Orthopaedic Surgery最新文献

{"title":"The Survival Rate and Its Influencing Factors of Modular Endoprosthetic Replacement With Uncemented Stem for the Proximal Femur After Primary Tumor Resection.","authors":"Zhuangzhuang Li, Yi Luo, Yitian Wang, Taojun Gong, Xuanhong He, Yong Zhou, Minxun Lu, Li Min, Chongqi Tu","doi":"10.1111/os.70146","DOIUrl":"10.1111/os.70146","url":null,"abstract":"<p><strong>Objective: </strong>Durable and biologically integrated fixation is critical for long-term implant survival in patients with primary bone tumors. However, limited evidence exists regarding the long-term outcomes of uncemented stem designs in this population. Specifically, we investigated: (1) the long-term patient and implant survivorship rates; (2) the influence of factors such as resection length and patient age on implant survival; and (3) the incidence and types of complications, particularly those requiring implant removal or revision.</p><p><strong>Methods: </strong>We retrospectively reviewed 76 patients (49 males, 27 females; mean age 41 years, range 14-78 years) who underwent proximal femoral replacement with a modular uncemented endoprosthesis between 2015 and 2022. The mean follow-up was 63.4 months (median: 60.5 months; range: 12-104 months). Functional outcomes were assessed using the Musculoskeletal Tumor Society (MSTS) score, while complications were classified based on the Henderson et al. system. Survivorship analyses were conducted using Kaplan-Meier methods.</p><p><strong>Results: </strong>The 5-year patient survival rate was 88.0%, and the 5-year implant survival rate was 90.4%. The mean MSTS score at final follow-up was 25.6 (range 16-30), with 87.7% of patients achieving good to excellent functional outcomes. Younger patients (< 30 years) exhibited poorer implant survival, while resection length did not significantly impact outcomes. Complications occurred in 18.4% of cases, categorized into type 1 (soft tissue-related, n = 3), type 2 (aseptic loosening, n = 2), type 3 (structural failure, n = 0), type 4 (infection, n = 3), type 5 (tumor recurrence, n = 3), and three cases of acetabular failure.</p><p><strong>Conclusions: </strong>Modular uncemented endoprostheses for proximal femoral replacement demonstrated promising survivorship and functional outcomes in patients with primary bone tumors. The low rate of aseptic loosening highlights the benefits of uncemented stem designs. However, younger age remains a risk factor for reduced implant longevity.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":"2869-2878"},"PeriodicalIF":2.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12497553/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145001059","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":"Correction to \"Surgical Outcomes of Olecranon Osteotomy Approach Combined With Submerged Kirschner Wires and Plate Fixation for Duckerley IIIB Distal Humeral Coronal Shear Fractures\".","authors":"","doi":"10.1111/os.70177","DOIUrl":"10.1111/os.70177","url":null,"abstract":"","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":"3002-3003"},"PeriodicalIF":2.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12497569/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145081341","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy of Conservative Approaches on Pain Relief and Function in Patients With Rotator Cuff Calcific Tendinopathy: Which Is the Best Option? A Systematic Review and Network Meta-Analysis.","authors":"Lucrezia Moggio, Nicola Marotta, Alessandro de Sire, Giorgia Lucia Benedetto, Giorgio Gasparini, Antonio Ammendolia, Elvira Immacolata Parrotta, Michele Mercurio","doi":"10.1111/os.70175","DOIUrl":"https://doi.org/10.1111/os.70175","url":null,"abstract":"<p><strong>Objective: </strong>Rotator cuff calcific tendinopathy is a leading cause of nontraumatic shoulder pain, frequently leading to articular and functional impairments, depicting an adhesive capsulitis-like clinical presentation. To date, there is a lack of evidence on the impact of conservative approaches, and no gold standard has been established for managing rotator cuff calcific tendinopathy. This systematic review aimed to identify the most effective conservative approach for reducing pain and improving function in rotator cuff calcific tendinopathy patients.</p><p><strong>Methods: </strong>PubMed, Scopus, and Cochrane Library databases were systematically searched from their inception until January 2, 2025, for English-language randomized clinical trials including adults affected by rotator cuff calcific tendinopathy undergoing conservative treatment. Data extraction was performed independently by two reviewers using a customized data extraction form, with consensus reached by a third reviewer. A network meta-analysis was subsequently carried out to compare the efficacy of different interventions. The risk of bias within the included randomized clinical trials was assessed using Version 2 of the Cochrane risk-of-bias tool for randomized trials. The study has been registered with PROSPERO, registration number CRD420250650833.</p><p><strong>Results: </strong>Nineteen articles were included. This study identified 1160 subjects affected by rotator cuff calcific tendinopathy. A pairwise comparison through a network meta-analysis indicated that platelet-rich plasma exhibited the highest probability (85%) of improving shoulder function, followed by disodium ethylenediamine tetra-acetic acid at 75%, aspiration techniques at 65%, and extracorporeal shockwave therapy at 57%. Regarding pain reduction, disodium ethylenediamine tetra-acetic acid showed the highest probability (66%), followed by kinesiotaping and needle aspiration, both at 61%.</p><p><strong>Conclusion: </strong>This systematic review and network meta-analysis identified several interventional techniques, including platelet-rich plasma and disodium ethylenediamine tetra-acetic acid injections, extracorporeal shockwave therapy, and needle aspiration, as more effective strategies for reducing pain and improving function in subjects affected by rotator cuff calcific tendinopathy.</p><p><strong>Level of evidence: </strong>I (systematic review of Level-I randomized controlled studies).</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145150326","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":"Pediatric Scoliosis in Osteogenesis Imperfecta: From Genetic Mechanisms to Therapeutic Strategies.","authors":"Vladislav Muldiiarov, Keely Buesing, Maegen J Wallace","doi":"10.1111/os.70170","DOIUrl":"https://doi.org/10.1111/os.70170","url":null,"abstract":"<p><p>Osteogenesis imperfecta (OI) is a hereditary connective tissue disorder characterized by increased bone fragility and a propensity for multiple fractures, often leading to various skeletal deformities. Spinal involvement, particularly the development of scoliosis, is one of the most serious clinical manifestations of OI, significantly impacting patients' quality of life. Scoliosis in OI is characterized by early onset and rapid progression, complicating its treatment and necessitating special attention. This review article consolidates the results of contemporary molecular-genetic studies on spinal deformities in children with OI and examines the risk factors for their progression. It provides an overview of existing methods for treating scoliotic deformities in OI, including surgical and conservative approaches, and discusses prospects for the implementation of new therapeutic strategies. The aim of the review is to enhance the understanding of the pathogenesis of spinal deformities in OI and to contribute to the development of more effective methods for their diagnosis and treatment.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145131539","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":"Retrospective Analysis of Clinical Management Strategies for Cage Retropulsion Following Posterior Lumbar Interbody Fusion.","authors":"Cheok-Wa Iao, Xinhu Guo, Weipeng Qiu, Qiang Qi, Zhaoqing Guo, Chuiguo Sun, Woquan Zhong, Weishi Li","doi":"10.1111/os.70174","DOIUrl":"https://doi.org/10.1111/os.70174","url":null,"abstract":"<p><strong>Objectives: </strong>Cage retropulsion (CR) is a common complication following posterior lumbar interbody fusion (PLIF). Symptomatic patients with CR often require revision surgery. However, there is a lack of literature supporting the effectiveness of conservative treatment for CR. This study compares clinical and radiographic outcomes between conservative treatment and revision surgery in patients with CR after PLIF.</p><p><strong>Methods: </strong>A total of 55 patients with CR after PLIF treated at our institution between 2016 and 2023 were retrospectively reviewed; postoperative radiographic data of follow-up were used to diagnose CR. Clinical outcomes were assessed before therapy and at the final follow-up using the visual analog scale (VAS) for lower back pain and leg pain, Oswestry Disability Index (ODI) scores, and Japanese Orthopedic Association 29 (JOA-29) scores. The treatment effectiveness was evaluated based on whether the score change reached the minimally clinically important difference (MCID). Radiographic indicators included the fusion rates, the extent of CR into the spinal canal, and the total displacement distance. Continuous variables were compared using independent samples t-tests or Mann-Whitney U tests, while categorical variables were analyzed using Chi-square or Fisher's exact tests, as appropriate. A p-value < 0.05 was considered statistically significant.</p><p><strong>Results: </strong>The fusion rates at the final follow-up for the conservative treatment group and the revision surgery group were 87.5% and 84.6%, respectively. There were no significant differences in final follow-up fusion rates, lower back pain VAS scores, leg pain VAS scores, JOA scores, or ODI scores between the two groups (all p > 0.05). Additionally, there was no difference in the proportion of patients whose lower back pain VAS, ODI, and JOA scores achieved MCID between groups (all p > 0.05). However, in the revision surgery group, the proportion of patients whose leg VAS scores reached MCID was significantly higher than in the conservative group (p = 0.001). In the revision surgery subgroup analysis, patients who did not achieve leg VAS MCID demonstrated significantly more severe cage retropulsion distance compared to MCID achievers (p = 0.03).</p><p><strong>Conclusions: </strong>Conservative treatment yields satisfactory outcomes in mild, symptomatic CR patients, particularly for low back pain. For patients with a CR distance less than 8.8 mm, conservative treatment and revision surgery showed comparable outcomes, whereas when the CR distance is ≥ 8.8 mm, revision surgery was recommended to improve clinical results. Both conservative treatment and revision surgery can yield favorable outcomes when appropriately indicated.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145131502","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":"Elastic Locking Intramedullary Nails Fixation in Trimalleolar Fractures.","authors":"Zhihui Zhao, Yingjian Zhao, Yongqing Wang, Zhiqiang Yang, Xiaohui Hao, Meiyue Liu, Jingtao Sun, Juwen Chen","doi":"10.1111/os.70179","DOIUrl":"https://doi.org/10.1111/os.70179","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;Since the 1960s, although open reduction and internal fixation for ankle fractures has been widely used, it is associated with complications such as wound dehiscence, infection, prominent hardware, and failure. Closed reduction and internal fixation, on the other hand, offers greater biomechanical strength, requires minimal incisions, and features low-profile hardware. Our study compares the efficacy of elastic locking intramedullary nails (ELIN) fixation featuring minimally invasive microenvironmental protection microstress shielding versus rigid internal fixation (RIF) for trimalleolar fractures.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This retrospective study included a total of 39 patients (2020-2024), comprising 10 men and 29 women (mean age, 55.9 years), who were assigned to the ELIN group or the RIF group. Comparing the different variables between the two groups, including surgical incision length, intraoperative blood loss, operative time, time until union, time to device removal, AOFAS scores, ankle dorsiflexion, and plantar flexion, postoperative complications, and patient satisfaction. The surgical incision length, intraoperative blood loss, and operative time conformed to a normal distribution, so the independent t-tests were used for statistical analysis. Time until union, time to device removal, AOFAS scores, ankle dorsiflexion, and plantar flexion, and patient satisfaction did not conform to a normal distribution; thus, the Mann-Whitney U test was adopted.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;All 39 patients were completed the surgery successfully. ELIN fixation is superior to RIF in surgical incision length (p &lt; 0.001), intraoperative blood loss (p = 0.047), operative time (p &lt; 0.001), time until union (p = 0.003), and time to device removal (p &lt; 0.001), with significant differences in the above parameters between the two groups. The AOFAS scores (p = 0.553), ankle dorsiflexion (p = 0.904), and plantar flexion (p = 0.799) were not significantly different between the two groups. One case of ankle pain was reported in each group at the sixth month postoperatively. By the end of the follow-up, the pain in these two cases had lessened or even disappeared after the patients reduced weight bearing on the injured ankle joint and took non-steroidal anti-inflammatory drugs under medical guidance. There was a surgical incision infection case in the RIF group, which healed after 3 weeks following daily wound dressing and use of sensitive antibiotics.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Compared with RIF, ELIN offers advantages including minimally invasive procedures, faster fracture union, shorter time to device removal, a more aesthetically pleasing appearance of the wound, and high patient satisfaction in treating trimalleolar fractures. These advantages well embody the concept of enhanced recovery after surgery. In contrast to traditional intramedullary fixation, ELIN realized locking fixation, reducing the risk of nail b","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145125145","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":"Bibliometric and Visualized Analysis of Research Relating to Spinal Modic Changes Reported Over the Period 2004-2024.","authors":"Haixin Wei, Hui Lu, Lei Li, Changpeng Qu, Hao Zhang, Xuexiao Ma","doi":"10.1111/os.70162","DOIUrl":"https://doi.org/10.1111/os.70162","url":null,"abstract":"<p><strong>Objective: </strong>Modic changes (MC) are pathological signal alterations occurring in the vertebral endplates and adjacent bone marrow. These changes are frequently linked to degenerative disc diseases and are associated with low back pain symptoms. However, despite increasing research interest, existing studies are fragmented, mostly descriptive, and lack a comprehensive, quantitative assessment of research patterns, hotspots, and collaboration networks in this field. This study aims to evaluate the current research landscape and global trends regarding spinal MC using bibliometric analysis.</p><p><strong>Methods: </strong>We retrieved relevant publications on spinal MC from the Web of Science Core Collection database, spanning January 2004 to August 2024. Using CiteSpace, we conducted a comprehensive analysis of keywords, co-authors, institutions, countries, research domains, cited literature, cited authors, and cited journals.</p><p><strong>Results: </strong>This study analyzed 603 articles published in 168 journals from 193 countries. China emerged as the leading contributor in terms of publication volume, while the University of Oulu in Finland demonstrated the most significant institutional impact. J. Karppinen was identified as the most prolific author, whereas M. Modic was the most frequently cited. Among journals, Spine accounted for the highest number of publications and citations. Key research hotspots identified through keyword analysis include \"degenerative disease,\" \"bone marrow changes,\" \"abnormalities,\" \"type II changes,\" \"lower back,\" \"protrusion,\" \"discectomy,\" \"paraspinal muscles,\" \"obesity,\" and \"overweight\".</p><p><strong>Conclusion: </strong>This study represents the first known bibliometric analysis and visualization of MC, offering clinicians valuable insights into research priorities and directions. Future investigations should prioritize the classification, pathophysiological mechanisms, and clinical significance of different types of MC, especially their roles in pain and functional impairment. Research should also explore the impact of obesity and paraspinal muscles on the progression of MC. Moreover, studies should examine the potential benefits of weight loss and muscle strengthening in alleviating symptoms. Finally, researchers should focus on leveraging artificial intelligence to improve the identification and understanding of MC.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145092279","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":"Comparison of Two-Dimensional and Three-Dimensional Preoperative Planning Measurements for High Tibial Osteotomy.","authors":"Haohao Bai, Yadi Sun, Jianxiong Ma, Ying Wang, Yan Wang, Bin Lu, Lei Sun, Hongzhen Jin, Xingwen Zhao, Xinlong Ma","doi":"10.1111/os.70118","DOIUrl":"https://doi.org/10.1111/os.70118","url":null,"abstract":"<p><strong>Objective: </strong>Knee osteoarthritis (KOA) is a prevalent condition characterized by cartilage degeneration, tissue destruction, and bone hyperplasia, with pain being the primary symptom. High tibial osteotomy (HTO) has emerged as an effective treatment for symptomatic unicompartmental KOA, focusing on realigning force vectors to redistribute mechanical stress and alleviate pain. This study aims to address the question of whether two-dimensional (2D) and three-dimensional (3D) preoperative planning methods yield different correction angles and distraction distances in open-wedge high tibial osteotomy (OWHTO). By comparing these methodologies, we seek to evaluate their impact on surgical outcomes and patient prognosis.</p><p><strong>Methods: </strong>A retrospective analysis was conducted involving patients diagnosed with unicompartmental medial knee osteoarthritis (KOA) who exhibited deviations in the mechanical axis of the lower limbs. These patients underwent OWHTO between January 2021 and August 2022. Both 3D and 2D preoperative planning procedures for OWHTO were employed, targeting an ideal alignment with the weight-bearing line (%WBL) set at 62.5%. The study quantitatively assessed the differences in correction angles and distraction distances associated with the two surgical planning methods using paired t-tests and non-parametric Wilcoxon signed-rank tests.</p><p><strong>Results: </strong>The study comprised a total of 102 patients. It was observed that the mean correction angle in the 2D approach was significantly greater than that recorded in the 3D approach (p < 0.001), with an average difference of 1.49° ± 1.70°. The medial opening gap differences for OWHTO between the two approaches measured 2.1 ± 2.06 mm.</p><p><strong>Conclusions: </strong>To summarize, the 2D preoperative planning method for OWHTO necessitates a larger correction angle and a wider medial opening gap relative to the 3D planning approach when aiming for the same WBL. Therefore, it is crucial for surgeons to take into account the variances between 2D and 3D planning and to evaluate potential correction errors during the surgical procedure while strategizing for OWHTO.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145086604","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":"Lateral Column Realignment Combined With Anterior Longitudinal Ligament Release Versus Three-Column Osteotomy in the Treatment of Thoracolumbar Kyphosis in Septuagenarians: A Retrospective Comparative Cohort Study.","authors":"Xue-Peng Wei, Hung-Lun Hsieh, Qing-De Wang, Yi-Hsun Huang, Erh-Ti Ernest Lin, Chen-Wei Yeh, Yuan-Shun Lo","doi":"10.1111/os.70176","DOIUrl":"https://doi.org/10.1111/os.70176","url":null,"abstract":"<p><strong>Objective: </strong>Adult thoracolumbar kyphosis secondary to osteoporotic vertebral fractures (OVF) impairs the quality of life. Traditional 3CO provides correction but carries a high risk of complications, especially in the elderly. Minimally invasive anterior approaches may be safer. This study aims to compare the radiographic and clinical outcomes of septuagenarians with thoracolumbar kyphosis treated with single-position navigated lateral column realignment with anterior longitudinal ligament release (LCR-A) plus posterior column osteotomy (PCO) and posterior spinal fusion (PSF), or percutaneous pedicle screws (PPS) versus three-column osteotomy (3CO).</p><p><strong>Materials and methods: </strong>This retrospective study included 21 patients with LCR-A and 54 with 3CO prospectively treated between March 2020 and April 2024. Radiographic parameters, the Oswestry Disability Index (ODI), SRS-22 scores, complications, and perioperative data were analyzed over a 2-year follow-up period.</p><p><strong>Results: </strong>Although LCR-A patients were older, they had significantly reduced blood loss, shorter operative times, and fewer fused levels than 3CO patients. LCR-A achieved comparable deformity correction, with fewer complications, lower postoperative ODI, and better SRS-22 scores. The LCR-A group maintained radiographic correction, with fewer new neurological deficits and lower rates of infection, ileus, and delirium.</p><p><strong>Conclusions: </strong>Single-position navigated LCR-A is a safer and less invasive alternative to 3CO in elderly patients with thoracolumbar kyphosis, offering effective deformity correction, fewer complications, improved functional outcomes, and enhanced recovery.</p><p><strong>Level of evidence: </strong>IV.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145086588","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":"Impact of Sagittal Reference Lines on Predicting Distal Junctional Kyphosis in Adolescent Idiopathic Scoliosis.","authors":"Po-Yao Wang, Chih-Wei Chen, Chuan-Ching Huang, Jui-Yo Hsu, Yuan-Fuu Lee, Yu-Cheng Yeh, Ming-Hsiao Hu, Po-Liang Lai, Shu-Hua Yang","doi":"10.1111/os.70171","DOIUrl":"https://doi.org/10.1111/os.70171","url":null,"abstract":"<p><strong>Objective: </strong>Incorporating the sagittal stable vertebra (SSV) in posterior spinal fusion (PSF) may reduce postoperative distal junctional kyphosis (DJK) in adolescent idiopathic scoliosis (AIS), but its determination varies across reference methods and may be affected by patient posture. This study aims to investigate the SSV determined by different sagittal reference lines in predicting the risk of DJK after PSF in AIS patients.</p><p><strong>Methods: </strong>This retrospective cohort study evaluated AIS patients with Lenke Type 1 or 2 curves treated with PSF between January 2009 and July 2017. The inclusion or exclusion of SSV in PSF based on SSV determined by different reference lines was assessed for its association with the postoperative DJK. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and odds ratio were calculated.</p><p><strong>Results: </strong>One hundred twenty-two patients (mean age at surgery: 15.1 ± 3.2 years) were included with the incidence of postoperative DJK 6.6%. PSF with the exclusion of SSV, defined by the vertebral level at which 50% of the vertebral body was anterior to the posterior sacral vertical line (PSVL), the midline between PSVL and the C7 plumb line (PSVL-C7PL Midline), and the line connecting the center point of the C7 vertebral body and the posterior superior corner of the sacrum (C7PSL), was significantly associated with the occurrence of postoperative DJK. Among the evaluated reference lines, PSVL demonstrated numerically higher sensitivity, NPV, odds ratio, and area under the curve (AUC), although these differences in AUC did not reach statistical significance.</p><p><strong>Conclusions: </strong>Although there are concerns about whether standing posture affects the SSV determined by a specific reference line, this study demonstrates that PSVL might be an effective and convenient reference line for identifying SSV.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145081323","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}