Comparative efficacy of robotic-assisted and freehand techniques for pedicle screw placement in spinal disorders: a meta-analysis and systematic review.

The efficacy and safety of robotic-assisted pedicle screw placement compared to traditional fluoroscopy-guided techniques are of great interest in the field of spinal surgery. This systematic review and meta-analysis aimed to compare the outcomes of these two methods in patients with spinal diseases. Following the PRISMA guidelines, we conducted a systematic search across PubMed, Embase, Web of Science, and Cochrane Library. We included randomized controlled trials comparing robotic-assisted and fluoroscopy-guided pedicle screw placement in patients with spinal diseases. Outcome measures included the accuracy of pedicle screw placement, postoperative complication rates, intraoperative radiation exposure time, and duration of surgery. Data were analyzed using Stata software. Our analysis included 12 studies. It revealed significantly higher accuracy in pedicle screw placement with robotic assistance (odds ratio [OR] = 2.83, 95% confidence interval [CI] = 2.20-3.64, P < 0.01). Postoperative complication rates, intraoperative radiation exposure time, and duration of surgery were similar between the two techniques (OR = 0.72, 95% CI = 0.31 to 1.68, P = 0.56 for complication rates; weighted mean difference [WMD] = - 0.13, 95% CI = - 0.93 to 0.68, P = 0.86 for radiation exposure time; WMD = 0.30, 95% CI = - 0.06 to 0.66, P = 0.06 for duration of surgery). Robotic-assisted pedicle screw placement offers superior placement accuracy compared to fluoroscopy-guided techniques. Postoperative complication rates, intraoperative radiation exposure time, and duration of surgery were comparable for both methods. Future studies should explore the potential for fewer complications with the robotic-assisted approach as suggested by the lower point estimate.

A meta-analysis of the risk of osteoporotic fractures in inflammatory bowel disease.

BACKGROUND: There are a variety of perspectives on the risk of osteoporotic fractures in inflammatory bowel disease (IBD), and few thorough assessments that are pertinent. OBJECTIVES: We conducted a meta-analysis to assess the risk of osteoporotic fractures in IBD. MATERIAL AND METHODS: A systematic literature search up to September 2022 was performed, and 1,158,982 subjects participated in the baseline trials of the selected studies. A total of 261,829 patients had IBD, while 897,153 were controls. Odds ratio (OR) and mean difference (MD) with 95% confidence intervals (95% CIs) were calculated to measure the risk of osteoporotic fractures in IBD patients using contentious and dichotomous approaches with a random or fixed influence model. RESULTS: The presence of IBD resulted in significantly higher frequency of osteoporotic fractures (OR: 1.42, 95% CI: 1.21-1.66, p < 0.001) compared to controls. Nevertheless, no significant differences in terms of osteoporotic fractures were found between ulcerative colitis (OR: 2.79, 95% CI: 0.88-8.87, p = 0.08) and Crohn's disease (OR: 1.84, 95% CI: 0.81-4.18, p = 0.14) compared to controls. CONCLUSION: This study found a strong correlation between the risk of osteoporotic fractures and inflammatory bowel disease. The small number of studies in certain comparisons requires care when analyzing the results.

Uncovering the mechanism of Radix Paeoniae Alba in the treatment of restless legs syndrome based on network pharmacology and molecular docking.

Restless legs syndrome (RLS) is a neurological motor disorder with a high prevalence. The treatment efficacy of RLS is unsatisfactory. Radix Paeoniae Alba (RPA) can effectively treat RLS symptoms such as the discomfort of the legs. RPA has great potential for the development of new medications for RLS. Hence, we explored the mechanism of RPA in the treatment of RLS using network pharmacology and molecular docking. The active components and targets of RPA were obtained from the Traditional Chinese Medicine System Pharmacology database and analysis platform and PharmMapper platform. The RLS-related targets were found in GeneCards, OMIM, DrugBank, and DisGeNET databases. The overlapping targets of RPA and RLS were then collected. The "active components-overlapping targets" network was built, and network topology analysis was performed. Furthermore, Cytoscape 3.9.1 software was used to screen the key components of RPA in the treatment of RLS. Protein-protein interaction was performed using the Search Tool for the Retrieval of Interacting Genes. The gene ontology functions and Kyoto Encyclopedia of Genes and Genomes signaling pathways were analyzed using ClusterProfiler, PathView, and other R packages to reveal the main mechanism of RPA in treating RLS. Component and protein structures were downloaded from the Traditional Chinese Medicine System Pharmacology and Protein Data Bank databases, respectively. The AutoDock 4.2.6 software was used for molecular docking. A total of 12 active components and 109 targets of RPA, as well as 2387 RLS-related targets, were collected. Following that, 47 overlapping targets were obtained. Furthermore, 5 key components and 12 core targets were screened. The results of gene ontology functions were as follows: 2368 biological processes, 264 molecular functions, and 164 cellular components. A total of 207 Kyoto Encyclopedia of Genes and Genomes signaling pathways were obtained, including the lipid and atherosclerosis pathway, the endocrine resistance pathway, the prolactin signaling pathway, and the IL-17 signaling pathway. The components and the core targets completed molecular docking stably. RPA has multi-component, multi-target, and multi-pathway characteristics in treating RLS, which could provide a basis for future research and improve clinical efficacy.

[3D mirror printing combined with minimally invasive percutaneous plate osteosynthesis in the treatment of adult median clavicle fracture].

OBJECTIVE: To retrospectively analyze clinical effect of 3D mirror printing combining with minimally invasive percutaneous plate osteosynthesis(MIPPO) technology in the treatment of adult clavicle fracture. METHODS: The clinical data of 32 adult patients with collarbone AllmanⅠdisplacement of fracture who had undergone the combination of 3D mirror printing with MIPPO technology treatment were collected from October 2019 to October 2020. There were 19 males and 13 females, aged from 19 to 55 years old with an average of(34.12±16.42) years old. According to Allman classification, there were 14 cases of AllmanⅠb and 18 cases of AllmanⅠc. Fracture occurred on the left in 17 cases and on the right in 15 cases. Postoperative complications, operation time, incision length, intraoperative blood loss, the number of fluoroscopies, fracture healing time of all patients were retrospectively analyzed, and the curative effect was evaluated by Constant-Murley shoulder joint score before operation, 1 and 6 months after operation. RESULTS: All the 32 patients were followed up for 6 to 8 months, with an average of (6.67±2.13) months. All the patients did not have postoperative complications such as incision infection and skin numbness in the operating area. The operation time was (35.37±4.28) min. The incision length was (3.78±0.45) cm. Intraoperative blood loss was(37.23±4.76) ml. The number of fluoroscopies was(3.12±0.47) times. Fracture healing time was (8.18±2.58) weeks. Constant-Murley shoulder joint score of the affected side at 1 and 6 months after operation was 81.08±3.92 and 98.03±1.05 respectively, which had a significant difference compared with 54.62±5.25 before operation(P<0.05). According to Constant-Murley shoulder function score at 6 months after operation, 30 cases were excellent and 2 cases were good. CONCLUSION: 3D mirror printing can effectively assist MIPPO technique in the treatment of adult clavicle AllmanⅠdisplaced fracture. It not only has the advantages of less trauma and fewer complications of the MIPPO technique, but also can further shorten the operation time and improve the operation maneuverability. It is a better method in the treatment of adult clavicle AllmanⅠdisplaced fracture.

[Finite element analysis of InterTan for the treatment of femoral intertrochanteric fractures].

OBJECTIVE: To study the biomechanical characteristics of InterTan for the treatment of femoral intertrochanteric fracture of Evans-Jensen IV. METHODS: Scanning the femur and internal plant of volunteers with spiral CT to obtain DICOM format data. Three-dimensional models of left femur and InterTan were reconstructed by Mimics software. On this basis, a three-dimensional finite element model of internal fixation for Evans-Jensen IV intertrochanteric fracture of femur was established. The stress and microstrain distribution of Von Mses in different models were studied. The biomechanical stability after internal fixation of the Evans Jensen IV femoral intertrochanteric fracture was analyzed. RESULTS: The stress pattern of the femur of InterTan model was the same as that of the normal femur, which was mainly located on the medial side of the proximal femur and the lower third of the femur. However, the stress of femur in InterTan model was lower than that in the same part of normal femur. The peak stress of the femur in the model was 13.92 MPa, located at the end of the inner plant in contact with the femur. The stress peak of the plant in the model was 146.5 MPa at the lower contact point between the tension nail and the main nail. CONCLUSIONS: InterTan fixation has obvious biomechanical advantages and is not easy to cause stress fractures in the middle femur in patients with osteopenic Evans-Jensen IV intertrochanteric fractures. In particular, for patients with greater activity in the intertrochanteric fracture of the Evans-Jensen IV femur, InterTan fixation has better stability and provides a theoretical basis for the choice of internal fixation.