Orthopaedic Surgery最新文献

{"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":"<p><strong>Purpose: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>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}

{"title":"Surgical Outcomes of Full-Endoscopic Degenerative Lumbar Lateral Recess Stenosis Decompression Through an Interlaminar Approach.","authors":"Chengqian Huang, Yingying Qin, Yizhu Huang, Xijiang Wei, Jing Zhuo, Shaofeng Wu, Jiarui Chen, Jichong Zhu, Tianyou Chen, Bin Zhang, Sitan Feng, Chenxing Zhou, Jiang Xue, Xinli Zhan, Chong Liu","doi":"10.1111/os.14376","DOIUrl":"https://doi.org/10.1111/os.14376","url":null,"abstract":"<p><strong>Objective: </strong>The conventional open decompression surgery for degenerative lumbar lateral recess stenosis (DLLRS) yields definitive therapeutic outcomes; however, it confronts numerous challenges, including extensive surgical trauma and iatrogenic spinal instability. The purpose of this study is to investigate the surgical outcomes of full-endoscopic DLLRS decompression by an interlaminar approach.</p><p><strong>Methods: </strong>A consecutive cohort of 275 patients, including 148 males and 127 females, with an average age of 64.62 (55-82) years, with DLLRS between July 2021 and December 2022, was reviewed in this retrospective study. The involved segments were L4/5 in 126 patients and L5/S1 in 149 patients. The computed tomography (CT) and magnetic resonance imaging (MRI) of the lumbar were examined before and after surgery to evaluate the degree of decompression. The VAS score of back and leg pain and the ODI scale were recorded preoperatively, 1 day, 1, 3, 6, and 12 months after surgery, and at the last follow-up. The modified Macnab score was determined at the last follow-up. One-way analysis of variance (ANOVA) was used to compare the VAS and ODI scores of back/leg pain at various time points before and after surgery.</p><p><strong>Results: </strong>All of the patients underwent surgery successfully. The average duration of surgery was 84.90 min, the average blood loss was 47.33 mL, and the length of hospitalization was 3-4 (3.31 ± 0.46) days, with no nerve injury, infections, or other complications. One-way ANOVA results showed significantly improved VAS and ODI scores for back/leg pain at each time point after surgery compared to those preoperatively (p < 0.05). The mean follow-up was 23.6 ± 2.3 (range, 15-32) months; at the last follow-up, the modified Macnab was excellent in 143 patients, good in 102 patients, fair in 18 patients, and poor in 12 patients.</p><p><strong>Conclusion: </strong>Full-endoscopic lumbar lateral recess decompression through an interlaminar approach is a safe and effective approach for DLLRS.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143493155","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":"Modic Changes in Patients Who Have Undergone Anterior Cervical Discectomy and Fusion: The Correlation With Fusion Success and Subsidence.","authors":"Yifei Deng, Xiang Zhang, Xiaqing Sheng, Beiyu Wang, Ying Hong, Xin Rong, Chen Ding, Jingjing An, Hao Liu","doi":"10.1111/os.14377","DOIUrl":"https://doi.org/10.1111/os.14377","url":null,"abstract":"<p><strong>Objective: </strong>There is a lack of research on modic change (MC) in the cervical spine, especially regarding its impact on patients following anterior cervical discectomy and fusion (ACDF). Some researchers strongly believe that MC may affect the prognosis after anterior cervical surgery. Thus, this study aimed to assess MC in patients who underwent ACDF, investigating its incidence, risk factors, and correlation with fusion success and subsidence rate.</p><p><strong>Methods: </strong>We retrospectively reviewed 154 patients who underwent single-level ACDF from January 2010 to December 2020, with a minimum follow-up of 12 months. Preoperative and postoperative clinical and radiological parameters were recorded at pre-operation, 1 week, 3 months after operation, and the last follow-up. The primary outcomes were the fusion rate and cage subsidence. Radiological measurements, including overall (Cobb C) and segmental cervical angle (Cobb S), anterior disc height (ADH), and posterior disc height (PDH) were also recorded. The independent t-test or Mann-Whiteny U test was used to compare continuous data, and categorical variables were assessed using the Pearson's chi-square test of Fisher's exact test. Logistic regression analysis was also adopted to distinguish corresponding factors related with the progress of MC.</p><p><strong>Results: </strong>Of the 154 patients, the incidence of MC was 44.2% (68/154). The group with MC showed a larger proportion of males and osteoporosis. The fusion rate of those with MC was 88.2% (60/68) while that in the non-MC group was 97.7% (84/86, p = 0.02). The MC group presented a subsidence rate of 27.9%, which was substantially higher than in the non-MC group (9.3%, p < 0.01). NDI and VAS neck was significantly higher in the MC group than in the non-MC group (p = 0.014; p = 0.039). Sex and osteoporosis were distinguished as independent factors related to MC by regression analysis (p = 0.006; p = 0.026).</p><p><strong>Conclusion: </strong>Preoperative MC could adversely hinder the fusion process and may increase the incidence of subsidence, affecting clinical outcomes of those underwent ACDF. Patients with MC, especially type 1 MC, are more easily suffered from neck pain than those without MC. Male sex and osteoporosis were risk factors for MC. In order to achieve a better bony fusion and avoid cage subsidence in those with MC, we encourage patients to prolong their immobilization duration with a cervical collar and precisely manage osteoporosis during the peri-operative period.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143493153","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":"Biomechanical Effects of Zero-P Height on Anterior Cervical Discectomy and Fusion: A Finite Element Study.","authors":"Cheng-Yi Huang, Jun-Bo He, Xing-Jing Wang, Ting-Kui Wu, Bei-Yu Wang, Jin Xu, Hao Liu","doi":"10.1111/os.14374","DOIUrl":"https://doi.org/10.1111/os.14374","url":null,"abstract":"<p><strong>Objective: </strong>The principle of selecting a Zero-P implant of an appropriate height remains a topic of debate, particularly when similarly sized implants seem to appropriately fit the intervertebral space. Thus, this study compared the biomechanical performance of smaller and larger Zero-P implants within an appropriate height range with that of oversized Zero-P implants for anterior cervical discectomy and fusion (ACDF).</p><p><strong>Methods: </strong>A three-dimensional finite element (FE) model of the C2-C7 cervical spine was constructed and validated. The implants were categorized as smaller (6 mm), larger (7 mm), and oversized (8 mm) according to the average intervertebral height and implant specifications. Thus, the following four FE models were constructed: the intact cervical spine model (M1), the 6 mm model (M2), the 7 mm model (M3), and the 8 mm (M4) Zero-P implant C5/6 segment ACDF surgical model. Then, a pure moment of 1.0 N·m combined with a follower load of 75 N was applied at C2 to simulate flexion, extension, lateral bending, and axial rotation.</p><p><strong>Results: </strong>The results indicated that the maximum stress on the vertebral body, intervertebral disc, and facet joints under self-weight increased with increasing Zero-P height. Under six different loading conditions, the maximum stress on the vertebral body in the surgical segment of the M4 model was generally greater than that in the M2 and M3 models. Following an increase in the height of the implant from 6 mm to 8 mm, the maximum stress increased, and the intervertebral disc stress of both segments reached its peak in the M4 model. In the M4 model, the implant experienced the highest stress, whereas the M2 model exhibited the lowest stress on the implant under both self-weight and loading conditions. Furthermore, the stress on the posterior facet joints of the surgical segment increased with increasing Zero-P height. The range of maximum stress on the posterior facet joints for the M3 model was situated between that of the M2 and M4 models.</p><p><strong>Conclusion: </strong>In summary, after determining the appropriate height range for the implant in accordance with the mean height of the intervertebral space, opting for a larger size appears to be more advantageous. This approach helps maintain the height of the intervertebral space and provides greater stress, promoting a tighter fit between the upper and lower endplates and the Zero-P. This tighter fit is crucial for maintaining spinal stability, enhancing the early bony fusion rate, and potentially leading to better postoperative outcomes.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-02-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143482690","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":"Use of Fluid Gelatin in Lumbar Spinal Stenosis Undergoing Unilateral Biportal Endoscopic: A Prospective, Randomized Controlled Trial.","authors":"Hao Yan, Mei Gao, Yu Zhang, Huaibin Wang, Yushan Zhu, Tiangang Zhou, Ruzhan Yao, Weiqiang Liu, Jesse Li-Ling","doi":"10.1111/os.70009","DOIUrl":"https://doi.org/10.1111/os.70009","url":null,"abstract":"<p><strong>Objectives: </strong>In patients with lumbar spinal stenosis (LSS) undergoing unilateral biportal endoscopic unilateral laminotomy for bilateral decompression (UBE-ULBD), damage to the epidural venous plexus often leads to bleeding, increasing the risk of surgical complications. Surgiflo Hemostatic Matrix (SHM) is a gelatin extracted from porcine skin, used for intraoperative hemostasis. This study aims to evaluate the effectiveness and safety of using SHM during UBE-ULBD surgery.</p><p><strong>Methods: </strong>From October 2023 to July 2024, a total of 96 patients with LSS underwent UBE-ULBD surgery. These 96 patients were randomly divided into two groups: the SHM group (48 patients, using flowable gelatin) and the non-SHM group (48 patients, not using flowable gelatin). The primary outcomes included intraoperative blood loss, postoperative drainage volume, and the 3-min hemostasis success rate. Secondary outcomes included symptomatic postoperative epidural hematoma (SPEH), surgical time, postoperative hospital stay, hospitalization costs, and complications. We used independent sample t-tests to compare continuous data, and chi-square tests or Fisher's exact tests to analyze categorical data.</p><p><strong>Results: </strong>The intraoperative blood loss and postoperative drainage volume in the SHM group were significantly less than those in the non-SHM group (p < 0.05), and the 3-min hemostasis success rate in the SHM group was significantly higher than that in the non-SHM group (p < 0.05). There were no statistically significant differences between the two groups regarding SPEH, postoperative hospital stay, hospitalization costs, and complications such as thrombosis formation and allergic reactions. However, the surgical time in the SHM group was significantly shorter than that in the non-SHM group (p < 0.05).</p><p><strong>Conclusion: </strong>When patients with LSS undergo UBE-ULBD, the use of fluid gelatin can effectively reduce intraoperative and postoperative bleeding without introducing additional complications.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-02-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143483213","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of Fluid Gelatin for Lumbar Spinal Stenosis Undergoing Lumbar Endoscopic Bilateral Decompression: A Prospective, Randomized Controlled Trial.","authors":"Hao Yan, Mingdong Yu, Huaibin Wang, Rongsheng Dou, Xiaoyan Xia, Ruzhan Yao, Weiqiang Liu, Jesse Li-Ling","doi":"10.1111/os.14373","DOIUrl":"https://doi.org/10.1111/os.14373","url":null,"abstract":"<p><strong>Objectives: </strong>In patients with lumbar spinal stenosis (LSS), prolonged compression of the epidural venous plexus heightens the risk of bleeding and hematoma during minimally invasive surgery. While absorbable fluid gelatin, an animal protein-based hemostatic agent, is available, its effectiveness in lumbar endoscopic unilateral laminotomy with bilateral decompression (LE-ULBD) remains debated. Our research aims to conduct a prospective randomized controlled trial to investigate the effectiveness and safety of this hemostatic material in patients undergoing LE-ULBD for LSS.</p><p><strong>Methods: </strong>From October 2023 to July 2024, a total of 90 patients with LSS who underwent LE-ULBD were enrolled in this study. The 90 patients were randomly divided into two groups: fluid gelatin group (45 cases, using fluid gelatin) and null-fluid gelatin group (45 cases, not using fluid gelatin). Primary outcomes included the success rate of achieving hemostasis within 3 min and symptomatic postoperative epidural hematoma (SPEH). Secondary outcomes encompassed surgical time, intraoperative blood loss, perioperative blood loss, length of stay, and complications. Independent sample t tests were used to compare continuous data. Chi-squared tests and Fisher's exact probability tests were used to analyze the categorical data.</p><p><strong>Results: </strong>The success rate of achieving hemostasis within 3 min (p < 0.05) was significantly higher in fluid gelatin group compared to that in the null-fluid gelatin group, and perioperative blood loss (p < 0.05) and surgical time (p < 0.05) were notably lower in the fluid gelatin group. However, there were no statistically significant differences between the two groups regarding intraoperative blood loss, length of stay, and complications, such as SPEH, allergy, and thrombus.</p><p><strong>Conclusion: </strong>In patients with LSS undergoing LE-ULBD surgery, using fluid gelatin can achieve rapid intraoperative hemostasis, shorten surgical time, and reduce perioperative blood loss without causing complications. Therefore, the conventional use of fluid gelatin in LE-ULBD surgery is an effective and safe strategy.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-02-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143482650","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The 3D-Printed Customized Femoral Short Stem Offers Improved Anatomical Parameters Restoration, Fitness and Biomechanical Performance Compared With Traditional Femoral Stem.","authors":"Ziang Jiang, Rongshan Cheng, Dimitris Dimitriou, Yangyang Yang, Tsung-Yuan Tsai, Liao Wang","doi":"10.1111/os.70000","DOIUrl":"https://doi.org/10.1111/os.70000","url":null,"abstract":"<p><strong>Objective: </strong>The traditional femoral stem is unsuitable for patients with severe proximal femoral bone defects or deformities. However, 3D-printed customized designs offer improved proximal femoral canal contact and enhance the initial stability of the femoral prosthesis. Therefore, this study aims to compare the anatomical parameters, contact parameters, and performance of the 3D-printed customized femoral short (CFS) stem with those of the traditional femoral stem following total hip arthroplasty (THA).</p><p><strong>Methods: </strong>An in vitro study simulating THA was performed using artificial femur models, with a 3D-printed CFS stem as the experimental group and a Trilock stem as the control group. Anatomical parameters, fitness, filling, micro-motion, and strain distribution were evaluated using artificial femoral models. Micro-motion and strain were recorded under different simulated bodyweight loading using a 3D digital image correlation measurement system.</p><p><strong>Results: </strong>The neck-shaft angles (NSA) and coronal femoral horizontal offset (CFHO) of the 3D-printed CFS stem (NSA: 125.22°, CFHO: 41.03 mm) were closer to those of the intact femur (NSA: 127.37°, CFHO: 43.27 mm) compare with the Trilock stem (NSA: 132.61°, CFHO: 32.98 mm). In addition, the 3D-printed CFS stem showed improved fitness at cross-sections (The top of the lesser trochanter: 6.31%, the middle of the lesser trochanter: 23.42%, the bottom of the lesser trochanter: 26.61%) and reduced micro-motion under different simulated bodyweight loads (1000: 0.043, 1375: 0.056, 2060 N: 0.061 mm).</p><p><strong>Conclusions: </strong>The 3D-printed CFS stem provides improved restoration of anatomical parameters, enhanced fitness, and superior biomechanical performance compared with the Trilock stem.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143458741","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}