ObjectiveTo re-evaluate the systematic review and meta-analysis (SR/MAs) of the efficacy of robot-assisted pedicle screw placement. MethodsThe CNKI, VIP, WanFang Data, SinoMed, PubMed, Embase, Cochrane Library, and Web of Science databases were electronically searched to collect SR/MAs of robot-assisted pedicle screw placement from inception to April 28, 2023. Two reviewers independently screened literature, extracted data and then assessed the quality of reports, methodological quality, risk of bias, and the strength of evidence quality by using PRISMA, AMSTAR-Ⅱ, ROBIS, and GRADE tool. ResultsA total of 20 SR/MAs were included. The results of the included studies showed that robot-assisted pedicle screw placement was more accurate and had a lower number of complications compared with freehand pedicle screw placement. The quality of reports, methodology, and evidence for pedicle screw placement efficiency in all SR/MAs were low or extremely low, with a high risk of bias. The main reasons included high heterogeneity of included studies, unclear research methods and selection criteria, and missing key reporting processes. ConclusionRobot-assisted pedicle screw placement may have better clinical efficiency than traditional freehand pedicle screw placement. But the quality of relational SR/MAs is low.
Objective To explore the timing of indwelling urinary catheter removal in male patients undergoing orthopedic surgery under general anesthesia by a prospective randomized controlled study. Methods Male patients who underwent orthopedic surgery under general anesthesia in the First People’s Hospital of Shuangliu District between September 2019 and January 2021 were selected prospectively. The patients were randomly assigned to group A (pull out the catheter before anesthesia) and group B (pull out the catheter within 24 hours after anesthesia) at a ratio of 1∶1 by sortition. The age, operation duration, operation site, heart rate when pulling out the catheter, first urination, urinary tract infection, patient comfort score, nursing satisfaction score and patient satisfaction related indicators of the two groups were recorded and analyzed. Results A total of 120 patients were included in the study. All patients successfully completed the trial without dropping out or quitting. There was no significant difference between the two groups in terms of age, operation duration and operation site (P>0.05). No urinary tract infection occurred in both groups. There was no significant difference in the first urination between the two groups (P>0.05). The heart rate of patients in group A when pulling out the catheter was slower than that of group B [(74.62 ± 11.38) vs. (84.52 ± 8.98) times/min], and the satisfaction of patients in group A (group A: 46 cases were satisfied, 11 cases were relatively satisfied, 3 cases were dissatisfied; group B: 17 cases were satisfied, 25 cases were relatively satisfied, 18 cases were dissatisfied), comfort score (17.82±2.73 vs. 16.68±2.13), and nursing satisfaction score (19.62±1.59 vs. 16.32±2.05) were better than those in group B (P<0.05). Conclusions For male patients who need catheterization before orthopedic surgery under general anesthesia, pulling out the catheter before waking up after anesthesia can effectively reduce the physiological stress reaction of patients, reduce discomfort, improve patient satisfaction, and reduce the workload of nurses after surgery, which is conducive to early rehabilitation exercise of patients.
ObjectiveTo review the current applications of machine learning in orthopaedic trauma and anticipate its future role in clinical practice. MethodsA comprehensive literature review was conducted to assess the status of machine learning algorithms in orthopaedic trauma research, both nationally and internationally. ResultsThe rapid advancement of computer data processing and the growing convergence of medicine and industry have led to the widespread utilization of artificial intelligence in healthcare. Currently, machine learning plays a significant role in orthopaedic trauma, demonstrating high performance and accuracy in various areas including fracture image recognition, diagnosis stratification, clinical decision-making, evaluation, perioperative considerations, and prognostic risk prediction. Nevertheless, challenges persist in the development and clinical implementation of machine learning. These include limited database samples, model interpretation difficulties, and universality and individualisation variations. ConclusionThe expansion of clinical sample sizes and enhancements in algorithm performance hold significant promise for the extensive application of machine learning in supporting orthopaedic trauma diagnosis, guiding decision-making, devising individualized medical strategies, and optimizing the allocation of clinical resources.
Objective To explore the impact of moxibustion combined with Shenque acupoint patching on postoperative gastrointestinal function in patients undergoing major orthopedic surgery. Methods Convenience sampling method was used to select patients undergoing major orthopedic surgery from Luoyang Orthopedic-Traumatological Hospital of Henan Province (Henan Provincial Orthopedic Hospital) between October and December 2024 as the research subjects. The trial group received intervention with moxibustion combined with Shenque acupoint patching on the basis of routine care, while the control group only received routine care. The time of first flatus/defecation, frequency of defecation within 7 days, incidence/degree of abdominal distension at 72 hours, and adverse events were compared between the two groups after surgery. Results Finally, 94 subjects were included, including 51 in the trial group and 43 in the control group. There was no statistically significant difference in the general condition between the two groups of patients (P>0.05). Compared with the control group, patients in the trial group had a shorter first flatus time [6.00 (5.00, 9.00) vs. 14.00 (6.83, 19.13) h] and spontaneous defecation time [26.00 (21.00, 52.10) vs. 50.20 (26.42, 69.35) h], and an increase in spontaneous defecation frequency [6.00 (4.00, 7.00) vs. 4.00 (3.00, 5.00)] within 7 days after surgery, with statistically significant differences (P<0.05). Neither the trial group nor the control group experienced any adverse events. Conclusion Moxibustion combined with Shenque acupoint patching can safely and effectively promote the recovery of gastrointestinal function in patients undergoing major orthopedic surgery, and is worthy of clinical promotion.
Objective To develope a modified surgical lavage tube to improve the efficacy of the treatment of orthopaedic postoperative infection. Methods A retrospective analysis was performed on 126 patients who received the pulsed lavage therapy with side-hole double valve lavage tube between March 2005 and March 2010. There were 98 males and28 females, aged 19-63 years (mean, 35 years). The infected sites included femur in 61 cases, tibiofibula in 46 cases, humerus in 12 cases, and patella in 7 cases. The lavage tube obstruction and defluvium, secondary infection of drainage opening, and wound heal ing were observed during treatment. Results No lavage tube defluvium occured during the lavage in all cases. Lavage tube obstruction occurred in 68 cases, edema at the peri pheral tissue was caused by obstruction in 9 cases; secondary infection at the lavage and drainage opening in 10 cases, which were cured after corresponding treatment. All cases achieved wound healing by first intention within 2 weeks. Lavage tube and drainage opening were closed within 1 month. All patients were followed up 1-5 years (mean, 18 months) with no recurrence. Conclusion Pulsed lavage therapy with side-hole double valve lavage tube can obviously improve the efficacy of the treatment of orthopaedic postoperative infection, so it is an effective modification to convention lavage.
Objective To conduct a systematic bibliometric analysis of recent research on robot-assisted orthopedic surgery, in order to reveal the research trends, hotspots, main contributors, and future development directions in this field. Methods On August 27, 2024, WoSCC (Web of Science Core Collection Database) was searched and relevant literature on robot-assisted orthopedic surgery from 2003 to 2023 was included. Excel 2016, VOSviewer (version 1.6.10), and CiteSpace (version 6.2.R6) were used for data collection and analysis. Results The total citation frequency of 1718 retrieved literature was 28978 times, with an average citation frequency of 16.87 times per article. The total citation frequency of articles in 2019 was the highest (4330 times), and the publication volume in 2023 was the highest (315 articles). Among the top 5 countries in terms of publication volume, the United States had the highest publication volume and total citation frequency, while China ranked second in terms of publication volume, but had the lowest average citation frequency per article. Analysis of cooperation between countries showed that the United States, China, Germany, and other countries had the most cooperation. Babar Kayani’s articles were cited the most frequently. Among the top 10 institutions in terms of publication volume, the Hospital for Special Surgery (United States) had the highest publication volume, the Pennsylvania State System of Higher Education (United States) had the highest total citation frequency for publications, and the average citation frequency of each article published by the University of Pittsburgh (United States) was the highest. The dynamic evolution of research hotspots suggested that early research mainly focused on the combination of traditional surgical techniques and navigation, while in recent years, research had mainly focused on computer-aided surgery, augmented reality, and medical robotics technology. Conclusions In recent years, significant progress has been made in the research of robot-assisted orthopedic surgery, with the United States taking a leading position in this field and having extensive global cooperation. Research hotspots show that with the continuous development of computer-aided surgery, augmented reality, and robotics technology, the field of orthopedic surgery is evolving towards more precise, individualized, and minimally invasive directions.
Objective To introduce the research update of microencapsulation and its application in orthopedics. Methods Recent articlesconcerned were extensively reviewed. Results Drugs and cells modified by genecould be encapsulated in different materials and be implanted in vivo avoiding a host immune system rejection. It act as a continuous source of desired medicine for enhancement of bone healing, the treatment of bone tumor and bone infection, and the regeneration of bone and cartilage. Conclusion Microencapsulation can be used asa carrier for drugs and cells modified gene to treat related disease in orthopedics.
Objective To summarize the surgical learning curve and preliminary operative experience of dual-robotic navigated minimally invasive treatment on pelvic fractures by TiRobot and Artis Zeego. Methods Between July 2019 and February 2021, 90 patients with pelvic fractures were treated with dual-robotic navigated minimally invasive surgery by TiRobot and Artis Zeego. There were 64 males and 26 females, with an average age of 46.5 years (range, 13-78 years). Body mass index was 14.67-32.66 kg/m2 (mean, 23.61 kg/m2). Causes of injuries included traffic accident in 43 cases, falling from height in 37 cases, low-energy injuries such as flat falls in 10 cases. The interval between injury and surgery was 1-36 days (mean, 7.3 days). According to the location of the implanted screws, the patients were divided into sacroiliac screw group (n=33), acetabular screw group (acetabulum anterior/posterior column, n=24), composite screws group (sacroiliac and acetabulum anterior/posterior column, n=33). According to the screw implantation time and accuracy, the surgical learning curve was plotted, and the differences in the relevant indicators between learning stage and skilled stage were compared. Results All 90 patients successfully completed the operation, the intraoperative bleeding volume was 5-200 mL (median, 20 mL). There was no vascular or nerve injury. All incisions healed by first intention. The screw implantation time ranged from 7.5 to 33.0 minutes (mean, 18.92 minutes), and the screw implantation accuracy ranged from 1.1 to 1.8 mm (mean, 1.56 mm). According to the learning curve, the practice stage of 3 groups was reached after 7, 10, and 11 cases, respectively. With the accumulation of surgical experience, the screw implantation time had a significant downward trend. Compared with the learning stage, the screw implantation time on skilled stage in 3 groups significantly shortened (P<0.05), but the difference in the screw implantation accuracy was not significant (P>0.05). Conclusion TiRobot and Artis Zeego assisted pelvic fracture surgery is safe and efficient, which helps the surgeon to quickly master the pelvic channel screw surgery, and the operation time is significantly shortened on the premise of ensuring the implantation accuracy.
Objective To investigate the prevalence of postoperative delirium (POD) in elderly patients undergoing major orthopedic surgery and analyze its influencing factors, so as to provide evidence for early screening and intervention of POD. Methods The medical records of elderly patients undergoing major orthopedic surgery in the Department of Orthopaedics of the First Medical Center, Chinese PLA General Hospital between January 2021 and December 2022 were retrospectively collected. The included patients were divided into POD group and non-POD group. The patients’ demographic characteristics, medical history, laboratory indicators, perioperative medication, intraoperative and postoperative indicators were collected to analyze the risk factors affecting POD. Results A total of 455 elderly patients were included. Among them, there were 75 cases in the POD group and 380 cases in the non-POD group. The incidence of POD was 16.5% (75/455). There were statistically significant differences in age, body mass index, number of combined underlying diseases≥3, albumin<35 g/L, American Society of Anesthesiologists (ASA) classification, intraoperative blood loss≥200 mL, intraoperative blood transfusion, postoperative Visual Analogue Scale (VAS) score, indwelling catheters, admission to intensive care unit (ICU), and length of ICU stay between the two groups (P<0.05). The results of logistic regression analysis showed that age≥79 years, number of combined underlying diseases≥3, albumin<35 g/L, intraoperative blood loss≥200 mL, ASA grade≥Ⅲ, postoperative VAS score, and postoperative admission to ICU (P<0.05) were independent influencing factors for POD occurrence in elderly patients undergoing major orthopedic surgery. Conclusions POD is one of the common postoperative complications in elderly patients undergoing major orthopedic surgery. Age≥79 years, number of combined underlying diseases≥3, albumin<35 g/L, intraoperative blood loss≥200 mL, ASA grade≥Ⅲ, postoperative VAS score, and postoperative admission to ICU are independent risk factors for POD in elderly patients undergoing major orthopedic surgery. Clinical staff should evaluate and screen these factors early and take preventive measures to reduce the incidence of POD.
ObjectiveTo evaluate the effectiveness of TiRobot-assisted surgery by O-arm navigation system for percutaneous minimally invasive treatment of posterior pelvic ring injury. Methods The clinical data of 76 patients with posterior pelvic ring injury between January 2016 and June 2021 were retrospectively analyzed. Among them, 45 cases were treated with minimally invasive percutaneous sacroiliac screw fixation assisted by TiRobot and O-arm navigation system (study group), 31 cases were treated with minimally invasive percutaneous sacroiliac screw fixation under the guidance of C-arm X-ray machine (control group). There was no significant difference in gender, age, cause of injury, Tile classification, time from injury to operation between the two groups (P>0.05). The operation time, intraoperative blood loss, the times of nail track adjustment, and intraoperative fluoroscopy times were recorded. The quality of fracture reduction was evaluated by Matta score. At last follow-up, Majeed score was used to evaluate the recovery of pelvic function. ResultsA total of 72 screws were implanted in the study group, with a median of 1 (1, 2) screws per patient. In the control group, 47 screws were implanted, with a median of 1 (1, 2) screws per patient. There was no significant difference in the number of screws between the two groups (Z=?0.392, P=0.695). The operation time, intraoperative blood loss, times of nail track adjustment, and intraoperative fluoroscopy times in the study group were significantly less than those in the control group (P<0.05). All patients were followed up 6-24 months (mean, 14 months). No serious complications was found after operation and during follow-up. Matta score was used to evaluate the quality of fracture reduction at 1 week after operation, and there was no significant difference between the two groups (Z=?1.135, P=0.256). At last follow-up, there was no significant difference of Majeed score between the two groups (Z=?1.279, P=0.201). ConclusionTiRobot-assisted surgery by O-arm navigation system is a reliable surgical method for the treatment of posterior pelvic ring injury, which can reduce the operation time and fluoroscopy times when compared with the traditional operation under the guidance of C-arm X-ray machine. The safety, accuracy, and efficiency of the operation were improved.
