Orthopaedic Surgery最新文献

{"title":"How Does the Stress in the Fixation Device Change during Different Stages of Bone Healing in the Treatment of Fractures? A Finite Element Study of External Fixation for Tibial Fractures.","authors":"Xuehai Jia, Changyong Shen, Bin Luo, Yi Yang, Kerui Zhang, Yi Deng, Jun Wen, Litai Ma","doi":"10.1111/os.14195","DOIUrl":"10.1111/os.14195","url":null,"abstract":"<p><strong>Background: </strong>Although the specific relationship between the stress changes in the external fixator during tibial fracture treatment and the bone healing process remains unclear, it is believed that stress variations in the external fixator scaffold can, to a certain extent, reflect the progress of tibial healing.</p><p><strong>Objective: </strong>This study aims to propose a non-invasive method for assessing the degree of fracture healing by monitoring the changes in stress transmission, the locations of stress-sensitive points, and displacement in the external fixator-tibia system during the healing process of tibial fractures.</p><p><strong>Methods: </strong>In this study, finite element models of tibial fractures at various healing stages were developed. Physiological conditions, including axial, torsional, and bending loads on the tibia, were simulated to evaluate stress and strain within the external scaffold-tibia system under normal physiological loading conditions.</p><p><strong>Results: </strong>The results indicate variations in the stress distribution between the external fixator and the tibia during different stages of healing. In the early phase of fracture healing, the external fixator plays a crucial role as the primary load-bearing unit under all three loading conditions. As the fracture healing progresses, the stress on the tibia gradually increases, concentrating on the medial part of the tibia under axial and torsional loading, and at the upper and lower ends, as well as the central part of the anterior and posterior tibia during bending loading. The stress at the callus gradually increases, while micro-movements decrease. The stress within the external bracket gradually decreases, with a tendency for the connecting rod to transfer stress towards the screws. Throughout the fracture healing process, the location of maximum stress in the external fixator remains unchanged. Under axial and torsional loading, the maximum stress is located at the intersection of the lowest screw and the bone cortex, while under bending loading, it is at the intersection of the second screw and the connecting rod.</p><p><strong>Conclusion: </strong>During the bone healing process, stress is transferred between the external fixation frame and the bone. As bone healing advances, the stress on the connecting rods and screws of the external fixation frame decreases, and the amplitude of stress changes diminishes. When complete and robust fusion is achieved, stress variations stabilize, and the location of maximum stress on the external fixation frame remains unchanged. The intersections of the lowest screw and the bone cortex, as well as the second screw and the connecting rod, can serve as sensitive points for monitoring the degree of bone healing.</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/PMC11541121/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142120301","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":"Multi-omics Analysis to Identify Key Immune Genes for Osteoporosis based on Machine Learning and Single-cell Analysis.","authors":"Baoxin Zhang, Zhiwei Pei, Aixian Tian, Wanxiong He, Chao Sun, Ting Hao, Jirigala Ariben, Siqin Li, Lina Wu, Xiaolong Yang, Zhenqun Zhao, Lina Wu, Chenyang Meng, Fei Xue, Xing Wang, Xinlong Ma, Feng Zheng","doi":"10.1111/os.14172","DOIUrl":"10.1111/os.14172","url":null,"abstract":"<p><strong>Objective: </strong>Osteoporosis is a severe bone disease with a complex pathogenesis involving various immune processes. With the in-depth understanding of bone immune mechanisms, discovering new therapeutic targets is crucial for the prevention and treatment of osteoporosis. This study aims to explore novel bone immune markers related to osteoporosis based on single-cell and transcriptome data, utilizing bioinformatics and machine learning methods, in order to provide novel strategies for the diagnosis and treatment of the disease.</p><p><strong>Methods: </strong>Single cell and transcriptome data sets were acquired from Gene Expression Omnibus (GEO). The data was then subjected to cell communication analysis, pseudotime analysis, and high dimensional WGCNA (hdWGCNA) analysis to identify key immune cell subpopulations and module genes. Subsequently, ConsensusClusterPlus analysis was performed on the key module genes to identify different diseased subgroups in the osteoporosis (OP) training set samples. The immune characteristics between subgroups were evaluated using Cibersort, EPIC, and MCP counter algorithms. OP's hub genes were screened using 10 machine learning algorithms and 113 algorithm combinations. The relationship between hub genes and immunity and pathways was established by evaluating the immune and pathway scores of the training set samples through the ESTIMATE, MCP-counter, and ssGSEA algorithms. Real-time fluorescence quantitative PCR (RT-qPCR) testing was conducted on serum samples collected from osteoporosis patients and healthy adults.</p><p><strong>Results: </strong>In OP samples, the proportions of bone marrow-derived mesenchymal stem cells (BM-MSCs) and neutrophils increased significantly by 6.73% (from 24.01% to 30.74%) and 6.36% (from 26.82% to 33.18%), respectively. We found 16 intersection genes and four hub genes (DND1, HIRA, SH3GLB2, and F7). RT-qPCR results showed reduced expression levels of DND1, HIRA, and SH3GLB2 in clinical blood samples of OP patients. Moreover, the four hub genes showed positive correlations with neutrophils (0.65-0.90), immature B cells (0.76-0.92), and endothelial cells (0.79-0.87), while showing negative correlations with myeloid-derived suppressor cells (negative 0.54-0.73), T follicular helper cells (negative 0.71-0.86), and natural killer T cells (negative 0.75-0.85).</p><p><strong>Conclusion: </strong>Neutrophils play a crucial role in the occurrence and development of osteoporosis. The four hub genes potentially inhibit metabolic activities and trigger inflammation by interacting with other immune cells, thereby significantly contributing to the onset and diagnosis of OP.</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/PMC11541141/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142140702","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":"Tourniquet Effect on Patients Undergoing Total Knee Arthroplasty: A Single-Blind, Randomized Controlled Trial.","authors":"Ziyang Dong, Yang Li, Heng Xue, Liyuan Tao, Hua Tian","doi":"10.1111/os.14184","DOIUrl":"10.1111/os.14184","url":null,"abstract":"<p><strong>Background: </strong>Tourniquet is applied in Total Knee Arthroplasty (TKA) to reduce intraoperative blood loss and improve view of surgical field. However, tourniquet use in TKA is still in dispute. Some researchers find that tourniquet may lead to extra side effects such as aggravated pain and limb swelling, while others consider that tourniquet has no significant adverse impact on clinical outcomes of TKA patients. This trial is conducted to evaluate tourniquet effect on TKA patients.</p><p><strong>Methods: </strong>A prospective, single-blind, randomized controlled trail is adopted with a sample size of 130 knees from August 2020 to February 2023. Patients undergoing TKA are randomly allocated to tourniquet group and non-tourniquet group. Outcomes including quadriceps thickness and stiffness, operation time, total blood loss, intraoperative blood loss, postoperative blood loss, transfusion rate, thigh circumference, knee and thigh VAS, D-Dimer and CRP level, knee function score, patient satisfaction, and complications are evaluated in this trial. Student's t-test, Mann-Whitney U test, Pearson's chi-square test, and Fisher's exact test are used in this study.</p><p><strong>Results: </strong>No significant difference in demographic information and baseline outcomes were found (p > 0.05). Participants in the tourniquet group had significantly less total blood loss and intraoperative blood loss, more postoperative blood loss, and higher D-Dimer level on postoperative day 3 when compared with non-tourniquet group (p < 0.05). Other outcomes including quadriceps thickness and stiffness, operation time, postoperative blood loss, transfusion rate, thigh circumference, knee and thigh VAS, D-Dimer level on postoperative day 1, CRP level, knee function score, patient satisfaction, and complications showed no significant difference (p > 0.05).</p><p><strong>Conclusion: </strong>Tourniquet application can effectively reduce intraoperative blood loss and total blood loss, without significant side effects. Hence, we advocate the regular use of tourniquet in primary TKA.</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/PMC11541142/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141907308","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":"Randomized Controlled Trial of a Novel Cementless vs. Cemented Total Knee Arthroplasty: Early Clinical and Radiographic Outcomes.","authors":"Enze Zhao, Xiaoyan Zhu, Haiwei Tang, Zhenyu Luo, Weinan Zeng, Zongke Zhou","doi":"10.1111/os.14178","DOIUrl":"10.1111/os.14178","url":null,"abstract":"<p><strong>Objective: </strong>Previous cementless total knee arthroplasty (TKA) designs faced challenges with insufficient initial fixation on tibial side, resulting in inferior functional outcomes and survival rates. The Zoned Trabecular Bone Cementless Knee is a novel implant designed for cementless TKA which aims to achieve excellent initial fixation, promoting effective osseointegration. The aim of this research was to compare the early clinical and radiographic results of this cementless TKA with cemented TKA.</p><p><strong>Methods: </strong>Between September 2021 and April 2022, 64 patients (64 knees) were recruited in this prospective randomized controlled trial to receive either cementless 3D-printed trabecular metal TKA or a cemented posterior stabilized TKA. Preoperative and postoperative clinical evaluations, including the range of motion (ROM), Knee Society Score (KSS), and the Reduced Western Ontario and MacMaster Universities Score (WOMAC), were conducted and analyzed for comparison. Radiographs and computed tomography scans were utilized to assess the initial fixation. The complications between the two groups were also recorded and compared. Continuous data were analyzed for significance using independent-samples t-test or the Mann-Whitney U test and categorical data were analyzed using chi-squared or Fisher's exact test.</p><p><strong>Results: </strong>Both groups demonstrated significant enhancement at 12 months follow-up in the ROM compared with baseline (ROM: 94.7 ± 23.4 vs. 113.1 ± 12.3 in cementless group and 96.5 ± 14.7 vs. 111.0 ± 12.8 in cemented group, p < 0.05). However, no statistical differences were observed between the two groups in postoperative ROM, KSS, or WOMAC score. The radiographs and computed tomography scans showed similar results, including radiolucent lines and osteolysis in either femoral or tibial. Additionally, there was no statistical difference in the overall complication rate between the two groups. Notably, one patient in the cementless TKA group required revision for periprosthetic infection as the end point.</p><p><strong>Conclusions: </strong>This novel 3D-printed trabecular metal cementless TKA achieved comparable clinical outcomes and initial fixation to cemented TKA in early stage. Longer-term examination is necessary to validate these results.</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/PMC11541117/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142018217","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":"Prevalence Characteristics of Osteoporosis Fractures in the Elderly in Two Regions of China and Analysis of the Lag Effect of Air Pollutants on them.","authors":"Zhipeng Ye, Qian Xiao, Shihang Liu, Shuai Zhou, Guangzhao Hou, Hongzhi Lv, Yingze Zhang","doi":"10.1111/os.14245","DOIUrl":"10.1111/os.14245","url":null,"abstract":"<p><strong>Objective: </strong>Air pollution is increasing and threatening human health. The objective of this study is to investigate the population distribution characteristics of elderly osteoporosis fractures in Hebei Province and Xinjiang Uygur Autonomous Region and to analyze the effects of air pollutants on the number of elderly osteoporosis fracture inpatients in the two regions.</p><p><strong>Method: </strong>A retrospective collection of elderly osteoporosis fracture cases was conducted in selected hospitals in Hebei Province and Xinjiang Uygur Autonomous Region from January 1, 2018 to December 31, 2022. The chi-square test was used to compare the distributional characteristics of the population in the two regions. Additionally, we used a distributed lag nonlinear model (DLNM) in order to assess the effect of air pollutants on the number of daily hospital admissions of elderly osteoporosis fracture patients in different regions.</p><p><strong>Result: </strong>A total of 19,203 elderly osteoporosis fracture patients were included in the study. The average age of these patients was 76.66 ± 7.55 years, and the majority of them were female (13,514 instances, 70.37%). The disparities in age distribution (χ² = 133.9 p < 0.001), fracture site (χ² = 62.0 p < 0.001), and hospitalization cost (Z = -15.635 p < 0.001) between the two regions were statistically significant. The lag effect curves of PM2.5, PM10, and NO₂ on the number of elderly osteoporosis fracture hospitalizations in Xinjiang Uygur Autonomous Region exhibited a similar pattern resembling a \"W\"-shaped curve. All three pollutants reached their highest values after a lag time of 14 days (PM2.5: RR = 1.053, 95% CI: 1.031, 1.074; PM10: RR = 1.031, 95% CI: 1.018, 1.043; NO₂: RR = 1.125, 95% CI: 1.070, 1.182). In Hebei Province, the largest impacts of PM2.5 and PM10 were observed after a lag of 14 days (PM2.5: RR = 1.022, 95% CI: 1.013, 1.028; PM10: RR = 1.013, 95% CI: 1.008, 1.018). Similarly, the maximum effect of NO₂ was observed after a lag of 11 days (RR = 1.020, 95% CI: 1.010, 1.028).</p><p><strong>Conclusion: </strong>There were differences in the epidemiological characteristics of hospitalized patients with osteoporosis fractures between the two regions, PM2.5, PM10, and NO₂ increased the number of hospitalizations for osteoporosis fractures. Exposure to air pollutants such as PM2.5 increases the risk of osteoporosis fractures in the elderly population.</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/PMC11541132/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142292754","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":"Early Radiographic and Clinical Outcomes of Robotic-arm-assisted versus Conventional Total Knee Arthroplasty: A Multicenter Randomized Controlled Trial.","authors":"Xiao Geng, Yuhang Zheng, Yang Li, Minwei Zhao, Yanqing Liu, Zijian Li, Hong Cai, Ming Zhang, Xinfeng Yan, Zhiwen Sun, Xin Lv, Feng Guo, Feng Li, Hua Tian","doi":"10.1111/os.14196","DOIUrl":"10.1111/os.14196","url":null,"abstract":"<p><strong>Objective: </strong>A robotic system was recently introduced to improve prosthetic alignment during total knee arthroplasty (TKA). The purpose of this multicenter, prospective, randomized controlled trial (RCT) was to determine whether robotic-arm-assisted TKA improves clinical and radiological outcomes when compared to conventional TKA.</p><p><strong>Methods: </strong>One hundred and thirty patients who underwent primary TKA were enrolled in this prospective, randomized controlled trial, which was conducted at three hospitals. Five patients were lost to follow-up 6 weeks after surgery. Therefore, 125 participants (63 in the intervention group and 62 in the control group) remained in the final analysis. The primary outcome was the rate at which the mechanical axis of the femur deviated by less than 3° from the mechanical axis of the tibia. This was evaluated by full-length weight-bearing X-rays of the lower limb 6 weeks postoperatively. Secondary outcomes included operation times, 6-week postoperative functional outcomes evaluated by the American Knee Society score (KSS) and the Western Ontario and McMaster Universities osteoarthritis index (WOMAC), short form-36 (SF-36) health survey results, and the occurrence of adverse events (AEs) and serious adverse events (SAEs).</p><p><strong>Results: </strong>At 6 weeks postoperatively, we found that the rate of radiographic inliers was significantly higher in the intervention group (78.7% vs 51.6%; p = 0.00; 95% confidence interval, 10.9% to 43.2%). The operation was significantly longer in the intervention group than in the control group (119.5 vs 85.0 min; p = 0.00). There were no significant differences in the 6-week postoperative functional outcomes, SF-36, AEs, and SAEs between the two groups. There were no AEs or SAEs that were determined to be \"positively related\" to the robotic system.</p><p><strong>Conclusion: </strong>Robotic-arm-assisted TKA is safe and effective, as demonstrated in this trial.</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/PMC11541113/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141971590","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":"Extracorporeal Shock Wave Therapy Versus Local Corticosteroid Injection for Chronic Lateral Epicondylitis: A Systematic Review with Meta-Analysis of Randomized Controlled Trials.","authors":"Lei Zhang, Xinyi Zhang, Long Pang, Zhuo Wang, Junliang Jiang","doi":"10.1111/os.14212","DOIUrl":"10.1111/os.14212","url":null,"abstract":"<p><p>Chronic lateral epicondylitis (LE), normally known as tennis elbow, is often managed by conservative treatments. Extracorporeal shock wave therapy (ESWT) and local corticosteroid injection (LCI) are among the most commonly used conservative treatments. However, the comparison between these two interventions remains controversial. This study aimed to compare the effectiveness and safety of ESWT and LCI for chronic LE. A systematic review and meta-analysis was conducted following the Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA) guidelines. PubMed, EMBASE, Cochrane Library, and Web of Science were searched for eligible studies until April 20, 2024. Meta-analyses were conducted using Manager V.5.4.1. Pooled effect sizes were expressed as the weighted mean difference (WMD) or odds ratio (OR), with 95% confidence intervals (CIs). A total of six randomized controlled trials (RCTs) were included. Compared with LCI, ESWT had inferior change in visual analogue scale (Δ VAS) (WMD, 1.14; 95% CI, 0.80 to 1.48; I² = 20%; p < 0.001), Δ grip strength (WMD, -4.01; 95% CI, -5.57 to -2.44; I² = 36%; p < 0.001), change in patient-rated tennis elbow evaluation (Δ PRTEE) score (WMD, 8.64; 95% CI, 4.70 to 12.58; I² = 0%; p < 0.001) at 1-month follow-up, but superior Δ VAS (WMD, -1.15; 95% CI, -1.51 to -0.80; I² = 6%; p < 0.001), Δ grip strength (WMD, 2.04; 95% CI, 0.90 to 3.18; I² = 3%; p = 0.0005), Δ PRTEE score (WMD, -9.50; 95% CI, -14.05 to -4.95; I² = 58%; p < 0.001) at 3-month follow-up, and superior Δ VAS (WMD, -1.81; 95% CI, -2.52 to -1.10; I² = 33%; p < 0.001), Δ grip strength (WMD, 3.06; 95% CI, 0.90 to 5.21; I² = 0%; p = 0.005) at 6-month follow-up. The two groups had a similarly low rate of adverse events (OR, 0.69; 95% CI, 0.05 to 8.60; I² = 67%; p = 0.77), all of which were mild. Both ESWT and LCI are effective and safe in treating chronic LE. Compared with LCI, ESWT showed inferior short-term (1-month) but superior long-term (3-month and 6-month) outcomes regarding pain relief and function recovery, with a similar rate of mild adverse events.</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/PMC11541127/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142093656","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 Role of Microvascular Variations in the Process of Intervertebral Disk Degeneration and Its Regulatory Mechanisms: A Literature Review.","authors":"Si-Ping Zhang, Min Tong, Shi-Da Li, Bin Zhang, Wenhao Zhang, Rong Wang, Zhen-Yu Dong, Yi-Fei Huang","doi":"10.1111/os.14209","DOIUrl":"10.1111/os.14209","url":null,"abstract":"<p><p>Microvascular changes are considered key factors in the process of intervertebral disk degeneration (IDD). Microvascular invasion and growth into the nucleus pulposus (NP) and cartilaginous endplates are unfavorable factors that trigger IDD. In contrast, the rich distribution of microvessels in the bony endplates and outer layers of the annulus fibrosus is an important safeguard for the nutrient supply and metabolism of the intervertebral disk (IVD). In particular, the adequate supply of microvessels in the bony endplates is the main source of the nutritional supply for the entire IVD. Microvessels can affect the progression of IDD through a variety of pathways. Many studies have explored the effects of microvessel alterations in the NP, annulus fibrosus, cartilaginous endplates, and bony endplates on the local microenvironment through inflammation, apoptosis, and senescence. Studies also elucidated the important roles of microvessel alterations in the process of IDD, as well as conducted in-depth explorations of cytokines and biologics that can inhibit or promote the ingrowth of microvessels. Therefore, the present manuscript reviews the published literature on the effects of microvascular changes on IVD to summarize the roles of microvessels in IVD and elaborate on the mechanisms of action that promote or inhibit de novo microvessel formation in IVD.</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/PMC11541140/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142110482","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":"Preliminary Application of Bilateral Submandibular Horizontal Incision in the Treatment of Upper Cervical Tumors.","authors":"Jingtao Ji, Guang Dong Chen, Jun Miao","doi":"10.1111/os.14247","DOIUrl":"10.1111/os.14247","url":null,"abstract":"<p><p>The upper cervical spine has a complex anatomical structure, making anterior surgical approaches challenging and prone to complications. This study aims to explore the use of bilateral submandibular incisions to provide safer and more convenient exposure of the upper cervical spine and to assess the feasibility of this approach for anterior surgical treatment of complex upper cervical diseases. From November 2019 to August 2021, three patients with malignant tumors of the upper cervical spine were subjected to an anterior-posterior combined approach for cervical tumor resection. The cohort consisted of one male and two females, aged between 41 and 51 years. The anterior approach began with a submandibular incision, followed by blunt dissection through the prevertebral muscles to expose the diseased vertebra. Subsequently, the diseased vertebra was excised, and either a titanium cage or a pre-customized 3D-printed artificial vertebral body was implanted anteriorly. Then, posterior fixation of the cervical spine was performed using pedicle screws to provide additional stability. Follow-up ranged from 8 to 34 months. All patients experienced varying degrees of pain relief within 24 hours post-operation. Frankel grading showed improvement by at least one grade in all three cases. Regular X-ray and magnetic resonance imaging examinations revealed no tumor recurrence or involvement of adjacent vertebrae in the surgical area. The anterior bilateral submandibular horizontal incision approach offers comprehensive exposure of the anatomical structures of the upper cervical spine. This approach introduces a new option for the anterior treatment of upper cervical spine diseases.</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/PMC11541126/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142471633","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 Role of Sole Lift in Treating Pediatric Idiopathic Scoliosis with Mild Thoracolumbar/Lumbar Curve.","authors":"Wang Zhi-Wei, Liang Cheng-Zhen, Chen Jun-Nan, Li Fang-Cai, Chen Qi-Xin, Chen Wei-Shan, Chen Gang, Zhang Ning, Li Jun, Li Hao","doi":"10.1111/os.14168","DOIUrl":"10.1111/os.14168","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;Lower limb discrepancy (LLD) was frequently observed in patients with idiopathic scoliosis (IS), potentially associated with etiopathogenesis. Although sole lifts had been proposed as a conservative treatment for IS, evidence supporting their efficacy was limited. This study aimed to assess the effects of sole lift intervention on pediatric patients with mild IS, specifically focusing on thoracolumbar/lumbar (TL/L) curvature.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Twenty patients, with an average age of 12.3 ± 3.1 years and presenting mild TL/L curve (15.6° ± 6.2°), were selected from a pool of 267 pediatric IS patients in the outpatient of our spine center from February 2023 to August 2023. Inclusion criteria comprised a main TL/L curve ranging between 10° and 40°, the lower limb positioned at the convexity of the main curve, and LLD of less than 2 cm; individuals requiring bracing or surgical intervention were excluded. Custom sole lifts were used to address the shorter lower limb with the objective of leveling the pelvis. Radiographic evaluations were conducted both before and after intervention using standing full spine posteroanterior radiographs and full leg length radiographs. Statistical analysis was undertaken to evaluate curve correction and its associations with other influencing factors.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The mean structural and functional LLD were 7.1 ± 4.5 mm and 7.1 ± 4.1 mm, respectively. Among the 20 patients, four exhibited structural LLD greater than 10 mm. The average follow-up duration was 6.4 ± 1.9 months (range: 3-8 months). Following sole lift intervention (7.0 ± 3.0 mm), a significant reduction was observed in the TL/L curve compared to the pre-sole lifting measurements (15.6° ± 6.2° vs. 12.1° ± 7.2°, p &lt; 0.001), as well as a notable decrease in the thoracic curve (12.2° ± 4.0° vs. 8.6° ± 6.3°, p = 0.064). Nine patients experienced a significant curve reduction of ≥5°, while eight showed a reduction between 0° and 5°; however, two patients exhibited no change in curve magnitude. Furthermore, the correction rate of the TL/L curve correlated significantly with functional LLD (r = -0.484, p = 0.030) and pelvic obliquity (r = -0.556, p = 0.011), highlighting the active pelvic compensation in maintaining balance between the spine and lower limbs. Conversely, no significant correlation was observed between curve correction and structural LLD (p &gt; 0.05). Additionally, even after adjusting for other influencing factors, the TL/L Cobb angle remained significantly different between pre- and post-sole lifting (p = 0.037).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;This study confirmed the effectiveness of sole lift intervention in correcting TL/L and thoracic curves among the mild IS children with a main TL/L curve, providing a supplementary conservative treatment option for patients with the lower limb at the convexity of the main curve. Moreover, our findings underscored the active compensation of the","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/PMC11541114/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142073450","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}