Orthopaedic Surgery最新文献

{"title":"High Detection Rate of Posterolateral Tibial Plateau Fractures and Poor Functional Outcomes in Type IIIB Impaction Fractures After Anterior Cruciate Ligament Rupture and Reconstruction.","authors":"Shijie Jiang, Weizhi Ren, Ruixia Zhu, Dimitris Dimitriou, Rongshan Cheng, Xiaojun Jia, Dong Zheng, Yuji Wang, Wei Xu","doi":"10.1111/os.14358","DOIUrl":"10.1111/os.14358","url":null,"abstract":"<p><strong>Objective: </strong>The incidence of anterior cruciate ligament (ACL) ruptures has been increasing annually. However, clinical surgeons have overlooked the impaction fractures of the posterolateral tibial plateau and lateral femoral condyle in patients with ACL ruptures. The purpose of the present study was to report the detection rate of the posterolateral tibial plateau impaction fractures in patients with ACL ruptures, and to evaluate the functional outcomes of patients following ACL reconstruction (ACLR) without treatment of the tibial fractures at a 2-year postoperative follow-up.</p><p><strong>Methods: </strong>Four hundred eighty-eight patients treated for ACL ruptures between January 2016 and June 2020 were retrospectively reviewed, and the posterolateral tibial plateau impaction fractures were classified based on MRI assessment. The detection rate of the posterolateral tibial plateau impaction fractures was calculated, and the functional outcomes (SF-12 Mental Component Summaries, SF-12 Physical Component Summaries, Tegner, Lysholm, IKDC, and KOOS) were evaluated at a 2-year postoperative follow-up.</p><p><strong>Results: </strong>The detection rate of posterolateral tibial plateau impaction fractures was 41.6% among ACL ruptures. Of these, 285 cases (58.4%) had no fractures, 98 cases (20.1%) had type I impaction fractures, 41 cases (8.4%) had type IIA impaction fractures, 15 cases (3.1%) had type IIB impaction fractures, 22 cases (4.5%) had type IIIA impaction fractures, and 27 cases (5.5%) had type IIIB impaction fractures. Patients with type IIIA or IIIB impaction fractures showed an increased detection rate of contact mechanism compared to the other subgroups. Significant differences in Tegner (postoperation) and KOOS (QOL) were found between no fracture and type IIIB impaction fractures in patients following ACLR.</p><p><strong>Conclusions: </strong>The detection rate of posterolateral tibial plateau impaction fractures in patients with ACL ruptures was high. Patients with type IIIB impaction fractures following ACLR had poor functional outcomes.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":"1086-1094"},"PeriodicalIF":1.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143009241","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":"Surgical Outcomes of Olecranon Osteotomy Approach Combined With Submerged Kirschner Wires and Plate Fixation for Duckerley IIIB Distal Humeral Coronal Shear Fractures.","authors":"Zhou-Feng Song, Wei-Qiang Zhao, Zeng-Li Zhang, Jie-Feng Huang","doi":"10.1111/os.70005","DOIUrl":"10.1111/os.70005","url":null,"abstract":"<p><strong>Objective: </strong>Duckerley type IIIB distal humerus fractures are rare and complex injuries that pose significant challenges in both diagnosis and treatment. Currently, no consensus exists on the fixation method, with existing approaches often struggling to handle small fragments and associated with issues like elbow instability. The purpose of this study is to evaluate the surgical outcomes of submerged Kirschner wires combined with plate or submerged screw fixation technique for the treatment of Duckerley type IIIB distal humerus fractures.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on 10 patients with Duckerley type IIIB distal humerus fractures who were treated at our hospital from February 2017 to April 2021. The treatment involved applying buried Kirschner wires combined with microplate or buried screw fixation technique through the olecranon osteotomy approach. The study included six males and four females, with a mean age of 51.4 ± 15.34 years (ranging from 22 to 69 years). During the follow-up, the elbow range of motion, Mayo Elbow Performance Score (MEPS), American Shoulder and Elbow Surgeons (ASES) score, and complications were assessed.</p><p><strong>Results: </strong>All 10 patients received regular clinical and imaging follow-up for a mean of 39.7 ± 8.8 months (range: 25-50 months). Postoperative incision healing was good for all patients, and no neurovascular injuries were noted. Two patients developed elbow pain. At the last follow-up before the internal fixation removal operation (9.6 ± 1.9 months), X-ray and CT findings confirmed bony healing, and no internal fixation loosening and breakage occurred in any of the patients, except for one case in which there was displacement of the Kirschner wires. The mean range of motion of the elbow before the internal fixation removal operation was extension 15.0° ± 21.6°, flexion 129.5° ± 28.1°, pronation 83.0° ± 9.2°, and supination 81.5° ± 8.0°. The MEPS score was 83.0 ± 8.3, and the ASES was 83.6 ± 7.8. At the last follow-up, the mean range of motion of the elbow was extension 10.0° ± 21.9°, flexion 133.5° ± 16.0°, pronation 88.0° ± 11.2°, and supination 85.0° ± 9.5°. The MEPS score was 84.6 ± 7.6, and the ASES was 84.1 ± 7.4.</p><p><strong>Conclusions: </strong>The treatment of Duckerley type IIIB low distal humerus fractures using submerged Kirschner wires combined with plate or submerged screw fixation technique has satisfactory advantages in terms of fracture reduction, maintenance of the position of internal fixation, and postoperative recovery.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":"1255-1264"},"PeriodicalIF":1.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143458739","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":"Effects of Fluid Gelatin for Lumbar Spinal Stenosis Undergoing Lumbar Endoscopic Bilateral Decompression: A Prospective, Randomized Controlled Trial.","authors":"Hao Yan, Mingdong Yu, Huaibin Wang, Rongsheng Dou, Xiaoyan Xia, Ruzhan Yao, Weiqiang Liu, Jesse Li-Ling","doi":"10.1111/os.14373","DOIUrl":"10.1111/os.14373","url":null,"abstract":"<p><strong>Objectives: </strong>In patients with lumbar spinal stenosis (LSS), prolonged compression of the epidural venous plexus heightens the risk of bleeding and hematoma during minimally invasive surgery. While absorbable fluid gelatin, an animal protein-based hemostatic agent, is available, its effectiveness in lumbar endoscopic unilateral laminotomy with bilateral decompression (LE-ULBD) remains debated. Our research aims to conduct a prospective randomized controlled trial to investigate the effectiveness and safety of this hemostatic material in patients undergoing LE-ULBD for LSS.</p><p><strong>Methods: </strong>From October 2023 to July 2024, a total of 90 patients with LSS who underwent LE-ULBD were enrolled in this study. The 90 patients were randomly divided into two groups: fluid gelatin group (45 cases, using fluid gelatin) and null-fluid gelatin group (45 cases, not using fluid gelatin). Primary outcomes included the success rate of achieving hemostasis within 3 min and symptomatic postoperative epidural hematoma (SPEH). Secondary outcomes encompassed surgical time, intraoperative blood loss, perioperative blood loss, length of stay, and complications. Independent sample t tests were used to compare continuous data. Chi-squared tests and Fisher's exact probability tests were used to analyze the categorical data.</p><p><strong>Results: </strong>The success rate of achieving hemostasis within 3 min (p < 0.05) was significantly higher in fluid gelatin group compared to that in the null-fluid gelatin group, and perioperative blood loss (p < 0.05) and surgical time (p < 0.05) were notably lower in the fluid gelatin group. However, there were no statistically significant differences between the two groups regarding intraoperative blood loss, length of stay, and complications, such as SPEH, allergy, and thrombus.</p><p><strong>Conclusion: </strong>In patients with LSS undergoing LE-ULBD surgery, using fluid gelatin can achieve rapid intraoperative hemostasis, shorten surgical time, and reduce perioperative blood loss without causing complications. Therefore, the conventional use of fluid gelatin in LE-ULBD surgery is an effective and safe strategy.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":"1162-1171"},"PeriodicalIF":1.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143482650","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":"Customized Metal 3D Printed Total Wrist Prosthesis in the Treatment of Severely Destroyed Wrist: Design Rationale and Clinical Applications.","authors":"Qipei Wei, Chang Liu, Shanlin Chen, Min Liu","doi":"10.1111/os.70030","DOIUrl":"https://doi.org/10.1111/os.70030","url":null,"abstract":"<p><strong>Objective: </strong>Severe destruction of the wrist joint after trauma, disease, or iatrogenic causes can lead to significant bone defects and deformities, limiting the options for surgeries. Bespoke 3D-printed metal prostheses were designed and used for four patients. This study aimed to describe the design rationale and report the clinical outcomes.</p><p><strong>Methods: </strong>Between 2022 and August 2024, we followed up on four patients with significant bone defects and deformities caused by various factors, who opted against arthrodesis. These patients were treated with customized 3D-printed prostheses replacements. All cases underwent assessment through clinical and radiological examinations, evaluating parameters including passive range of motion (ROM) of the wrist, grip strength, VAS of pain, and functional scales such as the Mayo score, Patient-Rated Wrist Evaluation (PRWE), and Quick Disabilities of the Arm, Shoulder, and Hand (quick DASH) score. A paired t-test was conducted to compare pre- and postoperative outcomes.</p><p><strong>Result: </strong>The mean follow-up period lasted 11.9 ± 6.7 months (range 6-18 months). All patients reported satisfying pain relief and enhanced function. The average ROM was 23.3° ± 5.7° of extension and 27.0° ± 18.6° of flexion. The average VAS score of pain was 1.5. The mean Mayo score, PRWE, and Quick DASH were 60.0, 31.5, and 28.3, respectively. No complications such as loosening, dislocation, or infection were observed during the follow-up period.</p><p><strong>Conclusions: </strong>Customized 3D-printed prosthetic replacements for severely destroyed wrists can provide good functional outcomes with a higher satisfaction rate.</p><p><strong>Level of evidence: </strong>IV.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143710943","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":"A Criterion of Reduction Quality of Femoral Neck Fractures Based on Spatial Residual Displacements of Femoral Head.","authors":"Shuang-Shuang Cui, Li-Kun Zhao, Jing-Bo Yu, Jian-Xiong Ma, Xin-Long Ma","doi":"10.1111/os.70027","DOIUrl":"https://doi.org/10.1111/os.70027","url":null,"abstract":"<p><strong>Objective: </strong>Currently, quality criteria for reduction after femoral neck fractures such as the Garden index are mainly based on two-dimensional x-rays. Research shows that current reduction quality criteria are no longer sufficient to meet the needs to reduce the incidence of osteonecrosis of the femoral head (ONFH). The purpose of this study is to construct a reduction quality criterion based on spatial residual displacements of 3D reconstruction and to predict the occurrence of ONFH.</p><p><strong>Methods: </strong>The subjects were from the Tianjin Hospital Hip Fracture cohort, all of whom experienced femoral neck fractures and underwent reduction and internal fixation at Tianjin Hospital and received 12 months of follow-up minimally postoperatively. CT scans were used for 3D reconstruction, and six spatial displacement indicators were measured. Risk factors of ONFH were identified using logistic regression, and a reduction quality criterion based on spatial residual displacements was constructed. Multivariate logistic regression models were performed to estimate the effect of reduction quality by the new criterion on ONFH.</p><p><strong>Results: </strong>Data from 391 patients were included in the final analysis. Preoperative displacement of the center of the femoral head (CFH), postoperative residual displacement of the CFH, and residual rotational displacement were proved to be independent risk factors for ONFH, with OR values of 3.83 (95% CI: 1.98, 7.48), 2.62 (95% CI: 1.05, 6.49), and 5.36 (95% CI: 2.46, 11.64), respectively. The new criterion was composed of two indicators and had three grades: when residual displacement of CFH is ≤ 4.075 mm, and residual rotational displacement of femoral head is ≤ 18.595°, the quality is excellent; when residual displacement of CFH is ≤ 4.075 mm and residual rotational displacement of femoral head is > 18.595° or when residual displacement of CFH is > 4.075 mm and residual rotational displacement of femoral head is ≤ 18.595°, the quality is moderate; when residual displacement of CFH is > 4.075 mm and residual rotational displacement is > 18.595°, the quality is poor. The risk of ONFH would increase 3.99 times (95% CI: 2.35, 6.78) for each lower grade in reduction quality. The logistic regression model was well discriminated with an AUC area of 0.802 and had good calibration with a p-value of > 0.05 by the Hosmer-Lemeshow test.</p><p><strong>Conclusion: </strong>A new reduction quality criterion for femoral neck fracture based on CT was constructed, and reduction quality before fixation by the new criterion was proved to be an independent predictive factor for ONFH. The logistic regression model had quite good discrimination and calibration for postoperative ONFH.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143730993","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":"Is There a Role of Photoacoustic Imaging in Sports Medicine: Evidence Today.","authors":"Chenggong Ma, Angat Naresh Chadha, Cheng Wu, Peter V Giannoudis, Jiong Jiong Guo","doi":"10.1111/os.70031","DOIUrl":"https://doi.org/10.1111/os.70031","url":null,"abstract":"<p><p>Diagnostic imaging in sports medicine includes traditional imaging modalities such as x-ray, computed tomography (CT), and magnetic resonance imaging (MRI). Despite having certain advantages, these imaging techniques often have lower sensitivity and specificity, making it difficult to detect soft tissue injuries and early-stage cartilage damage. They also lack the ability to assess the biomechanical properties and functional states of tissues. Photoacoustic imaging (PAI) offers a powerful, non-ionizing, and cost-effective alternative to traditional imaging techniques in the diagnosis and therapeutic monitoring of sports injuries. PAI combines the benefits of optical imaging and ultrasound to provide high-resolution images of deep tissues, including tendons and ligaments. This technology uses pulsed lasers to irradiate tissues, causing thermal expansion and generating ultrasound waves, which are then captured and converted into images. PAI is particularly adept at depicting blood vessels and soft tissues with high resolution and sensitivity to the optical absorption contrasts of oxy- and deoxyhemoglobin. It can assess tissue oxygenation and metabolic activities, which are crucial for evaluating the healing process in sports injuries. Herein, the role of PAI in sports medicine is assessed and particularly its advantages over traditional imaging methods such as x-rays, CT scans, and MRI scans in diagnosing musculoskeletal injuries.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143710944","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":"Treatment Trade-Offs and Choices for Femoral Fractures: A Systematic Review and Meta-Analysis.","authors":"Jiarui Li, Zhu Guo, Tianrui Wang, Kunyue Xing, Wenzhuo Wang, Yaowei Liu, Jiyao Xing, Hongfei Xiang, Jingdong Wang, Bohua Chen, Dongming Xing, Xiaolin Wu","doi":"10.1111/os.70001","DOIUrl":"https://doi.org/10.1111/os.70001","url":null,"abstract":"<p><p>In resource-limited settings, selecting the appropriate treatment for femoral fractures is crucial as it affects both patient recovery and the efficient use of medical resources. This review explores the treatment options for adult and elderly patients with surgical contraindications suffering from femoral fractures, with a particular emphasis on the trade-offs between surgical intervention and traction therapy. Through a systematic literature search of major databases such as PubMed, Web of Science, and the Cochrane Library, we identified 39 studies that met the inclusion criteria, focusing on complications, treatment effectiveness, functional recovery, and cost analysis. We found that although intramedullary nailing may offer better clinical outcomes, traction therapy often becomes the treatment of choice in resource-poor environments due to limited surgical resources. The professional judgment of physicians (OR 10.81; 95% CI 8.28-14.11), patient preferences (OR 1.33; 95% CI 0.80-2.21), and hospital surgical capacity (OR 1.87; 95% CI 0.56-6.28) are key factors influencing treatment choice. For elderly patients, the choice of treatment requires a balance between the risks of surgery and the potential complications of non-surgical treatment (OR 0.78; 95% CI 0.10-5.90). Ultimately, the decision-making process is complex and requires a comprehensive consideration of available resources, cost-effectiveness, patient health status, physician experience, patient preferences, and expected clinical outcomes. In resource-constrained areas, this process is particularly challenging and necessitates a careful consideration of the risks and benefits of both surgical and non-surgical treatment options.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143710945","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":"Three-Dimensional Mapping of Distal Clavicle Fractures: Displacement Patterns and Clinical Implications for Surgical Management.","authors":"Jinquan Liu, Jingyi Mi, Yesheng Jin, Fang Lin, Yongwei Wu, Yunhong Ma, Jun Liu, Zhonghua Xu, Li Tang, Aiping Zhu, Danfeng Jing, Yongjun Rui, Ming Zhou","doi":"10.1111/os.70033","DOIUrl":"https://doi.org/10.1111/os.70033","url":null,"abstract":"<p><strong>Objective: </strong>Current classifications inadequately address distal clavicle fracture instability due to their coronal plane focus, neglecting multiplanar displacement and underestimation of complexity on routine radiographs. This study aimed to bridge this gap by employing three-dimensional (3D) fracture mapping to characterize injury patterns, offering mechanistic insights to optimize surgical strategies.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on 81 patients diagnosed with acute distal clavicle fractures at Wuxi Ninth People's Hospital between 2019 and 2022. Axial and sagittal CT planes were utilized to demonstrate fracture line alignment. Manual simulated repositioning was performed for all fracture lines, which were subsequently graphically superimposed onto a standard template of the intact distal clavicle. A 3D map was generated and subsequently transformed into a heatmap. The classification of distal clavicle fractures was determined based on the updated and modified Neer classification. Two points were designated at the distal end of the fracture block and at the repositioned counterpart to assess the three-dimensional spatial position, including shortening along the x-axis, horizontal displacement along the y-axis, vertical displacement along the z-axis, as well as the displacement angles in the three planes, thereby quantifying the displacement of each distal clavicle fracture.</p><p><strong>Results: </strong>This study included 81 cases of distal clavicle fractures (43 cases on the left side and 38 cases on the right side). The distribution included 8 cases (9.88%) of Neer I, 5 cases (6.17%) of Neer IIA, 31 cases (38.27%) of Neer IIB, 11 cases (13.58%) of Neer IIC, 14 cases (17.28%) of Neer III, and 12 cases (14.81%) of Neer V. Fracture mapping revealed that the fracture lines were predominantly located in the distal one-third of the distal clavicle, with the highest concentration at the acromion end. The majority of displaced distal clavicle fractures exhibit multidirectional displacement, mainly posterior, superior, and shortening, along with angulation in the corresponding directions.</p><p><strong>Conclusions: </strong>Most displaced distal clavicle fractures involve multiple displacements and angulations, necessitating three-dimensional analysis during fracture reduction. A comprehensive 3D assessment of displacement patterns is essential for evaluating stability and guiding treatment. Fracture line analysis further enhances classification accuracy and informs imaging protocols and fixation strategies tailored to specific fracture types.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143692945","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":"Establishing a Staging System for Adjacent Segment Disease and Exploring Its Significance in Guiding Surgical Decisions: A Retrospective Study.","authors":"Changpeng Qu, Jianwei Guo, Hao Tao, Chuanli Zhou, Kai Zhu, Yihao Sun, Lei Li, Zhiming Liu, Hao Zhang, Xuexiao Ma","doi":"10.1111/os.70029","DOIUrl":"https://doi.org/10.1111/os.70029","url":null,"abstract":"<p><strong>Objective: </strong>The degeneration characteristics of adjacent segment disease are complex. Improper surgical planning has caused unnecessary surgical trauma and costs. The purpose of this study was to establish a staging system for adjacent segment disease and evaluate its guiding significance for surgical decisions in adjacent segment disease.</p><p><strong>Methods: </strong>A retrospective study was performed on 103 patients with adjacent segment disease who underwent treatment between January 2017 and January 2023. Based on radiological findings, adjacent segment disease was categorized into four stages, with no cases identified in Stage IV. Patients were divided into four intervention groups: Group A (control group, traditional posterior lumbar fusion with rod-screw revision), Group B (Stage I, percutaneous endoscopic decompression), Group C (Stage II, oblique lumbar interbody fusion), and Group D (Stage III, cortical bone trajectory screws with posterior lumbar interbody fusion). Clinical and radiological outcomes were evaluated postoperatively, at 3 months, and at 12 months. Statistical analysis was conducted using t-tests, Mann-Whitney U tests, chi-square tests, and Spearman's correlation.</p><p><strong>Results: </strong>Surgical expenses, duration, estimated blood loss, postoperative hospital stays, disc height index, and Pfirrmann grading all demonstrated significant correlations with the established grading system (p < 0.05). Patients achieved favorable clinical outcomes. Specifically, Groups B, C, and D showed earlier functional recovery compared to Group A, with Groups B and C experiencing more rapid relief from low back pain. Furthermore, Groups B, C, and D had shorter surgical times and reduced blood loss, while Groups B and C also incurred lower surgical costs and shorter hospital stays (p < 0.05).</p><p><strong>Conclusion: </strong>The new grading system, developed based on the characteristics of adjacent segment degeneration, showed excellent surgical adaptability, despite varying degrees of correlation across different factors. This system was closely linked to the degree of intervertebral disc degeneration and the intervertebral disc height index. All patients achieved favorable surgical outcomes, suggesting that this grading system could provide valuable guidance in making surgical treatment decisions.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143670573","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 Cervical Vertebral Bone Quality Score Is a Novel Reliable Index Reflecting the Condition of Paraspinal Muscles and Predicting Loss of Cervical Lordosis After Open-Door Laminoplasty.","authors":"Junhu Li, Xingxia Long, Linnan Wang, Qiujiang Li, Lei Wang, Yueming Song","doi":"10.1111/os.70028","DOIUrl":"https://doi.org/10.1111/os.70028","url":null,"abstract":"<p><strong>Objective: </strong>Recently, the MRI-based cervical vertebral bone quality (C-VBQ) scoring system has demonstrated accuracy in reflecting cervical bone quality and predicting postoperative complications from cervical spine surgery. Studies have shown that cervical bone quality is closely linked to loss of cervical lordosis (LCL) after open-door laminoplasty. Additionally, research on lumbar VBQ indicates a strong correlation between lumbar VBQ scores and lumbar paraspinal muscle quality. However, the relationship of C-VBQ score to cervical paraspinal muscles and LCL remains unclear. Therefore, this study aimed to explore the relationship between C-VBQ score and cervical paraspinal muscle-related parameters as well as postoperative LCL, in addition to exploring the risk factors associated with LCL.</p><p><strong>Methods: </strong>A total of 101 patients who underwent standard C3-C7 open-door laminoplasty at our institution from 2012 to 2022 were included in this study. The LCL group was defined as loss of cervical lordosis > 5° at 1-year postoperative follow-up. Cervical X-rays were obtained to measure the C2-7 Cobb angle, C2-7 sagittal vertical axis (SVA), T1 slope, and cervical range of motion (ROM). The relative cross-sectional area (RCSA) and degree of fat infiltration (DFF) of the deep cervical extensors, flexors, and all muscles were measured using image J software. Cervical CT Hounsfield unit (HU) and C-VBQ values were measured on preoperative CT and MRI T1-weighted mid-sagittal images, respectively. Then, demographics, cervical sagittal parameters, ROM, paraspinal muscle-related parameters, CT-HU and C-VBQ values were assessed for their correlation with LCL, and multivariate linear analysis was used to determine the risk factors associated with LCL. Finally, the relationship between C-VBQ scores and cervical paraspinal muscle-related parameters was evaluated.</p><p><strong>Results: </strong>A total of 55 (54.45%) patients were included in the LCL group due to loss of cervical lordosis > 5° at 1-year follow-up. LCL was positively correlated to the preoperative T1 slope, Flexion ROM, C2-7 ROM, Flexion/Extension ROM, Flexion muscles DFF, Extension muscles DFF, Average DFF, and C-VBQ scores, while it was negatively correlated to Extension ROM, Extension muscles RCSA, Total RCSA, and CT-HU values. Furthermore, Flexion/Extension ROM, Total RCSA, Average DFF, CT-HU, and C-VBQ values were independent risk factors for LCL. In addition, C-VBQ scores were significantly correlated with RCSA and DFF of Flexion and Extension muscles.</p><p><strong>Conclusions: </strong>This study is the first to find a significant correlation between C-VBQ scores and cervical paraspinal muscle quality. The C-VBQ score is a comprehensive indicator that reflects the quality of the cervical bone and paravertebral muscles, and it is a novel predictor of LCL after open-door laminoplasty.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143657892","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}