Orthopaedic Surgery最新文献

{"title":"Effects of Continuous Graduated Pneumatic Compression and Intermittent Pneumatic Compression on Lower Limb Hemodynamics for VTE Prophylaxis in Arthroplasty.","authors":"Binglong Li, Xuezhou Li, Weibo Zheng, Shusheng Wei, Baoqing Zhang, Jianwei Liu, Yongyuan Chen, Dan Wang, Qunshan Lu, Peilai Liu","doi":"10.1111/os.14360","DOIUrl":"10.1111/os.14360","url":null,"abstract":"<p><strong>Objective: </strong>Intermittent pneumatic compression (IPC) is considered the standard of care for preventing venous thromboembolism (VTE) in the hospital setting. However, its widespread adoption after hospitalization has been limited due to its shortcomings in obstruction of venous valves and blood reflux. The objective of this study is to compare the effects of continuous graduated pneumatic compression (CGPC), a new device with a novel mechanism, and IPC on lower hemodynamics and the incidence of VTE in patients undergoing arthroplasty.</p><p><strong>Methods: </strong>We randomized 123 participants undergoing knee arthroplasty to receive either IPC or CGPC from June 2022 through August 2023. An experienced sonographer used a Doppler ultrasound scanner to obtain hemodynamic indicators of venous blood. The primary outcome was the blood velocity of the femoral vein measured by a Doppler scanner. Secondary outcomes included the hemodynamic of the femoral vein and popliteal vein, quality of life at discharge and 30 days after surgery, symptomatic and asymptomatic VTE up to 30 days, and adverse events related to the IPC and CGPC device. For statistical analyses, Student's t-test, analysis of covariance, and the Mann-Whitney U test were used. Statistical significance was indicated with p < 0.05.</p><p><strong>Results: </strong>There was no significant difference in femoral vein velocity between the IPC and CGPC groups. However, CGPC demonstrated a significant increase in femoral vein flow compared to the IPC group, with a median (interquartile) increasing from 158.9 (122.9, 204.3) to 265.6 (203.3, 326.8) mL/min in the CGPC group and from 139.0 (103.3, 175.9) to 189.6 (161.4, 270.8) mL/min in the IPC group (p < 0.001). Similar trends were observed in popliteal vein measurements. The differences between the two groups were similar in terms of quality of life, incidence of VTE, and adverse events.</p><p><strong>Conclusion: </strong>The CGPC device provides a substantial increase in blood flow compared to the IPC device. Its safety and effectiveness have been preliminarily validated. The CGPC device presents a promising alternative for VTE prophylaxis in arthroplasty.</p><p><strong>Trial registration: </strong>Chinese Clinical Trial Registry (registration number: ChiCTR2300078201).</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":"1095-1104"},"PeriodicalIF":1.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143009240","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":"Opportunistic Screening for Local Osteoporosis of the Proximal Humerus on the Basis of Hounsfield Units: A Study of Patients With Rotator Cuff Tears.","authors":"Guihu Liu, Xiaolong Wang, Xieyu Wang, Yaxuan Zhang, Yinguang Ma, Haibin Zhou, Guangsi Shen","doi":"10.1111/os.14364","DOIUrl":"10.1111/os.14364","url":null,"abstract":"<p><strong>Objectives: </strong>The accuracy of dual-energy x-ray absorptiometry (DXA) in predicting proximal humerus osteoporosis in patients with rotator cuff tears (RCTs) undergoing arthroscopic rotator cuff repair (ARCR) is uncertain. The aim of this study was to assess the correlation of computed tomography (CT) Hounsfield units (HU) and the deltoid tuberosity index (DTI) with bone mineral density (BMD), and to evaluate the predictive value of HU values for implant selection.</p><p><strong>Methods: </strong>This study analyzed the preoperative shoulder CT scans and x-rays of 184 patients who underwent ARCR. Preoperative CT scans were utilized to assess the multiple anatomical parts of the proximal humerus to ascertain the HU values, whereas preoperative x-rays were analyzed to derive the DTI. Among them, 104 patients with preoperative DXA data were grouped according to the WHO diagnostic criteria for osteoporosis to establish the threshold HU values. The correlation between HU values and DTI and the lowest T score on DXA was studied, and the relationship between the HU value and the type of implant selected was discussed. The Pearson correlation coefficient was employed to examine the relationship between HU values, DTI, and T scores. And the Spearman correlation coefficient was employed to examine the relationship between HU values and enhanced fixation.</p><p><strong>Results: </strong>There was a significant correlation between the HU values and DTI and the lowest T score (r _{HU&T score} = 0.539-0.576, r _{DTI&T score} = 0.288, p < 0.05). On the basis of the lowest T score grouping, the threshold HU values for diagnosing proximal humeral osteoporosis were obtained: proximal humerus = 47.44, humeral head = 97.62, greater tuberosity = 10.9, and lesser tuberosity = 5.38. There was no correlation between HU values and enhanced fixation (using 5.5-mm anchors or metal anchors instead of 4.5-mm anchors or all-suture anchors) (r = -0.143 to -0.027, p > 0.05).</p><p><strong>Conclusion: </strong>Proximal humeral HU values were significantly correlated with DTI and the lowest T score on DXA. When the HU values in the proximal humerus in patients with RCTs fall below the thresholds, the surgery should be carefully planned. No correlation exists between HU values and enhanced fixation, thus further investigation through group studies is warranted.</p><p><strong>Level of evidence: </strong>Level III, study of nonconsecutive patients, diagnostic study.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":"1124-1132"},"PeriodicalIF":1.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143391425","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Role of Exerkines in the Treatment of Knee Osteoarthritis: From Mechanisms to Exercise Strategies.","authors":"Yuxiong Xu, Yizhuo Yang, Hanan Song, Ming Li, Weihao Shi, Tongwu Yu, Jianhao Lin, Yanli Yu","doi":"10.1111/os.14365","DOIUrl":"10.1111/os.14365","url":null,"abstract":"<p><p>With the increasing prevalence of knee osteoarthritis (KOA), the limitations of traditional treatments, such as their limited efficacy in halting disease progression and their potential side effects, are becoming more evident. This situation has prompted scientists to seek more effective strategies. In recent years, exercise therapy has gained prominence in KOA treatment due to its safety, efficacy, and cost-effectiveness, which are underpinned by the molecular actions of exerkines. Unlike conventional therapies, exerkines offer specific advantages by targeting inflammatory responses, enhancing chondrocyte proliferation, and slowing cartilage degradation at the molecular level. This review explores the potential mechanisms involved in and application prospects of exerkines in KOA treatment and provides a comprehensive analysis of their role. Studies show that appropriate exercise not only promotes overall health, but also positively impacts KOA by stimulating exerkine production. The effectiveness of exerkines, however, is influenced by exercise modality, intensity, and duration of exercise, making the development of personalized exercise plans crucial for KOA patients. Based on these insights, this paper proposes targeted exercise strategies designed to maximize exerkine benefits, aiming to provide novel perspectives for KOA prevention and treatment.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":"1021-1035"},"PeriodicalIF":1.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143033694","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":"Biomechanical Comparison of a Novel Facet Joint Fusion Fixation Device With Conventional Pedicle Screw Fixation Device: A Finite Element Analysis.","authors":"Feilong Sun, Haiyang Qiu, Yufei Ji, Longchao Wang, Wei Lei, Yang Zhang","doi":"10.1111/os.70003","DOIUrl":"10.1111/os.70003","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;The biomechanics of a novel facet joint fusion device is unknown. The objective of this study is to analyze and compare the biomechanical properties of a novel facet joint fusion device integrated with oblique lateral interbody fusion (OLIF) to those of a conventional pedicle screw fixation device, employing finite element analysis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A comprehensive three-dimensional finite element model of the L3-S1 lumbar spine was developed and validated. Based on this model, three surgical groups were created: OLIF combined with the bilateral facet joint fusion fixation (BFJFF + OLIF), unilateral pedicle screw fixation (UPSF + OLIF), and bilateral pedicle screw fixation (BPSF + OLIF), focusing on the L4-L5 level. A torque of 7.5 Nm was applied to simulate vertebral activities under six conditions: flexion, extension, lateral bending (left and right), and axial rotation (left and right). The maximum displacement at the L4-L5 segment was then calculated. The maximum stress values were recorded at the L4-L5 interbody fusion cage and the L3-L4 and L5-S1 segments.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;When compared to the other two models, the BFJFF + OLIF model exhibited the smallest maximum displacement value at the L4-L5 segment across all six working conditions. The BFJFF + OLIF model also demonstrated the lowest maximum stress value at the L4-L5 segment interbody fusion cage under flexion, as well as left and right lateral bending and axial rotation conditions when compared with the other models. However, under the extension condition at the L4-L5 interbody fusion cage, the BPSF + OLIF model showed the lowest maximum stress value. At the adjacent L3-L4 segments, the BFJFF + OLIF model registered the lowest maximum stress value during flexion and left lateral bending conditions. At L3-L4, under extension and right lateral bending conditions, the UPSF + OLIF model exhibited the lowest maximum stress value. Under left axial rotation at the L3-L4 segment, both the BFJFF + OLIF and UPSF+OLIF models demonstrated the smallest maximum stress values. Under right axial rotation at the L3-L4 segment, the BPSF + OLIF model recorded the smallest maximum stress value. Concurrently, at the L5-S1 segment, the BFJFF + OLIF model presented the lowest maximum stress value under conditions of flexion, as well as left and right lateral bending and axial rotation. In the L5-S1 segment during the extension condition, the UPSF+OLIF model exhibited the lowest maximum stress value.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;This study demonstrates that the novel device, when combined with OLIF, achieves 360° lumbar fusion by fusing the lumbar facet joints, thereby enhancing spinal stability post-fusion. Concurrently, stress on adjacent segments was diminished. The findings suggest that this device may serve as a novel internal fixation method. It may provide a new option for the surgical treatment of patients with low back pain in the fut","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":"1230-1242"},"PeriodicalIF":1.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143523926","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":"Clinical and Radiological Comparison of Unilateral Biportal Endoscopic and Percutaneous Transforaminal Endoscopic Discectomy in the Treatment of Lumbar Spinal Degenerative Disease.","authors":"Hongtao Ding, Xiao Han, Yonggang Xing, Yajun Liu, Da He, Xiaoguang Han","doi":"10.1111/os.14361","DOIUrl":"10.1111/os.14361","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;Unilateral biportal endoscopic discectomy (UBE) is an emerging and minimally invasive surgeryfor lumbar spinal degenerative disease. However, the efficacy, safety and the radiological changes of dural sac and paraspinal muscle of UBE compared with the conventional percutaneous transforaminal endoscopic discectomy (PTED) remains to be determined. The purpose of the study was to comprehensively compare the clinical efficacy between UBE and PTED in the surgical treatment of lumbar spinal degenerative disease.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;The clinical and radiological data of patients who underwent single-segment endoscopic surgery for lumbar spinal degenerative disease in our hospital from January 2021 to June 2022 were collected in the retrospective study. The visual analogue score (VAS) for back and leg pain, Oswestry disability index (ODI) before and 3, 6, and 12 months postoperative, changes of the cross-sectional area of the dural sac area and paraspinal muscles on axial T2-weighted MRI, operation time, intraoperative complications, MacNab criteria for evaluating efficacy at 12 months postoperatively, and recurrence rate of symptoms within 12 months were compared between patients undergoing PTED and UBE surgeries.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 142 patients were included. Among them 74 patients underwent PTED surgery, and 68 patients underwent UBE surgery. No statistically significant differences were identified between the groups in demographic variables. The average VAS and ODI scores in both groups showed significant improvement during the follow-up but without statistically significant difference between the groups. The average operation time in the PTED group was 74.82 ± 19.49 min shorter than the 81.36 ± 21.37 min in the UBE group, exhibiting no statistically significant difference. Although the incidence of complications and recurrence was lower in the UBE group (4.05% vs. 1.47%, p = 0.354; 4.05% vs. 1.47%, p = 0.354, respectively), these differences did not reach statistical significance. The dural sac area in the PTED group increased byan average of 43.16 ± 14.62 cm&lt;sup&gt;2&lt;/sup&gt;, and it was 68.53 ± 16.42 cm&lt;sup&gt;2&lt;/sup&gt; in the UBE group. Despite the dural sac area increased in both groups, the UBE group had a statistically significant greater improvement than the PTED group (p = 0.000). The area of the paraspinal muscle in the UBE group was significantly greater postoperatively (34.54 ± 2.75 cm&lt;sup&gt;2&lt;/sup&gt; vs. 36.22 ± 2.96 cm&lt;sup&gt;2&lt;/sup&gt;, p = 0.001) and significantly less than in the PTED group at 12 months postoperatively (31.17 ± 2.59 cm&lt;sup&gt;2&lt;/sup&gt; vs. 29.46 ± 3.11 cm&lt;sup&gt;2&lt;/sup&gt;, p = 0.001).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Both PTED and UBE surgeries can achieve satisfactory improvement in symptoms and function for patients with lumbar spinal degenerative disease and can be well-maintained as a first-line minimally invasive treatment. However, the UBE technique can achieve a better dec","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":"1105-1113"},"PeriodicalIF":1.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143033693","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":"Predictive Value of Preoperative Nutritional Risk Index for Screw Loosening After Lumbar Interbody Fusion in Elderly Patients With Lumbar Spine Diseases.","authors":"Youwei Ai, Qian Chen, Li Li, Juehan Wang, Ce Zhu, Hong Ding, Yongdi Wang, Zhuojie Xiao, Yuting Zhan, Yueming Song, Ganjun Feng, Limin Liu","doi":"10.1111/os.14369","DOIUrl":"10.1111/os.14369","url":null,"abstract":"<p><strong>Objective: </strong>Pedicle screw loosening is one of the common complications in elderly patients undergoing transforaminal lumbar interbody fusion (TLIF) for lumbar spine disease. Malnutrition, prevalent among elderly patients, has been shown to be associated with increased complications. The Geriatric Nutritional Risk Index (GNRI) serves as a simple indicator of nutritional status. However, the relationship between malnutrition, particularly GNRI, and pedicle screw loosening has not been adequately investigated. This study aims to investigate the relationship between GNRI and pedicle screw loosening following TLIF to guide the perioperative nutritional management of patients and prevent postoperative complications.</p><p><strong>Methods: </strong>A retrospective review was conducted on clinical data from patients who underwent single-level TLIF between 2014 and 2022. Data collection encompassed patient demographics, preoperative laboratory parameters, surgery-related data, perioperative radiographic data, and patient-reported outcomes were comprehensively documented. All patients were followed up for a minimum of 12 months. The relationship between GNRI and pedicle screw loosening was evaluated by univariate and multivariate Cox regression analysis, restricted cubic spline (RCS) analysis, receiver operating characteristic (ROC) analysis, and Kaplan-Meier survival analysis.</p><p><strong>Results: </strong>A total of 426 patients were included in the study. The rate of pedicle screw loosening rate was 16.4% at a minimum follow-up of 12 months. Patients with pedicle screw loosening exhibited significantly lower GNRI (89.0 ± 8.0 vs. 99.2 ± 9.3, p < 0.001) and volumetric bone mineral density measured by quantitative computed tomography (QCT-vBMD) (84.2 [interquartile range (IQR) 79.6-92.2] vs. 104.0 [IQR 88.2-126.0] mg/cm³, p < 0.001) compared with those in the non-loosening group. Multivariate Cox regression analysis identified sex (hazard ratio [HR] 1.433, 95% confidence interval [CI] 0.714-2.876, p = 0.027), age (HR 1.062, 95% CI 1.014-1.113, p = 0.012), GNRI (HR 0.841, 95% CI 0.711-0.994, p = 0.043), and QCT-vBMD (HR 0.982, 95% CI 0.967-0.997, p = 0.019) as independent risk factors for screw loosening. RCS analysis showed that GNRI was negatively correlated with screw loosening (p < 0.0001). The area under the curve (AUC) for the GNRI in predicting pedicle screw loosening was 0.794, with a cut-off value of 95.590 (sensitivity, 85.7%; specificity 65.2%). Kaplan-Meier survival analysis identified that the lower-level GNRI group exhibited a higher cumulative incidence of screw loosening (log-rank test, p < 0.0001).</p><p><strong>Conclusion: </strong>The GNRI was an independent risk factor for postoperative screw loosening in elderly patients undergoing TLIF for lumbar spine disease. Preoperative GNRI may potentially serve as a valuable tool in predicting postoperative screw loosening in elderly patients undergoing TLIF.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":"1152-1161"},"PeriodicalIF":1.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143066797","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":"How Accurately Does Bone Mineral Density Predict Bone Strength? A Clinical Observational Study of Osteoporosis Vertebral Compression Fractures in Postmenopausal Women.","authors":"Xuemeng Mu, Hengyan Zhang, Jia Zhang","doi":"10.1111/os.14354","DOIUrl":"10.1111/os.14354","url":null,"abstract":"<p><strong>Objectives: </strong>Dual energy x-ray absorptiometry (DXA) provides incomplete information about bone strength. There are few data on the relationship between osteoporosis-related examinations and bone strength. The objective of the present study was to determine which osteoporosis-related examinations best predicted trabecular bone strength, and to enhance a formula for predicting bone strength on the basis of bone density examination.</p><p><strong>Methods: </strong>This observational study included postmenopausal women (aged over 50 years) who underwent unilateral percutaneous kyphoplasty (PKP) surgery in the lumbar spine between September 2021 and June 2023. The pressure within each balloon expansion circle was extracted to reflect the true bone strength. The NHANES 2013-2014 data were used to assess the performance of the formula. The performance of the formula was compared with that of the observed actual fractures. Bland-Altman analysis was used to compare the agreement between the formula and the fracture risk assessment tool (FRAX) score.</p><p><strong>Results: </strong>A total of 40 postmenopausal women (mean age ± standard deviation, 70.90 years ± 10.30) were enrolled. The average balloon pressure was 59.23 psi (± 12.40, means ± SDs). The mean BMD of total lumbar spine (average of L1-L4) was 0.89 g/cm² ± 0.20 (mean ± standard), and the Pearson correlation coefficient between lumbar BMD and bone strength was 0.516. After adjusting for age and BMI, the DXA response rate to bone strength reached 72%. Calibration plots of the observed actual fractures versus those estimated via the bone strength formula were considered good fits. The Bland-Altman analysis revealed a nonsignificant difference between the formula and the FRAX score in predicting fracture risk.</p><p><strong>Conclusions: </strong>After adjustment, the DXA response rate to bone strength reached 72%, indicating a strong correlation. In addition, Bone Strength = DXA × 27 - Age × 0.585-BMI × 0.887 + 98.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":"1067-1074"},"PeriodicalIF":1.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142952717","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":"Targeting the Infrapatellar Branch of the Saphenous Nerve for Pain Relief in Patients With Acute or Chronic Knee Pain: A Systematic Review of Randomized Controlled Trials and Cohort Studies.","authors":"Qiangqiang Li, Aikeremu Aierken, Jianghui Qin, Dongyang Chen, Qing Jiang","doi":"10.1111/os.14349","DOIUrl":"10.1111/os.14349","url":null,"abstract":"<p><p>Blocking the infrapatellar branch of the saphenous nerve (IPBSN) can provide analgesic benefits for patients with postoperative acute pain or chronic pain, with minimal adverse effects. To evaluate the analgesic efficacy and potential adverse events associated with IPBSN block in patients suffering from acute or chronic knee pain. We conducted a systematic review across PubMed, Cochrane, Web of Science, and Embase to identify all relevant randomized controlled trials (RCTs) and cohort studies according to predefined selection criteria. The study quality of the RCTs was evaluated using the Cochrane risk of bias assessment tool, while cohort studies were assessed using the ROBINS-I risk of bias tool. The primary outcomes measured were pain intensity and opioid consumption following the nerve block. A total of eight studies were included in this systematic review, encompassing 613 subjects with 276 participants in the control group and 337 participants in the IPBSN block group. The level of evidence was rated high for the RCTs and moderate for the cohort studies. The nerve block was administrated either through the injection of local anesthetic or percutaneous cryoneurolysis targeting the IPBSN. The results indicated that the IPBSN block significantly improved pain relief and reduced opioid consumption in patients with acute postoperative or chronic pain, with no significant difference in the rate of adverse events relating to the procedures or device. The IPBSN block holds promise for improving pain relief and reducing opioid consumption. However, further well-designed randomized controlled trials are needed to confirm these results.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":"981-989"},"PeriodicalIF":1.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143399598","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":"What Is the Optimal Position of Low Tibial Tunnel in Transtibial Posterior Cruciate Ligament Reconstruction? A Quantitative Analysis Based on 2D CT Images and 3D Knee Models.","authors":"Laiwei Guo, Xiaoyun Sheng, Caijuan Dai, Xingwen Wang, Lianggong Zhao, Xiaohui Zhang, Bin Geng, Zhongcheng Liu, Rui Bai, Xiaoli Zheng, Meng Wu, Yuanjun Teng, Yayi Xia","doi":"10.1111/os.14379","DOIUrl":"10.1111/os.14379","url":null,"abstract":"<p><strong>Objectives: </strong>There is currently no consensus on the optimal placement of the low tibial tunnel for posterior cruciate ligament (PCL) reconstruction. This study aimed to perform the quantitative measurements of the optimal tangential low tibial-tunnel (OTLT) parameters based on 2D CT images and 3D virtual knee models and expect to provide reference data for clinical creation of the OTLT during the arthroscopic transtibial PCL reconstruction.</p><p><strong>Methods: </strong>This was a retrospective CT image study. A total of 101 patients between January 2018 and December 2020 were included in our study for analysis. The CT image data of included patients were imported into Mimics software to create the 3D knee models, and the OTLT for PCL reconstruction was simulated on 2D CT images and 3D knee models, respectively. With that, the distances of the tunnel's entry (ADT) and exit points (BDT) to the tibial plateau, the length of the tunnel (LT), and the angle of the tunnel (AT) were measured. Variables were compared using the independent t-test or the Mann-Whitney u test. Correlation analyses between the data and patient demographic factors were performed using the Pearson or Spearman correlation analysis. One-way ANOVA was used to compare differences among height subgroups.</p><p><strong>Results: </strong>The mean ADT, LT, and AT on 2D CT images were 57.96 ± 5.34 mm, 39.92 ± 5.49 mm, and 37.23° ± 4.57° respectively, smaller than the values on 3D knee models (61.86 ± 6.80 mm, 45.56 ± 4.27 mm, and 48.17° ± 6.12°, all p values < 0.001). While the mean BDT on 2D CT images was significantly larger than 3D knee models (35.28 ± 3.07 mm vs. 29.72 ± 3.00 mm, p < 0.001). The BDT showed larger in males than females, the LT showed larger in the taller group, and the AT seemed to be larger in females and shorter people (all p values < 0.05).</p><p><strong>Conclusion: </strong>The quantitative parameters of the OTLT based on 2D CT images and 3D knee models can be used as reference data for clinical surgeons to build an anteromedial OTLT during the arthroscopic transtibial PCL reconstruction.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":"1209-1219"},"PeriodicalIF":1.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143516318","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":"Pear-Shaped Disc as a Risk Factor for Postoperative Sclerotic Modic Changes After Transforaminal Lumbar Interbody Fusion.","authors":"Yang Xiao, Wenbin Shuai, Zhuang Zhang, Limin Liu, Yueming Song, Xi Yang","doi":"10.1111/os.14350","DOIUrl":"10.1111/os.14350","url":null,"abstract":"<p><strong>Objective: </strong>Pear-shaped disc could increase the risk of intraoperative end-plate injury, which may lead to postoperative sclerotic Modic Changes (MCs). However, there are no studies on the relationship between pear-shaped disc and postoperative sclerotic MCs. Therefore, this study investigates the risk factors for postoperative sclerotic MCs following transforaminal lumbar interbody fusion (TLIF). Specifically, the study focuses on the impact of pear-shaped disc on the occurrence of postoperative sclerotic MCs and evaluates its influence on clinical outcomes.</p><p><strong>Methods: </strong>A total of 411 patients undergoing TLIF between January 2018 and January 2022 were included. Among them, 50 developed postoperative sclerotic MCs, while 361 did not. The two groups were matched based on various parameters. Clinical and radiographic evaluations, including visual analogue scale (VAS), Oswestry disability index (ODI), lumbar X-ray, CT, and MRI, were performed. Statistical analysis included independent sample t test, Pearson's chi-square test, and binary logistic regression analysis.</p><p><strong>Results: </strong>After pairing, a total of 100 patients were included, including 50 patients in postoperative sclerotic MCs group and 50 patients in non-MCs group. There were 27 pear-shaped discs in the postoperative sclerotic MCs group, significantly higher than 7 in the non-MCs group (p < 0.001). Besides, BMI, endplate injury, and cage subsidence in the postoperative sclerotic MCs group were significantly higher than those in the non-MCs group, but the fusion rate was significantly lower than that in the non-MCs group. The postoperative and follow-up SL and surgical corrections of SL in postoperative sclerotic MCs group were significantly higher than those in non-MCs group. The independent risk factors identified for postoperative sclerotic MCs include pear-shaped disc and higher BMI.</p><p><strong>Conclusion: </strong>Pear-shaped disc and higher body mass index (BMI) as independent risk factors for postoperative sclerotic MCs. Patients with sclerotic MCs exhibited a lower fusion rate, increased cage subsidence, and poorer symptom improvement compared to those without MCs.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":"1036-1044"},"PeriodicalIF":1.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142952742","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}