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Early and Late Intrinsic Hand Muscle Reinnervation After End-to-Side AIN to Ulnar Motor Nerve Transfer. 端侧 AIN 至尺侧运动神经转移后的早期和晚期手部内在肌肉再神经支配
IF 1.8 Q2 ORTHOPEDICS Pub Date : 2024-11-06 DOI: 10.1177/15589447241286263
Eric C Mitchell, Mehran Mansouri, Thomas Miller, Douglas Ross, Joshua Gillis

Background: The "supercharge" end-to-side (SETS) anterior-interosseous-nerve (AIN) to ulnar-motor nerve transfer is used to improve intrinsic muscle recovery in cases of severe ulnar nerve compression or proximal axonotmetic injuries. Previous work has found differing intrinsic muscle recovery after this transfer. The objectives of this study were to examine the patterns of recovery in first dorsal interossei (FDI) and abductor digiti minimi (ADM) and the impact of AIN transfer to a specific fascicular location on the ulnar-motor nerve.

Methods: A retrospective review of one fellowship-trained surgeon's consecutive patients at a single center from December 2019 to September 2021 was conducted. Patients who had an AIN to ulnar-motor nerve transfer for any indication were included and were excluded if they had less than 9 months follow-up.

Results: Seventeen patients were included (88% male, mean age 55 ± 14 years). At early follow-up, compound muscle action potential amplitudes for ADM and FDI did not increase. Compound muscle action potential amplitude for ADM significantly increased at late follow-up (P < .01). Average British Medical Research Council (BMRC) strength increased at early follow-up for FDI (P < .05), but not ADM. The proportion of patients with BMRC ≥ 3 increased for FDI (P < .01) and ADM (P < .05) at late follow-up. Volar-ulnar AIN insertion position did not have a clear effect on outcomes.

Conclusions: The SETS AIN to ulnar-motor nerve transfer demonstrates clinical and electrophysiologic evidence of intrinsic muscle recovery and reinnervation, with differing recovery of outcomes. The role of specific fascicular targeting is still unclear and required further examination as does the mechanism behind differing intrinsic recovering.

背景:在严重尺神经压迫或近端轴突损伤的病例中,"增压 "端对侧(SETS)前内侧神经(AIN)至尺运动神经转移被用于改善内在肌肉恢复。之前的研究发现,这种转移后内在肌肉的恢复情况各不相同。本研究的目的是研究第一背侧肌间肌(FDI)和小伸肌(ADM)的恢复模式,以及将 AIN 转移到特定筋膜位置对尺神经运动神经的影响:方法:对一位接受过研究员培训的外科医生在2019年12月至2021年9月期间在一个中心的连续患者进行了回顾性审查。结果:纳入了 17 例患者(88%),其中有 1 例患者接受了 AIN 至尺运动神经转移术:共纳入 17 名患者(88% 为男性,平均年龄为 55 ± 14 岁)。在早期随访中,ADM 和 FDI 的复合肌肉动作电位振幅没有增加。在后期随访中,ADM 的复合肌肉动作电位振幅明显增加(P P P P P 结论:SETS AIN 至尺肌的复合肌肉动作电位振幅明显增加:SETS AIN 到尺骨运动神经转移显示了内在肌肉恢复和神经再支配的临床和电生理学证据,其恢复结果各不相同。特定筋束靶向的作用仍不明确,需要进一步研究,不同内在恢复背后的机制也是如此。
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引用次数: 0
Generic Volar Locking Plate Use in Distal Radius Fractures: A Prospective Randomized Study to Evaluate Clinical Outcomes and Cost Reduction. 在桡骨远端骨折中使用通用沃尔锁定钢板:评估临床疗效和降低成本的前瞻性随机研究。
IF 1.8 Q2 ORTHOPEDICS Pub Date : 2024-11-06 DOI: 10.1177/15589447241293168
Stephen A Doxey, Rebekah M Kleinsmith, Lily J Qian, Jeffrey B Husband, Deborah C Bohn, Brian P Cunningham

Background: The purpose of this study was to evaluate differences in 90-day clinical outcomes between patients treated with generic volar locking plates (VLPs) and conventional VLPs in distal radius fractures. Secondary aims included assessing for differences in surgical characteristics and cost between the groups.

Methods: From November 2022 to April 2023, a prospective block-randomized study was undertaken in which surgeons alternated between using a generic VLP and a conventional VLP each month. The institution's chargemaster database was cross-referenced for implant cost. Primary outcomes were 90-day readmission, reoperation, and mortality rates. Secondary outcomes included estimated blood loss, tourniquet time, and implant cost.

Results: A total of 66 patients were included. Most were women (n = 61, 92.4%), with an average age of 61.0 ± 11.5 years. There were no significant differences in age, sex, smoking status, AO Foundation/Orthopaedic Trauma Association classification, or tourniquet time between patients who received generic and conventional implants. The average total cost was higher with conventional implants than generic implants($1348.61 ± 100.77 and $702.38 ± 47.83, respectively; P < .001). The largest difference in cost came from pegs and screws that were used ($640.77 ± 90.93 vs $268.47 ± 45.93, P < .001). No patients experienced complications such as readmission, reoperation, or death within 90 days.

Conclusions: Total implant cost was lower for procedures where generic VLPs were used. Cost differences between generic and conventional implants are driven by the variable selection of pegs and screws. With no differences in 90-day outcomes, surgeons may consider using generic implants as a way of increasing the value of care delivery.

背景:本研究的目的是评估桡骨远端骨折患者使用通用型椎体锁定钢板(VLP)和传统型椎体锁定钢板治疗后90天临床疗效的差异。次要目的包括评估两组患者在手术特征和费用方面的差异:从2022年11月到2023年4月,开展了一项前瞻性整群随机研究,外科医生每月交替使用普通VLP和传统VLP。该机构的收费数据库与植入成本进行了交叉对比。主要结果是 90 天再入院率、再手术率和死亡率。次要结果包括估计失血量、止血带时间和植入成本:结果:共纳入 66 名患者。大多数患者为女性(n = 61,92.4%),平均年龄(61.0 ± 11.5)岁。接受普通植入物和传统植入物的患者在年龄、性别、吸烟状况、AO 基金会/矫形创伤协会分类或止血带时间方面没有明显差异。常规植入物的平均总成本高于普通植入物(分别为 1348.61 美元 ± 100.77 和 702.38 美元 ± 47.83;P < .001)。最大的成本差异来自使用的钉和螺钉(640.77 美元 ± 90.93 对 268.47 美元 ± 45.93,P < .001)。没有患者在90天内出现再次入院、再次手术或死亡等并发症:结论:使用普通 VLP 的手术植入总成本较低。结论:使用非专利 VLP 的手术总费用较低,非专利植入物和传统植入物之间的成本差异主要是由于对钉和螺钉的选择不同造成的。由于 90 天内的结果没有差异,外科医生可以考虑使用普通植入物来提高医疗服务的价值。
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引用次数: 0
Management Options and Clinical Outcomes After Flexor Tendon Ruptures Following Volar Plating of Distal Radius Fractures. 桡骨远端骨折外侧钢板固定后屈肌腱断裂的处理方案和临床疗效。
IF 1.8 Q2 ORTHOPEDICS Pub Date : 2024-11-05 DOI: 10.1177/15589447241292654
Hannah C Langdell, Emmanuel O Emovon, Warren C Hammert

Background: The transition to volar locking plates for the treatment of distal radius fractures has improved patients' range of motion, reduced extensor tendon issues, and hastened return to activity compared to older fixation methods or nonoperative treatment. One drawback to volar plating is the potential for flexor tendon ruptures due to aberrant plate or screw placement. This study aims to describe the reconstruction options and patient outcomes after flexor tendon rupture due to volar plating.

Methods: This is a single-institution, retrospective review of patients who presented with flexor tendon rupture from 2014 to 2023 after a distal radius fracture previously managed with a volar plate. Patient demographics, operative details, range of motion, complications, and patient-reported outcomes were collected.

Results: Ten patients presented with flexor tendon ruptures after volar plating for distal radius fractures from 2014 to 2023. The most common rupture was flexor pollicis longus (FPL) in 7 patients, followed by index finger flexor digitorum profundus (FDP) in 2 patients, and small and ring finger FDP rupture in 1 patient. Flexor pollicis longus (FPL) was reconstructed with a palmaris longus (PL) graft in 4 patients, ring finger flexor digitorum superficialis transfer in 2 patients, and repaired primarily in 1 patient. All patients with FPL ruptures regained functional thumb interphalangeal flexion except for 1 patient who reruptured 4 weeks after surgery.

Conclusions: Flexor tendon ruptures can occur following volar plating of distal radius fractures, even years after fixation of the fracture. These are attritional ruptures and generally reconstructed with tendon grafting of transfer, providing functional flexion of the affected digit.

背景:在治疗桡骨远端骨折方面,与旧式固定方法或非手术治疗相比,采用桡骨外侧锁定钢板可改善患者的活动范围,减少伸肌腱问题,加快恢复活动能力。沃尔钢板术的一个缺点是,由于钢板或螺钉放置不当,可能导致屈肌腱断裂。本研究旨在描述外翻固定导致屈肌腱断裂后的重建方案和患者疗效:这是一项单一机构的回顾性研究,研究对象为2014年至2023年期间桡骨远端骨折后出现屈肌腱断裂的患者,这些患者之前曾使用沃尔钢板进行治疗。研究收集了患者的人口统计学资料、手术细节、活动范围、并发症和患者报告的结果:结果:从2014年到2023年,10名患者在桡骨远端骨折沃尔钢板术后出现屈肌腱断裂。最常见的断裂是7名患者的屈指肌腱断裂,其次是2名患者的食指屈指肌腱断裂,以及1名患者的小指和无名指屈指肌腱断裂。4 名患者用掌长肌 (PL) 移植重建了屈指肌 (FPL),2 名患者进行了无名指屈指肌浅层转移,1 名患者主要进行了修复。除1名患者在术后4周再次断裂外,所有FPL断裂患者均恢复了拇指指间屈曲功能:结论:桡骨远端骨折后,即使在骨折固定数年后,也可能发生屈肌腱断裂。这些断裂属于自然断裂,一般会通过肌腱移植转移进行重建,从而使患侧指骨实现功能性屈曲。
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引用次数: 0
Infections and Patient Satisfaction in WALANT Hand Surgery in a Hospital Procedure Room. 医院手术室中 WALANT 手部手术的感染情况和患者满意度。
IF 1.8 Q2 ORTHOPEDICS Pub Date : 2024-11-05 DOI: 10.1177/15589447241284814
Michaela J Derby, Kelly N McKnight, Robert E Van Demark

Background: Wide-awake hand surgery has allowed many hand procedures to be moved out of the operating room and into minor procedure rooms while increasing efficiency, maintaining safety, and reducing both patient and hospital costs. The goal of this study was to evaluate patient satisfaction and postoperative complications of wide-awake local anesthesia with no tourniquet procedures performed in a community-based hospital procedure room. Methods: A total of 786 patients underwent 948 elective hand procedures in a hospital procedure room. At the conclusion of their surgeries, the patients were surveyed regarding their satisfaction. Following surgery, patients were evaluated for postoperative complications including infections. The trend in postoperative infection rates across 8 age groups was analyzed using a Cochran-Armitage test in R. Results: The overall infection rate was 6.2% (n = 59). All infections were superficial. Carpal tunnel had the highest number of infections (n = 25), followed by trigger finger (n = 8), and the combination trigger finger with carpal tunnel (n = 7). All infections were managed with antibiotics and/or soaks. Three patients did require a return to the operating room for irrigation and debridement. Ninety-nine percent of patients said the procedure room experience was better or the same as going to the dentist, would recommend wide-awake anesthesia to a friend or family member, and would undergo the procedure again. Conclusion: Wide-awake procedures performed in a hospital procedure room have low infection rates with high patient satisfaction.

背景:宽醒觉手部手术使许多手部手术从手术室转移到了小手术室,同时提高了效率,保证了安全,降低了患者和医院的成本。本研究旨在评估在社区医院手术室进行无止血带宽醒局部麻醉手术的患者满意度和术后并发症。研究方法共有 786 名患者在医院手术室接受了 948 例手部择期手术。手术结束后,对患者进行了满意度调查。手术后,对患者术后并发症(包括感染)进行了评估。使用 R 软件中的 Cochran-Armitage 检验分析了 8 个年龄组的术后感染率趋势:总感染率为 6.2%(n = 59)。所有感染均为表皮感染。腕管感染人数最多(n = 25),其次是扳机指(n = 8),以及扳机指和腕管合并感染(n = 7)。所有感染均采用抗生素和/或浸泡治疗。有三名患者需要返回手术室进行冲洗和清创。99%的患者表示手术室的体验比去看牙医更好或相同,会向朋友或家人推荐宽醒麻醉,并愿意再次接受手术。结论在医院手术室进行的宽醒手术感染率低,患者满意度高。
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引用次数: 0
Impact of Time to Fixation on Outcomes of Operative Treatment of Intra-articular Distal Radius Fractures. 固定时间对桡骨远端关节内骨折手术治疗结果的影响
IF 1.8 Q2 ORTHOPEDICS Pub Date : 2024-11-01 Epub Date: 2023-05-26 DOI: 10.1177/15589447231174642
A Jordan Grier, Kallie J Chen, Alexandra V Paul, Cynthia L Green, Marc J Richard, David S Ruch, Tyler S Pidgeon

Background: The incidence of operative treatment of distal radius fractures (DRFs) has increased recently, but the optimal timing for surgical fixation remains unclear. We hypothesized that: (1) an increase in time to fixation of intra-articular DRFs would increase the likelihood of postoperative complications; and (2) increased time from injury to fixation would lead to longer surgical time and worse range of motion (ROM) outcomes.

Methods: We retrospectively reviewed 299 fractures in 284 adult patients who underwent open reduction and internal fixation (ORIF) of a closed, intra-articular DRF at our institution over a 10.5-year period. Demographic information, time to surgery (TTS) from injury, surgical time, tourniquet time, complications, and final postoperative ROM were collected for logistic regression modeling to predict the risk of postoperative complication.

Results: Twenty-seven (9.0%) patients experienced postoperative complications. The median TTS (Q1-Q3) for all patients was 7.0 (4.0-12.0) days. Patients who experienced an early postoperative complication had significantly longer median TTS (10.0 days) than those who did not (7.0 days). Patients with longer TTS were more likely to experience a complication (odds ratio, 1.11; 95% confidence interval, 1.04-1.19; P = .006). Tourniquet time and final wrist ROM were not related to TTS. A logistic regression analysis found that early complication rate doubles at 7.0 days after injury (from 3.5% to 6.9%).

Conclusions: Patients with operative intra-articular distal radius fractures should ideally be fixed within 7 to 10 days of injury to minimize the risk of early postoperative complications. The tourniquet time and final ROM were not associated with time to surgery.

背景:近来,桡骨远端骨折(DRF)手术治疗的发生率有所上升,但手术固定的最佳时机仍不明确。我们假设(1) 增加关节内 DRF 的固定时间会增加术后并发症的可能性;(2) 增加从受伤到固定的时间会导致手术时间延长和活动范围 (ROM) 结果变差:我们回顾性研究了10.5年间在我院接受闭合性关节内DRF切开复位内固定术(ORIF)的284名成年患者的299处骨折。我们收集了患者的人口统计学信息、从受伤到手术的时间(TTS)、手术时间、止血带时间、并发症和最终术后ROM,并建立了逻辑回归模型来预测术后并发症的风险:结果:27 名患者(9.0%)出现了术后并发症。所有患者的中位 TTS(Q1-Q3)为 7.0(4.0-12.0)天。术后早期出现并发症的患者的 TTS 中位数(10.0 天)明显长于未出现并发症的患者(7.0 天)。TTS时间较长的患者更容易出现并发症(几率比为1.11;95%置信区间为1.04-1.19;P = .006)。止血带时间和最终腕关节ROM与TTS无关。逻辑回归分析发现,早期并发症发生率在伤后7.0天翻了一番(从3.5%增至6.9%):结论:关节内桡骨远端骨折患者最好在伤后7至10天内进行手术固定,以最大限度地降低术后早期并发症的风险。止血带时间和最终ROM与手术时间无关。
{"title":"Impact of Time to Fixation on Outcomes of Operative Treatment of Intra-articular Distal Radius Fractures.","authors":"A Jordan Grier, Kallie J Chen, Alexandra V Paul, Cynthia L Green, Marc J Richard, David S Ruch, Tyler S Pidgeon","doi":"10.1177/15589447231174642","DOIUrl":"10.1177/15589447231174642","url":null,"abstract":"<p><strong>Background: </strong>The incidence of operative treatment of distal radius fractures (DRFs) has increased recently, but the optimal timing for surgical fixation remains unclear. We hypothesized that: (1) an increase in time to fixation of intra-articular DRFs would increase the likelihood of postoperative complications; and (2) increased time from injury to fixation would lead to longer surgical time and worse range of motion (ROM) outcomes.</p><p><strong>Methods: </strong>We retrospectively reviewed 299 fractures in 284 adult patients who underwent open reduction and internal fixation (ORIF) of a closed, intra-articular DRF at our institution over a 10.5-year period. Demographic information, time to surgery (TTS) from injury, surgical time, tourniquet time, complications, and final postoperative ROM were collected for logistic regression modeling to predict the risk of postoperative complication.</p><p><strong>Results: </strong>Twenty-seven (9.0%) patients experienced postoperative complications. The median TTS (Q1-Q3) for all patients was 7.0 (4.0-12.0) days. Patients who experienced an early postoperative complication had significantly longer median TTS (10.0 days) than those who did not (7.0 days). Patients with longer TTS were more likely to experience a complication (odds ratio, 1.11; 95% confidence interval, 1.04-1.19; <i>P</i> = .006). Tourniquet time and final wrist ROM were not related to TTS. A logistic regression analysis found that early complication rate doubles at 7.0 days after injury (from 3.5% to 6.9%).</p><p><strong>Conclusions: </strong>Patients with operative intra-articular distal radius fractures should ideally be fixed within 7 to 10 days of injury to minimize the risk of early postoperative complications. The tourniquet time and final ROM were not associated with time to surgery.</p>","PeriodicalId":12902,"journal":{"name":"HAND","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11536765/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9525455","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
Dupuytren Disease Surgical Treatment: A Randomized Clinical Trial Comparing Partial Fasciectomy by Bruner Approach Versus Zetaplasty. 杜普伊特伦病的手术治疗:比较布鲁纳法部分筋膜切除术与Zetaplasty术的随机临床试验。
IF 1.8 Q2 ORTHOPEDICS Pub Date : 2024-11-01 Epub Date: 2023-07-23 DOI: 10.1177/15589447231185581
Renan G Leão, Vinicius Y de Moraes, Luis R Nakachima, João C Belloti, João B G Santos

Background: Dupuytren is a fibroproliferative pathology leading to contracture of the palmar fascia. Several approaches have been described for the surgical treatment with partial fasciectomy with few comparisons in literature. Our purpose is to compare the functional outcomes between the partial fasciectomy performed by Bruner type incision and zetaplasty incision.

Methods: The method used was a randomized clinical trial including adult patients of both sexes with surgical indication for Dupuytren disease presented to a reference center. Patients were randomly and consecutively allocated in the groups 1:1. We recorded the Disabilities of the Arm, Shoulder, and Hand (DASH) score; range of motion for active and passive extension of the metacarpophalangeal (MP) and proximal interphalangeal (PIP) joints; visual analog scale for pain; and complications.

Results: In all, 62 patients were included, with 48 patients reaching the minimum follow-up of 6 months with 63 operated fingers. In the Bruner approach group, we obtained a correction of the active and passive extension of the MP of 28° and of the PIP of 23°. In the zetaplasty group, correction of MP was 30° for active and passive, and 18° for active extension and 16° for passive extension of the PIP. The reduction in the DASH score was 10 points in the Bruner group and 22 points in the zetaplasty group. There was no statistically significant effect of the type of treatment on preoperative and postoperative differences in any of the parameters evaluated.

Conclusions: There were no statistically significant differences between the 2 techniques for self-reported functional outcomes or objective measures of physical examination.

背景介绍杜普伊特伦是一种导致掌筋膜挛缩的纤维增生性病变。目前已有几种筋膜部分切除术的手术治疗方法,但很少有文献对其进行比较。我们的目的是比较Bruner型切口和zetaplasty切口进行部分筋膜切除术的功能效果:方法:采用随机临床试验的方法,包括到参考中心就诊的有手术指征的杜普伊特伦病成年男女患者。患者以 1:1 的比例随机连续分配到各组。我们记录了手臂、肩部和手部残疾(DASH)评分;掌指关节(MP)和近端指间关节(PIP)主动和被动伸展的活动范围;疼痛视觉模拟量表;以及并发症:共有62名患者接受了治疗,其中48名患者的手术手指达到63个,随访时间最短为6个月。在布鲁纳方法组中,我们获得了主动和被动伸展 MP 28°和 PIP 23°的矫正效果。在Zetaplasty组中,MP的主动和被动伸展矫正为30°,PIP的主动伸展矫正为18°,被动伸展矫正为16°。Bruner组的DASH评分降低了10分,zetaplasty组降低了22分。治疗类型对术前和术后任何评估参数的差异均无统计学意义:在自我报告的功能结果或客观的体格检查指标方面,两种技术之间没有明显的统计学差异。
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引用次数: 0
Revisiting the Methodology and Implications of the Network Meta-Analysis on Dupuytren Disease Treatments: A Letter to the Editor. 重新审视杜普伊特伦氏病治疗网络 Meta 分析的方法和意义:致编辑的一封信
IF 1.8 Q2 ORTHOPEDICS Pub Date : 2024-11-01 Epub Date: 2023-12-15 DOI: 10.1177/15589447231218398
Ishith Seth, Warren M Rozen
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引用次数: 0
Response to: Revisiting the Methodology and Implications of the Network Meta-analysis on Dupuytren Disease Treatments: A Letter to the Editor. 回应重新审视杜普伊特伦病治疗方法网络 Meta 分析的方法和意义:致编辑的一封信。
IF 1.8 Q2 ORTHOPEDICS Pub Date : 2024-11-01 Epub Date: 2023-12-15 DOI: 10.1177/15589447231218397
Silas Nann, Joshua Kovoor, James Fowler, James Kieu, Aashray Gupta, Joseph Hewitt, Christopher Ovenden, Suzanne Edwards, Stephen Bacchi, Jonathan Henry W Jacobsen, Richard Harries, Guy Maddern
{"title":"Response to: Revisiting the Methodology and Implications of the Network Meta-analysis on Dupuytren Disease Treatments: A Letter to the Editor.","authors":"Silas Nann, Joshua Kovoor, James Fowler, James Kieu, Aashray Gupta, Joseph Hewitt, Christopher Ovenden, Suzanne Edwards, Stephen Bacchi, Jonathan Henry W Jacobsen, Richard Harries, Guy Maddern","doi":"10.1177/15589447231218397","DOIUrl":"10.1177/15589447231218397","url":null,"abstract":"","PeriodicalId":12902,"journal":{"name":"HAND","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11536806/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138803032","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
Effect of Capitolunate Positioning on Outcomes in Scaphoid Excision and 4-Bone Fusion Patients. Capitolunate定位对肩胛骨切除术和4骨融合术患者疗效的影响
IF 1.8 Q2 ORTHOPEDICS Pub Date : 2024-11-01 Epub Date: 2023-07-23 DOI: 10.1177/15589447231187074
Cameron L Hallihan, Robert J Goitz, Robert A Kaufmann, John R Fowler

Background: Scaphoid excision and 4-bone fusion (4BF) is a surgical procedure to treat scapholunate advanced collapse. Some surgeons align the lunate over the capitates, whereas others leave the capitate in its uncovered native position. The capitolunate angle may affect long-term outcomes. This study examined whether postsurgical outcomes differed based on these differences in positioning.

Methods: A retrospective analysis was performed for patients that underwent a 4BF between 2006 and 2020. Wrist range of motion; pain (0-10); and Disabilities of the Arm, Shoulder, and Hand (DASH) scores were recorded. The width of the capitate, the width of the lunate contacting the capitate, and the capitolunate angle were measured. Pearson correlations and t tests were performed. For t tests of capitolunate uncovering, patients were divided into 2 groups: patients with 0% capitate uncovering and patients with >0% uncovering. For capitolunate angle, the 2 groups were patients with a capitolunate angle of ≤10° and patients with a capitolunate angle of >10°.

Results: There was a significant correlation between capitate coverage and wrist extension, but no correlation for flexion, pain, or DASH scores. Group 1 (0% uncovering) had increased wrist extension and decreased pain compared with group 2 (>0% uncovering). There were no significant correlations or differences in the analyses of capitolunate angle's impact on outcomes.

Conclusions: In patients undergoing 4BF, those who had the lunate aligned to completely cover the capitate head had improved wrist extension and pain compared with patients where the capitate head was left partially uncovered. Capitolunate angle was not predictive of postsurgical outcomes.

背景:肩胛骨切除和四骨融合术(4BF)是一种治疗肩胛骨晚期塌陷的手术方法。一些外科医生会将新月形骨对准肩胛骨,而另一些外科医生则会将肩胛骨保留在未覆盖的原位。肩胛骨角度可能会影响长期疗效。本研究探讨了手术后的疗效是否会因定位的不同而有所差异:对2006年至2020年间接受4BF手术的患者进行了回顾性分析。记录了腕关节的活动范围、疼痛(0-10 分)以及手臂、肩部和手部残疾(DASH)评分。此外,还测量了头骨宽度、月骨接触头骨的宽度以及头骨与月骨的夹角。进行了皮尔逊相关性和 t 检验。在对帽状腱膜揭露度进行 t 检验时,将患者分为两组:帽状腱膜揭露度为 0% 的患者和揭露度大于 0% 的患者。在帽状腱膜角度方面,分为帽状腱膜角度≤10°和帽状腱膜角度>10°两组:结果:头状角覆盖率与腕关节伸展有明显相关性,但与屈曲、疼痛或DASH评分无相关性。第一组(0% 覆盖率)与第二组(>0% 覆盖率)相比,腕关节伸展度增加,疼痛减轻。在分析帽状腱膜角度对疗效的影响时,没有发现明显的相关性或差异:结论:在接受4BF手术的患者中,与帽状头部分未被覆盖的患者相比,月骨对齐以完全覆盖帽状头的患者的腕关节伸展和疼痛均有所改善。帽状头角度并不能预测术后效果。
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引用次数: 0
Efficacy and Safety of Different Trapezium Implants for Trapeziometacarpal Joint Osteoarthritis: A Systematic Review and Meta-Analysis. 不同梯形假体治疗梯形掌关节骨性关节炎的有效性和安全性:系统回顾与元分析》。
IF 1.8 Q2 ORTHOPEDICS Pub Date : 2024-11-01 Epub Date: 2023-07-02 DOI: 10.1177/15589447231183172
Ishith Seth, Gabriella Bulloch, Nimish Seth, Quentin Fogg, David J Hunter-Smith, Warren M Rozen

Background: The trapeziometacarpal joint (TMCJ) is the most common hand joint affected by osteoarthritis (OA), and trapezium implant arthroplasty is a potential treatment for recalcitrant OA. This meta-analysis aimed to investigate the efficacy and safety of various trapezium implants as an interventional option for TMCJ OA. Methods: Web of Science, PubMed, Scopus, Google Scholar, and Cochrane library databases were searched for relevant studies up to May 28, 2022. Preferred Reported Items for Systematic Review and Meta-Analysis guidelines were adhered to, and the protocol was registered in PROSPERO. The methodological quality was assessed by National Heart, Lung, and Blood Institute tools for observational studies and the Cochrane risk of bias tool. Subgroup analyses were performed on different replacement implants; the analysis was done using Open Meta-Analyst software and P values <.05 were considered statistically significant. Results: A total of 123 studies comprising 5752 patients were included. Total joint replacement (TJR) implants demonstrate greater significant improvements in visual analogue scale pain scores postoperatively. Interposition with partial trapezial resection implants were associated with highest grip strength and highest reduction in the Disabilities of the Arm, Shoulder, and Hand (DASH) score. Revision rates were highest in TJR (12.3%) and lowest in interposition with partial trapezial resection (6.2%). Conclusion: Total joint replacement and interposition with partial trapezial resection implants improve pain score, grip strength, and DASH scores more than other implant options. Future studies should focus on high-quality randomized clinical trials comparing different implants to accumulate higher quality evidence and more reliable conclusions.

背景:梯形掌关节(TMCJ)是受骨关节炎(OA)影响最常见的手部关节,梯形假体关节置换术是一种治疗顽固性 OA 的潜在方法。本荟萃分析旨在研究各种梯形假体作为TMCJ OA介入治疗方案的有效性和安全性。方法:检索科学网、PubMed、Scopus、谷歌学术和 Cochrane 图书馆数据库中截至 2022 年 5 月 28 日的相关研究。遵循《系统综述和元分析首选报告项目》指南,并在 PROSPERO 上注册了研究方案。方法学质量由美国国家心肺血液研究所的观察性研究工具和 Cochrane 偏倚风险工具进行评估。对不同的置换植入物进行了分组分析;分析采用 Open Meta-Analyst 软件和 P 值 结果:共纳入了 123 项研究,包括 5752 名患者。全关节置换(TJR)植入物在术后视觉模拟量表疼痛评分方面有更显著的改善。带部分斜方肌切除的内固定假体具有最高的握力和最高的手臂、肩部和手部残疾(DASH)评分降低率。TJR的翻修率最高(12.3%),而带部分斜方肌切除术的内插手术的翻修率最低(6.2%)。结论:与其他植入物相比,全关节置换术和带斜方肌部分切除术的内固定植入物能更有效地改善疼痛评分、握力和 DASH 评分。未来的研究应侧重于比较不同植入物的高质量随机临床试验,以积累更高质量的证据和更可靠的结论。
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