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Zhongguo Xiu Fu Chong Jian Wai Ke Za... May 2024To evaluate the effectiveness of using titanium alloy trabecular bone three-dimensional (3D) printed artificial vertebral body in treating cervical ossification of the...
OBJECTIVE
To evaluate the effectiveness of using titanium alloy trabecular bone three-dimensional (3D) printed artificial vertebral body in treating cervical ossification of the posterior longitudinal ligament (OPLL).
METHODS
A retrospective analysis was conducted on clinical data from 45 patients with cervical OPLL admitted between September 2019 and August 2021 and meeting the selection criteria. All patients underwent anterior cervical corpectomy and decompression, interbody bone graft fusion, and titanium plate internal fixation. During operation, 21 patients in the study group received titanium alloy trabecular bone 3D printed artificial vertebral bodies, while 24 patients in the control group received titanium cages. There was no significant difference in baseline data such as gender, age, disease duration, affected segments, or preoperative pain visual analogue scale (VAS) score, Japanese Orthopaedic Association (JOA) score, Neck Disability Index (NDI), vertebral height, and C Cobb angle ( >0.05). Operation time, intraoperative blood loss, and occurrence of complications were recorded for both groups. Preoperatively and at 3 and 12 months postoperatively, the functionality and symptom relief were assessed using JOA scores, VAS scores, and NDI evaluations. The vertebral height and C Cobb angle were detected by imaging examinations and the implant subsidence and intervertebral fusion were observed.
RESULTS
The operation time and incidence of complications were significantly lower in the study group than in the control group ( <0.05), while the difference in intraoperative blood loss between the two groups was not significant ( >0.05). All patients were followed up 12-18 months, with the follow-up time of (14.28±4.34) months in the study group and (15.23±3.54) months in the control group, showing no significant difference ( =0.809, =0.423). The JOA score, VAS score, and NDI of the two groups improved after operation, and further improved at 12 months compared to 3 months, with significant differences ( <0.05). At each time point, the study group exhibited significantly higher JOA scores and improvement rate compared to the control group ( <0.05); but there was no significantly difference in VAS score and NDI between the two groups ( >0.05). Imaging re-examination showed that the vertebral height and C Cobb angle of the two groups significantly increased at 3 and 12 months after operation ( <0.05), and there was no significant difference between 3 and 12 months after operation ( >0.05). At each time point, the vertebral height and C Cobb angle of the study group were significantly higher than those of the control group ( <0.05), and the implant subsidence rate was significantly lower than that of the control group ( <0.05). However, there was no significant difference in intervertebral fusion rate between the two groups ( >0.05).
CONCLUSION
Compared to traditional titanium cages, the use of titanium alloy trabecular bone 3D-printed artificial vertebral bodies for treating cervical OPLL results in shorter operative time, fewer postoperative complications, and lower implant subsidence rates, making it superior in vertebral reconstruction.
Topics: Humans; Titanium; Ossification of Posterior Longitudinal Ligament; Printing, Three-Dimensional; Cervical Vertebrae; Retrospective Studies; Spinal Fusion; Alloys; Decompression, Surgical; Cancellous Bone; Treatment Outcome; Vertebral Body; Female; Male; Bone Plates; Middle Aged
PubMed: 38752238
DOI: 10.7507/1002-1892.202403003 -
Medical Science Monitor : International... May 2024BACKGROUND This single-center study included 80 patients with multilevel cervical ossification of the posterior longitudinal ligament (OPLL) and aimed to compare... (Comparative Study)
Comparative Study
Comparative Analysis of Postoperative Sagittal Balance in Expansive Open-Door Laminoplasty versus Laminectomy with Fusion for Multilevel Ossification of Posterior Longitudinal Ligament: A Retrospective Study.
BACKGROUND This single-center study included 80 patients with multilevel cervical ossification of the posterior longitudinal ligament (OPLL) and aimed to compare postoperative sagittal balance following treatment with expansive open-door laminoplasty (LP) vs total laminectomy with fusion (LF). MATERIAL AND METHODS Data of 80 patients with multilevel OPLL treated with LP vs LF between January 2017 and January 2022 were retrospectively analyzed. The basic data, cervical sagittal parameters, and clinical outcomes of the patients were counted in the preoperative and postoperative periods, and complications were recorded. Forty patients underwent LP and 40 underwent LF. Cervical sagittal parameters were compared between and within the 2 groups. Clinical outcomes and complications were compared between the 2 groups. RESULTS At last follow-up, the postoperative C2-C7 Cobb angel, T1 slope (T1S), and C7 slope (C7S) were significantly higher in the LF group than in the LP group (P<0.001). C2-C7 SVA (cSVA) was slightly higher in the LF group (P>0.05) and significantly higher in the LP group (P<0.05). The incidence of postoperative complications in the LP group was significantly lower than in the LF group (P=0.02). The postoperative scores on the Visual Analog Scale (VAS), Neck Disability Index (NDI), and Japanese Orthopedic Association (JOA) were significantly improved in both groups (P<0.001). CONCLUSIONS Both procedures had good outcomes in neurological improvement. After posterior surgery, the cervical vertebrae all showed a tilting forward. Compared to LP, LF may change cervical balance in Cobb angel, T1S. LF has better efficacy in improving cervical lordosis compared with LP. Patients with high T1 slope after surgery may has more axial pain.
Topics: Humans; Ossification of Posterior Longitudinal Ligament; Laminoplasty; Male; Female; Retrospective Studies; Laminectomy; Middle Aged; Spinal Fusion; Cervical Vertebrae; Aged; Treatment Outcome; Postoperative Complications; Postoperative Period; Postural Balance; Adult
PubMed: 38745408
DOI: 10.12659/MSM.943057 -
Cureus Apr 2024Supracondylar humerus (SCH) fractures represent the most frequent elbow injury in young children. These fractures can be treated through either closed reduction with... (Review)
Review
A Systemic Review of Adolescent Supracondylar Fractures: What Is the Surgical Treatment, Open Reduction With Internal Fixation (ORIF) or Closed Reduction With Percutaneous Pinning (CRPP)?
Supracondylar humerus (SCH) fractures represent the most frequent elbow injury in young children. These fractures can be treated through either closed reduction with percutaneous pinning (CRPP) or open reduction with internal fixation (ORIF). Yet, the optimal treatment option for adolescents remains unclear. This research contrasts the results of CRPP and ORIF treatments for distal humerus fractures in adolescents. In June 2023, we conducted a comprehensive search of PUBMED, OVID MEDLINE, Web of Science, Cochrane Central Register of Controlled Trials, and various trial registries without any time restrictions. We evaluated the quality of qualifying studies using the Methodological Index for Non-randomized Studies (MINORS) and Cochrane risk measures for bias. We extracted data particularly related to patient demographics, fracture details, medical procedures followed, complications encountered, and the resulting outcomes. Out of the 488 studies identified, only four satisfied the inclusion criteria. Both methods illustrated comparable outcomes in terms of range of motion, averaging approximately 118 degrees in the ORIF group versus a span of 114 to 128 degrees in the CRPP group. The immobilization period varied, spanning 10 to 13 days for ORIF versus 24 to 29 days for CRPP. Despite this, CRPP displayed a decreased necessity for additional surgery. Notably, one study indicated a higher frequency of heterotopic ossification within the ORIF group. This review indicates that both CRPP and ORIF are effective for treating supracondylar fractures in adolescents, yielding similar results. However, CRPP has a lower need for follow-up surgery. Future studies with larger sample sizes are needed to solidify these findings, providing stronger guidance for treatment.
PubMed: 38741793
DOI: 10.7759/cureus.58123 -
Radiology Case Reports Aug 2024Fibrodysplasia ossificans progressiva (FOP) is a rare and progressively debilitating disorder affecting 1 in 2 million individuals. It is characterized by the...
Fibrodysplasia ossificans progressiva (FOP) is a rare and progressively debilitating disorder affecting 1 in 2 million individuals. It is characterized by the progressive ossification of soft tissues into ectopic bone and congenital malformations of the great toes. FOP leads to significant disability and can result in death due to thoracic insufficiency syndrome. These case reports examine the presentation, diagnosis, and management of FOP, highlighting the diagnostic challenges inherent in managing such rare conditions because of their unique clinical features. They underscore the need for increased awareness among healthcare practitioners to ensure early diagnosis and the implementation of effective management strategies.
PubMed: 38737178
DOI: 10.1016/j.radcr.2024.04.019 -
Disease Models & Mechanisms May 2024Heterotopic ossification is the inappropriate formation of bone in soft tissues of the body. It can manifest spontaneously in rare genetic conditions or as a response to...
Heterotopic ossification is the inappropriate formation of bone in soft tissues of the body. It can manifest spontaneously in rare genetic conditions or as a response to injury, known as acquired heterotopic ossification. There are several experimental models for studying acquired heterotopic ossification from different sources of damage. However, their tenuous mechanistic relevance to the human condition, invasive and laborious nature and/or lack of amenability to chemical and genetic screens, limit their utility. To address these limitations, we developed a simple zebrafish injury model that manifests heterotopic ossification with high penetrance in response to clinically emulating injuries, as observed in human myositis ossificans traumatica. Using this model, we defined the transcriptional response to trauma, identifying differentially regulated genes. Mutant analyses revealed that an increase in the activity of the potassium channel Kcnk5b potentiates injury response, whereas loss of function of the interleukin 11 receptor paralogue (Il11ra) resulted in a drastically reduced ossification response. Based on these findings, we postulate that enhanced ionic signalling, specifically through Kcnk5b, regulates the intensity of the skeletogenic injury response, which, in part, requires immune response regulated by Il11ra.
Topics: Animals; Zebrafish; Ossification, Heterotopic; Zebrafish Proteins; Gene Expression Regulation; Aging; Wounds and Injuries; Disease Models, Animal; Mutation
PubMed: 38736327
DOI: 10.1242/dmm.050724 -
Medicine May 2024To investigate the clinical characteristics of Eagle syndrome (ES) and evaluate psychological distress of the patients. Ten cases of ES were enrolled, clinical... (Observational Study)
Observational Study
To investigate the clinical characteristics of Eagle syndrome (ES) and evaluate psychological distress of the patients. Ten cases of ES were enrolled, clinical characteristics and management were analyzed. Psychological disorders of the patients were assessed by the test of self-rating anxiety scale (SAS) and self-rating depression scale (SDS). There were 8 females and 2 males varying from 34 to 56 years with a mean age of 44.86 ± 8.38 years. The main complaints included foreign body sensation of pharynx, odynophagia, vertigo with turning of the head-neck, pain of anterolateral neck, and toothache. Three cases were right-side affected, 6 cases were left-sided and 1 case was bilateral. Radiographic examination showed the elongated styloid process of bilateral in all cases, however, hypertrophy, improper inclination, abnormal angulation of styloid process and more complete calcification of stylohoid ligament of the complained side were observed compared to the opposite side. Eight cases suffered from anxiety and/or depression. A surgical intervention was carried out on 6 patients to resect the elongated styloid process, the symptoms and mental distress disappeared after the operation and no recurrence was found in their follow-ups. Meticulous interrogation of illness history, proper examination, and radiological studies may be valuable in diagnostic confirmation of ES. It is the hyperostosis, abnormal angulation of the styloid process rather than the simple elongation which is more likely to be attributed to the development of ES. Psychological disorders in ES patients were observed in our study and should be paid more attention in the future research.
Topics: Humans; Female; Male; Ossification, Heterotopic; Middle Aged; Adult; Temporal Bone; Anxiety; Depression
PubMed: 38728469
DOI: 10.1097/MD.0000000000038128 -
International Journal of Surgery Case... Jun 2024Heterotopic ossification (HO) develops when bone formation appears in soft tissues, usually after an injury or major surgery. Timely and accurately diagnosing of this...
INTRODUCTION
Heterotopic ossification (HO) develops when bone formation appears in soft tissues, usually after an injury or major surgery. Timely and accurately diagnosing of this rare event is essential due to the possibility of misdiagnosis as a maintained foreign body, infection, incisional neoplastic recurrence, and metastatic or primary neoplasms.
CASE PRESENTATION
In this study, we present a 57-year-old man who was operated for peritonitis due to perforated appendicitis, and an asymptomatic HO was accidentally found on an incisional line of previous open prostatectomy about 5 years earlier due to benign prostatic hyperplasia. A bone density lesion was seen in the fascia and on the incisional scar of previous surgery.
DISCUSSION
HO rarely occurs within an abdominal incision due to surgery. It is reported only within vertical midline incisions and mainly within the first year after the operation. Imaging confirms the diagnosis of HO in previous abdominal surgery scars, which reveals dense vertical calcification along the previous incisional scar. In the case of HO, the exclusive effective management is the entire surgical excision with primary closure, and NSAIDs are the preventive choices.
CONCLUSION
HO should be considered in patients presenting with discomfort or palpable mass or even asymptomatic patients with previous abdominal surgeries besides considering relative history such as surgical complications or neoplasms.
PubMed: 38704967
DOI: 10.1016/j.ijscr.2024.109655 -
Journal of ISAKOS : Joint Disorders &... May 2024In the forearm, posttraumatic heterotopic ossification usually forms as a proximal radioulnar synostosis. It can occur after soft tissue injury involving the...
In the forearm, posttraumatic heterotopic ossification usually forms as a proximal radioulnar synostosis. It can occur after soft tissue injury involving the interosseous membrane or after surgery involving the radio and ulna, such as distal biceps tendon repair. It can also be induced by radial head dislocation or fracture. Screening radiography can be used to select the appropriate time for excision. The synostosis can be resected when the ectopic bone margin and trabeculation appear mature on radiographs. An interval of 6-12 months from the injury is generally recommended based on ectopic bone maturity. Selection of the surgical approach depends on site, extension (elbow joint or proximal radioulnar joint), severity of the initial articular surface, and periarticular tissue injury. The posterolateral approach is indicated for synostoses: at or distal to the bicipital tuberosity, at the level of the radial head, and proximal radioulnar joint. The posterior global approach is recommended when the forearm synostosis is associated with complete bony ankylosis of the elbow involving the distal aspect of the humerus. After surgical resection of a proximal radioulnar synostosis, the exposed bone surfaces can be covered with interposition material to minimize recurrence.
PubMed: 38702039
DOI: 10.1016/j.jisako.2024.04.015 -
Molecular Medicine (Cambridge, Mass.) May 2024Ossification of the posterior longitudinal ligament (OPLL), an emerging heterotopic ossification disease, causes spinal cord compression, resulting in motor and sensory...
BACKGROUND
Ossification of the posterior longitudinal ligament (OPLL), an emerging heterotopic ossification disease, causes spinal cord compression, resulting in motor and sensory dysfunction. The etiology of OPLL remains unclear but may involve integrin αVβ3 regulating the process of osteogenesis and angiogenesis. In this study, we focused on the role of integrin αVβ3 in OPLL and explored the underlying mechanism by which the c(RGDyk) peptide acts as a potent and selective integrin αVβ3 inhibitor to inhibit osteogenesis and angiogenesis in OPLL.
METHODS
OPLL or control ligament samples were collected in surgery. For OPLL samples, RNA-sequencing results revealed activation of the integrin family, particularly integrin αVβ3. Integrin αVβ3 expression was detected by qPCR, Western blotting, and immunohistochemical analysis. Fluorescence microscopy was used to observe the targeted inhibition of integrin αVβ3 by the c(RGDyk) peptide on ligaments fibroblasts (LFs) derived from patients with OPLL and endothelial cells (ECs). The effect of c(RGDyk) peptide on the ossification of pathogenic LFs was detected using qPCR, Western blotting. Alkaline phosphatase staining or alizarin red staining were used to test the osteogenic capability. The effect of the c(RGDyk) peptide on angiogenesis was determined by EC migration and tube formation assays. The effects of the c(RGDyk) peptide on heterotopic bone formation were evaluated by micro-CT, histological, immunohistochemical, and immunofluorescence analysis in vivo.
RESULTS
The results indicated that after being treated with c(RGDyk), the osteogenic differentiation of LFs was significantly decreased. Moreover, the c(RGDyk) peptide inhibited the migration of ECs and thus prevented the nutritional support required for osteogenesis. Furthermore, the c(RGDyk) peptide inhibited ectopic bone formation in mice. Mechanistic analysis revealed that c(RGDyk) peptide could inhibit osteogenesis and angiogenesis in OPLL by targeting integrin αVβ3 and regulating the FAK/ERK pathway.
CONCLUSIONS
Therefore, the integrin αVβ3 appears to be an emerging therapeutic target for OPLL, and the c(RGDyk) peptide has dual inhibitory effects that may be valuable for the new therapeutic strategy of OPLL.
Topics: Integrin alphaVbeta3; Humans; Osteogenesis; Animals; Mice; Ossification of Posterior Longitudinal Ligament; Male; Female; Middle Aged; Neovascularization, Pathologic; Fibroblasts; Neovascularization, Physiologic; Cell Movement; Disease Models, Animal; Oligopeptides; Angiogenesis
PubMed: 38698308
DOI: 10.1186/s10020-024-00822-x -
Kansas Journal of Medicine 2024Despite the groundbreaking research by Judet and Letournel in the 1960s, the specific equipment, surgical approach, fixation strategy, and post-operative course for...
INTRODUCTION
Despite the groundbreaking research by Judet and Letournel in the 1960s, the specific equipment, surgical approach, fixation strategy, and post-operative course for treating acetabular fractures have not been standardized. Therefore, this study aimed to compare technological resources, operative procedures, and post-operative complications between patients treated for acetabular fractures in Romania and the United States (U.S.).
METHODS
Between February 2011 and August 2018, a total of 116 Romanian patients and 373 U.S. patients underwent open reduction and internal fixation for acetabular fractures. Data were collected prospectively for Romania and retrospectively for the U.S. The authors used T-tests, Fisher's exact tests, and odds ratios to analyze categorical data while ordinal date were assessed using logistic regression.
RESULTS
U.S. patients had higher comorbidity rates for diabetes, obesity, and hypertension. However, the initial quality of reduction, graded with Matta's criteria, was similar between American and Romanian patients. Post-operatively, U.S. patients had significantly higher Brooker criteria scores for heterotopic ossification. Rates of deep vein thrombosis, infections, sciatic nerve lesions, and loss of reduction between the two countries were not significantly different.
CONCLUSIONS
Given the similar initial reduction quality despite technological differences, the authors suggest that fundamental factors, such as surgeon training and experience, may have a greater impact than the availability of technologically advanced operative resources. Future research focusing on the efficacy of these advanced resources for acetabular fracture fixation could help determine their true impact on patient outcomes and improve the cost-effectiveness of this surgery.
PubMed: 38694170
DOI: 10.17161/kjm.vol17.21124