BMC Surgery最新文献

{"title":"The impact of death and caring for the dying and their families on surgeons - an AI assisted systematic scoping review.","authors":"Jun Rong Tan, Yun Ting Ong, Victoria Jia En Fam, Annushkha Sinnathamby, Nila Ravindran, Yaoyi Ng, Lalit Kumar Radha Krishna","doi":"10.1186/s12893-025-02792-1","DOIUrl":"10.1186/s12893-025-02792-1","url":null,"abstract":"<p><strong>Context: </strong>Surgeons are taking central roles in caring for patients leaving them prone to the emotional turmoil and grief of patients and families and the moral, psychological and existential distress of members of the interprofessional team and trainees. This has implications on patient safety and surgeon welfare.</p><p><strong>Objectives: </strong>A systematic scoping review was carried out to address the primary research question \"what is known of the effects of caring for the dying and the impact of patient's death on surgeons?\". It is hoped that the insights gained will better guide support and assessment of surgeons in their evolving roles.</p><p><strong>Methods: </strong>Guided by the Systematic Evidence-based Approach (SEBA), we conducted a systematic scoping review (SSR). This review included articles published between 1st January 2000 and 2nd September 2024 on Pubmed, Embase, Scopus, Google Scholar, ERIC databases. To enhance trustworthiness and enhance the comprehensiveness of our review the articles identified were also evaluated using ChatGPT 4o and Notebook LM. The findings of these assistive processes were compared with the independent thematic and content analysis carried out by the two research teams.</p><p><strong>Results: </strong>In total, 4966 titles and abstracts were identified, 174 full-text articles were reviewed, and 26 full-text articles analysed. With the findings of the assistive analysis by the AI tools echoing the findings of the research teams- two key domains were identified: (1) the impact on personhood, (2) predisposing factors.</p><p><strong>Conclusion: </strong>This AI assisted SSR in SEBA confirms that surgeons do suffer from the cumulative effects of caring for dying patients and their families and from the death of the patient and supporting the family and members of the interprofessional team and trainees. Without timely and personalized support surgeons are prone to depression, burnout, and substance abuse, and compromises to patient and family experiences, outcomes, safety and satisfaction. The need for effective longitudinal and personalized assessment tools is clear.</p>","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":"25 1","pages":"56"},"PeriodicalIF":1.6,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11796083/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143257094","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"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 value of the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) in colorectal cancer and colorectal anastomotic leakage patients: a retrospective study.","authors":"Nuo Xu, Jian-Xin Zhang, Jia-Jie Zhang, Zhuo Huang, Lian-Chun Mao, Zhi-Yong Zhang, Wei-Dong Jin","doi":"10.1186/s12893-024-02708-5","DOIUrl":"10.1186/s12893-024-02708-5","url":null,"abstract":"<p><strong>Objective: </strong>The purpose of this study was to investigate the influence and predictive value of preoperative peripheral blood neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) index on the prognosis of colorectal anastomotic leakage (CAL) patients.</p><p><strong>Methods: </strong>This study retrospectively analyzed the clinical data of 1016 patients who underwent radical resection for colorectal cancer at a single center between January 1, 2007 and December 31, 2023. In this study, NLR and PLR were analyzed before surgery. Kaplan-Meier survival analysis was performed according to the postoperative survival status of the patients. Nomogram and calibration curve were established by proportional hazards model (COX) to verify its predictive value.</p><p><strong>Results: </strong>A total of 890 patients with colorectal cancer, 102 patients with CAL, and 788 patients with non- anastomotic leakage (AL) colorectal cancer were enrolled for a median follow-up of 96 months (quartile range 33-133). In this study, COX regression analysis showed that preoperative NLR and PLR could predict the prognosis of CAL patients, and the optimal cut-off points of NLR and PLR were 2.89 and 157.62, respectively. Kaplan-Meier survival curve results showed that 5-year overall survival (OS) and disease-free survival (DFS) in the low NLR and PLR group were significantly higher than those in the high NLR and PLR group. OS and DFS were divided into high, low NLR and PLR groups. Finally, based on COX model, a nomogram analysis was conducted to analyze the risk factors affecting OS and DFS, and the accuracy and practicality of the model were verified by calibration curve and decision curve.</p><p><strong>Conclusion: </strong>Preoperative NLR and PLR can predict the long-term prognosis of colorectal cancer (CRC) and CAL patients, and patients with NLR ≥ 2.89 and PLR ≥ 157.62 have poor survival prognosis. Nomogram and calibration curve analysis will further improve the accuracy of OS and DFS prediction.</p>","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":"25 1","pages":"57"},"PeriodicalIF":1.6,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11796187/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143257099","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The surgical time-out: the relationship between perceptions of a safety-task anchor and surgical team workflow.","authors":"Vivian J Zagarese, Ivan Hernandez, Neil M A Hauenstein, Roseanne J Foti, Sarah H Parker","doi":"10.1186/s12893-025-02789-w","DOIUrl":"10.1186/s12893-025-02789-w","url":null,"abstract":"<p><strong>Background: </strong>The surgical time-out is a critical safety measure used in the operating room (OR). We examined the mediating relationship of the length of the time-out between team perceived usefulness of the time-out, and the rate at which the circulating nurse left the OR to retrieve instruments.</p><p><strong>Methods: </strong>60 cardiac surgical teams were observed performing their work. The length of the time-out and the rate at which the circulating nurse left the OR was obtained by observation of the surgical team. We administered a survey with a 7-point Likert scale to assess the surgical staff's perceived usefulness of the time-out at the end of the surgery. An analysis was conducted to test if length of the time-out mediated the relationship between perceived usefulness of the time-out and rate at which the nurse leaves the OR to retrieve an instrument useful for the surgery.</p><p><strong>Results: </strong>The relationship of the length of the time-out with the rate at which the nurse leaves the OR was non-significant (β = 0.089, p = .496). However, the relationship between perceived usefulness of the time-out with the length of the time-out was significant (β = 0.346, p < .05) and the effect between perceived usefulness of the time-out and the rate at which the nurse left the OR was statistically significant (β= - 0.424, p = < 0.001).</p><p><strong>Conclusion: </strong>In this study we explore how surgical teams' attitudes towards the usefulness of the time-out affect its utilization, and how attitudes about time-outs are related to the important process measure of rate at which the circulating nurse leaves the OR. The full mediation model was not supported by the data; however, there appears to be a relationship between the perceived usefulness of the time-out and the rate at which the circulating nurse leaves the OR.</p>","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":"25 1","pages":"55"},"PeriodicalIF":1.6,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11796080/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143257107","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical advances in kidney autotransplantation: a review.","authors":"Shengjie Lin, Jingci Gai, Shangjin Huang, Yingzhen He, Da Hao, Shuhang Luo, Yilong Lin, Jiang Qiu, Jun Li, Changxi Wang, Chenglin Wu","doi":"10.1186/s12893-024-02754-z","DOIUrl":"10.1186/s12893-024-02754-z","url":null,"abstract":"<p><p>Kidney autotransplantation is a surgical procedure with multiple indications and advancing technological approaches. Kidney autotransplantation is used to address complex kidney-related diseases including renal vascular lesions, ureteral diseases, tumors, loin pain-hematuria syndrome, and conditions affecting a solitary kidney or both kidneys. Renal artery lesions, including aneurysms and stenoses, often necessitate kidney autotransplantation in cases involving renal artery bifurcation or distant failure of endovascular repair. Complex ureteral lesions such as ureteral avulsions are commonly treated with kidney autotransplantation. Renal tumors, especially centrally located tumors or those involving the renal hilum, are treated using this technique while preserving renal function. It is worth emphasizing that this would be a rarely used last-resort technique in the modern era of minimally invasive nephron-sparing surgery. Kidney autotransplantation may be indicated for the rare condition of loin pain-hematuria syndrome when conservative measures fail. Additionally, individuals with solitary or bilateral kidney disease benefit from kidney autotransplantation to preserve their renal function. Traditional open-kidney autotransplantation involves renal extraction, workbench repair, and renal reimplantation. Technological advancements have introduced minimally invasive techniques including laparoscopic- and robot-assisted kidney autotransplantation, which reduce surgical trauma and recovery times. These techniques have shown promising outcomes, and robotic platforms have the potential to further reduce complications. In this study, we reviewed diverse indications and recent technological innovations in the field of kidney autotransplantation.</p>","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":"25 1","pages":"54"},"PeriodicalIF":1.6,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11796257/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143257091","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pancreatic exocrine insufficiency after pancreatic resection: a systematic review.","authors":"Marcello Di Martino, Ángela de la Hoz Rodriguez, Andrea Saibanti, Guillermo Salvador Camarmo, Nico Pagano, Elena Martín-Pérez, Matteo Donadon","doi":"10.1186/s12893-025-02787-y","DOIUrl":"10.1186/s12893-025-02787-y","url":null,"abstract":"<p><strong>Introduction: </strong>Pancreatic exocrine insufficiency (PEI) is a condition defined by a reduction in pancreatic exocrine activity that impairs normal digestion. Despite established guidelines recommendations, precise diagnosis of PEI after pancreatic resection are infrequently achieved. This review aims to provide a comprehensive overview of the methodology and accuracy of diagnostic tools available for evaluating PEI after pancreatic resection.</p><p><strong>Methods: </strong>A review of PEI diagnostic tests was conducted using a combined text and MeSH search strategy to identify relevant articles focused on post-pancreatectomy PEI diagnosis.</p><p><strong>Results: </strong>The literature search yielded 4,874 records, and 30 studies were included in the analysis, with a total of 2,305 patients. The reported frequency of PEI across the included studies varied widely, though more than two-thirds of included papers reported an incidence of PEI above 65% in patients who underwent pancreatoduodenectomy or distal pancreatectomy. The faecal elastase-1 (FE-1) test was the most frequently used test for diagnosing post-pancreatectomy PEI. Six studies compared the diagnostic accuracy of FE-1 with faecal fat tests or 13 C breath tests, finding no significant differences. Five studies reported on micronutrient deficiencies.</p><p><strong>Conclusion: </strong>The FE-1 test is the most commonly used diagnostic tool for post-pancreatectomy PEI; however, well-designed studies comparing the diagnostic accuracy of various tests for PEI are lacking. Additionally, few studies report on micronutrient deficiencies, variations in anthropometric data or PEI-related patient-reported outcomes. Future studies should aim to establish a gold standard for diagnosis and severity assessment of post-pancreatectomy PEI and provide guidance for tailored pancreatic enzyme replacement therapy.</p>","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":"25 1","pages":"53"},"PeriodicalIF":1.6,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11789297/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143123899","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Allograft tolerance after adult living donor liver transplantation: a case-control study.","authors":"Mohamed S Habl, Moataz Maher Emara, Reham A Zayed, Ahmed M Sultan, Ahmed Elsabagh, Ahmed Marwan Elsaid, Ehab E Abdel-Khalek, Mohamed M El-Saadany, Mohamed Abdel Wahab, Ahmed Shehta","doi":"10.1186/s12893-025-02780-5","DOIUrl":"10.1186/s12893-025-02780-5","url":null,"abstract":"<p><strong>Background: </strong>To investigate the incidence and potential predictors of immune tolerance among adult living donor liver transplant (LDLT) recipients.</p><p><strong>Methods: </strong>This case-control study included adult recipients who underwent LDLT between May 2004 and January 2018, with at least a 5-year follow-up after LDLT. We divided the study recipients into two groups: Group 1 (Tolerance Group) included recipients who achieved operational or prope tolerance for at least one year; Group 2 (Control Group) included recipients who did not achieve tolerance. We used logistic regression analysis to study the potential predictors of tolerance after LDLT.</p><p><strong>Results: </strong>We included 368 recipients, 275 (74.7%) in Group 1 and 93 (25.3%) in Group 2. Operational tolerance occurred in 13/275 (4.7%) recipients and prope tolerance in 262/275 (95.3%) recipients. Age was significantly higher in Group 1. The median time for tolerance among the study recipients was 60 months (36-168). During follow-up, Group 1 showed lower serum levels of bilirubin, liver enzymes, alkaline phosphatase, and gamma-glutamyl transferase. Group 1 had a lower incidence of acute cellular rejection (ACR), recurrent viral hepatitis, and biliary complications. Logistic regression identified preoperative MELD, indication for LDLT, ACR, recurrent viral hepatitis, and biliary complications as significant predictors for allograft tolerance after LDLT.</p><p><strong>Conclusion: </strong>Allograft tolerance occurred in 74.7% of this cohort. We suggest that the MELD score, indication for LT, ACR, recurrent viral hepatitis, and biliary complications are predictors of allograft tolerance after LDLT.</p>","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":"25 1","pages":"52"},"PeriodicalIF":1.6,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11783700/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143069101","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Radiofrequency ablation combined with immunotherapy to treat hepatocellular carcinoma: a comprehensive review.","authors":"Gui-Lin Xie, Zhi-Han Zhong, Tai-Wei Ye, Zun-Qiang Xiao","doi":"10.1186/s12893-025-02778-z","DOIUrl":"10.1186/s12893-025-02778-z","url":null,"abstract":"<p><strong>Background and aim: </strong>Hepatocellular carcinoma (HCC) is a highly immunogenic tumor and the third leading cause of cancer-related deaths worldwide with an increasing incidence. Therefore, the combination of immunotherapy with other approaches, such as anti-angiogenic agents and local area therapy, has become a new strategy for HCC treatment.</p><p><strong>Methods: </strong>We searched PubMed and Web of Science and extracted publications relating to the radiofrequency ablation (RFA) and immunotherapy. The search terms were: \"radiofrequency ablation\", \"immunotherapy\" and \"hepatocellular carcinoma\", and manual searches of eligible articles from literature reference lists were performed. We then thoroughly reviewed the literature on ablation combined with immunotherapy for HCC, analyzed the relevant mechanism, and explored the safety and effectiveness of this form of combination therapy.</p><p><strong>Results: </strong>RFA combined with immunotherapy in HCC is reported to have good efficacy and controllable safety. On the one hand, RFA can induce the immunogenic substances including Ficolin-3, IL-1 and heat shock protein and regulate the immune cells by mediating the Th1/Th2 ratio, increasing Th17 cells, etc. On the other hand, RFA treatment can lead to tumor immune microenvironment reconstruction, increasing the proportion of functional T cells and upregulate PD-1 in T cells in distant tumors without RFA. This combined strategy has the ability to enhance the anti-tumor immune response through synergies, significantly reduce the risk of recurrence and improve survival.</p><p><strong>Conclusions: </strong>RFA combined with immunotherapy yields a good synergistic effect: it can further strengthen anti-tumor response, delay distant tumor growth, reduce tumor recurrence and metastasis, providing new options for HCC systemic treatment.</p>","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":"25 1","pages":"47"},"PeriodicalIF":1.6,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11776151/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143061298","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advancements in minimally invasive treatment of deltoid ligament injuries combined with distal tibiofibular syndesmosis injuries.","authors":"Kun Liu, Xiaoyan Ji, Peng Su","doi":"10.1186/s12893-025-02779-y","DOIUrl":"10.1186/s12893-025-02779-y","url":null,"abstract":"<p><p>The deltoid ligament (medial collateral ligament) and the syndesmosis (a composite ligamentous structure at the distal tibiofibular junction) are critical for maintaining ankle stability. In cases of high-energy ankle fractures, these structures are often injured simultaneously, leading to instability and potential long-term complications such as post-traumatic arthritis. This review aims to explore advancements in minimally invasive techniques for the treatment of combined deltoid ligament and syndesmosis injuries, with a focus on optimizing surgical outcomes and reducing patient morbidity. Current treatment strategies primarily involve cortical screws for syndesmosis stabilization and anchor fixation for deltoid ligament repair. Recent innovations, such as bioabsorbable screws, suture-button devices with elastic micromotion, and syndesmotic plates, have demonstrated potential in improving biomechanical stability while minimizing complications. Furthermore, minimally invasive techniques, including arthroscopic repairs with suture anchors, as well as ligament reconstruction using autografts, allografts, or synthetic ligaments, are becoming increasingly popular. By incorporating these advancements, the field is moving toward more effective and patient-centered approaches to achieve anatomical and functional restoration under minimally invasive principles. Future research should focus on further validating these techniques and identifying the most effective strategies for complex injuries.</p>","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":"25 1","pages":"50"},"PeriodicalIF":1.6,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11776317/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143069098","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictive role of the prognostic nutritional index for long-term prognosis among patients undergoing pancreatoduodenectomy: a meta-analysis.","authors":"Ying Liu, Keyu Li","doi":"10.1186/s12893-024-02757-w","DOIUrl":"10.1186/s12893-024-02757-w","url":null,"abstract":"<p><strong>Purpose: </strong>To identify the predictive role of the preoperative prognostic nutritional index (PNI) for long-term survival in patients undergoing pancreatoduodenectomy.</p><p><strong>Methods: </strong>The PubMed, EMBASE, Web of Science, Cochrane Library and CNKI databases were searched up to October 28, 2024. The primary outcomes included overall survival (OS) and disease-free survival (DFS). Hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated, and subgroup analyses by country, type of cancer and source of HR were performed.</p><p><strong>Results: </strong>Fifteen studies with 2106 patients were included. The pooled results demonstrated that a lower preoperative PNI was related to poorer OS (HR = 1.60, 95% CI: 1.38-1.86, P < 0.001) and DFS (HR = 1.44, 95% CI: 1.00-2.07, P = 0.051). Subgroup analysis stratified by country (China vs. non-China), type of cancer (pancreatic cancer vs. nonpancreatic cancer vs. mixed) and source of HR (univariate vs. multivariate analysis) revealed similar results.</p><p><strong>Conclusion: </strong>On the basis of the available evidence, the preoperative PNI might serve as a novel prognostic indicator in patients undergoing pancreatoduodenectomy, with a lower PNI predicting worse survival. However, more high-quality studies are needed to further verify the above findings.</p>","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":"25 1","pages":"51"},"PeriodicalIF":1.6,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11776240/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143069150","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative analysis of the parapatellar and subpatellar approaches in reducing peripheral knee pain post-intramedullary tibial fracture surgery.","authors":"Shaoyu Han, Bingjun Cui, Lang Wu, Chuangong Wang, Zhixiang Chen","doi":"10.1186/s12893-025-02777-0","DOIUrl":"10.1186/s12893-025-02777-0","url":null,"abstract":"<p><strong>Introduction: </strong>Intramedullary tibial nailing is a standard treatment for tibial shaft fractures. Postoperative knee pain significantly impacts functional recovery; however, studies on this issue are limited. This study evaluated the effect of the parapatellar approach for intramedullary nailing on postoperative knee pain.</p><p><strong>Materials and methods: </strong>A total of 29 patients with tibial shaft fractures treated with intramedullary nails from March 2019 to January 2022 were divided into two groups based on the surgical approach: the semi-extended lateral parapatellar approach and the conventional subpatellar ligament split approach. Recorded metrics included operation time, intraoperative fluoroscopy count, intraoperative bleeding volume, Visual Analog Scale (VAS) scores for knee pain at 24 h, 72 h, 1 week, and 1 month postoperatively, fracture healing time and Lysholm knee functional scores at 12 months.</p><p><strong>Results: </strong>Both groups completed the operation without significant differences in operation time, intraoperative bleeding, fracture healing time, or intraoperative fluoroscopy (P > 0.05). The parapatellar group showed significantly better VAS scores for knee pain at 24 h, 72 h, and 1 week postoperatively compared to the control group (P < 0.05), with no significant difference at 1 month. After 12 months, Lysholm scores indicated no significant differences in knee support, locking, and swelling (P > 0.05); however, the parapatellar group showed significant improvements in lameness, instability, stair climbing, squatting, and pain (P < 0.05). Overall, the parapatellar group outperformed the control group (P = 0.01). Additionally, long-term follow-up revealed potential advantages of the parapatellar approach in improving long-term functional outcomes.</p><p><strong>Conclusions: </strong>Using the parapatellar approach for tibial intramedullary nailing avoids splitting the patellar ligament and entering the joint cavity, minimizing knee joint impact and effectively reducing postoperative knee pain, with potential benefits in long-term functional recovery.</p>","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":"25 1","pages":"46"},"PeriodicalIF":1.6,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11776146/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143061261","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}