mixed linear regression analyses were employed to investigate the relationships between OW, the changes in DTR, PTS, and TT-TG distance. Restricted cubic spline curve fitting and threshold effects were used to assess potential non-linear relationships between the independent variables and changes in TT-TG distance. Stratification analysis was conducted to assess the stability of the results.</p><p><strong>Results: </strong>One hundred and two knee joints from 66 patients were included. TT-TG distance change was positively correlated with OW (β = 0.551, 95% CI: 0.340, 0.762, p < 0.001) and DTR change (β = 0.284, 95% CI: 0.196, 0.371, p < 0.001). Restricted cubic spline curve fitting and threshold effect analyses did not identify any non-linear relationships or inflection points between OW, DTR change, and TT-TG distance change. Further, stratification analysis of DTR in various directions confirmed the stability of the linear relationship between DTR change and TT-TG distance change.</p><p><strong>Conclusions: </strong>The TT-TG distance change exhibited a positively correlated linear relationship with OW and DTR change during STB-MOWHTO. For every 1 mm increase in OW, TT-TG distance increased by an average of 0.551 mm. For every 1° increase in DTR, TT-TG distance increased by an average of 0.284 mm.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":"2844-2850"},"PeriodicalIF":2.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12497537/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144883386","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anatomy Analysis of C5 CT Images in Children Aged 1-14 Years.","authors":"Jiarui Chen, Chengqian Huang, Chenxing Zhou, Hua Jiang, Sitan Feng, Guobing Deng, Tianyou Chen, Jiang Xue, Zhongxian Zhou, Shaofeng Wu, Jichong Zhu, Dequan Liu, Jiakun Li, Shixin Pan, Xiangtao Xie, Yingying Qin, Xinli Zhan, Chong Liu","doi":"10.1111/os.70126","DOIUrl":"10.1111/os.70126","url":null,"abstract":"<p><strong>Objective: </strong>There is a lack of large-scale anatomical studies on children's C5 vertebrae, and experience with posterior cervical spine fixation surgery in children is limited, posing challenging clinical issues. This study aims to investigate the size, morphology, and developmental growth of the C5 pedicle and lateral mass in children under 14 years of age, and to assess the feasibility of screw placement.</p><p><strong>Methods: </strong>We collected CT image data of children aged 1-14 years who underwent cervical spine CT scans at our hospital from June 2018 to June 2020, measured the imaging anatomy of C5 vertebral arches and lateral masses. The t-test was used for difference testing and the least squares method was used for fit analysis.</p><p><strong>Results: </strong>The C5 vertebral arches and lateral masses in children increase in size with age, with varying growth rates, initially rapid, then slow in the middle, and rapid again later. In children aged 2-3 years, the C5 pedicle width is 3.56 ± 0.34 mm, and the lateral mass height is 3.84 ± 0.37 mm, allowing for the use of a 3.5 mm diameter pedicle and lateral mass screw in children over 3 years old. Among children aged 1-14 years, the average values of angles A, C, and E show relatively small fluctuations, indicating stable anatomical structures, while angle D significantly increases with age. Fitting analysis results reveal that the various parameters are mainly correlated with power curves, including both quadratic and cubic curves.</p><p><strong>Conclusion: </strong>In children over 3 years old, both the C5 pedicle and lateral mass reach a diameter of over 3.5 mm, allowing for the placement of a 3.5 mm screw. Preoperative thin-section CT scans and careful measurement of various anatomical parameters are essential. This study provides specific imaging anatomical parameters for the C5 pedicle and lateral mass in children, serving as a morphological anatomical reference for posterior cervical spine fixation surgery and designing pediatric posterior cervical spine screws.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":"2927-2934"},"PeriodicalIF":2.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12497548/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144963712","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sagittal Classification of Calcified Lumbar Disc Herniation and Therapeutic Analysis of Percutaneous Endoscopic Interlaminar Discectomy.","authors":"Kai Zhang, Yingchuang Tang, Hanwen Li, Peng Peng, Xingbang Ruan, Xiangyan Zhen, Bin Meng, Huilin Yang, Junxin Zhang, Haiqing Mao, Kangwu Chen","doi":"10.1111/os.70152","DOIUrl":"10.1111/os.70152","url":null,"abstract":"<p><strong>Background: </strong>Calcified lumbar disc herniation (CLDH) is one specific type of lumbar disc herniation (LDH). Currently, there are no uniform classification standards for different calcification degrees of herniated lumbar disc tissue. Percutaneous endoscopic interlaminar discectomy (PEID) has been proved to exhibit great efficacy in treating LDH, but whether it can achieve satisfactory results in treating CLDH with different calcification remains unclear.</p><p><strong>Methods: </strong>A total of 271 patients who suffered from single CLDH (97 patients) or NCLDH (non-calcified lumbar disc herniation) who received PEID surgery between January 2016 and December 2018 in our hospital participated in this retrospective study. Moreover, CLDH was divided into four grades based on preoperative sagittal CT images, including 34 Grade I, 22 Grade II, 19 Grade III, and 22 Grade IV. Operative time was evaluated between the two groups. In addition, VAS (leg pain), ODI, and MacNab scale score were applied to assess the efficacy of PEID in treating CLDH with different calcification degrees by Student's t tests or χ² test.</p><p><strong>Results: </strong>All the patients successfully underwent PEID surgery. According to the analysis, the operative time in the CLDH group was significantly longer than that in NCLDH group. Preoperative and postoperative VAS (leg pain) and ODI scores have no significant differences between the CLDH and NCLDH groups. Furthermore, postoperative modified MacNab scale scores and complication rates were almost the same in the two groups. However, there were some differences in terms of VAS (leg pain), ODI, and MacNab scores during LDH patients with different degrees of calcification. CLDH was divided into four grades in our study, and the analysis displayed that VAS (leg pain) and ODI scores after operation in the Grade IV CLDH group were both obviously higher than those in the control group. Moreover, the modified MacNab scale showed that excellent or good rates in the Grade IV CLDH group (73%) were lowest, and they were significantly lower than those in the control group (91%). The other statistical indexes such as recurrence and complication rates showed no significant difference in CLDH with different degrees of calcification.</p><p><strong>Conclusion: </strong>CLDH was innovatively divided into four grades in our study. PEID is an effective and safe surgical method for treating CLDH; it can achieve a satisfactory outcome. However, it should be considered carefully in the treatment of lumbar disc herniation with severe calcification (Grade IV).</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":"2887-2894"},"PeriodicalIF":2.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12497560/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144963797","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Optimal Dose, Efficacy and Safety of Tranexamic Acid on Hemorrhage Control for High Tibial Osteotomy: A Network Meta-Analysis.","authors":"Zhihu Zhao, Fei Xing, Wei Luo, Xin-Long Ma","doi":"10.1111/os.70140","DOIUrl":"10.1111/os.70140","url":null,"abstract":"<p><strong>Objective: </strong>This systematic review and network meta-analysis was performed to explore the optimal dose, efficacy, and safety of tranexamic acid (TXA) treatments versus placebo for high tibial osteotomy (HTO) patients.</p><p><strong>Methods: </strong>PubMed, Embase, Cochrane Library, Wanfang database, and Chinese National Knowledge Infrastructure (CNKI) databases were searched for the randomized controlled trials (RCTs) meeting prespecified inclusion criteria up to March 2024. Interventions included TXA and placebo treatments. The outcomes included total blood loss, drainage, hemoglobin drop, the occurrence of deep venous thrombosis (DVT) and hematoma. Traditional meta-analysis and network meta-analysis were performed by Stata and R software, respectively.</p><p><strong>Results: </strong>Traditional meta-analysis revealed that TXA was associated with a decrease in the total blood loss, drainage volume, and hemoglobin drop (p < 0.05). There was no significant difference between TXA and placebo in terms of the occurrence of DVT and hematoma (p > 0.05). Compared with placebo, intravenous (iv) 10 mg/kg, iv 10 mg/kg (3 doses), iv 2 g, iv 2 g (2 doses), iv 2 g + topical (top) 3 g, iv 50 mg/kg, and top 10 mg/kg decreased the total blood loss with statistical significance (p < 0.05). Compared with placebo, iv 10 mg/kg (WMD = -379.91, 95% CI: -378.92, -81.22) decreased the drainage volume with statistical significance. Compared with placebo, iv 10 mg/kg (3 doses), iv 1 g, iv 1 g + top 2 g, iv 2 g + top 1 g, and iv 50 mg/kg decreased the hemoglobin drop with statistical significance. No statistically significant difference was found when the two interventions were compared against each other for the occurrence of DVT and hematoma (p > 0.05). The SUCRA shows that iv 10 mg/kg ranked first for reducing total blood loss (SUCRA, 90.7%) and drainage volume (SUCRA, 94.3%). The SUCRA shows that iv 1 g + top 2 g ranked first (SUCRA, 93.7%) for reducing hemoglobin drop.</p><p><strong>Conclusion: </strong>Administration with TXA was associated with a decrease in blood loss in HTO patients. The optimal dose of TXA for reducing blood loss was iv 10 mg/kg. As for reducing hemoglobin drop, iv 1 g + top 2 g ranked first. Administration of TXA was not associated with an increase in the occurrence of DVT and hematoma. However, most evidence was graded as low/very low confidence due to study limitations, imprecision, and heterogeneity. Therefore, these findings should be interpreted as preliminary signals rather than definitive conclusions. Further high-quality randomized trials are required to validate dose-dependent efficacy and long-term safety outcomes.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":"2784-2808"},"PeriodicalIF":2.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12497536/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145041006","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}