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Vertebral Body Tethering in Skeletally Immature Patients: Results of a Prospective U.S. FDA Investigational Device Exemption Study. 未成熟骨骼患者的椎体系扎术:一项前瞻性美国FDA研究器械豁免研究的结果。
IF 4.4 1区 医学 Q1 ORTHOPEDICS Pub Date : 2024-12-24 DOI: 10.2106/JBJS.24.00033
A Noelle Larson, Julia E Todderud, Smitha E Mathew, Ahmad Nassr, Arjun S Sebastian, D Dean Potter, Todd A Milbrandt

Background: The purpose of this study was to report on 2-year results of vertebral body tethering (VBT), performed under a Food and Drug Administration protocol, to obtain insight into outcomes and complications.

Methods: Forty prospectively enrolled patients with adolescent idiopathic scoliosis (AIS) who had a Sanders score of ≤4 or a Risser score of ≤2 underwent VBT for curves between 40° and 70°. Surgical, radiographic, and patient-reported outcomes were reviewed at a minimum 2-year follow-up.

Results: Mean age at surgery was 13 (range, 10 to 16) years. The 40 patients were 90% female; 95% White, 2.5% other, and 2.5% unreported; and 92.5% non-Hispanic, 5% Hispanic, and 2.5% unreported. A mean of 8 (range, 5 to 12) levels were instrumented. Most patients were at Sanders 4 (65%) and Risser 0 (63%). Mean length of stay was 3 ± 1 days, estimated blood loss was 236 ± 158 (range, 25 to 740) mL, and operative time was 4.4 ± 1.4 hours. Mean correction of the major curve was 44% (range, 22% to 95%) on the 3-month standing radiograph, 49% at 1 year, and 46% (range, -10% to 93%) at 2 years. The mean major Cobb angle improved from 51° ± 8° (range, 40° to 70°) preoperatively to 27° ± 11° (range, 3° to 56°) at 2 years. Success at 2 years, defined by a Cobb angle of <35° and no reoperation, was seen in 30 patients (75%) and was associated with a mean Cobb angle of <35° on the first postoperative standing radiograph (p < 0.001). Twelve patients (30%) demonstrated improvement in the curve with growth. By 2 years, 2 (5%) of the patients underwent repeat surgery (1 release for overcorrection, 1 lumbar VBT for lumbar curve progression after thoracic VBT). The Scoliosis Research Society (SRS) satisfaction score improved 2 years following surgery (p < 0.001), but other SRS domains only remained stable over time. Beyond 2 years, 1 additional lumbar tether was required after thoracic VBT, 1 implant was removed, and 3 fusions were performed, for a 10% fusion rate and overall 20% reoperation rate at a mean of 3.8 ± 1.1 years of follow-up. The rate of cord breakage in the study population was 20%.

Conclusions: In skeletally immature patients treated in the U.S. under a prospective Investigational Device Exemption, there was a 75% rate of successful outcomes at 2 years. Most correction was obtained at the time of surgery, and inadequate intraoperative curve correction was associated with a higher Cobb angle on the first postoperative standing radiograph and failure by 2 years.

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

背景:本研究的目的是报告在食品和药物管理局方案下进行的椎体系扎术(VBT)的2年结果,以深入了解结果和并发症。方法:40例前瞻性纳入的青少年特发性脊柱侧凸(AIS)患者,Sanders评分≤4或Risser评分≤2,在40°至70°之间进行VBT。在至少2年的随访中回顾了手术、放射学和患者报告的结果。结果:平均手术年龄为13岁(范围10 ~ 16岁)。40例患者中90%为女性;95%白人,2.5%其他,2.5%未报告;92.5%非西班牙裔,5%西班牙裔,2.5%未报告。平均测量8个水平(范围5至12)。大多数患者为Sanders 4级(65%)和Risser 0级(63%)。平均住院时间3±1天,估计失血量236±158(范围25 ~ 740)mL,手术时间4.4±1.4小时。3个月站立x线片主曲线的平均校正率为44%(范围,22%至95%),1年为49%,2年为46%(范围,-10%至93%)。平均主Cobb角从术前的51°±8°(范围40°至70°)改善到2年后的27°±11°(范围3°至56°)。结论:在美国接受前瞻性研究性器械豁免治疗的骨骼不成熟患者中,2年的成功率为75%。大多数矫正是在手术时进行的,术中曲线矫正不充分与术后第一次站立x线片上较高的Cobb角和2年的失败有关。证据等级:治疗性II级。有关证据水平的完整描述,请参见作者说明。
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引用次数: 0
Cephalomedullary Nailing for Subtrochanteric and Reverse-Oblique Femoral Fractures: Comparison of a Single Versus Dual Lag Screw Device. 头髓内钉治疗股骨粗隆下骨折和股骨逆斜骨折:单拉力螺钉与双拉力螺钉的比较。
IF 4.4 1区 医学 Q1 ORTHOPEDICS Pub Date : 2024-12-24 DOI: 10.2106/JBJS.24.00404
Andrew D Ablett, Conor McCann, Tony Feng, Victoria Macaskill, William M Oliver, John F Keating

Background: Subtrochanteric proximal femoral fractures are generally treated with cephalomedullary nail fixation. We aimed to compare outcomes of subtrochanteric fracture fixation using a single lag screw (Gamma3 nail, GN) or dual lag screw (INTERTAN nail, IN) device.

Methods: The primary outcome measure was mechanical failure, defined as lag screw cut-out or back-out, nail breakage, or peri-implant fracture. Secondary outcomes included reoperation for mechanical failure, deep infection, or nonunion, and technical predictors of mechanical failure. Adult patients (≥18 years of age) with a subtrochanteric proximal femoral fracture treated at a single center were retrospectively identified using electronic records. All patients who underwent fixation using either a long GN (November 2010 to January 2017) or IN (March 2017 to April 2022) were included. Medical records and radiographs were reviewed to identify operative complications.

Results: A total of 587 patients were included: 336 in the GN group (median age, 82 years; 73% female) and 251 in the IN group (median age, 82 years; 71% female). The risk of mechanical failure was 3-fold higher in the GN group (adjusted hazard ratio [aHR], 2.87; p = 0.010), with screw cut-out (p = 0.04) and back-out (p = 0.04) only observed in the GN group. We observed a greater risk of reoperation for mechanical failure in the GN group, but this did not achieve significance (aHR, 2.02; p = 0.16). Independent predictors of mechanical failure included varus malalignment of >5° for cut-out (aHR, 17.43; p = 0.012), a tip-to-apex distance of >25 mm for back-out (aHR, 9.47; p = 0.019), and shortening of >1 cm for peri-implant fracture (aHR, 5.44; p = 0.001).

Conclusions: For older patients with subtrochanteric and reverse-oblique femoral fractures, the dual lag screw design of the IN nail was associated with a lower risk of mechanical failure compared with the single lag screw design of the GN nail.

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

背景:股骨粗隆下近端骨折通常采用头髓内钉固定。我们的目的是比较使用单拉力螺钉(Gamma3钉,GN)或双拉力螺钉(INTERTAN钉,IN)装置固定转子下骨折的结果。方法:主要结局指标是机械故障,定义为拉力螺钉切断或向后拔出,指甲断裂或种植体周围骨折。次要结局包括机械故障、深度感染或骨不连的再手术,以及机械故障的技术预测指标。在单一中心治疗的成年股骨粗隆下近端骨折患者(≥18岁)通过电子记录进行回顾性鉴定。所有使用长GN(2010年11月至2017年1月)或IN(2017年3月至2022年4月)固定的患者均纳入研究。回顾了医疗记录和x线片,以确定手术并发症。结果:共纳入587例患者:GN组336例(中位年龄82岁;女性占73%),in组251例(中位年龄82岁;71%的女性)。GN组发生机械故障的风险高出3倍(调整风险比[aHR], 2.87;p = 0.010),只有GN组出现螺钉切出(p = 0.04)和回出(p = 0.04)。我们观察到GN组因机械故障再手术的风险更高,但这没有达到显著性(aHR, 2.02;P = 0.16)。机械故障的独立预测因子包括切口内翻5°(aHR, 17.43;p = 0.012),倒车的尖端到尖端的距离为>25 mm (aHR, 9.47;p = 0.019),种植体周围骨折缩短1 cm (aHR, 5.44;P = 0.001)。结论:对于老年股骨粗隆下和股骨逆斜骨折患者,与GN钉的单拉力螺钉设计相比,IN钉的双拉力螺钉设计与较低的机械失效风险相关。证据等级:治疗性III级。有关证据水平的完整描述,请参见作者说明。
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引用次数: 0
Glucagon-Like Peptide-1 Receptor Agonists Decrease Medical and Surgical Complications in Morbidly Obese Patients Undergoing Primary TKA. 胰高血糖素样肽-1受体激动剂减少原发性TKA的病态肥胖患者的医疗和手术并发症。
IF 4.4 1区 医学 Q1 ORTHOPEDICS Pub Date : 2024-12-24 DOI: 10.2106/JBJS.24.00468
Billy I Kim, Scott M LaValva, Michael L Parks, Peter K Sculco, Alejandro G Della Valle, Gwo-Chin Lee

Background: Weight optimization methods in morbidly obese patients with a body mass index (BMI) of ≥40 kg/m2 undergoing total knee arthroplasty (TKA) have shown mixed results. The purpose of this study was to evaluate the effect of perioperative use of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) in patients with a BMI of ≥40 kg/m2 undergoing primary TKA.

Methods: Using an administrative claims database, patients with morbid obesity undergoing primary TKA were stratified into GLP-1 RA use for 3 months before and after the surgical procedure (treatment group) and GLP-1 RA non-use (control group), and were matched on the basis of patient age, gender, diagnosis of type-2 diabetes mellitus, and Charlson Comorbidity Index (CCI). In addition, these groups were compared with a contemporaneous cohort of patients undergoing TKA with a BMI of 35.0 to 39.9 kg/m2. Outcomes including infection, complications, revision, and readmission were compared between the matched cohorts.

Results: There were significant decreases in the rates of 90-day periprosthetic joint infection (PJI) (1.0% compared with 1.8%; p = 0.037), any medical complications (10.6% compared with 12.7%; p = 0.033), pulmonary embolism (<0.4% compared with 0.6%; p = 0.050), and readmissions (5.3% compared with 8.9%; p < 0.001) in patients with a BMI of ≥40 kg/m2 who were taking GLP-1 RA versus the control group who were not. There were no differences in the 2-year rates of surgical complications (p > 0.05) between these groups. Compared with obese patients (BMI of 35.0 to 39.9 kg/m2), patients who had a BMI of ≥40 kg/m2 and were taking a GLP-1 RA did not have increased rates of infection or 90-day or 2-year complications (p > 0.05).

Conclusions: GLP-1 RA administration for at least 90 days prior to and after primary TKA in patients with a BMI of ≥40 kg/m2 was associated with reductions in the risks of 90-day PJI, any medical complications, and readmission. Additionally, the reduced complication rate that was achieved was similar to that of obese patients with a BMI of 35.0 to 39.9 kg/m2 undergoing TKA. Randomized clinical trials are needed to define the true effect of these agents on clinical outcomes following TKA.

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

背景:体重优化方法在接受全膝关节置换术(TKA)的体重指数(BMI)≥40 kg/m2的病态肥胖患者中显示出不同的结果。本研究的目的是评估胰高血糖素样肽-1受体激动剂(GLP-1 RAs)在BMI≥40 kg/m2的原发性TKA患者围手术期使用的效果。方法:利用行政索赔数据库,将原发性TKA患者分为术前和术后3个月使用GLP-1 RA的组(治疗组)和未使用GLP-1 RA的组(对照组),并根据患者年龄、性别、2型糖尿病诊断和Charlson合并症指数(CCI)进行匹配。此外,将这些组与同期BMI为35.0至39.9 kg/m2的TKA患者进行比较。结果包括感染、并发症、翻修和再入院在匹配队列之间进行比较。结果:90天假体周围关节感染(PJI)发生率显著降低(1.0%);P = 0.037),任何医疗并发症(10.6%比12.7%;P = 0.033),肺栓塞发生率(0.05)。与肥胖患者(BMI为35.0 ~ 39.9 kg/m2)相比,BMI≥40 kg/m2且服用GLP-1 RA的患者感染、90天或2年并发症发生率均未增加(p < 0.05)。结论:BMI≥40 kg/m2的患者在原发性TKA前后至少90天给予GLP-1 RA与90天PJI、任何医学并发症和再入院风险的降低相关。此外,减少的并发症发生率与BMI为35.0至39.9 kg/m2的肥胖患者接受TKA相似。需要随机临床试验来确定这些药物对TKA后临床结果的真正影响。证据等级:治疗性III级。有关证据水平的完整描述,请参见作者说明。
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引用次数: 0
Coronal Plane Alignment of the Knee (CPAK) Type Shifts Toward Constitutional Varus with Increasing Kellgren and Lawrence Grade: A Radiographic Analysis of 17,365 Knees. 随着Kellgren和Lawrence分级的增加,膝关节冠状面排列(CPAK)型向体质内翻转移:17365个膝关节的x线分析
IF 4.4 1区 医学 Q1 ORTHOPEDICS Pub Date : 2024-12-24 DOI: 10.2106/JBJS.24.00316
Sung Eun Kim, Samuel MacDessi, Daeseok Song, Joong Il Kim, Byung Sun Choi, Hyuk-Soo Han, Du Hyun Ro

Background: Studies investigating constitutional alignment across various grades of osteoarthritis (OA) are limited. This study explored the distribution of Coronal Plane Alignment of the Knee (CPAK) types and associated radiographic parameters with increasing OA severity.

Methods: In this retrospective cross-sectional study, 17,365 knees were analyzed using deep learning software for radiographic measurements. Knees were categorized on the basis of the Kellgren and Lawrence (KL) grade and CPAK type. Radiographic measurements were the hip-knee-ankle angle (HKAA), lateral distal femoral angle (LDFA), medial proximal tibial angle (MPTA), arithmetic HKAA (aHKA), joint line obliquity (JLO), and joint line convergence angle (JLCA). Age-stratified analysis was performed to differentiate the impact of age on OA severity.

Results: A shift in the most common CPAK type from II to I was found with increasing KL grade (p < 0.05). Furthermore, there was a corresponding increase in LDFA and JLCA with increasing KL grade, while HKAA, MPTA, and aHKA decreased after KL grade 2. Age exhibited limited association with LDFA and MPTA, suggesting that OA severity is the dominant factor related to the CPAK distribution.

Conclusions: The study found a shift in CPAK type with worsening OA. It is possible that constitutional varus types are more susceptible to OA, or that their increased OA prevalence is related to anatomical changes. This analysis offers new insights into alterations in CPAK type that occur with OA and underscores the importance of understanding pre-arthritic anatomy when performing joint reconstruction.

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

背景:研究不同级别骨关节炎(OA)的体质排列是有限的。本研究探讨了膝关节冠状面排列(CPAK)类型和相关影像学参数随骨性关节炎严重程度增加的分布。方法:在这项回顾性横断面研究中,使用深度学习软件对17365个膝关节进行放射测量分析。膝关节根据Kellgren和Lawrence (KL)分级和CPAK类型进行分类。x线测量为髋关节-膝关节-踝关节角(HKAA)、外侧股骨远端角(LDFA)、内侧胫骨近端角(MPTA)、算术HKAA (aHKA)、关节线倾斜度(JLO)和关节线收敛角(JLCA)。进行年龄分层分析以区分年龄对OA严重程度的影响。结果:随着KL分级的增加,最常见的CPAK型由II型向I型转变(p < 0.05)。随着KL分级的增加,LDFA和JLCA相应升高,而HKAA、MPTA和aHKA在KL分级后降低。年龄与LDFA和MPTA的相关性有限,提示OA严重程度是影响CPAK分布的主要因素。结论:研究发现CPAK类型随着OA的恶化而改变。这可能是体质内翻类型更容易患OA,或者他们的OA患病率增加与解剖改变有关。该分析为骨性关节炎发生时CPAK类型的改变提供了新的见解,并强调了在进行关节重建时了解关节炎前解剖结构的重要性。证据等级:预后III级。有关证据水平的完整描述,请参见作者说明。
{"title":"Coronal Plane Alignment of the Knee (CPAK) Type Shifts Toward Constitutional Varus with Increasing Kellgren and Lawrence Grade: A Radiographic Analysis of 17,365 Knees.","authors":"Sung Eun Kim, Samuel MacDessi, Daeseok Song, Joong Il Kim, Byung Sun Choi, Hyuk-Soo Han, Du Hyun Ro","doi":"10.2106/JBJS.24.00316","DOIUrl":"10.2106/JBJS.24.00316","url":null,"abstract":"<p><strong>Background: </strong>Studies investigating constitutional alignment across various grades of osteoarthritis (OA) are limited. This study explored the distribution of Coronal Plane Alignment of the Knee (CPAK) types and associated radiographic parameters with increasing OA severity.</p><p><strong>Methods: </strong>In this retrospective cross-sectional study, 17,365 knees were analyzed using deep learning software for radiographic measurements. Knees were categorized on the basis of the Kellgren and Lawrence (KL) grade and CPAK type. Radiographic measurements were the hip-knee-ankle angle (HKAA), lateral distal femoral angle (LDFA), medial proximal tibial angle (MPTA), arithmetic HKAA (aHKA), joint line obliquity (JLO), and joint line convergence angle (JLCA). Age-stratified analysis was performed to differentiate the impact of age on OA severity.</p><p><strong>Results: </strong>A shift in the most common CPAK type from II to I was found with increasing KL grade (p < 0.05). Furthermore, there was a corresponding increase in LDFA and JLCA with increasing KL grade, while HKAA, MPTA, and aHKA decreased after KL grade 2. Age exhibited limited association with LDFA and MPTA, suggesting that OA severity is the dominant factor related to the CPAK distribution.</p><p><strong>Conclusions: </strong>The study found a shift in CPAK type with worsening OA. It is possible that constitutional varus types are more susceptible to OA, or that their increased OA prevalence is related to anatomical changes. This analysis offers new insights into alterations in CPAK type that occur with OA and underscores the importance of understanding pre-arthritic anatomy when performing joint reconstruction.</p><p><strong>Level of evidence: </strong>Prognostic Level III. 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":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2024-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11781555/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142885803","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"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
Determining If Post-Injury Financial Distress Was Preexisting or Injury-Induced: A Prospective Cohort Study of Patients with Lower-Extremity Trauma. 确定损伤后经济困难是先前存在的还是损伤引起的:下肢创伤患者的前瞻性队列研究。
IF 4.4 1区 医学 Q1 ORTHOPEDICS Pub Date : 2024-12-24 DOI: 10.2106/JBJS.24.00345
Nathan N O'Hara, Mark J Gage, Casey Loudermilk, Alice Bell, David Okhuereigbe, Vivian Li, Joshua E Lawrence, Kristin E Turner, Murali Kovvur, Robert V O'Toole, Gerard P Slobogean, Lily R Mundy

Background: Previous research has estimated that over one-half of patients with orthopaedic trauma experience financial distress after the injury. However, it is unknown what proportion of patients lived under financial distress before the injury and, therefore, the causal effect of the injury on financial distress. This study examined changes in financial distress after the injury and factors associated with new post-injury financial distress.

Methods: A prospective cohort study was performed at a single academic trauma center, leveraging patients' 2-week recall of their pre-injury financial circumstances to permit a quasi-experiment design. Adult patients with a surgically treated lower-extremity fracture were included. The primary outcome was self-reported financial distress. Pre-injury financial distress was compared with financial distress in the 6 months after the injury. Multinomial logistic regression was used to identify factors associated with new financial distress after the injury.

Results: A total of 200 study participants were enrolled (median age, 42 years [interquartile range, 32 to 59 years]); 56% of patients were male. Financial distress was present in 40% of the study participants before the injury. The fracture was associated with an absolute increase of 19% (95% confidence interval [CI], 5% to 34%; p < 0.001) in the prevalence of financial distress. New post-injury financial distress was associated with working before the injury (odds ratio [OR], 6.9 [95% CI, 2.2 to 22]; p < 0.001) and earning <$70,000 per year (OR, 3.6 [95% CI, 1.2 to 10]; p = 0.02).

Conclusions: The findings suggest that 2 of 5 patients with a lower-extremity fracture had experienced financial distress before the injury. The prevalence of financial distress increased to 3 of 5 after the injury. Working and earning <$70,000 per year before the injury substantially elevated the patients' risk of new financial distress post-injury. Future efforts should target interventions to reduce financial distress in this at-risk population.

Level of evidence: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

背景:先前的研究估计,超过一半的骨科创伤患者在受伤后经历经济困难。然而,尚不清楚有多少比例的患者在受伤前生活在经济困境中,因此,受伤对经济困境的因果影响。本研究考察了受伤后财务困境的变化以及与新的受伤后财务困境相关的因素。方法:一项前瞻性队列研究在一个单一的学术创伤中心进行,利用患者对他们受伤前的经济状况的2周回忆来允许准实验设计。包括手术治疗的下肢骨折的成年患者。主要结果是自我报告的财务困境。比较伤前和伤后6个月的财务困境。使用多项逻辑回归来确定与损伤后新财务困难相关的因素。结果:共纳入200名研究参与者(中位年龄42岁[四分位数范围32至59岁]);56%的患者为男性。在受伤前,40%的研究参与者存在经济困难。骨折与绝对增加19%相关(95%置信区间[CI], 5%至34%;P < 0.001)。新的受伤后经济困难与受伤前的工作相关(优势比[OR], 6.9 [95% CI, 2.2至22];结论:研究结果表明,5例下肢骨折患者中有2例在受伤前经历过经济困难。受伤后,经济窘迫的发生率增加到3 / 5。工作和收入证据水平:预后II级。有关证据水平的完整描述,请参见作者说明。
{"title":"Determining If Post-Injury Financial Distress Was Preexisting or Injury-Induced: A Prospective Cohort Study of Patients with Lower-Extremity Trauma.","authors":"Nathan N O'Hara, Mark J Gage, Casey Loudermilk, Alice Bell, David Okhuereigbe, Vivian Li, Joshua E Lawrence, Kristin E Turner, Murali Kovvur, Robert V O'Toole, Gerard P Slobogean, Lily R Mundy","doi":"10.2106/JBJS.24.00345","DOIUrl":"https://doi.org/10.2106/JBJS.24.00345","url":null,"abstract":"<p><strong>Background: </strong>Previous research has estimated that over one-half of patients with orthopaedic trauma experience financial distress after the injury. However, it is unknown what proportion of patients lived under financial distress before the injury and, therefore, the causal effect of the injury on financial distress. This study examined changes in financial distress after the injury and factors associated with new post-injury financial distress.</p><p><strong>Methods: </strong>A prospective cohort study was performed at a single academic trauma center, leveraging patients' 2-week recall of their pre-injury financial circumstances to permit a quasi-experiment design. Adult patients with a surgically treated lower-extremity fracture were included. The primary outcome was self-reported financial distress. Pre-injury financial distress was compared with financial distress in the 6 months after the injury. Multinomial logistic regression was used to identify factors associated with new financial distress after the injury.</p><p><strong>Results: </strong>A total of 200 study participants were enrolled (median age, 42 years [interquartile range, 32 to 59 years]); 56% of patients were male. Financial distress was present in 40% of the study participants before the injury. The fracture was associated with an absolute increase of 19% (95% confidence interval [CI], 5% to 34%; p < 0.001) in the prevalence of financial distress. New post-injury financial distress was associated with working before the injury (odds ratio [OR], 6.9 [95% CI, 2.2 to 22]; p < 0.001) and earning <$70,000 per year (OR, 3.6 [95% CI, 1.2 to 10]; p = 0.02).</p><p><strong>Conclusions: </strong>The findings suggest that 2 of 5 patients with a lower-extremity fracture had experienced financial distress before the injury. The prevalence of financial distress increased to 3 of 5 after the injury. Working and earning <$70,000 per year before the injury substantially elevated the patients' risk of new financial distress post-injury. Future efforts should target interventions to reduce financial distress in this at-risk population.</p><p><strong>Level of evidence: </strong>Prognostic Level II. 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":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2024-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142885807","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}
引用次数: 0
Ankle-Brachial Index Is an Effective Screening Tool for Vascular Injury in Schatzker Type-4 to 6 Tibial Plateau Fractures with Symmetric Pulses. 踝肱指数是Schatzker型4 ~ 6型胫骨平台对称脉冲骨折血管损伤的有效筛查工具
IF 4.4 1区 医学 Q1 ORTHOPEDICS Pub Date : 2024-12-23 DOI: 10.2106/JBJS.24.00545
Adam H Kantor, Tyler J Thorne, Willie Dong, Eleanor H Sato, Dillon C O'Neill, David L Rothberg, Justin M Haller, Thomas F Higgins, Lucas S Marchand

Background: Schatzker type-4 to 6 tibial plateau fractures most commonly occur when the distal femur is driven through the proximal tibial articular surface. This mechanism of injury can be equivalent to a knee dislocation and carries an increased risk of vascular injury. Our institution screens all Schatzker type-4 to 6 tibial plateau fractures with symmetric pulses for a vascular injury by measuring the ankle-brachial index (ABI). The purpose of this study was to describe our screening protocol and to determine its effectiveness at identifying vascular injuries.

Methods: Our screening protocol consisted of measuring the ABI of the injured limb for all Schatzker type-4 to 6 tibial plateau fractures that presented with symmetric pulses. An ABI of ≤0.9 prompted a computed tomographic angiogram (CTA) of the injured extremity. We retrospectively reviewed all Schatzker type-4 to 6 tibial plateau fractures from 2006 to 2023 that presented to a single level-I academic trauma center. We collected demographic, fracture, ABI, and vascular injury data and examined the effectiveness of our screening protocol.

Results: We identified 437 Schatzker type-4 to 6 tibial plateau fractures (mean age, 47 years; 59% male). There were 102 (23%) Schatzker type-4 fractures, 4 (1%) type-5 fractures, and 331 (76%) type-6 fractures. Eight fractures (2%) had a concomitant vascular injury; none of the vascular injuries were missed. An ABI of ≤0.9 had a positive predictive value of 0.250, and an ABI of >0.9 had a negative predictive value of 1.000. The sensitivity of the ABI was 1.000, whereas the specificity was 0.056. Thirty-seven fractures were in patients with an ABI of >0.9 at presentation who underwent a CTA of the injured limb for nonorthopaedic indications, with no vascular injuries identified.

Conclusions: The ABI has frequently been cited as a valuable screening tool for vascular injury after a knee dislocation, but its application to Schatzker type-4 to 6 tibial plateau fractures had not yet been described. Our results indicate that this screening protocol is both safe and effective, with no missed vascular injuries over a 17-year period.

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

背景:Schatzker型4 - 6型胫骨平台骨折最常见于股骨远端穿过胫骨近端关节面。这种损伤机制相当于膝关节脱位,并增加血管损伤的风险。我们的机构通过测量踝臂指数(ABI),以对称脉冲筛选所有Schatzker 4型至6型胫骨平台骨折是否存在血管损伤。本研究的目的是描述我们的筛选方案,并确定其在识别血管损伤方面的有效性。方法:我们的筛选方案包括测量所有出现对称脉冲的Schatzker 4型至6型胫骨平台骨折的受伤肢体ABI。ABI≤0.9提示对受伤肢体进行计算机断层血管造影(CTA)检查。我们回顾性地回顾了2006年至2023年在一个一级学术创伤中心就诊的所有Schatzker 4型至6型胫骨平台骨折。我们收集了人口统计学、骨折、ABI和血管损伤数据,并检验了我们筛选方案的有效性。结果:我们发现437例Schatzker 4 - 6型胫骨平台骨折(平均年龄47岁;59%的男性)。Schatzker 4型骨折102例(23%),5型骨折4例(1%),6型骨折331例(76%)。8例骨折(2%)伴有血管损伤;血管损伤无一遗漏。ABI≤0.9的阳性预测值为0.250,ABI≤0.9的阴性预测值为1.000。ABI的敏感性为1.000,特异性为0.056。37例骨折患者就诊时ABI为>.9,因非矫形指征对受伤肢体行CTA检查,未发现血管损伤。结论:ABI经常被认为是膝关节脱位后血管损伤的一种有价值的筛查工具,但其在Schatzker 4 - 6型胫骨平台骨折中的应用尚未被描述。我们的研究结果表明,这种筛查方案既安全又有效,在17年的时间里没有遗漏血管损伤。证据等级:诊断级III。有关证据水平的完整描述,请参见作者说明。
{"title":"Ankle-Brachial Index Is an Effective Screening Tool for Vascular Injury in Schatzker Type-4 to 6 Tibial Plateau Fractures with Symmetric Pulses.","authors":"Adam H Kantor, Tyler J Thorne, Willie Dong, Eleanor H Sato, Dillon C O'Neill, David L Rothberg, Justin M Haller, Thomas F Higgins, Lucas S Marchand","doi":"10.2106/JBJS.24.00545","DOIUrl":"https://doi.org/10.2106/JBJS.24.00545","url":null,"abstract":"<p><strong>Background: </strong>Schatzker type-4 to 6 tibial plateau fractures most commonly occur when the distal femur is driven through the proximal tibial articular surface. This mechanism of injury can be equivalent to a knee dislocation and carries an increased risk of vascular injury. Our institution screens all Schatzker type-4 to 6 tibial plateau fractures with symmetric pulses for a vascular injury by measuring the ankle-brachial index (ABI). The purpose of this study was to describe our screening protocol and to determine its effectiveness at identifying vascular injuries.</p><p><strong>Methods: </strong>Our screening protocol consisted of measuring the ABI of the injured limb for all Schatzker type-4 to 6 tibial plateau fractures that presented with symmetric pulses. An ABI of ≤0.9 prompted a computed tomographic angiogram (CTA) of the injured extremity. We retrospectively reviewed all Schatzker type-4 to 6 tibial plateau fractures from 2006 to 2023 that presented to a single level-I academic trauma center. We collected demographic, fracture, ABI, and vascular injury data and examined the effectiveness of our screening protocol.</p><p><strong>Results: </strong>We identified 437 Schatzker type-4 to 6 tibial plateau fractures (mean age, 47 years; 59% male). There were 102 (23%) Schatzker type-4 fractures, 4 (1%) type-5 fractures, and 331 (76%) type-6 fractures. Eight fractures (2%) had a concomitant vascular injury; none of the vascular injuries were missed. An ABI of ≤0.9 had a positive predictive value of 0.250, and an ABI of >0.9 had a negative predictive value of 1.000. The sensitivity of the ABI was 1.000, whereas the specificity was 0.056. Thirty-seven fractures were in patients with an ABI of >0.9 at presentation who underwent a CTA of the injured limb for nonorthopaedic indications, with no vascular injuries identified.</p><p><strong>Conclusions: </strong>The ABI has frequently been cited as a valuable screening tool for vascular injury after a knee dislocation, but its application to Schatzker type-4 to 6 tibial plateau fractures had not yet been described. Our results indicate that this screening protocol is both safe and effective, with no missed vascular injuries over a 17-year period.</p><p><strong>Level of evidence: </strong>Diagnostic Level III. 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":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2024-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142881804","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}
引用次数: 0
Outcomes Following Direct Anterior Approach Total Hip Arthroplasty: A Contemporary Multicenter Study. 直接前路全髋关节置换术的结果:一项当代多中心研究。
IF 4.4 1区 医学 Q1 ORTHOPEDICS Pub Date : 2024-12-23 DOI: 10.2106/JBJS.24.00132
Jacob M Wilson, Matthew L Hadley, Dirk Larson, Cameron K Ledford, Joshua S Bingham, Cody C Wyles, Michael J Taunton

Background: The direct anterior approach (DAA) is a popular approach for primary total hip arthroplasty (THA). However, the contemporary outcomes for DAA THA need further elucidation. Therefore, we aimed to describe implant survivorship, complications, and clinical outcomes after DAA THA.

Methods: From our multi-institutional total joint registry, 3,184 patients who had undergone 3,698 primary DAA THA between 2010 and 2019 were identified. The identified patients had a mean age of 65 years and a mean body mass index (BMI) of 29 kg/m2, and 53% of patients were female. The indications for revision and reoperation and the incidence of complications were collected and analyzed. Potential risk factors, including age, sex, BMI, and high-volume compared with low-volume operating surgeons, were examined. Descriptive statistics and Kaplan-Meier survivorship with Cox regression analyses were performed.

Results: At 10 years following primary DAA THA, the cohort had 96% (95% confidence interval [CI], 95% to 98%) survivorship free of any revision and 94% (95% CI, 92% to 96%) survivorship free of any reoperation. The leading indications for revision were periprosthetic joint infection (PJI) (n = 24; 5-year cumulative incidence, 0.93% [95% CI, 0.6% to 1.5%]), periprosthetic fracture (n = 20; 5-year cumulative incidence, 0.62% [95% CI, 0.4% to 1.0%]), and aseptic loosening (n = 14; 11 femoral, 3 acetabular; 5-year cumulative incidence, 0.84% [95% CI, 0.5% to 1.5%]). A BMI of ≥40 kg/m2 was found to be significantly associated with PJI (hazard ratio [HR], 6.4; p < 0.001), reoperation (HR, 3.5; p < 0.001), and nonoperative complications (HR, 2.3; p = 0.018). Survivorship free of recurrent instability was 99.6% (95% CI, 99.4% to 99.8%) at 5 and 10 years, and the cumulative incidence of revision for instability was 0.14% at 5 years.

Conclusions: In one of the largest published series to date, survivorship following DAA THA was satisfactory at early to intermediate follow-up. The leading indications for revision were PJI, periprosthetic fracture, and aseptic loosening. Instability after DAA THA was uncommon and infrequently led to revision. As a note of caution, a BMI of ≥40 kg/m2 was identified as a risk factor for adverse outcome after DAA THA.

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

背景:直接前路入路(DAA)是原发性全髋关节置换术(THA)的常用入路。然而,DAA的当代结果需要进一步阐明。因此,我们的目的是描述DAA THA后种植体的存活、并发症和临床结果。方法:从我们的多机构联合总登记中,确定了2010年至2019年期间接受了3,698例原发性DAA THA的3,184例患者。确诊患者平均年龄65岁,平均体重指数(BMI)为29 kg/m2,女性占53%。收集并分析手术适应证及并发症的发生情况。潜在的危险因素,包括年龄、性别、身体质量指数、大手术量与小手术量的比较。描述性统计和Kaplan-Meier生存分析采用Cox回归分析。结果:在首次DAA THA后10年,该队列有96%(95%置信区间[CI], 95%至98%)无任何修订的生存率,94% (95% CI, 92%至96%)无任何再手术的生存率。翻修的主要适应症是假体周围关节感染(PJI) (n = 24;5年累计发病率,0.93% [95% CI, 0.6% ~ 1.5%]),假体周围骨折(n = 20;5年累积发病率,0.62% [95% CI, 0.4% - 1.0%])和无菌性松动(n = 14;11只股骨,3只髋臼;5年累计发病率,0.84% [95% CI, 0.5% ~ 1.5%])。BMI≥40 kg/m2与PJI显著相关(风险比[HR], 6.4;p < 0.001),再手术(HR, 3.5;p < 0.001),非手术并发症(HR, 2.3;P = 0.018)。5年和10年无复发性不稳定的生存率为99.6% (95% CI, 99.4%至99.8%),5年不稳定修正的累积发生率为0.14%。结论:在迄今为止发表的最大的系列研究之一中,DAA THA术后早期至中期随访的生存率令人满意。翻修的主要适应症是PJI、假体周围骨折和无菌性松动。DAA后的不稳定并不常见,很少导致翻修。值得注意的是,BMI≥40 kg/m2被确定为DAA THA后不良结果的危险因素。证据等级:治疗性IV级。参见《作者说明》获得证据等级的完整描述。
{"title":"Outcomes Following Direct Anterior Approach Total Hip Arthroplasty: A Contemporary Multicenter Study.","authors":"Jacob M Wilson, Matthew L Hadley, Dirk Larson, Cameron K Ledford, Joshua S Bingham, Cody C Wyles, Michael J Taunton","doi":"10.2106/JBJS.24.00132","DOIUrl":"https://doi.org/10.2106/JBJS.24.00132","url":null,"abstract":"<p><strong>Background: </strong>The direct anterior approach (DAA) is a popular approach for primary total hip arthroplasty (THA). However, the contemporary outcomes for DAA THA need further elucidation. Therefore, we aimed to describe implant survivorship, complications, and clinical outcomes after DAA THA.</p><p><strong>Methods: </strong>From our multi-institutional total joint registry, 3,184 patients who had undergone 3,698 primary DAA THA between 2010 and 2019 were identified. The identified patients had a mean age of 65 years and a mean body mass index (BMI) of 29 kg/m2, and 53% of patients were female. The indications for revision and reoperation and the incidence of complications were collected and analyzed. Potential risk factors, including age, sex, BMI, and high-volume compared with low-volume operating surgeons, were examined. Descriptive statistics and Kaplan-Meier survivorship with Cox regression analyses were performed.</p><p><strong>Results: </strong>At 10 years following primary DAA THA, the cohort had 96% (95% confidence interval [CI], 95% to 98%) survivorship free of any revision and 94% (95% CI, 92% to 96%) survivorship free of any reoperation. The leading indications for revision were periprosthetic joint infection (PJI) (n = 24; 5-year cumulative incidence, 0.93% [95% CI, 0.6% to 1.5%]), periprosthetic fracture (n = 20; 5-year cumulative incidence, 0.62% [95% CI, 0.4% to 1.0%]), and aseptic loosening (n = 14; 11 femoral, 3 acetabular; 5-year cumulative incidence, 0.84% [95% CI, 0.5% to 1.5%]). A BMI of ≥40 kg/m2 was found to be significantly associated with PJI (hazard ratio [HR], 6.4; p < 0.001), reoperation (HR, 3.5; p < 0.001), and nonoperative complications (HR, 2.3; p = 0.018). Survivorship free of recurrent instability was 99.6% (95% CI, 99.4% to 99.8%) at 5 and 10 years, and the cumulative incidence of revision for instability was 0.14% at 5 years.</p><p><strong>Conclusions: </strong>In one of the largest published series to date, survivorship following DAA THA was satisfactory at early to intermediate follow-up. The leading indications for revision were PJI, periprosthetic fracture, and aseptic loosening. Instability after DAA THA was uncommon and infrequently led to revision. As a note of caution, a BMI of ≥40 kg/m2 was identified as a risk factor for adverse outcome after DAA THA.</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":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2024-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142881963","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}
引用次数: 0
What's Important: Fertility Preservation During Orthopaedic Residency. 重点:在骨科住院期间保留生育能力。
IF 4.4 1区 医学 Q1 ORTHOPEDICS Pub Date : 2024-12-23 DOI: 10.2106/JBJS.24.01000
Nina D Fisher
{"title":"What's Important: Fertility Preservation During Orthopaedic Residency.","authors":"Nina D Fisher","doi":"10.2106/JBJS.24.01000","DOIUrl":"https://doi.org/10.2106/JBJS.24.01000","url":null,"abstract":"","PeriodicalId":15273,"journal":{"name":"Journal of Bone and Joint Surgery, American Volume","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2024-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142882089","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}
引用次数: 0
Xylazine-Associated Necrotic Upper-Extremity Wounds: A Single Hospital System's Experience with 82 Patients and 125 Wounds. 二甲嗪相关的上肢坏死伤口:单一医院系统82例患者125处伤口的经验。
IF 4.4 1区 医学 Q1 ORTHOPEDICS Pub Date : 2024-12-23 DOI: 10.2106/JBJS.24.00534
Sebastian D Arango, Jason C Flynn, Jacob H Zeitlin, Tristan B Weir, Andrew J Miller

Background: The rise in xylazine-adulterated heroin and fentanyl poses novel challenges to hand surgeons and a rising epidemic of necrotic upper-extremity wounds. While prior case studies have focused on particularly severe and complex xylazine-associated necrotic (XAN) wounds, the aim of this consecutive case series was to characterize the variability of presentations (ranging from mild to severe) at a single institution at the epicenter of the xylazine epidemic.

Methods: Patients presenting to a tertiary referral center for XAN upper-extremity wounds were retrospectively identified from emergency department visits and hospital admissions between January 2021 and December 2023. Patient characteristics, clinical findings, treatment, and hospitalization-related measures were recorded. Wounds were classified according to the depth, density, size, and presence of osteomyelitis. All of the variables were quantified using descriptive statistics.

Results: In total, 82 patients with 125 XAN wounds were included in the study. The mean age was 40.3 ± 8.2 years, and 57% of the patients were men. Of the 125 wounds, 54% had associated osteomyelitis, 78% were confluent, and 47%involved more than two-thirds of the anatomic region. Surgery was recommended for 78% of the patients and was performed in 62%, with 13% undergoing amputation. Complications rates were high (77%) and included bacteremia (40%) and death (5%). Patients were hospitalized a mean of 4.1 times and were discharged against medical advice 2.8 times per year.

Conclusions: This study presents a broad perspective on demographic, social, and medical factors in patients with XAN wounds of the upper extremity. Given the complexity and burden of this public health crisis, early intervention is important to prevent complications and mitigate costs.

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

背景:掺杂氯嗪的海洛因和芬太尼的增加给手外科医生带来了新的挑战,并且上肢坏死伤口的流行率也在上升。虽然以前的病例研究集中在特别严重和复杂的木嗪相关坏死(XAN)伤口上,但本连续病例系列的目的是表征在木嗪流行中心的单一机构中表现的可变性(从轻度到重度)。方法:回顾性分析2021年1月至2023年12月期间,在三级转诊中心就诊的XAN上肢伤口患者的急诊和住院情况。记录患者特征、临床表现、治疗和住院相关措施。根据伤口的深度、密度、大小和是否存在骨髓炎进行分类。所有变量均采用描述性统计进行量化。结果:共纳入82例125例XAN伤口患者。平均年龄40.3±8.2岁,男性占57%。在125例伤口中,54%伴有骨髓炎,78%为融合性,47%累及超过三分之二的解剖区域。78%的患者建议手术治疗,62%的患者接受手术治疗,13%的患者接受截肢治疗。并发症发生率高(77%),包括菌血症(40%)和死亡(5%)。患者平均每年住院4.1次,不遵医嘱出院2.8次。结论:本研究为上肢XAN创伤患者的人口统计学、社会和医学因素提供了广阔的视角。鉴于这一公共卫生危机的复杂性和负担,早期干预对于预防并发症和降低成本至关重要。证据等级:治疗性IV级。参见《作者说明》获得证据等级的完整描述。
{"title":"Xylazine-Associated Necrotic Upper-Extremity Wounds: A Single Hospital System's Experience with 82 Patients and 125 Wounds.","authors":"Sebastian D Arango, Jason C Flynn, Jacob H Zeitlin, Tristan B Weir, Andrew J Miller","doi":"10.2106/JBJS.24.00534","DOIUrl":"https://doi.org/10.2106/JBJS.24.00534","url":null,"abstract":"<p><strong>Background: </strong>The rise in xylazine-adulterated heroin and fentanyl poses novel challenges to hand surgeons and a rising epidemic of necrotic upper-extremity wounds. While prior case studies have focused on particularly severe and complex xylazine-associated necrotic (XAN) wounds, the aim of this consecutive case series was to characterize the variability of presentations (ranging from mild to severe) at a single institution at the epicenter of the xylazine epidemic.</p><p><strong>Methods: </strong>Patients presenting to a tertiary referral center for XAN upper-extremity wounds were retrospectively identified from emergency department visits and hospital admissions between January 2021 and December 2023. Patient characteristics, clinical findings, treatment, and hospitalization-related measures were recorded. Wounds were classified according to the depth, density, size, and presence of osteomyelitis. All of the variables were quantified using descriptive statistics.</p><p><strong>Results: </strong>In total, 82 patients with 125 XAN wounds were included in the study. The mean age was 40.3 ± 8.2 years, and 57% of the patients were men. Of the 125 wounds, 54% had associated osteomyelitis, 78% were confluent, and 47%involved more than two-thirds of the anatomic region. Surgery was recommended for 78% of the patients and was performed in 62%, with 13% undergoing amputation. Complications rates were high (77%) and included bacteremia (40%) and death (5%). Patients were hospitalized a mean of 4.1 times and were discharged against medical advice 2.8 times per year.</p><p><strong>Conclusions: </strong>This study presents a broad perspective on demographic, social, and medical factors in patients with XAN wounds of the upper extremity. Given the complexity and burden of this public health crisis, early intervention is important to prevent complications and mitigate costs.</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":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2024-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142882092","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}
引用次数: 0
Sacroiliac Joint: Function, Pathology, Treatment, and Contribution to Outcomes in Spine and Hip Surgery. 骶髂关节:脊柱和髋关节手术的功能、病理、治疗和对结果的影响。
IF 4.4 1区 医学 Q1 ORTHOPEDICS Pub Date : 2024-12-23 DOI: 10.2106/JBJS.24.00380
Isabel Horton, Jennifer McDonald, Jeroen Verhaegen, Simon Dobransky, Kawan S Rakhra, Philippe Phan, Jean Yves Lazennec, George Grammatopoulos

➢ Low back pain has a lifetime incidence of up to 84% and represents the leading cause of disability in the United States; 10% to 38% of cases can be attributed to sacroiliac joint (SIJ) dysfunction as an important pain generator.➢ Physical examination of the SIJ, including >1 provocation test (due to their moderate sensitivity and specificity) and examination of adjacent joints (hip and lumbar spine) should be routinely performed in all patients presenting with low back, gluteal, and posterior hip pain.➢ Radiographic investigations including radiographs, computed tomography, and magnetic resonance imaging with protocols optimized for the visualization of the SIJs may facilitate the diagnosis of common pathologies.➢ Intra-articular injections with anesthetic can be helpful in localizing the source of low back pain. Over-the-counter analgesics, physiotherapy, intra-articular injections, radiofrequency ablation, and surgery are all management options and should be approached from the least invasive to the most invasive to minimize the risks of complications.➢ Lumbar fusion surgery predisposes patients to more rapid SIJ degeneration and can also result in more rapid degenerative changes in the hip joints, especially with SIJ fusion.➢ Hip surgery, including hip arthroplasty and preservation surgery, is not a risk factor for SIJ degeneration, although reduced outcomes following hip surgery can be seen in patients with degenerative SIJ changes.

下腰痛的终生发病率高达84%,是美国致残的主要原因;10% ~ 38%的病例可归因于骶髂关节(SIJ)功能障碍,这是一个重要的疼痛源。(四)所有出现腰、臀、髋后部疼痛的患者均应常规检查SIJ,包括>1激发试验(因其敏感性和特异性中等)和相邻关节(髋关节和腰椎)检查。(五)放射检查,包括x线摄影、计算机断层扫描和磁共振成像,采用针对sij可视化优化的方案,可促进常见病变的诊断。(四)关节内注射麻药有助于定位腰痛来源。非处方止痛剂、物理治疗、关节内注射、射频消融和手术都是治疗选择,应该从侵入性最小到侵入性最大,以尽量减少并发症的风险。腰椎融合术易使患者发生更快的SIJ退变,也可导致髋关节更快的退行性改变,尤其是SIJ融合。髋关节手术,包括髋关节置换术和保留手术,不是SIJ退变的危险因素,尽管在退行性SIJ改变患者中可以看到髋关节手术后的预后降低。
{"title":"Sacroiliac Joint: Function, Pathology, Treatment, and Contribution to Outcomes in Spine and Hip Surgery.","authors":"Isabel Horton, Jennifer McDonald, Jeroen Verhaegen, Simon Dobransky, Kawan S Rakhra, Philippe Phan, Jean Yves Lazennec, George Grammatopoulos","doi":"10.2106/JBJS.24.00380","DOIUrl":"https://doi.org/10.2106/JBJS.24.00380","url":null,"abstract":"<p><p>➢ Low back pain has a lifetime incidence of up to 84% and represents the leading cause of disability in the United States; 10% to 38% of cases can be attributed to sacroiliac joint (SIJ) dysfunction as an important pain generator.➢ Physical examination of the SIJ, including >1 provocation test (due to their moderate sensitivity and specificity) and examination of adjacent joints (hip and lumbar spine) should be routinely performed in all patients presenting with low back, gluteal, and posterior hip pain.➢ Radiographic investigations including radiographs, computed tomography, and magnetic resonance imaging with protocols optimized for the visualization of the SIJs may facilitate the diagnosis of common pathologies.➢ Intra-articular injections with anesthetic can be helpful in localizing the source of low back pain. Over-the-counter analgesics, physiotherapy, intra-articular injections, radiofrequency ablation, and surgery are all management options and should be approached from the least invasive to the most invasive to minimize the risks of complications.➢ Lumbar fusion surgery predisposes patients to more rapid SIJ degeneration and can also result in more rapid degenerative changes in the hip joints, especially with SIJ fusion.➢ Hip surgery, including hip arthroplasty and preservation surgery, is not a risk factor for SIJ degeneration, although reduced outcomes following hip surgery can be seen in patients with degenerative SIJ changes.</p>","PeriodicalId":15273,"journal":{"name":"Journal of Bone and Joint Surgery, American Volume","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2024-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142882065","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}
引用次数: 0
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Journal of Bone and Joint Surgery, American Volume
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