Bone and Arthrosurgery Science

Comparison of the Wiltse Approach and Percutaneous Pedicle Screw Fixation for the Treatment of Neurologically Intact Thoracolumbar Fractures

Palihati Baiketuerxun — 2024-02-20

Purpose: To compare the curative effect of two minimally invasive techniques for neurologically intact thoracolumbar fractures. Methods: 37 patients with type A fractures without neurological deficits were selected and divided into two groups. Among them, 18 patients received percutaneous pedicle screw fixation (PPSF group), and 19 patients were treated using a mini-open Wiltse approach with pedicle screw fixation (WPSF group). The clinical outcomes, surgery-related results, and radiological findings were compared between the two groups. Results: The length of incision, intraoperative blood loss, post-operative hospitalization time, satisfaction, visual analog score (VAS), and Cobb’s angle between the two groups showed no significant differences (P > 0.05). However, the operation time and the number of intraoperative fluoroscopy of the WPSF group were significantly lower than those of the PPSF group (P < 0.05). Conclusion: Both minimally invasive techniques are effective for neurologically intact thoracolumbar fractures. Nevertheless, the mini-open Wiltse approach has lower radiation exposure and a shorter learning curve compared with PPSF. A larger sample, multi-center randomized controlled study is necessary to prove the clinical effectiveness of the Wiltse approach.

Modification of Biodegradable Polymer Nanofibers for Cartilage Tissue Engineering Applications: A Review

Kirubanandan Shanmugam — 2024-03-20

Tissue engineering is the use of a combination of cells, engineering and materials methods, and suitable biochemical and physiochemical factors to improve or replace biological functions at the injured site. The designing of a biomaterial that can mimic the three-dimensional tissues in vivo is still challenging. Biodegradable polymers are used for the development of tissue engineering constructs in the form of sponges, films, and macroporous scaffolds, which do not influence cell fate processes such as cell differentiation, migration, and proliferation. Biodegradable polymer nanofibers fabricated by electrospinning have gathered great attention in tissue engineering applications. The electrospun materials have a nanofibrous morphology that is closest to the natural extracellular matrix (ECM). The electrospun material is composed of three-dimensional networks of nanosized fibrous materials that mimic an extracellular matrix such as collagen, elastin, and keratin. These polymers fabricated in the form of fibers in nanosize cause a more favorable microenvironment for cells. We prepared the PLGA/PPG (polylactic-co-glycolic acid/polypropylene glycol) nanofibers by electrospinning technique. PLGA (85:15)/PLGA (75:25) nanofibers are hydrophobic, which can be minimized by the addition of PPG to give better hydrophilicity for cell adhesion for tissue engineering constructs. The morphology of the electrospun fibers of the composite of PLGA and PPG was observed using scanning electron microscopy (SEM). The results proved that the small amount of polypropylene glycol polymer to the polylactic-co-glycolic acid (PLGA 85:15) drastically improves the hydrophilicity of the electrospun nanofibers. The addition of a small amount of hydrophilic polymer to the biodegradable hydrophobic polymer increases the hydrophilic property and can be used for nanofiber-based tissue engineering constructs. In addition, the biomimetic approach for tissue engineering scaffolds for cartilage repair has been discussed.

Surgery for Spinal Deformities in Patients with Osteoporosis — A Secondary Publication

Sang-Il Kim — 2024-03-20

Objective: This review aims to present relevant considerations for the surgical treatment of spinal deformities accompanied by osteoporosis, how surgeons are trying to overcome the challenges posed by osteoporosis in patients with spinal deformities, and directions for further development. Summary of literature review: Various trials have been carried out to overcome the short- and long-term complications associated with osteoporosis in order to achieve successful clinical results in the surgical treatment of spinal deformities. Methods: A comprehensive review of relevant articles was conducted. Results: The surgical goal of treating spinal deformities is to reverse neurological compromise and restore balanced spine alignment. To achieve these goals, several surgical considerations should be kept in mind. Osteoporosis is an important issue related to early and long-term complications following surgery. Methods of overcoming the challenges posed by osteoporosis such as rigid fixation techniques, proper selection of the fusion levels, perioperative medical treatment, and effective bone grafting materials are described herein; however, further development in these areas is also necessary. Conclusions: Osteoporosis may be a major obstacle in spinal deformity surgery. Although several effective attempts have been made to overcome these limitations, further research and trials are necessary to obtain better results.

Analysis of the Effect of Rehabilitation Nursing Intervention on Functional Recovery in Patients with Rheumatoid Arthritis

Honglian Ma — 2024-03-20

Objective: To explore and analyze the effect of rehabilitation nursing intervention on functional recovery in patients with rheumatoid arthritis. Methods: From May 2020 to May 2023, 150 patients with rheumatoid arthritis who received integrated treatment of Tibetan and Western medicine in the rheumatology department were selected as the research subjects. They were divided into the rehabilitation group and the reference group according to the double-blind mechanism, with 75 cases in each group. The rehabilitation group received rehabilitation nursing intervention and the reference group received basic nursing. The standard of living, joint function recovery, and nursing satisfaction were compared between the two groups. Results: Before the intervention, there was no statistically significant difference (P > 0.05) in living standards such as physiology, mental outlook, emotional performance, and social culture between the groups. After the intervention, the standard of living such as culture, of the rehabilitation group was significantly better than that of the reference group (P < 0.05). Before the intervention, there was no statistically significant difference (P > 0.05) in the recovery of joint functions such as the number of joint tenderness, grip strength of both hands, duration of morning stiffness, and number of joint swelling among the groups. After the intervention, the number of joint tenderness, hand grip strength, duration of morning stiffness, number of joint swelling, and other joint function recovery in the rehabilitation group were significantly better than those in the reference group (P < 0.05). The nursing satisfaction of the rehabilitation group was significantly higher than that of the reference group (P < 0.05). Conclusion: Rehabilitation nursing intervention can accelerate the recovery of joint function and improve the living standard of patients with rheumatoid arthritis.

The Impact of Toe Amputation on the Quality of Life of Diabetic Foot Patients: A Cardiff Wound Impact Schedule (CWIS) Evaluation

Linxuan Zou — 2024-03-20

Background: The treatment and management of diabetic foot significantly impact the quality of life (QoL) of patients, yet studies concerning the effects of toe amputation on QoL are relatively limited. Methods: This study included 12 diabetic foot patients with Wagner Grade 4 who underwent toe amputation. Using the Cardiff Wound Impact Schedule (CWIS), we systematically assessed their QoL before and after the surgery. Results: Data indicated that there were significant improvements in multiple areas of QoL post-surgery. Particularly in the domains of “overall quality of life” and “well-being,” average scores demonstrated noticeable declines compared to pre-surgery levels. Statistical analysis further confirmed the significance of these results. Conclusion: Toe amputation holds significant value in enhancing the QoL for diabetic foot patients. This study provides robust evidence for clinical decision-making, emphasizing that treatment choices should consider the QoL of the patient in addition to physiological outcomes.

Advances in the Treatment of Bone Nonunion in Limb Fractures

Ling Guo — 2024-03-20

Limb fractures are a common disease type in clinical practice caused by incidents such as traffic accidents and work-related injuries in daily life. Most patients gradually recover after receiving internal fixation treatment, and the treatment effect is relatively significant. According to relevant surveys and studies, the probability of bone nonunion in postoperative patients is 5–10%, which is a common complication. Nonunion is a condition where the fractured bone has not healed after an extended period of time, e.g. 9 months after treatment, and there is no sign of improvement for 3 consecutive months, necessitating timely treatment. This article reviews the research progress in the treatment of nonunion in limb fractures.

Application Effects of Light Lumbar Anesthesia and Nerve Block Anesthesia in Elderly Hip Joint Surgery

Sanjie Gao — 2024-03-20

Objective: To analyze the application effects of light lumbar anesthesia and nerve block anesthesia in elderly hip joint surgery. Methods: A total of 40 patients indicated for hip joint surgery from February 2021 to February 2022 were randomly divided into the control group and the observation group, each with 20 patients. The control group received nerve block anesthesia and the observation group was given light lumbar anesthesia. Results: Based on the results, the anesthetic effect in the observation group was better than that in the control group (P < 0.05), the difference was statistically significant. Conclusion: Compared with nerve block anesthesia, light lumbar anesthesia can achieve better analgesic effects and stable blood circulation in elderly patients undergoing hip joint surgery.

The Effect of Arthroscopic Microfracture in the Treatment of Ankle Osteoarthritis Combined with Cartilage Damage

Zongwei Li — 2024-03-20

Objective: To observe the specific effect of arthroscopic microfracture treatment on patients with ankle osteoarthritis and cartilage damage. Methods: 60 patients with ankle osteoarthritis combined with cartilage damage treated in our hospital from January 2022 to December 2022 were selected and divided into the control group and the experimental group using the random number table method, each with 30 cases. Subjects in the experimental group were treated with arthroscopic microfracture, while subjects in the control group were treated with conventional surgery. Results: After the intervention, the total treatment effectiveness of the experimental group was higher than that in the control group (P < 0.05); the inflammatory factor levels in the experimental group were lower than those in the control group (P < 0.05); the pain scores of the experimental group were lower than those in the control group (P < 0.05); the quality of life in the experimental group were higher than those in the control group (P < 0.05). Conclusion: During the treatment process of the experimental group, patients with ankle osteoarthritis combined with cartilage damage were given arthroscopic microfracture therapeutic intervention, and the post-treatment effect was relatively good. After treatment and intervention, the patients’ symptoms were significantly relieved, the inflammatory reaction was improved, the pain was reduced, and the quality of life was enhanced.

Treatment Efficacy of CT-Guided Percutaneous Kyphoplasty Combined with Three-Dimensional Coordinate Guidance System on Osteoporotic Vertebral Compression Fracture

Kun Liu — 2024-03-20

Purpose: To investigate the clinical effect of percutaneous kyphoplasty (PKP) guided by computed tomography (CT) combined with the three-dimensional coordinate guidance system on the treatment of osteoporotic vertebral compression fracture (OVCF). Methods: 32 cases of OVCF in the elderly admitted to our hospital from October 2019 to March 2021 underwent CT-guided PKP combined with the three-dimensional coordinate guidance system, and 36 vertebrae were treated. The patients’ VAS pain scores (visual analog scale) and ODI (Oswestry disability index) were observed after surgery, and the paired t-test was used to compare these indexes. Results: The 36 vertebrae that were treated with CT-guided PKP combined with the three-dimensional coordinate guidance system underwent unilateral pedicle puncture according to the path planned by CT images. With the ideal position of the puncture needle and a high success rate of puncture, the puncture time was 1.2–2.6 minutes, with an average of about 1.5 minutes; the injected bone cement ranged from 3 to 5.5 mL, with an average of 4.2 mL, and there were no spinal nerve injuries or leakage of the cement in the canal. VAS score decreased from 7.65 ± 0.60 before the operation to 2.59 ± 0.28 one day after the operation (P < 0.01); ODI decreased from 62.3 ± 2.18 before the operation to 27.91 ± 1.32 after the operation (P < 0.01). Conclusion: The application of CT-guided PKP combined with the three-dimensional coordinate guidance system has the advantages of accurate puncture, short operation time, less intraoperative bleeding, and low complications. This treatment is safe, reliable, and satisfactory for patients, and is worthy of clinical promotion.

Clinical Efficacy of Needle-Knife Therapy Combined with Muscle Energy Technique in the Treatment of Lateral Epicondylitis of the Humerus

Zugang Zhou — 2024-03-20

Objective: To observe the clinical efficacy of needle-knife therapy combined with muscle energy technique in treating external humeral epicondylitis and analyze its advantages. Method: 71 patients with lateral epicondylitis of the humerus were randomly divided into an experimental group (n = 36 cases, needle-knife therapy combined with muscle energy technique) and a control group (n = 35 cases, electroacupuncture therapy combined with muscle energy technique) using a random number method. The visual analog scale (VAS) scores, Mayo elbow performance score (MEPS), Barthel index (BI) scores, and self-rating anxiety scale (SAS) scores were compared between the two groups before and after treatment and during follow-up. Results: At the end of the treatment and follow-up period, within the same group, the VAS score decreased (P < 0.05), while the MEPS, BI index score, and SAS score increased (P < 0.05). In intergroup comparison, the VAS scores of the experimental group were lower than those of the control group; the MEPS, BI index score, and SAS score did not show statistically significant differences between groups at each time point (P > 0.05). Conclusion: The combination of needle-knife therapy and muscle energy technique in treating lateral epicondylitis of the humerus has advantages such as good analgesic effect, less treatment frequency, and consolidated long-term efficacy, which is worthy of further research and promotion.