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Wang CT, Huang B, Thogiti N, Zhu WX, Chang CH, Pao JL, Lai F. Successful real-world application of an osteoarthritis classification deep-learning model using 9210 knees-An orthopedic surgeon's view. J Orthop Res 2023; 41:737-746. [PMID: 35822355 DOI: 10.1002/jor.25415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Revised: 05/23/2022] [Accepted: 07/07/2022] [Indexed: 02/04/2023]
Abstract
This study aimed to evaluate the performance of a deep-learning model to evaluate knee osteoarthritis using Kellgren-Lawrence grading in real-life knee radiographs. A deep convolutional neural network model was trained using 8964 knee radiographs from the osteoarthritis initiative (OAI), including 962 testing set images. Another 246 knee radiographs from the Far Eastern Memorial Hospital were used for external validation. The OAI testing set and external validation images were evaluated by experienced specialists, two orthopedic surgeons, and a musculoskeletal radiologist. The accuracy, interobserver agreement, F1 score, precision, recall, specificity, and ability to identify surgical candidates were used to compare the performances of the model and specialists. Attention maps illustrated the interpretability of the model classification. The model had a 78% accuracy and consistent interobserver agreement for the OAI (model-surgeon 1 К = 0.80, model-surgeon 2 К = 0.84, model-radiologist К = 0.86) and external validation (model-surgeon 1 К = 0.81, model-surgeon 2 К = 0.82, model-radiologist К = 0.83) images. A lower interobserver agreement was found in the images misclassified by the model (model-surgeon 1 К = 0.57, model-surgeon 2 К = 0.47, model-radiologist К = 0.65). The model performed better than specialists in identifying surgical candidates (Kellgren-Lawrence Stages 3 and 4) with an F1 score of 0.923. Our model not only had comparable results with specialists with respect to the ability to identify surgical candidates but also performed consistently with open database and real-life radiographs. We believe the controversy of the misclassified knee osteoarthritis images was based on a significantly lower interobserver agreement.
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Affiliation(s)
- Cheng-Tzu Wang
- Department of Orthopaedic Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan.,Graduate Institute of Networking and Multimedia, National Taiwan University, Taipei, Taiwan
| | - Brady Huang
- Department of Computer Science, New York University, New York, New York, USA
| | - Nagaraju Thogiti
- Department of Mathematics, University of Southern California, Los Angeles, California, USA
| | - Wan-Xuan Zhu
- Graduate Institute of Networking and Multimedia, National Taiwan University, Taipei, Taiwan
| | - Chih-Hung Chang
- Department of Orthopaedic Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan.,Graduate School of Biotechnology and Bioengineering, Yuan Ze University, Taoyuan, Taiwan
| | - Jwo-Luen Pao
- Department of Orthopaedic Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan.,General Education Center, Lunghwa University of Technology, Taoyuan, Taiwan
| | - Feipei Lai
- Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taipei, Taiwan
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Pao JL. Biportal Endoscopic Transforaminal Lumbar Interbody Fusion Using Double Cages: Surgical Techniques and Treatment Outcomes. Neurospine 2023; 20:80-91. [PMID: 37016856 PMCID: PMC10080423 DOI: 10.14245/ns.2346036.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 03/03/2023] [Indexed: 04/03/2023] Open
Abstract
Objective: To describe the surgical techniques and the treatment outcomes of biportal endoscopic transforaminal lumbar interbody fusion (BETLIF) using double cages.Methods: This study included 89 patients with 114 fusion segments between July 2019 and May 2021. One pure polyetheretherketone (PEEK) cage and 1 composite titanium-PEEK cage were used for interbody fusion. Clinical outcomes measures included visual analogue scale (VAS) scores for lower back pain and leg pain, Oswestry Disability Index (ODI), and Japanese Orthopedic Association (JOA) scores. Computed tomography (CT) of the lumbar spine 1 year postoperatively was used to evaluate the Bridwell interbody fusion grades.Results: There were significant improvement in VAS for lower back pain from 5.2 ± 3.1 to 1.7 ± 2.1, VAS for leg pain from 6.3 ± 2.5 to 1.7 ± 2.0, ODI from 46.7 ± 17.0 to 12.7 ± 16.1, and JOA score from 15.6 ± 6.3 to 26.4 ± 3.2. The p-values were all < 0.001. The average hospital stay was 5.7 ± 1.1 days. The CT studies available for 60 fusion segments showed successful fusion (Bridwell grade I or grade II) in 56 segments (93.3%). Significant cage subsidence of more than 2 mm was only noted in 3 segments (5.0%). Complications included 1 dural tear, 2 pedicle screws malposition, and 2 epidural hematomas, in which 2 patients required reoperations.Conclusion: BETLIF with double cages provided good neural decompression and a sound environment for interbody fusion with a big cage footprint, a large amount of bone graft, endplate preservation, and segmental stability.
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Affiliation(s)
- Jwo-Luen Pao
- Department of Orthopedic Surgery, Far-Eastern Memorial Hospital, New Taipei City, Taiwan
- Longhwa University of Science and Technology, Taoyuan, Taiwan
- Corresponding Author Jwo-Luen Pao Department of Orthopedic Surgery, Far-Eastern Memorial Hospital, 21, Section 2, Nanya South Road, Banqiao District, New Taipei 22060, Taiwan
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Lai CC, Fang HW, Chang CH, Pao JL, Chang CC, Chen YJ. Unusual capitate fracture with dorsal shearing pattern and concomitant carpometacarpal dislocation with a 6-year follow-up: A case report. World J Clin Cases 2023; 11:2060-2066. [PMID: 36998955 PMCID: PMC10044964 DOI: 10.12998/wjcc.v11.i9.2060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 02/10/2023] [Accepted: 02/27/2023] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND Isolated capitate fractures are rare carpal fractures. Following high-energy injuries, capitate fractures are usually associated with other carpal fractures or ligament injuries. The management of capitate fractures depends on the fracture pattern. Here, we report an unusual capitate fracture with a dorsal shearing pattern and concomitant carpometacarpal dislocation, with a 6-year follow-up. To the best of our knowledge, this fracture pattern and surgical management have not been previously reported.
CASE SUMMARY A 28-year-old man presented with left-hand volar tenderness and decreased grip strength that persisted for one month after a traffic accident. Radiography showed a distal capitate fracture with carpometacarpal joint incongruence. Computed tomography (CT) revealed a distal capitate fracture with carpometacarpal joint dislocation. The distal fragment was rotated by 90° in the sagittal plane, and an oblique shearing fracture pattern was noted. Open reduction and internal fixation (ORIF) with a locking plate were performed using the dorsal approach. The imaging studies performed 3 mo and 6 years following surgery revealed a healed fracture, and the Disabilities of the Arm, Shoulder, and Hand and visual analog scale scores were significantly improved.
CONCLUSION CT can detect capitate fractures with dorsal shearing pattern and concomitant carpometacarpal dislocation. ORIF using a locking plate are possible.
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Affiliation(s)
- Chien-Cheng Lai
- Department of Orthopedic Surgery, Far Eastern Memorial Hospital, New Taipei City 220, Taiwan
- Department of Chemical Engineering and Biotechnology, National Taipei University of Technology, Taipei 106, Taiwan
| | - Hsu-Wei Fang
- Department of Chemical Engineering and Biotechnology, National Taipei University of Technology, Taipei 106, Taiwan
| | - Chih-Hung Chang
- Department of Orthopedic Surgery, Far Eastern Memorial Hospital, New Taipei City 220, Taiwan
- Graduate School of Biotechnology and Bioengineering, Yuan Ze University, Taoyuan 320, Taiwan
| | - Jwo-Luen Pao
- Department of Orthopedic Surgery, Far Eastern Memorial Hospital, New Taipei City 220, Taiwan
| | - Chun-Chien Chang
- Department of Orthopedic Surgery, Far Eastern Memorial Hospital, New Taipei City 220, Taiwan
| | - Yeong-Jang Chen
- Department of Orthopedics, Fu Jen Catholic University Hospital, Fu Jen Catholic University, New Taipei City 243, Taiwan
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Huang YP, Pao JL, Chien TW, Lin JCJ, Chou PH. Thematic analysis of articles on artificial intelligence with spine trauma, vertebral metastasis, and osteoporosis using chord diagrams: A systematic review and meta-analysis. Medicine (Baltimore) 2022; 101:e32369. [PMID: 36596060 PMCID: PMC9803480 DOI: 10.1097/md.0000000000032369] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Spine trauma, vertebral metastases, and osteoporosis (SVO) can result in serious health problems. If the diagnosis of SVO is delayed, the prognosis may be deteriorated. The use of artificial intelligence (AI) is an essential method for minimizing the diagnostic errors associated with SVO. research achievements (RAs) of SVO on AI are required as a result of the greatest number of studies on AI solutions reported. The study aimed to: classify article themes using visualizations, illustrate the characteristics of SVO on AI recently, compare RAs of SVO on AI between entities (e.g., countries, institutes, departments, and authors), and determine whether the mean citations of keywords can be used to predict article citations. METHODS A total of 31 articles from SVO on AI (denoted by T31SVOAI) have been found in Web of Science since 2018. The dominant entities were analyzed using the CJAL score and the Y-index. Five visualizations were applied to report: the themes of T31SVOAI and their RAs in comparison for article entities and verification of the hypothesis that the mean citations of keywords can predict article citations, including: network diagrams, chord diagrams, dot plots, a Kano diagram, and radar plots. RESULTS There were five themes classified (osteoporosis, personalized medicine, fracture, deformity, and cervical spine) by a chord diagram. The dominant entities with the highest CJAL scores were the United States (22.05), the University of Pennsylvania (5.72), Radiology (6.12), and Nithin Kolanu (Australia) (9.88). The majority of articles were published in Bone, J. Bone Miner. Res., and Arch. Osteoporos., with an equal count (=3). There was a significant correlation between the number of article citations and the number of weighted keywords (F = 392.05; P < .0001). CONCLUSION A breakthrough was achieved by displaying the characteristics of T31SVOAI using the CJAL score, the Y-index, and the chord diagram. Weighted keywords can be used to predict article citations. The five visualizations employed in this study may be used in future bibliographical studies.
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Affiliation(s)
- Yu-Po Huang
- Department of Orthopedic Surgery, Far-Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Jwo-Luen Pao
- Department of Orthopedic Surgery, Far-Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Tsair-Wei Chien
- Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan
| | | | - Po-Hsin Chou
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Orthopedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan
- * Correspondence: Po-Hsin Chou, Department of Orthopedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan (e-mail: )
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Hsu TL, Yang CJ, Pao JL. Salmonella spondylodiscitis and epidural abscess successfully treated with unilateral biportal endoscopic discectomy and debridement: a rare case report. J Int Med Res 2022; 50:3000605221085405. [PMID: 35321567 PMCID: PMC8958527 DOI: 10.1177/03000605221085405] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Spinal epidural abscess (SEA) is a rare but severe infection with potentially devastating consequences. Epidural abscesses caused by Salmonella serogroup C2 are even rarer and tend to be more invasive with multidrug resistance. Early diagnosis, effective use of antibiotics and surgical intervention are the mainstay strategies for managing SEA, especially for more virulent and multidrug-resistant Salmonella infections. This case report presents a rare case of an elderly and fragile woman with Salmonella spondylodiscitis and an extensive epidural abscess, which were successfully treated with intravenous antibiotics and unilateral biportal endoscopic (UBE) debridement and drainage through four small surgical incisions. After surgery, her fever subsided, she regained consciousness and her low back pain dramatically improved. Follow-up magnetic resonance imaging showed complete resolution of the epidural abscess. At 6 months after surgery, the patient regained muscle strength, ambulated with a walker and had no recurrence of the infection. The UBE technique can effectively eradicate infection while minimizing surgery-related risks and complications. A multidisciplinary team is required to achieve a good outcome.
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Affiliation(s)
- Ta-Li Hsu
- Department of Orthopaedic Surgery, Far Eastern Memorial Hospital, New Taipei City
| | - Chia-Jui Yang
- Department of Infectious Disease, Division of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City.,School of Medicine, 34914National Yang Ming Chiao Tung University, National Yang Ming Chiao Tung University, Taipei
| | - Jwo-Luen Pao
- Department of Orthopaedic Surgery, Far Eastern Memorial Hospital, New Taipei City.,General Education Centre, Longhwa University of Science & Technology, Taoyuan
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Abstract
BACKGROUND The unilateral biportal endoscopic (UBE) technique provides minimally invasive decompression for degenerative lumbar canal stenosis (DLCS). With appropriate control of the hydrostatic pressure of normal saline irrigation, the surgery can be performed in a clear and magnified surgical field through 2 small surgical wounds. METHODS A review of published literature in PubMed was performed to identify studies of UBE decompression for DLCS. The outcome measures include operation time, length of hospital stay, estimated blood loss, visual analog scale (VAS) scores for back and leg pain, Oswestry Disability Index (ODI), and the Macnab criteria. RESULTS A total of 76 relevant studies were retrieved through the PubMed search. After screening, 15 studies comprising 6 case series, 6 comparative studies, and 3 randomized controlled trials were included in this review. Significant improvements in pain and neurological symptoms were obtained in all studies. In the 6 case series studies, the outcome measures were extracted from each study and summarized. The follow-up periods ranged from 8.6 to 29 months. The operation time was 72.0 min. The VAS score for leg pain was reduced from 7.8 to 1.7, and the VAS score for back pain was reduced from 5.8 to 1.7. The ODI was reduced from 63.0 to 20.7, and 87.3% of patients reported good to excellent outcomes according to the Macnab criteria. The complication rates ranged from 5.5% to 13.8%, with dural tear having the highest incidence rate. In the comparative studies and randomized controlled trials examining the UBE, microscopic, microendoscopic, and uniportal endoscopic techniques, the UBE technique showed treatment results that were comparable with the others. Compared with the microscopic technique, the UBE technique resulted in significantly less tissue trauma and quicker recovery with less wound pain, lower serum creatine kinase and C-reactive protein levels, and lower ODI in the very early postoperative period. The UBE technique also provided adequate decompression with less facet joint destruction than all the other decompression techniques. CONCLUSIONS The UBE technique is safe and effective for decompression of DLCS. Along with its efficacy in decompression, this technique is capable of preserving segmental stability. However, a long-term comparative study is required to verify this hypothesis.
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Affiliation(s)
- Jwo-Luen Pao
- Department of Orthopedic Surgery, Far-Eastern Memorial Hospital, New Taipei, Taiwan .,Longhwa University of Science & Technology, Taoyuan, Taiwan
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Lai CC, Wang TM, Chang CH, Pao JL, Fang HW, Chang CC, Lin SM, Lan TY. Calcaneal lengthening using ipsilateral fibula autograft in the treatment of symptomatic pes valgus in adolescents. BMC Musculoskelet Disord 2021; 22:977. [PMID: 34814872 PMCID: PMC8609868 DOI: 10.1186/s12891-021-04855-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 11/08/2021] [Indexed: 11/16/2022] Open
Abstract
Background Evans calcaneal lengthening osteotomy is used to treat symptomatic flexible flatfoot when conservative treatment fails. Grafts such as autologous iliac bone grafts, allografts, and xenografts are implanted at the osteotomy site to lengthen the lateral column of the hindfoot. This study aimed to present the outcomes of an autologous mid-fibula bone graft used for calcaneal lengthening in symptomatic pes valgus in adolescents. Methods We retrospectively examined 23 ft of 13 adolescents who underwent surgery between July 2014 and January 2018. The radiological and clinical outcomes (American Orthopaedic Foot and Ankle Society ankle-hindfoot scale scores) were assessed during a mean follow-up of 49.7 (range, 30.9–73.4) months. The mean distance of the lengthening site was measured to evaluate graft sinking or collapse. The Goldberg scoring system was used to determine the degree of union at the donor and recipient sites. Results The calcaneal pitch and the anteroposterior and lateral talo-first metatarsal (Meary) angles showed significant correction, from 14.4 to 19.6 (p < 0.001), and from 14.5 to 4.6 (p < 0.001) and 13.5 to 8.5 (p < 0.001), respectively. The mean distance of the lengthening site showed no significant change (p = 0.203), suggesting no graft sinking or postoperative collapse. The lateral distal tibial angle showed no significant difference (p = 0.398), suggesting no postoperative ankle valgus changes. Healing of the recipient and donor sites occurred in 23 and 21 ft, respectively. The American Orthopaedic Foot and Ankle Society ankle-hindfoot scores improved significantly, from 68.0 to 98.5 (p < 0.001). Conclusions Evans calcaneal lengthening using an ipsilateral mid-fibula bone autograft resulted in significant improvement in clinical and radiological outcomes without ankle valgus deformity. Hence, it could be a treatment option for lateral column calcaneal lengthening in adolescents.
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Affiliation(s)
- Chien-Cheng Lai
- Department of Orthopedic Surgery, Far Eastern Memorial Hospital, No. 21, Sec. 2, Nanya S. Rd., New Taipei City, 220, Taiwan.,Department of Chemical Engineering and Biotechnology, National Taipei University of Technology, Taipei, Taiwan
| | - Ting-Ming Wang
- Department of Orthopedic Surgery, School of Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Chih-Hung Chang
- Department of Orthopedic Surgery, Far Eastern Memorial Hospital, No. 21, Sec. 2, Nanya S. Rd., New Taipei City, 220, Taiwan.,Graduate School of Biotechnology and Bioengineering, Yuan Ze University, Taoyuan, Taiwan
| | - Jwo-Luen Pao
- Department of Orthopedic Surgery, Far Eastern Memorial Hospital, No. 21, Sec. 2, Nanya S. Rd., New Taipei City, 220, Taiwan
| | - Hsu-Wei Fang
- Department of Chemical Engineering and Biotechnology, National Taipei University of Technology, Taipei, Taiwan
| | - Chun-Chien Chang
- Department of Orthopedic Surgery, Far Eastern Memorial Hospital, No. 21, Sec. 2, Nanya S. Rd., New Taipei City, 220, Taiwan
| | - Shang-Ming Lin
- Department of Materials and Textiles, Asia Eastern University of Science and Technology, New Taipei City, Taiwan
| | - Tsung-Yu Lan
- Department of Orthopedic Surgery, Far Eastern Memorial Hospital, No. 21, Sec. 2, Nanya S. Rd., New Taipei City, 220, Taiwan. .,Department of Orthopedic Surgery, School of Medicine, National Taiwan University Hospital, Taipei, Taiwan. .,Department of Materials and Textiles, Asia Eastern University of Science and Technology, New Taipei City, Taiwan.
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Abstract
Background Unilateral biportal endoscopic (UBE) decompression is a minimally invasive (MI) approach to treat degenerative lumbar canal stenosis (DLCS). Decompression can be performed in a clear and magnified surgical field with proper control of normal saline inflow and outflow. Methods Clinical and radiographic data of 81 consecutive patients of DLCS treated between July 2018 and Feb 2019 using UBE techniques were reviewed. They were 38 males and 43 females with an average age of 70.2. Sixty-nine had pure canal stenosis and 12 patients had associated spondylolisthesis. Bilateral decompression via unilateral laminotomy was performed from the side on patients with more severe neurological symptoms. This is a retrospective study from chart review and image analysis. Therefore, we don't have formal ethical information for this study, and it is not mandatory in our hospital. Results At the final follow-up, the mean VAS for low back pain was improved from 4.3±3.0 to 1.2±1.0 and the VAS for leg symptoms was improved from 7.3±2.2 to 0.9±0.7. The mean JOA score and ODI was significantly improved from 13.3±7.9 to 25.3±5.0 and from 54.6±16.9 to 14.6±12.6, respectively. Modified Macnab criteria were excellent in 47 patients (58.0%), good in 29 (35.8%), fair in 5 (6.2%). The average hospital stay was 3.6±2.4 days. MRI before and after the operation showed the cross-sectional dural area (CSDA) was significantly increased from 71.4±36.5 to 177.3±59.2 mm2, corresponding to a 201.9%±188.0% increase. The percentage of facet joint preservation was 84.2% on the approach side and 92.9% on the contralateral side. Complications included 4 dural tears, 1 transient motor weakness, 1 inadequate decompression, and 1 epidural hematoma. Conclusions With UBE techniques, decompression for DLCS can be performed safely and effectively. The soft tissue and facet joint destruction are minimized; therefore, it is possible to avoid spinal fusion as well as to preserve the segmental stability.
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Affiliation(s)
- Jwo-Luen Pao
- Department of Orthopedic Surgery, Far-Eastern Memorial Hospital, New Taipei
| | - Shang-Ming Lin
- Department of Materials and Textiles, Oriental Institute of Technology, New Taipei
| | - Wen-Chi Chen
- Department of Orthopedic Surgery, Far-Eastern Memorial Hospital, New Taipei
| | - Chih-Hung Chang
- Department of Orthopedic Surgery, Far-Eastern Memorial Hospital, New Taipei
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Lin CH, Lin SM, Lan TY, Pao JL. Pneumocephalus with Conscious Disturbance After Full Endoscopic Lumbar Diskectomy. World Neurosurg 2019; 131:112-115. [DOI: 10.1016/j.wneu.2019.07.200] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 07/26/2019] [Indexed: 10/26/2022]
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Wang CT, Chen JW, Wu K, Chen CS, Chen WC, Pao JL, Chang CH, Lan TY. Suboptimal outcomes after closed reduction and internal fixation of displaced femoral neck fractures in middle-aged patients: is internal fixation adequate in this age group? BMC Musculoskelet Disord 2018; 19:190. [PMID: 29885670 PMCID: PMC5994253 DOI: 10.1186/s12891-018-2120-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Accepted: 05/31/2018] [Indexed: 02/07/2023] Open
Abstract
Background There have been many studies regarding nongeriatric femoral neck fractures (FNFs), which included patients of a wide age range (between 20 and 60 years old). We aimed to determine whether internal fixation provided acceptable outcomes for middle-aged patients with displaced FNFs, and identify predictors of successful internal fixation. Methods A total of 117 patients, aged 50–60 years and who underwent closed reduction and unilateral internal fixation using cannulated screws, were included. The outcomes were classified as either “complications” (varus malunion, femoral neck shortening, non-union/early collapse, avascular necrosis, or arthroplasty during the follow-up) or “optimal outcomes” (no complications). Patients with displaced FNFs (Garden stages III–IV, n = 69) were categorized according to whether they experienced acceptable or unacceptable reduction. We evaluated whether patients’ clinical characteristics could predict optimal outcomes. Results Patients with displaced FNFs generally experienced complications (84.1%). Twenty-two percent of patients experienced optimal outcomes when acceptable reduction was achieved. Patients with unacceptable reductions experienced complications. Optimal outcomes were positively associated with Pauwels’ type II fracture (OR: 8.67, p = 0.025) and negatively associated with excessive alcohol consumption (p = 0.045). Conclusions Compared with the younger age group, complication rates are higher in middle-aged patients with displaced FNFs treated using cannulated screws. If internal fixation is to be used for a displaced FNF, patient selection is essential. Care must be taken to avoid selecting patients with excessive alcohol consumption, while successful internal fixation may be more likely for patients with Pauwels’ type II fracture.
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Affiliation(s)
- Cheng-Tzu Wang
- Department of Orthopaedic Surgery, Far Eastern Memorial Hospital, No. 21, Sec. 2, Nanya S. Rd., Banciao Dist, New Taipei City, 220, Taiwan
| | - Jia-Wan Chen
- Department of Mechanical Engineering, Oriental Institute of Technology, New Taipei City, Taiwan
| | - Karl Wu
- Department of Orthopaedic Surgery, Far Eastern Memorial Hospital, No. 21, Sec. 2, Nanya S. Rd., Banciao Dist, New Taipei City, 220, Taiwan.,Department of Mechanical Engineering, Oriental Institute of Technology, New Taipei City, Taiwan
| | - Chiang-Sang Chen
- Department of Orthopaedic Surgery, Far Eastern Memorial Hospital, No. 21, Sec. 2, Nanya S. Rd., Banciao Dist, New Taipei City, 220, Taiwan
| | - Wen-Chih Chen
- Department of Orthopaedic Surgery, Far Eastern Memorial Hospital, No. 21, Sec. 2, Nanya S. Rd., Banciao Dist, New Taipei City, 220, Taiwan
| | - Jwo-Luen Pao
- Department of Orthopaedic Surgery, Far Eastern Memorial Hospital, No. 21, Sec. 2, Nanya S. Rd., Banciao Dist, New Taipei City, 220, Taiwan
| | - Chih-Hung Chang
- Department of Orthopaedic Surgery, Far Eastern Memorial Hospital, No. 21, Sec. 2, Nanya S. Rd., Banciao Dist, New Taipei City, 220, Taiwan
| | - Tsung-Yu Lan
- Department of Orthopaedic Surgery, Far Eastern Memorial Hospital, No. 21, Sec. 2, Nanya S. Rd., Banciao Dist, New Taipei City, 220, Taiwan. .,Department of Mechanical Engineering, Oriental Institute of Technology, New Taipei City, Taiwan.
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Chen YJ, Pao JL, Chen CS, Chen YC, Chang CC, Hung FM, Chang CH. Evaluation of New Biphasic Calcium Phosphate Bone Substitute: Rabbit Femur Defect Model and Preliminary Clinical Results. J Med Biol Eng 2017; 37:85-93. [PMID: 28286465 PMCID: PMC5325870 DOI: 10.1007/s40846-016-0203-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Accepted: 05/26/2016] [Indexed: 11/28/2022]
Abstract
Autogenous bone grafting, used to repair bone defects, is limited and the donor site can experience complications. Compared to autogenous bone graft, artificial bones have different porosity, which might make them suitable alternatives to bone grafts. Here, two porous biphasic calcium phosphate bone substitutes, namely Bicera™ and Triosite™, are used in an animal study and clinical practice to find a suitable porosity for implantation. Bicera™ and Triosite™ consist of 60 wt% hydroxyapatite and 40 wt% β-tricalcium phosphate, with the porosity of Bicera™ (82%) being higher than that of Triosite™ (70%). In the animal study, the implantation procedure was carried out on twenty-four female New Zealand rabbits. 12 weeks after implantation, the new bones were well infiltrated into the Bicera™ and Triosite™ bone grafts. In the clinical study, patients with comminuted fracture, fracture nonunion, or arthrodesis were included in the study of bone substitution with Bicera™. 27 patients underwent fracture fixation treatment. Bone healing of 22.22% (6/27) of patients happened within 3 months after the surgery, and that of 66.67% (18/27) of patients happened within 6 months. These results reveal that Bicera™ has good incorporation with host bone, and that new bone is able to grow within the porous structure, giving it high potential in the treatment of bone defects.
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Affiliation(s)
- Yeong-Jang Chen
- Department of Orthopaedic Surgery, Far Eastern Memorial Hospital, Banqiao, 21 Nanya S. Rd. Sec. 2, Banciao Dist., New Taipei City, 220 Taiwan.,Department of Orthopaedic Surgery, National Taiwan University Hospital, Taipei, 10002 Taiwan
| | - Jwo-Luen Pao
- Department of Orthopaedic Surgery, Far Eastern Memorial Hospital, Banqiao, 21 Nanya S. Rd. Sec. 2, Banciao Dist., New Taipei City, 220 Taiwan.,Institute of Biomedical Engineering, National Taiwan University, Taipei, 10002 Taiwan
| | - Chiang Sang Chen
- Department of Orthopaedic Surgery, Far Eastern Memorial Hospital, Banqiao, 21 Nanya S. Rd. Sec. 2, Banciao Dist., New Taipei City, 220 Taiwan.,Institute of Biomedical Engineering, National Taiwan University, Taipei, 10002 Taiwan
| | - Yu-Chun Chen
- Department of Orthopaedic Surgery, Far Eastern Memorial Hospital, Banqiao, 21 Nanya S. Rd. Sec. 2, Banciao Dist., New Taipei City, 220 Taiwan.,Graduate School of Biotechnology and Bioengineering, Yuan Ze University, Taoyuan, 32003 Taiwan
| | - Chun-Chien Chang
- Department of Orthopaedic Surgery, Far Eastern Memorial Hospital, Banqiao, 21 Nanya S. Rd. Sec. 2, Banciao Dist., New Taipei City, 220 Taiwan
| | - Fang-Ming Hung
- Department of Surgical Intensive Care Unit, Far Eastern Memorial Hospital, New Taipei City, 220 Taiwan
| | - Chih-Hung Chang
- Department of Orthopaedic Surgery, Far Eastern Memorial Hospital, Banqiao, 21 Nanya S. Rd. Sec. 2, Banciao Dist., New Taipei City, 220 Taiwan.,Graduate School of Biotechnology and Bioengineering, Yuan Ze University, Taoyuan, 32003 Taiwan
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12
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Wang TY, Pao JL, Yang RS, Jang JSR, Hsu WL. The adaptive changes in muscle coordination following lumbar spinal fusion. Hum Mov Sci 2015; 40:284-97. [DOI: 10.1016/j.humov.2015.01.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Revised: 12/03/2014] [Accepted: 01/05/2015] [Indexed: 10/24/2022]
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13
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Pao JL, Yang RS, Hsiao CH, Hsu WL. Trunk Control Ability after Minimally Invasive Lumbar Fusion Surgery during the Early Postoperative Phase. J Phys Ther Sci 2014; 26:1165-71. [PMID: 25202174 PMCID: PMC4155213 DOI: 10.1589/jpts.26.1165] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Accepted: 02/16/2014] [Indexed: 11/24/2022] Open
Abstract
[Purpose] Lumbar fusion has been used for spinal disorders when conservative treatment
fails. The minimally invasive approach causes minimal damage to the back muscles and
shortens the postoperative recovery time. However, evidence regarding functional recovery
in patients after minimally invasive lumbar spinal fusion is limited. The purpose of this
study was to investigate how trunk control ability is affected after minimally invasive
lumbar fusion surgery during the early postoperative phase. [Subjects and Methods] Sixteen
patients and 16 age- and sex-matched healthy participants were recruited. Participants
were asked to perform a maximum forward reaching task and were evaluated 1 day before and
again 1 month after the lumbar fusion surgery. Center of pressure (COP) displacement, back
muscle strength, and scores for the Visual Analog Scale, and Chinese version of the
modified Oswestry Disability Index (ODI) were recorded. [Results] The healthy control
group exhibited more favorable outcomes than the patient group both before and after
surgery in back strength, reaching distance, reaching velocity, and COP displacement. The
patient group improved significantly after surgery in all clinical outcome measurements.
However, reaching distance decreased, and the reaching velocity as well as COP
displacement did not differ before and after surgery. [Conclusion] The LBP patients with
lumbar fusion surgery showed improvement in pain intensity 1 month after surgery but no
improvement in trunk control during forward reaching. The results provide evidence that
the back muscle strength was not fully recovered in patients 1 month after surgery and
limited their ability to move their trunk forward.
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Affiliation(s)
- Jwo-Luen Pao
- Institute of Biomedical Engineering, National Taiwan University, Taiwan ; Division of Orthopedic Surgery, Department of Surgery, Far Eastern Memorial Hospital, Taiwan
| | - Rong-Sen Yang
- Department of Orthopedics, National Taiwan University Hospital, Taiwan ; Department of Orthopedics, College of Medicine, National Taiwan University, Taiwan
| | - Chen-Hsi Hsiao
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taiwan
| | - Wei-Li Hsu
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taiwan ; Physical Therapy Center, National Taiwan University Hospital, Taiwan
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14
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Lan TY, Chen CY, Liao PF, Chen WC, Wu K, Pao JL, Chang CH. Comminuted olecranon fractures treated with anatomically preshaped locking and nonlocking plates: A retrospective comparative study. ACTA ACUST UNITED AC 2013. [DOI: 10.1016/j.fjmd.2013.01.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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16
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Pao JL, Chen WC, Chen PQ. Clinical outcomes of microendoscopic decompressive laminotomy for degenerative lumbar spinal stenosis. Eur Spine J 2009; 18:672-8. [PMID: 19238459 DOI: 10.1007/s00586-009-0903-2] [Citation(s) in RCA: 103] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2008] [Revised: 01/11/2009] [Accepted: 01/24/2009] [Indexed: 11/28/2022]
Abstract
The goal of surgical treatment for degenerative lumbar spinal stenosis (LSS) is to effectively relieve the neural structures by various decompressive techniques. Microendoscopic decompressive laminotomy (MEDL) is an attractive option because of its minimally invasive nature. The aim of prospective study was to investigate the effectiveness of MEDL by evaluating the clinical outcomes with patient-oriented scoring systems. Sixty consecutive patients receiving MEDL between December 2005 and April 2007 were enrolled. The indications of surgery were moderate to severe stenosis, persistent neurological symptoms, and failure of conservative treatment. The patients with mechanical back pain, more than grade I spondylolisthesis, or radiographic signs of instability were not included. A total of 53 patients (36 women and 17 men, mean age 62.0) were included. Forty-five patients (84.9%) were satisfied with the treatment result after a follow-up period of 15.7 months (12-24). The clinical outcomes were evaluated with the Oswestry disability index (ODI) and the Japanese Orthopedic Association (JOA) score. Of the 50 patients providing sufficient data for analysis, the ODI improved from 64.3 +/- 20.0 to 16.7 +/- 20.0. The JOA score improved from 9.4 +/- 6.1 to 24.2 +/- 6.0. The improvement rate was 73.9 +/- 30.7% and 40 patients (80%) had good or excellent results. There were 11 surgical complications: dural tear in 5, wrong level operation in 2, and transient neuralgia in 4 patients. No wound-related complication was noted. Although the prevalence of pre-operative comorbidities was very high (69.8%), there was no serious medical complication. There was no post-operative instability at the operated segment as evaluated with dynamic radiographs at final follow-up. We concluded that MEDL is a safe and very effective minimally invasive technique for degenerative LSS. With an appropriate patient selection, the risk of post-operative instability is minimal.
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Affiliation(s)
- Jwo-Luen Pao
- Division of Orthopedic Surgery, Department of Surgery, Far Eastern Memorial Hospital, Pan-Chiao, Taipei, Taiwan
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17
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Chung SD, Chiu B, Chang HC, Pao JL. Pott's disease with bilateral paraspinal abscesses. Int J Infect Dis 2009; 13:e335-6. [PMID: 19185526 DOI: 10.1016/j.ijid.2008.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2008] [Accepted: 12/12/2008] [Indexed: 10/21/2022] Open
Affiliation(s)
- Shiu-Dong Chung
- Division of Urology, Department of Surgery, Far Eastern Memorial Hospital, Ban Ciao, Taipei, Taiwan
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18
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Pao JL, Jiang CC. Retrograde intramedullary nailing for nonunions of supracondylar femur fracture of osteoporotic bones. J Formos Med Assoc 2005; 104:54-9. [PMID: 15660180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023] Open
Abstract
Nonunion of supracondylar femur fracture remains a challenging problem because of limited treatment options. The situation is more complex when it occurs in elderly patients with osteoporotic bones. We report the treatment of 3 elderly patients with supracondylar femur fracture nonunion after open reduction and internal fixation with various plate-screw internal fixation systems. Two of these patients had traumatic fractures and the third had a periprosthetic fracture after primary total knee arthroplasty (TKA). After revision surgeries using retrograde nailing techniques, all fractures united eventually. When combined with indirect reduction, these techniques provide superior biomechanical properties and reduce the need for soft tissue dissection.
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Affiliation(s)
- Jwo-Luen Pao
- Division of Orthopedic Surgery, Department of Surgery, Far Eastern Memorial Hospital, Taipei, Taiwan
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Abstract
Amputation after total knee arthroplasty (TKA) is an extremely rare but disastrous complication. Most of the reported cases resulted from refractory deep joint sepsis or perioperative vascular complications. We present a case of above-knee amputation resulting from vascular complications after recurrent dislocations of a TKA in a patient with underlying end-stage renal disease. The possible association between certain metabolic diseases and instability of TKA is discussed. In contrast to the high incidence of vascular complications after traumatic knee dislocation, popliteal artery injury after TKA dislocation is seldom encountered. The importance of careful evaluation and serial physical examinations to exclude the possibility cannot be overemphasized, however. When compromise of the circulation was recognized, emergent exploration of the popliteal fossa for repair of the vascular injury presented the best chance to save the limb.
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Affiliation(s)
- Jwo-Luen Pao
- Department of Orthopedic Surgery, National Taiwan University Hospital, Taipei, Taiwan, Republic of China
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Abstract
Prosthetic joint infection with Candida is uncommon. Only 28 cases have been reported in the English literature. Successful reimplantation after eradication of Candida infection has been reported in 3 hip joints and only 1 knee. We present the case of a 68-year-old woman with chronic Candida parapsilosis infection of a prosthetic knee joint. Removal of the prosthesis, thorough débridement, and antifungal therapy treated the infection successfully. Antifungal therapy included 6 weeks of parenteral administration of fluconazole followed by 4 weeks of oral fluconazole. The involved knee joint was reimplanted 3 months after initial treatment. The prosthetic joint was pain free and functioned satisfactorily during the ensuing 4 years. No recurrence of infection was noted. The principle in treating Candida prosthetic infection generally has been the same as that of bacterial prosthetic infection. In chronic cases, removal of implants, thorough débridement, and effective antifungal therapy are mandatory for the eradication of infection. Reimplantation of the prosthesis can be performed successfully in a staged surgical procedure with the interval between the 2 stages shortened to 3 months.
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Affiliation(s)
- S H Yang
- Department of Orthopaedic Surgery, National Taiwan University Hospital, Taipei, Taiwan
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