Orthopaedic Surgery最新文献

{"title":"Posterior Circulation Ischemic Stroke From Atlantoaxial Instability and Lateral Dislocation due to Os Odontoideum: Case Report and Review of Literature.","authors":"Xianghe Wang, Yao Li, Minghao Shao, Jingjuan Liang, Weijun Tang, Jixian Lin, Xiaosheng Ma, Hongli Wang, Xiang Han","doi":"10.1111/os.14261","DOIUrl":"10.1111/os.14261","url":null,"abstract":"<p><strong>Background: </strong>Strokes in young individuals often stem from unusual causes. Posterior circulation ischemic stroke caused by vertebral artery insufficiency due to atlantoaxial instability or dislocation is rare. We present a case of posterior circulation ischemic stroke due to an unstable os odontoideum and review the current literature. The clinical features and imaging manifestations are described to promote awareness of etiology, early diagnosis, and assessment.</p><p><strong>Case presentation: </strong>A 24-year-old male presented with recurrent right-sided limb numbness and weakness and cerebellar ataxia due to posterior circulation ischemic stroke. The work-up revealed thrombosis reformation in the tortuous left vertebral artery. It is noteworthy that the patient developed compression and chronic damage of the vertebral artery secondary to atlantoaxial instability and lateral dislocation due to an os odontoideum. He underwent antiplatelet and anticoagulant therapy, cervical traction, and posterior atlantoaxial screw fixation and fusion with iliac crest autograft. The postoperative course was uneventful. At 6-month follow-up, the patient had a solid fusion mass and rigid stability of the atlantoaxial joint without neurologic deficits or ischemic sequelae.</p><p><strong>Conclusions: </strong>For unexplained posterior circulation ischemic stroke, it is important to consider unstable os odontoideum as a potential etiology, especially in pediatric and young adult male patients. Atlantoaxial instability and dislocation with os odontoideum, especially when occurring laterally, may cause insufficiency of the vertebral artery and subsequent posterior circulation ischemic strokes. The significance of lateral atlantoaxial dislocation in the genesis of vertebral artery injury and the necessity for specific positional imaging are emphasized.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11541124/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142471713","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 of Outside-In Hip Arthroscopy without Traction in the Treatment of Hip Synovial Osteochondromatosis.","authors":"Weigang Wu, Meng Liu, Chenhe Zhou, Huajie Mao, Huiguo Wu, Zhiqiang Wu, Chiyuan Ma","doi":"10.1111/os.14258","DOIUrl":"10.1111/os.14258","url":null,"abstract":"<p><p>Arthroscopic treatments of hip synovial osteochondromatosis are mostly performed under traction, resulting in neurovascular injury or iatrogenic damage to the labrum or cartilage. This study aimed to assess the effectiveness of outside-in hip arthroscopy without traction in treating hip synovial osteochondromatosis. This retrospective study was conducted on a series of patients with hip synovial osteochondromatosis treated using outside-in hip arthroscopy without traction in our hospital between 2018 and 2020. Plain radiography and magnetic resonance imaging (MRI) scans were obtained. The Harris hip score (HHS), hip range of motion (ROM), and visual analog scale (VAS) scores were analyzed. The preoperative scores and last follow-up scores were compared with a paired-sample t test. The complications and recurrence postsurgery were recorded. This study included five patients (three male and two female) with an average age of 41 years (range 28-54 years). The mean follow-up time was 25.2 months (range 18-36 months). All patients experienced groin pain relief and improved ROM. The mean VAS score was significantly lower postoperatively (0.4 ± 0.5) than preoperatively (3.2 ± 0.8) (p < 0.001). The mean HHS improved from 58.6 ± 12.7 (range 43-73) to 89.8 ± 5.26 (range 81-95) (p < 0.001). No major complications, including infection, perineal numbness and swelling, neurotrosis, thromboembolism, or severe persistent pain, were reported. Synovial osteochondromatosis recurred in one patient after 2 years of follow-up without any obvious symptoms such as hip pain or joint locking. Therefore, no further treatment was necessary. This study showed that outside-in hip arthroscopy without traction might be a viable option for treating hip synovial osteochondromatosis, effectively and safely relieving symptoms with minimal complications, especially in patients without lesions in the central compartment.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11541137/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142361870","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":"Morphological Measurement and Clinical Significance of Abnormal Development of Distal Femur with Hemophilia Knee Arthritis: A Consideration on the Renewal of Total Knee Prosthesis.","authors":"Ru Feng, Houlong Ye, Wang Fang, Chun Zhang, Renfei Qi, Juehua Jing, Yunfeng Yao","doi":"10.1111/os.14170","DOIUrl":"10.1111/os.14170","url":null,"abstract":"<p><strong>Objective: </strong>The knee joint of hemophiliacs may face the result of local morphological changes due to long-term irritation of synovitis. This study aims to elucidate the morphological characteristics of distal femur in hemophilic arthritis (HA) and compare the compatibility of three types of prostheses with the anteroposterior (AP) and mediolateral (ML) dimensions of the femoral osteotomy surface.</p><p><strong>Methods: </strong>This study retrospectively and randomly selected 50 patients with HA registered for treatment at our hospital from June 2016 to August 2022 as the study subjects, with an equal number of male osteoarthritis (OA) patients and healthy male individuals set as the control group. This study used medical digitalization software to simulate osteotomies on the distal femur during total knee arthroplasties (TKA) for 50 patients with HA, OA patients, and the healthy population, respectively, and measure the morphological parameters to compare with three commonly used femoral components of TKA in clinical practice. The differences between the femur resection of anteroposterior and mediolateral (FRAP, FRML) osteotomy surface and the prosthesis's BOX-AP/ML were compared in three prostheses. One-way ANOVA and multiple Kruskal-Wallis H test were used for the normal or non-normal distribution data, and pairwise comparisons between groups were conducted using the Bonferroni method, and the linear correlation analysis was utilized to assess the relationship between section femoral morphological data and prosthesis parameters.</p><p><strong>Result: </strong>In HA patients, the morphological characteristics of the distal femur were shown as shorter than femur AP (FAP), medial and lateral condyle anterior-posterior dimension (FMCAP, FLCAP), notch width (NW), posterolateral condyle height (PLCH), posteromedial condyle width (PMCW), and posterior condylar axis length (PCAL) dimension. They had comparatively smaller femur section aspect ratios (p < 0.005). They showed longer posterolateral condyle width (PLCW), anterior condyle mediolateral dimension (FRACML), anterolateral condyle height (ALCH), and femur resection anterior condylar mediolateral (FRACML) dimension (p < 0.005). They showed larger distal femur aspect ratio and resection aspect ratio (FAR, FRAR, p < 0.005). All selected prostheses showed ML undercoverage under similar AP dimensions, and ML undersizing of Attune systems was more obvious in three femoral prostheses.</p><p><strong>Conclusion: </strong>The distal femur morphological change of HA patient is shown as smaller AP dimension, narrow posterior condyle spacing, lower and shallower trochlear, thinner anterior condyle, wider and lower intercondylar notch and higher posterior-lateral condyle. The selected prostheses showed ML undercoverage under similar AP dimensions. This typical morphological tendency of the distal femur seems to warrant consideration in the process of knee joint prosthesis upgrading.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11541134/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141893983","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":"Clinical Outcome of an All Arthroscopic 'Whole Layer' Rotator Cuff Repair Technique with Simultaneous Biceps Tenodesis.","authors":"Chiu-Yu Shih, Pei-Ru Lin, Hui-Chen Huang, Cheng-Pu Hsieh","doi":"10.1111/os.14198","DOIUrl":"10.1111/os.14198","url":null,"abstract":"<p><strong>Objective: </strong>To retrospectively evaluate clinical outcomes, including function and pain, of patients after our all arthroscopic \"whole layer\" rotator cuff repair technique with simultaneous biceps tenodesis procedure; factors influencing results were also evaluated. Given the frequent association of rotator cuff tear with long head of biceps lesion and the need for effective combined treatment strategies, this study aims to evaluate the efficacy of our technique and compare it with established methods. We hypothesized that our technique would significantly improve function and reduce pain in patients with rotator cuff tears and biceps pathology.</p><p><strong>Methods: </strong>This is a retrospective study that included patients older than 20 years who underwent all arthroscopic \"whole layer\" rotator cuff repair technique with simultaneous biceps tenodesis procedures for concomitant rotator cuff tear and long head biceps pathology, from 2016 to 2020. Patients were evaluated preoperatively and at a minimum of 2 years of follow-up using the American Shoulder and Elbow Surgeons (ASES) and visual analogue scale (VAS) scores paired t-tests were used for analysis and statistical significance was set at p < 0.05(two-tailed). The satisfaction rate and complications were also evaluated.</p><p><strong>Results: </strong>After an average follow-up of 2.3 years, 118 patients demonstrated significant improvement in both the ASES score (from 36.13 to 95.01, p < 0.001) and VAS score (from 6.81 to 0.89, p < 0.001). Ninety-four percent of the patients reported satisfaction with the surgical outcome. No complications related to Popeye deformity, biceps cramping pain, or ipsilateral shoulder reoperation were observed. Factors such as age, sex, body mass index (BMI), smoking status, alcohol consumption, hypertension, and diabetes did not influence the results. Patients showed significant improvement in both the ASES and VAS scores (p < 0.001).</p><p><strong>Conclusion: </strong>At a mean follow-up time of 2.3 years, the all arthroscopic \"whole layer\" rotator cuff repair technique with simultaneous biceps tenodesis is a therapeutic and efficient procedure. The procedure revealed a satisfactory functional outcome, reduced pain, and minimal complications and reoperations.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11541120/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142056230","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":"Does the Angulation of the Screws in the Zero-P Implant Affect the Clinical and Radiological Outcomes of Patients?","authors":"Cheng-Yi Huang, Xia-Qing Sheng, Ting-Kui Wu, Bei-Yu Wang, Ding-Ke Wen, Li He, Hao Liu","doi":"10.1111/os.14182","DOIUrl":"10.1111/os.14182","url":null,"abstract":"<p><strong>Objective: </strong>When implanting the Zero-P device, the screws of Zero-P form a bone wedge with a 40 ± 5° cranial and caudal angle (CCA). However, no study has been performed in the optimal CCA of the Zero-P implant. To investigate whether the cranial/caudal angles (CCA) of the screws affect the clinical and radiological outcomes in patients undergoing ACDF with the Zero-P implant.</p><p><strong>Methods: </strong>From January 2016 to December 2023, we retrospectively analyzed 186 patients who underwent 1-level ACDF with the Zero-P device. The patients were divided into four groups: group A (cranial angle ≤40°, caudal angle ≤40°); group B (cranial angle ≤40°, caudal angle >40°); group C (cranial angle >40°, caudal angle ≤40°); and group D (cranial angle >40°, caudal angle >40°). The clinical outcomes, including Japanese Orthopaedic Association (JOA), neck disability index (NDI), and visual analogue scale (VAS) scores, the radiological parameters, including cervical lordosis (CL), cervical lordosis of operated segments (OPCL), intervertebral space height (ISH) and fusion rate (FR), and the complications, were evaluated and compared. Parametric tests, non-parametric tests, and chi-square tests were conducted to analyze the data.</p><p><strong>Results: </strong>The OPCL of group A was significantly less than that of the other groups at the final follow-up (p < 0.05). The ISH of group D was significantly less than that of group A at the final follow-up (p < 0.05). The subsidence rate of group A was significantly less than that of group D at the final follow-up (p < 0.05). At the final follow-up, the upper adjacent-level degeneration (ASD) of group D was significantly less severe than that of groups A and B (p < 0.05). The clinical outcomes do not differ among groups (p > 0.05).</p><p><strong>Conclusion: </strong>A larger CCA of the screws (cranial angle >40°, caudal angle >40°) was better for maintaining OPCL and reducing the incidence of ASD. A smaller CCA of the screws (cranial angle ≤40°, caudal angle ≤40°) was better for maintaining ISH and reducing the rate of subsidence.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11541112/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141897940","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 Variation Range of Posterior Condylar Offset Associated with Positive Clinical Outcomes of Primary Total Knee Arthroplasty: A Retrospective Analysis.","authors":"Yanlin Zhong, Zengfa Deng, Cheng Gu, Ming Li, Yan Kang, Weiming Liao, Zhiqi Zhang","doi":"10.1111/os.14183","DOIUrl":"10.1111/os.14183","url":null,"abstract":"<p><strong>Objective: </strong>Posterior condylar offset (PCO) and anterior condylar offset (ACO) exert an influence on the sagittal alignment in total knee arthroplasty (TKA). However, there is no common consensus that the variation range of posterior condylar offset (PCO) is associated with patient-reported outcome measures (PROMs) and the optimum variation range of PCO. This study aims to investigate the correlation between PCO and the PROMs of primary TKA for osteoarthritis (OA) and find out the optimal variation range of the PCO.</p><p><strong>Methods: </strong>In this study, we performed a radiographic analysis of 106 patients (112 knees) with primary TKA. Patients were divided into two cohorts (A and B) according to the Western Ontario and McMaster Universities Osteoarthritis index (WOMAC). Correlations between the sagittal parameter and WOMAC were investigated using univariate and multivariate analysis. The receiver operating characteristic (ROC) curve was used to establish the cut-off value for the optimal variation range. We then further investigated how different variation range affects the WOMAC subscale score and forgotten-joint-score-12 (FJS-12).</p><p><strong>Results: </strong>Univariate analysis revealed a correlation between the variation range of PCO (p < 0.01), ACO (p < 0.01) and PROMs. Multivariate analysis showed that only PCO was associated with PROMs. In the ROC graph, the cut-off value of the variation range of PCO is 2.85 mm (AUC = 0.66, Youden index = 0.26). The WOMAC functional ability score of the group outside the PCO variation range of 2.85 mm significantly increased compared to the group within the range.</p><p><strong>Conclusion: </strong>In this study, PCO variation was significantly associated with clinical outcomes in TKA and the optimal PCO variation range was within 2.85 mm. Maintaining the PCO variation within 2.85 mm could enhance functional recovery and patient satisfaction.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11541138/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141897941","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":"Characteristic of Paraspinal Muscle Change in Coronal Sub-type of Degenerative Lumbar Scoliosis and its Potential Clinical Significance.","authors":"Zhenguo Shang, Hengrui Chang, Jiaxin Xu, Wenyuan Ding, Hui Wang, Di Zhang","doi":"10.1111/os.14185","DOIUrl":"10.1111/os.14185","url":null,"abstract":"<p><strong>Objective: </strong>Clarifying paraspinal muscle (PM) change in degenerative lumbar scoliosis (DLS) is positive to evaluate the progression of scoliosis. This research compares the characteristic of PM change among different coronal sub-types of DLS and explores its potential clinical significance.</p><p><strong>Methods: </strong>A total of 84 DLS patients between June 2019 to December 2021 were retrospectively analyzed. Patients were classified into three types based on the coronal balance distance (CBD): Type A, CBD <3 cm; Type B: C7 Plumb Line (C7PL) shifted to the concave side of the curve, and CBD >3 cm; Type C: C7PL shifted to the convex side of the curve, and CBD >3 cm. Fat infiltration rates in the multifidus (MS) and erector spinae (ES) at the apex of the main and fractional curves, and spinopelvic parameters were analyzed statistically. Pearson's or Spearman's correlation was applied to analyze the correlation between asymmetric degree of PM change and these parameters in three types.</p><p><strong>Results: </strong>There were 62 cases with coronal sub-Type A, 6 cases with Type B, and 16 cases with Type C. Patients in Type B and C demonstrated higher fat infiltration in MS on the concave side of both the main and fractional curves when compared to those in Type A. The asymmetric degree of ES change was positively correlated with CBD at the apex of the main curve in Type B and at the apex of the fractional curve in Type C respectively, and that of MS was positively correlated with apical vertebral rotation, while negatively strong-correlated with pelvic incidence and sacral slope in Type C.</p><p><strong>Conclusion: </strong>PM fatty infiltration presented difference among varied coronal sub-types of DLS patients. The CBD in Type B and C patients was correlated with the asymmetric degree of ES change.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11541118/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141907307","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":"Analysis of Failed Atlantoaxial Reduction: Causes of Failure and Strategies for Revision.","authors":"Boyan Zhang, Yueqi Du, Can Zhang, Maoyang Qi, Hongfeng Meng, Tianyu Jin, Guoqing Cui, Jian Guan, Wanru Duan, Zan Chen","doi":"10.1111/os.14197","DOIUrl":"10.1111/os.14197","url":null,"abstract":"<p><strong>Objective: </strong>The craniovertebral junction (CVJ) presents intricate anatomical challenges. In severe or irreducible malformations, complications such as reduction loss and fixation failure may occur, necessitating revision surgery. The posterior facet joint distraction and fusion (PFDF) technique, offers a solely posterior approach for revisions. Hence, we delineate varied revision scenarios, proposing surgical strategies and technical details to enhance outcomes and mitigate risks, thereby enriching the neurosurgical community's repertoire.</p><p><strong>Methods: </strong>This was a retrospective cohort study, analyzed patient data from Xuanwu Hospital, between 2017 to 2023. All patients had a history of surgical treatment for CVJ malformations, and experienced failure or loss of reduction. The distance from the odontoid process tip to the Chamberlain's line (DCL), the atlantodental interval (ADI), clivus-canal angle, cervicomedullary angle, width of subarachnoid space, CVJ area, and width of syrinx were used for radiographic assessment. Japanese Orthopaedic Association (JOA) scores and SF-12 scores were used for clinical assessment. Independent sample t-tests were employed. A significance level of p < 0.05 indicates statistically significant differences.</p><p><strong>Results: </strong>We analyzed data from 35 patients. For patients who underwent PFDF, the postoperative DCL, ADI, and clivus-canal angle significantly improved. For all patients, the postoperative cervicomedullary angle, width of subarachnoid space, CVJ area, and width of syrinx all demonstrated significant improvement, indicating the relief of neural compression. All patients showed significant improvement in both symptoms and clinical assessments.</p><p><strong>Conclusion: </strong>Severe atlantoaxial joint locking or ligament contracting are the fundamental cause of reduction and fixation failure. Anterior odontoidectomy is indicated for patients with robust bony fusion of the atlantoaxial joint in an unreduced position. The PFDF technique is safe and effective for patients with incomplete atlantoaxial bony fusion. Preoperative assessment of surgical feasibility and vertebral artery status ensures surgical safety and efficacy.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11541122/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142073445","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":"Clinical Analysis and Imaging Study of Lateral Lumbar Intervertebral Fusion in the Treatment of Degenerative Lumbar Scoliosis.","authors":"Yi-Bo Zhao, Yuan-Zhang Jin, Xiao-Feng Zhao, Xiang-Dong Lu, De-Tai Qi, Run-Tian Zhou, Xiao-Nan Wang, Hai-Feng Liu, Liang Chen, Kun Xi, Yang-Zhang, Tian-Sheng Sun, Shi-Qing Feng, Zhi-Cheng Zhang, Bin Zhao","doi":"10.1111/os.14151","DOIUrl":"10.1111/os.14151","url":null,"abstract":"<p><strong>Objective: </strong>As the population ages and technology advances, lateral lumbar intervertebral fusion (LLIF) is gaining popularity for the treatment of degenerative lumbar scoliosis (DLS). This study investigated the feasibility, minimally invasive concept, and benefits of LLIF for the treatment of DLS by observing and assessing the clinical efficacy, imaging changes, and complications following the procedure.</p><p><strong>Methods: </strong>A retrospective analysis was performed for 52 DLS patients (12 men and 40 women, aged 65.84 ± 9.873 years) who underwent LLIF from January 2019 to January 2023. The operation time, blood loss, complications, clinical efficacy indicators (visual analogue scale [VAS], Oswestry disability index [ODI], and 36-Item Short Form Survey), and imaging indicators (coronal position: Cobb angle and center sacral vertical line-C7 plumbline [CSVL-C7PL]; and sagittal position: sagittal vertical axis [SVA], lumbar lordosis [LL], pelvic incidence angle [PI], and thoracic kyphosis angle [TK] were measured). All patients were followed up. The above clinical evaluation indexes and imaging outcomes of patients postoperatively and at last follow-up were compared to their preoperative results.</p><p><strong>Results: </strong>Compared to the preoperative values, the Cobb angle and LL angle were significantly improved after surgery (p < 0.001). Meanwhile, CSVL-C7PL, SVA, and TK did not change much after surgery (p > 0.05) but improved significantly at follow-up (p < 0.001). There was no significant change in PI at either the postoperative or follow-up timepoint. The operation took 283.90 ± 81.62 min and resulted in a total blood loss of 257.27 ± 213.44 mL. No significant complications occurred. Patients were followed up for to 21.7 ± 9.8 months. VAS, ODI, and SF-36 scores improved considerably at postoperative and final follow-up compared to preoperative levels (p < 0.001). After surgery, the Cobb angle and LL angle had improved significantly compared to preoperative values (p < 0.001). CSVL-C7PL, SVA, and TK were stable after surgery (p > 0.05) but considerably improved during follow-up (p < 0.001). PI showed no significant change at either the postoperative or follow-up timepoints.</p><p><strong>Conclusion: </strong>Lateral lumbar intervertebral fusion treatment of DLS significantly improved sagittal and coronal balance of the lumbar spine, as well as compensatory thoracic scoliosis, with good clinical and radiological findings. Furthermore, there was less blood, less trauma, and quicker recovery from surgery.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11541115/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141793030","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":"A 3D-CT Study of the Cortical Bone Trajectory Screw Placement Parameters Based on Lumbar CT.","authors":"Weibo Zeng, Shengxuan Hu, Zhemin Zhu, Shuai Wang, Lijun Guo, Benchao Shi","doi":"10.1111/os.14202","DOIUrl":"10.1111/os.14202","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;The cortical bone trajectory (CBT) technology is an effective substitute for traditional pedicle screw (PS) technology. However, there is still controversy about the CBT screw technology placement strategy. The objective of this study was to simulate cortical screw placement with the help of three-dimensional (3D) software, to discuss the differences in screws between genders and vertebral segments, and to explore a safer and more efficient strategy for cortical screw placement.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Mimics Medical software was used to construct a 3D model of the lumbar spine, and the placement of CBT screws was simulated. The volume of each vertebral body from L1 to L5, the pedicle isthmus height (IH), the pedicle isthmus width (IW), and the sagittal vertebral distance (SAVD) were measured. The transverse distance (TD) and the longitudinal distance (LD) between the ideal starting point (SP) and the clinical SP (the intersection Q of the midline of the superior articular process and the horizontal line 1 mm below the transverse process) were measured. The cephalad angle (CA), lateral angle (LA), maximum screw diameter (MSD), maximum screw length (MSL) of each trajectory of the L1 to L5 vertebral bodies, and the percentage of the screw insertion depth (PSID) into the vertebral body were measured. Data were statistically analyzed using Student's t-test, one-way analysis of variance (ANOVA), and Tukey's test.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Vertebral anatomical parameters and CBT screw parameters differed between males and females. Female patients had lower IH, IW, SAVD, CA, LA, MSD, and MSL than males. IH was greatest in L1 (male, 17.81 mm; female, 16.12 mm) and the smallest in L5 (male, 14.11 mm; female, 13.05 mm). IW was smallest in L1 (male, 8.89 mm; female, 7.37 mm) and greatest in L5 (male, 16.59 mm; female, 15.43 mm). The MSD of males was smallest in L1 (6.05 mm) and greatest in L3 (7.06 mm); the MSD of females was smallest in L1 (5.13 mm) and greatest in L4 (6.64 mm). MSL was greatest at L3 (male, 33.63 mm; female, 32.28 mm) and smallest at L5 (male, 31.25 mm; female, 29.97 mm). CA was smallest in L1 (male, 22.80°; female, 21.92°) and greatest in L3 (male, 25.29°; female, 24.33°). LA was smallest in L1 (male 12.37°, female 11.27°) and greatest in L5 (male 13.56°, female 12.96°). Among the males, TD was smallest at L1 (-0.51 mm) and greatest at L5 (1.37 mm), while LD was greatest at L2 (3.46 mm) and smallest at L5 (2.40 mm). In females, TD was greatest at L1 (0.12 mm) and smallest at L3 (-0.51 mm), while LD was greatest at L1 (3.69 mm) and smallest at L5 (2.08 mm). In the overall sample, the incidence of SAVD and PSID gradually increased from L1 to L5.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;The optimal screw placement strategy for CBT screws varies significantly according to sex and vertebral body segments, particularly noting the specificity of screw placement at L5. The optimal screw placement strategy s","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11541135/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142073502","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}