Journal of Joint Surgery and Research最新文献_第8页

Accuracy of acetabular cup placement in total hip arthroplasty using an augmented reality navigation “pin-less” system: A pilot study 使用增强现实导航 "无针 "系统进行全髋关节置换术中髋臼杯置入的准确性：试点研究

Journal of Joint Surgery and Research

Pub Date : 2024-06-21 DOI: 10.1016/j.jjoisr.2024.06.002

Tetsuya Kimura , Tatsuya Tamaki , Hiroyuki Ogawa

Purpose

Currently, there is limited information regarding the utilization of pin-less augmented reality (AR) assistance in total hip arthroplasty (THA). This preliminary study aimed to evaluate the precision of acetabular cup placement in THA utilizing the AR Navigation “Pin-less” System (Pin-less AR navigation, prototype).

Methods

A total of 72 consecutive primary THAs in 58 patients were categorized into two groups: the Pin-less AR navigation group and the conventional group. All THAs were conducted via the direct anterior approach. First, the absolute value of difference between the intra-operative and post-operative angles (absolute difference) was calculated in the Pin-less AR navigation group. Second, the absolute value of error between the post-operative angles and the target angles (absolute target error) was assessed both in the Pin-less AR navigation group and the conventional group.

Results

The absolute difference in inclination and anteversion angles was 2.2 ± 1.4° and 2.4 ± 1.5°, respectively. The absolute target error in the Pin-less AR navigation group versus the conventional group was 1.9 ± 1.5° versus 4.2 ± 2.7° in inclination (P < 0.001) and 2.3 ± 1.5° versus 3.1 ± 2.1° in anteversion (P = 0.092). The percentage of acetabular cups placed within ±5° from the target angles was significantly higher in the Pin-less AR navigation group (90.3%) compared with the conventional group (52.6%) (P < 0.001).

Conclusions

This study demonstrates that Pin-less AR navigation yielded generally accurate acetabular cup positioning, surpassing the conventional method. Further research is warranted to thoroughly evaluate Pin-less AR navigation.

目的目前，有关在全髋关节置换术（THA）中使用无针增强现实（AR）辅助的信息非常有限。本初步研究旨在评估在全髋关节置换术中使用 "无针 "AR 导航系统（Pin-less AR navigation，原型）进行髋臼杯置放的精确度。方法将 58 名患者的 72 例连续全髋关节置换术分为两组：无针 AR 导航组和传统组。所有 THAs 均通过直接前路进行。首先，计算无针孔 AR 导航组术中和术后角度差的绝对值（绝对差）。其次，评估了无针孔 AR 导航组和传统组术后角度与目标角度之间误差的绝对值（绝对目标误差）。结果倾角和前内翻角度的绝对差值分别为 2.2 ± 1.4° 和 2.4 ± 1.5°。无针 AR 导航组与传统组的绝对目标误差分别为：倾斜 1.9 ± 1.5° 对 4.2 ± 2.7°（P < 0.001），内翻 2.3 ± 1.5° 对 3.1 ± 2.1°（P = 0.092）。与传统方法组（52.6%）相比，无针孔 AR 导航组（90.3%）放置的髋臼杯与目标角度的距离在 ±5° 以内的比例明显更高（P < 0.001）。有必要开展进一步研究，对无针式 AR 导航进行全面评估。

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引用次数: 0

Method for defining the horizontal plane in fluoroscopic kinematic analysis 在透视运动学分析中定义水平面的方法

Journal of Joint Surgery and Research

Pub Date : 2024-06-21 DOI: 10.1016/j.jjoisr.2024.05.002

Takahiro Arakawa , Kenichi Kono , Tetsuya Tomita , Takaharu Yamazaki , Masashi Tamaki , Shoji Konda , Teruya Ishibashi , Ryota Yamagami , Kohei Kawaguchi , Tomofumi Kage , Ryo Murakami , Hiroshi Inui , Shuji Taketomi , Sakae Tanaka

Purpose

In vivo kinematics of skeletal joints and prostheses is affected by gravity; therefore, absolute tilt must be taken into account. However, current fluoroscopic kinematic analysis cannot measure the tilt. This study introduces and validates a method for defining the horizontal plane in fluoroscopy systems to measure the tilt of an object.

Methods

A rectangular metal plate (200 × 200 × 10 mm) with a flatness of 0.03/100 mm was horizontally adjusted using a leveler (sensitivity of 0.02° and accuracy of ±0.06°), and its three-dimensional coordinate was calculated from a two-dimensional fluoroscopic image. A coordinate calculation formula was developed, with precision and accuracy assessed via computer simulations. Actual fluoroscopic tests included four aspects: accuracy under the same condition; accuracy under different X-ray tube height; reproducibility when changing X-ray tube height; and reproducibility when the flat panel was tilted and returned.

Results

The theoretical measurement error indicated by the computer simulations was 0.0 ± 0.2° on the xy-plane and 0.0 ± 0.0° on the yz-plane. The actual experimental results showed that the horizontal plane tilt was measured to be −0.2 ± 0.1° tilt on the xy-plane and 0.3 ± 0.0° tilt on the yz-plane for the device used in this study. The F-test showed no significant differences between the computer simulations and the actual experiments. There were no significant differences between the four actual tests.

Conclusions

This method enables the horizontal plane to be defined and the tilt of an object to be measured in fluoroscopic kinematic analysis.

目的骨骼关节和假体的体内运动学受重力影响，因此必须考虑绝对倾斜。然而，目前的透视运动学分析无法测量倾斜度。本研究介绍并验证了一种在透视系统中定义水平面以测量物体倾斜度的方法。方法使用水平仪（灵敏度为 0.02°，精确度为 ±0.06°）水平调整平整度为 0.03/100 mm 的矩形金属板（200 × 200 × 10 mm），并根据二维透视图像计算其三维坐标。我们开发了一个坐标计算公式，并通过计算机模拟对精确度和准确性进行了评估。实际透视测试包括四个方面：相同条件下的精确度；不同 X 射线管高度下的精确度；改变 X 射线管高度时的再现性；平板倾斜和返回时的再现性。实际实验结果表明，本研究中使用的设备在 xy 平面上测得的水平面倾斜度为 -0.2 ± 0.1°，在 yz 平面上测得的水平面倾斜度为 0.3 ± 0.0°。F 检验表明，计算机模拟与实际实验之间没有显著差异。结论这种方法可以在透视运动学分析中定义水平面并测量物体的倾斜度。

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引用次数: 0

Soft tissue balance in total knee arthroplasty: Clinical value of intra-operative measurement 全膝关节置换术中的软组织平衡：术中测量的临床价值

Journal of Joint Surgery and Research

Pub Date : 2024-05-29 DOI: 10.1016/j.jjoisr.2024.05.001

Tomoyuki Matsumoto , Naoki Nakano , Masanori Tsubosaka , Hirotsugu Muratsu

Purpose:

Considering successful clinical outcomes, accurate osteotomy/implantation and soft tissue balancing are essential in total knee arthroplasty (TKA). However, intra-operative assessment of soft tissue balance remains difficult, and management is left much to the surgeon's subjective feel and experience. The aim of this paper was to review various soft tissue balance assessments and their relationship with pre- and intra-operative factors and clinical outcomes.

Methods:

Literature regarding the history of soft tissue balance measurement, various types of measurement tools, theory of recent measurement, influence of various factors on soft tissue balance, and influence of soft tissue balance on clinical outcomes in TKA was reviewed using the PubMed database.

Results:

Soft tissue balance measurement has switched from the unphysiological condition, i.e., with assessment between bone cut surfaces and patellar eversion, to the physiological condition, i.e. with femoral component placement and patellofemoral joint reduction. Type of prosthesis, implant design, surgical technique, and pre-operative factors affect intra-operative soft tissue balance. Intra-operative soft tissue balance also affects post-operative range of motion and patient-reported outcome measures.

Conclusions:

Intra-operative quantitative soft tissue balance measurement and management with physiological knee condition, which is closely influenced by various pre-operative and intra-operative factors, is important for the achievement of high knee function and patient satisfaction.

目的：考虑到成功的临床结果，准确的截骨/植入和软组织平衡对全膝关节置换术（TKA）至关重要。然而，术中对软组织平衡的评估仍然很困难，管理在很大程度上取决于外科医生的主观感觉和经验。本文旨在回顾各种软组织平衡评估及其与术前、术中因素和临床结果的关系。方法：使用 PubMed 数据库回顾了有关软组织平衡测量的历史、各种类型的测量工具、最新测量理论、各种因素对软组织平衡的影响以及软组织平衡对 TKA 临床结果的影响等方面的文献、结果：软组织平衡测量已从非生理状态（即评估骨切面和髌骨外翻）转变为生理状态（即股骨组件置入和髌股关节缩小）。假体类型、植入物设计、手术技术和术前因素都会影响术中软组织平衡。结论：术中软组织平衡的定量测量和管理与膝关节生理状态密切相关，受术前和术中各种因素的影响，对实现高膝关节功能和患者满意度非常重要。

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引用次数: 0

Pre- and post-operative knee alignment phenotypes in restricted kinematic alignment, mechanical alignment total knee arthroplasty, and unicompartmental knee arthroplasty 限制性运动对位、机械对位全膝关节置换术和单髁膝关节置换术的术前和术后膝关节对位表型

Journal of Joint Surgery and Research

Pub Date : 2024-05-22 DOI: 10.1016/j.jjoisr.2024.04.003

Shotaro Araki, Takafumi Hiranaka, Takaaki Fujishiro, Koji Okamoto

Purpose

The coronal plane alignment of the knee (CPAK) classification has been introduced as a simple system to classify knee phenotypes based on leg alignment [hip–knee–ankle angle (HKA) and joint line obliquity (JLO)]. Differences in post-operative phenotype between mechanical alignment (MA) and kinematic alignment (KA) total knee arthroplasty (TKA) have been reported, but not the phenotypes after unicompartmental knee arthroplasty (UKA). Moreover, most studies have focused upon Western populations. This study compared pre- and post-operative knee phenotypes between MA-TKA, KA-TKA, and UKA in a Japanese cohort.

Methods

In this study, 230 knees in 165 patients who underwent UKA, 124 knees in 80 patients who underwent MA-TKA, and 80 knees in 51 patients who underwent restricted KA-TKA in Takatsuki General Hospital between March 2019 and January 2021 were retrospectively investigated. Pre- and post-operative lateral distal femoral angle (LDFA) and medial proximal tibial angle (MPTA) were measured, and JLO (MPTA + LDFA) and arithmetic HKA (aHKA) (MPTA – LDFA) were calculated and compared between the surgeries.

Results

Pre-operative JLO and aHKA did not significantly differ between the three groups (pre. JLO, p = 0.164; pre. aHKA, p = 0.13). Pre-operatively, 62.0% of knees were categorized as type I (varus leg alignment and medially sloped joint line). After UKA, 59.1% of type I inherited the pre-operative phenotype, whereas most cases were altered in MA-TKA and KA-TKA (4.8% and 30.0%, respectively, inherited the pre-operative phenotype).

Conclusions

The pre-operative phenotype was mostly inherited after UKA and to a lesser extent after KA-TKA, whereas it tended to be altered after MA-TKA.

目的膝关节冠状面对位（CPAK）分类法是根据腿部对位[髋-膝-踝角度（HKA）和关节线斜度（JLO）]对膝关节表型进行分类的简单系统。有报道称，机械对位（MA）和运动对位（KA）全膝关节置换术（TKA）的术后表型存在差异，但单隔间室膝关节置换术（UKA）的表型却未见报道。此外，大多数研究都集中在西方人群。本研究比较了日本队列中MA-TKA、KA-TKA和UKA的术前和术后膝关节表型。本研究回顾性调查了2019年3月至2021年1月期间在高槻综合医院接受UKA的165名患者的230个膝关节、接受MA-TKA的80名患者的124个膝关节以及接受限制性KA-TKA的51名患者的80个膝关节。测量术前和术后股骨外侧远端角度（LDFA）和胫骨内侧近端角度（MPTA），计算JLO（MPTA + LDFA）和算术HKA（aHKA）（MPTA - LDFA），并对不同手术进行比较。术前，62.0%的膝关节被归类为I型（腿屈曲对齐和关节线内侧倾斜）。UKA术后，59.1%的I型膝关节继承了术前的表型，而MA-TKA和KA-TKA术后大多数病例的表型发生了改变（分别有4.8%和30.0%的病例继承了术前的表型）。

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引用次数: 0

Impact of prognostic nutritional index on the occurrence of post-operative delirium after total knee arthroplasty 预后营养指数对全膝关节置换术后谵妄发生率的影响

Journal of Joint Surgery and Research

Pub Date : 2024-05-18 DOI: 10.1016/j.jjoisr.2024.04.004

Kensuke Hotta, Mitsuru Hanada, Yukihiro Matsuyama

Purpose

Delirium has been reported to cause delayed functional recovery, prolonged hospitalization, future institutionalization, increased mortality, and increased healthcare costs. However, there are no reports on how prognostic nutritional index (PNI), Controlling Nutritional Status (CONUT) score, and geriatric nutritional risk index (GNRI) are related to delirium after total knee arthroplasty (TKA). This study aimed to identify risk factors for post-operative delirium after TKA using various pre-operative nutritional assessments (PNI, CONUT score, and GNRI).

Methods

In total, 289 patients who underwent primary TKA between September 2011 and April 2022 in our institute (Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan) were enrolled. Patients were divided into two groups: those who developed post-operative delirium (Group D), and those who did not (Group ND). Pre-operative risk factors, including nutritional indices, for post-operative delirium were evaluated.

Results

Group D comprised 16 participants, while Group ND comprised 273 participants. Comparisons between the two groups revealed significant differences in age, PNI, CONUT score, GNRI, and history of cerebrovascular disease. Multiple logistic regression analysis revealed that significant risk factors for delirium after TKA were age, PNI, and history of cerebrovascular disease. A receiver operating characteristic curve indicated that the cutoff values for delirium were 47.4 for PNI (sensitivity, 0.810; specificity, 0.875) and 78.5 years for age (sensitivity, 0.813; specificity, 0.722).

Conclusions

Risk factors for post-operative delirium after TKA were PNI <47.4, age >78.5 years, and history of cerebrovascular disease. Patients exceeding these pre-operative cutoff values or with a history of cerebrovascular disease should receive counseling about delirium before surgery.

目的据报道，谵妄会导致功能恢复延迟、住院时间延长、未来入院治疗、死亡率上升以及医疗费用增加。然而，目前还没有关于预后营养指数（PNI）、营养状况控制评分（CONUT）和老年营养风险指数（GNRI）与全膝关节置换术（TKA）后谵妄的关系的报道。本研究旨在通过各种术前营养评估（PNI、CONUT 评分和 GNRI）来确定 TKA 术后谵妄的风险因素。方法：本研究所（日本静冈县浜松市浜松大学医学院）在 2011 年 9 月至 2022 年 4 月期间共招募了 289 名接受初级 TKA 手术的患者。患者分为两组：术后出现谵妄的患者（D组）和未出现谵妄的患者（ND组）。结果 D组有16人，ND组有273人。通过比较发现，两组在年龄、PNI、CONUT 评分、GNRI 和脑血管疾病史方面存在显著差异。多元逻辑回归分析显示，年龄、PNI 和脑血管病史是导致 TKA 术后谵妄的重要风险因素。接收器操作特征曲线显示，谵妄的临界值为 PNI 47.4（灵敏度 0.810；特异度 0.875）和年龄 78.5（灵敏度 0.813；特异度 0.722）。超过上述术前临界值或有脑血管疾病史的患者应在手术前接受有关谵妄的咨询。

{"title":"Impact of prognostic nutritional index on the occurrence of post-operative delirium after total knee arthroplasty","authors":"Kensuke Hotta, Mitsuru Hanada, Yukihiro Matsuyama","doi":"10.1016/j.jjoisr.2024.04.004","DOIUrl":"https://doi.org/10.1016/j.jjoisr.2024.04.004","url":null,"abstract":"<div><h3>Purpose</h3><p>Delirium has been reported to cause delayed functional recovery, prolonged hospitalization, future institutionalization, increased mortality, and increased healthcare costs. However, there are no reports on how prognostic nutritional index (PNI), Controlling Nutritional Status (CONUT) score, and geriatric nutritional risk index (GNRI) are related to delirium after total knee arthroplasty (TKA). This study aimed to identify risk factors for post-operative delirium after TKA using various pre-operative nutritional assessments (PNI, CONUT score, and GNRI).</p></div><div><h3>Methods</h3><p>In total, 289 patients who underwent primary TKA between September 2011 and April 2022 in our institute (Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan) were enrolled. Patients were divided into two groups: those who developed post-operative delirium (Group D), and those who did not (Group ND). Pre-operative risk factors, including nutritional indices, for post-operative delirium were evaluated.</p></div><div><h3>Results</h3><p>Group D comprised 16 participants, while Group ND comprised 273 participants. Comparisons between the two groups revealed significant differences in age, PNI, CONUT score, GNRI, and history of cerebrovascular disease. Multiple logistic regression analysis revealed that significant risk factors for delirium after TKA were age, PNI, and history of cerebrovascular disease. A receiver operating characteristic curve indicated that the cutoff values for delirium were 47.4 for PNI (sensitivity, 0.810; specificity, 0.875) and 78.5 years for age (sensitivity, 0.813; specificity, 0.722).</p></div><div><h3>Conclusions</h3><p>Risk factors for post-operative delirium after TKA were PNI <47.4, age >78.5 years, and history of cerebrovascular disease. Patients exceeding these pre-operative cutoff values or with a history of cerebrovascular disease should receive counseling about delirium before surgery.</p></div>","PeriodicalId":100795,"journal":{"name":"Journal of Joint Surgery and Research","volume":"2 2","pages":"Pages 71-76"},"PeriodicalIF":0.0,"publicationDate":"2024-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949705124000100/pdfft?md5=4fc7f0e0e6dc526e38580c8fff16fbfa&pid=1-s2.0-S2949705124000100-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141068849","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Significant improvement in locomotive functions after total knee arthroplasty but worse than those of independent ambulatory community dwellers 全膝关节置换术后运动功能明显改善，但不如独立行走的社区居民

Journal of Joint Surgery and Research

Pub Date : 2024-04-26 DOI: 10.1016/j.jjoisr.2024.04.001

Seiya Miyamoto , Takehiko Sugita , Naohisa Miyatake , Nozomi Itou , Akira Sasaki , Ikuo Maeda , Masayuki Kamimura , Takashi Aki , Toshimi Aizawa

Purpose

This study investigated the adequacy of improvements in locomotive syndrome (LS) and other clinical outcomes after total knee arthroplasty (TKA) for medial knee osteoarthritis.

Methods

A total of 74 patients who underwent unilateral primary TKA were evaluated pre-operatively and 3, 6, and 12 months post-TKA using the 25-question Geriatric Locomotive Function Scale (GLFS-25) to evaluate the severity of LS, the Japanese Knee Osteoarthritis Measure (JKOM), the Knee Society Score (KSS), the timed up and go (TUG) test, and range of motion of the knee joint (ROM). The GLFS-25 score and the severity of LS were compared between these patients and independent ambulatory community dwellers (273 males and 477 females).

Results

The GLFS-25, JKOM, KSS, TUG scores, and ROM significantly improved post-operatively. The pre-operative incidence of LS stage 3, indicating the worst locomotive function, decreased from 81.1% to 24.3% at the final follow-up. However, the median (interquartile range) GLFS-25 score of 13 (6–23) seemed much worse, and the incidence of LS stage 3 of 24.3% seemed much higher even 12 months post-TKA compared with independent ambulatory community dwellers.

Conclusions

The GLFS-25 score and other clinical outcome scales significantly improved after TKA. However, improvements in locomotive functions were not adequate as approximately 25% of patients remained with LS stage 3. Besides ordinary rehabilitation programmes after TKA, some interventions, such as more rigorous muscle exercises, would be necessary to obtain greater improvements in LS.

目的本研究探讨了内侧膝骨关节炎全膝关节置换术（TKA）后运动综合征（LS）和其他临床结果的改善是否充分。方法对74名接受单侧初级TKA的患者进行术前、术后3个月、6个月和12个月的评估，使用25个问题的老年运动功能量表（GLFS-25）评估LS的严重程度、日本膝关节骨关节炎测量（JKOM）、膝关节社会评分（KSS）、定时起立行走（TUG）测试和膝关节活动范围（ROM）。结果 GLFS-25、JKOM、KSS、TUG 评分和 ROM 在术后均有明显改善。术前LS 3期（表示运动功能最差）的发生率从81.1%下降到最终随访时的24.3%。结论 TKA术后GLFS-25评分和其他临床结果量表均有明显改善。然而，运动功能的改善并不充分，因为约 25% 的患者仍处于 LS 3 期。除了 TKA 术后的普通康复计划外，还需要一些干预措施，如更严格的肌肉锻炼，以进一步改善运动功能障碍。

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引用次数: 0

Bone substitute fracture in open wedge high tibial osteotomy: Comparison of two different bone substitutes 开放式楔形高胫骨截骨术中的骨替代物骨折：两种不同骨替代物的比较

Journal of Joint Surgery and Research

Pub Date : 2024-04-25 DOI: 10.1016/j.jjoisr.2024.04.002

Ryuichi Nakamura , Masaki Amemiya , Kaori Matsumoto , Ippei Yoshida , Fumiyoshi Kawashima , Tomoyuki Shimakawa , Akira Okano

Purpose

The aim of this study was to retrospectively compare bone substitute fracture patterns and outcomes in patients who underwent open wedge high tibial osteotomy (OWHTO) with OSferion60 or OSferion60 Marvelous bone substitutes. Patients with and without bone substitute fractures were compared and risk factors for bone substitute fracture were identified.

Methods

Included patients were physically active non-smokers with knee osteoarthritis and deformity in the proximal tibia, persistent pain, and <5° of flexion contracture. OWHTO was performed with a TriS plate and a target femorotibial angle (FTA) of 170°. Full weight-bearing began the day after surgery. Pre-, intra-, and post-operative evaluations of demographic, clinical, and radiological factors were performed. Regression analysis was performed to identify risk factors for bone substitute fracture.

Results

Data for 63 patients were analyzed (OSferion60, n = 28 and Marvelous, n = 35; bone substitute fracture, n = 32 and non-bone substitute fracture, n = 31). No significant differences were found between the bone substitute groups in patient characteristics and pre-operative and 2-year FTA, Japanese Orthopaedic Association (JOA) score, and flexion range. FTA and JOA scores improved significantly 2 years post-operatively (both p < 0.001). There were 32 bone substitute fractures (OSferion60, n = 20; Marvelous, n = 12); all occurred by the 1-month follow-up. Gap filling occurred significantly earlier in the Marvelous group versus the OSferion60 group (p < 0.001). Risk factors for bone substitute fracture were weaker bone substitute [odds ratio (OR) = 8.34; p < 0.001] and lateral hinge fracture (OR = 11.7; p = 0.045).

Conclusions

Although bone substitute fracture was common in both bone substitute groups, this did not affect outcomes. However, lateral hinge fractures are a particular concern.

目的本研究旨在回顾性比较使用 OSferion60 或 OSferion60 Marvelous 骨替代物进行开放式楔形高胫骨截骨术（OWHTO）的患者的骨替代物骨折模式和预后。方法纳入的患者均为身体活跃的非吸烟者，患有膝关节骨性关节炎，胫骨近端畸形，持续疼痛，屈曲挛缩5°。OWHTO采用TriS钢板，目标股胫夹角（FTA）为170°。术后第二天开始完全负重。对人口统计学、临床和放射学因素进行了术前、术中和术后评估。对 63 名患者的数据进行了分析（OSferion60，28 人；Marvelous，35 人；骨替代物骨折，32 人；非骨替代物骨折，31 人）。在患者特征、术前和 2 年 FTA、日本骨科协会（JOA）评分和屈曲范围方面，骨替代物组之间没有发现明显差异。术后 2 年，FTA 和 JOA 评分均有明显改善（P 均为 0.001）。共有 32 例骨替代物骨折（OSferion60，20 例；Marvelous，12 例），所有骨折都发生在 1 个月的随访期间。Marvelous组发生间隙填充的时间明显早于OSferion60组（p <0.001）。骨替代物骨折的风险因素是较弱的骨替代物[比值比 (OR) = 8.34; p <0.001]和侧铰链骨折（OR = 11.7; p = 0.045）。然而，外侧铰链骨折尤其令人担忧。

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引用次数: 0

Changes in ulnar and median nerve conduction velocity after reverse total shoulder arthroplasty: Correlation with distalization and lateralization 反向全肩关节置换术后尺神经和正中神经传导速度的变化：与远端化和外侧化的相关性

Journal of Joint Surgery and Research

Pub Date : 2024-04-10 DOI: 10.1016/j.jjoisr.2024.03.003

Kotaro Yamakado

Purpose

The purpose of this study was to assess ulnar and median nerve injury after reverse total shoulder arthroplasty (RSA) by measuring the sensory nerve conduction velocity (SCV). The secondary objective was to evaluate the impact of lateralization and/or distalization on SCV changes.

Methods

Twenty consecutive cases were prospectively included and retrospectively reviewed. SCV of the ulnar and median nerves as well as humeral lateralization/distalization quantified by plain radiography were evaluated pre-operatively and at 1 week post-operatively. Changes in SCV were tested using the paired t-test, and correlations between humeral lateralization/distalization and SCV changes were tested using Kendall's rank correlation coefficient and maximal information coefficient (MIC).

Results

The SCV of the ulnar nerve was delayed from 55.4 m/s pre-operatively to 53.0 m/s post-operatively (p = 0.021), whereas there was no significant change in the median nerve (p = 0.17). There was a weak to moderate correlation between ulnar nerve SCV delay and lateralization (τ = −0.38; p = 0.021; MIC = 0.70) but no significant correlation with distalization (p = 0.65; MIC = 0.56).

Conclusions

Following RSA, a small but significant delay in SCV of the ulnar nerve was observed. A negative correlation was found between lateralization and SCV delay of the ulnar nerve.

目的本研究旨在通过测量感觉神经传导速度（SCV）来评估反向全肩关节置换术（RSA）后尺神经和正中神经的损伤情况。方法前瞻性地纳入 20 例连续病例并进行回顾性分析。在术前和术后 1 周评估尺神经和正中神经的 SCV 以及通过平片量化的肱骨外侧化/远端化。结果尺神经的SCV从术前的55.4 m/s延迟到术后的53.0 m/s（p = 0.021），而正中神经没有显著变化（p = 0.17）。尺神经SCV延迟与侧化之间存在弱到中等程度的相关性（τ = -0.38；p = 0.021；MIC = 0.70），但与远化无明显相关性（p = 0.65；MIC = 0.56）。结论RSA后，尺神经的SCV延迟虽小，但却很明显，侧化与尺神经SCV延迟之间呈负相关。

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引用次数: 0

Preoperative factors associated with patient satisfaction after modified kinematically aligned total knee arthroplasty in varus knees 膝关节外翻的改良运动学配准全膝关节置换术后患者满意度的术前相关因素

Journal of Joint Surgery and Research

Pub Date : 2024-03-26 DOI: 10.1016/j.jjoisr.2024.03.001

Kemmei Ikuta, Tomoyuki Matsumoto, Naoki Nakano, Yuichi Kuroda, Shinya Hayashi, Ryosuke Kuroda

Purpose

Kinematically aligned-total knee arthroplasty (KA-TKA) has recently attracted significant interest because it delivers better clinical outcomes than mechanically aligned (MA)-TKA. However, the optimal preoperative factors that maximize the effectiveness of KA-TKA remain controversial. Therefore, we aimed to determine the preoperative factors that are appropriate for and might benefit from modified KA-TKA, based on patient-reported outcome measures (PROMs).

Methods

The relationships between postoperative satisfaction and other variables in 84 patients with varus-type osteoarthritis of the knee who underwent primary modified KA-TKAs were investigated using stepwise multiple regression analysis. Patients were assigned to groups that were satisfied or dissatisfied with their outcomes after KA-TKA according to the 2011 Knee Society Scores. The cutoff for preoperative advanced activities scores (AASs) for excellent satisfaction were determined by analyzing receiver operating characteristic (ROC) curves. The variables correlated with excellent satisfaction were identified using logistic regression models.

Results

A preoperative variable relevant to patient satisfaction was AAS (β = 0.465). The results of the ROC curve analysis revealed eight optimal cut-offs for preoperative AASs that predicted excellent satisfaction, with a sensitivity and specificity of 0.700 and 0.625, respectively. Logistic regression analysis revealed that AASs significantly contributed to excellent patient satisfaction (odds ratio, 1.181; p = 0.001).

Conclusions

Individuals who were highly active preoperatively were good candidates for KA-TKA. This modified kinematically aligned surgical technique can satisfy the demands of highly active patients.

目的机械对位全膝关节置换术（KA-TKA）最近引起了广泛关注，因为它比机械对位全膝关节置换术（MA-TKA）具有更好的临床疗效。然而，能使 KA-TKA 效果最大化的最佳术前因素仍存在争议。因此，我们的目的是根据患者报告的结果指标（PROMs），确定适合改良 KA-TKA 并可能从中获益的术前因素。方法采用逐步多元回归分析法研究了 84 例接受原发性改良 KA-TKA 的膝关节外翻型骨关节炎患者的术后满意度与其他变量之间的关系。根据 2011 年膝关节协会评分，患者被分配到对 KA-TKA 术后效果满意或不满意的组别。通过分析接收器操作特征曲线（ROC），确定了术前高级活动评分（AAS）的极佳满意度临界值。结果与患者满意度相关的术前变量是 AAS（β = 0.465）。ROC 曲线分析结果显示，术前 AAS 的 8 个最佳临界值可预测优良满意度，灵敏度和特异度分别为 0.700 和 0.625。逻辑回归分析表明，AASs 显著提高了患者的满意度（几率为 1.181；P = 0.001）。结论术前活动量大的患者适合接受 KA-TKA 手术，这种改良的运动对齐手术技术可以满足活动量大的患者的需求。

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引用次数: 0

Effect of deep medial collateral ligament release during high knee flexion movements 膝关节高屈曲运动中深层内侧副韧带松解的效果

Journal of Joint Surgery and Research

Pub Date : 2024-03-16 DOI: 10.1016/j.jjoisr.2024.03.002

Kenichi Kono , Shoji Konda , Masashi Tamaki , Sakae Tanaka , Tetsuya Tomita

Purpose

The medial preserving gap technique has recently been used in total knee arthroplasty. Generally, the deep medial collateral ligament (DMCL) is released using this technique. However, the effect of DMCL release on the kinematics and length of the ligaments remains unknown. This study aimed to clarify how DMCL release affects the kinematics and length change of the ligaments during high knee flexion movements.

Methods

Three cadaveric knees were examined using a computed tomography-based navigation system. The following parameters were evaluated: femoral rotation and varus-valgus angle relative to the tibia; anteroposterior translation of the sulcus distal to the medial epicondyle (medial side) and tip of the lateral epicondyle of the femur (lateral side); mediolateral translation of the medial and lateral sides of the plane perpendicular to the tibial mechanical axis; and kinematic pathways during non-weight-bearing knee flexion, cross-legged motion, and sideways motion.

Results

There were no significant differences in the kinematics and length change of the ligaments during all movements after DMCL release compared with that before DMCL release.

Conclusion

DMCL release did not affect the kinematics and length change of the ligaments.

目的最近，内侧保留间隙技术被用于全膝关节置换术。一般来说，采用这种技术可以松解深内侧副韧带（DMCL）。然而，DMCL松解对韧带运动学和长度的影响仍然未知。本研究旨在阐明在膝关节高屈曲运动时，DMCL松解如何影响韧带的运动学和长度变化。评估了以下参数：股骨旋转和相对于胫骨的曲髋角；内上髁远端沟（内侧）和股骨外上髁顶端（外侧）的前向平移；垂直于胫骨机械轴平面的内侧和外侧的内外侧平移；以及膝关节非负重屈曲、跨腿运动和侧向运动时的运动学路径。结果DMCL松解后与DMCL松解前相比，韧带在所有运动中的运动学和长度变化均无明显差异。

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引用次数: 0