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3D Printing Technology in Pediatric Orthopedics: a Primer for the Clinician. 3D打印技术在儿科骨科:临床医生入门。
IF 4.1 2区 医学 Q1 ORTHOPEDICS Pub Date : 2023-09-01 DOI: 10.1007/s12178-023-09847-x
Wei Wu, Samir Sabharwal, Michael Bunker, Sanjeev Sabharwal

Purpose of review: This article reviews the basics of 3D printing and provides an overview of current and future applications of this emerging technology in pediatric orthopedic surgery.

Recent findings: Both preoperative and intraoperative utilization of 3D printing technology have enhanced clinical care. Potential benefits include more accurate surgical planning, shortening of a surgical learning curve, decrease in intraoperative blood loss, less operative time, and fluoroscopic time. Furthermore, patient-specific instrumentation can be used to improve the safety and accuracy of surgical care. Patient-physician communication can also benefit from 3D printing technology. 3D printing is rapidly advancing in the field of pediatric orthopedic surgery. It has the potential to increase the value of several pediatric orthopedic procedures by enhancing safety and accuracy while saving time. Future efforts in cost reduction strategies, making patient-specific implants including biologic substitutes and scaffolds, will further increase the relevance of 3D technology in the field of pediatric orthopedic surgery.

回顾目的:本文回顾了3D打印的基础知识,并概述了这项新兴技术在儿科骨科手术中的当前和未来应用。最新研究发现:术前和术中使用3D打印技术提高了临床护理水平。潜在的好处包括更准确的手术计划,缩短手术学习曲线,减少术中出血量,减少手术时间和透视时间。此外,患者专用器械可用于提高手术护理的安全性和准确性。医患交流也可以从3D打印技术中受益。3D打印技术在小儿骨科领域发展迅速。通过提高安全性和准确性,同时节省时间,它有可能增加几个儿科骨科手术的价值。未来在降低成本策略方面的努力,制造包括生物替代品和支架在内的患者特异性植入物,将进一步提高3D技术在儿科骨科手术领域的相关性。
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引用次数: 1
Congenital Cervical Stenosis: a Review of the Current Literature. 先天性颈椎狭窄:当前文献综述。
IF 4.1 2区 医学 Q1 ORTHOPEDICS Pub Date : 2023-09-01 DOI: 10.1007/s12178-023-09857-9
Alyssa M Goodwin, Wellington K Hsu

Purpose of review: Congenital cervical stenosis (CCS) is a phenomenon in which an individual has a narrow canal due to abnormal anatomy which can present with earlier degenerative symptoms due to a reduced sagittal diameter. The diagnosis of CCS is important to individual treatment and preventative measures. Often, athletes are warned against sport participation that may cause damage to the cervical spine. There may be a predisposition in certain populations, but lack of data limits conclusions. The current review investigates recent literature on the definition, pathoanatomy, clinical presentation, and management of CCS. It specifically interrogates potential populations predisposed to this condition.

Recent findings: The current literature reveals a potential predisposition for CCS in the black population when compared to the white population; however, many studies do not report race when discussing CCS patients. The lack of data limits a consensus on specific populations with a congenitally narrow canal. CCS may be more prevalent in specific populations. With knowledge of populations more at risk for this condition, physicians and teams can be alert when evaluating players and young adults. Furthermore, this may provide insight into risk for symptoms with degenerative disease. These findings introduce an avenue for further research into CCS.

回顾目的:先天性颈椎狭窄(CCS)是一种由于解剖结构异常导致椎管狭窄的现象,由于矢状直径减小,可以出现早期退行性症状。CCS的诊断对个体化治疗和预防措施具有重要意义。通常,运动员被警告不要参加可能导致颈椎损伤的运动。在某些人群中可能存在易感性,但缺乏数据限制了结论。本综述调查了最近关于CCS的定义、病理解剖、临床表现和治疗的文献。它专门询问有这种倾向的潜在人群。最近的发现:目前的文献揭示了与白人人群相比,黑人人群中有潜在的CCS易感性;然而,许多研究在讨论CCS患者时没有报告种族。数据的缺乏限制了对先天性狭窄的特定人群的共识。CCS可能在特定人群中更为普遍。由于了解了患这种疾病的高危人群,医生和团队在评估球员和年轻人时可以保持警惕。此外,这可能有助于了解退行性疾病症状的风险。这些发现为进一步研究CCS提供了一条途径。
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引用次数: 0
The Role of Cervical Disc Arthroplasty in Elite Athletes. 颈椎椎间盘置换术在优秀运动员中的作用。
IF 4.1 2区 医学 Q1 ORTHOPEDICS Pub Date : 2023-09-01 DOI: 10.1007/s12178-023-09858-8
Hogan Brecount, Alyssa Goodwin, David M Hiltzik, Wellington K Hsu

Purpose of review: Cervical disc arthroplasty (CDA) for the treatment of symptomatic cervical disc herniations (CDH) is a promising treatment for professional athletes. In recent years, a number of high-profile athletes have returned to professional play within three months after CDA, raising important questions about the potential of this procedure within this patient group. We provide the first comprehensive review of available literature for the safety and efficacy of CDA in professional contact sport athletes.

Recent findings: CDA provides theoretical biomechanical advantages over anterior cervical discectomy and fusion (ACDF) and posterior foraminotomy (PF), as CDA is the only operation for treatment of CDH that provides neural decompression, stability and height restoration, with preserved range of motion. While the comparative long-term results from each procedure are unknown, CDA has provided encouraging promise in its use in professional contact athletes. We aim to aid ongoing discussions regarding the controversies in spine surgery for professional athletes by providing a scientific review of the available evidence-based literature involving cervical disc arthroplasty in this population. In general, we believe that CDA is a viable alternative to ACDF and PF for the contact professional athlete who requires full neck range of motion and desires an expedited return to play. For collision athletes, the short- and long-term safety and efficacy profile of this procedure is promising but still unclear.

综述目的:颈椎间盘置换术(CDA)治疗症状性颈椎间盘突出症(CDH)是一种很有前途的治疗方法。近年来,许多知名运动员在CDA术后三个月内就恢复了职业比赛,这引发了关于该手术在该患者群体中的潜力的重要问题。我们提供了第一个关于CDA在职业接触运动运动员中的安全性和有效性的文献综述。最近的研究发现:CDA在理论上比前路颈椎椎间盘切除术和融合术(ACDF)和后路椎间孔切开术(PF)具有生物力学优势,因为CDA是唯一一种治疗CDH的手术,可以提供神经减压、稳定和高度恢复,并保留活动范围。虽然每种手术的比较长期结果尚不清楚,但CDA在专业接触运动员中的应用提供了令人鼓舞的希望。我们的目的是通过对现有的以证据为基础的文献进行科学回顾,以帮助正在进行的关于专业运动员脊柱手术争议的讨论,这些文献涉及该人群的颈椎间盘置换。总的来说,我们相信CDA是ACDF和PF的一个可行的替代方案,对于需要完整的颈部活动范围和希望快速恢复比赛的接触性专业运动员来说。对于碰撞运动员来说,这种手术的短期和长期的安全性和有效性是有希望的,但仍不清楚。
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引用次数: 0
Postoperative Rehabilitation for Arthroscopic Management of Femoroacetabular Impingement Syndrome: a Contemporary Review. 股骨髋臼撞击综合征关节镜治疗的术后康复:当代综述。
IF 4.1 2区 医学 Q1 ORTHOPEDICS Pub Date : 2023-09-01 DOI: 10.1007/s12178-023-09850-2
Stefan Hanish, Maaz Muhammed, Shayne Kelly, Steven DeFroda

Purpose of review: Femoroacetabular impingement syndrome (FAIS) is a common cause of hip pain that may potentially lead to osteoarthritis. Operative management of FAIS seeks to arthroscopically reshape the abnormal hip morphology and repair the labrum. For rehabilitation following operative management, a structured physical therapy program is unanimously recommended for the patient to return to their previous level of physical activity. Yet, despite this unanimous recommendation, significant heterogeneity exists among the current recommendations for postoperative physical therapy programs.

Recent findings: A four-phase postoperative physical therapy protocol is favored among current literature, with each phase being comprised of its own goals, restrictions, precautions, and rehabilitation techniques. Phase 1 aims to protect the integrity of the surgically repaired tissues, reduce pain and inflammation, and regain ~ 80% of full ROM. Phase 2 guides a smooth transition to full weightbearing, so the patient may regain functional independence. Phase 3 helps the patient become recreationally asymptomatic and restores muscular strength and endurance. Finally, phase 4 culminates in the pain-free return to competitive sports or recreational activity. At this time, there exists no single, unanimously agreed upon postoperative physical therapy protocol. Among the current recommendations, variation exists regarding specific timelines, restrictions, precautions, exercises, and techniques throughout the four phases. It is imperative to reduce ambiguity in current recommendations and more specifically define postoperative physical therapy following operative management of FAIS to more expeditiously return patients to functional independence and physical activity.

回顾目的:股髋臼撞击综合征(FAIS)是髋关节疼痛的常见原因,可能导致骨关节炎。FAIS的手术治疗旨在关节镜下重塑异常的髋关节形态并修复髋关节唇。对于手术后的康复,一致建议患者采用结构化的物理治疗方案,使其恢复到以前的身体活动水平。然而,尽管有这种一致的建议,但目前关于术后物理治疗方案的建议存在显著的异质性。最近的发现:在目前的文献中,四阶段的术后物理治疗方案受到青睐,每个阶段都包括自己的目标、限制、预防措施和康复技术。第一阶段的目的是保护手术修复组织的完整性,减轻疼痛和炎症,并恢复~ 80%的完全ROM。第二阶段指导平稳过渡到完全负重,因此患者可能恢复功能独立性。第三阶段帮助患者无娱乐性症状,恢复肌肉力量和耐力。最后,第四阶段的高潮是无痛苦地恢复竞技体育或娱乐活动。目前,还没有统一的、一致同意的术后物理治疗方案。在目前的建议中,在四个阶段的具体时间表、限制、预防措施、练习和技术方面存在差异。当务之急是减少目前建议的模糊性,更具体地定义FAIS手术治疗后的术后物理治疗,以更快地使患者恢复功能独立和身体活动。
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引用次数: 0
Current Concepts in the Measurement of Glenohumeral Bone Loss. 肱骨盂骨丢失测量的最新概念。
IF 4.1 2区 医学 Q1 ORTHOPEDICS Pub Date : 2023-09-01 DOI: 10.1007/s12178-023-09852-0
Ryan R Thacher, Julia S Retzky, Mihir S Dekhne, Yousi A Oquendo, Harry G Greditzer

Purpose: The extent of glenohumeral bone loss seen in anterior shoulder dislocations plays a major role in guiding surgical management of these patients. The need for accurate and reliable preoperative assessment of bone loss on imaging studies is therefore of paramount importance to orthopedic surgeons. This article will focus on the tools that are available to clinicians for quantifying glenoid bone loss with a focus on emerging trends and research in order to describe current practices.

Recent findings: Recent evidence supports the use of 3D CT as the most optimal method for quantifying bone loss on the glenoid and humerus. New trends in the use of 3D and ZTE MRI represent exciting alternatives to CT imaging, although they are not widely used and require further investigation. Contemporary thinking surrounding the glenoid track concept and the symbiotic relationship between glenoid and humeral bone loss on shoulder stability has transformed our understanding of these lesions and has inspired a new focus of study for radiologists and orthopedist alike. Although a number of different advanced imaging modalities are utilized to detect and quantify glenohumeral bone loss in practice, the current literature supports 3D CT imaging to provide the most reliable and accurate assessments. The emergence of the glenoid track concept for glenoid and humeral head bone loss has inspired a new area of study for researchers that presents exciting opportunities for the development of a deeper understanding of glenohumeral instability in the future. Ultimately, however, the heterogeneity of literature, which speaks to the diverse practices that exist across the world, limits any firm conclusions from being drawn.

目的:观察肩关节前脱位患者肱骨盂骨丢失的程度对指导手术治疗具有重要意义。因此,对骨科医生来说,在影像学研究中对骨质流失进行准确可靠的术前评估是至关重要的。本文将重点介绍临床医生可用于量化盂骨丢失的工具,重点是新兴趋势和研究,以描述当前的实践。最近的发现:最近的证据支持使用3D CT作为量化关节盂和肱骨骨丢失的最佳方法。3D和中兴核磁共振成像的新趋势代表了CT成像的令人兴奋的替代方案,尽管它们尚未被广泛使用,需要进一步的研究。围绕肩关节轨迹概念的当代思考以及肩关节和肱骨骨丢失对肩部稳定性的共生关系改变了我们对这些病变的理解,并激发了放射科医生和骨科医生的新研究重点。尽管在实践中使用了许多不同的先进成像方式来检测和量化盂肱骨丢失,但目前的文献支持3D CT成像提供最可靠和准确的评估。肩关节和肱骨头骨丢失的肩关节径迹概念的出现为研究人员提供了一个新的研究领域,为未来对肩关节不稳定的深入了解提供了令人兴奋的机会。然而,从根本上说,文学的异质性(反映了世界各地存在的各种实践)限制了得出任何确定的结论。
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引用次数: 0
Fracture Dislocations of the Glenohumeral Joint. 盂肱关节骨折脱位。
IF 4.1 2区 医学 Q1 ORTHOPEDICS Pub Date : 2023-08-01 DOI: 10.1007/s12178-023-09846-y
Joseph T Labrum, Nicolas P Kuttner, Yousif Atwan, Joaquin Sanchez-Sotelo, Jonathan D Barlow

Purpose of review: Proximal humerus fracture dislocations typically result from high-energy mechanisms and carry specific risks, technical challenges, and management considerations. It is vital for treating surgeons to understand the various indications, procedures, and complications involved with their treatment.

Recent findings: While these injuries are relatively rare in comparison with other categories of proximal humerus fractures, fracture dislocations of the proximal humerus require treating surgeons to consider patient age, activity level, injury pattern, and occasionally intra-operative findings to select the ideal treatment strategy for each injury. Proximal humerus fracture dislocations are complex injuries that require special considerations. This review summarizes recent literature regarding the evaluation and management of these injuries as well as the indications and surgical techniques for each treatment strategy. Thorough pre-operative patient evaluation and shared decision-making should be employed in all cases. While nonoperative management is uncommonly considered, open reduction and internal fixation (ORIF), hemiarthroplasty, and reverse total shoulder replacement are at the surgeon's disposal, each with their own indications and complication profile.

综述目的:肱骨近端骨折脱位通常由高能机制引起,具有特定的风险、技术挑战和管理方面的考虑。对于治疗外科医生来说,了解各种适应症、手术程序和治疗过程中的并发症是至关重要的。最近的研究结果:虽然与其他类型的肱骨近端骨折相比,这些损伤相对罕见,但肱骨近端骨折脱位需要治疗外科医生考虑患者的年龄、活动水平、损伤模式,以及偶尔的术中发现,以选择每种损伤的理想治疗策略。肱骨近端骨折脱位是需要特殊考虑的复杂损伤。这篇综述总结了最近关于这些损伤的评估和管理的文献,以及每种治疗策略的指征和手术技术。在所有病例中都应采用彻底的术前患者评估和共同决策。虽然非手术治疗很少被考虑,但外科医生可以选择切开复位内固定(ORIF)、半关节置换术和反向全肩关节置换术,每种方法都有自己的适应症和并发症。
{"title":"Fracture Dislocations of the Glenohumeral Joint.","authors":"Joseph T Labrum,&nbsp;Nicolas P Kuttner,&nbsp;Yousif Atwan,&nbsp;Joaquin Sanchez-Sotelo,&nbsp;Jonathan D Barlow","doi":"10.1007/s12178-023-09846-y","DOIUrl":"https://doi.org/10.1007/s12178-023-09846-y","url":null,"abstract":"<p><strong>Purpose of review: </strong>Proximal humerus fracture dislocations typically result from high-energy mechanisms and carry specific risks, technical challenges, and management considerations. It is vital for treating surgeons to understand the various indications, procedures, and complications involved with their treatment.</p><p><strong>Recent findings: </strong>While these injuries are relatively rare in comparison with other categories of proximal humerus fractures, fracture dislocations of the proximal humerus require treating surgeons to consider patient age, activity level, injury pattern, and occasionally intra-operative findings to select the ideal treatment strategy for each injury. Proximal humerus fracture dislocations are complex injuries that require special considerations. This review summarizes recent literature regarding the evaluation and management of these injuries as well as the indications and surgical techniques for each treatment strategy. Thorough pre-operative patient evaluation and shared decision-making should be employed in all cases. While nonoperative management is uncommonly considered, open reduction and internal fixation (ORIF), hemiarthroplasty, and reverse total shoulder replacement are at the surgeon's disposal, each with their own indications and complication profile.</p>","PeriodicalId":10950,"journal":{"name":"Current Reviews in Musculoskeletal Medicine","volume":"16 8","pages":"346-357"},"PeriodicalIF":4.1,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10382466/pdf/12178_2023_Article_9846.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10268459","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Return to Sport After Hip and Knee Arthroplasty: Counseling the Patient on Resuming an Active Lifestyle. 髋关节和膝关节置换术后重返运动:建议患者恢复积极的生活方式。
IF 4.1 2区 医学 Q1 ORTHOPEDICS Pub Date : 2023-08-01 DOI: 10.1007/s12178-023-09839-x
Armin Arshi, Andrew J Hughes, Joseph X Robin, Javad Parvizi, Yale A Fillingham

Purposeof review: The purpose of this review is to summarize the available literature on the epidemiology, biomechanics, clinical outcomes, and complications of return to sport after TJA, as well as provide guidelines for patients' safe return to athletic activity.

Recent findings: As volume and indications for total joint arthroplasty (TJA) expand, arthroplasty candidates today are demographically younger, more physically active, and have higher expectations for postoperative function. Many TJA patients wish to resume sports activity that may theoretically place their reconstruction under more biomechanical stress and risk for early wear or failure. Recommendations for postoperative patient activity following TJA have historically largely been surgeon-dependent and in the context of evolving prosthetic design and surgical techniques. We endorse a three-tiered framework for return to sporting activities: (1) low-impact sports are generally recommended, (2) intermediate-impact sports are generally recommended with experience, and (3) high-impact sports are generally not recommended though activity-specific joint decisions between patient and surgeon can be made.

综述目的:本综述的目的是总结TJA术后恢复运动的流行病学、生物力学、临床结局和并发症方面的现有文献,为患者安全恢复运动提供指导。最近的发现:随着全关节置换术(TJA)的容量和适应症的扩大,关节置换术的候选人在人口统计学上更年轻,更活跃,对术后功能有更高的期望。许多TJA患者希望恢复体育活动,这可能在理论上使他们的重建承受更多的生物力学压力和早期磨损或失败的风险。TJA术后患者活动的建议在历史上很大程度上取决于外科医生,并且在不断发展的假体设计和手术技术的背景下。我们支持一个三层框架,用于恢复体育活动:(1)通常建议进行低强度运动,(2)通常建议进行有经验的中等强度运动,(3)通常不建议进行高强度运动,尽管可以由患者和外科医生共同决定具体的活动。
{"title":"Return to Sport After Hip and Knee Arthroplasty: Counseling the Patient on Resuming an Active Lifestyle.","authors":"Armin Arshi,&nbsp;Andrew J Hughes,&nbsp;Joseph X Robin,&nbsp;Javad Parvizi,&nbsp;Yale A Fillingham","doi":"10.1007/s12178-023-09839-x","DOIUrl":"https://doi.org/10.1007/s12178-023-09839-x","url":null,"abstract":"<p><strong>Purposeof review: </strong>The purpose of this review is to summarize the available literature on the epidemiology, biomechanics, clinical outcomes, and complications of return to sport after TJA, as well as provide guidelines for patients' safe return to athletic activity.</p><p><strong>Recent findings: </strong>As volume and indications for total joint arthroplasty (TJA) expand, arthroplasty candidates today are demographically younger, more physically active, and have higher expectations for postoperative function. Many TJA patients wish to resume sports activity that may theoretically place their reconstruction under more biomechanical stress and risk for early wear or failure. Recommendations for postoperative patient activity following TJA have historically largely been surgeon-dependent and in the context of evolving prosthetic design and surgical techniques. We endorse a three-tiered framework for return to sporting activities: (1) low-impact sports are generally recommended, (2) intermediate-impact sports are generally recommended with experience, and (3) high-impact sports are generally not recommended though activity-specific joint decisions between patient and surgeon can be made.</p>","PeriodicalId":10950,"journal":{"name":"Current Reviews in Musculoskeletal Medicine","volume":"16 8","pages":"329-337"},"PeriodicalIF":4.1,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10382373/pdf/12178_2023_Article_9839.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10276712","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 1
Quadriceps Dysfunction Following Joint Preservation Surgery: A Review of the Pathophysiologic Basis and Mitigation Strategies. 关节保留手术后的股四头肌功能障碍:病理生理学基础和缓解策略综述。
IF 2.9 2区 医学 Q1 ORTHOPEDICS Pub Date : 2023-08-01 Epub Date: 2023-05-27 DOI: 10.1007/s12178-023-09844-0
Daniel J Cognetti, Thomas B Lynch, Elizabeth Rich, Asheesh Bedi, Aman Dhawan, Andrew J Sheean

Purpose of review: To characterize quadriceps muscle dysfunction associated with knee joint preservation surgery, with a focus on its pathophysiology and promising approaches to mitigate its impact on clinical outcomes.

Recent findings: Quadriceps dysfunction (QD) associated with knee joint preservation surgery results from a complex interplay of signaling, related to changes within the joint and from those involving the overlying muscular envelope. Despite intensive rehabilitation regimens, QD may persist for many months postoperatively and negatively impact clinical outcomes associated with various surgical procedures. These facts underscore the need for continued investigation into the potential detrimental effects of regional anesthetic and intraoperative tourniquet use on postoperative quadriceps function, with an outward focus on innovation within the field of postoperative rehabilitation. Neuromuscular stimulation, nutritional supplementation, cryotherapy, blood flow restriction (BFR), and open-chain exercises are all potential additions to postoperative regimens. There is compelling literature to suggest that these modalities are efficacious and may diminish the magnitude and duration of postoperative QD. A clear understanding of QD, with respect to its pathophysiology, should guide perioperative treatment and rehabilitation strategies and influence ongoing rehabilitation-based research and innovation. Moreover, clinicians must appreciate the magnitude of QD's effect on diminished clinical outcomes, risk for re-injury and patients' ability (or inability) to return to pre-injury level of activity following knee joint preservation procedures.

综述的目的:描述与膝关节保留手术相关的股四头肌功能障碍的特征,重点关注其病理生理学以及减轻其对临床结果影响的可行方法:最近的研究结果:与膝关节保留手术相关的股四头肌功能障碍(QD)是由一系列复杂的信号相互作用引起的,这些信号与关节内部的变化以及涉及上层肌肉包膜的变化有关。尽管进行了强化康复治疗,但 QD 仍可能在术后持续数月,并对各种外科手术的临床疗效产生负面影响。这些事实突出表明,有必要继续研究区域麻醉和术中止血带的使用对术后股四头肌功能的潜在不利影响,并将重点放在术后康复领域的创新上。神经肌肉刺激、营养补充、冷冻疗法、血流限制(BFR)和开链运动都是术后康复疗法的潜在补充。有令人信服的文献表明,这些方法都很有效,可以减少术后 QD 的程度和持续时间。清楚地了解 QD 的病理生理学,应能指导围手术期治疗和康复策略,并影响以康复为基础的持续研究和创新。此外,临床医生还必须了解 QD 对临床疗效的影响程度、再次受伤的风险以及患者在膝关节保留手术后恢复到受伤前活动水平的能力(或无法恢复到受伤前活动水平)。
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引用次数: 0
Management of Glenoid Bone Loss in Primary Reverse Total Shoulder Arthroplasty. 初次逆行全肩关节置换术中肩关节骨丢失的处理。
IF 4.1 2区 医学 Q1 ORTHOPEDICS Pub Date : 2023-08-01 DOI: 10.1007/s12178-023-09845-z
Nabil Mehta, Gregory P Nicholson

Purpose of review: Glenoid bone loss presents distinct challenges in reverse total shoulder arthroplasty (rTSA) which, if unaddressed, can cause complications including poor outcomes and early implant failure. The purpose of this review is to discuss the etiology, evaluation, and management strategies of glenoid bone loss in primary rTSA.

Recent findings: Three-dimensional computed tomography (3D CT) imaging and preoperative planning software have revolutionized the understanding of complex glenoid deformity and wear patterns from bone loss. With this knowledge, a detailed preoperative plan can be created and implemented for a more optimal management strategy. When appropriately indicated, deformity correction techniques with biologic or metal augmentation are successful in addressing the glenoid bone deficiency, creating optimal implant position, and thus providing stable baseplate fixation and improving outcomes. Thorough evaluation and characterization of the degree of glenoid deformity with 3D CT imaging is necessary prior to treatment with rTSA. Eccentric reaming, bone grafting, and augmented glenoid components have shown promising results in correcting glenoid deformity due to bone loss, but long-term outcomes are currently unknown.

回顾目的:肩关节盂骨丢失是逆行全肩关节置换术(rTSA)中明显的挑战,如果不加以解决,可能导致并发症,包括预后不良和早期植入失败。本综述的目的是讨论原发性rTSA中盂骨丢失的病因、评估和管理策略。最近发现:三维计算机断层扫描(3D CT)成像和术前计划软件已经彻底改变了对复杂的肩关节畸形和骨质流失造成的磨损模式的理解。有了这些知识,就可以制定详细的术前计划,并实施更优化的管理策略。在适当的情况下,生物或金属隆胸的畸形矫正技术可以成功地解决关节盂骨缺损,创造最佳的植入物位置,从而提供稳定的底板固定和改善预后。在rTSA治疗之前,有必要通过3D CT成像对关节盂畸形程度进行全面评估和表征。偏心扩孔、植骨和增强盂骨假体在纠正骨质丢失引起的盂骨畸形方面显示出有希望的结果,但长期结果目前尚不清楚。
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引用次数: 0
Preventing and Treating Infection in Reverse Total Shoulder Arthroplasty. 逆向全肩关节置换术中感染的预防与治疗。
IF 4.1 2区 医学 Q1 ORTHOPEDICS Pub Date : 2023-08-01 DOI: 10.1007/s12178-023-09843-1
Alexander R Markes, Joseph Bigham, C Benjamin Ma, Jaicharan J Iyengar, Brian T Feeley

Purpose of review: Periprosthetic infection after shoulder arthroplasty is relatively uncommon though associated with severe long-term morbidity when encountered. The purpose of the review is to summarize the recent literature regarding the definition, clinical evaluation, prevention, and management of prosthetic joint infection after reverse shoulder arthroplasty.

Recent findings: The landmark report generated at the 2018 International Consensus Meeting on Musculoskeletal Infection has provided a framework for diagnosis, prevention, and management of periprosthetic infections after shoulder arthroplasty. Shoulder specific literature with validated interventions to reduce prosthetic joint infection is limited; however existing literature from retrospective studies and from total hip and knee arthroplasty allows us to make relative guidelines. One and two-stage revisions seem to demonstrate similar outcomes; however, no controlled comparative studies exist limiting the ability to make definitive recommendations between the two options. We report on recent literature regarding the current diagnostic, preventative, and treatment options for periprosthetic infection after shoulder arthroplasty. Much of the literature does not distinguish between anatomic and reverse shoulder arthroplasty, and further high-level shoulder specific studies are needed to answer questions generated from this review.

综述目的:肩关节置换术后假体周围感染相对不常见,但一旦遇到会导致严重的长期发病率。本综述的目的是总结关于肩关节置换术后假体关节感染的定义、临床评价、预防和处理的最新文献。最新发现:2018年国际肌肉骨骼感染共识会议上产生的具有里程碑意义的报告为肩关节置换术后假体周围感染的诊断、预防和管理提供了框架。肩关节特异性文献与有效干预措施减少假体关节感染是有限的;然而,来自回顾性研究和全髋关节和膝关节置换术的现有文献允许我们制定相关指南。一阶段和两阶段的修订似乎显示出类似的结果;然而,没有对照比较研究限制了在这两种选择之间做出明确建议的能力。我们报告了最近关于肩关节置换术后假体周围感染的诊断、预防和治疗选择的文献。许多文献没有区分解剖肩关节置换术和反向肩关节置换术,需要进一步的高水平肩部特异性研究来回答本综述中产生的问题。
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引用次数: 0
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Current Reviews in Musculoskeletal Medicine
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