Hasil untuk "Orthopedic surgery"

Sotiropoulos Spyridon, Kalafatis Eleftherios, Michalakakos Evaggelos et al.

Introduction: Chronic low back pain (CLBP) is a leading global cause of disability. Acupuncture is increasingly integrated into its management, yet its standalone effectiveness compared to usual care remains uncertain. This review aimed to assess the immediate (≤2 weeks) and intermediate (2 weeks–6 months) effects of acupuncture versus usual care on pain and disability in adults with CLBP. Methods: A systematic review and meta-analysis of randomized controlled trials was conducted, searching MEDLINE, CENTRAL, Scopus, and PEDro through November 2024. Eligible studies compared acupuncture (body, electroacupuncture, scalp) to usual care (physiotherapy, education, medication, and exercise) in adults with CLBP. Outcomes included pain and disability at immediate and intermediate follow-up. Data were pooled using a random-effects model. Risk of bias was assessed with the PEDro scale, and GRADE was used to evaluate evidence certainty. Sensitivity and subgroup analyses were conducted to explore clinical and methodological heterogeneity and test the reliability of findings. Results: A total of 2.956 records were identified, and 8 RCTs (n = 1,123 participants) were included in this study. Acupuncture significantly reduced pain at both immediate (SMD = –0.73, 95% CI –1.04 to –0.42) and intermediate (SMD = –1.13, 95% CI –1.82 to –0.43) timepoints. Disability also improved at both follow-ups (immediate: SMD = –0.49, 95% CI –0.68 to –0.30 and intermediate: SMD = –0.79, 95% CI –1.18 to –0.41). Sensitivity analyses confirmed effect robustness, especially in electroacupuncture subgroups. Certainty of evidence ranged from low to very low due to risk of bias, inconsistency, and suspected publication bias. Discussion: Acupuncture appears more effective than usual care for reducing pain and disability in adults with CLBP, but the certainty of evidence is low, warranting cautious interpretation.

Kaihua Song, Jiayue Cheng, Yuming Wang et al.

BackgroundPostoperative residual numbness following lumbar disc herniation (LDH) surgery is a relatively common symptom. Existing drugs and physical therapies are not very effective. Acupuncture is effective for the treatment of LDH, but there are limited reports on its use for postoperative numbness. Based on clinical observations and literature review, we hypothesize that combining umbilical acupuncture (UA) with warm needle acupuncture(WA) may yield superior efficacy compared to electroacupuncture(EA) alone, enhancing immune function, promoting nerve recovery, and improving microcirculation through synergistic effects, thereby filling the gap in this treatment field.ObjectiveThis proposed trial aimed to evaluate the effectiveness and safety of UA (umbilical acupuncture) combined with WA (warm needle acupuncture) in treating residual numbness after LDH surgery. To verify the hypothesis that the combined method is superior to traditional electroacupuncture.MethodsThis proposed study is a single-center, single-blind, prospective, randomized controlled trial (RCT) involving patients with LDH who were hospitalized and underwent percutaneous endoscopic lumbar discectomy (PELD) at our hospital. Patients meeting the inclusion criteria will be randomly assigned to either the treatment group (umbilical acupuncture combined with warm needle acupuncture) or the control group (electroacupuncture). The participants will be assessed on the first day after surgery, and acupuncture treatment will begin on the second day and continue for three consecutive days, with each session lasting 30 minutes. After that, the treatment mixture was changed three times a week for four weeks. All patients received standard Western medical drug treatment. After the treatment is concluded, a six-month follow-up will be conducted. The primary efficacy indicator will be the visual analog scale (VAS) score for numbness. The secondary efficacy indicators will include the 10 g monofilament test, 40 g pressure acupuncture sensation examination, Japanese Orthopedic Association (JOA) score, lower limb electromyography (H-reflex differences, F-wave conduction velocity, and latency), VAS score, traditional Chinese medicine symptom scoring, and Short Form 36-Health Survey (SF-36) score. Any adverse events occurring during the trial will be recorded. The data will be analyzed according to a predefined statistical analysis plan.DiscussionThis trial combines UA with WA to create a new non-invasive treatment for numbness after LDH surgery, an area where current therapies are inadequate. If proven effective, this combination therapy could offer a safer and more effective alternative to drug treatment, and provide evidence for the integration acupuncture strategies.Clinical trial registrationhttp://itmctr.ccebtcm.org.cn/, identifier ITMCTR2024000328.

Yi Li, Xiaolin Quan, Cheng Zhou et al.

Abstract Object Although periprosthetic joint infection (PJI) can affect multiple joints simultaneously, most individuals with multiple joint involvement exhibit PJI in only one joint. Data regarding the metachronous PJI management for these patients are limited. This study aimed to explore the risk factors for metachronous PJI in patients with multiple prosthetic joints, thereby guiding and optimizing clinical practice. Methods The MEDLINE, Web of Science, Cochrane Library, and EMBASE were searched for all clinical studies of metachronous PJI from inception until May 2024. The clinical studies on risk factors for metachronous PJI in patients with multiple prosthetic joints after experiencing a periprosthetic infection were collected, with two authors independently screening the literatures. Newcastle Ottawa scale was used as a quality assessment tool for the included studies, and the meta-analysis was conducted to evaluate the potential risk factors of metachronous PJI. Results A total of 1,544 patients with PJI after multiple joint arthroplasties were reported in 9 studies, including 189 with metachronous PJI. The meta-analysis showed that methicillin-resistant staphylococcus aureus (MRSA; OR, 3.43; 95%CI, 1.71–6.88; p = 0.0005), rheumatoid arthritis (RA; OR, 2.38; 95%CI, 1.06–5.38; p = 0.04), history of steroid use (OR, 2.93; 95%CI, 1.58–5.43; p = 0.0007), and previous or ongoing non-periprosthetic infection (OR, 4.47; 95%CI, 1.45–13.82; p = 0.009) were identified as significant risk factors for metachronous PJI in patients with multiple prosthetic joints. However, there was no significant difference between the metachronous PJI group and non-metachronous group in terms of revision, age, diabetes, and gender. Conclusion Patients with MRSA, RA, history of steroid use, previous or ongoing non-periprosthetic infection are at significantly higher risk for metachronous PJI. Further research is needed to optimize management strategies for preventing metachronous PJI in patients with multiple prostheses after a single joint PJI.

Maximilian Weber, Daniel Wild, Jens Kleesiek et al.

Point cloud registration aligns 3D point clouds using spatial transformations. It is an important task in computer vision, with applications in areas such as augmented reality (AR) and medical imaging. This work explores the intersection of two research trends: the integration of AR into image-guided surgery and the use of deep learning for point cloud registration. The main objective is to evaluate the feasibility of applying deep learning-based point cloud registration methods for image-to-patient registration in augmented reality-guided surgery. We created a dataset of point clouds from medical imaging and corresponding point clouds captured with a popular AR device, the HoloLens 2. We evaluate three well-established deep learning models in registering these data pairs. While we find that some deep learning methods show promise, we show that a conventional registration pipeline still outperforms them on our challenging dataset.

Martin Guillemaud, Alice Longhena, Louis Cousyn et al.

Epilepsy surgery, particularly for temporal lobe epilepsy (TLE), remains a vital treatment option for patients with drug-resistant seizures. However, accurately predicting surgical outcomes remains a significant challenge. This study introduces a novel biomarker derived from brain connectivity, analyzed using non-Euclidean network geometry, to predict the surgery outcome in TLE. Using structural and diffusion magnetic resonance imaging (MRI) data from 51 patients, we examined differences in structural connectivity networks associated to surgical outcomes. Our approach uniquely utilized hyperbolic embeddings of pre- and post-surgery brain networks, successfully distinguishing patients with favorable outcomes from those with poor outcomes. Notably, the method identified regions in the contralateral hemisphere relative to the epileptogenic zone, whose connectivity patterns emerged as a potential biomarker for favorable surgical outcomes. The prediction model achieves an area under the curve (AUC) of 0.87 and a balanced accuracy of 0.81. These results underscore the predictive capability of our model and its effectiveness in individual outcome forecasting based on structural network changes. Our findings highlight the value of non-Euclidean representation of brain networks in gaining deeper insights into connectivity alterations in epilepsy, and advancing personalized prediction of surgical outcomes in TLE.

Pedro Poggiali, MD, Jared M. May, BS, Jill E. Larson, MD et al.

ABSTRACT: Background: Clubfoot occurs in 30% of patients with myelomeningocele (MM) and is the most frequent foot deformity in patients with arthrogryposis (ART). Patients have high recurrence rates with more conservative interventions and may require talectomy. This study investigated the long-term clinical outcomes of talectomy in patients with MM and ART and identified factors associated with favorable outcomes. Methods: A retrospective chart review was performed on cases of clubfoott in MM and ART between 1975 and 2010, excluding if follow-up was <5 years or had incomplete charts. A plantigrade, stable, and braceable foot was graded as a good result. Statistical analysis included descriptive statistics, chi-square with continuity correction, Spearman correlation, and Mann-Whitney, with P ​< ​.05 reaching significance. Results: In total, 944 cases of clubfoot in patients with MM and ART were identified. Of those, 53 underwent talectomy and 31 feet were included in the analysis. Average age on talectomy date was 4.16 ​± ​2.46 years and the mean follow-up since surgery was 15.71 ​± ​8.43 years. “Good results” were found in 24 (77.4%) feet, while 7 feet (22.6%) required additional surgery. Older age at talectomy date was associated with good results at the last clinical visit (P ​= ​.03). Primary talectomies were associated with more subsequent surgeries per foot when compared with salvage talectomies (P ​= ​.03). A Functional Mobility Scale (FMS) of 3-1-1 or higher was associated with a good outcome (P ​= ​.022) and all “poor results” (7 feet, 22.6%) were found in patients with FMS lower than 3-1-1. Conclusions: Talectomy was performed in 5.6% of cases, demonstrating its rare use in treatment of clubfoot in patients with MM and ART. Nevertheless, these long-term outcomes demonstrate that talectomy surgery may be a good option for the treatment of nonidiopathic clubfoot. Good outcomes are maintained at long-term follow-up, suggesting a satisfactory correction remained until adulthood. Finally, a higher FMS was a predictor of success, suggesting that this procedure should be performed in ambulatory patients. Key Concepts: (1) Talectomy remains a rare procedure, utilized in only 5.6% of clubfoot cases of patients with myelomeningocele or arthrogryposis. (2) “Good” results, defined as a plantigrade, stable, and braceable foot was achieved in 77.4% of patients. (3) Older age at time of talectomy was associated with improved results. (4) A Functional Mobility Scale (FMS) of 3-1-1 or higher was associated with good outcomes and thus may be a predictor of success. Level of Evidence: Level IV

D. Lindström, O. S. Azodi, A. Wladis et al.

Zhuoqi Cheng

This study presents a conceptual design of laparoscopic forceps whose grasping torque can be directly controlled by the user. By integrating an adjustable constant torque mechanism, the handle opening angle is converted to the grasping torque irrespective of the jaw opening angle. This feature overcomes the limitation regarding of the lack of direct haptic feedback in laparoscopic minimally invasive surgery, preventing damage of delicate tissue during forceps grasping.

Ke Li, Feng-Long Sun, Heng-Bing Guo et al.

Abstract Purpose The changes in the lower limb alignment were vitally important after high tibial osteotomy (HTO). Therefore, the purpose of present study was to analyze the characteristics of plantar pressure distribution after HTO, and to investigate the effect of plantar pressure distribution on postoperative limb alignment. Methods Between May 2020 and April 2021, varus knee patients undergoing HTO were evaluated in the present study. The peak pressure of plantar regions, medial-lateral pressure ratio (MLPR), foot progression angle (FTA), anteroposterior COP (AP-COP), lateral symmetry of COP (LS-COP), and the radiographic parameters were evaluated preoperatively and at the final follow-up. Compared among the slight valgus (SV), moderate valgus (MV) and large valgus (LV) groups at the final follow-up, the peak pressure of HM, HC and M5 regions, and the MLPR were compared; the Knee Injury and Osteoarthritis Outcome Score4 (KOOS4) including four subscales, and the American of orthopedic foot and ankle society (AOFAS) were evaluated. Results The WBL%, HKA and TPI angle changed significantly after HTO (P < 0.001). The preoperative group exhibited a lower peak pressure in the HM region (P < 0.05) and higher peak pressure in the M5 region (P < 0.05); the pre- and postoperative groups exhibited a lower peak pressure in the HC region (P < 0.05); the rearfoot MLPR was significantly lower and LS-COP was significantly higher in the preoperative group (P = 0.017 in MLPR and 0.031 in LS-COP, respectively). Comparison among the SV, MV and LV groups, the SV group indicated a lower peak pressure in the HM region (P = 0.036), and a lower MLPR in the rearfoot (P = 0.033). The KOOS Sport/Re score in the MV and LV groups increased significantly compared with the SV group (P = 0.042). Conclusion Plantar pressure distribution during the stance phase in patients with varus knee OA following HTO exhibited a more medialized rearfoot plantar pressure distribution pattern than that before surgery. Compared with the small valgus alignment, a moderate to large valgus alignment allows patients to walk with a more even medial and lateral plantar pressure distribution, which is more similar to healthy adults.

Gerard F. Marciano MD, Harrison R. Ferlauto MD, Jamie Confino MD et al.

Background: Percutaneous ankle fusion is an emerging technique with minimal published outcome data. The goal of the present study is to retrospectively review clinical and radiographic outcomes following percutaneous ankle fusion and provide technique tips to perform percutaneous ankle fusion. Methods: Patients >18 years of age, treated by a single surgeon, from February 2018 to June 2021, who underwent primary isolated percutaneous ankle fusion supplemented with platelet-derived growth factor B (rhPDGF-BB) and beta-tricalcium phosphate, with at least 1-year follow-up were included. Surgical technique consisted of percutaneous ankle preparation followed by fixation with 3 headless compression screws. Pre- and postoperative visual analog scale (VAS) and Foot Function Index (FFI) were compared using paired t tests. Fusion was assessed radiographically by the surgeon on postoperative radiographs and computed tomography (CT) at 3 months postoperatively. Results: Twenty-seven consecutive adult patients were included in the study. Mean follow-up was 21 months. Mean age was 59.8 years. Mean preoperative and postoperative VAS scores were 7.4 and 0.2, respectively ( P  < .01). Mean preoperative FFI pain domain, disability domain, activity restriction domain, and total score were 20.9, 16.7, 18.5, and 56.4, respectively. Mean postoperative FFI pain domain, disability domain, activity restriction domain, and total score were 4.3, 4.7, 6.7, and 15.8, respectively ( P  < .01). Fusion was achieved in 26 of 27 patients (96.3%) at 3 months. Four patients (14.8%) had complications. Conclusion: We found in this cohort with surgery performed by a surgeon highly experienced in minimally invasive surgery that percutaneous ankle fusion augmented with a bone graft supplement achieved a high rate of fusion (96.3%) and a significant improvement in pain and function postoperatively while associated with minimal complications. Level of Evidence: Level IV, case series.

Todd H. Lanman, MD, Jason M. Cuellar, MD, PhD, Nicole Mottole, BE et al.

Background: Motion of a solid body involves translation and rotation. Few investigations examine the isolated translational and rotational components associated with disc arthroplasty devices. This study investigates single- and multi-level cervical disc arthroplasty with respect to index and adjacent level range of motion. The investigators hypothesized that single- and multilevel cervical disc replacement will lead to comparable or improved motion at implanted and adjacent levels. Methods: Seven human cervical spines from C2 to C7 were subjected to displacement-controlled loading in flexion, extension, and lateral bending under intact, 1-Level (C5–C6), 2-Level (C5–C6, C6–C7) and 3-Level (C5–C6, C6–C7, C4–C5) conditions. 3D motions sensors were mounted at C4, C5, and C6. Motion data for translations and rotations at each level for each surgical condition and loading mode were compared to intact conditions. Results: 1-Level: The index surgery resulted in statistically increased translations in extension and lateral bending at all levels with statistically increased translation observed in flexion in the superior and inferior levels. In rotation, the index surgeries decreased rotation under flexion, with remaining levels not statistically different to intact conditions. 2-Level: A device placed inferiorly resulted in statistically increased translations at all levels in extension with statistically increased translations superior and inferior to the index level in flexion. Lateral bending resulted in increased nonsignificant translations. Rotations were elevated or comparable to the intact level for all loading. 3-Level: Translations were statistically increased for all levels in all loading modes while rotations were elevated or were comparable to the intact level for all loading modes and levels. Conclusions: Micromotion sensors permitted monitoring and recording of small magnitude angulations and translations using a loading mechanism that did not over constrain cervical segmental motion. Multilevel cervical disc arthroplasty yielded comparable or increased overall motion at the index and adjacent levels compared to intact conditions.

L. Okafor, Antonia F. Chen

Primary total hip arthroplasty (THA) has been recognized as a reliable intervention for patients with end-stage osteoarthritis. Despite several notable advances in this procedure, studies have identified at least 7% of patients who remain dissatisfied. There is no general consensus on how to measure patient satisfaction in orthopedic surgery. However, validated tools have been used in multiple studies to further investigate this problem. A comprehensive review was conducted to examine the factors associated with patient satisfaction following THA. Associations in literature included patient expectation, age, sex, pain management, patient comorbidities (medical or psychiatric that existed prior to surgery), and length of stay. The continuous collection of patient satisfaction data using validated and reliable measurement tools is necessary to improve this important patient-reported outcome after THA.

P. Ngan, W. Moon

Eleonora Tagliabue, Daniele Meli, Diego Dall'Alba et al.

Autonomous robotic surgery requires deliberation, i.e. the ability to plan and execute a task adapting to uncertain and dynamic environments. Uncertainty in the surgical domain is mainly related to the partial pre-operative knowledge about patient-specific anatomical properties. In this paper, we introduce a logic-based framework for surgical tasks with deliberative functions of monitoring and learning. The DEliberative Framework for Robot-Assisted Surgery (DEFRAS) estimates a pre-operative patient-specific plan, and executes it while continuously measuring the applied force obtained from a biomechanical pre-operative model. Monitoring module compares this model with the actual situation reconstructed from sensors. In case of significant mismatch, the learning module is invoked to update the model, thus improving the estimate of the exerted force. DEFRAS is validated both in simulated and real environment with da Vinci Research Kit executing soft tissue retraction. Compared with state-of-the art related works, the success rate of the task is improved while minimizing the interaction with the tissue to prevent unintentional damage.

Aftab Ali, Muhammad Usman

We extend the surgical tool box for quantum graphs to anti-standard and $δ'$ vertex conditions. Monotonicity properties of eigenvalues of graph Laplacian with $δ'$ interactions at vertices depend on the sign of vertex parameter. Using several interlacing inequalities between eigenvalues of graph Laplacian with different vertex conditions and surgery principles we obtain new upper and lower bounds on the eigenvalues of $δ$ and $δ'$ Laplacians.

Pu Ying, Mingjia Gu, Xiaowei Jiang et al.

Abstract Background This study retrospectively analyzed and evaluated the potential correlations of serum calcium, serum phosphorus, and calcium-phosphorus product (Ca–P product) with the incidence of osteoporotic vertebral compression fractures (OVCFs), with the aim of exploring whether the Ca–P product can be used as a serological indicator to predict the risk of OVCFs. Methods This study randomly enrolled 400 elderly patients in our hospital with OVCFs and 400 patients with hip and knee arthroplasty due to femoral head necrosis or osteoarthritis from August 2013 to April 2021. Age, sex, past medical history, and admission biochemical indicators, including albumin, blood urea nitrogen, serum creatinine, serum calcium and serum phosphorus, were collected for statistical analysis. Results Albumin, serum calcium, serum phosphorus, Ca–P product, corrected serum calcium and corrected Ca–P product were lower in the OVCF group than in the non-OVCF group (P < 0.05). Multivariate logistic regression analysis showed that low values of serum calcium, serum phosphorus, Ca–P product, corrected blood calcium, and corrected Ca–P product can all be risk factors for OVCF. The ROC curve showed that the Ca–P product and corrected Ca–P product were effective in predicting the risk of OVCFs. The predictive value of the Ca–P product was the best; the cutoff point was 29.88, the sensitivity was 0.72 and the specificity was 0.62. The cutoff point of the corrected Ca–P product was 30.50, the sensitivity was 0.74, and the specificity was 0.62. Conclusion The Ca–P product and corrected Ca–P product can be used as serological indicators to predict the risk of OVCFs in elderly individuals. Early clinical interventions targeting this risk factor can further reduce the risk of OVCFs. Also, timely and regular testing of the serum calcium and phosphorus level is recommended and encouraged for this group of people.

Mohammed S. Alorjani, Ismail I. Matalka, Mahmoud A. Alfaqih et al.

<i>Background and Objectives</i>: Sarcomas are rare malignant tumors of mesenchymal origin. Their low prevalence and histological heterogeneity make their diagnosis a challenging task. To the best of our knowledge, the epidemiology of soft tissue sarcomas (STSs) was not well studied in Jordan. This study thus aimed to determine STS epidemiologic trends at King Abdullah University Hospital (KAUH); a tertiary hospital that provides cancer healthcare for 70% of the population in Irbid Governorate, North Jordan. The findings of this study will provide a good reference point of the burden of STSs in Jordan and the Middle East region. <i>Materials and Methods</i>: All cases with confirmed STS diagnoses who attended KAUH from January 2003 until December 2018 were included in the initial analysis. Bone sarcomas, gastrointestinal stromal tumors and uterine sarcomas were not included in the study. Information collected from the pathology reports and electronic medical records was used to determine STS prevalence, incidence rate, age and gender distributions, histological types and anatomic location. Cases were reviewed by three pathologists with interest in soft tissue tumors. The findings were compared with literature. <i>Results</i>: In total, 157 STS cases were reported (1.9% of cancers diagnosed at KAUH during the 16-year study period). Crude annual incidence rate (IR) per 100,000 person-years ranged from 0.48 in 2015 to 1.83 in 2011 (average = 1.04). Age-standardized IR (ASR)_(World _WHO _2000–2025) was 1.37. Male:female ratio was 1.3:1. Median age was 39 years. Age ranged from <1 year to 90 years. Overall STS rates increased with age. The most common histological types were liposarcoma (19%), rhabdomyosarcoma (17%) and leiomyosarcoma (10%). The most common anatomic location was the extremity (40.1%), followed by the trunk (14.7%), then head and neck (10.8%). <i>Conclusion</i>: STSs are rare in North Jordan. A slight increase in their incidence was identified during the study period similar to global trends. The collection of relevant data on established risk factors along with a broader scale evaluation of the epidemiology of STS in the Middle East region is recommended to better evaluate disease burden and trends.

Dejin Yang, Yixin Zhou, Hongyi Shao et al.

Objective To analyze the deformity origins and distribution among valgus knees to individualize their morphological features. Methods Radiographic images of 105 valgus knees were analyzed. Long‐film radiographs and computed tomography were collected for every knee. A malalignment test was performed on standing long‐film radiographs. The hip‐knee‐ankle angle (HKA), the anatomical lateral distal femoral angle (aLDFA), and the anatomical medial proximal tibial angle (aMPTA) were measured on long‐film radiographs. The distal condylar angle and posterior condylar angle on distal femur were further measured on computed tomography scans. The tibial bone varus angle was measured on long‐film radiographs as well. All the valgus knees were sorted into different subtypes according to the origins of bony deformity, and the prevalence of each subtype was reported. Finally, to examine the inter‐observer reproducibility of this classification system, two observers measured the deformities and did the classification for all the 105 knees independently and then the intraclass correlation coefficient (ICC) was calculated. Results Among the 105 knees, 48 knees (45.7%) had apparent deformity from the tibial plateau, and 62 knees (59.0%) had apparent deformity from the supracondylar region of the femur. Eighteen knees (17.1%) had distal condylar angle >7°, among which 11 knees had posterior condylar angle >3° simultaneously. Valgus knees had five subtypes of bone deformity origins—the supracondylar part of the femur, the distal aspect of the lateral femoral condyle, both distal and posterior aspects of the lateral femoral condyle, the tibial plateau, or the metaphyseal segment of the tibia. A valgus knee could be labeled as only one subtype, or a combination of two or more subtypes. Labeling 105 knees with origin of the most severe deformity, the prevalence of each subtype was 40.0%, 5.7%, 9.5%, 28.6%, and 16.2%, respectively. The intra‐observer and inter‐observer ICC of this classification system was 0.992 and 0.976, respectively. Conclusions Valgus knees can be classified into different subtypes according to deformity origins. This radiological classification system has satisfactory reproducibility. It helps surgeons better individualize morphological features of valgus knees.

Ana Bia, F. Guerra-Pinto, Bruno S. Pereira et al.

H. Matusiewicz