Orthopaedic Surgery最新文献

{"title":"4in1 Procedure in Treating Congenital Dislocation of Patella in Children.","authors":"Meng-Jie Chen, Yi-Chen Wang, Qi-Chao Ma, Qin Zhang, Ting-Ting Li, Fang-Chun Jin, Yi Luo","doi":"10.1111/os.70144","DOIUrl":"10.1111/os.70144","url":null,"abstract":"<p><strong>Objectives: </strong>Congenital dislocation of patella (CDP) is a rare condition and surgery is needed to treat CDP once a diagnosis is made. The 4in1 procedure includes lateral release, correction of quadriceps, Roux-Goldthwait procedure, and medial patello-femoral ligament (MPFL) reconstruction. This study was aimed at evaluating the efficacy and outcome of the 4in1 procedure in the operative treatment of CDP.</p><p><strong>Methods: </strong>CDP patients were retrospectively collected from two operative centers from January 2013 to December 2024. For all patients, patellae on both sides were examined by x-ray, CT, and MR bilaterally. Ten patients (14 patellae) underwent 4in1 procedure. Gradual passive and active exercises of knee motion and quadriceps were begun as tolerated. Kujala Score was collected before and after the operation.</p><p><strong>Results: </strong>This cohort included 10 patients (4 males, 6 females), with 4 cases of bilateral involvement and 6 unilateral cases (total 14 limbs). The mean age at surgery was 8.36 years (4-14 years), with an average surgical duration of 157.7 min and intraoperative blood loss of 35.6 mL. Kujala scores improved from 39.9 preoperatively to 82.9 postoperatively (p < 0.001). All patients were followed up for at least 1 year. All patellae were centerized on the groove postoperatively with no recurrence.</p><p><strong>Conclusion: </strong>CDP is a rare lower limb skeletal disorder requiring thorough evaluation. Early diagnosis and 4in1 procedure optimize patellar stability and knee function, preventing long-term complications.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":"2647-2652"},"PeriodicalIF":2.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12404859/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144760705","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":"Analysis of Intraoperative and Postoperative Hinge Fractures of Patients With Genu Valgum Treated With Lateral Open Wedge Distal Femoral Osteotomy.","authors":"Zijian Lian, Bin Zhao, Jianxiong Ma, Songqing Ye, Haohao Bai, Zhihu Zhao, Xuan Jiang, Fei Xing, Yao Deng, Wei Luo, Xinlong Ma","doi":"10.1111/os.70142","DOIUrl":"10.1111/os.70142","url":null,"abstract":"<p><strong>Objective: </strong>Hinge fracture is a known complication of lateral open wedge distal femoral osteotomy (LOWDFO). However, few studies have differentiated between intraoperative hinge fractures (IHF) and postoperative hinge fractures (PHF). This study aims to investigate the causes of these two types of fractures to help reduce complication rates and improve surgical outcomes.</p><p><strong>Methods: </strong>We retrospectively analyzed data from 100 patients with genu valgum deformity and lateral unicompartmental osteoarthritis who underwent distal femoral osteotomy at our hospital between January 1st, 2022, and January 1st, 2024, in our hospital. Clinical parameters, radiological data, and the associated factors influencing IHF and PHF were analyzed. Radiological data such as mechanical axis deviation (MAD) and mechanical lateral distal femur angle (mLDFA) were collected. Clinical outcomes such as osteoarthritis index and time of healing were evaluated. Based on fracture morphology, IHF and PHF were further classified into Type 1 (extension), Type 2 (distal) and Type 3 (proximal) for detailed analysis. Statistical analyses included t-tests, Chi-square tests, and regression models to identify factors associated with IHF and PHF.</p><p><strong>Results: </strong>A total of 87 patients were included in this study. The mean healing time of patients with all kinds of hinge fractures (3.4 ± 1.2 months) was longer than that of patients with no hinge fractures (2.8 ± 0.7 months), which was significant, p = 0.013. The MAD correction, mLDFA correction, and mLDFA correction ratio were related to hinge fractures (p = 0.010, 0.002, and 0.002 respectively). The body weight was higher in all types of hinge fractures group (IHF and PHF together) than the no hinge fractures group. The IHF group had a longer time of healing than the no IHF group. In the IHF group, the mLDFA correction (p = 0.005), mLDFA correction ratio (p = 0.005), and BMI (p = 0.031) were higher than the no IHF group. The PHF was related to hinge position. The group of hinge localized proximal to the adductor tubercle (AT) had a higher rate of PHF than the group of hinge localized in the adductor tubercle (p = 0.001). The healing time in the IHF group (3.9 ± 1.4 months) was significantly longer than the healing time in the PHF group (2.7 ± 0.4 months) (p = 0.002).</p><p><strong>Conclusion: </strong>In patients with genu valgum undergoing LOWDFO, IHF and PHF represent distinct clinical entities. IHF is associated with greater mLDFA correction, higher mLDFA correction ratios, and increased body weight. In contrast, PHF is primarily associated with hinge position, with a higher incidence observed when the hinge is located proximal to the adductor tubercle. Among the two, IHF has a more pronounced impact on delayed bone healing.</p><p><strong>Level of evidence: </strong>Retrospective study Level IV.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":"2629-2639"},"PeriodicalIF":2.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12404878/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144784919","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":"Resorbable Bio-Inductive Collagen Implant for Rotator Cuff Repair: What We Know, What We Need to Know, and the Path Forward.","authors":"Jiaxin Tian, Fengxing Ding, Zhe Wang, Niu Muting, Chen Liu, Zipeng Ye, Huiang Chen, Caizhi Wu, Shaowei Yi, Yubo Fan, Jinzhong Zhao, Shiyi Cao, Bin Ma","doi":"10.1111/os.70141","DOIUrl":"10.1111/os.70141","url":null,"abstract":"<p><strong>Objectives: </strong>Rotator cuff injuries are a leading cause of shoulder dysfunction, where bio-inductive collagen implants have demonstrated promising results in promoting tendon regeneration and reducing retear rates. However, existing evidence lacks consistent evaluation across varying follow-up durations, while the specific factors influencing their safety and effectiveness remain undetermined. This study aims to evaluate the quality of evidence regarding the safety, efficacy, and impact factors of applying the resorbable bio-inductive collagen implant clinically to repair rotator cuff injuries.</p><p><strong>Methods: </strong>The study protocol was registered on PROSPERO (CRD42022367522). A systematic literature search of PubMed, Web of Science, Embase, and Cochrane Library (from inception to October 2024) for clinical studies on bio-inductive collagen implants for rotator cuff repair. Two investigators independently screened studies, extracted data, and assessed quality (using RoB1 for RCTs, NOS for cohort studies and JBI critical appraisal tools for case series). Primary outcomes included postoperative tendon thickness, shoulder function scores (ASES/Constant), and re-tear rates. Data were analyzed using random/fixed-effects models to calculate mean differences (MDs) with 95% CIs, with subgroup analyses for tear type, patient age, and postoperative mobilization time. Statistical analyses were performed using Stata 17.0.</p><p><strong>Results: </strong>Seventeen studies were included. The meta-analysis results showed that postoperative tendon thickness of the patients increased statistically compared with the baseline, at 3 months (MD = 2.22; 95% CI: 1.61, 2.83; p < 0.001), 6 months (MD = 2.30; 95% CI: 1.44, 3.16; p < 0.001), 12 months (MD = 2.15; 95% CI: 1.58, 2.72; p < 0.001), and 24 months (MD = 1.05; 95% CI: 0.02, 2.08; p = 0.045). Postoperative shoulder joint function improved significantly. The ASES score and Constant score of the patients were significantly higher than the baseline at 6 months (ASES: MD = 35.90; 95% CI: 32.97, 38.83; p < 0.001), 12 months (ASES: MD = 40.83; 95% CI: 37.56, 44.10; p < 0.001; Constant: MD = 28.59; 95% CI: 21.44, 35.74; p < 0.001), and 24 months (ASES: MD = 39.80; 95% CI: 31.32, 48.27; p < 0.001; Constant: MD = 32.84; 95% CI: 28.72, 36.97; p < 0.001).</p><p><strong>Conclusion: </strong>The bio-inductive collagen implant is effective and safe for healing rotator cuff injuries. Patient age may be an important moderator affecting its efficacy. The impact of tear size and postoperative activities on efficacy needs to be further explored through in-depth clinical studies.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":"2541-2557"},"PeriodicalIF":2.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12404871/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144804494","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Prognostic Role of Perioperative Dexamethasone in Aseptic Revision Hip Arthroplasty-A Retrospective Cohort Study.","authors":"Qiyu Xie, Zhixin Liao, Hong Xu, Wai Yao, Xuming Chen, Xufeng Wan, Duan Wang, Zongke Zhou","doi":"10.1111/os.70113","DOIUrl":"10.1111/os.70113","url":null,"abstract":"<p><strong>Objective: </strong>Aseptic hip revision arthroplasty often results in significant postoperative pain, inflammation, nausea, and vomiting. While perioperative dexamethasone has demonstrated benefits in primary hip arthroplasty, its efficacy and safety in revision procedures remain unclear. This study aims to evaluate the effects of perioperative dexamethasone on postoperative pain, inflammation, postoperative nausea and vomiting (PONV), and safety in aseptic hip revision.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted on 414 patients undergoing aseptic hip revision arthroplasty between 2008 and 2023. Patients were categorized into two groups: those receiving dexamethasone perioperatively (n = 218) and a control group (n = 196). Outcomes included Visual Analog Scale (VAS) pain scores, inflammation markers including C-reactive protein (CRP) and interleukin-6 (IL-6), PONV incidence, analgesic and antiemetic usage, length of stay (LOS), and postoperative complications. Independent samples t-test or Mann-Whitney U test is applied to continuous variables based on normality, while chi-square test or Fisher's exact test is used for categorical variables according to sample size.</p><p><strong>Results: </strong>The dexamethasone group (average dose: 12.67 mg) exhibited significantly lower VAS scores (p < 0.001) and reduced morphine use on postoperative days (PODs) 1-3. CRP (POD2: 40.60 mg/L vs. 111.66 mg/L) and IL-6 levels (POD1: 31.85 pg/mL vs. 138.28 pg/mL) were significantly lower in the dexamethasone group (both p < 0.001). PONV incidence (28.4% vs. 40.81%) and antiemetic usage were reduced in the dexamethasone group. No significant differences were observed in LOS or postoperative complications between the two groups.</p><p><strong>Conclusion: </strong>Perioperative low-dose dexamethasone effectively mitigates pain, inflammation, and PONV in aseptic hip revision arthroplasty without increasing the risk of complications.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":"2570-2578"},"PeriodicalIF":2.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12404864/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144765124","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":"Minimal Clinically Important Differences in Conservative Treatment Versus Hip Arthroscopy for Femoroacetabular Impingement Syndrome: A Frequentist Meta-Analysis of RCTs.","authors":"Nikolai Ramadanov, Jonathan Lettner, Maximilan Voss, Robert Prill, Robert Hable, Dobromir Dimitrov, Roland Becker","doi":"10.1111/os.70097","DOIUrl":"10.1111/os.70097","url":null,"abstract":"<p><p>Several meta-analyses of surgical versus non-operative treatment of femoroacetabular impingement syndrome (FAIS) have been published, but reliable evidence is still lacking. The aim of this meta-analysis of randomized controlled trials (RCTs) was to assess the outcomes of FAIS patients treated conservatively compared with those treated with hip arthroscopy (HAS). PubMed, CENTRAL of the Cochrane Library, Epistemonikos, and Embase databases were searched up to March 31, 2025. Quality was assessed using the Cochrane Risk of Bias 2 tool, the level of evidence for each outcome parameter was determined using the GRADE system, and publication bias was presented in funnel plots. In a common effect and random effects meta-analysis, mean differences (MDs) between the conservative treatment group and the HAS group were calculated with 95% confidence intervals (CIs) using the Hartung-Knapp-Sidik-Jonkman heterogeneity estimator. A total of 7 RCTs with a total of 489 patients in the conservative treatment group and 484 patients in the HAS group met the inclusion criteria. Of the 7 RCTs included, four were assessed as having a low risk of bias, one as having a moderate risk of bias, and two as having a high risk of bias. The outcomes \"post-intervention functional MCID\" and \"iHOT at ≤ 12 months post-intervention\" had a high level of evidence, and the outcome \"HOS-ADL at ≤ 8 months post-intervention\" had a moderate level of evidence. No significant publication bias was detected for any outcome. The HAS group had a statistically significant 0.85 higher post-intervention functional MCID (common effect model: MD: 0.85 CIs 0.53-1.17; random effects model: MD: 0.85 CIs 0.64-1.06; I ² = 0%; τ ² = 0.02; p = 0.96) and a statistically significant 10.74 higher iHOT at ≤ 12 months post-intervention than the conservative treatment group (common effect model: MD: 10.74 CIs 7.06 to 14.42; random effects model: MD: 10.98 CIs 6.62 to 15.34; I ² = 0%; τ ² = 7.52; p = 0.62). There was no difference between the HAS group and the conservative treatment group in HOS-ADL at ≤ 8 months post-intervention (common effect model: MD: 5.62 CIs 1.76 to 9.48; random effects model: MD: 4.10 CIs -12.31 to 20.50; I ² = 69%; τ ² = 29.88; p = 0.04). This meta-analysis using high-quality statistical methods showed a statistically significant higher post-intervention functional MCID and iHOT at ≤ 12 months post-intervention in favor of the HAS group compared to the conservative treatment group. HOS-ADL at ≤ 8 months post-intervention showed no differences.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":"2514-2528"},"PeriodicalIF":2.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12404880/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144567641","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":"Evaluation of Indirect Decompression Effect After Extreme Lateral Lumbar Interbody Fusion Using Three-Dimensional Volumetric Measurements-A Retrospective Study.","authors":"Huiwen Zhou, Hanming Bian, Yiming Zhang, Wentao Wan, Qingqian Zhao, Lianyong Wang, Chao Chen, Yang Liu, Ye Tian, Xinlong Ma, Xinyu Liu, Qiang Yang","doi":"10.1111/os.70108","DOIUrl":"10.1111/os.70108","url":null,"abstract":"<p><strong>Background: </strong>Two-dimensional (2D) radiographic methods are suggested for evaluating radiographic outcomes following indirect decompression via extreme lateral interbody fusion (XLIF). Nonetheless, assessing neural decompression in a single imaging plane could potentially lead to an underestimation of the effects on central canal and foraminal volumes.</p><p><strong>Objective: </strong>This study aims to evaluate the radiographic changes associated with XLIF procedures using three-dimensional (3D) volumetric measurements and to investigate the effect of indirect decompression achieved through this procedure.</p><p><strong>Methods: </strong>The retrospective clinical and radiological data of 44 patients between June 2019 and June 2022 who underwent single- or multilevel XLIF were analyzed. Preoperative and postoperative computed tomography (CT) scans facilitated 3D reconstructions. The effect of indirect decompression, manifesting as the elevation of the cranial vertebra, was quantified by measuring the volumetric change in the spinal canal, calculated through the subtraction of the spinal canal's geometry from a cylinder predefined both preoperatively and postoperatively. The relationship between these volumetric changes and clinical outcomes was then determined. Correlations between changes in volumetric measurements and clinical outcomes were assessed using Pearson's or Spearman's correlation coefficients, depending on the data distribution.</p><p><strong>Results: </strong>Change in the spinal canal volume (ΔV) due to the XLIF proved to be significant (mean ΔV = 1629.28 ± 775.43 mm³, n = 44, p < 0.05). A significant, positive correlation was found between ΔV significant association between pain intensity (low back and leg pain) and the magnitude of the volumetric increase of the spinal canal was shown (p < 0.05 for LP and ODI, p = 0.06 for LBP).</p><p><strong>Conclusion: </strong>The developed method demonstrates accuracy, reproducibility, and applicability for analyzing XLIF, with significant potential for application in other spinal surgical methods. The volumetric changes exhibit predictive capability regarding the extent of indirect spinal canal decompression. A larger ΔV correlates with greater clinical benefits observed in XLIF surgery.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":"2558-2569"},"PeriodicalIF":2.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12404862/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144699189","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":"Application of Transverse Tibial Bone Transfer in Diabetic Foot Patients: A Comprehensive Evaluation of Postoperative Prognostic Factors and Risk Factors.","authors":"Nan Liu, Sihui Dai, Dameng Liu, Xiao Sun, Guoliang Ren, Lijia Pei, Shuming Ye, Jian Huang","doi":"10.1111/os.70124","DOIUrl":"10.1111/os.70124","url":null,"abstract":"<p><strong>Objective: </strong>Diabetic foot is a serious complication of diabetes, often leading to poor prognosis and increased risk of amputation. Transverse tibial bone transport (TTT) has emerged as a promising limb salvage technique. However, some patients still experience adverse postoperative outcomes. This study aimed to analyze the influencing factors for poor prognosis after TTT and explore the correlations and clinical significance of key risk factors.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on the clinical data of 120 diabetic foot patients treated with TTT at the Department of Hand and Foot Surgery, our hospital, from January 2016 to May 2024. The incidence and types of adverse outcomes were recorded. Independent sample t-tests were employed for comparing continuous variables between two groups. Univariate and multivariate logistic regression analyses were used to identify significant prognostic factors. Pearson or Spearman correlation analysis was applied depending on data distribution, and Receiver Operating Characteristic (ROC) curves were constructed to assess diagnostic performance.</p><p><strong>Results: </strong>Among the patients, 95% retained their feet, 81.67% maintained functional feet, and 5% underwent amputation. Complications included osteotomy margin necrosis (8.33%), lower limb venous thrombosis (5.83%), and pin tract infection (2.5%). A total of 26 patients experienced adverse outcomes. Univariate analysis showed significant differences in foot temperature, VAS score, resting pain, transcutaneous oxygen pressure, blood glucose, calcium, and CRP levels (p < 0.05). Multivariate analysis identified foot temperature, transcutaneous oxygen pressure, blood glucose, and CRP as independent risk factors. Correlation analysis revealed that foot temperature was positively correlated with transcutaneous oxygen pressure and negatively correlated with blood glucose and CRP. Blood glucose was positively correlated with CRP. ROC analysis showed good diagnostic performance for foot temperature (AUC = 0.891), transcutaneous oxygen pressure (AUC = 0.954), blood glucose (AUC = 0.850), and CRP (AUC = 0.908), with a combined AUC of 0.998 (Sensitivity = 100.00%, Specificity = 96.81%).</p><p><strong>Conclusion: </strong>This study suggests that foot temperature, transcutaneous oxygen pressure, blood glucose, and CRP are significant risk factors for poor postoperative prognosis in diabetic foot patients undergoing tibial transverse osteotomy. These factors are interrelated and have high diagnostic value for predicting adverse outcomes, especially when used in combination. Clinically, monitoring changes in these factors can help predict the occurrence of poor postoperative outcomes in diabetic foot patients, thereby supporting the development of personalized treatment plans.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":"2708-2716"},"PeriodicalIF":2.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12404873/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144753950","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":"AUSS Assisted ACAF Technique in the Treatment of Ossification of the Posterior Longitudinal Ligament Extending to the C2 Segment.","authors":"Zhishen Niu, Xiaohui Ding, Bin Zhang, Qi Zhang, En Song, Jiangang Shi, Jingchuan Sun","doi":"10.1111/os.70127","DOIUrl":"10.1111/os.70127","url":null,"abstract":"<p><strong>Objective: </strong>This study aims to propose and evaluate the clinical efficacy of a novel non-coaxial endoscopic-assisted technique for establishing the \"Shelter Space\" in Anterior Controllable Antedisplacement and Fusion (ACAF) for treating high-level (C2-involved) cervical ossification of the posterior longitudinal ligament (COPLL).</p><p><strong>Methods: </strong>Sixteen patients diagnosed with high-level OPLL (involving C2) who underwent AUSS (Arthroscopic-Assisted Uni-Portal Spinal Surgery) assisted ACAF treatment were enrolled, and their outcomes were analyzed. The OPLL below C2 was managed via ACAF, including discectomy at involved levels, appropriately removing the anterior part of the affected vertebrae below C2, placement of intervertebral cages, fixation with anterior cervical plates, and isolation of the vertebrae-OPLL complex (VOC). For C2-level OPLL, after achieving hemostasis, the posteroinferior portion of the C2 vertebral body was ground under non-coaxial endoscopic assistance based on the thickness of C2-OPLL to create a \"shelter\" facilitating anterior displacement of the ossified mass posterior to C2. Finally, the C2 OPLL and the VOC from lower segments were elevated. Preoperative and postoperative clinical and radiological parameters, along with surgical complications, were documented.</p><p><strong>Results: </strong>Postoperative CT and MRI confirmed adequate spinal cord decompression using the AUSS assisted ACAF technique. Significant improvements were observed in the Reserve Space for the Cord at the Edge (RSCE) and the occupying rate (OR) of the spinal canal. No specific complications were observed postoperatively. At the final follow-up of 12 months, all patients exhibited marked neurological recovery.</p><p><strong>Conclusion: </strong>The AUSS assisted ACAF technique effectively circumvents the technical challenges and complications associated with traditional open Shelter techniques, enhancing surgical precision and feasibility. This method is a viable, user-friendly, and effective approach for managing high-level COPLL with myelopathy. However, large-scale studies with control groups are warranted to further validate the universality and safety of this technique.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":"2756-2767"},"PeriodicalIF":2.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12404856/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144753951","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 Novel \"Personalized Safe Zone\" for Acetabular Cup Placement During Total Hip Arthroplasty in Patients With Spinopelvic Pathology: Concept, Construction, and Clinical Application.","authors":"Xiaoyu Wan, Tao Li, Jinsong Liu, Jun Luo, Zengrui Zhang, Wenqian Xu, Zhiguang Chen, Jiawen Xia, Yingxing Xu","doi":"10.1111/os.70129","DOIUrl":"10.1111/os.70129","url":null,"abstract":"<p><strong>Objective: </strong>A higher risk of dislocation was still found in patients with spinopelvic disorders, despite the acetabular cup was placed within the classical \"Lewinnek safe zone.\" This study aimed to reveal the risk factors of acetabular cup placement during total hip arthroplasty (THA) in patients with spinopelvic pathology, construct and validate a novel \"Personalized Safe Zone\" based on the Hip-Spine Classification System (HSCS) to reduce the prosthetic impingement and dislocation in these patients.</p><p><strong>Methods: </strong>One retrospective study was conducted on patients with spinopelvic pathologies underwent the primary THA admitted to the First Affiliated Hospital of Kunming Medical University from January 2017 and May 2023. According to the inclusion and exclusion criteria, the general information (Age, gender, Primary disease, Side, BMI) and radiological parameters of patients were collected, including spinal parameters (pelvic incidence [PI], pelvic tilt [PT], sacral slope [SS], lumbar lordosis angle [LL], sagittal vertical axis, thoracic kyphosis angle, cobb angle), pelvic parameters (cup inclination [CI], cup anteversion [CA], disparity in bilateral femoral offset), and spinopelvic parameters (absolute value of PI minus LL [|PI-LL|], change of sacral slope [ΔSS], combined sagittal index [CSI]). The correlation between the above parameters and prosthesis dislocation after THA was assessed and a clinical prediction model was constructed by R language. Subsequently, the ranges of \"Personalized Safe Zone\" for the acetabular cup placement in the four subgroups classified by the HSCS, were defined as the mean ± standard deviation of CA and CI in each nondislocation subgroup, and were validated by a cohort study.</p><p><strong>Results: </strong>There were correlations between ΔSS, |PI-LL|, CA, standing CSI and anterior dislocation, ΔSS, |PI-LL|, CA, sitting CSI and posterior dislocation. The ranges of \"Personalized Safe Zone\" in each subgroup were as follows: 1A (CA = 14.11° ± 4.57°, CI = 38.65° ± 6.32°), 1B (CA = 17.23° ± 3.15°, CI = 38.19° ± 5.45°), 2A (CA = 15.76° ± 4.08°, CI = 38.95° ± 6.21°), 2B (CA = 19.50° ± 3.73°, CI = 39.50° ± 6.48°). Moreover, a significant reduction in prosthesis dislocation and impingement was investigated, when the acetabular cup was placed according to the \"Personalized Safe Zone.\"</p><p><strong>Conclusions: </strong>These parameters, including ΔSS, |PI-LL|, CA, CSI should be fully considered when placing acetabular cup during THA and the novel \"Personalized Safe Zone\" could reduce the dislocation and prosthetic impingement after THA in patients with spinopelvic pathology.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":"2596-2607"},"PeriodicalIF":2.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12404877/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144784918","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":"Radiographic Anatomy and Clinical Value of the Modified Corner Approach in Interlaminar Endoscopic Lumbar Discectomy.","authors":"Sizheng Zhan, Haoning Ma, Yuming Wang, Ping Yi, Xiangsheng Tang","doi":"10.1111/os.70143","DOIUrl":"10.1111/os.70143","url":null,"abstract":"<p><strong>Objective: </strong>The first step of interlaminar endoscopic lumbar discectomy (IELD) is puncture localization, which lacks standardized protocols and requires a significant learning curve. To address this, we developed a modified corner approach targeting the junction of the S1 superior endplate and facet joint. This study aims to characterize the radiographic anatomy and assess the clinical utility of this modified approach.</p><p><strong>Method: </strong>Computed tomography (CT) and magnetic resonance imaging (MRI) data from 100 patients were analyzed to measure distances between the target and adjacent structures (dura sac, pedicle, L5 nerve, and S1 nerve). The learning curve of interlaminar endoscopic lumbar discectomy (IELD) surgery based on the modified corner approach was determined by prospectively collecting data from 80 patients.</p><p><strong>Results: </strong>The mean distance between the target and the dura sac was 4.59 ± 1.74 mm. The mean distance between the target and the inferior border of the L5 nerve was 10.14 ± 1.72 mm, rang from 7.52 to 13.54 mm. The mean distance between the target and the outer edge of the S1 nerve was 0.51 ± 0.91 mm, rang from -0.12 to 2 mm. The mean distance between the target and the inner edge of the S1 pedicle was 3.77 ± 1.04 mm. The distance between the target and the dura sac and the inner edge of the pedicle is mainly affected by the patient's age.</p><p><strong>Conclusion: </strong>The modified corner approach is a simple, safe, and repeatable surgical approach with the intersection of the superior endplate and facet joint as the puncture target. For patients without or with mild facet joint degeneration, the puncture target can be appropriately moved inward by 2 mm.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":"2640-2646"},"PeriodicalIF":2.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12404854/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144753952","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}