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The 2023 American Orthopaedic Association-Japanese Orthopaedic Association (AOA-JOA) Traveling Fellowship. 2023 年美国矫形外科协会-日本矫形外科协会(AOA-JOA)旅行奖学金。
IF 4.4 1区 医学 Q1 ORTHOPEDICS Pub Date : 2024-09-18 Epub Date: 2024-05-30 DOI: 10.2106/JBJS.24.00060
Tessa Balach, Jean-Claude D'Alleyrand, Shen-Ying Richard Ma, John A Scolaro
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引用次数: 0
Synovial Fluid Cutibacterium acnes Antigen Is Detected Among Shoulder Samples with High Inflammation and Early Culture Growth. 在肩关节高度炎症和早期培养生长的样本中检测到滑膜液痤疮杆菌抗原
IF 4.4 1区 医学 Q1 ORTHOPEDICS Pub Date : 2024-09-18 Epub Date: 2024-07-01 DOI: 10.2106/JBJS.23.00409
Krista O Toler, Pearl R Paranjape, Alex McLaren, Carl Deirmengian

Background: An emerging paradigm suggests that positive Cutibacterium acnes shoulder cultures can result from either true infection or contamination, with true infections demonstrating a host inflammatory response and early culture growth. This clinical retrospective study examines the relationship between C. acnes antigen, C. acnes culture results, and inflammation.

Methods: From January 2021 to July 2023, 1,365 periprosthetic synovial fluid samples from 347 institutions were tested for shoulder infection at a centralized clinical laboratory. A biomarker scoring system based on the 2018 International Consensus Meeting (ICM) definition was utilized to assign each sample an inflammation score. Associations between inflammation, culture results, and C. acnes antigen results were assessed utilizing cluster and correlation analyses.

Results: Of 1,365 samples, 1,150 were culture-negative and 215 were culture-positive (94 C. acnes and 121 other organisms). Among the 94 C. acnes culture-positive samples, unsupervised clustering revealed 2 distinct sample clusters (silhouette coefficient, 0.83): a high-inflammation cluster (n = 67) and a low-inflammation cluster (n = 27). C. acnes antigen levels demonstrated moderate-strong positive correlation with inflammation (Spearman ρ, 0.60), with 166-fold higher levels of C. acnes antigen in high-inflammation samples (16.6 signal/cutoff [S/CO]) compared with low-inflammation samples (0.1 S/CO) (p < 0.0001). The days to C. acnes culture positivity demonstrated weak-inverse correlation with inflammation (Spearman ρ = -0.38), with 1.5-fold earlier growth among the 67 high-inflammation samples (6.7 compared with 10.4 days; p < 0.0001). Elevated C. acnes antigen was observed in only 4 (0.38%) of 1,050 low-inflammation culture-negative samples and in only 5 (4.9%) of 103 high-inflammation non- C. acnes -positive cultures. However, 19.0% of high-inflammation, culture-negative samples demonstrated elevated C. acnes antigen.

Conclusions: Synovial fluid C. acnes antigen was detected among shoulder samples with high inflammation and early culture growth, supporting the emerging paradigm that these samples represent true infection. Future research should explore antigen testing to differentiate contamination from infection and to identify culture-negative C. acnes infections.

Level of evidence: Diagnostic Level III . See Instructions for Authors for a complete description of levels of evidence.

背景:一种新出现的模式表明,痤疮棒状杆菌肩部培养结果呈阳性可能是由于真正的感染或污染,而真正的感染表现为宿主炎症反应和早期培养生长。本临床回顾性研究探讨了痤疮丙酸杆菌抗原、痤疮丙酸杆菌培养结果和炎症之间的关系:方法:从 2021 年 1 月到 2023 年 7 月,来自 347 家机构的 1,365 份关节周围滑液样本在一家集中式临床实验室接受了肩关节感染检测。采用基于 2018 年国际共识会议(ICM)定义的生物标志物评分系统对每个样本进行炎症评分。利用聚类分析和相关分析评估了炎症、培养结果和痤疮丙酸杆菌抗原结果之间的关联:在 1,365 个样本中,1,150 个样本培养阴性,215 个样本培养阳性(94 个痤疮丙酸杆菌样本和 121 个其他微生物样本)。在 94 个痤疮丙酸杆菌培养阳性样本中,无监督聚类发现了两个不同的样本群(剪影系数为 0.83):高炎症群(n = 67)和低炎症群(n = 27)。痤疮丙酸杆菌抗原水平与炎症呈中强正相关(Spearman ρ,0.60),与低炎症样本(0.1 S/CO)相比,高炎症样本中的痤疮丙酸杆菌抗原水平(16.6 信号/截止值 [S/CO])高出 166 倍(p < 0.0001)。痤疮丙酸杆菌培养阳性天数与炎症呈弱逆相关(Spearman ρ = -0.38),67 个高炎症样本的痤疮丙酸杆菌培养阳性天数提前了 1.5 倍(6.7 天与 10.4 天相比;p < 0.0001)。在 1050 份低炎症培养阴性样本中,只有 4 份(0.38%)观察到痤疮丙酸杆菌抗原升高,在 103 份高炎症非痤疮丙酸杆菌阳性培养样本中,只有 5 份(4.9%)观察到痤疮丙酸杆菌抗原升高。然而,19.0% 的高炎症培养阴性样本显示痤疮丙酸杆菌抗原升高:滑膜液痤疮丙酸杆菌抗原在高炎症和早期培养生长的肩关节样本中被检测到,支持了这些样本代表真正感染的新兴模式。未来的研究应探索抗原检测,以区分污染和感染,并确定培养阴性的痤疮丙酸杆菌感染:诊断级别 III。有关证据等级的完整描述,请参阅 "作者须知"。
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引用次数: 0
What's New in Orthopaedic Rehabilitation. 骨科康复的新进展。
IF 4.4 1区 医学 Q1 ORTHOPEDICS Pub Date : 2024-09-18 DOI: 10.2106/JBJS.24.00841
Donald Kasitinon, Alia Hemeida, Reed C Williams, Mahmood Gharib, Sara Raiser, Amanda Wise, Nitin B Jain
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引用次数: 0
Using Multimodal Assessments to Reevaluate Depression Designations for Spine Surgery Candidates. 使用多模态评估重新评估脊柱手术候选者的抑郁认定。
IF 4.4 1区 医学 Q1 ORTHOPEDICS Pub Date : 2024-09-18 Epub Date: 2024-07-25 DOI: 10.2106/JBJS.23.01195
Braeden Benedict, Madelyn Frumkin, Kathleen Botterbush, Saad Javeed, Justin K Zhang, Salim Yakdan, Brian J Neuman, Michael P Steinmetz, Zoher Ghogawala, Michael P Kelly, Burel R Goodin, Jay F Piccirillo, Wilson Z Ray, Thomas L Rodebaugh, Jacob K Greenberg

Background: Depression is common in spine surgery candidates and may influence postoperative outcomes. Ecological momentary assessments (EMAs) can overcome limitations of existing depression screening methods (e.g., recall bias, inaccuracy of historical diagnoses) by longitudinally monitoring depression symptoms in daily life. In this study, we compared EMA-based depression assessment with retrospective self-report (a 9-item Patient Health Questionnaire [PHQ-9]) and chart-based depression diagnosis in lumbar spine surgery candidates. We further examined the associations of each depression assessment method with surgical outcomes.

Methods: Adult patients undergoing lumbar spine surgery (n = 122) completed EMAs quantifying depressive symptoms up to 5 times daily for 3 weeks preoperatively. Correlations (rank-biserial or Spearman) among EMA means, a chart-based depression history, and 1-time preoperative depression surveys (PHQ-9 and Psychache Scale) were analyzed. Confirmatory factor analysis was used to categorize PHQ-9 questions as somatic or non-somatic; subscores were compared with a propensity score-matched general population cohort. The associations of each screening modality with 6-month surgical outcomes (pain, disability, physical function, pain interference) were analyzed with multivariable regression.

Results: The association between EMA Depression scores and a depression history was weak (r rb = 0.34 [95% confidence interval (CI), 0.14 to 0.52]). Moderate correlations with EMA-measured depression symptoms were observed for the PHQ-9 (r s = 0.51 [95% CI, 0.37 to 0.63]) and the Psychache Scale (r s = 0.68 [95% CI, 0.57 to 0.76]). Compared with the matched general population cohort, spine surgery candidates endorsed similar non-somatic symptoms but significantly greater somatic symptoms on the PHQ-9. EMA Depression scores had a stronger association with 6-month surgical outcomes than the other depression screening modalities did.

Conclusions: A history of depression in the medical record is not a reliable indication of preoperative depression symptom severity. Cross-sectional depression assessments such as PHQ-9 have stronger associations with daily depression symptoms but may conflate somatic depression symptoms with spine-related disability. As an alternative to these methods, mobile health technology and EMAs provide an opportunity to collect real-time, longitudinal data on depression symptom severity, potentially improving prognostic accuracy.

Level of evidence: Diagnostic Level III . See Instructions for Authors for a complete description of levels of evidence.

背景:抑郁症在脊柱手术患者中很常见,可能会影响术后效果。生态瞬间评估(EMA)可通过纵向监测日常生活中的抑郁症状,克服现有抑郁症筛查方法的局限性(如回忆偏差、历史诊断不准确等)。在本研究中,我们比较了基于 EMA 的抑郁评估与回顾性自我报告(9 项患者健康问卷 [PHQ-9])和基于病历的腰椎手术候选者抑郁诊断。我们进一步研究了每种抑郁评估方法与手术结果之间的关联:方法:接受腰椎手术的成年患者(n = 122)在术前 3 周内完成了 EMA,每天最多 5 次量化抑郁症状。分析了 EMA 平均值、基于病历的抑郁病史以及术前 1 次抑郁调查(PHQ-9 和心理痛苦量表)之间的相关性(秩比值或斯皮尔曼)。采用确证因子分析将 PHQ-9 问题分为躯体抑郁和非躯体抑郁;将子分数与倾向分数匹配的普通人群队列进行比较。通过多变量回归分析了每种筛查方式与 6 个月手术结果(疼痛、残疾、身体功能、疼痛干扰)之间的关系:结果:EMA 抑郁症评分与抑郁症病史之间的相关性较弱(rrb = 0.34 [95% 置信区间 (CI),0.14 至 0.52])。PHQ-9(rs = 0.51 [95% CI, 0.37 to 0.63])和心理痛苦量表(rs = 0.68 [95% CI, 0.57 to 0.76])与 EMA 测量的抑郁症状呈中度相关。与匹配的普通人群队列相比,脊柱手术患者在 PHQ-9 上表现出的非躯体症状相似,但躯体症状明显更多。与其他抑郁筛查方式相比,EMA抑郁评分与6个月手术结果的关联性更强:结论:医疗记录中的抑郁症病史并不能可靠地说明术前抑郁症状的严重程度。PHQ-9等横断面抑郁评估与日常抑郁症状的关联性更强,但可能会将躯体抑郁症状与脊柱相关残疾混为一谈。作为这些方法的替代方法,移动医疗技术和 EMA 为收集抑郁症状严重程度的实时、纵向数据提供了机会,有可能提高预后的准确性:证据级别:诊断三级。有关证据级别的完整描述,请参阅 "作者须知"。
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引用次数: 0
What's New in Hip Surgery. 髋关节手术的新进展。
IF 4.4 1区 医学 Q1 ORTHOPEDICS Pub Date : 2024-09-18 Epub Date: 2024-07-25 DOI: 10.2106/JBJS.24.00676
Lisa C Howard, Gerard A Sheridan
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引用次数: 0
The Alpha Angle. 阿尔法角
IF 4.4 1区 医学 Q1 ORTHOPEDICS Pub Date : 2024-09-16 DOI: 10.2106/JBJS.23.01089
Seper Ekhtiari, Olivia Fairhurst, Lily Mainwaring, Vikas Khanduja

➢ The alpha angle was originally defined on magnetic resonance imaging (MRI) scans, using a plane, parallel to the axis of the femoral neck. However, much of the literature on the alpha angle has used radiographs or other imaging modalities to quantify the alpha angle.➢ The measurement of the alpha angle can be unreliable, particularly on radiographs and ultrasound.➢ If radiographs are used to measure the alpha angle, the circle of best-fit method should be used on multiple different views to capture various locations of the cam lesion, and "eyeballing" or estimating the alpha angle should be avoided.➢ The cam lesion is a dynamic and 3-dimensional (3D) problem and is unlikely to be adequately defined or captured by a single angle.➢ Modern technology, including readily available 3D imaging modalities, as well as intraoperative and dynamic imaging options, provides novel, and potentially more clinically relevant, ways to quantify the alpha angle.

➢ α角最初是在磁共振成像(MRI)扫描中使用与股骨颈轴线平行的平面来定义的。➢ 如果使用X光片测量α角,则应在多个不同视图上使用最佳拟合圆法捕捉凸轮病变的不同位置,并应避免 "目测 "或估计α角。➢ 凸轮病变是一个动态的三维(3D)问题,不可能用一个角度就能充分定义或捕捉到。 ➢ 现代技术,包括现成的三维成像模式以及术中和动态成像选项,提供了新颖且可能更贴近临床的方法来量化α角。
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引用次数: 0
Demographics, Indications, and Revision Rates for Radial Head Arthroplasty: Analysis of Data from the Australian Orthopaedic Association National Joint Replacement Registry. 桡骨头关节置换术的人口统计学、适应症和翻修率:澳大利亚矫形外科协会全国关节置换登记处数据分析》(Australian Orthopaedic Association National Joint Replacement Registry)。
IF 4.4 1区 医学 Q1 ORTHOPEDICS Pub Date : 2024-09-06 DOI: 10.2106/JBJS.24.00072
Narinder Kumar, Belinda J Gabbe, Richard S Page, Sze-Ee Soh, David R J Gill, Dylan Harries, Ilana N Ackerman

Background: Population-level data from national arthroplasty registries enable the use and outcomes of arthroplasty procedures to be monitored over time. This study aimed to describe the demographics, indications, and outcomes (up to 15 years) for radial head arthroplasty (RHA) procedures in Australia, as well as the factors associated with an increased likelihood of revision.

Methods: Individual-level deidentified data on demographics and surgery characteristics, including revision surgery, were obtained from the Australian Orthopaedic Association National Joint Replacement Registry for all primary isolated RHA procedures that had been performed from 2007 to 2021. The probability of prosthesis survival was determined using Kaplan-Meier estimates. Cox proportional hazards models were used to calculate hazard ratios (HRs) for revision.

Results: A total of 3,457 primary RHAs were performed during the study period (mean follow-up, 5.6 years; range, 0 to 15 years). The mean age at the time of RHA was 53 years, with female predominance (n = 2,009, 58%). The most common indication for RHA was fracture or dislocation (n = 3,166, 92%), followed by osteoarthritis (n = 232, 7%). The radial head prostheses that were most commonly used were monopolar (n = 3,378, 98%) with a modular design (n = 3,442, 99.6%) and cementless fixation (n = 3,387, 98%). Both metallic and nonmetallic prostheses were used (52% and 48%, respectively). Of the total cohort, 160 revisions (5%) were performed during the 15-year period; most revisions occurred in the first 5 years. The most common revision indication was prosthesis loosening (n = 62, 39%), and 54% of the revisions (n = 87) involved a change of the radial component. In multivariable analysis, primary procedures for osteoarthritis (HR, 1.65; 95% confidence interval [CI], 1.01 to 2.70) or "other" indications (e.g., inflammatory arthritis, osteonecrosis, or tumor) were revised more frequently (HR, 3.68; 95% CI, 1.14 to 11.91) than procedures for fracture or dislocation. Procedures with nonmetallic prostheses had higher rates of revision (HR, 1.61; 95% CI, 1.17 to 2.22) than those with metallic prostheses.

Conclusions: Trauma remained the most prevalent indication for RHA in Australia from 2007 to 2021. Encouragingly, revision rates were low, most notably for RHA that had been performed for fracture or dislocation. The likelihood of revision was highest for RHA procedures performed for osteoarthritis and for an indication other than osteoarthritis or trauma. Nonmetallic prostheses had a higher rate of revision than metallic prostheses.

Level of evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

背景:通过国家关节成形术登记处提供的人口级数据,可以对关节成形术的使用情况和结果进行长期监测。本研究旨在描述澳大利亚桡骨头关节成形术(RHA)的人口统计学、适应症和结果(长达15年),以及与翻修可能性增加相关的因素:从澳大利亚矫形外科协会全国关节置换登记处获得了2007年至2021年期间进行的所有初次孤立RHA手术的人口统计学和手术特征(包括翻修手术)的个人层面去身份化数据。假体存活概率采用Kaplan-Meier估计值确定。采用Cox比例危险模型计算翻修的危险比(HRs):研究期间共进行了3457例初次RHA(平均随访时间为5.6年;随访时间范围为0至15年)。RHA时的平均年龄为53岁,女性居多(n = 2,009,58%)。桡骨头假体最常见的适应症是骨折或脱位(n = 3,166,92%),其次是骨关节炎(n = 232,7%)。最常用的桡骨头假体是模块化设计的单极假体(3,378 例,98%)(3,442 例,99.6%)和无骨水泥固定假体(3,387 例,98%)。使用金属和非金属假体的比例分别为 52% 和 48%。在 15 年的时间里,共进行了 160 次翻修(5%);大多数翻修发生在前 5 年。最常见的翻修适应症是假体松动(62例,39%),54%的翻修(87例)涉及桡骨组件的更换。在多变量分析中,因骨关节炎(HR,1.65;95% 置信区间[CI],1.01 至 2.70)或 "其他 "适应症(如炎性关节炎、骨坏死或肿瘤)而进行的初次手术的翻修率(HR,3.68;95% 置信区间[CI],1.14 至 11.91)高于因骨折或脱位而进行的手术。与使用金属假体的手术相比,使用非金属假体的手术翻修率更高(HR,1.61;95% CI,1.17 至 2.22):结论:从2007年到2021年,在澳大利亚,创伤仍然是RHA最常见的适应症。令人鼓舞的是,翻修率很低,尤其是因骨折或脱位而进行的RHA。因骨关节炎和骨关节炎或外伤以外的适应症而进行的RHA手术的翻修率最高。非金属假体的翻修率高于金属假体:证据等级:治疗III级。有关证据级别的完整描述,请参阅 "作者须知"。
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引用次数: 0
The Role of Journals in Reporting Sex and Gender-Based Outcomes: Should We Adopt Guidelines, and What Else Can We Do to Improve Reporting? 期刊在报告性别和基于性别的结果中的作用:我们是否应该采用指南,我们还能做些什么来改进报告?
IF 4.4 1区 医学 Q1 ORTHOPEDICS Pub Date : 2024-09-04 Epub Date: 2024-07-29 DOI: 10.2106/JBJS.24.00035
Andrew J Schoenfeld

➤ Sex and gender are inconsistently reported in musculoskeletal research. A panel of journal editors and other interested parties who participated in The Journal of Bone and Joint Surgery Sex and Gender Reporting in Musculoskeletal Research Symposium met in 2023 to help define the roles of journals and other stakeholders in addressing this issue.➤ This report summarizes the resulting recommendations and presents several different ways in which orthopaedic journals may elect to introduce to their readers, reviewers, and authors the importance of considering sex and gender in orthopaedic research.➤ Many current sex and gender-related funding agency mandates as well as the Sex and Gender Equity in Research (SAGER) guidelines are most readily applied to prospective research and/or randomized controlled trials.➤ The panel was supportive of endorsing SAGER or a similar set of guidelines as a tool that can help authors to consider the most effective means of evaluating the influences of sex and gender within the context of orthopaedic research.➤ Engaging readers, reviewers, and authors on multiple fronts, with purpose and intention, is likely the most important approach to increase awareness and to enhance the quality of evidence utilized to support clinical decisions in orthopaedic surgery.

➤ 肌肉骨骼研究中的性别报告不一致。参加《骨与关节外科杂志》(Journal of Bone and Joint Surgery)"肌肉骨骼研究中的性别报告 "研讨会的期刊编辑和其他相关人士于 2023 年召开了一次会议,以帮助确定期刊和其他利益相关者在解决这一问题中的角色。➤ 目前许多与性和性别相关的资助机构规定以及 "研究中的性和性别平等 (SAGER) 指南 "最容易应用于前瞻性研究和/或随机对照试验。➤ 让读者、审稿人和作者有目的、有意识地从多方面参与进来,可能是提高认识和提高证据质量的最重要方法,这些证据可用于支持骨科手术的临床决策。
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引用次数: 0
Validating Orthopaedic Data Evaluation Panel (ODEP) Ratings Across 9 Orthopaedic Registries: Total Hip Implants with an ODEP Rating Perform Better Than Those without an ODEP Rating. 在 9 个骨科登记处验证骨科数据评估小组 (ODEP) 评级:获得 ODEP 评级的全髋关节假体比未获得 ODEP 评级的表现更好。
IF 4.4 1区 医学 Q1 ORTHOPEDICS Pub Date : 2024-09-04 Epub Date: 2024-05-31 DOI: 10.2106/JBJS.23.00793
Lotje A Hoogervorst, Maartje M van Tilburg, Anne Lübbeke, Tim Wilton, Rob G H H Nelissen, Perla J Marang-van de Mheen

Background: Orthopaedic Data Evaluation Panel (ODEP) ratings of total hip (TH) and total knee (TK) implants are informative for assessing implant performance. However, the validity of ODEP ratings across multiple registries is unknown. Therefore, we aimed to assess, across multiple registries, whether TH and TK implants with a higher ODEP rating (i.e., an A* rating) have lower cumulative revision risks (CRRs) than those with a lower ODEP rating (i.e., an A rating) and the extent to which A* and A-rated implants would be A*-rated on the basis of the pooled registries' CRR.

Methods: Implant-specific CRRs at 3, 5, and 10 years that were reported by registries were matched to ODEP ratings on the basis of the implant name. A meta-analysis with random-effects models was utilized for pooling the CRRs. ODEP benchmark criteria were utilized to classify these pooled CRRs.

Results: A total of 313 TH cups (54%), 356 TH stems (58%), 218 TH cup-stem combinations (34%), and 68 TK implants (13%) with unique brand names reported by registries were matched to an ODEP rating. Given the low percentage that matched, TK implants were not further analyzed. ODEP-matched TH implants had lower CRRs than TH implants without an ODEP rating at all follow-up time points, although the difference for TH stems was not significant at 5 years. No overall differences in CRRs were found between A* and A-rated TH implants, with the exception of TH cup-stem combinations, which demonstrated a significantly lower CRR for A*A*-rated cup-stem combinations at the 3-year time point. Thirty-nine percent of A*-rated cups and 42% of A*-rated stems would receive an A* rating on the basis of the pooled registries' CRR at 3 years; however, 24% of A-rated cups and 31% of A-rated stems would also receive an A* rating, with similar findings demonstrated at longer follow-up.

Conclusions: At all follow-up time points, ODEP-matched TH implants had lower CRRs than TH implants without an ODEP rating. Given that the performance of TH implants varied across countries, registries should first validate ODEP ratings with use of country-specific revision data to better guide implant selection in their country. Data source transparency and the use of revision data from multiple registries would strengthen the ODEP benchmarks.

Level of evidence: Therapeutic Level III . See Instructions for Authors for a complete description of levels of evidence.

背景:骨科数据评估小组(ODEP)对全髋关节(TH)和全膝关节(TK)植入物的评级可为评估植入物性能提供信息。然而,ODEP 评级在多个登记处的有效性尚不清楚。因此,我们的目的是在多个登记处中评估ODEP评级较高(即A*级)的TH和TK植入体是否比ODEP评级较低(即A级)的植入体具有更低的累积翻修风险(CRR),以及根据汇总登记处的CRR,A*级和A级植入体在多大程度上会被评为A*级:方法:根据植入物名称,将注册机构报告的植入物 3 年、5 年和 10 年的特定 CRR 与 ODEP 评级进行匹配。采用随机效应模型进行荟萃分析,以汇总CRR。结果:共有 313 个 TH 杯(54%)、356 个 TH 茎(58%)、218 个 TH 杯-茎组合(34%)和 68 个 TK 种植体(13%)与 ODEP 评级相匹配。由于匹配的比例较低,因此未对 TK 植入体进行进一步分析。在所有随访时间点,与 ODEP 匹配的 TH 植入体的 CRR 均低于未获得 ODEP 评级的 TH 植入体,但在 5 年时,TH 茎的差异并不显著。A*级和A级TH种植体的CRR总体上没有差异,但TH杯-柄组合除外,在3年的时间点上,A*A*级杯-柄组合的CRR明显较低。根据汇总登记的3年CRR,39%的A*级杯体和42%的A*级柄将获得A*评级;然而,24%的A级杯体和31%的A级柄也将获得A*评级,在更长时间的随访中也有类似的结果:结论:在所有随访时间点上,与 ODEP 匹配的 TH 种植体的 CRR 均低于未获得 ODEP 评级的 TH 种植体。鉴于各国 TH 种植体的表现不尽相同,登记处应首先利用各国的翻修数据对 ODEP 评级进行验证,以更好地指导本国的种植体选择。数据来源的透明度和使用来自多个登记处的翻修数据将加强 ODEP 基准:治疗水平 III。有关证据等级的完整描述,请参阅 "作者须知"。
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引用次数: 0
Ten-Year Follow-up of Posterior Decompression and Fusion Surgery for Thoracic Ossification of the Posterior Longitudinal Ligament. 胸椎后纵韧带骨化的后方减压和融合手术十年随访》(Posterior Decompression and Fusion Surgery for Thoracic Ossification of Posterior Longitudinal Ligament)。
IF 4.4 1区 医学 Q1 ORTHOPEDICS Pub Date : 2024-09-04 Epub Date: 2024-08-05 DOI: 10.2106/JBJS.23.01475
Sadayuki Ito, Hiroaki Nakashima, Naoki Segi, Jun Ouchida, Ryotaro Oishi, Ippei Yamauchi, Yuichi Miyairi, Yoshinori Morita, Yukihito Ode, Shiro Imagama

Background: We evaluated the clinical, functional, and quality of life (QoL) outcomes of surgical treatment of thoracic ossification of the posterior longitudinal ligament (T-OPLL).

Methods: We retrospectively evaluated 51 patients followed for ≥10 years after posterior decompression and corrective fusion surgery for T-OPLL. The data collected included demographics, comorbidities, and pre- and postoperative symptoms. The Japanese Orthopaedic Association (JOA) score, numerical rating scale (NRS) for back and leg pain, and EuroQol-5 Dimension-5 Level (EQ-5D-5L) were used to assess neurological function, pain, and QoL. Imaging evaluations were conducted to assess changes in kyphotic angles and ossification progression.

Results: A significant improvement was observed in the JOA score from preoperatively (3.7) to 2 years postoperatively (7.9) (p < 0.05); the score remained stable thereafter. The mean EQ-5D-5L score improved from 0.53 preoperatively to 0.68 at 10 years postoperatively (p < 0.001). NRS scores for back and leg pain decreased from 5.4 to 3.5 and 4.0 to 3.0, respectively, from preoperatively to 10 years (p < 0.001 for both). Radiographic outcomes showed changes in kyphotic angles and ossification areas, with no significant progression after 2 years. Fourteen (27.5%) of the patients experienced postoperative complications. Of these, 8 (15.7%) required reoperation, 6 (11.8%) in the perioperative period and 2 (3.9%) later. Four (7.8%) of the patients underwent additional surgeries for conditions including lumbar spinal canal stenosis and cervical OPLL. Nonetheless, physical function in all cases with postoperative complications or additional surgery remained stable over the decade.

Conclusions: Surgical treatment of T-OPLL is effective in improving neurological function, QoL, and pain management over an extended period. The long-term outcomes of T-OPLL surgery revealed that, although cervical and lumbar spinal lesions led to reoperations, they did not affect QoL, and relative improvement was maintained even after 10 years.

Level of evidence: Therapeutic Level IV . See Instructions for Authors for a complete description of levels of evidence.

背景:我们评估了胸椎后纵韧带骨化(T-OPLL)手术治疗的临床、功能和生活质量(QoL):我们评估了胸椎后纵韧带骨化症(T-OPLL)手术治疗的临床、功能和生活质量(QoL)结果:我们对 51 名 T-OPLL 后路减压和矫正融合手术后随访≥10 年的患者进行了回顾性评估。收集的数据包括人口统计学、合并症、术前和术后症状。日本骨科协会(JOA)评分、腰腿痛数字评分量表(NRS)和欧洲量表(EQ-5D-5L)用于评估神经功能、疼痛和生活质量。此外,还进行了影像学评估,以评估畸形角的变化和骨化进展:从术前(3.7)到术后两年(7.9),JOA评分有了明显改善(P < 0.05);此后评分保持稳定。EQ-5D-5L 平均得分从术前的 0.53 提高到术后 10 年的 0.68(p < 0.001)。背部和腿部疼痛的 NRS 评分分别从术前的 5.4 分降至 3.5 分和 4.0 分降至 3.0 分(均 p < 0.001)。影像学结果显示,畸形角度和骨化区域发生了变化,2年后无明显进展。14名患者(27.5%)出现了术后并发症。其中,8 例(15.7%)需要再次手术,6 例(11.8%)在围手术期,2 例(3.9%)在术后。有 4 名患者(7.8%)因腰椎管狭窄和颈椎 OPLL 等疾病接受了额外手术。尽管如此,所有出现术后并发症或接受额外手术的病例的身体功能在这十年间都保持稳定:结论:T-OPLL 的手术治疗能有效改善神经功能、生活质量并长期控制疼痛。T-OPLL手术的长期疗效表明,虽然颈椎和腰椎病变导致了再次手术,但并不影响生活质量,而且即使在10年后,相对改善仍能保持:证据级别:治疗四级。有关证据级别的完整描述,请参阅 "作者须知"。
{"title":"Ten-Year Follow-up of Posterior Decompression and Fusion Surgery for Thoracic Ossification of the Posterior Longitudinal Ligament.","authors":"Sadayuki Ito, Hiroaki Nakashima, Naoki Segi, Jun Ouchida, Ryotaro Oishi, Ippei Yamauchi, Yuichi Miyairi, Yoshinori Morita, Yukihito Ode, Shiro Imagama","doi":"10.2106/JBJS.23.01475","DOIUrl":"10.2106/JBJS.23.01475","url":null,"abstract":"<p><strong>Background: </strong>We evaluated the clinical, functional, and quality of life (QoL) outcomes of surgical treatment of thoracic ossification of the posterior longitudinal ligament (T-OPLL).</p><p><strong>Methods: </strong>We retrospectively evaluated 51 patients followed for ≥10 years after posterior decompression and corrective fusion surgery for T-OPLL. The data collected included demographics, comorbidities, and pre- and postoperative symptoms. The Japanese Orthopaedic Association (JOA) score, numerical rating scale (NRS) for back and leg pain, and EuroQol-5 Dimension-5 Level (EQ-5D-5L) were used to assess neurological function, pain, and QoL. Imaging evaluations were conducted to assess changes in kyphotic angles and ossification progression.</p><p><strong>Results: </strong>A significant improvement was observed in the JOA score from preoperatively (3.7) to 2 years postoperatively (7.9) (p < 0.05); the score remained stable thereafter. The mean EQ-5D-5L score improved from 0.53 preoperatively to 0.68 at 10 years postoperatively (p < 0.001). NRS scores for back and leg pain decreased from 5.4 to 3.5 and 4.0 to 3.0, respectively, from preoperatively to 10 years (p < 0.001 for both). Radiographic outcomes showed changes in kyphotic angles and ossification areas, with no significant progression after 2 years. Fourteen (27.5%) of the patients experienced postoperative complications. Of these, 8 (15.7%) required reoperation, 6 (11.8%) in the perioperative period and 2 (3.9%) later. Four (7.8%) of the patients underwent additional surgeries for conditions including lumbar spinal canal stenosis and cervical OPLL. Nonetheless, physical function in all cases with postoperative complications or additional surgery remained stable over the decade.</p><p><strong>Conclusions: </strong>Surgical treatment of T-OPLL is effective in improving neurological function, QoL, and pain management over an extended period. The long-term outcomes of T-OPLL surgery revealed that, although cervical and lumbar spinal lesions led to reoperations, they did not affect QoL, and relative improvement was maintained even after 10 years.</p><p><strong>Level of evidence: </strong>Therapeutic Level IV . See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":15273,"journal":{"name":"Journal of Bone and Joint Surgery, American Volume","volume":null,"pages":null},"PeriodicalIF":4.4,"publicationDate":"2024-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141893426","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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Journal of Bone and Joint Surgery, American Volume
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