Orthopaedic Surgery最新文献

{"title":"Intraoperative Neurophysiological Monitoring in Patients With Marfan Syndrome Scoliosis.","authors":"Kaiyi Cao, Wanyou Liu, Junyin Qiu, Yinkun Li, Zezhang Zhu, Yong Qiu, Benlong Shi","doi":"10.1111/os.70168","DOIUrl":"https://doi.org/10.1111/os.70168","url":null,"abstract":"<p><strong>Objective: </strong>This study compared the intraoperative neurophysiological monitoring (IONM) data between patients with Marfan syndrome (MFS) scoliosis undergoing posterior spinal correction surgery and those with idiopathic scoliosis (IS).</p><p><strong>Methods: </strong>Patients diagnosed with MFS who underwent posterior spinal correction surgery between January 2018 and December 2023 were reviewed. Patients with IS who underwent posterior spinal correction surgery were randomly selected as the control group. Motor-evoked potentials (MEPs) and somatosensory-evoked potentials (SEPs) were measured separately on the convex and concave sides of the main curve. We recorded IONM failure and asymmetrical SEPs waveforms. For each patient, we assessed the apical vertebral translation, Cobb angle of the main curve, curve pattern, deformity angular ratio (DAR), and global kyphosis. Independent-sample t-test and chi-square tests were conducted to compare differences between the IS and MFS groups.</p><p><strong>Results: </strong>We included 238 girls with IS and 118 patients with MFS scoliosis (45 men and 73 women). The rates of MEPs and SEPs were 95.4% and 93.7% in girls with IS, and 92.4% and 89.8% in patients with MFS scoliosis, respectively. In the MFS group, the average N45 latency, P37 latency, and amplitude of SEPs were 49.5 ± 3.9 ms, 39.9 ± 3.5 ms, and 2.5 ± 1.4 μV on the convex side and 50.1 ± 4.0 ms, 39.9 ± 3.5 ms, and 2.4 ± 1.3 μV on the concave side, respectively. The MEP amplitude was 731.7 ± 734.3 μV on the concave side and 854.3 ± 778.2 μV on the convex side. Patients in the IS group had lower SEP-N45 and SEP-P37 latencies than the patients in the MFS group (p < 0.001). Asymmetrical SEPs were observed in 102 patients in the IS group and 52 patients in the MFS group, respectively (p = 0.879). IONM waveform failure was identified in 21 patients in the IS group and 17 patients in the MFS group, respectively (p = 0.108). IONM failure was more likely in patients with a larger C-DAR, S-DAR, T-DAR, and Cobb angle of the main curve preoperatively (p = 0.017, 0.005, 0.001, and 0.001, respectively).</p><p><strong>Conclusions: </strong>In patients with MFS scoliosis, the success rates of MEPs and SEPs during posterior spinal fusion were 92.4% and 89.8%. Compared to MFS patients, those with IS demonstrated shorter SEP latencies, with similar MEP and SEP amplitudes. MFS patients with higher DAR values and larger Cobb angles of the main curve preoperatively were at a higher risk of IONM failure.</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":"145081328","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":"Radiographic Predictors of Leg Shortening After Curved Intertrochanteric Varus Osteotomy in Osteonecrosis of the Femoral Head.","authors":"Hiroaki Ido, Yusuke Osawa, Yasuhiko Takegami, Hiroto Funahashi, Yuto Ozawa, Takamune Asamoto, Shiro Imagama","doi":"10.1111/os.70172","DOIUrl":"https://doi.org/10.1111/os.70172","url":null,"abstract":"<p><strong>Purpose: </strong>Curved intertrochanteric varus osteotomy (CVO) is a joint-preserving option for young patients with osteonecrosis of the femoral head (ONFH), but postoperative leg length discrepancy (LLD) remains a concern. This study investigated factors associated with leg shortening in both the early postoperative phase (P1) and the healing phase until bone union (P2).</p><p><strong>Methods: </strong>This retrospective study included 48 patients (51 hips) with non-traumatic ONFH who underwent CVO. Radiographic evaluations were performed preoperatively, immediately postoperatively, and at bone union. Pearson's correlation coefficient was used to correlations between radiographic parameters and leg shortening in P1 and P2. Patients were divided into groups based on whether leg shortening ≥ 5 mm was observed in each phase, and statistical comparisons were conducted. Multivariate logistic regression analyses were performed to identify independent risk factors for leg shortening ≥ 5 mm.</p><p><strong>Results: </strong>Leg shortening ≥ 5 mm occurred in 17.6% of hips in P1 and 47.1% in P2. Lateral shift of the osteotomy arc center correlated with leg shortening in P1 (r = 0.689, p < 0.0001). Varus angle and changes in femoral anteversion were also correlated in both P1 and P2 (P1: r = 0.362/0.322; P2: r = 0.404/0.754, all p < 0.05). Greater varus angle and lateral/distal shift of the osteotomy center were significantly associated with P1 shortening. In P2, greater changes in femoral anteversion, increased osteotomy distance from the midpoint of the lesser trochanter, and larger varus angle were significant factors. Multivariate analysis identified lateral shift of the osteotomy center as an independent predictor in P1 (OR, 1.30; 95% CI, 1.06-1.81; p = 0.004). In P2, change in femoral anteversion was an independent predictor of leg shortening ≥ 5 mm (OR: 1.24, 95% CI: 1.07-1.51; p = 0.003).</p><p><strong>Conclusion: </strong>Leg shortening post-CVO progresses during surgery and bone healing. Careful surgical planning and postoperative management, particularly in cases requiring extensive varus correction or anteversion changes, is essential for minimizing LLD and optimizing outcomes.</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":"145075823","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Outcomes of RA FE-TLIF Compared to FE-TLIF in Patients With Lumbar Spondylolisthesis: A Retrospective Study.","authors":"Lin Zhao, Zhengxuan Peng, Lei Cao, Mingdong Lu, Zhanxiang Wu, Ning Ding, Sheng Zhou, Jie Liu","doi":"10.1111/os.70166","DOIUrl":"https://doi.org/10.1111/os.70166","url":null,"abstract":"<p><strong>Background: </strong>Lumbar spondylolisthesis (LS) is a spinal disorder that often necessitates surgical intervention. However, evidence on the comparative clinical value of robot-assisted full-endoscopic transforaminal lumbar interbody fusion (RA FE-TLIF) versus conventional FE-TLIF in early-grade (Grades I and II) LS remains limited, leaving uncertainty about its true clinical value in this patient population. This study aims to compare the clinical efficacy and safety of FE-TLIF with RA FE-TLIF in patients with Grade I and II LS.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on 47 patients who underwent surgical treatment for LS between April 2022 and April 2023 at our hospital. Patients were divided into two groups: 22 underwent RA FE-TLIF, and 25 underwent FE-TLIF. Key outcomes measured included operative time, intraoperative blood loss, postoperative recovery time, fusion rate, screw placement accuracy, Visual Analogue Scale (VAS), the Japanese Orthopaedic Association (JOA) scores, and the incidence of postoperative complications. Statistical analyses were performed using the independent-sample t test for continuous variables and the chi-square test for categorical variables, with a significance threshold of p < 0.05.</p><p><strong>Results: </strong>The RA FE-TLIF group exhibited significantly shorter operative times and lower intraoperative blood loss compared to the FE-TLIF group (p < 0.05). Postoperative recovery, as measured by hospital stay, was also shorter in the RA FE-TLIF group (p = 0.001). VAS and JOA scores indicated greater pain relief and functional improvement in the RA FE-TLIF group, with statistically significant differences observed at both 1 month and final follow-up (p < 0.05). The incidence of postoperative complications was lower in the RA FE-TLIF group, though this difference was not statistically significant (p = 0.144). Complete fusion rates were 95.45% in the RA FE-TLIF group and 88.00% in the FE-TLIF group, with no significant difference (p > 0.05). Screw placement accuracy was higher in the RA FE-TLIF group (97.73%) than in the FE-TLIF group (89.00%), with a significant difference (p < 0.05).</p><p><strong>Conclusion: </strong>RA FE-TLIF demonstrates superior clinical outcomes compared to FE-TLIF in the treatment of LS. These findings support the broader adoption of RA FE-TLIF as a preferred surgical technique for this condition.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145001012","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":"Remnant Preservation in Anterior Cruciate Ligament Reconstruction Versus Non-Preservation Methods: A Systematic Review and Meta-Analysis.","authors":"Chao Fan Chen, Ling Yao Kong, Tao Li, Lei Yao, Yang Xu, Li Wang, Hong Yu Zhou, Jian Li","doi":"10.1111/os.70167","DOIUrl":"https://doi.org/10.1111/os.70167","url":null,"abstract":"<p><p>To manage anterior cruciate ligament (ACL) injury, both remnant-preserving anterior cruciate ligament reconstruction (ACLR) and standard ACLR without remnant preservation are applied. This study aims to systematically evaluate clinical outcomes of remnant-preserving versus standard ACLR techniques by analyzing randomized controlled trials (RCTs). The PubMed, Embase, and Cochrane Library databases were used to identify studies published from January 2000 to November 2024. Based on the PICOS framework, we systematically reviewed RCTs in which patients with ACL injuries compared ACLR with remnant preservation versus standard ACLR in terms of International Knee Documentation Committee (IKDC) score, Lysholm score, Lachman test, pivot shift test, KT1000/2000 arthrometer side-to-side difference (SSD), synovial coverage, proprioception evaluation, cyclops lesion, and range of motion (ROM). Data were pooled using the random-effects model or fixed-effects model, based on the heterogeneity. The quality of the included literature was assessed based on the Cochrane Risk of Bias tool (ROB 2.0), and the GRADE criteria were applied to rate evidence quality for key outcomes. Review Manager 5.4 and Stata 15 were used for the statistical analyses. The relative risk (RR) was used for dichotomous data, and the mean difference (MD) was used for continuous variable data. Both types of indicators were expressed as 95% confidence intervals (CIs). The minimal clinically important difference (MCID) was adopted to determine whether patients improved enough clinically to notice a difference. Subgroup analyses were conducted for outcomes failing to reach MCID thresholds in order to examine potential modifiers of different follow-up durations and remnant preservation techniques. A total of 10 studies were included in the qualitative review and meta-analysis. Although there were statistically significant differences between the remnant preservation group and the standard technique group in favor of the remnant preservation technique with respect to postoperative Lysholm score (MD 1.44; 95% CI, 0.60-2.29; I² = 23%; p < 0.01) (GRADE: Moderate), SSD (MD -0.57; 95% CI, -0.98 to -0.15; I² = 86%; p < 0.01) (GRADE: Low) and proprioception recovery (MD -0.57; 95% CI, -0.83 to -0.31; I² = 0%; p < 0.01) (GRADE: Low), these observed differences are so small that they are unlikely to be clinically relevant. No differences were found in other clinical outcomes between the two groups. The follow-up duration and remnant preservation techniques were not identified as the key factors influencing the differences between remnant preservation ACLR and standard ACLR. No clinically meaningful benefit in postoperative knee stability or function; remnant preservation may be considered primarily when technical feasibility is high and remnant quality is optimal. This is achieved without increasing the risk of cyclops lesions and deficiency of ROM.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144992953","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":"Learning Curves Associated With Robotic Total Hip Arthroplasty: A Scoping Review.","authors":"Abith Ganesh Kamath, Saran Singh Gill, Srikar Reddy Namireddy, Matija Krkovic","doi":"10.1111/os.70130","DOIUrl":"10.1111/os.70130","url":null,"abstract":"<p><strong>Introduction: </strong>Robotic total hip arthroplasty (rTHA) is gaining widespread adoption, yet the learning curve (LC) associated with its implementation remains uncertain. Understanding LCs is crucial to optimizing training protocols and improving patient outcomes. This scoping review assesses LCs in rTHA by evaluating operative time, leg length discrepancy (LLD), and acetabular component inclination (ACI).</p><p><strong>Methods: </strong>A systematic search was conducted across PubMed, MEDLINE, Embase, Scopus, and Web of Science following PRISMA guidelines. Studies assessing the LC of rTHA based on operative efficiency, radiographic accuracy, and surgical outcomes were included.</p><p><strong>Results: </strong>A total of 12 studies were included. Improvements in operative time were observed at a median of 13 cases, ranging from 7 to 35 cases. Both LLD and ACI findings were inconsistent, with little evidence of a LC found in the literature.</p><p><strong>Conclusion: </strong>This review highlights the learning curve in rTHA, with proficiency improving after early cases. Standardized benchmarks and training models could enhance learning and enable comparisons across robotic systems. Future research should refine proficiency thresholds, assess system differences, and develop structured training for optimal rTHA adoption.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":"2529-2540"},"PeriodicalIF":2.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12404875/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144699190","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":"Measurements of Posterior Tibial Slope of the Ankle Joint on CT Images and Virtual Radiographs.","authors":"Yuanjun Teng, Jian Yu, Kangrui Zhang, Lijun Da, Sixian Li, Jianming Zhou, Wenming Chen, Xu Wang, Xin Ma","doi":"10.1111/os.70111","DOIUrl":"10.1111/os.70111","url":null,"abstract":"<p><strong>Objective: </strong>The posterior tibial slope (PTS) is essential in the assessment of ankle alignment. However, its standardized reference value has not been adequately investigated. This study aims to compare the PTS of the ankle joint on virtual radiographs and CT images and determine the effect of participants' demographic characteristics on the PTS.</p><p><strong>Methods: </strong>A retrospective analysis was conducted in healthy populations who underwent CT scans of the ankle joint. A total of 106 participants (53 males and 53 females) were included in our study. The three-dimensional model of the ankle joint was reconstructed by CT images, and the standard coronal and sagittal planes were produced using the anatomical coordinate system. The PTS was measured on different CT sagittal planes and virtual radiographs. All measurements were performed using three reference axes, including the anterior cortex axis, the anatomical axis, and the posterior cortex axis of the tibial shaft. Subgroup and correlation analyses were performed to investigate the effect of participants' demographic characteristics (the age, height, gender, and BMI) on the PTS. Statistical comparisons between two groups were performed using independent t-tests, while variations across sagittal planes and reference axes were analyzed through one-way analysis of variance.</p><p><strong>Results: </strong>The mean values of PTS varied from 76.7° to 83.4° on different sagittal planes of CT images, and there was an increasing trend for PTS from the medial to lateral CT images. The mean values of PTS on the virtual radiograph were 81.6°, 82.3°, and 80.8° for the anterior cortex, anatomical, and posterior cortex axes, respectively. Significant differences in PTS measurements were found between CT images and virtual radiographs (p < 0.05). However, no differences were found while using different reference axes on PTS measurements (p < 0.05). Subgroup analysis showed females had a greater PTS than males, indicating a gender-based difference in the anatomy of the PTS.</p><p><strong>Conclusion: </strong>The PTS varied on CT images and radiographs, and the anterior cortex, anatomical, and posterior cortex axes do not significantly influence the PTS measurements. The observed gender-based differences highlight the need for individualized surgical planning and the development of sex-specific implants.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":"2680-2688"},"PeriodicalIF":2.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12404855/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144699191","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":"Comparison of Unicompartmental Knee Arthroplasty Versus High Tibial Osteotomy for Medial Knee Osteoarthritis: An Updated Meta-Analysis of 56,000 Patients.","authors":"Muhammad Hassan Waseem, Zain Ul Abideen, Muhammad Haris Khan, Muhammad Fawad Tahir, Muhammad Mukhlis, Aisha Kakakhail, Eiman Zeeshan, Mahnoor Usman, Misha Khalid, Ameer Haider Cheema, Sania Aimen, Javed Iqbal, Haseeb Javed Khan","doi":"10.1111/os.70049","DOIUrl":"10.1111/os.70049","url":null,"abstract":"<p><p>Osteoarthritis (OA) is a prevalent degenerative joint disease primarily affecting hip and knee joints, with an estimated 300 million cases globally. This study is crucial as it provides an updated, comprehensive comparison of unicompartmental knee arthroplasty (UKA) and high tibial osteotomy (HTO) for treating medial knee osteoarthritis, offering valuable insights into their relative effectiveness. The findings aim to inform clinical decision-making and improve patient outcomes by identifying the superior treatment option. A comprehensive search was conducted across PubMed, Cochrane Library, and Google Scholar until August 1, 2024. Statistical analysis used Review Manager 5.4 with a random-effects model, risk ratio (RR), and mean differences (MD) with 95% confidence intervals (CI) for the dichotomous and continuous outcomes, respectively. The Newcastle-Ottawa Scale was used for quality assessment, and funnel plots were used to analyze publication bias. GRADE assessment was done to gauge the certainty of the evidence. Thirty-nine studies, involving a total of 56,686 patients, were evaluated for comparison. UKA significantly reduced the complications (RR = 0.37; 95% CI: [0.25, 0.54]; p < 0.0001; I² = 30%), revision rates to total knee arthroplasty (TKA) (RR = 0.64; 95% CI: [0.41, 0.99]; p = 0.05; I² = 72%) and postoperative pain (MD = -0.33; 95% CI: [-0.64, -0.03]; p = 0.03; I² = 89%) compared to HTO, while range of motion (ROM) (RR = -3.55; 95% CI: [-7.16, 0.52]; p = 0.09; I² = 98%) and walking speed (MD = 0.02; 95% CI: [-0.04, 0.07]; p = 0.56; I² = 0%) and surgical site infections(RR = 1.40; 95% CI: [0.30, 6.53]; p = 0.67; I² = 86%) were comparable. All the functional knee scores are comparable except the Hospital for Special Surgery (HSS) score, which is increased in UKA (MD = 2.63; 95% CI: [0.52, 4.74]; p = 0.01; I² = 76%). UKA is superior to HTO, offering lower revision rates, reduced postoperative pain, fewer complications, and better functional scores.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":"2499-2513"},"PeriodicalIF":2.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12404872/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144691169","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":"Dura Vibration Difference Between PTP Bone Resection and Upper Facet Joints En Bolc Resection in Posterior Thoracic Decompression.","authors":"Rui Wang, Yingjie Zheng, Weixiang Ke, Junfei Hu, Guangming Xia, Yu Dai, Yuan Xue","doi":"10.1111/os.70138","DOIUrl":"10.1111/os.70138","url":null,"abstract":"<p><strong>Objective: </strong>In thoracic posterior decompression surgery, the traditional pedicle-to-pedicle (PTP) approach may have limitations in achieving complete decompression and may also pose potential risks of injury to the spinal cord. Through comparative analysis with the PTP method, the study explored the safety of posterior thoracic decompression via the pedicle-ossification tunnel (POT), aiming to provide a more scientific and safer clinical surgical pathway selection.</p><p><strong>Methods: </strong>Combined with preoperative image data and intraoperative operation images, the POT decompression method was deeply analyzed. In this study, the thoracic vertebrae of sheep were taken as experimental specimens. The water sac was placed close to the joint level of the articular process to simulate the spinal cord, and the experiment was carried out by the surgical methods of PTP and POT respectively with a high-speed bur. The laser displacement sensor (LDS) was used to monitor the vibration displacement of the water sac, and the collected vibration data was divided into 0.1 s/frame (500 vibration signal data points), which were used to calculate the curvature change of the vibration displacement curve. The Wilcoxon rank sum test was used for statistical analysis. Milling parameters for the high-speed bur were set to: milling depth 0.5 mm, milling speed 0.5 mm/s, milling angle 45^°, and spherical bit size 4 mm.</p><p><strong>Results: </strong>Combining the detailed preoperative image data and intraoperative images of key operations, the study first provides a detailed description of the surgical steps for safe posterior thoracic decompression via the POT. Then, based on Euler-Bernoulli beam theory, the vibration of the \"spinal cord\" under different surgery pathways (POT and PTP) in posterior thoracic decompression was further studied. The statistical analysis showed that the vibration amplitude and curvature value of the vibration curve of POT and PTP were significantly different (p < 0.05). As the milling position approached POT, the amplitude and curvature values also decreased gradually.</p><p><strong>Conclusion: </strong>Through theoretical analysis and experimental verification, the safety and effectiveness of posterior thoracic decompression via POT was thoroughly investigated. The milling pathway via POT could not only achieve the surgical purpose of complete decompression, but also avoid the contact area between OLF and dura as much as possible, thus reducing the irritation to the spinal cord.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":"2735-2743"},"PeriodicalIF":2.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12404885/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144743506","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":"Quantifying the Trajectory of Percutaneous Endoscopic Lumbar Discectomy in 3D Lumbar Models Based on Automated MR Image Segmentation-A Cross-Sectional Study.","authors":"Zhihai Su, Yunfei Wang, Chengjie Huang, Qingqing He, Junjie Lu, Zheng Liu, Yiou Zhang, Qiaochu Zhao, YuChen Zhang, Jianan Cai, Shumao Pang, Zhen Yuan, Ziyang Chen, Tao Chen, Hai Lu","doi":"10.1111/os.70112","DOIUrl":"10.1111/os.70112","url":null,"abstract":"<p><strong>Objective: </strong>Creating a 3D lumbar model and planning a personalized puncture trajectory has an advantage in establishing the working channel for percutaneous endoscopic lumbar discectomy (PELD). However, existing 3D lumbar models, which seldom include lumbar nerves and dural sac reconstructions, primarily depend on CT images for preoperative trajectory planning. Therefore, our study aims to further investigate the relationship between different virtual working channels and the 3D lumbar model, which includes automated MR image segmentation of lumbar bone, nerves, and dural sac at the L4/L5 level.</p><p><strong>Methods: </strong>Preoperative lumbar MR images of 50 patients with L4/L5 lumbar disc herniation were collected from a teaching hospital between March 2020 and July 2020. Automated MR image segmentation was initially used to create a 3D model of the lumbar spine, including the L4 vertebrae, L5 vertebrae, intervertebral disc, L4 nerves, dural sac, and skin. Thirty were then randomly chosen from the segmentation results to clarify the relationship between various virtual working channels and the lumbar 3D model. A bivariate Spearman's rank correlation analysis was used in this study.</p><p><strong>Results: </strong>Preoperative MR images of 50 patients (34 males, mean age 45.6 ± 6 years) were used to train and validate the automated segmentation model, which had mean Dice scores of 0.906, 0.891, 0.896, 0.695, 0.892, and 0.892 for the L4 vertebrae, L5 vertebrae, intervertebral disc, L4 nerves, dural sac, and skin, respectively. With an increase in the coronal plane angle (CPA), there was a reduction in the intersection volume involving the L4 nerves and atypical structures. Conversely, the intersection volume encompassing the dural sac, L4 inferior articular process, and L5 superior articular process increased; the total intersection volume showed a fluctuating pattern: it initially decreased, followed by an increase, and then decreased once more. As the cross-section angle (CSA) increased, there was a rise in the intersection volume of both the L4 nerves and the dural sac; the intersection volume involving the L4 inferior articular process grew while that of the L5 superior articular process diminished; the overall intersection volume and the intersection volume of atypical structures initially decreased, followed by an increase.</p><p><strong>Conclusion: </strong>In terms of regularity, the optimal angles for L4/L5 PELD are a CSA of 15° and a CPA of 15°-20°, minimizing harm to the vertebral bones, facet joint, spinal nerves, and dural sac. Additionally, our 3D preoperative planning method could enhance puncture trajectories for individual patients, potentially advancing surgical navigation, robots, and artificial intelligence in PELD procedures.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":"2689-2698"},"PeriodicalIF":2.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12404874/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144760722","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":"Modified Frailty Index-11-A New Predictor of Postoperative Complications in the Aging Thoracic Spinal Stenosis Patients.","authors":"Zixuan Xu, Yuanyu Hu, Lei Yuan, Guanghui Chen, Shuai Jiang, Xinhu Guo, Yu Jiang, Woquan Zhong, Weishi Li, Zhongqiang Chen, Chuiguo Sun","doi":"10.1111/os.70128","DOIUrl":"10.1111/os.70128","url":null,"abstract":"<p><strong>Objective: </strong>Operation for thoracic spinal stenosis (TSS) is considered a high-risk surgery. Because of the frailty of elderly patients, the prediction for postoperative complications is crucial. This study investigated the relationship between frailty, as measured by the modified frailty index-11 (mFI-11), and postoperative complications in elderly patients with thoracic myelopathy secondary to TSS.</p><p><strong>Methods: </strong>A retrospective review was conducted of 391 patients aged 65 years or older, with 209 males and 182 females, who underwent surgery for TSS at Peking University Third Hospital from 2012 to 2023. Patients were stratified into subgroups based on mFI-11 score. Data on perioperative complications, including systemic and local events, were collected. Univariate and multivariate analyses were performed to determine the association between frailty and perioperative complications and to identify independent risk factors.</p><p><strong>Results: </strong>A total of 391 elderly patients undergoing decompression and fusion for TSS were included and categorized by mFI-11 score: 0 (n = 73), 0.09 (n = 159), 0.18 (n = 98), and ≥ 0.27 (n = 61). Multivariate analysis identified the mFI-11 as an independent risk factor for surgical site infection (SSI) (OR = 7.250, p = 0.022), gastrointestinal complications (OR = 2.461, p = 0.029), urologic complications (OR = 4.855, p = 0.001), respiratory complications (OR = 13.968, p = 0.033), postoperative fever (OR = 2.256, p < 0.001), and postoperative transfusion (OR = 1.962, p = 0.014). Moreover, mFI ≥ 0.27 is a threshold for severe complications (OR = 15.886, p = 0.017), and mFI ≥ 0.18 is a threshold for any postoperative complications (OR = 6.338, p < 0.001) and minor complications (OR = 5.915, p < 0.001).</p><p><strong>Conclusions: </strong>The mFI-11 score is an effective predictor of the risk of surgical site infection, gastrointestinal complications, urologic complications, respiratory complications, postoperative fever, and postoperative transfusion in elderly patients undergoing TSS surgery. Patients with mFI scores ≥ 0.18 are at a significantly higher risk of any postoperative complications or minor complications, with mFI scores ≥ 0.27 indicating severe complications. Frailty, as assessed by mFI-11, and non-neurological complications did not significantly impact the long-term recovery rate.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":"2588-2595"},"PeriodicalIF":2.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12404868/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144682869","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}