Orthopaedic Surgery最新文献

{"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":"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":"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":"Comparison of the Outcomes of Endoscopic Posterolateral Interbody Fusion and Lateral Interbody Fusion in the Treatment of Lumbar Degenerative Disease: A Systematic Review and Network Meta-Analysis.","authors":"Xijian Hu, Lei Yan, Jing Chai, Xiaofeng Zhao, Haifeng Liu, Jinhuai Zhu, Huo Chai, Yibo Zhao, Bin Zhao","doi":"10.1111/os.14371","DOIUrl":"https://doi.org/10.1111/os.14371","url":null,"abstract":"<p><strong>Objective: </strong>Although endoscopic technologies have been increasingly applied in lumbar fusion surgery in recent years, the advantages and disadvantages of endoscopic posterolateral fusion compared with lateral fusion remain unclear. Six different single-level lumbar interbody fusion procedures were compared to determine whether indirect decompression fusion could achieve levels of efficacy and safety comparable to those of minimally invasive direct decompression fusion in the treatment of lumbar degenerative disease (LDD).</p><p><strong>Method: </strong>A literature search was conducted in the PubMed, Embase, and Cochrane Library databases, and studies on the treatment of LDD published from 2004 to March 2024 were retrieved. The data of preset clinical outcome measures, including operation time, intraoperative estimated blood loss (EBL), length of hospital stay (LOS), complications, visual analog scale (VAS) score, and the Oswestry Disability Index (ODI), were extracted from the studies.</p><p><strong>Results: </strong>Thirty-five studies with 3467 patients were included in this review. Network meta-analysis revealed no significant differences in improvements in pain and disability or adverse events among the procedures, except for uniportal endoscopic lumbar interbody fusion (UELIF), which resulted in a lower degree of improvement in the ODI than oblique lateral interbody fusion (OLIF). Stand-alone lateral lumbar interbody fusion (SA-LLIF) exhibited the best performance in terms of indicators of early efficacy, such as surgical time and LOS. OLIF and SA-LLIF had higher fusion rates than did UELIF and minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF). MIS-TLIF resulted in greater EBL than did OLIF, SA-LLIF, and UELIF.</p><p><strong>Conclusion: </strong>Minimally invasive lumbar interbody fusion achieves good therapeutic results in LDD patients regardless of the use of indirect or direct decompression, whereas SA-LLIF has better early efficacy.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143080713","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":"Feasibility and Safety of the C1 \"Zero Angle\" Screw: A Novel \"In-Out-In\" Technique for Atlantoaxial Dislocation.","authors":"Zexing Chen, Xinzhao Huang, Xiaobao Zou, Peirong Lian, Guoqiang Liu, Junlin Chen, Changrong Zhu, Xiangyang Ma","doi":"10.1111/os.14309","DOIUrl":"10.1111/os.14309","url":null,"abstract":"<p><strong>Objectives: </strong>To minimize the risk of V3 segment of vertebral artery (VA) injury in the atlantoaxial dislocation (AAD) patients with C1 pedicle height less than 4.0 mm and provide a strong toggle force in irreducible AAD and revision surgery. We evaluated the feasibility of C1 \"Zero Angle\" screw (C1ZAS) and safe entry point with \"in-out-in\" technique as an alternative option for C1 pedicle screw (PS) in cases with AAD.</p><p><strong>Methods: </strong>Sixty-one patients with AAD or atlantoaxial instability (AAI) (45 male and 16 female) who underwent cervical computed tomography and magnetic resonance imaging scans in our center between January 1, 2022 and December 31, 2023 were retrospectively reviewed. Measurements were made around the ideal trajectory and entry point of C1ZAS using computerized tomography (CT) and magnetic resonance imaging (MRI) in 61 patients. Radiographic measurements included (A) the distance from the recess to the transverse foramen (RTF); (B) the tricortical screw zone (TSZ); (C) the lateral mass height along the C1ZAS trajectory (LMH); (D) the screw length of C1ZAS (ZSL); (E) the screw length of C1 PS (PSL); (F) the distances from the recess to the dura (RD); (G) the distance from the recess to the spinal cord (RSC); (H) the distance from the inner of lateral mass to the spinal cord (ILMSC). During the period of January 1, 2022 to December 31, 2023, C1ZAS placement with \"in-out-in\" technique was used as an alternative option for C1 PS in 8 patients with AAD and unilateral/bilateral narrow C1 pedicles.</p><p><strong>Results: </strong>The average RTF, TSZ, LMH, ZSL, RD, RSC, and ILMSC were 7.71, 6.14, 8.32, 33.23, 4.68, 10.02, and 2.91 mm respectively. The entry point of the C1ZAS was defined as the projection point of the inner of the recess to the posterior arch and the trajectory should be angled cephalad by 8.7° and medially by 0°. The 61 patients (122 sides) with AAD or AAI were classified into three groups: the low-risk (76 sides, 62%), the intermedial-risk (18 sides, 15%), and the high-risk (28 sides, 23%) groups. Satisfactory C1ZAS placement and atlantoaxial reduction were achieved in all eight patients with AAD and unilateral/bilateral narrow C1 pedicles. No instance of C1ZAS placement-related VA injury or dural laceration was observed.</p><p><strong>Conclusions: </strong>When the placement of C1 PS is not feasible in patients with AAD and unilateral/bilateral narrow C1 pedicles, C1ZAS placement with \"in-out-in\" technique can be considered an effective alternative option, providing tricortical or quadricortical purchase for rigid fixation of the atlas.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":"437-445"},"PeriodicalIF":1.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11787991/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142770951","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":"Oblique Lumbar Interbody Fusion Combined With Anterolateral Fixation and Cement Augmentation for the Treatment of Degenerative Lumbar Diseases in the Elderly Population: A Retrospective Study.","authors":"Weiqi Han, Lei He, Fei Wang, Xiaofeng Zhao, Cong Jin","doi":"10.1111/os.14315","DOIUrl":"10.1111/os.14315","url":null,"abstract":"<p><strong>Objectives: </strong>Cage subsidence is a common complication of oblique lumbar interbody fusion (OLIF), particularly in elderly patients with osteoporosis or osteopenia. While bilateral pedicle screw fixation (BPS) is effective in reducing subsidence, it is associated with longer operative times, increased blood loss, and greater tissue trauma. In contrast, anterolateral fixation (AF) is less invasive but linked to higher subsidence rates. Ensuring both minimal invasiveness and adequate stability in OLIF-assisted fixation remains a significant challenge. This study aimed to evaluate the efficacy of combining AF with cement augmentation (AF + CA) in reducing cage subsidence and improving clinical outcomes compared with AF and BPS.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on 138 elderly patients with degenerative lumbar diseases treated with OLIF. Patients were divided into three groups: AF + CA (32 patients), AF (32 patients), and BPS (74 patients). Clinical and radiographic outcomes were compared among the groups, and logistic regression analyses were performed to identify risk factors for cage subsidence after OLIF.</p><p><strong>Results: </strong>At 1 year postoperatively, the disc height of the AF + CA group was significantly greater than that of the AF group. The cage subsidence rate in the AF + CA group was 24.3%, significantly lower than that in the AF group (48.8%, p < 0.05) and comparable to the BPS group (30.4%). Survivorship curve analysis showed better outcomes in reducing cage subsidence in the AF + CA group compared with the AF group, with no significant difference between the AF + CA and BPS groups. Compared with the AF + CA and BPS groups, the AF group had significantly higher grades and severity of cage subsidence. Fusion rates at 1 year were 91.9% in the AF + CA group, 90.2% in the AF group, and 95.1% in the BPS group, with no significant differences. The AF + CA group had significantly shorter operative times, less intraoperative blood loss, lower VAS scores at 3 days and 1 year postoperatively, and lower ODI scores at 3 days and 3 months compared with the BPS group. Multivariate regression analysis revealed that AF was a significant risk factor for cage subsidence, with an odds ratio of 3.399 compared with AF + CA.</p><p><strong>Conclusions: </strong>AF + CA effectively reduces cage subsidence in OLIF surgeries, offering results comparable to BPS while providing advantages such as shorter surgical time, reduced blood loss, and improved early postoperative outcomes. AF + CA is a viable alternative, especially for elderly patients with comorbidities who may not tolerate the longer operative durations or greater blood loss associated with BPS.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":"446-459"},"PeriodicalIF":1.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11787981/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142770970","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":"Key Decision-Making in Post-Failed Internal Fixation of Intertrochanteric Fractures Hip Arthroplasty: A Multicenter Retrospective Study on Fracture Healing's Impact on Femoral Component Selection.","authors":"Jiexin Huang, Jiagu Huang, Haiqi Ding, Jianhua Lyu, Changyu Huang, Yang Chen, Qijin Wang, Hongyan Li, Baijian Wu, Ying Huang, Minghui Yang, Xinyu Fang, Wenming Zhang","doi":"10.1111/os.14303","DOIUrl":"10.1111/os.14303","url":null,"abstract":"<p><strong>Purpose: </strong>Following failed internal fixation of intertrochanteric fractures (FIF-ITF), the decision to use a long-stem or standard-stem femoral implant in hip arthroplasty is still debated. This study aimed to explore how the healing status of fractures after FIF-ITF failure affects the choice of femoral stem and clinical outcomes.</p><p><strong>Methods: </strong>Our retrospective cohort study reviewed 105 cases of patients with FIF-ITF who underwent hip arthroplasty at three tertiary Grade A hospitals between December 2012 and December 2022. We compared the clinical outcomes between patients with healed and unhealed fractures, focusing on the selection of femoral stems in relation to proximal medial support and the healing status of the greater trochanter. The primary outcomes measured were functional results, operative time, blood loss, and incidence of complications. A subgroup analysis was conducted to further evaluate the influence of the proximal medial buttress and greater trochanteric healing on femoral stem selection. Statistical analysis included binary and ordinal logistic regression to identify factors influencing the choice of femoral stems. Additionally, a decision tree model was developed to visually represent and explore the relationship between fracture healing status and the selection of femoral components.</p><p><strong>Results: </strong>The study included 38 patients with healed fractures and 67 patients with unhealed fractures. Patients in the healed group predominantly chose standard stems and experienced better functional outcomes (p < 0.001, p = 0.002). In contrast, the unhealed group preferred long stems, resulting in longer surgical durations and increased blood loss (p = 0.008, p < 0.001). Binary logistic regression analysis revealed that nonunion of the proximal femoral medial buttress was an independent risk factor for long stems (p < 0.0001, OR = 10.402).</p><p><strong>Conclusion: </strong>The selection of femoral prostheses following FIF-ITF is influenced by the fracture healing status, particularly the presence of proximal femoral medial buttress. The decision tree model suggested that long-stem prostheses are more appropriate when there is inadequate fracture healing and the proximal femoral medial buttress is absent.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":"470-481"},"PeriodicalIF":1.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11787966/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142786179","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":"Computer-Aided High Tibial Osteotomy-A Comparative Study of Commonly Used 3D Printing Technology and Navigation Application.","authors":"Elvis Chun-Sing Chui, Kyle Ka-Kwan Mak, Randy Hin-Ting Ng, Ericsson Chun-Hai Fung, Mei-Shuen Chan, Kai Yue, Lawrence Chun-Man Lau, Clifford Long-Fung Chan, Edmond Wing-Fung Yau, Wei Zhao, Xiuyun Su, Jin Zhang, Jianglong Xu, Hongxun Sang, Guoxian Pei, Louis Wing-Hoi Cheung, Sheung-Wai Law, Michael Tim-Yun Ong, Patrick Shu-Hang Yung","doi":"10.1111/os.14274","DOIUrl":"10.1111/os.14274","url":null,"abstract":"<p><strong>Background: </strong>High tibial osteotomy (HTO) is a surgical procedure for treating certain knee conditions. Proper execution of HTO can preserve joint function and delay or avoid the need for total knee replacement. This study compared different 3D printing techniques (fused deposition modeling, selective laser sintering, and direct metal laser sintering) and a navigation system for their suitability in assisting HTO surgeries.</p><p><strong>Methods: </strong>Tibial saw-bones were used as models, and surgical guides and the navigation system were employed during the procedures. Six parameters (planning time, manufacturing time, delivery time, material cost, operation time, and accuracy) were evaluated. One-way analysis of variance (ANOVA) and t-test were used for the analysis.</p><p><strong>Results: </strong>The results showed that the metal surgical guides had the highest accuracy (angle differences mean, 2.4°) and operation time (mean 9.75 min), followed by plastic guides, classic guides, and the navigation system. The differences in accuracy were attributed to factors like rigidity, melting point, and errors during incisions.</p><p><strong>Conclusions: </strong>The study recommended metal surgical guides as the best option for assisting HTO due to their accuracy and operation time. And the results have implications for orthopedic surgeons performing HTO surgeries, as they can use this information to improve postoperative outcomes, such as mechanical axis alignment and quality of life for HTO patients.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":"593-602"},"PeriodicalIF":1.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11787984/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142876900","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}