Fibrous dysplasia is one of many well-known disorders in which there is a defect in the remodeling process of immature bone to mature into lamellar bone, and it often exists in metaphyseal and diaphyseal parts of the long bone. In this report, we describe a rare case where fibrous dysplasia was found only in the proximal part of the epiphysis of the tibia without other bony lesions.A 14-year-old Asian girl was referred to our hospital after slipping down with pain on the left knee. A radiograph showed an abnormal finding of a central radiolucent lesion with a marginal sclerotic border near the proximal tibial spine. A magnetic resonance image showed the lesion at low signal intensity on a T1-weighted image and at high signal intensity on a T2-weighted image. The biopsy results led us to conclude that the lesion was a fibrous dysplasia.If an abnormal lesion on the epiphysis, especially in long bones, is detected on a radiograph, several differential diagnoses can be made. Although fibrous dysplasia is usually not encountered as an epiphyseal lesion, it is important to incorporate all the clinical, radiographic and pathologic features to diagnose monostotic fibrous dysplasia when the lesion is located at the epiphyseal location.
Posterior lumbar fusion is a safe and effective surgical method for diseases, such as lumbar stenosis, spondylolisthesis, lumbar instability, spinal deformity, and tumor. Pedicle screw (PS) fixation was first introduced by Bouche and has been adopted as the gold standard for posterior lumbar fusion. Santoni and colleagues introduced a new methodological screw insertion technique that uses a cortical bone trajectory (CBT), described as that from a medial to lateral path in the transverse axial plane and caudal to the cephalad path in the sagittal plane through the pedicle for maximum contact of the screw with the cortical bone. Owing to the lower invasiveness, superior cortical bone contact, and reduced neurovascular injury incidence, the CBT technique has been widely used in posterior lumbar fusion; however, these advantages have not been proven in clinical/radiological and biomechanical studies. We designed the present study to review the existing evidence and evaluate the merit of CBT screw fixation. Six electronic databases were searched for relevant articles published in August 2020 using the search terms "cortical bone trajectory," "CBT spine," "CBT fixation," "cortical pedicle screws," and "cortical screws." Studies were analyzed and divided into the following groups: "biomechanics investigation," "surgical technique," and "clinical/radiological studies." Most studies compared CBT and PS fixation, and the CBT screw fixation method showed better or similar outcomes.
Carpal tunnel syndrome is diagnosed based on history, physical examination, and nerve conduction testing; however, there are no clear criteria for the diagnosis of carpal tunnel syndrome. Recently, studies have aimed to diagnose carpal tunnel syndrome through ultrasound or MRI. The purpose of this study was to compare and analyze the cross-sectional area of the median nerve between patients with carpal tunnel syndrome and a control group.From July 2015 to August 2017, we retrospectively analyzed fishery and white-collar workers (164 people, 37 men, 127 women). Carpal tunnel syndrome was diagnosed on the basis of both physical examination and nerve conduction testing. A negative result in either test led to exclusion from the study.In total, 164 wrist MRI were retrieved, with 67 patients diagnosed with carpal tunnel syndrome and 97 patients allocated to the control group. The mean value of cross-sectional area at the pisiform was 18.8 mm2 in the MRI of the carpal tunnel syndrome patients and 12.1 mm2 (p-value <0.05) in the control group. The mean value of cross-sectional area at the hook of hamate was 11.70 mm2 and that at the control group was 11.67 mm2 (p-value 0.055).Cross-sectional area at pisiform in MRI is a valuable factor in the diagnosis of carpal tunnel syndrome and in predicting the duration of pain.
Delphinidin (Delp), a natural antioxidant, has shown promise in treating age-related ailments such as osteoarthritis (OA). This study investigates the impact of delphinidin on intervertebral disc degeneration (IVDD) using human nucleus pulposus cells (hNPCs) subjected to hydrogen peroxide. Various molecular and cellular assays were employed to assess senescence, extracellular matrix (ECM) degradation markers, and the activation of AMPK and autophagy pathways. Initially, oxidative stress (OS)-induced hNPCs exhibited notably elevated levels of senescence markers like p53 and p21, which were mitigated by Delp treatment. Additionally, Delp attenuated IVDD characteristics including apoptosis and ECM degradation markers in OS-induced senescence (OSIS) hNPCs by downregulating MMP-13 and ADAMTS-5 while upregulating COL2A1 and aggrecans. Furthermore, Delp reversed the increased ROS production and reduced autophagy activation observed in OSIS hNPCs. Interestingly, the ability of Delp to regulate cellular senescence and ECM balance in OSIS hNPCs was hindered by autophagy inhibition using CQ. Remarkably, Delp upregulated SIRT1 and phosphorylated AMPK expression while downregulating mTOR phosphorylation in the presence of AICAR (AMPK activator), and this effect was reversed by Compound C, AMPK inhibitor. In summary, our findings suggest that Delp can safeguard hNPCs from oxidative stress by promoting autophagy through the SIRT1/AMPK/mTOR pathway.
Background: The Sanders classification is a widely used method for classifying calcaneal fractures. Type IV fractures (>4 fragments) are known to vary in the number of fracture fragments. However, all relevant cases are classified as type IV irrespective of the number of fragments. We investigated the need for evaluation of postoperative prognoses based on radiologic factors and subtypes of Sanders classification type IV fractures. Methods: Fifty-six Sanders type IV calcaneal fractures were enrolled between 2010 and 2018. Patients were divided into two groups according to the number of fragments: four fragments (group 1) and more than four fragments (group 2). Radiologic evaluation was performed using a postoperative recovery percentage calculated from postoperative reduction of the Böhler angle, Gissane angle, and vertical height. Radiologic evaluation was divided into two groups according to postoperative recovery: good and bad recovery groups. American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score and visual analog scale (VAS) score were used for clinical outcome evaluation. Results: There was no significant difference in AOFAS ankle-hindfoot score ( P = .909) or VAS score ( P = .963) between groups 1 and 2. However, there was a significant ( P = .001) difference in AOFAS ankle-hindfoot score or VAS score between good and bad recovery groups. Conclusions: Clinical results of Sanders type IV fractures were not related to the number of bone fragments but to the degree of injury to the Böhler angle, Gissane angle, and vertical height. Therefore, subtype classification of type IV calcaneal fractures is superfluous, and it is important to try to restore these parameters during surgery.
Purpose: We attempted to evaluate the effectiveness of the new modified Smith-Robinson bone graft method for performing cervical anterior interbody fusion. Materials and Methods: Forty-two patients had anterior interbody fusion on the cervical spine, using an anterior approach and the new modified Smith-Robinson's method (NMSR), between September 2001 and June 2006. There were 30 males and 12 females, with an average age of 51.2 years and the mean follow up period was 39.5 months. We measured the area from C4 to C6 in 32 cases. This was compared with the contact area of the bone graft of the NMSR method and the Original Smith-Robinson method (OSR). We also checked the time to bone union and changes of Cobb's angle at the final follow-up to evaluate the effectiveness of the NMSR. Results: Bony fusion was obtained in all cases. The average size of the OSR were 169 and 152 mm 2 , in the males and females respectively, whereas those of the NMSR were 263, and 228 mm 2 . Therefore, the average size of the NMSR increased to 94 mm 2 and 76 mm 2 than those of the OSR method in the males and females. The average time to radiological bone union was 9.6 weeks and the changes of Cobb's angle at final follow-up were 2.5±2.6 o . Conclusion: The NMSR technique was a very effective method for cervical anterior interbody fusion. It could enlarge the bone graft size about 50-56% compared with the OSR technique. It also shortened the period of bone union and also increased the bone union rate.
Spinal-pelvic parameters are utilized in orthopedics for assessing patients' curvature and body alignment in diagnosing, treating, and planning surgeries for spinal and pelvic disorders. Segmenting and autodetecting the whole spine from lateral radiographs is challenging. Recent efforts have employed deep learning techniques to automate the segmentation and analysis of whole-spine lateral radiographs. This study aims to develop an artificial intelligence (AI)-based deep learning approach for the automated segmentation, alignment, and measurement of spinal-pelvic parameters through whole-spine lateral radiographs. We conducted the study on 932 annotated images from various spinal pathologies. Using a deep learning (DL) model, anatomical landmarks of the cervical, thoracic, lumbar vertebrae, sacrum, and femoral head were automatically distinguished. The algorithm was designed to measure 13 radiographic alignment and spinal-pelvic parameters from the whole-spine lateral radiographs. Training data comprised 748 digital radiographic (DR) X-ray images, while 90 X-ray images were used for validation. Another set of 90 X-ray images served as the test set. Inter-rater reliability between orthopedic spine specialists, orthopedic residents, and the DL model was evaluated using the intraclass correlation coefficient (ICC). The segmentation accuracy for anatomical landmarks was within an acceptable range (median error: 1.7-4.1 mm). The inter-rater reliability between the proposed DL model and individual experts was fair to good for measurements of spinal curvature characteristics (all ICC values > 0.62). The developed DL model in this study demonstrated good levels of inter-rater reliability for predicting anatomical landmark positions and measuring radiographic alignment and spinal-pelvic parameters. Automated segmentation and analysis of whole-spine lateral radiographs using deep learning offers a promising tool to enhance accuracy and efficiency in orthopedic diagnostics and treatments.
The aim of this study was to verify the practicability of the cortical bone trajectory (CBT) method by comparing the clinical outcomes including the complications between the CBT method and pedicle screws (PSs).
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