Postoperative Parameters Research Articles

Laparoscopic Nissen fundoplication is more cost-effective than open Nissen fundoplication in children

BackgroundNissen fundoplication is one of the most common surgical procedures for gastroesophageal reflux. Current and previous research comparing laparoscopic Nissen fundoplication (LNF) versus open Nissen fundoplication (ONF) in children suggest ambiguous conclusions. The purpose of this retrospective study was to compare the outcome for children operated with LNF or ONF at our institution and to evaluate the economic aspects.Methods32 consecutive patients (LNF: n = 18, ONF: n = 14) operated with Nissen fundoplication between the years 2011–2017 were included in the study. Data was collected by examination of the patient journals and preoperative, operative, postoperative, and post-discharge parameters were analyzed.ResultsCompared to ONF, the LNF group had shorter operating time (165.2 vs 216.6 min, p < 0.05), shorter overall operating room duration (315.0 vs 334.9 min, p < 0.05) and shorter postoperative hospital stay (3.8 vs 8.1 days, p < 0.05). The LNF group also required less morphine (1.2 vs 1.7 mg/kg, p < 0.05) and the total cost per case was 39% lower (261.1 vs 427.4 kSEK, p < 0.05). No difference was seen in postoperative complications and results.ConclusionLaparoscopic Nissen fundoplication is more cost-effective compared to open surgery and reduces postoperative hospital stay and morphine requirements.

Impact of skeletal muscle mass of the trunk and extremities on standing spine parameters before and after surgery for adult spinal deformity with a minimum 2-year follow-up.

The effect of skeletal muscle mass of the trunk and extremities on sagittal imbalance of the spine before and after surgery for adult spinal deformity (ASD) has not been elucidated. The purpose of this study was to examine the correlation between reduced skeletal muscle mass of the trunk and extremities, as well as spinopelvic parameters, preoperatively, postoperatively and at least 2years after surgery for ASD. This retrospective observational study included 140 consecutive patients who had undergone surgery for ASD and were followed-up for at least 2years and whose skeletal muscle mass could be measured preoperatively using whole-body dual-energy X-ray absorptiometry. Correlations between skeletal muscle mass and spinopelvic parameters were assessed preoperatively, postoperatively, and after 2years of follow-up. All spinopelvic parameters were significantly improved postoperatively compared with preoperatively. Between the postoperative period and two years post-surgery, a significant loss of correction was observed in SVA and GT. Trunk muscles mass showed significant negative correlations with preoperative PT, SS, PI-LL, SVA, GT, and TPA, but there was no significant correlation with postoperative parameters. Through univariate and multivariate regression analysis, lower limb skeletal muscle mass showed a significant negative correlation with SVA at two years postoperatively and the loss of corrected SVA (ΔSVA) over two years. This study revealed that lower extremity muscle mass was implicated in the loss of corrected SVA 2years after surgery. This study is clinically meaningful as it suggests that strength training for the lower extremities, performed preoperatively and/or postoperatively, can improve sagittal imbalances of the spine in patients with severe ASD or maintain SVA after corrective surgery.

The impact of lower thoracic versus upper lumbar upper instrumented vertebra in minimally invasive correction of adult spinal deformity.

The goal of this study was to compare the impact of using a lower thoracic (LT) versus upper lumbar (UL) level as the upper instrumented vertebra (UIV) on clinical and radiographic outcomes following minimally invasive surgery for adult spinal deformity. A multicenter retrospective study design was used. Inclusion criteria were age ≥ 18 years, and one of the following: coronal Cobb angle > 20°, sagittal vertical axis > 50 mm, pelvic tilt > 20°, pelvic incidence-lumbar lordosis mismatch > 10°. Patients were treated with circumferential or hybrid minimally invasive techniques at ≥ 3 spinal levels and had a 2-year minimum follow-up. They were then divided into 2 groups depending on whether the UIV was in the UL region, defined as a UIV location of L1-2, or the LT region, defined as T10-12. A total of 114 of 223 patients met the inclusion criteria (68 LT and 46 UL). The UL group was older (67.5 vs 62.3 years; p = 0.015). Preoperative spinopelvic parameters were similar, except for sacral slope, which was higher in the UL group (30.5° vs 26.5°; p < 0.001). The percentage of patients with fixation crossing the lumbosacral junction was also similar (70.6% vs 67.4%; p = 0.717). Postoperative lumbar lordosis (42.5° vs 35.5°; p = 0.01) and change in coronal Cobb angle (-23.2° vs -9.6°; p < 0.001) were greater in the LT group, but other changes in postoperative spinopelvic parameters and changes in health-related quality-of-life scores were similar between groups. Reoperation rates were lower in the UL group (17.4% vs 36.8%; p = 0.025), largely associated with fewer radiographic failures (UL = 10.9% vs LT = 26.5%; p = 0.042); however, overall complication rates were not significantly different (UL = 43.5% vs LT = 60.3%; p = 0.077). Selecting a UL vertebra for UIV in minimally invasive surgical correction of adult spinal deformity results in lower reoperation rates compared to extending fixation to the LT region. This choice also correlates with shorter operating room times and reduced estimated blood loss. Although extending fixation to the LT region is associated with slightly greater lumbar lordosis and a greater change in the coronal Cobb angle, clinical outcomes were similar between the LT and UL groups for UIV.

Short-term outcomes of gradual ulnar lengthening in multiple hereditary osteochondromas of the forearm with monolateral external fixator.

Hereditary multiple exostoses is an autosomal dominant genetic condition primarily affecting long bones. Forearm deformities, including wrist ulnar deviation, ulnar shortening, radial or ulnar bowing, and radial head dislocation, are common manifestations. Gradual ulnar lengthening is suggested as a viable treatment option for managing these deformities. This retrospective single-center study included 15 forearms treated with gradual ulnar lengthening using a monolateral external fixator by a single surgeon. Clinical and radiological characteristics were recorded preoperatively and during follow-ups. The Wilcoxon signed-rank test compared preoperative and postoperative radiological and clinical parameters, while McNemar's test assessed changes in radial head dislocation or subluxation. Significant radiological improvements were observed post-treatment. Proportional ulnar length increased from a mean of 0.85 ± 0.10 preoperatively to 1.11 ± 0.03 at the last follow-up (P < 0.001). Ulnar variance decreased from a mean of 17.6 ± 5.58 mm preoperatively to 0.13 ± 1.81 mm at the last follow-up (P < 0.001), while radial bowing decreased from a mean of 0.06 ± 0.02 to 0.05 ± 0.01 at the last follow-up (P < 0.001). In addition, the radioarticular angle decreased significantly from a mean of 29.93 ± 7.34 to 20.20 ± 5.71° (P < 0.001). The incidence of radial head dislocation or subluxation decreased significantly, from 11 patients preoperatively to only one at the last follow-up. These findings demonstrate the effectiveness of gradual ulnar lengthening with a monolateral external fixator in correcting forearm deformities and reducing the incidence of radial head dislocation or subluxation.

Optimising reduction and implant positioning in intertrochanteric fracture treatment: An evaluation of the effects of a structured educational program.

Intertrochanteric fractures are common in older adults and pose significant challenges in terms of morbidity and mortality. Accurate reduction and optimal implant positioning during operative stabilisation of these fractures reduce the rates of complications and reoperations while improving functional outcomes in this population. This study aimed to assess the effects of a structured educational intervention on the radiographic outcomes, reduction quality, and revision rates of intertrochanteric fractures. We initiated a training program that included an instructional video on interpreting intraoperative fluoroscopic views, as well as instructions and an algorithm for reducing and stabilising intertrochanteric fractures and mandated its implementation for all operating surgeons. We thus established an intervention cohort (n = 209) of patients who underwent surgery after the program's introduction, which we compared with a historical control cohort (n = 207) of patients who had undergone surgery before the program's implementation. The analysed postoperative radiographic parameters included the Baumgaertner reduction index, tip-apex distance (TAD), restoration of the caput-collum-diaphyseal angle, and calcar displacement. Mortality and the need for revision surgery were monitored for 2 years postoperatively. We observed significant improvements in the intervention cohort, particularly among the less experienced surgeons. The TAD was reduced by 7 %, indicating improved implant positioning. Similarly, the Baumgaertner reduction index revealed an increase in 'good' reductions (40.2% vs. 37.2 %). Additionally, the rates of revision surgery (4.8% vs. 11.1 %) and mechanical complications (1.9% vs. 6.3 %) were lower in the intervention cohort than in the control cohort. Implementation of the structured training program led to better radiographic outcomes for intertrochanteric fractures, especially among less experienced surgeons. The observed improvements in reduction quality and decrease in revision rates underscore the potential benefits of incorporating educational interventions in orthopaedic trauma treatment.

A new distal radius fracture classification depending on the specific fragments through machine learning clustering method

PurposesThe objective of this study was to investigate intra-articular distal radius fractures, aiming to provide a comprehensive analysis of fracture patterns and discuss the corresponding treatment strategies for each pattern.Methods294 cases of intra-articular distal radius fractures lines were collected and clustered thorough K-means and hierarchical clustering algorithm. The demographic data of patients and the clinical treatment outcomes were recorded. For functional evaluation, quick Disabilities of the Arm, Shoulder, and Hand (DASH) score, visual analog scale (VAS) pain score, range of motion (ROM) of the wrist joint and the percentage of the grip strength relative to the healthy wrist at 12 months follow-up were evaluated and recorded; For radiographic parameters of volar tilt (VT), radial inclination (RI), and ulnar variance (UV) were obtained; The occurrence of complications was carefully assessed and documented.ResultsTotally 294 patients were included and divided into the volar side affected group and the dorsal side affected groups. And each group was further categorized into three types: type I, with two parts fractures with either one volar/dorsal side intact; type II, with three parts fractures with volar/dorsal side simply affected; and type III, with four parts fractures with volar/dorsal side communited affected. The volar plate fixation was performed as the standard treatment, while the combined plate fixation was used for comminuted dorsal bone defects of the metaphysis and impaction. There were no differences in the postoperative radiograph parameters, functional outcomes and incidences of complications for each type of volar side group and dorsal side group except that the 3.2 type DRFs showed less range of flexion (75.56±7.48)° and extension (61.65±9.9)° than other dorsal types.ConclusionsA new intra-articular distal radius fractures classification was proposed based on the affection condition of volar or dorsal side. The volar plate fixation is an effective treatment for the intra-articular distal radius fractures, while combined plate fixation can be considered as an alternative treatment for dorsal side comminuted fractures.Level of evidenceIII a

Absorbable Powder Haemostat Use in Minimally Invasive Thoracic Surgery.

Background: Significant intraoperative and postoperative blood loss are rare but possibly life-threatening complications after lung resection surgery either during open or minimally invasive procedures. Microporous Polysaccharide Haemospheres (ARISTA™AH) have demonstrated time-efficient haemostasis, lower postoperative blood volumes and a lower blood transfusion requirement, without any identified adverse events across other specialities. The primary aim of our study was to evaluate the impact of ARISTA™AH on short-term postoperative outcomes in thoracic surgery. Our secondary aim was to compare ARISTA™AH with other commonly used haemostatic agents. Methods: We retrospectively reviewed a prospectively collected database of consecutive early-stage lung cancer patients surgically treated in two European centres (October 2020-December 2022). Exclusion criteria included open surgery, patients with coagulopathy/anticoagulant medication, major intraoperative bleeding, non-anatomical lung resection and age <18 years. The cohort was divided into five groups according to the haemostatic agent that was used. Propensity score matching was used to estimate the effect of ARISTA™AH on various intra- and postoperative parameters (continuous and binary outcome modelling). Results: A total of 482 patients (M/F:223/259; VATS 97/RATS 385) with a mean age of 68.9 (±10.6) years were analysed. In 253 cases, ARISTA™AH was intraoperatively used to control bleeding. This cohort of patients had a significant reduction in total drain volume by 135 mls (standard error 53.9; p = 0.012). The use of ARISTA™AH did reduce the average length of a hospital stay (-1.47 days) and the duration of chest drainage (-0.596 days), albeit not significantly. In the ARISTA™AH group, we observed no postoperative bleeding, no blood transfusion requirement, no 30-day mortality and no requirement for redo surgery. The use of ARISTA™AH significantly reduced the odds of postoperative complications, as well as the need for transfusion and redo surgery. Conclusions: Our data showed that Microporous Polysaccharide Haemospheres are a safe and effective haemostatic device. Their use has a positive effect on the short-term postoperative outcomes of patients surgically treated for early-stage lung cancer.

Risk factors for recurrenсe of hydronephrosis in children

Introduction. Relapse after radical correction of congenital hydronephrosis (CH) in children occurs in 5–11% of cases. However, the predictors of repeated obstruction of the pyeloureteral segment (PUS) have not yet been sufficiently evaluated, which determines the relevance of the topic. Aim: to detect the risk factors for recurrence of hydronephrosis in children to develop methods for its prevention. Materials and methods. There were examined one hundred children with hydronephrosis divided into 2 groups. Group 1 consisted of 50 patients with recurrent hydronephrosis (RH), group 2 (control) — 50 children without RH with a comparable functional condition of the affected kidney. The analysis of the influence of pre-, intra- and postoperative parameters on the outcome of the primary intervention was carried out. Results. During primary intervention in CH patients from group 1, we identified the following significant differences compared with patients of group 2: the use of non-resection pyeloplasty; a more extended stricture of the PUS; an indentation of less than 5 mm from the edge of stenosis; tension of the edges of the anastomosis due to insufficient mobilization; acute pyelonephritis during the early postoperative period. When the anastomosis tissues were stretched, only one type of urine drainage (internal or external) was performed in patients from group 1, and combined drainage was provided in patients of group 2. Conclusion. To prevent recurrence of hydronephrosis in children, it is necessary to perform exclusively resection ureteropyeloplasty with adequate tissue mobilization and a wide margin from the edge of stenosis, use combined drainage when stretching the edges of the anastomosis and ensure the observation of operated children before moving to the adult network.

Incidence of acute angle closure in patients with primary angle closure without prophylactic iridotomy during pharmacological mydriasis for cataract surgery.

The objective was to study the incidence of acute primary angle closure (acute PAC) during pharmacologic mydriasis before cataract surgery and changes in anterior chamber angle parameters in patients with primary angle closure diseases (PACD) with and without prophylaxis laser peripheral iridotomy (LPI). This was a prospective, comparative study of cataract patients with PACD with and without prophylaxis LPI presented at the Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand during June 2022 to December 2023. The incidence of acute PAC during pharmacologic mydriasis prior to cataract surgery was recorded. Changes in anterior chamber depth (ACD) and anterior chamber angle parameters measured with anterior segment optical coherence tomography before and after cataract surgery were compared between groups using Student t test. There were 195 eyes of 116 patients with a mean age of 70 years enrolled in the study. Eighty patients were women and 36 were men. There were 99 eyes without prophylaxis LPI and 96 eyes with LPI. There was significantly more angle-closure glaucoma in the non-LPI group than in the LPI group. Preoperatively, all anterior chamber angle parameters were significantly greater in the LPI group than in the non-LPI group (P < .001 all parameters), except ACD (P = .83) and anterior chamber width (ACW) (P = .30). All participants underwent uneventful cataract surgery. Postoperatively, all parameters of the anterior chamber angle and ACD increased significantly in both groups. When comparing between groups, all postoperative anterior chamber angle parameters were not significantly different between the groups, but ACD was significantly greater (P = .036) and ACW was lower in the LPI group (P = .008). There was no incidence of acute PAC occurring during pharmacological mydriasis before cataract surgery in both groups. There was no incidence of acute PAC in patients with and without prophylaxis LPI during pharmacological mydriasis in the preoperative preparation for cataract surgery. Eyes without LPI showed significantly lower preoperative anterior chamber angle parameters compared to eyes with previous LPI, but not significantly different postoperatively. The benefits of prophylactic LPI for PACD scheduled for cataract surgery must be further investigated.

Analysis of the top-down HoLEP learning curve: A single-center experience of two clinical fellows.

Holmium laser enucleation of the prostate (HoLEP) is known to have a steep learning curve. The top-down technique was introduced to lessen the number of procedures required to master HoLEP. We aimed to present the experiences of two successive clinical fellows with the top-down HoLEP learning curve and compare their performance with the supervisor. We conducted a prospective study of 40 patients who underwent top-down HoLEP performed by two successive fellows at our institution from September 2020 to November 2022. Before data collection, each learner observed three top-down HoLEP procedures and assisted with seven additional cases before independently performing top-down HoLEP under supervision. We collected data from each fellow's first 20 consecutive top-down HoLEP procedures. The learners' cases were grouped according to chronological order (Cases 1-10 and 11-20). The primary outcome was defined as the number of cases before the fellow could independently complete all steps of top-down HoLEP without any major intraoperative complications. The secondary outcomes included the intraoperative and postoperative outcomes of both groups. The fellows' 40 cumulative cases were then compared against retrospective data from 148 procedures conducted by their supervisor. There were no significant differences in patient demographics for both clinical fellows. Each learner performed the first 20 cases independently without needing the supervisor to intervene. No major intraoperative complications were recorded, and there were no statistically significant differences in intraoperative and postoperative outcomes between fellows' cases. There was a statistically significant difference between the fellows and their supervisor in terms of operative efficiency and enucleation efficiency (p < 0.001). We did not find a significant difference between the fellows and the supervisor regarding intraoperative complications, major postoperative complications, or postoperative subjective and objective parameters. Top-down HoLEP shows promising and reproducible results in shortening HoLEP's learning curve. Larger comparative and multi-institutional studies are warranted.

The Influencing Factors of Breast Morphological Changes After Dual-Plane Augmentation with Smooth Round Implans: A Correlational Study.

Breast morphology is the primary objective indicator for evaluating the outcome of augmentation surgery. Studies have indicated that breast morphology undergoes certain changes during the early postoperative period, which may result in a discrepancy between postoperative outcomes and preoperative design. This study utilized three-dimensional scanning technology and statistical methods to analyze the influencing factors of breast morphology changes, aiming to provide reference for implant selection and preoperative surgical planning. The study included patients who underwent endoscopic-assisted transaxillary dual-plane augmentation from July 2020 to June 2022. Anthropometry and three-dimensional scanning were performed on the enrolled patients, and the change values of postoperative breast morphological parameters were calculated. Spearman rank correlation tests were performed to assess the correlation between these changes and implant parameters as well as anthropometric measurements. Factors with high correlation were selected, and multivariate linear regression analysis was conducted. A total of 30 patients (60 breasts) were enrolled. The average downward displacement of the inframammary fold was 0.4 ± 0.3 cm, and the average outward displacement of the medial breast border was 0.2 ± 0.1 cm, both highly positively correlated with implant volume. The length of nipple-medial breast border increased by 0.5 ± 0.3 cm, highly positively correlated with the stretchability of the medial pole. The length of the nipple-to-inframammary fold increased by 0.6 ± 0.3 cm, highly positively correlated with implant volume and stretchability of the lower pole. Nipple displacement was 0.3 ± 0.2 cm outward, highly positively correlated with the stretchability of the medial pole. Nipple elevation was 0.2 ± 0.2 cm, highly positively correlated with implant volume and stretchability of the lower pole. Breast projection decreased by 0.4 ± 0.2 cm, highly positively correlated with preoperative breast projection. The average reduction in breast volume was 25.6 ± 15.7 cc, with the reduction value highly positively correlated with preoperative breast volume. After smooth round implant augmentation mammoplasty, the breasts experienced slight downward and outward displacement, with the main influencing factor being the implant volume. Nipple displacement outward and upward, as well as lateral displacement, was primarily influenced by the stretchability of the medial pole. Upward displacement was mainly influenced by implant volume and the stretchability of the lower pole. The increase in length of the nipple-to-inframammary fold skin was most significantly influenced by implant volume and the stretchability of the lower pole. Breast convexity and volume gradually decreased, with preoperative breast size having the most significant impact on these changes. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Sesamoid Bone Reduction in Hallux Valgus: Comparing Radiological Outcomes of Hallux Valgus Following Distal Chevron Osteotomy and Modified McBride Procedure.

Background: Hallux valgus is a common forefoot disorder with hundreds of proposed management techniques. Distal chevron osteotomy with a modified McBride procedure has been traditionally recommended for mild hallux valgus because of its simple and less invasive nature with fewer complications, faster recovery, and reliable outcomes. In recent years, the indications for this procedure have expanded to include hallux valgus with severe deformities. This study aims to compare the radiographic outcomes of the surgical treatment for moderate versus severe hallux valgus patients from the perspective of sesamoid bone reduction. Materials and Methods: A retrospective review of medical records identified 99 feet from 94 patients that were treated with distal chevron osteotomy with a modified McBride procedure. These feet were divided by the preoperative hallux valgus angle and intermetatarsal angle into the moderate and severe groups. Results: Postoperative radiographic parameters significantly improved in both groups after treatment, indicating adequate deformity correction. Improvement in the sesamoid position was better in the moderate group compared to that in the severe group. The recurrence rate in the severe group was higher than that in the moderate group without statistical significance. Conclusions: Based on the radiographic results of the postoperative position following sesamoid reduction, the distal chevron osteotomy with a modified McBride procedure is effective for treating moderate hallux valgus deformities. However, this treatment strategy may be associated with a higher recurrence rate in cases of severe hallux valgus deformity. A complete reduction in the sesamoids should be emphasized during the management of severe hallux valgus deformity.

Evaluation of hallux valgus treatment: is classical angular correction approach relevant?

Hallux valgus correction is mostly done by metatarsal procedures, and widely accepted strategy is to decide which surgical method should be used is based on radiological severity using intermetatarsal (IMA) and hallux valgus (HVA) angles (classical angular correction approach-CACA). The aim of the study is to compare the postoperative improvement in radiographic parameters and morphologic appearance of the foot between patients operated with and without adhering to CACA strategy based on classical severity classification using angle measurements. A retrospective comparative study between two groups (conforming and not conforming to proposed algorithm) was performed. Of 122 feet of 119 patients underwent metatarsal procedures for hallux valgus between October 2022 and November 2023, 92 feet of 92 patients were enrolled in the study (age 43.86 ± 16.1years, 15.2% male). Patients were classified into two groups as conforming and non-conforming to CACA algorithm based on IMA and HVA angles (mild: IMA ≤ 13°, HVA ≤ 30°; moderate: 13° < IMA < 20°, 30° < HVA < 40°; severe: IMA ≥ 20°, HVA ≥ 40°). Algorithm proposed distal osteotomies for mild cases, shaft osteotomies for moderate cases and proximal osteotomies or tarsometatarsal arthrodeses for severe cases. HVA and IMA corrections after surgery, bony foot width, soft tissue foot width, medial eminence bony distance and medial soft tissue distance alterations, American Orthopaedic Foot and Ankle Society Metatarsophalangeal-Interphalangeal Scale (AOFAS-MTP-IP) scores and improvement of foot appearance according to Manchester scale in postoperative first year follow-up were compared between groups. 58 procedures (group 1) conformed CACA, while 34 (group 2) did not. There was no statistically significant difference in terms of IMA (3.81° ± 4.01°, 2.72° ± 2.25°, p = 0.423), HVA (12.78° ± 7.81°, 10.31° ± 5.4°, p = 0.106) bony forefoot width (4.41 ± 6.66mm, 1.65 ± 6.67mm, p = 0.059), soft tissue forefoot width (1.21 ± 6.61mm, 2.41 ± 7.45mm, p = 0.423), medial eminence width (5.72 ± 3.17mm, 6.07 ± 3mm, p = 0.609) alterations and AOFAS-MTP-IP scores (82.17 ± 5.26, 83.06 ± 5.18, p = 0.435) between groups. Medial soft tissue width increased in both groups (2.74 ± 2.53mm, 1.48 ± 1.67mm, p = 0.011). Manchester stages were improved in 45 feet in group 1 (77.6%) and 19 feet in group 2 (55.9%) (p = 0.029). The CACA strategy of treating more severe deformities with more proximal procedures and milder deformities with distal osteotomies did not significantly impact postoperative radiologic parameters. Nonetheless, following CACA strategy is likely to improve the morphologic appearance of the foot. III, comparative study.

Vertebral Column Decancellation for Correcting Cervicothoracic Kyphotic Deformity in Patients With Ankylosing Spondylitis.

Surgery to correct the cervicothoracic kyphotic deformity in ankylosing spondylitis (AS) can be associated with serious neurovascular risks. According to the literature, there are no clinical reports documenting the use of vertebral column decancellation (VCD) in the treatment of cervicothoracic kyphotic deformity in patients with AS. The purpose of the present study was to retrospectively analyze and evaluate the effect of VCD on cervicothoracic kyphotic deformity in patients with AS. Records of eight patients with cervicothoracic kyphotic deformity who underwent VCD at C7 in our institution were retrospectively reviewed. The mean duration of clinical follow-up after surgery was 19 months. The cervical lordosis (CL) and C2-C7 sagittal vertical axis (SVA) were meticulously measured on full-length spine radiographs. The chin-brow vertical angle (CBVA) was measured on clinical photographs. Outcome measures utilized included the Neck Disability Index (NDI), the Japanese Orthopaedic Association (JOA) Score, and a Visual Analog Scale (VAS) for neck pain. The data analysis was performed using SPSS version 26.0 for Windows. For paired data adhering to a normal distribution, we utilized paired sample t-tests to analyze preoperative and postoperative imaging parameters. Statistical significance was established at a p value threshold of < 0.01. All eight patients successfully completed the surgery. With an average VCD osteotomy angle of 47.6° ± 8.1° (±SD), the mean preoperative CBVA was 81.1° ± 17.6° (±SD), while the immediate postoperative value was 19.9° ± 5.7° (±SD). The overall average correction was 61.2° ± 18.9°. The mean preoperative cervical sagittal imbalance was 93.4 ± 27.3 mm (±SD), while the immediate postoperative value was 40.2 ± 18.9 mm (±SD). The overall average correction was 53.2 ± 28.1 mm. None of the eight patients experienced intraoperative complications, including nerve or vascular injury, cerebrospinal fluid leakage, or any other related complications. In the cohort of eight patients, the mean values for estimated blood loss, surgical time, and hospital stay were 1313 mL, 248 min, and 18 days, respectively. In comparison to preoperative scores, statistically significant improvement was noted in all patients in the postoperative period with regard to NDI, JOA, and VAS (p < 0.01, using a paired t-test). The VCD procedure proves to be a dependable and efficient approach for addressing cervicothoracic kyphotic deformities. It achieves remarkable corrections in cervical kyphosis and CBVA. Chinese Clinical Trial Registry: 2400090375.

Comparative analysis of suture-based and Hem-O-lok closure techniques in laparoscopic appendectomy for uncomplicated acute appendicitis: a retrospective propensity score matching study.

The optimal method for appendix stump closure in laparoscopic appendectomy (LA) remains debated. This study aims to evaluate the impact of suture-based closure and Hem-O-lok techniques on postoperative complications following LA for uncomplicated appendicitis. A retrospective analysis was conducted on patients with uncomplicated appendicitis treated by LA from January 2019 to December 2021. These patients were categorized into two groups: the suture-based closure group (223 cases) and the Hem-O-lok group (272 cases). Propensity score matching addressed potential discrepancies between the groups. Intraoperative and postoperative parameters of both groups were then compared. Post-matching, the operative duration in the suture-based group was longer than in the Hem-O-lok group (45.9 ± 9.7min versus 42.8 ± 8.9min, P = 0.001). The incidence of postoperative intra-abdominal abscesses and fluid collections was significantly lower in the suture-based closure group (P = 0.032). Multivariate logistic regression analysis revealed that the Hem-O-lok clamp technique [odds ratio (OR) = 5.69, 95% confidence interval (CI): 1.01-64.25, P = 0.047] was a notable risk factor for intra-abdominal abscesses and fluid collections. The suture-based closure technique significantly reduced the incidence of postoperative intra-abdominal abscesses and fluid collections compared with the Hem-O-lok technique in patients undergoing LA for uncomplicated appendicitis.

Biomechanical and clinical evaluation of PSO, modified PSO and VCR treating OVCF kyphosis: a finite element analysis

ObjectiveTo confirm the effect of surgery on spinal column biomechanics and to provide theoretical support for the advantages and disadvantages of different surgical methods and their clinical efficacy.Methods33 continuous patients with no significant difference in risk factors related to the mechanical complications were enrolled in this retrospective study. Sagittal parameters were measured in the pre-, post-operative and following-up lateral radiograph of spine. An finite element (FE) model was created using CT scanning from a female volunteer with osteoporotic vertebral compression fracture (OVCF) with solely kyphosis. Pedicle subtraction osteotomy (PSO), vertebral column resection (VCR) and modified PSO(mPSO) for OVCF were simulated on FE model. Stress distribution and deformation of the FE model were measured.ResultsClinical - All differences in preoperative spinal sagittal parameters were not statistically significant. mPSO showed it is superior to PSO and VCR in multiple postoperative and following-up spinal sagittal parameters. The operation duration and intraoperative blood loss of mPSO are less than the other two. For postoperative mechanical complications, no statistically significant differences were observed. Biomechanical - Six operating conditions (flexion, extension, left/right bending, left/right twisting) for each post-operative FE model have been examined. In most conditions, the displacement of mPSO is similar to that of PSO, with both larger than that of VCR. All the maximum equivalent stress on the vertebral body is within the safe range. The stress is mainly distributed on the T10 vertebral body and the fixed vertebral body L2, while the stress of VCR is greater than that of mPSO and PSO. The intervertebral disc pressure is highest in VCR, followed by PSO, and lowest in mPSO under all conditions. The maximum pressure on the intervertebral discs is located between T10 and T11.ConclusionThe finite element analysis showed that mPSO has a similar spine stability to PSO, and possibly creates a better environment for bone-to-bone fusion and prevents adjacent segments degeneration. Combined with its less surgical risks, we believe that the modified pedicle subtraction osteotomy may be an appropriate strategy for indicated cases of OVCF.

Comparison of robot versus fluoroscopy-assisted pedicle screw instrumentation in adolescent idiopathic scoliosis surgery: a Meta-analysis

AimTo investigate the safety and accuracy of robot-assisted pedicle screw placement in adolescent idiopathic scoliosis (AIS) surgery.MethodsPubMed, Medline, Embase, Cochrane Library, Web of Science, CNKI, and EMCC databases were searched for studies utilizing the clinical data of adolescent idiopathic scoliosis patients (robot-assisted and fluoroscopy-assisted group) who underwent posterior pedicle screw fixation to collect preoperative, postoperative and follow-up indexes and imaging parameters, including screw implantation accuracy, the number of intraoperative fluoroscopy times, amount of bleeding, operation time, postoperative VAS score and postoperative Cobb angle.ResultsSix studies were included in this meta-analysis, including 154 patients in the intervention group and 171 patients in the control group. Our results showed that screw implantation accuracy (WMD 1.07, 95% CI (1.01,1.14), P = 0.03) was higher than that in the control group. The number of intraoperative fluoroscopy times (WMD -6.11, 95% CI (-9.60, -2.62), P = 0.0006) and operation time (WMD 31.52, 95% CI (5.70,57.35), P = 0.02) in the robot group were less, and the differences were statistically significant. Intraoperative blood (WMD -59.05, 95% CI (-212.81,94.70), P = 0.45), postoperative VAS score (WMD -0.07, 95% CI (-0.24,0.11), P = 0.46), preoperative Cobb angle (WMD 0.79, 95% CI (-1.12,2.69), P = 0.42) (Fig. 7), postoperative Cobb angle (WMD -0.25, 95% CI (-1.12,0.62), P = 0.57) (Fig. 8) had no statistical significance in the robot group compared with control group.ConclusionThe robot navigation system can improve screw implantation accuracy and reduce the operation time and radiation exposure during the operation.

Comparative Analysis of Outcomes and Kyphotic Risk Factors After Cervical Laminoplasty in 2 Different Ossification of the Posterior Longitudinal Ligament Groups and Cervical Spondylotic Myelopathy.

Cervical laminoplasty is commonly used to treat cervical spondylotic myelopathy (CSM) and ossification of the posterior longitudinal ligament (OPLL). Postoperative kyphotic changes can restrict spinal cord dorsal shift, leading to poor neurological outcomes. This study analyzes risk factors for loss of cervical lordosis (LCL) after laminoplasty in 3 groups: CSM, continuous OPLL, and other OPLL. It also evaluates postoperative changes in cervical spine parameters: C2-7 sagittal vertical axis, C2-7 Cobb angle (CA), T1 slope, and C2 slope. This retrospective study included 154 patients who underwent cervical laminoplasty from January 2018 to January 2023. Patients were categorized into 3 groups: CSM (Group 1), continuous OPLL group (Group 2), and noncontinuous OPLL group (Group 3). Preoperative and postoperative radiographic parameters were measured. Analysis of variance and Tukey HSD post hoc tests identified significant differences among the groups. Receiver operating characteristic analysis determined the cutoff value of K-line tilt. Kyphotic changes (>10°) were observed in 18.2% of patients postoperatively: 23.8% in Group 1, 1.7% in Group 2, and 28.3% in Group 3. Significant differences were found among the groups in preoperative K-line, C2-7 CA, extension C2-7 CA, and C2 slope (P < .05). Univariate and multivariate analyses revealed that greater age, higher K-line tilt, lower preoperative CA-extensor CA, and lower extensor muscle volume were significant risk factors of LCL in Groups 1 and 3. In Group 2, higher preoperative K-line tilt and K-line negative status were associated with greater LCL. Receiver operating characteristic analysis showed that K-line tilt is a strong predictive parameter with a threshold of 15.15°. The continuous OPLL group had a lower likelihood of postoperative kyphosis due to structural support. K-line tilt, dynamic extension reserve, and extensor muscle volume were significant predictors of LCL in CSM and segmental OPLL groups. K-line tilt is a valuable radiographic parameter for predicting outcomes and guiding surgical decisions in cervical laminoplasty patients.

Long-term effects of orthognathic surgery on masticatory function in individuals with cleft lip and palate: A prospective study

ObjectiveTo prospectively evaluate the long-term effects of orthognathic surgery on masticatory function in individuals with repaired complete cleft lip and palate and to compare the results with a control group. Material and methodsA total of 40 individuals were prospectively analyzed before (PRE-ORTHOG) and approximately 12 months after orthognathic surgery (POST-ORTHOG). The participants were divided into two groups: 1) Cleft Lip and Palate Group (CLP): 20 adults with CLP undergoing orthognathic surgery (14 ♂, 6 ♀, age 24 ± 3 years), and 2) Control Group (CON): 20 paired adults with Angle Class I skeletal pattern who had never undergone orthognathic surgery (14 ♂, 6 ♀, age 25 ± 5 years). Three variables were evaluated: 1) Bite Force (BF) (measured in Newtons – N) presented as the average of the bite force from the right and left molars (x‾ RM + LM), using a gnathodynamometer (IDDK Kratos), 2) Masticatory Efficiency (ME) (ranging from 0 to 1, with values closer to 1 indicating poorer efficiency), assessed through a dual-color masticatory gum test analyzed visually and optoelectronically (ViewGum©), and 3) Masticatory Capacity (MC): patient-reported ability to chew, rated on a two-point scale (P/R = poor to reasonable, G/O = good to optimal). ResultsIn the PRE-ORTHOG phase, the BF for the CLP group (x‾ RM + LM = 285 ± 141) was significantly lower compared to the CON group (x‾ RM + LM = 524 ± 202). In the POST-ORTHOG phase, the CLP group (x‾ RM + LM = 373 ± 129) showed significant improvements in BF in relation to the PRE-ORTHOG phase, with values similar to those of the CON group. Masticatory efficiency improved significantly in the POST-ORTHOG phase (0.222 ± 0.071) compared to PRE-ORTHOG (0.470 ± 0.126) in the CLP group, while PRE-ORTHOG values were worse than those of the CON group (0.148 ± 0.050). Furthermore, 45 % of CLP participants reported P/R MC before surgery, while none reported this after surgery, a statistically significant improvement. The POST-ORTHOG MC results for CLP participants were comparable to the CON group, with 100 % reporting G/O MC after surgery. ConclusionsOverall, the group with CLP demonstrated impaired masticatory function in the preoperative phase compared to the control group across all variables analyzed. Orthognathic surgery improves masticatory function in patients with CLP, with postoperative parameters comparable to those of the control group.

Accuracy of 3D printing template‐assisted CT‐guided radioactive iodine‐125 seed implantation for peripheral locally recurrent rectal cancer: A retrospective study

AbstractObjectiveThis study aimed to investigate the accuracy of needle insertion and dosimetric parameters in three‐dimensional printing template (3D‐PT)‐assisted computed tomography (CT)‐guided radioactive iodine‐125 (125I) seed implantation (RISI) for the treatment of peripheral locally recurrent rectal cancer (pLRRC).Materials and methodsA total of 37 patients with pLRRC who underwent 3D‐assisted CT‐guided RISI treatment at Peking University Third Hospital between January 2016 and November 2019 were included in this study. All patients underwent preoperative assessment, CT simulation positioning, preoperative plan design, 3D template printing, 3D template reduction, needle and seed implantation, postoperative dosimetry evaluation, postoperative care, and regular follow‐up. The preoperative and postoperative needle position, angle, and tip distance were compared. The dosimetric parameters, including D90 (the dose to 90% of the target volume), D100, V100 (the volume receives 100% of the prescribed dose), V150, V200, conformal index (CI), external index (EI), and homogeneity index (HI), were compared among preoperative plan, intraoperative plan, and postoperative plan. The perioperative complications were assessed.ResultsThe total number of needles was 595. The depths of needle insertion in preoperative and intraoperative plans were 109.87 ± 1.33 mm and 108.46 ± 1.26 mm, respectively, with no significant difference (p &gt; 0.05). The angles of needle insertion in preoperative and intraoperative plans were (93.55 ± 2.05)° and (92.04 ± 1.99)°, respectively, with no significant difference (p &gt; 0.05). The average deviation of the needle insertion distance was 1.99 ± 0.08 mm. There were no differences in preoperative, intraoperative, and postoperative parameters, including D90, D100, V100, V150, V200, CI, EI, and HI. All patients were closely followed up during the perioperative period (from seven days before surgery to seven days after surgery). No patients experienced severe perioperative complications. A total of eight patients (21.6%) experienced grade 1−2 complications. Among all patients, six individuals (16.2%) experienced pain, one patient (2.7%) had a fever, and one patient (2.7%) suffered from a hemorrhage. All patients recovered after conservative treatment.ConclusionThe needle insertion in 3D‐PT‐assisted CT‐guided RISI showed good accuracy for treating pLRRC.