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  • Expression of xylosyltransferases I and II and their role in the pathogenesis of arthrofibrosis
    J. Orthop. Surg. Res. (IF 1.907) Pub Date : 2020-01-23
    Anke Bernstein; Sven N. A. Reichert; Norbert P. Südkamp; Sergio Latorre Hernandez; Andreas G. Nerlich; Jan Kühle; Hermann O. Mayr

    Arthrofibrosis is a painful and restraining complication that occurs after about 10% of total knee arthroplasty and cruciate ligament surgery. The pathogenesis of arthrofibrosis has not yet been fully understood. Stress signals stimulate immune cells, and fibroblast differentiates into myofibroblast, which produce a large amount of collagen. Xylosyltransferases also appear to be involved in these pathways. They catalyze proteoglycan biosynthesis, which is involved in tissue remodeling and myofibroblast differentiation. The aim of this study was to investigate the relationship between the disease arthrofibrosis and the expression of the two isoforms of xylosyltransferases I and II. Tissue samples from 14 patients with arthrofibrosis were compared with tissue samples from seven healthy controls. The xylosyltransferases were detected by immunohistochemistry. The tissues were divided into four different areas of interest: vessels, synovialis, cell-poor and cell-rich fibrosis, or cell-poor and cell-rich areas in the control group. A quantification of the results was performed by modification of the immunoreactive score according to Remmele and Stegner. Xylosyltransferase I was expressed in the various tissue types at varying rates. Xylosyltransferase I expression was considerably and significantly stronger than that of xylosyltransferase II. The following sequences of xylosyltransferase I and xylosyltransferase II expression were determined as follows: vessels >> cell-rich fibrosis > cell-poor fibrosis > synovialis. A positive correlation between the number of positive fibroblasts and the immunoreactive scoring system (IRS) was documented. The significant positive correlation of xylosyltransferase -I expression with increasing number of fibroblasts demonstrates a high myofibroblast differentiation rate, which implies a gradual event as the pathogenesis of arthrofibrosis.

    更新日期:2020-01-23
  • Prediction of wear performance in femoral and tibial conformity in patient-specific cruciate-retaining total knee arthroplasty
    J. Orthop. Surg. Res. (IF 1.907) Pub Date : 2020-01-22
    Yong-Gon Koh; Kyoung-Mi Park; Hwa-Yong Lee; Joon-Hee Park; Kyoung-Tak Kang

    Articular surface curvature design is important in tibiofemoral kinematics and the contact mechanics of total knee arthroplasty (TKA). Thus far, the effects of articular surface curvature have not been adequately discussed with respect to conforming, nonconforming, and medial pivot designs in patient-specific TKA. Therefore, this study evaluates the underlying relationship between the articular surface curvature geometry and the wear performance in patient-specific TKA. We compare the wear performances between conventional and patient-specific TKA under gait loading conditions using a computational simulation. Patient-specific TKAs investigated in the study are categorized into patient-specific TKA with conforming articular surfaces, medial pivot patient-specific TKA, and bio-mimetic patient-specific TKA with a patient’s own tibial and femoral anatomy. The geometries of the femoral components in patient-specific TKAs are identical. The anterior-posterior and internal-external kinematics change with respect to different TKA designs. Moreover, the contact pressure and area did not directly affect the wear performance. In particular, conforming patient-specific TKAs exhibit the highest volumetric wear and wear rate. The volumetric wear in a conforming patient-specific TKA is 29% greater than that in a medial pivot patient-specific TKA. The findings in this study highlight that conformity changes in the femoral and tibial inserts influence the wear performance in patient-specific TKA. Kinematics and contact parameters should be considered to improve wear performance in patient-specific TKA. The conformity modification in the tibiofemoral joint changes the kinematics and contact parameters, and this affects wear performance.

    更新日期:2020-01-23
  • Treatment of patellar dislocation with arthroscopic medial patellofemoral ligament reconstruction using gracilis tendon autograft and modified double-patellar tunnel technique: minimum 5-year patient-reported outcomes
    J. Orthop. Surg. Res. (IF 1.907) Pub Date : 2020-01-22
    Guanying Gao; Ping Liu; Yan Xu

    The purpose of this study was to retrospectively analyze the clinical outcomes of patients with recurrent patellar dislocation who underwent arthroscopic medial patellofemoral ligament (MPFL) reconstruction using gracilis tendon autograft and a modified double-patellar tunnel method. We hypothesized that our modified method would provide good clinical outcomes. Patients who underwent arthroscopic MPFL reconstruction with autograft gracilis tendon and modified double-patellar tunnels technique for recurrent patellar dislocation and were followed up for a minimum of 5 years were identified, and the clinical and follow-up data were retrospectively analyzed. Preoperatively, joint hypermobility was assessed with the Beighton score. The Insall–Salvati ratio, TT–TG distance, and Q angle were measured on radiographic images. Patient-reported outcomes including the Kujala, Lysholm, and Tegner scores were collected preoperatively and postoperatively. Patient satisfaction was assessed at the end of 5 years. Complications and recurrent dislocation occurring after surgery were recorded. A total of 79 patients (94 knees) were enrolled; of these, 13 (16.5%) were lost to follow-up. The data of 66 patients (80 knees) were available for final analysis. Mean age at surgery was 21.3 ± 7.8 years. Mean follow-up time was 66.1 ± 5.5 months (range, 60–78 months). Postoperative patient-reported outcome was not associated with Beighton score, Insall–Salvati ratio, or TT–TG distance. Q angle was negatively correlated to Kujala scores and Lysholm scores. Severity of trochlear dysplasia was not associated with postoperative patient-reported outcome. The mean Kujala score increased from 69.4 ± 7.9 to 96.1 ± 1.9, the mean Tegner score increased from 3.1 ± 1.3 to 5.9 ± 1.3, and the mean Lysholm score increased from 73.5 ± 14.6 to 95.3 ± 3.4. Two patients experienced recurrent patellar dislocation during follow-up. MPFL reconstruction using autologous gracilis tendon under arthroscopy appears to be a reliable and safe method for treating recurrent patellar dislocation. Level IV.

    更新日期:2020-01-23
  • Posterolateral fusion combined with posterior decompression shows superiority in the treatment of severe lumbar spinal stenosis without lumbar disc protrusion or prolapse: a retrospective cohort study
    J. Orthop. Surg. Res. (IF 1.907) Pub Date : 2020-01-22
    Chenxu Wang; Xiang Yin; Liang Zhang; Xin Xue; Yu Xiang; Huaijian Jin; Mingyong Liu; Jianhua Zhao

    Currently, discectomy and posterior decompression combined with lumbar circumferential fusion (CF) have been accepted as a major procedure for severe lumbar spinal stenosis (LSS). However, studies on severe LSS without protruded intervertebral disc to minimize study bias are lacking. We aimed to investigate the effectiveness of sole posterior decompression with lumbar posterolateral fusion (PLF) and the necessity of discectomy and CF in patients with severe LSS without lumbar disc protrusion or prolapse. This retrospective cohort study included 153 severe LSS patients without lumbar disc protrusion or prolapse who were admitted in a tertiary spine center with at least a 2-year follow-up between January 2014 and August 2017. Patients were divided into the PLF (n = 77; those who underwent posterior decompression with PLF in 1–3 segments) or CF (n = 76; those who underwent posterior decompression and discectomy with CF in 1–3 segments) groups. Pedicle screw instrumentation was applied to avoid postoperative instability. Clinical outcomes were assessed by visual analog scale (VAS), Oswestry Disability Index (ODI), and Japanese Orthopedic Association Score (JOA, lumbar pain score). Duration of operation, blood loss, surgical cost, and postoperative complications were analyzed. Height of intervertebral space, lumbar lordosis, and bone union were confirmed by lumbar radiography or computed tomography. Both groups achieved significant improvement in JOA, ODI, and VAS compared with preoperative values (P < 0.001), but without significant difference between the two groups. Both groups achieved high fusion rate without difference and correction of lumbar lordosis and intervertebral space height (P < 0.001), especially in the CF group (P < 0.05). Duration of operation, blood loss, and operation cost were significantly higher in the CF group than in the PLF group (P < 0.001). Eight complications were found in both groups (1, PLF group; 7, CF group; P < 0.05). After posterior decompression, PLF successfully achieves bony fusion and symptom relief with lower complication rate, lesser surgical blood loss, shorter operative time, and lesser cost than CF. Thus, sole posterior decompression with PLF is an effective treatment for severe LSS without lumbar disc protrusion or prolapse.

    更新日期:2020-01-23
  • Establishment of an in vivo rat model for chronic musculoskeletal implant infection
    J. Orthop. Surg. Res. (IF 1.907) Pub Date : 2020-01-21
    Eivind Witsø; Linh Hoang; Kirsti Løseth; Kåre Bergh

    The aim of the study was to establish an experimental chronic musculoskeletal infection model in vivo characterized by (a) a small bacterial inoculum, (b) no general or local signs of infection, (c) several parallels (implants) in each animal and finally (d) a model that is technically easy to perform. Bone xenografts with steel plates were implanted intramuscularly in rats. To the xenografts, different inocula of Staphylococcus aureus and two strains of Staphylococcus epidermidis were added. The animals were observed for different time periods before the removal of the xenografts. The xenografts and steel plates were subjected to quantitative bacterial culture after sonication. Additional steel plates were subjected to scanning electron microscopy (SEM) for visualization of biofilm formation. Inoculation of bone grafts with S. aureus did produce a pyogenic infection in all animals. A chronic infection was established in rats where the bone grafts were inoculated with S. epidermidis. A bacterial inoculum of 100 colony-forming units (CFU) of S. epidermidis was adequate as a minimum infective dose. During a period of up until 42 days, the animals infected with S. epidermidis had no general or local signs of infection. According to the results of the quantitative bacterial culture of sonicate fluid and SEM, a biofilm was developed on all implants. In the present in vivo model, a very small bacterial inoculum succeeded in establishing a chronic musculoskeletal implant infection where a biofilm was formed on the implants. The experimental model is easy to perform and allows several implants in each animal. The model could be useful for the study of biofilm formation in vivo on different implants and different surfaces.

    更新日期:2020-01-22
  • Treatment comparison of femoral shaft with femoral neck fracture: a meta-analysis
    J. Orthop. Surg. Res. (IF 1.907) Pub Date : 2020-01-20
    Yao Lu; Yakang Wang; Zhe Song; Qian Wang; Liang Sun; Cheng Ren; Hanzhong Xue; Zhong Li; Kun Zhang; Dingjun Hao; Yang Zhao; Teng Ma

    To compare the efficacy and complications between reconstruction nail and hollow screw+plate in patients with femoral shaft and femoral neck fracture. The full text of studies on clinical efficacy involving reconstruction nail and hollow screw+plate was retrieved from multiple databases. Review Manager 5.0 was adopted for meta-analysis, sensitivity analysis, and bias analysis. The meta-analysis was conducted with respect to the operation time, blood loss, healing time of the femoral shaft, healing time of the femoral neck, and complications. Finally, 10 studies met the eligibility criteria, including 991 patients. The meta-analysis suggested better characteristics for the reconstruction nail compared with the hollow screw+plate regarding operation time (OR = − 82.41, 95% CI [− 91.72, − 73.10], P < 0.00001; P for heterogeneity < 0.00001, I2 = 98%), blood loss (OR = − 388.01, 95% CI [− 422.95, − 353.06], P < 0.00001; P for heterogeneity < 0.00001, I2 = 99%), healing time of femoral shaft (MD = − 3.89, 95% CI [− 4.74, − 3.05], P < 0.00001; P for heterogeneity < 0.00001, I2 = 99%), healing time of femoral neck (MD = − 4.04, 95% CI [− 4.33, − 3.75], P < 0.00001; P for heterogeneity = 0.008, I2 = 60%), and complications (OR = 0.47, 95% CI [0.31, 0.73], P = 0.0006; P for heterogeneity = 1.00, I2 = 0%). This meta-analysis shows that a reconstruction nail is a more efficient and safer treatment than a hollow screw+plate for patients with femoral shaft and femoral neck fracture.

    更新日期:2020-01-21
  • Ipsilateral femoral neck and shaft fractures fixation with proximal femoral nail antirotation II (PFNA II): technical note and cases series
    J. Orthop. Surg. Res. (IF 1.907) Pub Date : 2020-01-20
    Kuen-Ting Wu; Shih-Jie Lin; Ying-Chao Chou; Hsiang-Hen Cheng; Po-Chong Wen; Che-Han Lin; Wen-Ling Yeh

    Combined ipsilateral femoral neck and shaft fractures are an uncommon type of fractures. A number of different implant options are available for the management of this injury. Two-device procedures were suggested because of the higher rate of malunion by single-device treatment. However, surgical treatment using a cephalomedullary nail is still an alternative option that provides better mechanical advantage and minimal invasion. This study details the technique of treating these pattern fractures with proximal femoral nail anti-rotation II (PFNA-II) to achieve an acceptable reduction in both fracture sites. Ten cases of ipsilateral femoral neck and shaft fractures under reduction by PFNA II were included and reviewed. A saw-bone model was also utilized to perform the detailed technique of reduction and fixation of PFNA II. Under the special technique by using the PFNA II, all ten cases achieved optimal reduction and alignment of both fracture sites in intra-operative fluoroscopy. There was no intra-operative complication noted. After 6 months of follow-up, radiography revealed proper alignment and well union of the fractures. Fixation of ipsilateral femoral neck and shaft fractures with a single construct provides advantages of good biomechanical function, minimal invasion, reduced blood loss, and less operation time when comparing to two-device fixation. Thus, if acceptable reduction could be achieved, fixation by one PFNA II was a good alternative choice for this injury pattern.

    更新日期:2020-01-21
  • Comparison of efficacy and safety between oral and intravenous administration of tranexamic acid for primary total knee/hip replacement: a meta-analysis of randomized controlled trial
    J. Orthop. Surg. Res. (IF 1.907) Pub Date : 2020-01-20
    Wei Ye; Yafang Liu; Wei Feng Liu; Xiao Long Li; Yanqiang Fei; Xing Gao

    Tranexamic acid (TXA) has been demonstrated to reduce blood loss following primary total knee and hip arthroplasty. This study aimed to compare the efficacy and safety of oral and intravenous tranexamic acid for primary total knee and hip arthroplasty. The PubMed, Embase, and Cochrane Library databases were searched for relevant studies published before June 20, 2019. Studies clearly reporting a comparison of oral and intravenous TXA were selected, and total blood loss (TBL), the decline in hemoglobin (DHB), deep vein thrombosis (DVT), intramuscular venous thrombosis (IVT), the length of hospital stay, and the transfusion rate were evaluated. The weighted mean differences and relative risks were calculated using a fixed-effects or random-effects model. Ten studies involving 1140 (oral 557; intravenous 583) patients were included in this meta-analysis. There was no significant difference in terms of total blood loss, the decline in hemoglobin, the length of hospital stay, the incidence of DVT or IVT, or the transfusion rate between the oral and intravenous groups, and five studies reported that oral TXA was associated with a lower cost. Our research suggests that compared with intravenous use of TXA, the oral approach has similar clinical outcomes and is less expensive for total joint replacement patients.

    更新日期:2020-01-21
  • Reoccurring discogenic low back pain (LBP) after discoblock treated by oblique lumbar interbody fusion (OLIF)
    J. Orthop. Surg. Res. (IF 1.907) Pub Date : 2020-01-20
    Junhui Liu; Yongqing He; Bao Huang; Xuyang Zhang; Zhi Shan; Jian Chen; Shunwu Fan; Fengdong Zhao

    To determine the efficacy of OLIF in the treatment of reoccurring discogenic low back pain (LBP) after discoblock We included 108 patients with LBP that was suspected to be discogenic (such as high intensity zone, Schmorl’s nodes, Modic changes Type I, etc.), from August 2015 to August 2017. All patients underwent discography, and patients whose LBP was confirmed to be discogenic received discoblock. Patients who had reoccurring pain after discoblock underwent OLIF. Perioperative parameters and complications were recorded. The VAS and Oswestry Disability Index (ODI) were assessed at preoperation, and 1 week and 1, 3, 6, and 12 months after the surgery. The fusion rate was evaluated. Of 108 patients, 89 were confirmed to have discogenic LBP, and 32/89 patients with reoccurring LBP pain after discoblock underwent OLIF. Twenty-eight patients were followed up for ≥ 1 year. The OLIF operation lasted for 92 ± 34 min. Blood loss during the operation was 48 ± 15 ml. The mean incision length was 3.0 ± 0.6 cm. The average length of stay was 4.8 ± 1.9 days. The VAS and ODI scores decreased from 8.1 ± 1.7 preoperatively to 0.9 ± 0.4, and from 71.2 ± 11.3 to 9.3 ± 3.1, 12 months postoperatively, respectively. The total incidence of complications was 15.6%, including 2 cases of cage subsidence, 2 cases of ipsilateral hip flexor weakness, and 1 case of ipsilateral anterior thigh pain. All symptoms relieved or disappeared during follow-up. The fusion rate was 96.9%. Reoccurring discogenic LBP after discoblock should be considered as a suitable group for treatment by OLIF.

    更新日期:2020-01-21
  • Clinical outcome and explant histology after using a cellular bone allograft in two-stage total hip arthroplasty
    J. Orthop. Surg. Res. (IF 1.907) Pub Date : 2020-01-16
    Cambize Shahrdar; Julie McLean; Elena Gianulis; Davorka Softic; Xiaofei Qin; Mark A. Moore; Jingsong Chen

    Although use of cellular bone allografts (CBA) in orthopedic surgery has become increasingly common, little information is available regarding their short-term clinical performance. In these two case reports of two-stage hip arthroplasties, ViviGen Formable CBA (V-CBA) was used in stage one to fill voids left by previous metal implants. The two patients had distinctly different health profiles, but each of them had previous metal implants due to a hip fracture. In the otherwise healthy 49-year-old male patient, the total hip arthroplasty (THA) was performed 7 weeks after nail removal and V-CBA backfill. In the 64-year-old female patient with Type 1 diabetes and severe osteoporosis, stage 2 was performed after 12 weeks. At the time of THA for each patient, bone containing some V-CBA was removed to accommodate the hip implant. The explants were histologically analyzed for bone matrix, mineralization, and neovascularization. Histological staining showed substantial new bone formation and neovascularization in both explants albeit at different levels of maturity. Although limited, these results suggest that V-CBA may facilitate new bone formation in healthy as well as in metabolically challenged patients. V, case report

    更新日期:2020-01-17
  • Effect of switching administration of alendronate after teriparatide for the prevention of BMD loss around the implant after total hip arthroplasty, 2-year follow-up: a randomized controlled trial
    J. Orthop. Surg. Res. (IF 1.907) Pub Date : 2020-01-16
    Akira Morita; Naomi Kobayashi; Hyonmin Choe; Hiroyuki Ike; Taro Tezuka; Shota Higashihira; Yutaka Inaba

    Stress shielding after total hip arthroplasty (THA) can induce bone mineral density (BMD) loss around the femoral implant. Several studies using drug have described methods to prevent BMD loss around implants following THA. Switching from teriparatide to alendronate was reported to increase lumbar BMD; on the other hands, it is unclear whether switching from teriparatide to alendronate is effective around the implant. The aim of this study is that changes in BMD is compared in patients switched from teriparatide to alendronate, in patients treated with alendronate alone, and in control patients without medication after total hip arthroplasty. Patients were randomized into three groups, those switched to alendronate after teriparatide (switch: n = 17), those receiving continuous alendronate (ALD: n = 15), and control untreated patients (control: n = 16) and followed up for 2 years after THA. Baseline periprosthetic BMD was measured by dual-energy X-ray absorptiometry (DEXA) 1 week after THA, followed by subsequent measurements at 1 and 2 years postoperatively. Lumbar BMD was also evaluated at preoperatively, 1 and 2 years postoperatively. Two years after surgery, BMD (%) at zone 1 was significantly higher in the switch group than in the control group (P = 0.02). BMD (%) at zone 7 was significantly higher in the switch and ALD groups than in the control group (P = 0.01, P = 0.03). Lumbar BMD (%) anterior-posterior (AP) side was significantly higher in the switch group than in the ALD and control groups 2 years after surgery. On the other hand, lumbar BMD (%) lateral side was significantly higher in the switch and ALD groups than control group 2 years after surgery. Switching therapy had a significant effect on BMD of the lumbar spine and zones 1 and 7 at 2 years postoperatively. At zone 1 in particular, it was found to be more effective than ALD alone. UMIN, registry number UMIN000016158. Registered 8 January 2015

    更新日期:2020-01-17
  • Anti-sliding plate technique for coronal shear fractures of the distal humerus
    J. Orthop. Surg. Res. (IF 1.907) Pub Date : 2020-01-17
    Zhe Song; Qian Wang; Teng Ma; Chen Wang; Na Yang; Hanzhong Xue; Zhong Li; Yangjun Zhu; Kun Zhang

    The purpose of this study is to discuss the surgical strategy, technical feasibility, and clinical efficacy of coronal shear fractures of the distal humerus using the anti-sliding plate technique. Fifty-two patients (35 males and 17 females) were treated with the anti-sliding plate technique in our hospital from January 2012 to January 2017. The average age of the patients was 40.4 years. They were classified according to the Dubberley classification system and treated with the anti-sliding plate technique. The long-term functional scores represented by the Mayo Elbow Performance Index and complications were evaluated. Fractures were classified as follows: 11 type-IA, 5 type-IB, 16 type-IIA, 4 type-IIB, 13 type-IIIA, and 3 type-IIIB according to the Dubberley classification system. All patients were treated with open reduction and internal fixation by the extensile lateral approach and completed a clinical and radiographic follow-up (average, 17.6 months). The average Mayo elbow performance score was 90.6 points, with 36 excellent, 11 good, and 5 fair results. The average range of movement of the elbow joint was 3° (0–15°) for extension and 136° (90–150°) for flexion. The anti-sliding plate technique follows basic AO principles and neutralizes the shearing force combined with lag screws and/or Kirschner wires after the anatomic reduction of the fracture. It allows for the stable internal fixation of the fracture, which is critical for early mobilization and a good functional outcome. Level IV, Case Series, Treatment Study

    更新日期:2020-01-17
  • Autogenous fibula graft and cannulated screw fixation to cephalic cut out after DHS fixation: a retrospective study
    J. Orthop. Surg. Res. (IF 1.907) Pub Date : 2020-01-15
    Yan Sun; Tao Huang; Jiangtao Lin; Junbo Ge; Benjun Bi; Zhilin Cao; Huanyu Hong

    This study aimed to explore the effect of the treatment through autologous fibula graft and hollow needle fixation to treat femoral head cutting after dynamic hip screw (DHS) fixation. A total of 41 patients were admitted to the department of orthopedic trauma and received DHS fixation. Preoperative and postoperative harris score of hip function, limb shortening length and collodiaphysial angle between operation group (n = 11) and non-operation group (n = 13) were compared. There was no difference between the two groups before surgery (P > 0.05). There was a difference between the preoperative and postoperative in the operation group (P < 0.05). The excellent and good rate of the hip function score in patients 6 months after the operation was 55.6%. In the operation group, the hip function score increased after surgery (P < 0.001). Except for two groups of patients before operation, there was a difference in the limb shortening length and collodiaphysial angle between the operation group and non-operation group in other time points after surgery (P < 0.001). The application of the autogenous fibula graft and hollow nail fixation was effective in treating femoral head cutting after DHS fixation, and patients’ subjective evaluation and objective indicators’ outcomes of follow up were satisfactory, which was worthy of clinical application.

    更新日期:2020-01-16
  • Long-term outcomes of limb salvage treatment with custom-made extendible endoprosthesis for bone sarcoma around the knee in children
    J. Orthop. Surg. Res. (IF 1.907) Pub Date : 2020-01-16
    Changye Zou; Zhiqiang Zhao; Tiao Lin; Yongfu Huang; Xianbiao Xie; Junqiang Yin; Gang Huang; Bo Wang; Jingnan Shen

    Limb salvage for bone sarcoma around the knee in skeletally immature children is challenging because of interference on two critical growth plates in the lower limb. This retrospective study aims to evaluate long-term outcomes and influence on growth of the lower limb of the cemented extendible endoprostheses. Forty-five children with bone sarcoma around the knee, who underwent custom-made extendible endoprosthesis replacements, were included in this study. The average follow-up was 10.1 years. Survival, prosthetic-related complications and revision, functional outcomes, and influence on growth by prosthesis implantation were recorded. The 5-year disease-free survival and overall survival are 54.9% and 72.7%, and the 5-year prosthesis survival rate is 59.4%. The prosthesis was extended 4.2 cm in average. Limb length discrepancies of 20 patients were within 2 cm, and growth inhibition of proximal tibial epiphysis by passive implant insertion was observed. Aseptic loosening in 7 patients was the most significant complication. The Musculoskeletal Tumor Society score at last visit was 83.2%. The use of custom-made extendible endoprosthesis provided good functional results for children with bone tumor around the knee. Further improvement of the prosthesis design and operation technique will help to decrease complication and gain better limb function.

    更新日期:2020-01-16
  • Association between breastfeeding and osteoporotic hip fracture in women: a dose-response meta-analysis
    J. Orthop. Surg. Res. (IF 1.907) Pub Date : 2020-01-16
    Haixiang Xiao; Quan Zhou; Gouqi Niu; Guansheng Han; Zhongchuan Zhang; Qingbo Zhang; Jianzhong Bai; Xunbing Zhu

    Approximately 300 mg of calcium a day is provided into infants to maintain the physical development of infants, and 5 to 10% bone loss occurs in women during breastfeeding. Hip fractures are considered the most serious type of osteoporotic fracture. We performed this meta-analysis to investigate the association between breastfeeding and osteoporotic hip fractures. PubMed and Embase were searched until May 1, 2019, for studies evaluating the relationship between breastfeeding and osteoporotic hip fracture in women. The quality of the included studies was evaluated by the methodological index for non-randomized studies (MINORS). For the dose-response meta-analysis, we used the “generalized least squares for trend estimation” method proposed by Greenland and Longnecker to take into account the correlation with the log RR estimates across the duration of breastfeeding. Seven studies were moderate or high quality, enrolling a total of 103,898 subjects. The pooled outcomes suggested that breastfeeding can decrease the incidence of osteoporotic hip fracture (RR = 0.64 (95% CI 0.43, 0.95), P = 0.027). Dose-response analysis demonstrated that the incidence of osteoporotic hip fracture decreased with the increase of breastfeeding time. The RR and 95% CI for 3 months, 6 months, 12 months, and 24 months were RR = 0.93, 95% CI 0.88, 0.98; RR = 0.87, 95% CI 0.79, 0.96; RR = 0.79, 95% CI 0.67, 0.92; and RR = 0.76, 95% CI 0.59, 0.98, respectively, whereas no significant relationship was found between them when the duration of breastfeeding time was more than 25 months. Our meta-analysis demonstrated that the incidence of osteoporotic hip fracture decreased with the extension of breastfeeding time. However, there is no significant relationship between them when the duration of breastfeeding time was more than 25 months.

    更新日期:2020-01-16
  • How to judge pelvic malposition when assessing acetabular index in children? Three simple parameters can determine acceptability
    J. Orthop. Surg. Res. (IF 1.907) Pub Date : 2020-01-15
    Yi Yang; Daniel Porter; Li Zhao; Xiang Zhao; Xuan Yang; Suxian Chen

    The acetabular index (AI) is the most commonly used parameter for diagnosing hip dysplasia. Pelvic malposition can result in misinterpretation of AI measurement especially in younger children. We aimed to investigate the correlation between pelvic orientation and acetabular index (AI) by using digital reconstructed radiographs (DRRs) and identify reliable parameters predictive of pelvic orientation on plain radiographs. We retrospectively identified 33 children (52 hips) who received dual source CT examinations. Virtual pelvic models were reconstructed after scanning. After orientating in the standard neutral position, the models were rotated and tilted around corresponding axes. DRRs were generated at every 3° during the process. The acetabular index, the horizontal diameter (Dh) and vertical diameter (Dv) of bilateral obturator foramina, the vertical distance (h) between upper border of pubic symphysis, and Hilgenreiner’s line were measured on each DRR by two independent observers. Rotation index (Rr = right Dh/left Dh), tilt index (Rt = h/Dv), intra-observer error, and inter-observer error of AI were calculated. For tilt and rotation up to 12.0°, AI increased with anterior tilt and decreased with posterior tilt. And for rotation, it increased on the side toward which the pelvis rotated and decreased on the opposite side. AI varied dramatically if angulation exceeded 6.0°. Malposition below this limit demonstrated the intra- and inter-observer errors were ± 2.0° and ± 3.0° respectively and caused no significant effect on AI measurement. For children up to age 6 years, an acceptable pelvic plain radiograph can be determined when Rt is approximately between 0.9 and 1.4 and Rr between 0.7 and 1.5. For the first time, we have identified parameters derived from a group of subjects which can predict this degree of malposition. The parameters obturator diameters (Dh), obturator height (Dv), and distance (h) between symphysis and Hilgengreiner’s line can be feasibly measured on X-ray and employed in clinical practice to assess the acceptability of the pediatric pelvic radiograph prior to measurement of the AI.

    更新日期:2020-01-15
  • Correction of marked sagittal deformity with circumferential minimally invasive surgery using oblique lateral interbody fusion in adult spinal deformity
    J. Orthop. Surg. Res. (IF 1.907) Pub Date : 2020-01-15
    Seung Won Park; Myeong Jin Ko; Young Baeg Kim; Jean Charles Le Huec

    Spinal surgery performed entirely with minimally invasive surgery is referred to as circumferential MIS (cMIS). However, cMIS still has a limited sagittal correction capability for adult spinal deformity (ASD) with a marked sagittal deformity. We investigated the effectiveness of cMIS using oblique lateral interbody fusion (OLIF) and percutaneous posterior spine fixation in correcting marked sagittal deformity. This study retrospectively evaluated 23 patients with ASD with marked sagittal deformity who underwent cMIS using OLIF without osteotomy and were followed-up for at least 24 months (whole group). The whole group was divided into the following two groups according to the type of interbody fusion at L5–S1: the OLIF51 group (n = 13) underwent OLIF at L1–L5 and L5–S1 and the TLIF51 group (n = 10) underwent OLIF at L1–L5 and transforaminal lumbar interbody fusion (TLIF) at L5–S1. Sagittal vertebral axis (SVA; 125.7 vs. 29.5 mm, p < 0.001), lumbar lordosis (LL; 18.2° vs. 51.7°, p < 0.001), and pelvic incidence-LL mismatch (PI-LL, 35.5° vs. 5.3°) significantly improved postoperatively in the whole group. The OLIF51 group showed significantly higher postoperative LL than the TLIF51 group (55.5° vs. 46.9°, p < 0.001). OLIF yielded a significantly greater disc angle at L5–S1 than did TLIF (18.4° vs. 6.9°, p < 0.001). Proximal junctional kyphosis occurred significantly earlier in the OLIF51 group than in the TLIF51 group (8.6 vs. 26.3 months, p < 0.001). Successful sagittal correction in ASD patients with marked sagittal deformity was achieved with cMIS using OLIF. OLIF at L5–S1 showed a synergistic effect in sagittal deformity correction by cMIS.

    更新日期:2020-01-15
  • Comparison of concomitant injuries and patient-reported outcome in patients that have undergone both primary and revision ACL reconstruction—a national registry study
    J. Orthop. Surg. Res. (IF 1.907) Pub Date : 2020-01-10
    Eleonor Svantesson; Eric Hamrin Senorski; Frida Kristiansson; Eduard Alentorn-Geli; Olof Westin; Kristian Samuelsson

    Anterior cruciate ligament (ACL) revision surgery has been associated with inferior outcome compared with primary ACL reconstruction. However, this has rarely been investigated in a consecutive cohort limited to patients that have undergone both primary and revision ACL reconstruction. This study aimed to assess differences in outcome and concomitant injuries between primary and revision ACL reconstruction in such a cohort, and to identify predictors of the patient-reported outcome after ACL revision. Patients who had undergone both primary and revision ACL reconstruction were identified in the Swedish National Knee Ligament Registry. Patients aged 13–49 years with hamstring tendon primary ACL reconstruction and data on the Knee Injury and Osteoarthritis Outcome Score (KOOS) on at least one occasion (preoperative or one year postoperatively) at both surgeries were eligible. Concomitant injuries and the KOOS were compared between each patient’s primary and revision ACL reconstruction. Linear regression analyses were performed to determine predictors of the one-year KOOS after ACL revision. A total of 1014 patients were included. Cartilage injuries increased at ACL revision (p < 0.001), as 23.0% had a cartilage injury at ACL revision that was not present at primary ACL reconstruction. The 1-year KOOS was lower after ACL revision compared with primary ACL reconstruction, with the largest difference in the KOOS sports and recreation (5.2 points, SD 32.2, p = 0.002). A posterolateral corner (PLC) injury at ACL revision was a negative predictor of KOOS, with the largest effect on the sports and recreation subscale (β = − 29.20 [95% CI − 50.71; − 6.69], p = 0.011). The use of allograft for ACL revision was an independent predictor of a poorer KOOS QoL (β = − 12.69 [95% CI − 21.84; − 3.55], p = 0.0066) and KOOS4 (β = − 11.40 [95% CI − 19.24; − 3.57], p = 0.0044). Patients undergoing ACL revision reported a 1-year outcome that was slightly inferior to the 1-year outcome after their primary ACL reconstruction. An ACL revision was associated with an increase in cartilage injuries. A PLC injury at ACL revision and the use of allograft for ACL revision predicted a clinically relevant poorer KOOS one year after ACL revision.

    更新日期:2020-01-11
  • Influence of inflammatory arthritis on leukocyte esterase strip results in the diagnosis of periprosthetic joint infection
    J. Orthop. Surg. Res. (IF 1.907) Pub Date : 2020-01-10
    Jinling Zhang; Binjie Gui; Fangyue Cheng; Genxiang Rong; Zhi Tang; Cailiang Shen

    The leukocyte esterase (LE) strip is considered as a helpful method to detect infection, which might be influenced by other inflammatory diseases. This study aims to explore whether the centrifugation of synovial fluid could influence the positive result of LE strip caused by inflammatory arthritis during the diagnosis of periprosthetic joint infection (PJI). From March 2016 to December 2018, 64 patients who were diagnosed as PJI or aseptic arthritis and another 20 patients with inflammatory arthritis were enrolled in our study. After synovial fluid samples were obtained, the LE strip test was performed with and without centrifugation. Then clinicians read the color changes 3 min after the samples were dropped and classify the results based on the instruction of strip. The differences between septic and aseptic arthritis patients and septic and inflammatory arthritis patients were analyzed. Among the included 21 PJI samples, 19 of them showed positive results (++) of LE strip before centrifugation. After centrifugation, two samples changed from two-positive (++) to one-positive (+), which is also considered as positive. Before centrifugation, 29 of the LE strip tests in the aseptic arthritis group (43 samples included) were ++ or +. After centrifugation, 16 of the samples yielded negative results. Among 20 samples with inflammatory arthritis, LE strip of 18 samples were positive (++ or +) before centrifugation, among which only 3 samples remained as positive after centrifugation. LE strip test results could be influenced by inflammatory arthritis during the diagnosis of PJI. Centrifugation should be performed for LE strip tests to determine whether the result is a true positive or a false positive influenced by inflammatory arthritis.

    更新日期:2020-01-11
  • Does isolated atlantoaxial fusion result in better clinical outcome compared to occipitocervical fusion?
    J. Orthop. Surg. Res. (IF 1.907) Pub Date : 2020-01-09
    Katharina E. Wenning; Martin F. Hoffmann

    The C0 to C2 region is the keystone for range of motion in the upper cervical spine. Posterior procedures usually include a fusion of at least one segment. Atlantoaxial fusion (AAF) only inhibits any motion in the C1/C2 segment whereas occipitocervical fusion (OCF) additionally interferes with the C0/C1 segment. The purpose of our study was to investigate clinical outcome of patients that underwent OCF or AAF for upper cervical spine injuries. Over a 5-year period (2010–2015), consecutive patients with upper cervical spine disorders were retrospectively identified as having been treated with OCF or AAF. The Numeric Pain Rating Scale (NPRS) and the Neck Disability Index (NDI) were used to evaluate postoperative neck pain and health restrictions. Demographics, follow-up, and clinical outcome parameters were evaluated. Infection, hematoma, screw malpositioning, and deaths were used as complication variables. Follow-up was at least 6 months postoperatively. Ninety-six patients (male = 42, female = 54) underwent stabilization of the upper cervical spine. OCF was performed in 44 patients (45.8%), and 52 patients (54.2%) were treated with AAF. Patients with OCF were diagnosed with more comorbidities (p = 0.01). Follow-up was shorter in the OCF group compared to the AAF group (6.3 months and 14.3 months; p = 0.01). No differences were found related to infection (OCF 4.5%; AAF 7.7%) and revision rate (OCF 13.6%; AAF 17.3%; p > 0.05). Regarding bother and disability, no differences were discovered utilizing the NDI score (AAF 21.4%; OCF 37.4%; p > 0.05). A reduction of disability measured by the NDI was observed with greater follow-up for all patients (p = 0.01). Theoretically, AAF provides greater range of motion by preserving the C0/C1 motion segment resulting in less disability. The current study did not show any significant differences regarding clinical outcome measured by the NDI compared to OCF. No differences were found regarding complication and infection rates in both groups. Both techniques provide a stable treatment with comparable clinical outcome.

    更新日期:2020-01-09
  • Knockdown of miR-660 protects nucleus pulposus cells from TNF-a-induced apoptosis by targeting serum amyloid A1
    J. Orthop. Surg. Res. (IF 1.907) Pub Date : 2020-01-06
    Hao Jie Zhang; Xue Hai Ma; Song Lin Xie; Shu lian Qin; Cong Zhi Liu; Zhen Guo Zhang

    Intervertebral disc degeneration (IVDD) is a well-known cause of lower back pain, which is induced by multiple factors including increased apoptosis and decreased survival of nucleus pulposus cells. In this study, we evaluate the effect and potential mechanism of miR-660 on the nucleus pulposus cells apoptosis induced by TNF-α. First, we collected tissue of nucleus pulposus from IVDD and healthy controls. General characteristic of the IVDD and healthy control was also collected. And, we also collected nucleus pulposus cells that stimulated by TNF-α or control. miRNA microarray was performed to identify the differentially expressed miRNAs. Apoptosis rate and miR-660 relative expression was measured after stimulated with different concentration of TNF-α to identify the optimal concentration of TNF-α. Second, we successfully constructed antigomiR-660 to block the miR-660 expression in nucleus pulposus cells and then stimulated with TNF-α (100 ng/ml, 12 h). The apoptosis rates and relative protein expression were then measured again. The target association between miR-660 and SAA1 was confirmed by dual-luciferase reporter. There was no significant difference between the age (IVDD: 39 ± 10 years, healthy controls: 36 ± 7 years), BMI and sex between IVDD and healthy controls. Microarray analysis found that miR-660 was significantly up-regulated in IVDD and TNF-α treated groups, which was further identified by PCR. We found that the rate of apoptosis and miR-660 expression increased with TNF-α concentration increased. Finally, TNF-a with 100 ng/ml was used for further experiment. Compared with TNF-α group, TNF-α + antigomiR-660 could significantly down-regulated the apoptosis rate and relative protein (c-Caspase3 and c-Caspase7). Dual-luciferase reporter revealed that miR-660 could directly binding to the SAA1 at 80–87 sites. Compared with TNF-α alone group, TNF-α + antigomiR-660 significantly up-regulated the SAA1 expression (P < 0.05). These results indicated that knockdown of miR-660 protected the nucleus pulposus from apoptosis that induced TNF-α via up-regulation of SAA1. Further studies should focus on the role of miR-660 in protecting IVDD in vivo.

    更新日期:2020-01-07
  • Mid-term results after proximal humeral fractures following angular stable plate fixation in elderly patients—which scores can be evaluated by a telephone-based assessment?
    J. Orthop. Surg. Res. (IF 1.907) Pub Date : 2020-01-06
    Patrick Ziegler; Kim Stierand; Christian Bahrs; Marc-Daniel Ahrend

    The aim was to evaluate postsurgical outcome in elderly patients (> 70 years) after open reduction and internal fixation (ORIF) of proximal humeral fractures and compare the test-retest agreement of scores which are frequently used to assess the outcome of upper extremity disorders. Ninety patients (78.1 ± 5.2 years) with a minimum follow-up of 2 years (3.7 ± 0.9 years) following angular stable plate fixation of a proximal humeral fracture (2-part: 34, 3-part: 41, 4-part: 12) were enrolled. Two telephone-based interviews assessed Disabilities of the Arm, Shoulder and Hand Score (DASH), Oxford Shoulder Score (OSS), and Constant Score adjusted for interview assessment (CS) by two independent interviewers. Correlations, Bland-Altman analyses, Cross tabulation, and weighted Kappa measure of agreement (k) were calculated to assess differences and the test-retest agreement between the categories of each score. In the first and second interview, we could state fair outcomes: CS 91 (range 40–100) and 65.5 (23–86), DASH 12.5 (0–64.2) and 18.3 (0–66.7), and OSS 58 (33–60) and 55 (25–60) points. The test-retest correlations were r = 0.67, r = 0.77, and r = 0.71 for CS, DASH, and OSS. Bland-Altman analyses showed absolute mean individual score differences of − 22.3, 4.9, and − 3.0 for CS, DASH, and OSS. Limits of agreement represented possible differences of 21.6%, 15.5%, and 9.0% of CS, DASH, and OSS. The category agreements were medium to high: CS 55.9% (k = 0.08), DASH 87.2% (k = 0.62), and OSS 99.3% (k = 0.74). Patients showed good subjective outcomes. The test-retest agreement of the interview-adjusted CS was low, but telephone-based assessment of OSS and DASH present as an alternative to collect outcomes in elderly patients. (250/2011BO2).

    更新日期:2020-01-06
  • Pedicle screw placement in spinal neurosurgery using a 3D-printed drill guide template: a systematic review and meta-analysis
    J. Orthop. Surg. Res. (IF 1.907) Pub Date : 2020-01-03
    Chengqiang Yu; Yufu Ou; Chengxin Xie; Yu Zhang; Jianxun Wei; Xiaoping Mu

    Many surgeons believe that the use of a 3D-printed drill guide template shortens operative time and reduces intraoperative blood loss compared with those of the free-hand technique. In this study, we investigated the effects of a drill guide template on the accuracy of pedicle screw placement (the screw placed completely in the pedicle), operative time, and intraoperative blood loss. We systematically searched the major databases, such as Medline via PubMed, EMBASE, Ovid, Cochrane Library, and Google Scholar, regarding the accuracy of pedicle screw placement, operative time, and intraoperative blood loss. The χ2 test and I2 statistic were used to examine heterogeneity. Odds ratios (ORs) with 95% confidence intervals (CIs) were used to calculate the accuracy rate of pedicle screw placement, and weighted mean differences (WMDs) with 95% CIs were utilized to express operative time and intraoperative blood loss. This meta-analysis included 13 studies (seven randomized controlled trials and six prospective cohort studies) involving 446 patients and 3375 screws. The risk of research bias was considered moderate. Operative time (WMD = − 20.75, 95% CI − 33.20 ~ − 8.29, P = 0.001) and intraoperative blood loss (WMD = − 106.16, 95% CI − 185.35 ~ − 26.97, P = 0.009) in the thoracolumbar vertebrae, evaluated by a subgroup analysis, were significantly different between groups. The 3D-printed drill guide template has advantages over the free-hand technique and improves the accuracy of pedicle screw placement (OR = 2.88; 95% CI, 2.39~3.47; P = 0.000). The 3D-printed drill guide template can improve the accuracy rate of pedicle screw placement, shorten operative time, and reduce intraoperative blood loss.

    更新日期:2020-01-04
  • Predictive formula of cervical lordosis in asymptomatic young population
    J. Orthop. Surg. Res. (IF 1.907) Pub Date : 2020-01-03
    Yuchen Zhu; Zhongcheng An; Yingjian Zhang; Hao Wei; Liqiang Dong

    Not a large number of previous studies have reported the normal sagittal balance of the cervical spine and physiological cervical lordosis (CL) has not been clearly defined yet. This was a prospective radiological analysis of asymptomatic subjects. The following cervical sagittal parameters were measured: CL, thoracic inlet angle (TIA), T1 slope (T1S), neck tilt (NT), and C2–7 sagittal vertical axis (C2–7 SVA). The Pearson correlation test was calculated, and the stepwise multiple regression analysis was conducted by using the CL (dependent variable) and the other cervical sagittal parameters (independent variables) to determine the best sets of predictors. A paired sample t test was conducted between the predicted and measured values. The mean age of 307 participants was 24.54 + 3.07. The mean CL, TIA, T1S, NT, and C2–C7 SVA was 17.11° ± 6.31°, 67.87° ± 7.78°, 25.84° ± 5.36°, 42.53° ± 6.68°, and 14.60 ± 8.20 mm, respectively. The formula was established as follows: CL = 0.762 × T1S − 0.392 × C2–C7 SVA + 0.25 × TIA − 13.795 (R = 0.812, R2 = 0.660) (stepwise multiple regression) and CL = 0.417 × TIA − 11.193 (R = 0.514, R2 = 0.264) (simple linear regression). There was no statistical difference between the predicted CL and the measured CL (t = 0.034, P = 0.973). There was a significant correlation between CL and other cervical sagittal parameters, including TIA, T1S, NT, and C2–C7 SVA in asymptomatic Chinese population. The results of this study may serve as a normal reference value for the study of asymptomatic population.

    更新日期:2020-01-04
  • Different spinal subtypes with varying characteristics of lumbar disc degeneration at specific level with age: a study based on an asymptomatic population
    J. Orthop. Surg. Res. (IF 1.907) Pub Date : 2020-01-03
    Shao-qing Chen; Qing-ping Li; Ying-ying Huang; An-na Guo; Rui-fang Zhang; Pei-pei Ye; Zhi-han Yan; Jia-wei He

    The relationship between spinal sagittal subtypes and lumbar disc degeneration is unclear. Thus, we aimed to investigate the relationship between lumbar intervertebral disc degeneration and age in asymptomatic healthy individuals with different sagittal alignments. In this cross-sectional observational study, we examined 209 asymptomatic young and middle-aged volunteers (123 women and 86 men) who were divided into the following three groups according to age: groups A (20–30 years), B (31–40 years), and C (41–50 years). The volunteers underwent full-spine standing lateral radiography and magnetic resonance imaging (MRI, 3.0 T) of the lumbar spine. Based on panoramic radiography, two observers measured the spinopelvic parameters and classified the spine into Roussouly subtypes. The degree of disc degeneration was assessed based on T2-weighted images according to the Pfirrmann classification. There was a statistically significant difference in the degree of degeneration of type I spine between groups B and C at L4-L5 (P < 0.03) and L5-S1 (P < 0.01) and between groups A and C at L1-L2 (P < 0.04) and L4-L5 (P < 0.01). The degeneration degree of type II spine at all levels were significantly different between groups A and C. No statistically significant difference was found between groups A and B in all subtypes except for type II spine at L1-L2 (P < 0.04). A significant difference was found at four levels between groups B and C in type III spine (P < 0.05) and between groups A and C. For type IV spine, there was a significant difference in the degree of degeneration at L4-L5 (P < 0.02) between groups A and C. Moreover, almost all single parameters were not strongly correlated with the degree of disc degeneration. The different spinal subtypes have characteristics of lumbar disc degeneration at specific levels with age. We considered that spinal classification could be used as a predictor of lumbar disc degeneration. Our data may be helpful to increase awareness of the relationship between spinal subtypes and lumbar disc degeneration. 3

    更新日期:2020-01-04
  • Endoscopic rhizotomy for chronic lumbar zygapophysial joint pain
    J. Orthop. Surg. Res. (IF 1.907) Pub Date : 2020-01-03
    Yuntao Xue; Tao Ding; Dajie Wang; Jianli Zhao; Huilin Yang; Xiaofeng Gu; Dehong Feng; Yafeng Zhang; Hao Liu; Fenglin Tang; Wanyi Wang; Miao Lu; Chao Wu

    Chronic lumbar zygapophysial joint pain is a common cause of chronic low back pain. Percutaneous radiofrequency ablation (RFA) is one of the effective management options; however, the results from the traditional RFA need to be improved in certain cases. The aim of this study is to investigate the effect of percutaneous radiofrequency ablation under endoscopic guidance (ERFA) for chronic low back pain secondary to facet joint arthritis. This is a prospective study enrolled 60 patients. The cases were randomized into two groups: 30 patients in the control group underwent traditional percutaneous radiofrequency ablation, others underwent ERFA. The lumbar visual analog scale (VAS), MacNab score, and postoperative complications were used to evaluate the outcomes. All outcome assessments were performed at postoperative 1 day, 1 month, 3 months, 6 months, and 12 months. There was no difference between the two groups in preoperative VAS (P > 0.05). VAS scores, except the postoperative first day, in all other postoperative time points were significantly lower than preoperative values each in both groups (P < 0.05). There was no significant difference between the two groups in VAS at 1 day, 1 month, and 3 months after surgery (P > 0.05). However, the EFRA demonstrated significant benefits at the time points of 3 months and 6 months (P > 0.05). The MacNab scores of 1-year follow-up in the ERFA group were higher than that in the control group (P < 0.05). The incidence of complications in the ERFA group was significantly less than that in the control group (P < 0.05). ERFA may achieve more accurate and definite denervation on the nerves, which leads to longer lasting pain relief.

    更新日期:2020-01-04
  • Monteggia-like lesions in adults treated with radial head arthroplasty—mid-term follow-up of 27 cases
    J. Orthop. Surg. Res. (IF 1.907) Pub Date : 2020-01-03
    Matthias Jung; Corinna Groetzner-Schmidt; Felix Porschke; Paul A. Grützner; Thorsten Guehring; Marc Schnetzke

    The aim of the study was to analyze the functional and radiological outcome of Monteggia-like lesions in adults with unreconstructible fracture of the radial head and treatment with radial head arthroplasty. Twenty-seven patients (mean age 56 years; range 36 to 79 years) with a Monteggia-like lesion and treatment with radial head replacement were included in this retrospective study. Minimum follow-up was 2 years. Clinical assessment included the pain level with the visual analog scale in rest (VASR) and under pressure (VASP), range of motion, Mayo Elbow Performance Score (MEPS), and Disability of the Arm, Shoulder, and Hand score (DASH). A detailed radiological evaluation was performed. Complications and revisions were also analyzed. After a mean follow-up period of 69 months (range, 24 to 170) the mean DASH score was 30 ± 24, the MEPS averaged 77 ± 20 points, the mean VASR was 2.1 ± 2.4, and VASP was 4.5 ± 3.5. Mean loss of extension was 24° ± 18 and flexion was 124° ± 20. Heterotopic ossifications were noted in 12 patients (44%). A total of 17 complications were noted in 11 patients (41%), leading to 15 revision surgeries in 9 patients (33%). Patients with a complicated postoperative course showed a worse clinical outcome compared with patients without complications measured by MEPS (68 ± 22 vs. 84 ± 16), DASH (49 ± 16 vs. 20 ± 22) and ulnohumeral motion (77° ± 31 vs. 117° ± 23). Monteggia-like lesions with unreconstructible radial head fracture and treatment with radial head replacement are prone to complications and revisions.

    更新日期:2020-01-04
  • Below-elbow or above-elbow cast for conservative treatment of extra-articular distal radius fractures with dorsal displacement: a prospective randomized trial
    J. Orthop. Surg. Res. (IF 1.907) Pub Date : 2019-12-30
    Gaetano Caruso; Francesco Tonon; Alessandro Gildone; Mattia Andreotti; Roberto Altavilla; Alessandra Valentini; Giorgia Valpiani; Leo Massari

    Distal radial fractures are common traumatic injuries, but their management remains controversial also in case of conservative treatment regarding the type of immobilisation. Hence, we conducted a two-arm, parallel-group, prospective randomised trial to compare the capacity of long casts (above-elbow) and short casts (below-elbow) to maintain the reduction of extra-articular distal radius fractures with dorsal displacement (AO/OTA classification: 2R3A2.2). Seventy-four eligible patients with AO/OTA 2R3A2.2 fractures treated with closed reduction and cast immobilisation were randomised to the long cast group (n°= 37) or to the short cast group (n°= 37). Baseline radiological parameters, radial inclination (RI), radial height (RH), ulnar variance (UV) and palmar tilt (PT) were taken, and compared with clinical (DASH, Mayo Wrist and Mayo Elbow) and radiological scores taken at 7–10 days, 4 weeks and 12 weeks. Furthermore, to evaluate correlations between radiological parameters and functional outcomes, patients were divided into two groups according to whether or not their radiological parameters at Follow-ups 2 and 3 were acceptable, i.e. within the range 11–12 mm for RH, 16°–28° for RI, − 4–+ 2 mm for UV and 0°–22° for PT. Patient demographic and baseline radiological parameters were similar between groups. At follow-up, there were no statistically significant differences between the two types of cast in terms of RI, RH, UV or PT, or Mayo wrist or DASH scores. Short cast group patients displayed better Mayo elbow score at follow-up 2 (4 weeks), but this difference was no longer statistically significant at follow-up 3 (12 weeks). No statistically significant differences in clinical outcomes were found between patients who presented acceptable radiographic parameters at follow-up and those who did not. As there were no significant differences between short casts and long casts in terms of fracture reduction maintenance or clinical outcomes, short casts are an effective method of post-reduction immobilisation in AO/OTA 2R3A2.2 fracture of the radius. Radiological parameters outside the range conventionally considered acceptable do not preclude a satisfactory clinical outcome. ClinicalTrials.gov PRS, NCT04062110. Registred 20 August 2019.

    更新日期:2019-12-31
  • Tape suture for stabilization of incomplete posterior pelvic ring fractures—biomechanical analysis of a new minimally invasive treatment for incomplete lateral compression pelvic ring fractures
    J. Orthop. Surg. Res. (IF 1.907) Pub Date : 2019-12-27
    Christopher Alexander Becker; Adrian Cavalcanti Kussmaul; Eduardo Manuel Suero; Markus Regauer; Matthias Woiczinski; Christian Braun; Wilhelm Flatz; Oliver Pieske; Christian Kammerlander; Wolfgang Boecker; Axel Greiner

    Incomplete lateral compression fractures (including AO Type B2.1) are among the most common pelvic ring injuries. Although the treatment of choice remains controversial, sacroiliac (SI) screws are commonly used for the operative treatment of incomplete lateral compression fractures of the pelvic ring. However, the disadvantages of SI screws include the risk of nerve root or blood vessel injury. Recently, tape sutures have been found useful as stabilizing material for the treatment of injuries of the syndesmosis, the rotator cuff and knee ligaments. In this current study, we aimed to test the biomechanical feasibility of tape sutures to stabilize the pelvis in the setting of AO Type B2.1 injury. Six human cadaveric pelvises underwent cyclic loading to compare the biomechanical stability of different osteosynthesis methods in a B2.1 fracture model. The methods tested in this experiment were a FiberTape® suture and the currently established SI screw. A 3D ultrasound tracking system was used to measure fracture fragment motion. Linear regression was used to model displacement and stiffness at the posterior and anterior pelvic ring. At the posterior fracture site, the FiberTape® demonstrated similar displacement (2.2 ± 0.8 mm) and stiffness (52.2 ± 18.0 N/mm) compared to the sacroiliac screw (displacement 2.1 ± 0.6 mm, P > 0.999; stiffness 50.8 ± 13.0 N/mm, P > 0.999). Considering the anterior fracture site, the FiberTape® again demonstrated similar displacement (3.8 ± 1.3 mm) and stiffness (29.5 ± 9.0 N/mm) compared to the sacroiliac screw (displacement 2.9 ± 0.8 mm, P = 0.2196; stiffness 37.5 ± 11.5 N/mm, P = 0.0711). The newly presented osteosynthesis, the FiberTape®, shows promising results for the stabilization of the posterior pelvic ring in AO Type B2.1 lateral compression fractures compared to a sacroiliac screw osteosynthesis based on its minimal-invasiveness and the statistically similar biomechanical properties.

    更新日期:2019-12-30
  • Plate-related results of opening wedge high tibial osteotomy with a carbon fiber reinforced poly-ether-ether-ketone (CF-PEEK) plate fixation: a retrospective case series of 346 knees
    J. Orthop. Surg. Res. (IF 1.907) Pub Date : 2019-12-27
    Claudia Hartz; Ralph Wischatta; Eckhardt Klostermeier; Malte Paetzold; Klaus Gerlach; Frank Pries

    While open wedge high tibial osteotomy (owHTO) is an established standard procedure to treat medial osteoarthritis of the knee in combination with varus deformity, it bears the risk of postoperative hardware failures and lateral cortical hinge fractures. This in turn can lead to an accelerated osteoarthritis, non-union, or a loss of correction accuracy. The purpose of the study was to evaluate the radiologic outcomes of owHTO with a carbon fiber reinforced poly-ether-ether-ketone (CF-PEEK) plate fixation in patients with medial osteoarthritis and varus deformity. Three hundred twenty-four consecutive patients (346 knees) who were treated with owHTO using the PEEKPower HTO plate were included in this retrospective study; 89.9% of the patients were overweight or obese. Patients were followed by conventional radiographs over a 12-month period. Typical plate-related results such as the time and quality of gap healing as well as the correction accuracy were analyzed. Furthermore, the number of lateral cortex fractures was determined. Bony consolidation was observed after a mean gap healing time of 4.0 ± 1.7 months independent on the patients’ weight (p = 0.2302). With increasing gap sizes, bony healing was significantly prolonged (p < 0.001). Additionally, patients with greater gap sizes had a significantly increased risk for a lateral cortex fracture (p = 0.0041). However, none of the patients had a non-union 1 year postoperative. A hinge fracture occurred in 30% of patients. Hinge fractures with Takeuchi grades I and II increased the gap healing time compared to no fracture (p = 0.0069 and p = 0.0002, respectively), but only 1.2% of patients with hinge fracture had a clinical relevant loss of correction ≥ 3 mm. No implant failures were found. Open wedge HTO using the PEEKPower HTO plate for patients with medial osteoarthritis of the knee in combination with tibial varus deformity leads to excellent bony consolidation also in cases with a hinge fracture, a gap size > 12 mm as well as for severely obese patients.

    更新日期:2019-12-30
  • Posterior percutaneous endoscopic lumbar discectomy combined with the vertical anchoring technique for lumbar disc herniation with distant upward migration
    J. Orthop. Surg. Res. (IF 1.907) Pub Date : 2019-12-27
    Yu Xia; Qiongyue Zhang; Xiang Gao; Keran Wang; Xun Zhang; Yu Du; Liang Chen

    Posterior percutaneous endoscopic lumbar discectomy (PELD) has become a preferred procedure for the treatment of simple lumbar disc herniation (LDH) but has rarely been reported for distant upward migration. The purpose of this research was to investigate the feasibility, safety, clinical efficacy and technical points of posterior PELD combined with the vertical anchoring technique (VAT) for the treatment of LDH with distant upward migration. Thirteen patients with distant upward migrated LDH who underwent posterior PELD combined with the VAT from March 2016 to May 2018 were selected. Among these cases, the herniated disc was located at L3/4 in 2 patients, L4/5 in 9 patients and L5/S1 in 2 patients. The operative time, length of hospital stay and postoperative complications were recorded. The visual analogue score (VAS), Oswestry Disability Index (ODI), Japanese Orthopaedic Association (JOA) scores and modified MacNab criteria were used to assess surgical efficacy. All 13 patients underwent successful surgery. We compared the VAS, ODI and JOA scores before and after surgery. The differences were statistically significant (P < 0.05). According to the modified MacNab criteria, 10 patients were assessed as “excellent”, 2 patients were assessed as “good” and 1 patient was assessed as “fair” at the last follow-up. The rate of satisfactory outcomes was 92.3%. Posterior PELD combined with the VAT is a safe and feasible procedure for the treatment of LDH with distant upward migration and represents a new approach for this type of surgery.

    更新日期:2019-12-30
  • Effect of hospital volume on outcomes of total hip arthroplasty: a systematic review and meta-analysis
    J. Orthop. Surg. Res. (IF 1.907) Pub Date : 2019-12-27
    Syed Hamza Mufarrih; Muhammad Owais Abdul Ghani; Russell Seth Martins; Nada Qaisar Qureshi; Sayyeda Aleena Mufarrih; Azeem Tariq Malik; Shahryar Noordin

    A shift in the healthcare system towards the centralization of common yet costly surgeries, such as total hip arthroplasty (THA), to high-volume centers of excellence, is an attempt to control the economic burden while simultaneously enhancing patient outcomes. The “volume-outcome” relationship suggests that hospitals performing more treatment of a given type exhibit better outcomes than hospitals performing fewer. This theory has surfaced as an important factor in determining patient outcomes following THA. We performed a systematic review with meta-analyses to review the available evidence on the impact of hospital volume on outcomes of THA. We conducted a review of PubMed (MEDLINE), OVID MEDLINE, Google Scholar, and Cochrane library of studies reporting the impact of hospital volume on THA. The studies were evaluated as per the inclusion and exclusion criteria. A total of 44 studies were included in the review. We accessed pooled data using random-effect meta-analysis. Results of the meta-analyses show that low-volume hospitals were associated with a higher rate of surgical site infections (1.25 [1.01, 1.55]), longer length of stay (RR, 0.83[0.48–1.18]), increased cost of surgery (3.44, [2.57, 4.30]), 90-day complications (RR, 1.80[1.50–2.17]) and 30-day (RR, 2.33[1.27–4.28]), 90-day (RR, 1.26[1.05–1.51]), and 1-year mortality rates (RR, 2.26[1.32–3.88]) when compared to high-volume hospitals following THA. Except for two prospective studies, all were retrospective observational studies. These findings demonstrate superior outcomes following THA in high-volume hospitals. Together with the reduced cost of the surgical procedure, fewer complications may contribute to saving considerable opportunity costs annually. However, a need to define objective volume-thresholds with stronger evidence would be required. PROSPERO CRD42019123776.

    更新日期:2019-12-30
  • The short- to midterm effectiveness of stemless prostheses compared to stemmed prostheses for patients who underwent total shoulder arthroplasty: a meta-analysis
    J. Orthop. Surg. Res. (IF 1.907) Pub Date : 2019-12-30
    Wei Peng; Yufu Ou; Chenglong Wang; Jianxun Wei; Xiaoping Mu; Zhian He

    To systematically compare the short- to midterm effectiveness of stemless prostheses to that of stemmed prostheses for patients who underwent total shoulder arthroplasty (TSA) and to provide a guideline for clinical decision-making. PubMed, the Cochrane Library, and Web of Science were searched with the given search terms until July 2019 to identify published articles evaluating the clinical outcomes for stemless prostheses compared with stemmed prostheses for patients who underwent TSA. Data extraction and the quality assessment of the included studies were independently performed by two authors. Stata software 14.0 was used to analyze and synthesize the data. Two randomized controlled trials and six case-controlled studies with a total of 347 shoulders were included in this meta-analysis. The results of this meta-analysis showed that there were no significant differences between the stemless and stemmed prostheses in terms of the Constant score, pain score, strength, activities of daily living, postoperative range of motion (ROM), and postoperative maximum active ROM. This is the first meta-analysis reporting the clinical results of stemless TSA in the short- to midterm follow-up period. Both types of shoulder prostheses were similar in achieving satisfactory clinical outcomes.

    更新日期:2019-12-30
  • Exosomes derived from platelet-rich plasma present a novel potential in alleviating knee osteoarthritis by promoting proliferation and inhibiting apoptosis of chondrocyte via Wnt/β-catenin signaling pathway
    J. Orthop. Surg. Res. (IF 1.907) Pub Date : 2019-12-30
    Xuchang Liu; Lubo Wang; Chengshan Ma; Guozong Wang; Yuanji Zhang; Shui Sun

    Platelet-rich plasma (PRP) provides a nonsurgical approach for treating osteoarthritis (OA). Exosomes that play vital roles in intercellular communication have been studied extensively. Here, we investigated the therapeutic potential and molecular mechanism of exosomes derived from PRP (PRP-Exos) in alleviating OA. Exosomes derived from PRP(PRP-Exos) were isolated and purified using the exoEasy Maxi Kit and then identified and analyzed. Primary rabbit chondrocytes were isolated and treated with interleukin 1 beta (IL-1β) to establish the OA model in vitro. Proliferation, migration, and apoptosis assays were measured and compared between PRP-Exos and activated PRP (PRP-As) to evaluate the therapeutic effects on OA. The mechanism involving the Wnt/β-catenin signaling pathway was investigated by Western blot analysis. In vivo, we established animal knee OA model by surgery to compare the therapeutic effect of PRP-Exos and PRP-As. We successfully isolated and purified exosomes from PRP using the exoEasy Maxi Kit. We also isolated and identified chondrocytes from the New Zealand white rabbit and established the IL-1β-induced OA model; meanwhile, PRP-Exos and PRP-As both inhibited the release of tumor necrosis factor-α(TNF-α) and there was no statistically significant difference between the two. In proliferation, migration, scratch assay, the promoting effect of PRP-Exos was significantly more better than PRP-As. Furthermore, PRP-Exos could significantly decreased apoptotic rate of OA chondrocyte compared with PRP-As. In Western blot analysis, the expression of β-catenin, and RUNX2, Wnt5a were increased in IL-1β-treated chondrocytes, but PRP-Exos and PRP-As could both reverse these changes, and the reversal effect of the former was better than the latter. In vivo, we found that both PRP-Exos and PRP-As displayed the progression of OA, and the effect of PRP-Exos was obviously better than PRP-As by chondrocyte count and Osteoarthritis Research Society International (OARSI) scoring system. The therapeutic effects of PRP-Exos on OA were similar or better compared with those of PRP-As in vitro or in vivo. PRP-Exos acting as carriers containing growth factors derived from PRP present a novel therapy for OA by activating the Wnt/β-catenin signaling pathway.

    更新日期:2019-12-30
  • Prediction of time to prosthesis implantation as a function of joint anatomy in patients with developmental dysplasia of the hip
    J. Orthop. Surg. Res. (IF 1.907) Pub Date : 2019-12-30
    Michael Müller; Anasthasia Rakow; Georgi I. Wassilew; Tobias Winkler; Carsten Perka

    Developmental dysplasia of the hip (DDH) can lead to pain and premature secondary osteoarthritis at an early stage. Joint-preserving osteotomy is an established solution to this problem. In contrast, a conservative approach would result in pain persistence, ultimately raising the patients question for a possible date of expected prosthesis implantation. The aim of the study was to identify the relationship between the dysplastic hip anatomy and the time of prosthesis implantation in order to enable prognostic predictions in younger patients with symptomatic DDH. Data from 129 hips who received THA due to secondary DDH osteoarthritis were evaluated. The preoperative hip anatomy was evaluated for AI and LCE angle. Multiple linear regression analyses were then used to correlate the influence of these parameters with the patient’s age at the time of surgery. In addition, a graphical relationship was derived by the method of power least squares curve fitting with second-degree polynomials. The mean age for THA was 54.3 ± 11 years. The time of surgery correlated significantly with LCE (0.37) and AI (− 0.3) (p < 0.001). The mean age of patients with LCE angle ≤ 10° was 41.9 ± 14.0 years, for LCE 11–20° 52.7 ± 9.5 years, and for LCE 21–30° 57.0 ± 10.3 years. The following formula could then be determined for the calculation of the potential patient age at the time of THA as a function of LCE angle: age pTHA = 40.2 + 0.8 × LCE angle − 0.01 × (LCE angle)2. A significant correlation between the extent of dysplasia and the time of prosthesis implantation was identified. In particular, the LCE and the AI correlated strongly with the time of implantation. The more dysplastic the angles were, the sooner the THA was necessary. Using the calculations presented in this study, the probable age of prosthesis implantation can be prognosticated and included in a counseling session about treatment options for DDH.

    更新日期:2019-12-30
  • Clavicle hook plate versus distal clavicle locking plate for Neer type II distal clavicle fractures
    J. Orthop. Surg. Res. (IF 1.907) Pub Date : 2019-12-30
    Liang Li; Tian-yan Li; Peichao Jiang; Guizhen Lin; Hongxiao Wu; Xiaochuan Han; Xuezhong Yu

    The purpose of this meta-analysis was to compare clavicle hook plates versus distal clavicle locking plates for the treatment of Neer type II distal clavicle fractures. PubMed (1996 to January 2019), Embase (1980 to January 2019), Web of Science (1990 to January 2019), the Cochrane Library (January 2019), and the China National Knowledge Infrastructure (January 2019) were systematically searched without language restrictions for literature retrieval. The Constant-Murley shoulder joint function score at 3 and 6 months after the operation and the postoperative complications after the operation (shoulder joint pain, abduction restriction, fracture delay healing, subacromial impingement) were the outcomes. Stata 12.0 was used for the meta-analysis. A total of 9 clinical trials involving 446 patients were finally included in this meta-analysis. The results showed that the improvement in the Constant-Murley shoulder joint function score in the distal locking plate group was better than that in the clavicle hook plate group at 3 and 6 months after the operation (P < 0.05). There were fewer cases of shoulder joint pain and restricted shoulder abduction range of motion in the distal locking plate group, and the difference was statistically significant (P < 0.05). There were no statistically significant differences in fracture delay healing and subacromial impingement between the two groups (P > 0.05). Compared with the clavicular hook plate, the distal clavicle locking plate for the treatment of Neer type II distal clavicle fractures is associated with better shoulder function recovery and fewer complications related to pain and abduction restriction.

    更新日期:2019-12-30
  • The factors driving self-efficacy in intractable chronic pain patients: a retrospective study
    J. Orthop. Surg. Res. (IF 1.907) Pub Date : 2019-12-30
    Hironori Tsuji; Tomoko Tetsunaga; Tomonori Tetsunaga; Keiichiro Nishida; Haruo Misawa; Toshifumi Ozaki

    The fear-avoidance model is a theoretical paradigm for explaining acute and chronic pain. In this model, pain catastrophizing plays an important role. On the other hand, self-efficacy influences whether patients view their pain optimistically, ultimately preventing the conversion of pain into intractable pain. The aim of the present study was to evaluate the factors that influence self-efficacy in patients with chronic pain. Study participants included 147 outpatients (35 men, 112 women) with intractable chronic pain who visited our hospital between September 2014 and July 2015. Their mean age was 71.0 (range 32–92) years. Pain sites were as follows: low back, 97 patients; knee, 71 patients; shoulder, 34 patients; and hip, 15 patients. All patients were assessed using the following measures: Numeric Rating Scale (NRS), Pain Catastrophizing Scale (PCS), Hospital Anxiety and Depression Scale (HADS), Pain Disability Assessment Scale (PDAS), and Pain Self-Efficacy Questionnaire (PSEQ). All participants were further divided into two groups based on median PSEQ scores (group L: PSEQ of 35 points or less, n = 74; group H: PSEQ greater than 35 points, n = 73). The factors that influenced self-efficacy in these patients were analyzed using univariate and multiple linear regression analyses. Significant differences were observed in gender; pain duration; and NRS, PDAS, HADS, and PCS scores between group L and group H. Multiple linear regression analysis revealed that self-efficacy was correlated with PDAS score, HADS depression score, and pain duration. Patients with longer pain duration indicated greater self-efficacy and patients with higher pain disability and depression exhibited lower self-efficacy.

    更新日期:2019-12-30
  • Overstuffing in resurfacing hemiarthroplasty is a potential risk for failure
    J. Orthop. Surg. Res. (IF 1.907) Pub Date : 2019-12-30
    Pieter C. Geervliet; Jore H. Willems; Inger N. Sierevelt; Cornelis P. J. Visser; Arthur van Noort

    Literature describes the concern of an overstuffed shoulder joint after a resurfacing humeral head implant (RHHI). The purpose of this study was to evaluate inter-observer variability of (1) the critical shoulder angle (CSA), (2) the length of the gleno-humeral offset (LGHO), and (3) the anatomic center of rotation (COR) in a patient population operated with a Global Conservative Anatomic Prosthesis (CAP) RHHI. The measurements were compared between the revision and non-revision groups to find predictive indicators for failure. Pre- and postoperative radiographs were retrieved from 48 patients who underwent RHHI from 2007 to 2009 using a Global CAP hemiarthroplasty for end-stage osteoarthritis. This cohort consisted of 36 females (12 men) with a mean age of 77 years (SD 7.5). Two musculoskeletal radiologist and two specialized shoulder orthopedic surgeons measured the CSA, LGHO, and COR of all patients. The inter-observer reliability showed excellent reliability for the CSA, LGHO, and the COR, varying between 0.91 and 0.98. The mean COR of the non-revision group was 4.9 mm (SD 2.5) compared to mean COR of the revision group, 8 mm (SD 2.2) (p < 0.01). The COR is the predictor of failure (OR 1.90 (95%Cl 1.19–3.02)) with a cut of point of 5.8 mm. The mean CSA was 29.8° (SD 3.9) There was no significant difference between the revision and non-revision groups (p = 0.34). The mean LGHO was 2.6 mm (SD 3.3) post-surgery. The mean LGHO of the revision group was 3.9 (SD 1.7) (p = 0.04) post-surgery. Despite the difference in mean LGHO, this is not a predictor for failure. The CSA, LGHO, and COR can be used on radiographs and have a high inter-observer agreement. In contrast with the CSA and LGHO, we found a correlation between clinical failure and revision surgery in case of a deviation of the COR greater than 5 mm. Institutional review board, number: ACLU 2016.0054, Ethical Committee number: CBP M1330348. Registered 7 November 2006.

    更新日期:2019-12-30
  • Comparison of the operative time for open door laminoplasty using titanium plate spacers or hydroxyapatite block spacers: a retrospective study
    J. Orthop. Surg. Res. (IF 1.907) Pub Date : 2019-12-30
    Takahiro Inui; Koichi Inokuchi; Yoshinobu Watanabe; Kentaro Matsui; Yuhei Nakayama; Keisuke Ishii; Takashi Suzuki; Taketo Kurozumi; Hirotaka Kawano

    Titanium plate (TP) and hydroxyapatite (HA) spacers are widely used during open-door laminoplasty, performed with the patient in a prone position. Reducing operative time is an important consideration, particularly to reduce the risk of postoperative complications in older patients. The purpose of this retrospective cohort study was to compare the operative time for open-door laminoplasty using TP or HA spacers. Consecutive patients with a spinal cord injury, without bone injury, and ≥ 50 years of age were included. Multivariate regression analysis was used to compare the operative time between patients in the TP and HA group, adjusting for known factors that can influence surgical and postoperative outcomes. Propensity score matching was used to confirm the robustness of the primary outcome. The cumulative incidence of postoperative complications over 1-year after surgery was also compared. Of the 164 patients forming our study group, TP spacers were used in 62 and HA in 102. Operative time was significantly shorter for the TP (128 min) than HA (158 min) group (p < 0.001). Both multivariate and propensity score matching analyses confirmed a significant reduction in operative time for the TP, compared to HA, group (regression coefficient, − 30 min and − 38 min, p < 0.001 and p < 0.001, respectively). There was no significant difference in the cumulative incidence of postoperative complications. The use of TP spacers reduced the operative time for cervical open-door laminoplasty by about 30 min, compared to the use of HA spacers, with no difference in the rate of postoperative complications.

    更新日期:2019-12-30
  • Topping-off surgery vs posterior lumbar interbody fusion for degenerative lumbar disease: a finite element analysis
    J. Orthop. Surg. Res. (IF 1.907) Pub Date : 2019-12-30
    Yunpeng Fan; Shaobo Zhou; Tao Xie; Zefeng Yu; Xiao Han; Liulong Zhu

    Adjacent segment disease (ASD) is a common complication after posterior lumbar interbody fusion (PLIF). Recently, a topping-off surgery (non-fusion with Coflex) has been developed to reduce the risk of ASD, yet whether and how the topping-off surgery can relieve ASD remains unclear. The purpose of this study was to explore the biomechanical effect of PLIF and Coflex on the adjacent segments via finite element (FE) analysis and discuss the efficacy of Coflex in preventing ASD. A FE model of L3–L5 segments was generated based on the CT of a healthy volunteer via three commercially available software. Coflex and PLIF devices were modeled and implanted together with the segment model in the FE software. In the FE model, a pre-compressive load of 500 N, equal to two-thirds of the human body mass, was applied on the top surface of the L3. In addition, four types of moments (anteflexion, rear protraction, bending, and axial rotation) set as 10 Nm were successively applied to the FE model combined with this pre-compressive load. Then, the range of motion (ROM), the torsional rigidity, and the maximum von Mises equivalent stress on the L3–L4 intervertebral disc and the implant were analyzed. Both Coflex and PLIF reduced ROM. However, no significant difference was found in the maximum von Mises equivalent stress of adjacent segment disc between the two devices. Interestingly enough, both systems increased the torsional rigidity at the adjacent lumbar segment, and PLIF had a more significant increase. The Coflex implant had a larger maximum von Mises equivalent stress. Both Coflex and PLIF reduced ROM at L3–L4, and thus improved the lumbar stability. Under the same load, both devices had almost the same maximum von Mises equivalent stress as the normal model on the adjacent intervertebral disc. But it is worthy to notice the torsional rigidity of PLIF was higher than that of Coflex, indicating that the lumbar treated with PLIF undertook a larger load to reach ROM of Coflex. Therefore, we presumed that ADS was related to a higher torsional rigidity.

    更新日期:2019-12-30
  • Modern instant messaging platform for postoperative follow-up of patients after total joint arthroplasty may reduce re-admission rate
    J. Orthop. Surg. Res. (IF 1.907) Pub Date : 2019-12-27
    Qing-Yuan Zheng; Lei Geng; Ming Ni; Jing-Yang Sun; Peng Ren; Quan-Bo Ji; Jun-Cheng Li; Guo-Qiang Zhang

    Follow-up after artificial joint replacement greatly helps achieve surgical outcomes. Mobile internet technology and mobile terminal equipment may increase the effectiveness of artificial joint replacement. However, only a few studies have evaluated the effectiveness of this technology. We aimed to analyze the reasons and outcomes of patients who used the instant messaging platform after undergoing artificial joint replacement. Among the 548 cases of arthroplasty (250 hips, 298 knees) performed between December 2015 and June 2018 in the Department of Joint Surgery of our institution; 358 (164 hip joints, 194 knee joints) participated in instant messaging platform consultation, whereas the remaining 190 (86 hip joints, 104 knee joints) participated in traditional telephone consultation, as a control group. Follow-up time was from December 2015 to August 2018 (follow-up period was 2–32 months). Data on age, sex, type of surgery, date of surgery, date of discharge, and length of hospital stay were collected from electronic medical records. We analyzed the consultation contents of 358 patients who participated in instant messaging platform consultation. Counseling was mainly related to pain (13.6%), appointment review (12.4%), activity problems (10.5%), and incision problems (8.9%). Most problems were resolved through online guidance, with 8.4% of patients requiring only outpatient treatment and 2.5% of patients requiring rehospitalization. A total of 190 patients were followed up through traditional telephone consultation; 6.8% of patients required outpatient department treatment and 7.4% were eventually re-admitted. The instant messaging platform consultation service effectively informs patients of potential postoperative problems and helps resolve them. It allows early detection and management of postoperative adverse events, including problems related to medication, wound, and activity, thereby effectively reducing readmission rate.

    更新日期:2019-12-27
  • Rates of periprosthetic infection and surgical revision in Beijing (China) between 2014 and 2016: a retrospective multicenter cross-sectional study
    J. Orthop. Surg. Res. (IF 1.907) Pub Date : 2019-12-26
    Hui-ming Peng; Long-chao Wang; Ji-ying Cheng; Yi-xin Zhou; Hua Tian; Jian-hao Lin; Wan-shou Guo; Yuan Lin; Tie-bing Qu; Ai Guo; Yong-ping Cao; Xi-sheng Weng

    Periprosthetic joint infection (PJI) is a rare but devastating complication after total joint arthroplasty. There is a paucity of data on the incidence and prevalence of periprosthetic infection in mainland China. This study aimed to analyze the rates of surgical revision after arthroplasty due to PJI and the procedures followed in Beijing, China. The study involved a retrospective multicenter cross-sectional survey of patients undergoing revisions for periprosthetic infection after hip/knee arthroplasty at nine hospitals in Beijing from 2014 to 2016. Age, gender, body mass index, primary diagnosis, comorbidity, primary surgery, treatment methods, and post-revision complications were analyzed. A total of 38,319 hip/knee arthroplasties and 366 (0.96%) revisions for PJI were identified. Of these, 161 (161/14,110; 1.14%) revisions involved hip arthroplasty, whereas 205 (205/24,209; 0.85%) revisions were due to knee arthroplasty. Procedures for revisions of infected hip included 7 (4.3%) cases of open debridement and prosthesis retention, 32 (19.9%) cases of one-stage exchange, 121 (75.2%) cases of two-stage exchange, and 1 (0.007%) case of hip dissection. As for the infected knee, the procedures included 45 (22.0%) cases of open debridement and prosthesis retention, 13 (6.3%) cases of one-stage exchange, 143 (69.8%) cases of two-stage exchange, and 4 (0.02%) cases of knee fusion. The study found the rates of revision due to PJI to be low. Nonetheless, the incidence of PJI in mainland China could be higher and calls for more elaborate studies in geographically and socioeconomically diverse health institutions.

    更新日期:2019-12-27
  • Correction to: Arthroscopic treatment of focal osteochondral lesions of the first metatarsophalangeal joint
    J. Orthop. Surg. Res. (IF 1.907) Pub Date : 2019-12-23
    Ersin Kuyucu; Harun Mutlu; Serhat Mutlu; Baris Gülenç; Mehmet Erdil

    This article [2] was published twice [1] due to a production error. The original article [1] should be considered the version of record and used for citation purposes. The publisher apologizes to the authors and readers for the error and any inconvenience caused.

    更新日期:2019-12-23
  • Anterior percutaneous full-endoscopic transcorporeal decompression of the spinal cord for single-segment cervical spondylotic myelopathy: The technical interpretation and 2 years of clinical follow-up
    J. Orthop. Surg. Res. (IF 1.907) Pub Date : 2019-12-23
    Weijun Kong; Zhijun Xin; Qian Du; Guangru Cao; Wenbo Liao

    ACDF is the standard procedure for treatment of cervical spondylotic myelopathy (CSM), but a long-term follow-up has been revealed some associated complications of swallowing discomfort, displacement of the fusion device, and accelerated degeneration of the adjacent segment. To evaluate the clinical outcomes of anterior percutaneous full-endoscopic transcorporeal decompression of the spinal cord (APFETDSC) for single-segment CSM and to analyze the clinical efficacy, surgical characteristics, and complication prevention. A total of 32 patients who underwent APFETDSC for single-segment CSM from Aug. 2015 to Apr. 2017 were reviewed. Operating time, time of walking out of bed postoperation, length of hospitalization, complications, neck pain visual analog scale (VAS), and Japanese Orthopaedic Association Score (JOA) were evaluated. Measurement of intervertebral height (HI) of surgical segments on cervical neutral X-ray, Harrison’s method was used to measure cervical spine angle (CSA). The operation time was 103.3 ± 12.95 min, time of walking out of bed after surgery was 19.81 ± 4.603 h, the length of postoperative hospital stay was 57.48 ± 19.48 h. The postoperative neck pain VAS and JOA were significantly improved compared with preoperation(p < 0.001). The postoperative HI was statistical significance decreased compared with preoperation(p < 0.001), but the HI reduction was less than 0.5 mm, without adverse clinical symptoms. The postoperative CSA was significantly improved compared with preoperative(p < 0.001). The excellent and good rate was 87.5%, and the JOA improvement rate was 75.52 ± 11.11%. There was no cervical instability, vertebral fracture, wound infection, and other complications. APFETDSC is a safe and effective minimally invasive technique with small auxiliary injuries for single-segment CSM while avoiding the sequelae of ACDF. Its short-term clinical efficacy was good and no significant effect on cervical stability.

    更新日期:2019-12-23
  • The BMP signaling pathway enhances the osteoblastic differentiation of bone marrow mesenchymal stem cells in rats with osteoporosis
    J. Orthop. Surg. Res. (IF 1.907) Pub Date : 2019-12-23
    Bin Zhao; Gengyan Xing; Aiyuan Wang

    This study was conducted with the aim of exploring the effect of the BMP signaling pathway on osteoblastic differentiation in rat bone marrow mesenchymal stem cells (rBMSCs) in rats with osteoporosis (OP). The bilateral ovaries of female SD rats were resected for the establishment of a rat OP model. The osteoblastic differentiation of isolated rBMSCs was identified through osteogenic induction. Adipogenetic induction and flow cytometry (FCM) were used to detect adipogenic differentiation and the expression of rBMSC surface markers. The rBMSCs were grouped into the blank group, NC group, si-BMP2 group, and oe-BMP2 group. The expression levels of key factors and osteogenesis-related factors were determined by Western blot and quantitative real-time polymerase chain reaction (qRT-PCR). The formation of calcified nodules was observed by alizarin red staining. ALP activity was measured by alkaline phosphatase staining. The rats with OP had greater weight but decreased bone mineral density (BMD) than normal rats (all P < 0.01). The rBMSCs from rats with OP were capable of osteoblastic differentiation and adipogenic differentiation and showed high expression of CD44 (91.3 ± 2.9%) and CD105 (94.8 ± 2.1%). Compared with the blank group, the oe-BMP2 group had elevated BMP-2 and Smad1 levels and an increase in calcified nodules and ALP-positive staining areas (all P < 0.05). Moreover, the expression levels of Runx2, OC, and OPN in the oe-BMP2 group were relatively higher than those in the blank group (all P < 0.05). The findings in the si-BMP2 group were opposite to those in the oe-BMP2 group. BMP signaling pathways activated by BMP-2 can promote the osteoblastic differentiation of rBMSCs from rats with OP.

    更新日期:2019-12-23
  • One-stage simultaneous hip-preserving surgeries for the management of bilateral femoral head osteonecrosis: a mean 7.0-year follow-up
    J. Orthop. Surg. Res. (IF 1.907) Pub Date : 2019-12-21
    Wenjun Feng; Pengcheng Ye; Shihao Ni; Peng Deng; Lu Lu; Jinlun Chen; Jianchun Zeng; Xinyu Qi; Jie Li; Ke Jie; Houran Cao; Zhijun Yue; Haitao Zhang; Yirong Zeng

    A retrospective study was conducted to evaluate and compare the clinical and radiological outcomes of one-stage fibular impaction allografting and vascularized greater trochanter flap autografting for the treatment of bilateral osteonecrosis of the femoral head (ONFH). Patients who underwent one-stage aforementioned hip-preserving surgeries due to bilateral ONFH were retrospectively reviewed from January 2008 to December 2013. Sixty-nine patients (138 hips) with a mean age of 31.5 years and mean follow-up of 7.0 years were included. Hips that underwent fibular impaction allografting and vascularized greater trochanter flap autografting were assigned as group A and group B, respectively. Harris Hip Score (HHS) and Visual Analogue Scale (VAS) were used for clinical evaluation, and a series of X-ray images were used for radiological assessment. For inter-group analysis, the paired t test was used for continuous data, and the Wilcoxon rank sum test was used for non-parametric data, while the Mann-Whitney U test was used for intra-group analysis. The HHS and VAS in both groups A and B had a substantial advancement when compared with the preoperative level (p < 0.01). Fibular impaction allografting can achieve more pain relief (p < 0.01), though no clinical difference was found in terms of minimal clinically important difference (MCID < 10 points). Group A showed better radiological results than group B (p = 0.04). It was discovered that the appropriate indication for each procedure was patients with Association for Research on Osseous Circulation (ARCO) stages II and III, respectively. One-stage hip-preserving surgeries for the management of bilateral ONFH could obtain good medium and long-term outcomes. It was recommended that fibular impaction allografting is more suitable for patients in ARCO stage II, while for patients in ARCO stage III, vascularized greater trochanter flap autografting is a better preference. Retrospectively registered.

    更新日期:2019-12-21
  • Minimally invasive percutaneous plate osteosynthesis versus intramedullary nail fixation for distal tibial fractures: a systematic review and meta-analysis
    J. Orthop. Surg. Res. (IF 1.907) Pub Date : 2019-12-21
    Bo Wang; Yang Zhao; Qian Wang; Bin Hu; Liang Sun; Cheng Ren; Zhong Li; Kun Zhang; Dingjun Hao; Teng Ma; Yao Lu

    The treatment for distal tibial fractures remains controversial to date. Minimally invasive percutaneous plate osteosynthesis (MIPPO) and intramedullary nailing (IMN) are well-accepted and effective methods for distal tibial fractures, but these methods were associated with complications. This study aimed to assess and compare the clinical and functional outcomes in patients with distal tibial fractures treated with MIPPO or IMN. We systematically reviewed randomized controlled trials (RCTs) that compared MIPPO with IMN in patients with distal tibial fractures from inception till 15 August 2019. Also, quantitative summaries of time to reunion, rate of complications, and functional outcomes were evaluated. The pooled results suggested that patients in the MIPPO group had a longer time to reunion with a mean difference of 1.21 weeks [P = 0.02; 95% confidence interval (CI) 0.16–2.26)] than those in the IMN group. The overall union complications and deep infection between IMN and MIPPO were similar (P > 0.05). IMN had a significantly low risk of wound complications [risk ratio (RR) = 0.51, P = 0.00, 95% CI 0.34–0.77)]. The pooled functional outcomes of the two groups remained controversial by different evaluating scores. Compared to MIPPO, IMN had a significantly low risk of wound complications and associated with limited time for reunion. Although the pooled functional outcomes of the two groups were controversial due to different evaluating scores, IMN was the preferred surgical technique than MIPPO for treating distal tibial fractures.

    更新日期:2019-12-21
  • Risk factors for refracture after plate removal for midshaft clavicle fracture after bone union
    J. Orthop. Surg. Res. (IF 1.907) Pub Date : 2019-12-21
    Shang-Wen Tsai; Hsuan-Hsiao Ma; Fang-Wei Hsu; Te-Feng Arthur Chou; Kun-Hui Chen; Chao-Ching Chiang; Wei-Ming Chen

    Open reduction and internal fixation (ORIF) with plates and screws is one of the treatment options for clavicle fractures. However, an additional operation for implant removal after union of the fracture is commonly performed due to a high incidence of hardware irritation. Despite union of the fracture, a subsequent refracture might occur after removal of the implant which requires additional surgeries for fixation. This study aims to determine the risk factors associated with refracture of the clavicle after hardware removal. We retrospectively reviewed the medical records of 278 patients that were diagnosed with a midshaft clavicle fracture (male 190; female 88) that had (1) undergone ORIF of the clavicle with plates and (2) received a second operation for removal of hardware after solid union of the fracture between 2010 and 2017. Their mean age was 40.1 ± 15.1 years, and mean interval from fixation to plate removal was 12.5 ± 7.5 months. The patients were then divided into two groups based on the presence of refracture (n = 20) or without refracture (n = 258). We analyzed patient demographics, interval between fixation and implant removal, fracture classification (AO/OTA, Robinson), fixation device, whether wires or interfragmentary screws were used, clavicular length, and bone diameter at the fracture site. The overall refracture rate was 7.2%, and the mean interval between plate removal and refracture was 23.9 days. A multivariate analysis showed that female (adjusted odds ratio [aOR] 4.74; 95% CI 1.6–14.1) and body mass index [BMI] (for every 1-unit decrease, aOR 1.25; 95% CI 1.06–1.48) were risk factors for refracture. In women, BMI was the only risk factor. The optimal BMI cutoff value was 22.73. In a female patient with a lower BMI, the refracture rate was 29.8%. There are no significant radiographic parameters associated with refracture. Routine plate removal in a female patient with a low BMI after bony union of a midshaft clavicle fracture is not recommended because of a high refracture rate.

    更新日期:2019-12-21
  • Associations between serum calcium, 25(OH)D level and bone mineral density in older adults
    J. Orthop. Surg. Res. (IF 1.907) Pub Date : 2019-12-21
    Minbo Liu; Xiaocong Yao; Zhongxin Zhu

    Calcium and vitamin D play important roles in bone health as essential nutrients. We explored whether serum calcium, 25(OH)D were associated with bone mineral density (BMD) in older adults. This cross-sectional study was conducted on a sample of 4595 participants (2281 men and 2314 women) aged ≥ 50 years (from 50 to 85 years, 60.1 ± 8.7 years for men and 62.0 ± 9.7 years for women) from the National Health and Nutrition Examination Survey (NHANES) 2001–2006. The independent variables were serum calcium and 25(OH)D. The dependent variable was lumbar BMD. The other variables were considered potential effect modifiers. We performed weighted multivariate linear regression models and smooth curve fittings to evaluate the associations between them. Subgroup analyses were also performed. We observed a negative association between serum calcium and lumbar BMD in the fully adjusted model. In the subgroup analyses, this association was no longer significant among males and other race/ethnicity. On the other hand, there was a positive association between serum 25(OH)D and lumbar BMD in the fully adjusted model. In the subgroup analyses, this association did not differ in different age groups, between men and women. However, the association between serum 25(OH)D and lumbar BMD followed a U-shaped curve in Mexican Americans. This cross-sectional study indicated that serum calcium negatively correlated with lumbar BMD, and serum 25(OH)D positively correlated with lumbar BMD in older adults. However, the association between serum calcium and lumbar BMD in males followed a U-shaped curve.

    更新日期:2019-12-21
  • Open reduction and compression with double Kirschner wires for the treatment of old bony mallet finger
    J. Orthop. Surg. Res. (IF 1.907) Pub Date : 2019-12-21
    Junjun Tang; Kejian Wu; Jinchang Wang; Jian Zhang

    The management of old bony mallet fingers is complicated. The aim of the study is to present a new method of open reduction and compression with double Kirschner wires (K-wires) in treating old bony mallet fingers. This was a retrospective analysis of patients with old closed bony mallet fingers treated between June 2013 and December 2016. Complications were observed. The range of motion (ROM) of the DIP joints was measured using a protractor. At the last follow-up, anteroposterior and lateral X-ray of the affected finger was performed, the flatness of the articular surface was scored, and the results were graded using Crawford’s criteria. Seventeen patients were followed up for 8 (6–19) months. The width of the avulsion fracture block accounted for 25–62% of the articular surface of the distal phalanx. Twelve (70.6%) patients had anterior dislocation of the interphalangeal joint. All patients reported healing at the fracture sites. Healing time was 7.6 ± 2.1(5–13) weeks. All patients had incision healing of I/Class A. Lateral X-ray showed 13 and four patients had excellent and good articular surface flatness, respectively. At the last follow-up, no traumatic arthritis was present. Only one patient developed mild pain after surgery (VAS score of 3). Postoperative ROM was 76.5 ± 10.6° (P = 0.0625 vs. healthy side). At the last follow-up, the angle of loss of dorsiflexion was 0–10° (P < 0.0001 vs. baseline). The flexion angle was 50–90° (P = 0.0625 vs. healthy side). Open reduction and compression with double K-wires is feasible in treating old bony mallet finger.

    更新日期:2019-12-21
  • The prototype BS-II for computer measurement of biomechanical characteristics of the human cadaverous lumbar spine
    J. Orthop. Surg. Res. (IF 1.907) Pub Date : 2019-12-19
    Vladislav Janák; Luděk Bartoněk; Lumír Hrabálek; Jiří Keprt; Jiří Charamza

    The new second-generation computer system BS-II (Bio-Spine-II) based on the National Instruments’ development environment has been designed and constructed for evaluating the stability of various surgical fixative methods of the cadaverous lumbar spine (L1–L5). BS-II holds the measured sample using aluminum fixtures and using four computer-controlled stepper motors; it performs a circular movement (warm up of the specimen), programmatically driven extension (back bend), right and left lateral flexion (lateral bend), left and right axial torsion (rotation), and axial compression (pressure). Four strain gauges are used to measure the stiffness of the sample. The movement of individual components (vertebrae) is contactlessly monitored by two CCD (charge couple device) cameras. The obtained data are in digital form continuously stored in the computer memory for further processing. The functionality of the equipment was verified on the cadaverous specimen of the human spine. The stiffness of the sample was measured by strain gauges, and the results were processed using linear regression analysis. Movements of vertebrae were determined by circular discs covered with appropriate patterns. The discs have been linked with the respective vertebrae and were contactlessly monitored by two CCD (charge couple device) cameras and evaluated using digital image processing methods and 2D digital FFT (fast Fourier transformation). Direction and displacement of the individual components were determined by the band of the calculated spectrum. The new device BS-II is controlled by a modifiable computer program designed in the National Instruments’ development environment which allows statistical processing of the sample, including its warming up. The computer system BS-II for measurement of biomechanical properties of the spine sample was designed. Functionality of the device was verified by implementation of LUMIR XLIF CAGE implant into a cadaver sample of the human spine. Comparison of the rigidity of the intact and stabilized sample is shown in the graphs of article. The achieved results contributed to certification of the implant into the surgical practice. The designed computer BS-II system is designed for biomechanical measurements of the lumbar part of the human spine, especially for verification of surgical fixation methods. The system is based on the knowledge and experience with a manually operated measuring device designed by Palacky University Olomouc. The computer programmatic control allows the user to change the conditions and parameters of the measurement procedure in a planned way, which allows the results to be processed in, among other things, a statistical way. If suitable models are used (3D printing), the BS-II system can be used to verify procedures for surgical stabilization of the spine in the training of future doctors. The obtained data of stiffness and image information are stored in digital form and can be used for next offline sophisticated study of biomechanical properties of specimens (accurate vertebral geometry, statistical processing, 3D printing, etc.). The usefulness of the BS-II system is demonstrated in the case of biomechanical analysis of the implantation of LUMIR XLIF CAGE implant to a human cadaver specimen of the spine.

    更新日期:2019-12-20
  • Reliability of synovial fluid alpha-defensin and leukocyte esterase in diagnosing periprosthetic joint infection (PJI): a systematic review and meta-analysis
    J. Orthop. Surg. Res. (IF 1.907) Pub Date : 2019-12-19
    Yisheng Chen; Xueran Kang; Jie Tao; Yunpeng Zhang; Chenting Ying; Weiwei Lin

    Synovial fluid proteins had been applied as diagnostic biomarkers for periprosthetic joint infection (PJI) in recent research papers. Thus, this meta-analysis aimed to estimate the diagnostic efficiency of synovial fluid α-defensin and leukocyte esterase (LE) for PJI. We conducted our systematic review by searching the keywords in online databases such as PubMed, Embase, Cochrane, Elsevier, Springer, and Web of Science from the time of database inception to October 2018. Inclusion criteria were as follows: patients who have undergone knee, hip, or shoulder joint replacements; α-defensin or leukocyte esterase (LE strip) of synovial fluid was detected as the biomarker for PJI diagnosis; and Musculoskeletal Infection Society (MSIS) or utilizing a combination of clinical data was considered as the gold standard. Diagnostic parameters including sensitivity, specificity, diagnostic odds ratio (DOR), and area under the summary of receiver operating characteristics curve (AUSROC) were calculated for the included studies to evaluate the synovial fluid α-defensin and LE for PJI diagnosis. After full-text review, 28 studies were qualified for this systematic review, 16 studies used α-defensin and the other 12 were conducted using LE strip. The pooled sensitivity, specificity, and DOR of LE strip were 87% (95% CI 84–90%), 96% (95% CI 95–97%), and 170.09 (95% CI 97.63–296.32), respectively, while the pooled sensitivity, specificity, and DOR of α-defensin were 87% (95% CI 83–90%), 97% (95% CI 96–98%), and 158.18 (95% CI 74.26–336.91), respectively. The AUSROC for LE strip and α-defensin were 0.9818 and 0.9685, respectively. Both LE strip and α-defensin of synovial fluid provide rapid and convenient diagnosis for PJI. Sensitivity of α-defensin and LE strip are the same, while both these two methods have high specificity in clinical practice.

    更新日期:2019-12-19
  • Intramedullary nailing for pertrochanteric fractures of proximal femur: a consecutive series of 323 patients treated with two devices
    J. Orthop. Surg. Res. (IF 1.907) Pub Date : 2019-12-18
    Pompeo Catania; Daniele Passaretti; Giorgio Montemurro; Simone Ripanti; Stefano Carbone; Vittorio Candela; Michele Carnovale; Stefano Gumina; Francecsco Pallotta

    Pertrochanteric fractures (PFs) frequently affect the lower limb of osteoporotic patients and represent an important cause of morbidity and mortality in the elderly. In this prospective randomized controlled trial, we have compared functional and radiological results and complications of patients affected by PFs treated with two intramedullary proximal femoral nails. We enrolled 323 subjects with PFs, classified according to AO/OTA system as 31.A1 (pertrochanteric simple) and 31.A2 (pertrochanteric multifragmentary). Patients were divided into two groups according to the osteosynthesis devices: group A, Elos-Intrauma® nail (155 cases) and group B, Gamma 3-Stryker® nail (168 cases). Pre-operatively, the baseline characteristics of each patient (gender, age, weight and BMI) were collected. Intraoperative blood loss, subjective pain by visual analogue scale (VAS), esthetic satisfaction, functional scores of the hip by Harris Hip Score (HHS), and Western Ontario and McMaster Universities Arthritis Index (WOMAC) were noted. The post-operative degree of fracture reduction was assessed. Each patient had a minimum follow-up of 12 months. The study group was composed of 106 male and 217 female with an average age of 85.4 (range, 65–90, standard deviation (SD) 5.95) years. No statistical differences about sex and age distribution were noted between the two groups. Group A reported lower intraoperative blood loss, 45 ml vs 51 ml, respectively (p < 0.001). There was not any statistical difference about operative time. Group A had a better reduction of fracture (p = 0.0347). The greatest difference was detectable comparing subgroups 31.A2 (p = 0.032). There were no statistical differences about complication frequency and the overall rate was 25% (80 cases). Finally, there was no difference in terms of VAS, HHS, and WOMAC score between the two groups on each follow-up. Patients of group A showed a higher subjective satisfaction index at 1 post-operative year, 7.42 (SD 1.19) vs 6.45 (SD 1.35) of group B (p < 0.001). Elos® nail is a reliable device on a short-term follow-up and represents an alternative choice to the Gamma 3® nail, a well-known and appreciated system for over 25 years.

    更新日期:2019-12-19
  • Concerns on modeling postmenopausal osteoporosis on young female rats
    J. Orthop. Surg. Res. (IF 1.907) Pub Date : 2019-12-18
    Pavlos Lelovas; Ismene Dontas

    Dear Editor, We have read the research article entitled “A multi-factorial analysis of bone morphology and fracture strength of rat femur in response to ovariectomy” by Rocabado JMR, Kaku M, Nozaki K, Ida T, Kitami M, Ayogi Y, and Uoshima K which was published in the Journal of Orthopaedic Surgery and Research (2018;13:318). We would like to congratulate the authors for their diligent study but we would also like to pinpoint some of our concerns regarding the paper. One of the first concerns is the selection of the rats’ age. Although the authors stated from the beginning of the article that their main focus is the study of postmenopausal osteoporosis, the age of the animals was 10 weeks old. According to Turner et al., “The growing rat is a useful model for evaluating the effects of endocrine, nutritional and other environmental factors on peak bone mass. The young rapidly growing rat is appropriate for studies designed to investigate factors related to peak bone mass but is a poor model for the adult human skeleton because skeletal growth is mediated by cellular processes which are not active in adults” [1]. Additionally, according to Jee and Yao, “it is reasonable to recommence the evaluation of treatment in the 9-month-old ovariectomized female rat. A female rat of this age has reached peak bone mass and can be manipulated to simulate clinical findings of post-menopausal osteoporosis.” [2]. Therefore, it is apparent that the selection of young growing rats, instead of mature ones, may not lead to accurate findings that could be translated to human postmenopausal osteoporosis. As far as the conservation of bone specimens for biomechanical testing is concerned, Turner and Burr have reported regarding formaldehyde fixation of bone “Fixation in this manner increases collagen crosslinking and therefore will alter the properties of the bone tissue more significantly than alcohol preservation. Testing fixed samples only provides data relative to other fixed samples and should never be used as an accurate measure of the true properties of bone” [3]. Therefore, the article’s between groups comparisons are valid; however, their metric results do not represent true bone biomechanical parameters. The authors could have chosen to preserve their bone specimens in gauze soaked in normal saline and stored at − 20 °C, as supported by Turner and Burr [3]. Another point of concern was the short period for the establishment of osteoporosis (8 weeks). According to the literature, this is a very short time period to observe changes in bone strength. For the femoral mid-shaft, the earliest time after ovariectomy in order to observe decreases in biomechanical strength is 270 days, while in the first 3 months (12 weeks approximately), it is well documented that a transient increase in bone strength may be observed [2]. For this reason, the increase in bone strength observed by the authors is not surprising or contradictory as they stated but rather anticipated. Furthermore, due to differences in bone physiology between humans and rats (lack of a well-developed system of Haversian remodeling, bone periosteal apposition occurring after ovariectomy in order to compensate endosteal resorption), Jee and Yao supported that “Since the most sensitive index of cortical bone loss involves the enlargement of the marrow cavity from the resorption of endocortical bone adjacent to marrow, a measurement of the thickness of the inner 1/2 or 1/3 of the cortex adjacent to the marrow proves to be meaningful” [2]. These changes may take longer time than 8 weeks to be observed [4]. Consequently, a longer experimental time for the establishment of bone loss in cortical bone, as well as appropriate methodology (evaluation of the inner instead of the full section of the femoral midshaft), may have led the authors to results more consistent with the existing literature and applicable to the human condition. Not applicable 1. Turner RT, Maran A, Lotinun S, Hefferan T, Evans GL, Zhang M, Sibonga JD. Animal models for osteoporosis. Rev Endocr Metab Disord. 2001;2(1):117–27. CAS Article Google Scholar 2. Jee WSS, Yao W. Overview: animal models of osteopenia and osteoporosis. J Musculoskelet Neuronal Interact. 2001;1:193–207. CAS PubMed Google Scholar 3. Turner CH, Burr DB. Basic biomechanical measurements of bone: a tutorial. Bone. 1993;14:595–608. CAS Article Google Scholar 4. Danielsen CC, Mosekilde L, Svenstrup B. Cortical bone mass, composition, and mechanical properties in female rats in relation to age, long-term ovariectomy, and estrogen substitution. Calcif Tissue Int. 1993;52:26–33. CAS Article Google Scholar Download references Not applicable Funding The authors declare no funding for the current manuscript. Affiliations Laboratory for Research of the Musculoskeletal System, School of Medicine, National & Kapodistrian University of Athens, 10, Athinas Str., K.A.T. Hospital, 145 61, Kifissia, Greece Pavlos Lelovas  & Ismene DontasAuthors Search for Pavlos Lelovas in: PubMed • Google Scholar Search for Ismene Dontas in: PubMed • Google Scholar Contributions Both authors have contributed in the design and preparation of the current manuscript. Both authors read and approved the final manuscript. Corresponding author Correspondence to Pavlos Lelovas. Ethics approval and consent to participate Not applicable Consent for publication Both authors consent for the publication of the manuscript. Competing interests The authors declare that they have no competing interests. Publisher’s Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. An author's reply to this comment is available online at https://doi.org/10.1186/s13018-019-1485-2. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Reprints and Permissions Cite this article Lelovas, P., Dontas, I. Concerns on modeling postmenopausal osteoporosis on young female rats. J Orthop Surg Res 14, 450 (2019) doi:10.1186/s13018-019-1313-8 Download citation Received 19 June 2019 Accepted 12 August 2019 Published 18 December 2019 DOI https://doi.org/10.1186/s13018-019-1313-8

    更新日期:2019-12-19
  • Response to Letter to the Editor: Concerns on modeling postmenopausal osteoporosis in young female rats
    J. Orthop. Surg. Res. (IF 1.907) Pub Date : 2019-12-18
    Juan Marcelo Rosales Rocabado; Masaru Kaku; Kosuke Nozaki; Takako Ida; Megumi Kitami; Yujin Aoyagi; Katsumi Uoshima

    Dear Editor, We appreciate Dr. Lelovas and Dr. Dontas’ interest and concerns regarding our manuscript, titled “A multi-factorial analysis of bone morphology and fracture strength of rat femur in response to ovariectomy,” which was recently published in the Journal of Orthopaedic Surgery and Research [1], and very much appreciate the opportunity to respond. In the study, we aimed to comprehensively evaluate changes in the bone architecture that influence its fracture strength in response to estrogen deficiency of the ovariectomized (OVX) rat model. The changes in bone architecture induced by OVX varied at different sites, especially between trabecular and cortical bones. The OVX increased the external diameter of the cortical bone with a concomitant increase in bone strength at the mid-diaphysis, while the trabecular bone volume was decreased at the distal-metaphysis. One of the concerns raised was that the increased breaking force at the mid-diaphysis after OVX might be a consequence of the use of young rats, as we used rats that were 10 weeks old at the time of OVX and analyzed them at 18 weeks old. Considering the remodeling status and microarchitecture of the rat cortical bone, the use of aged rats (> 9 months old) and long observation periods (> 6 months) have been recommended for osteoporosis studies [2, 3]. However, it was reported that OVX still increases the external diameter of long bones with a concomitant increase in bone strength even in 9-month-old rats [4]. Besides, due to the slow remodeling rate of the tissue, especially the cortical bone, sensitive detection approaches must be employed with aged-OVX models [5]. Note that fracture risk has not been reproduced in animal models, and the true degree of correspondence between bone changes in animal models and humans remains elusive [2]. Consequently, aged rats are not always suitable for the study of osteoporosis. While animal studies provide insight into understanding biological responses, special attention is needed when discussing the clinical relevance of the results obtained in animal studies. Another concern involves the usage of a fixative to preserve specimens for the mechanical test. To precisely calculate the mechanical parameters of the bone, measurement of the bone architecture of each specimen prior to the mechanical test is crucial. In our experiment, we used microcomputed tomography images to analyze the dimensional parameters along with the bone mineral density (BMD). Scanning requires placing the samples at room temperature for a relatively long period of time. Thawing of frozen specimens, may cause protein degradation and thus, alterations in the mechanical properties of the tissue. Therefore, we chose to perform formaldehyde fixation for 3 days at 4 °C. Possible side effects of formaldehyde fixation are the formation of additional intra- and intermolecular crosslinks and the elution of inorganic components, as previously described [6]. However, a study reported that 2 weeks of formaldehyde fixation did not alter the elastic mechanical properties of murine bones [7]. It has also been reported that the BMD, as well as the initial Young’s modulus, show no significant differences between formaldehyde-fixed samples and frozen samples for up to 6 months of preservation [8]. Concerns about the use of fixed specimens for the mechanical test are mainly due to the long fixation periods; hence, the use of shorter fixation times can minimize side effects [7]. As pointed out, the experimental settings, including the age of the animals and the test conditions, can dramatically affect the study outcome. Although the use of aged rats may provide a model more closely resembling postmenopausal osteoporosis, there are drawbacks to this model as well. Thus, various approaches and comprehensive analyses are required to understand the etiology of multi-factorial bone disorders. Future studies using aged animals and longer observation periods will enhance our understanding of OVX-induced bone architectural changes, which is important to establish accurate bone fracture risk assessment in the clinic. Not applicable 1. Rosales Rocabado JM, Kaku M, Nozaki K, Ida T, Kitami M, Aoyagi Y, Uoshima K. A multi-factorial analysis of bone morphology and fracture strength of rat femur in response to ovariectomy. J Orthop Surg Res. 2018;13(1):318. Article Google Scholar 2. Lelovas PP, Xanthos TT, Thoma SE, Lyritis GP, Dontas IA. The laboratory rat as an animal model for osteoporosis research. Comp Med. 2008;58(5):424–30. CAS PubMed PubMed Central Google Scholar 3. Jee WS, Yao W. Overview: animal models of osteopenia and osteoporosis. J Musculoskel Neuronal Interact. 2001;1(3):193–207. CAS Google Scholar 4. Aerssens J, van Audekercke R, Talalaj M, Geusens P, Bramm E, Dequeker J. Effect of 1alpha-vitamin D3 and estrogen therapy on cortical bone mechanical properties in the ovariectomized rat model. Endocrinology. 1996;137(4):1358–64. CAS Article Google Scholar 5. Danielsen CC, Mosekilde L, Svenstrup B. Cortical bone mass, composition, and mechanical properties in female rats in relation to age, long-term ovariectomy, and estrogen substitution. Calcified Tissue Int. 1993;52(1):26–33. CAS Article Google Scholar 6. Kikugawa H, Asaka T. Effect of long-term formalin preservation on the bending properties and fracture toughness of bovine compact bone. J Japan Inst Metals. 2005;69(2):267–71. CAS Article Google Scholar 7. Nazarian A, Hermannsson BJ, Muller J, Zurakowski D, Snyder BD. Effects of tissue preservation on murine bone mechanical properties. J Biomech. 2009;42(1):82–6. Article Google Scholar 8. Unger S, Blauth M, Schmoelz W. Effects of three different preservation methods on the mechanical properties of human and bovine cortical bone. Bone. 2010;47(6):1048–53. Article Google Scholar Download references Not applicable Funding Not applicable Affiliations Division of Bio-Prosthodontics, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan Juan Marcelo Rosales Rocabado , Masaru Kaku , Takako Ida , Megumi Kitami , Yujin Aoyagi  & Katsumi Uoshima Department of Biofunction Research, Institute of Biomaterials and Bioengineering, Tokyo Medical and Dental University, Tokyo, Japan Kosuke NozakiAuthors Search for Juan Marcelo Rosales Rocabado in: PubMed • Google Scholar Search for Masaru Kaku in: PubMed • Google Scholar Search for Kosuke Nozaki in: PubMed • Google Scholar Search for Takako Ida in: PubMed • Google Scholar Search for Megumi Kitami in: PubMed • Google Scholar Search for Yujin Aoyagi in: PubMed • Google Scholar Search for Katsumi Uoshima in: PubMed • Google Scholar Contributions JMRR and MKa wrote the manuscript. KN, TI, MKi, YA, and UK critically revised the manuscript. All authors have read and approved the final submitted manuscript. Corresponding author Correspondence to Masaru Kaku. Ethics approval and consent to participate Not applicable Consent for publication Not applicable Competing interests The authors declare that they have no competing interests Publisher’s Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Reprints and Permissions Cite this article Rocabado, J.M.R., Kaku, M., Nozaki, K. et al. Response to Letter to the Editor: Concerns on modeling postmenopausal osteoporosis in young female rats. J Orthop Surg Res 14, 451 (2019) doi:10.1186/s13018-019-1485-2 Download citation Published 18 December 2019 DOI https://doi.org/10.1186/s13018-019-1485-2

    更新日期:2019-12-19
  • Therapeutic effect of percutaneous kyphoplasty combined with anti-osteoporosis drug on postmenopausal women with osteoporotic vertebral compression fracture and analysis of postoperative bone cement leakage risk factors: a retrospective cohort study
    J. Orthop. Surg. Res. (IF 1.907) Pub Date : 2019-12-18
    Shuaihao Huang; Xiaowen Zhu; Dan Xiao; Jianxiong Zhuang; Guoyan Liang; Changxiang Liang; Xiaoqing Zheng; Yuhong Ke; Yunbing Chang

    The purpose of this study is to explore the therapeutic effect of percutaneous kyphoplasty (PKP) combined with anti-osteoporosis drug, zoledronic acid, on postmenopausal women with osteoporotic vertebral compression fracture (OVCF) and to perform an analysis of postoperative bone cement leakage risk factors. A total of 112 OVCF patients, according to therapeutic regimens, were divided into control group (n = 52, treated with PKP) and observation group (n = 60, treated with PKP and zoledronic acid injection). Postoperative tumor necrosis factor-α and interleukin-6 levels were significantly decreased in the two groups, compared with those before treatment (both P < 0.05); bone mineral density (BMD), serum bone gla protein (BGP), and vertebral height ratio of injured vertebrae were significantly increased, and procollagen type I N-terminal propeptide (PINP), Cobb angle, visual analogue scale/score (VAS), and Oswestry disability index (ODI) were significantly decreased compared with those before treatment (all P < 0.05). There were significantly higher changes in difference value of BMD, PINP, BGP, vertebral height ratio of injured vertebrae, Cobb angle, VAS, and ODI levels and significantly better therapeutic effect in the observation group than those in the control group (all P < 0.05). Multivariate logistic regression analysis showed that the use of zoledronic acid, vertebral height ratio of injured vertebrae, and ODI were independent factors affecting the therapeutic effect, and that the dosage of bone cement, and peripheral vertebrae wall damage were independent risk factors causing postoperative bone cement leakage. There were no significant differences in postoperative bone cement leakage rate between the two groups. Peripheral vertebrae wall damage and the dosage of bone cement are independent risk factors causing bone cement leakage in OVCF patients treated with PKP. PKP combined with zoledronic acid has an improvement effect on the condition of postmenopausal women with OVCF and reduces the inflammation and pain in patients, which is beneficial to clinical treatment.

    更新日期:2019-12-19
  • Design and evaluation of nano-hydroxyapatite/poly(vinyl alcohol) hydrogels coated with poly(lactic-co-glycolic acid)/nano-hydroxyapatite/poly(vinyl alcohol) scaffolds for cartilage repair
    J. Orthop. Surg. Res. (IF 1.907) Pub Date : 2019-12-17
    Weiping Su; Yihe Hu; Min Zeng; Mingqing Li; Shaoru Lin; Yangying Zhou; Jie Xie

    Poly(vinyl alcohol) (PVA) hydrogels have been widely used in synthetic cartilage materials. However, limitations of PVA hydrogels such as poor biomechanics and limited cell ingrowth remain challenges in this field. This work aimed to design novel nano-hydroxyapatite (nano-HA)/poly(vinyl alcohol) (PVA) hydrogels coated with a poly(lactic-co-glycolic acid) (PLGA)/nano-HA/PVA scaffold to counter the limitations of PVA hydrogels. The core, comprising nano-HA/PVA hydrogel, had the primary role of bearing the mechanical load. The peripheral structure, composed of PLGA/nano-HA/PVA, was designed to favor interaction with surrounding cartilage. The double-layer HA/PVA hydrogel coated with PLGA/HA/PVA scaffold was successfully prepared using a two-step molding method, and the mechanical properties and biocompatibility were characterized. The mechanical properties of the novel PLGA/HA/PVA scaffold modified HA/PVA hydrogel were similar to those of native cartilage and showed greater sensitivity to compressive stress than to tensile stress. Rabbit chondrocytes were seeded in the composites to assess the biocompatibility and practicability in vitro. The results showed that the peripheral component comprising 30 wt% PLGA/5 wt% HA/15 wt% PVA was most conducive to rabbit chondrocyte adhesion and proliferation. The study indicated that the double-layer HA/PVA hydrogel coated with PLGA/HA/PVA scaffold has the potential for cartilage repair.

    更新日期:2019-12-18
  • Correction to: Total hip arthroplasty with modular stem for Crowe I and II developmental dysplasia of the hip
    J. Orthop. Surg. Res. (IF 1.907) Pub Date : 2019-12-17
    Xiangpeng Kong; Yunming Sun; Minzhi Yang; Yonggang Zhou; Jiying Chen; Wei Chai; Yan Wang

    In the original publication of this article [1], an sentence needs to be added in the end of the caption of Figure 1 and Figure 3: cited in our previous study [18].

    更新日期:2019-12-18
  • Artesunate prevents knee intraarticular adhesion via PRKR-like ER kinase (PERK) signal pathway
    J. Orthop. Surg. Res. (IF 1.907) Pub Date : 2019-12-17
    Hui Chen; Jin Tao; Jingcheng Wang; Lianqi Yan

    Intraarticular scar adhesion refers to a serious complication caused by knee surgery or trauma, leading to various sequelae (e.g., articular cartilage degeneration and knee joint stiffness). Artesunate (ART) has exhibited an effect to suppress fibroblast proliferation, whereas the exact mechanism remains unclear. This study aims to delve into the possible mechanism of ART in suppressing joint adhesion. The effect of ART on reduced intraarticular adhesions was ascertained by histological staining and immunohistochemical analysis through vivo experiments. Cell Counting Kit-8 (CCK-8) assay, Western blot analysis, flow cytometry, and tunnel staining were used to detect the effect of ART in promoting fibroblast apoptosis and delve into its possible signaling pathway. The results of hematoxylin-eosin (HE) staining suggested that the number of fibroblasts decreased with the increase in ART concentration. The results of Masson staining were similar, with the increase in concentration, the collagen content decreased. Immunohistochemical results showed that the expression of endoplasmic reticulum stress (ERS) characteristic proteins 78 kDa glucose-regulated protein 78 (GRP78) and C/EBP homologous protein (CHOP) increased in a concentration-dependent manner. CCK-8 results suggested that ART could inhibit fibroblast viability in a concentration- and time-dependent manner. Results of flow cytometry, tunnel staining, and Western blot suggested the apoptosis of fibroblasts occurred after ART treatment. Cells with caspase inhibitors were treated, and apoptotic proteins cleaved-poly ADP-ribose polymerase (cleaved PARP) and cleaved-caspase 3 were detected; the results showed that the apoptotic effect of ART was reduced. The expressions of ERS-related protein CHOP and apoptosis-related protein Bax were upregulated, while the expression of Bcl-2 was downregulated, and the ratio of Bax/Bcl-2 increased in a concentration-dependent manner. Continuous detection of PRKR-like ER kinase (PERK) pathway-related proteins showed that the expression of p-PERK and phosphorylating eukaryotic initiation factor 2α (p-eIF2α) increased in a time-dependent and concentration-dependent manner. PERK pathway inhibitors could partially inhibit ART-mediated apoptosis through PERK pathway. ART can promote fibroblast apoptosis through PERK pathway, a classical ERS pathway, and thus prevent fibrosis in the surgical area after joint surgery.

    更新日期:2019-12-18
  • Gamma 3 U-Blade lag screws in patients with trochanteric femur fractures: are rotation control lag screws better than others?
    J. Orthop. Surg. Res. (IF 1.907) Pub Date : 2019-12-16
    Jehyun Yoo; Sangmin Kim; Junyoung Choi; Jihyo Hwang

    Intramedullary hip nails may be classified as blades or screws depending on the type of lag screw used. Recently, a combination of lag screw types with a U-clip insertion has also been used. The purpose of this study was to evaluate the clinical and radiological outcomes of these new screw types. A total of 185 patients with trochanteric femoral fractures (age ≥ 65 years) who underwent surgery with intramedullary nails were selected. Surgeries with InterTrochanteric/SubTrochanteric (ITST), Proximal Femoral Nail Antirotation (PFNA), and Gamma 3 U-Blade lag screws were performed between January 2011 and June 2016. The AO/OTA classification, presence of a basicervical fracture type on 3D-CT, BMI, BMD, reduction quality, position of the lag screw, TAD (tip apex distance) of the lag screw, sliding distance of the lag screw, varus change (neck shaft angle), radiological union period, fixation failure and functional outcome as determined by walking ability were analyzed. There were 3/60 (5.0%) cases of fixation failure in the ITST group, all caused by cut-out; 4/57 (7.0%) in the PFNA II group: 3 caused by cut-through and 1 by metal fracture; 1/68 (1.5%) in the Gamma 3 U-Blade lag screw group (P = 0.301). In each group, the sliding distance of the lag screw showed a significant difference (P = 0.017), whereas significant sliding over 10 mm showed no statistically significant results. There was only one (1.5%) case of fixation failure in the Gamma 3 U-Blade lag screw group. The sliding distance of the U-Blade was found to be in the middle, between the PFNA II (shorter) and ITST (longer) implants. The new rotational control lag screw seems to be comparable to other screw types.

    更新日期:2019-12-17
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