Orthopaedic Surgery最新文献

{"title":"Freehand Placement of a Transiliac-Transsacral Screw for Fixation of Posterior Pelvic Ring Injuries.","authors":"Guangping Liu, Zhiguang Chen, Wenhao Cao, Yubo Zheng, Jiaqi Li, Jie He, Changda Li, Hua Chen, Peifu Tang","doi":"10.1111/os.14326","DOIUrl":"10.1111/os.14326","url":null,"abstract":"<p><strong>Objective: </strong>There are many advantages to stabilize the posterior pelvic ring injuries with a transiliac-transsacral (TITS) screw percutaneously. To identify the correct entry point and insert a guidewire accurately for a TITS screw, we propose a method of specifying the optimal entry point, and introduce a technique of enabling freehand placement of a guidewire with fluoroscopic guidance.</p><p><strong>Methods: </strong>In this retrospective study, 116 patients who underwent pelvic CT scans and pelvic lateral radiographs at our institution from January 2020 to April 2022 were enrolled. The optimal entry point for a TITS screw was formulated in the strict mid-sagittal CT plane, and then transferred to the pelvic lateral radiograph relying on the sacral cortexes which were easily visible even in the poor fluoroscopy. The relative position of this point to other anatomical markers was checked to confirm its feasibility as an entry point. With the method to locate the entry point, 18 patients suffered the posterior pelvic ring injuries were treated with TITS screws through hammering a reverse Kirschner wire (K-wire) to insert a guidewire assisted by a canula, followed by the validation of the screw placement accuracy.</p><p><strong>Results: </strong>The transferred point in radiograph was consistently beneath the sacral alar slope, and located posteroinferior to the iliac cortical density (ICD) and anterosuperior to the sacral nerve root tunnel in all 116 patients. In clinical practice, 18 TITS screws were successfully placed in 18 patients without cortex violation. The average operative time for each screw was 20.11 ± 6.29 min, with an average of 14.11 ± 6.81 fluoroscopic shots per screw. At the 3-month follow-up, fracture healing was confirmed in all patients. The average Majeed score was 89.61 ± 6.90 at the final follow-up.</p><p><strong>Conclusions: </strong>It's feasible to identify an entry point for a TITS screw based on the sacral cortexes, and hammering a reverse K-wire assisted by a percutaneous kyphoplasty (PKP) canula is a safe and practical technique for guidewire insertion.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":"781-789"},"PeriodicalIF":1.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11872379/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142896531","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":"Popliteal Artery Injury After Arthroscopic Knee Surgery: A Retrospective Multicenter Cohort Study.","authors":"Zhenmu Xu, Kai Jiang, Yueming Chen, Hao He, Weihong Zhu","doi":"10.1111/os.14334","DOIUrl":"10.1111/os.14334","url":null,"abstract":"<p><strong>Objective: </strong>Popliteal artery injury is a rare but serious complication of arthroscopic knee surgery. The absence of comprehensive data and standardized guidelines underscores the urgent need for further investigation. This study examines the incidence, risk factors, management strategies, and long-term outcomes of popliteal artery injury in the context of arthroscopic knee procedures.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study utilizing data from 21 medical institutions in Hunan Province, China, from January 2018 to December 2022. We identified patients who underwent arthroscopic knee surgery and complained of postsurgical popliteal artery injury. Patients were followed up for 43.1 ± 13.23 months (ranging from 22 to 58 months). The primary outcome was joint function, which was evaluated by a postoperative range of motion (ROM), International Knee Documentation Committee (IKDC) scores, Lysholm knee scores, and Visual Vascular Quality of Life Questionnaire (VascuQoL) scores. These data from different postoperative periods were compared via paired t-test to assess postoperative recovery. The secondary outcome was vascular patency of the affected limb, which was evaluated through vascular color Doppler ultrasound.</p><p><strong>Results: </strong>Among the 17,000 knee arthroscopic procedures analyzed, 10 patients were identified with popliteal artery injury (0.059%). The surgeries performed included arthroscopic cystectomy for popliteal cysts, cruciate ligament reconstruction, and posterior horn of the lateral meniscus repair. Treatments for popliteal artery injury included percutaneous intravascular stent implantation (one patient), direct suture repair (four patients), allograft vascular transplantation (one patient), and reconstruction with an autogenous greater saphenous vein (four patients). After a mean follow-up time of 43.1 ± 13.23 months (ranging from 22 to 58 months), no complications were reported. Compared with patients at 1 month after surgery, patients at 2 years after surgery presented improved knee function and ROM. The average Lysholm score increased significantly from 13.8 ± 4.21 to 68.2 ± 15.50, the IKDC score increased from 11.6 ± 2.46 to 48.1 ± 11.75, and the VascuQoL score improved from 54.8 ± 9.54 to 92.5 ± 15.90. Knee extension improved from 13.3° ± 2.36° to 3.5° ± 4.12°, and knee flexion increased from 49.5° ± 12.57° to 107° ± 21.63°. All patients successfully resumed daily activities postoperatively.</p><p><strong>Conclusion: </strong>Popliteal artery injury is a catastrophic complication that warrants significant attention during knee arthroscopy. This injury can occur in various types of arthroscopic knee procedures. Prompt diagnosis and effective intervention are crucial for minimizing the potential detriment associated with popliteal artery injury.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":"822-830"},"PeriodicalIF":1.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11872355/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142906925","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":"Surgical Treatment of Coronoid Fracture With Elbow Varus Posteromedial Rotatory Instability: An Instructional Review.","authors":"Xinan Zhang, Yongqing Wang, Xiaohui Li","doi":"10.1111/os.14348","DOIUrl":"10.1111/os.14348","url":null,"abstract":"<p><p>Varus posteromedial rotatory instability (VPMRI) of the elbow is one of the complex elbow instability. The primary sites of injury encompass fractures of the anteromedial coronoid process and injuries to the lateral collateral ligament of the elbow. Some patients may present with involvement of the medial collateral ligament of the elbow. Owing to its distinctive injury mechanism and imaging characteristics, this condition is infrequent in clinical practice and susceptible to misdiagnosis and missed diagnosis. Literature reviews indicate that conservative management of VPMRI is associated with numerous complications, such as persistent pain, traumatic arthritis, and chronic elbow instability. Consequently, surgical intervention has emerged as the recommended treatment modality. Nonetheless, the lack of systematic research on VPMRI in clinical practice has been inconclusive regarding the optimal internal fixation techniques and surgical approaches. Therefore, investigating the treatment modalities, surgical techniques, and internal fixation strategies for VPMRI associated with coronoid fractures holds substantial importance for informing clinical management. In this review, we systematically synthesize the existing literature on coronoid fractures with VPMRI for offering a valuable reference for future clinical treatment.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":"694-702"},"PeriodicalIF":1.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11872376/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142927674","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":"Treatment of Type IV Fragility Fractures of Pelvis With Robotic-Assisted Minimally Invasive Triangular Fixation.","authors":"Wei Tian, Feng-Shuang Jia, Jia-Ming Zheng, Zhao-Jie Liu, Jian Jia","doi":"10.1111/os.14338","DOIUrl":"10.1111/os.14338","url":null,"abstract":"<p><strong>Objective: </strong>Type IV fragility fractures of pelvis (FFP IV) are serious and complicated and the treatment is challengeable. Robotic-assisted minimally invasive triangular fixation (RoboTFX) is a new and advanced technique to treat this injury. The objective of this report is to evaluate the clinical outcomes of FFP IV treated with RoboTFX.</p><p><strong>Methods: </strong>From March 2017 to December 2022, 22 consecutive patients with FFP IV were included in the study. Patients were divided into two groups according to the surgical method employed (RoboTFX or robotic-assisted minimally invasive iliosacral screws, RoboISS). Between two groups, we compared clinical data on operation time, intraoperative bleeding, intraoperative fluoroscopy time, favorable fracture healing rate, implant loosening rate, and Majeed pelvic outcome score.</p><p><strong>Results: </strong>All operations were undertaken from 3 to 15 days (average 5.7 ± 1.7 days) following primary injuries. All patients were followed up continuously 15 months. The average surgical time was 125.3 ± 15.5 (55-190) min in group RoboTFX, 137.1 ± 17.2 min in group RoboISS (p > 0.05). The average amount of intraoperative bleeding was 320.4 ± 25.2 (50-550) mL in group RoboTFX, 302.4 ± 21.5 (50-500) mL in Group 2 (p > 0.05). The average intraoperative fluoroscopy time of the two groups was 23.3 ± 4.5 (15-35) s in group RoboTFX and 40.3 ± 3.8 (10-75) s in group RoboISS (p < 0.05). No patients experienced loss of reduction, 5 of 40 screws had implant loosening in group RoboTFX, meanwhile 13 of 48 screws had implant loosening in Group 2. Four of 20 vertical sacral fractures were healed undesirable including 2 nonunion and the favorable healing rate of 80% in group RoboTFX, meanwhile 8 of 24 fractures were undesirable including 4 nonunion and the favorable healing rate was 66.7% in group RoboISS. Implant loosening rate in the RoboTFX group were all significantly better than those of the RoboISS group (p < 0.05). There were no occurrences of wound infection in both groups, and Majeed scores for the last follow-up were 76.2 ± 3.4 in group RoboTFX and 74.2 ± 2.7 in group RoboISS (p > 0.05).</p><p><strong>Conclusion: </strong>RoboTFX has the advantages of less intraoperative fluoroscopy and implant loosening rate compared to RoboISS which is better than other methods. We thus recommend RoboTFX as an effective option for treating FFP IV. However, the indications of its operation should be strictly evaluated.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":"848-857"},"PeriodicalIF":1.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11872377/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142896536","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":"Comprehensive Analysis Reveals the Potential Diagnostic Value of Biomarkers Associated With Aging and Circadian Rhythm in Knee Osteoarthritis.","authors":"Hao Li, Yuze Yang, Bo Li, Jiaju Yang, Pengyu Liu, Yuanpeng Gao, Min Zhang, Guangzhi Ning","doi":"10.1111/os.14370","DOIUrl":"10.1111/os.14370","url":null,"abstract":"<p><strong>Objective: </strong>Knee osteoarthritis (KOA) is characterized by structural changes. Aging is a major risk factor for KOA. Therefore, the objective of this study was to examine the role of genes related to aging and circadian rhythms in KOA.</p><p><strong>Methods: </strong>This study identified differentially expressed genes (DEGs) by comparing gene expression levels between normal and KOA samples from the GEO database. Subsequently, we intersected the DEGs with aging-related circadian rhythm genes to obtain a set of aging-associated circadian rhythm genes differentially expressed in KOA. Next, we conducted Mendelian randomization (MR) analysis, using the differentially expressed aging-related circadian rhythm genes in KOA as the exposure factors, their SNPs as instrumental variables, and KOA as the outcome event, to explore the causal relationship between these genes and KOA. We then performed Gene Set Enrichment Analysis (GSEA) to investigate the pathways associated with the selected biomarkers, conducted immune infiltration analysis, built a competing endogenous RNA (ceRNA) network, and performed molecular docking studies. Additionally, the findings and functional roles of the biomarkers were further validated through experiments on human cartilage tissue and cell models.</p><p><strong>Results: </strong>A total of 75 differentially expressed aging-circadian rhythm related genes between the normal group and the KOA group were identified by difference analysis, primarily enriched in the circadian rhythm pathway. Two biomarkers (PFKFB4 and DDIT4) were screened by MR analysis. Then, immune infiltration analysis showed significant differences in three types of immune cells (resting dendritic cells, resting mast cells, and M2 macrophages), between the normal and KOA groups. Drug prediction and molecular docking results indicated stable binding of PFKFB4 to estradiol and bisphenol_A, while DDIT4 binds stably to nortriptyline and trimipramine. Finally, cell lines with stable expression of the biomarkers were established by lentiviral infection and resistance screening, Gene expression was significantly elevated in overexpressing cells of PFKFB4 and DDIT4 and reversed the proliferation and migration ability of cells after IL-1β treatment.</p><p><strong>Conclusions: </strong>Two diagnostic and therapeutic biomarkers associated with aging-circadian rhythm in KOA were identified. Functional analysis, molecular mechanism exploration, and experimental validation further elucidated their roles in KOA, offering novel perspectives for the prevention and treatment of the disease.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":"922-938"},"PeriodicalIF":1.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11872380/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143024189","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":"A Study on the Effects of Gluteal Muscle Activation on the Electromyography of Lower Limb Muscles in Young Male Patients With Patellofemoral Pain Syndrome.","authors":"Wu Yue, Ren Shuang, Huang Hongshi, Ao Yingfang, Gou Bo","doi":"10.1111/os.14320","DOIUrl":"10.1111/os.14320","url":null,"abstract":"<p><strong>Objective: </strong>Patellofemoral pain syndrome (PFPS) is a common knee issue, and hip joint function significantly affects knee health. Gluteus activation exercises are a promising treatment for PFPS. This study aims to investigate the impact of gluteal muscle activation exercises on the muscle involvement and movement patterns of young male patients with PFPS.</p><p><strong>Methods: </strong>Our study was a randomized controlled clinical trial study from June 2020 to December 2021, included 18 young male patients with PFPS, randomly divided into two groups: the gluteus activation group (GAG) and control group (CON), with nine cases in each group. The GAG underwent gluteal muscle activation exercises for 40 min per session, three times per week, for 6 weeks; the CON received no intervention. At baseline and after 6 weeks, the integrated electromyography (IEMG), contribution rates (CRs), and activation times (ATs) of the gluteus maximus (GM), vastus medialis (VM), rectus femoris (RF), vastus lateralis (VL), biceps femoris (BF), and semitendinosus (ST) muscles of the affected lower limb during stair-climbing exercise were assessed. Additionally, the explosive power (EP) of the lower limbs and the visual analog scale (VAS) pain value of the knee joint were evaluated. Paired sample t-tests and independent sample t-tests were used to compare the differences within and between groups.</p><p><strong>Results: </strong>After 6 weeks, the GAG showed a significant increase in the IEMG of GM by 118 ± 67.09 μVs compared to CON (p < 0.05), and an increase in the CR of the GM by 6.75% (p < 0.05). Additionally, the AT of the GM and BF was significantly reduced (p < 0.05), and the lower limb EP increased by 14.66% compared to the CON (p < 0.05). Concurrently, there was a very significant reduction in the knee VAS pain score (p < 0.01). The CON exhibited no significant changes in the EMG indices of the lower limbs, EP, and VAS before and after the 6 weeks (p > 0.05).</p><p><strong>Conclusion: </strong>A 6-week gluteal muscle activation training program for patients with PFPS can adjust and optimize the IEMG, CR, and firing order of the lower limb muscle groups, enhance EP, and alleviate pain.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":"744-752"},"PeriodicalIF":1.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11872381/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143053049","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":"Biomechanical Comparison of a Novel Facet Joint Fusion Fixation Device With Conventional Pedicle Screw Fixation Device: A Finite Element Analysis.","authors":"Feilong Sun, Haiyang Qiu, Yufei Ji, Longchao Wang, Wei Lei, Yang Zhang","doi":"10.1111/os.70003","DOIUrl":"https://doi.org/10.1111/os.70003","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;The biomechanics of a novel facet joint fusion device is unknown. The objective of this study is to analyze and compare the biomechanical properties of a novel facet joint fusion device integrated with oblique lateral interbody fusion (OLIF) to those of a conventional pedicle screw fixation device, employing finite element analysis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A comprehensive three-dimensional finite element model of the L3-S1 lumbar spine was developed and validated. Based on this model, three surgical groups were created: OLIF combined with the bilateral facet joint fusion fixation (BFJFF + OLIF), unilateral pedicle screw fixation (UPSF + OLIF), and bilateral pedicle screw fixation (BPSF + OLIF), focusing on the L4-L5 level. A torque of 7.5 Nm was applied to simulate vertebral activities under six conditions: flexion, extension, lateral bending (left and right), and axial rotation (left and right). The maximum displacement at the L4-L5 segment was then calculated. The maximum stress values were recorded at the L4-L5 interbody fusion cage and the L3-L4 and L5-S1 segments.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;When compared to the other two models, the BFJFF + OLIF model exhibited the smallest maximum displacement value at the L4-L5 segment across all six working conditions. The BFJFF + OLIF model also demonstrated the lowest maximum stress value at the L4-L5 segment interbody fusion cage under flexion, as well as left and right lateral bending and axial rotation conditions when compared with the other models. However, under the extension condition at the L4-L5 interbody fusion cage, the BPSF + OLIF model showed the lowest maximum stress value. At the adjacent L3-L4 segments, the BFJFF + OLIF model registered the lowest maximum stress value during flexion and left lateral bending conditions. At L3-L4, under extension and right lateral bending conditions, the UPSF + OLIF model exhibited the lowest maximum stress value. Under left axial rotation at the L3-L4 segment, both the BFJFF + OLIF and UPSF+OLIF models demonstrated the smallest maximum stress values. Under right axial rotation at the L3-L4 segment, the BPSF + OLIF model recorded the smallest maximum stress value. Concurrently, at the L5-S1 segment, the BFJFF + OLIF model presented the lowest maximum stress value under conditions of flexion, as well as left and right lateral bending and axial rotation. In the L5-S1 segment during the extension condition, the UPSF+OLIF model exhibited the lowest maximum stress value.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;This study demonstrates that the novel device, when combined with OLIF, achieves 360° lumbar fusion by fusing the lumbar facet joints, thereby enhancing spinal stability post-fusion. Concurrently, stress on adjacent segments was diminished. The findings suggest that this device may serve as a novel internal fixation method. It may provide a new option for the surgical treatment of patients with low back pain in the fut","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143523926","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Paraspinal Sarcopenia on Clinical Outcomes in Intervertebral Disc Degeneration Patients Following Percutaneous Transforaminal Endoscopic Lumbar Discectomy.","authors":"Tianci Fang, Zhifang Xue, Quan Zhou, Jiawen Gao, Jian Mi, Huilin Yang, Feng Zhou, Hao Liu, Junxin Zhang","doi":"10.1111/os.70006","DOIUrl":"https://doi.org/10.1111/os.70006","url":null,"abstract":"<p><strong>Objective: </strong>The paraspinal muscles are a crucial component of the spine's extrinsic stabilization system. While the impact of paraspinal muscle sarcopenia on patient-reported outcome measures (PROMs) after lumbar surgery is well known, its effects following percutaneous transforaminal endoscopic discectomy (PTED) have not been investigated. To investigate the prognostic value of preoperative paraspinal sarcopenia on long-term PROMs after PTED, and to identify independent predictors of chronic postoperative low back pain.</p><p><strong>Methods: </strong>In this retrospective cohort study, 145 patients who underwent PTED for lumbar disc herniation (2017-2022) were stratified into sarcopenia (n = 52) and non-sarcopenia (n = 93) groups using sex-specific psoas muscle index (PMI) thresholds (male: < 6.36 cm²/m²; female: < 3.92 cm²/m²). Preoperative MRI/CT was used to quantify paraspinal muscle parameters, including PMI, multifidus muscle index (MMI), erector spinae muscle index (EMI), Goutallier-classified fat infiltration (FI) severity (Grades 0-4), and multifidus muscle density (MMD). Primary outcomes were assessed via the visual analog scale (VAS; 0-10) and Oswestry disability index (ODI; 0%-100%) at preoperative, 1-month, 6-month, and final follow-up (mean 65.6 weeks). Multivariate logistic regression was performed to identify independent predictors of chronic pain (defined as VAS ≥ 4 at final follow-up).</p><p><strong>Results: </strong>The study cohort comprised 145 patients (69 female, 76 male; mean age: 50.1 ± 7.6 years). The sarcopenia group exhibited significantly lower muscle indices (PMI: 4.55 vs. 7.48 cm²/m², p < 0.001, MMI: 2.61 ± 0.80 vs. 3.66 ± 0.94 cm²/m², p < 0.001, EMI: 9.72 ± 2.46 vs. 12.54 ± 2.27 cm²/m², p < 0.001) and higher FI severity (p < 0.05). At final follow-up, the sarcopenia group reported significantly worse pain (VAS: 3.04 ± 1.25 vs. 2.31 ± 1.50, p = 0.004) and disability (ODI: 28.33 ± 6.61 vs. 21.57 ± 7.28, p < 0.001). Multivariate analysis identified BMI (OR = 1.319), PMI (OR = 0.745), MMI (OR = 0.454), and moderate/severe multifidus FI (OR = 7.036) as independent predictors of chronic pain (all p < 0.05).</p><p><strong>Conclusion: </strong>Paraspinal sarcopenia, particularly multifidus degeneration, is a modifiable determinant of chronic pain after PTED. Preoperative muscle quality assessment combined with targeted rehabilitation may optimize outcomes.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143516309","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":"Neutrophil-Lymphocyte Ratio as Predictor for Acute Infection After Primary Total Joint Arthroplasty in Rheumatoid Arthritis Patients.","authors":"Yahao Lai, Jiaxuan Fan, Ning Lv, Xiaoyu Li, Wenxuan Zhao, Zeyu Luo, Zongke Zhou","doi":"10.1111/os.70002","DOIUrl":"https://doi.org/10.1111/os.70002","url":null,"abstract":"<p><strong>Objectives: </strong>Preoperative levels of certain inflammatory markers in the blood can predict acute infection after primary total joint arthroplasty in patients without inflammatory disease, but whether they can do so in patients with rheumatoid arthritis is unclear. The objectives of this study were to determine whether, with appropriate cut-off values, (1) preoperative levels of NLR predicted postoperative acute infection; and (2) preoperative plasma fibrinogen, monocyte-lymphocyte ratio, C-reactive protein or erythrocyte sedimentation rate predicted postoperative acute infection.</p><p><strong>Methods: </strong>We retrospectively analyzed 964 patients with rheumatoid arthritis who underwent primary total joint arthroplasty at our hospital between January 2010 and November 2020. We compared preoperative levels of inflammatory markers including neutrophil-lymphocyte ratio (NLR), monocyte-lymphocyte ratio (MLR), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), plasma fibrinogen (FIB) between patients who suffered acute infection or not within 90 days after surgery. The ability of markers to predict infection was assessed in terms of the area under receiver operating characteristic curves (AUC) based on optimal cut-off values determined from the Youden index.</p><p><strong>Results: </strong>Among the 964 patients, 27 (2.8%) experienced acute infection. Preoperative levels of individual inflammatory markers predicted infection with the following AUCs and cut-off values: NLR, 0.704 (cut-off: 2.528); MLR, 0.608 (0.2317); CRP, 0.516 (4.125 mg/L); ESR, 0.533 (66.5 mm/h); and FIB, 0.552 (3.415 g/L). The neutrophil-lymphocyte ratio showed diagnostic sensitivity of 92.6% and specificity of 43.3%, while the monocyte-lymphocyte ratio showed sensitivity of 77.8% and specificity of 46.3%.</p><p><strong>Conclusion: </strong>The preoperative NLR shows some ability to predict acute infection after total joint arthroplasty in patients with rheumatoid arthritis. Monitoring this ratio, perhaps in conjunction with other markers not analyzed here, may be useful for optimizing the timing of surgery in order to minimize risk of postoperative infection.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143516313","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What Is the Optimal Position of Low Tibial Tunnel in Transtibial Posterior Cruciate Ligament Reconstruction? A Quantitative Analysis Based on 2D CT Images and 3D Knee Models.","authors":"Laiwei Guo, Xiaoyun Sheng, Caijuan Dai, Xingwen Wang, Lianggong Zhao, Xiaohui Zhang, Bin Geng, Zhongcheng Liu, Rui Bai, Xiaoli Zheng, Meng Wu, Yuanjun Teng, Yayi Xia","doi":"10.1111/os.14379","DOIUrl":"https://doi.org/10.1111/os.14379","url":null,"abstract":"<p><strong>Objectives: </strong>There is currently no consensus on the optimal placement of the low tibial tunnel for posterior cruciate ligament (PCL) reconstruction. This study aimed to perform the quantitative measurements of the optimal tangential low tibial-tunnel (OTLT) parameters based on 2D CT images and 3D virtual knee models and expect to provide reference data for clinical creation of the OTLT during the arthroscopic transtibial PCL reconstruction.</p><p><strong>Methods: </strong>This was a retrospective CT image study. A total of 101 patients between January 2018 and December 2020 were included in our study for analysis. The CT image data of included patients were imported into Mimics software to create the 3D knee models, and the OTLT for PCL reconstruction was simulated on 2D CT images and 3D knee models, respectively. With that, the distances of the tunnel's entry (ADT) and exit points (BDT) to the tibial plateau, the length of the tunnel (LT), and the angle of the tunnel (AT) were measured. Variables were compared using the independent t-test or the Mann-Whitney u test. Correlation analyses between the data and patient demographic factors were performed using the Pearson or Spearman correlation analysis. One-way ANOVA was used to compare differences among height subgroups.</p><p><strong>Results: </strong>The mean ADT, LT, and AT on 2D CT images were 57.96 ± 5.34 mm, 39.92 ± 5.49 mm, and 37.23° ± 4.57° respectively, smaller than the values on 3D knee models (61.86 ± 6.80 mm, 45.56 ± 4.27 mm, and 48.17° ± 6.12°, all p values < 0.001). While the mean BDT on 2D CT images was significantly larger than 3D knee models (35.28 ± 3.07 mm vs. 29.72 ± 3.00 mm, p < 0.001). The BDT showed larger in males than females, the LT showed larger in the taller group, and the AT seemed to be larger in females and shorter people (all p values < 0.05).</p><p><strong>Conclusion: </strong>The quantitative parameters of the OTLT based on 2D CT images and 3D knee models can be used as reference data for clinical surgeons to build an anteromedial OTLT during the arthroscopic transtibial PCL reconstruction.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143516318","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}