Journal of orthopaedics最新文献_第6页

Decreased fracture risk in cystic fibrosis patients treated with CFTR modulator therapy 囊性纤维化患者接受CFTR调节剂治疗可降低骨折风险

IF 1.5 Q3 ORTHOPEDICS

Journal of orthopaedics

Pub Date : 2025-12-15 DOI: 10.1016/j.jor.2025.12.042

Akin Adio , Miguel Fiandeiro , Jehad Feras Alsamhori , Imad Ashkar , Peter Boufadel , John G. Horneff , Joseph A. Abboud

Background

Cystic fibrosis–related bone disease contributes substantially to fragility fractures and morbidity in patients with cystic fibrosis (CF). Cystic Fibrosis Transmembrane conductance Regulator (CFTR) modulators have been shown to improve pulmonary and nutritional outcomes, but their impact on skeletal health remains incompletely defined.

Methods

We conducted a retrospective cohort study using the TriNetX Research Network, which aggregates deidentified electronic medical records from 168 health care organizations. Patients with CF who initiated CFTR modulators between 2012 and 2023 were compared with matched CF patients without modulator exposure. Sub-analyses examined outcomes in patients receiving elexacaftor/tezacaftor/ivacaftor (ETI) versus non-ETI modulators. A 1:1 propensity score matching algorithm balanced demographic and clinical covariates. The primary outcome was 2-year fracture risk. Relative risks (RR) with 95 % confidence intervals (CI) were calculated.

Results

After matching, 5639 patients receiving CFTR modulators were compared with controls. Modulator therapy was associated with significantly reduced risk of overall fracture (RR 0.48, p < .0001), with protective effects observed for hand or wrist, forearm, upper limb, femur, lower leg, and vertebral fractures. Both ETI and non-ETI modulators were associated with significantly lower fracture risk compared with no therapy. There were no significant differences in fracture outcomes between ETI and non-ETI users.

Conclusion

In this large, population-based analysis, CFTR modulator therapy was associated with lower 2-year fracture risk. These findings extend the benefits of modulator therapy beyond pulmonary and nutritional domains, highlighting its potential role in skeletal protection.

背景：囊性纤维化相关骨病是囊性纤维化（CF）患者脆性骨折和发病率的重要因素。囊性纤维化跨膜传导调节剂（CFTR）已被证明可改善肺部和营养状况，但其对骨骼健康的影响仍不完全明确。方法我们利用TriNetX研究网络进行了一项回顾性队列研究，该研究收集了来自168家医疗机构的未识别电子病历。在2012年至2023年期间开始使用CFTR调节剂的CF患者与未使用调节剂的匹配CF患者进行比较。亚分析检查了接受elexaftor /tezacaftor/ivacaftor （ETI）和非ETI调节剂的患者的结果。1:1倾向评分匹配算法平衡了人口统计学和临床协变量。主要终点为2年骨折风险。计算相对危险度（RR），置信区间为95%。结果经配对后，5639例CFTR调制剂患者与对照组进行比较。调节剂治疗与整体骨折风险显著降低相关（RR 0.48, p < 0.0001），对手部或手腕、前臂、上肢、股骨、小腿和椎体骨折均有保护作用。与未接受治疗的患者相比，ETI和非ETI调节剂均显著降低骨折风险。ETI和非ETI使用者骨折结局无显著差异。在这项基于人群的大型分析中，CFTR调节剂治疗与较低的2年骨折风险相关。这些发现将调节剂治疗的益处扩展到肺和营养领域之外，突出了其在骨骼保护中的潜在作用。

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引用次数: 0

Assessments and interventions in individuals with lower extremity torsional abnormality: A scoping review 评估和干预措施的个人与下肢扭转异常：范围审查

IF 1.5 Q3 ORTHOPEDICS

Journal of orthopaedics

Pub Date : 2025-12-14 DOI: 10.1016/j.jor.2025.12.029

M. Gagnon , N. Abdel Fattah , L. Groszman , N. Kabbes , M. Bernstein , L.N. Veilleux

引用次数: 0

Clinical and arthroscopic outcomes of hamstring autograft ACL reconstruction in patients aged 60 Years and older compared with middle-aged patients 60岁及以上患者自体腘绳肌腱前交叉韧带重建的临床和关节镜效果与中年患者的比较

IF 1.5 Q3 ORTHOPEDICS

Journal of orthopaedics

Pub Date : 2025-12-14 DOI: 10.1016/j.jor.2025.12.034

Masashi Kubota , Tsuneari Takahashi , Mitsuharu Nakashima , Satomi Ugawa , Katsushi Takeshita

Background

Although Anterior cruciate ligament reconstruction (ACLR) in elderly patients has traditionally been avoided, the clinical demand for ACLR in individuals aged ≥60 years is growing recently. Nevertheless, few studies have directly compared outcomes of ACLR between elderly and middle-aged patients, especially using second-look arthroscopy. Furthermore, prior comparative studies have focused on allograft or bone–patellar tendon–bone grafts; evidence specific to hamstring autograft ACLR remains limited.

Objectives

To compare clinical and arthroscopic outcomes of hamstring autograft ACLR in patients aged ≥60 years versus 40–59 years.

Methods

In this retrospective cohort, 56 patients aged ≥40 years underwent primary hamstring autograft ACLR between 2018 and 2024. Patients were grouped as middle-aged (40–59 years, n = 34) or older (≥60 years, n = 22). Outcomes included Lysholm score, Tegner activity score, anterior tibial translation, and arthroscopic cartilage status.

Results

There were no significant differences in Lysholm score at 1 year postoperatively (82.1 ± 14.4 vs. 83.4 ± 10.9; p = 0.721) or in ΔLysholm score (27.6 ± 19.0 vs. 28.6 ± 22.7; p = 0.865) between middle-aged and older groups. Postoperative Tegner activity score also did not differ between groups (4.00 [1.00–7.00] vs. 3.00 [2.00–5.00]; p = 0.156). Second-look arthroscopic evaluations revealed no significant group differences in cartilage degeneration across all compartments. No complications or graft failures were observed in either group.

Conclusion

Patients aged ≥60 years demonstrated comparable clinical and arthroscopic outcomes to those of middle-aged patients following hamstring autograft ACLR. With appropriate patient selection, advanced age alone should not limit the indication for ACLR.

虽然传统上避免对老年患者进行前交叉韧带重建（ACLR），但最近对≥60岁患者进行ACLR的临床需求正在增长。然而，很少有研究直接比较老年和中年患者ACLR的结果，特别是使用第二眼关节镜。此外，先前的比较研究主要集中在同种异体移植或骨-髌肌腱-骨移植；针对腿筋自体移植ACLR的证据仍然有限。目的比较≥60岁和40-59岁患者行自体腘绳肌ACLR的临床和关节镜效果。方法回顾性研究2018 - 2024年间56例年龄≥40岁的患者行原发性自体腿筋ACLR手术。患者分为中年人（40-59岁，n = 34）和老年人（≥60岁，n = 22）。结果包括Lysholm评分、Tegner活动评分、胫骨前移位和关节镜下软骨状态。结果中老年组术后1年Lysholm评分（82.1±14.4比83.4±10.9,p = 0.721）、ΔLysholm评分（27.6±19.0比28.6±22.7,p = 0.865）差异均无统计学意义。术后Tegner活动评分组间差异无统计学意义（4.00 [1.00-7.00]vs. 3.00 [2.00-5.00]; p = 0.156）。二次关节镜评估显示各组间室软骨退变无显著差异。两组均未见并发症或移植物衰竭。结论：年龄≥60岁的患者与中年患者行自体腘绳肌腱ACLR术后的临床和关节镜预后相当。通过适当的患者选择，高龄不应限制ACLR的适应症。

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引用次数: 0

Optimized data augmentation for osteosarcoma detection in deep and lightweight networks 优化了深度和轻量级网络中骨肉瘤检测的数据增强

IF 1.5 Q3 ORTHOPEDICS

Journal of orthopaedics

Pub Date : 2025-12-13 DOI: 10.1016/j.jor.2025.12.013

Waala Gouda , Sidra Tahir , Tariq Ali , Abdul Shahid

Osteosarcoma (Ost) is an extremely aggressive primary bone malignancy that mostly occurs among children and young adults. Precise histopathological classification is challenging due to strong intra- and inter-tumoral heterogeneity, combined with the scarcity of annotated datasets. The current study demonstrates a systematic deep learning (DL) methodology crafted to investigate the effects of preprocessing and data augmentation approaches to osteosarcoma image classification. Hematoxylin and Eosin (H&E)-stained histopathological images were obtained from the publicly accessible UT Southwestern/UT Dallas Osteosarcoma dataset and standardized to standard noise reduction, contrast enhancement, and artifact suppression procedures to facilitate tissue prominence. Controlled augmentation settings were built (no augmentation, and 650, 1000, and 1500 synthetic images per class) to investigate how sequential dataset enlargement impacts generalization performance. Four transfer learning models similar to VGG19, InceptionV3, InceptionResNetV2, and NasMobileNet were fine-tuned and assessed through accuracy, sensitivity, specificity, and ROC-AUC metrics. The results confirm that moderate augmentation provided the best results, with NasMobileNet reporting 95.07 % accuracy, 95 % sensitivity, and 95 % specificity (AUC = 0.96), whereas deeper models like InceptionResNetV2 took advantage of increased augmentation (up to 94.37 % accuracy). Statistical analysis further confirmed that the found differences were not significant (p > 0.05), indicating support for consistency among models. The results overall highlight that the efficacy of augmentation depends on the model and that integration of systematic analysis with interpretability enhances the reliability of osteosarcoma classification through the power of deep learning.

骨肉瘤（Ost）是一种极具侵袭性的原发性骨恶性肿瘤，主要发生在儿童和年轻人中。由于肿瘤内部和肿瘤间的异质性强，加上注释数据集的稀缺性，精确的组织病理学分类具有挑战性。目前的研究展示了一种系统的深度学习（DL）方法，旨在研究预处理和数据增强方法对骨肉瘤图像分类的影响。苏木精和伊红（H&；E）染色的组织病理学图像来自可公开访问的UT Southwestern/UT Dallas骨肉瘤数据集，并标准化为标准降噪、对比度增强和伪影抑制程序，以促进组织突出。建立了受控的增强设置（不增强，每个类650、1000和1500张合成图像）来研究顺序数据集扩展如何影响泛化性能。四种迁移学习模型类似于VGG19、InceptionV3、InceptionResNetV2和NasMobileNet，通过准确性、灵敏度、特异性和ROC-AUC指标进行微调和评估。结果证实，适度增强提供了最好的结果，NasMobileNet报告95.07%的准确度，95%的灵敏度和95%的特异性（AUC = 0.96），而像InceptionResNetV2这样的深度模型利用了增加的增强（高达94.37%的准确度）。进一步统计分析证实，发现的差异不显著（p > 0.05），支持模型之间的一致性。结果总体上强调了增强的有效性取决于模型，并且通过深度学习的力量将系统分析与可解释性相结合，增强了骨肉瘤分类的可靠性。

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引用次数: 0

Mental health and pain trends among U.S. adults with arthritis: A comparative analysis of 2019 and 2023 national data 美国成年关节炎患者的心理健康和疼痛趋势：对2019年和2023年国家数据的比较分析

IF 1.5 Q3 ORTHOPEDICS

Journal of orthopaedics

Pub Date : 2025-12-13 DOI: 10.1016/j.jor.2025.12.032

Nicholas Frappa, Melina Villa, Zachary Tamweber, Ellen Lutnick

Introduction

The COVID-19 pandemic led to broad increases in depression, anxiety, and psychological distress. Adults with arthritis may be especially vulnerable due to high baseline pain, functional limitations, and longstanding psychosocial burden. This study evaluated changes in depression, anxiety, counseling use, and pain burden from 2019 to 2023 and compared outcomes between adults with and without arthritis using nationally representative U.S. data.

Methods

Adults ≥18 years from the 2019 and 2023 National Health Interview Survey (NHIS) Adult Files were analyzed. Outcomes included lifetime depression, lifetime anxiety disorder, current counseling use, and three-month pain frequency and interference. Demographic and clinical characteristics were compared by year and arthritis status. Changes were assessed using proportion comparisons. Multivariable logistic regression examined associations between race/ethnicity and arthritis, mental-health, and pain outcomes, adjusting for age, sex, and survey year.

Results

The sample included 61,519 adults (31,997 in 2019; 29,522 in 2023). Depression, anxiety, counseling use, and pain burden all increased significantly from 2019 to 2023 (p < .001). Arthritis prevalence remained stable (25.7 %–26.2 %). Across both years, adults with arthritis had roughly twice the prevalence of depression (28.5 % vs 16.4 % in 2023) and anxiety (24.9 % vs 16.1 %) compared with those without arthritis, and substantially higher frequent pain (53.6 % vs 16.5 %). Within the arthritis cohort, depression and anxiety remained stable, while counseling use increased modestly (7.7 %–9.0 %, p = .004). Racial and ethnic disparities persisted across arthritis, pain, and mental-health outcomes.

Conclusion

Adults with arthritis consistently showed higher depression, anxiety, and pain than those without arthritis, with no evidence of post-pandemic worsening. These findings suggest longstanding vulnerability rather than new pandemic-related change and support integrating brief mental-health screening into routine musculoskeletal care to improve timely recognition and referral.

2019冠状病毒病大流行导致抑郁、焦虑和心理困扰的普遍增加。由于高基线疼痛、功能限制和长期的社会心理负担，成年关节炎患者可能特别容易受到伤害。该研究评估了2019年至2023年抑郁、焦虑、咨询使用和疼痛负担的变化，并使用具有全国代表性的美国数据比较了患有和不患有关节炎的成年人的结果。方法对2019年和2023年全国健康访谈调查（NHIS）成人档案中≥18岁的成年人进行分析。结果包括终生抑郁、终生焦虑障碍、当前咨询使用情况、三个月疼痛频率和干扰。按年龄和关节炎状况比较人口学和临床特征。使用比例比较来评估变化。多变量逻辑回归检验了种族/民族与关节炎、心理健康和疼痛结局之间的关系，调整了年龄、性别和调查年份。结果共纳入成人61,519例（2019年31,997例，2023年29,522例）。从2019年到2023年，抑郁、焦虑、咨询使用和疼痛负担均显著增加（p < .001）。关节炎患病率保持稳定（25.7% - 26.2%）。在这两年中，与没有关节炎的人相比，患有关节炎的成年人患抑郁症（28.5%比16.4%）和焦虑症（24.9%比16.1%）的患病率大约是他们的两倍，而且频繁疼痛的发生率也高得多（53.6%比16.5%）。在关节炎队列中，抑郁和焦虑保持稳定，而咨询的使用适度增加（7.7% - 9.0%,p = 0.004）。在关节炎、疼痛和心理健康结果方面，种族和民族差异依然存在。结论：成人关节炎患者的抑郁、焦虑和疼痛持续高于无关节炎患者，且无大流行后恶化的证据。这些发现表明长期存在的脆弱性，而不是新的与大流行相关的变化，并支持将简短的心理健康筛查纳入常规的肌肉骨骼护理，以提高及时的识别和转诊。

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引用次数: 0

Anterior cruciate ligament anatomy of Vietnamese adults and applications in arthroscopic anterior cruciate ligament reconstruction surgery with all-inside single-bundle technique 越南成人前交叉韧带解剖及全内单束技术在关节镜下前交叉韧带重建手术中的应用

IF 1.5 Q3 ORTHOPEDICS

Journal of orthopaedics

Pub Date : 2025-12-13 DOI: 10.1016/j.jor.2025.12.027

Lam Tran Quoc , Trinh Le Khanh , Hanh Tran Mi

Arthroscopic anterior cruciate ligament (ACL) reconstruction is increasingly performed in Vietnam, with the all-inside technique offering advantages such as minimized invasiveness, reduced postoperative pain, and the ability to use shorter, larger-diameter grafts to lower failure rates. Accurate tunnel placement is critical for optimizing surgical outcomes, and detailed understanding of population-specific ACL anatomy plays an essential role. This study aimed to describe the anatomical characteristics of the ACL in Vietnamese adults and to evaluate clinical outcomes of all-inside single-bundle ACL reconstruction based on these anatomical parameters.

Twenty fresh Vietnamese adult knee specimens were dissected to assess ACL length, femoral attachment morphology, tibial attachment morphology, and key anatomical reference distances. Additionally, 68 patients with ACL rupture underwent arthroscopic anatomic reconstruction with a 4-strand hamstring autograft using the all-inside technique and were clinically followed at 3, 6, 12, and 18 months. Functional recovery was assessed using Lysholm and IKDC scores.

The mean ACL length was 28.08 ± 1.01 mm. The femoral attachment measured 14.19 ± 1.87 × 11.24 ± 1.76 mm; distances from its center to the Resident's ridge, posterior cartilage, and distal cartilage were 5.67 ± 0.11 mm, 8.26 ± 0.55 mm, and 12.54 ± 0.52 mm, respectively. The tibial attachment measured 13.59 ± 1.57 × 10.67 ± 1.34 mm, with distances to the RER ridge and ACL ridge of 11.63 ± 0.55 mm and 9.46 ± 0.41 mm. Clinically, Lysholm scores improved from 58.84 ± 6.79 preoperatively to 97.8 ± 5.73 at final follow-up. IKDC results showed 54 grade A, 11 grade B, and 3 grade C outcomes, with no reruptures.

Applying Vietnamese-specific ACL anatomy in all-inside reconstruction yielded favorable clinical results and represents a promising approach for ACL injuries in Vietnam.

关节镜下前交叉韧带（ACL）重建在越南越来越多地进行，全内部技术具有诸如最小侵入性，减少术后疼痛以及能够使用更短，更大直径的移植物以降低失败率等优点。准确的隧道放置是优化手术效果的关键，详细了解人群特异性ACL解剖结构起着至关重要的作用。本研究旨在描述越南成人前交叉韧带的解剖学特征，并基于这些解剖学参数评估全内单束前交叉韧带重建的临床结果。20个新鲜的越南成人膝关节标本被解剖以评估前交叉韧带长度、股骨附着形态、胫骨附着形态和关键的解剖学参考距离。此外，68例前交叉韧带破裂患者接受了关节镜下解剖重建，采用全内技术进行了4股腘绳肌腱自体移植，并在3、6、12和18个月进行了临床随访。使用Lysholm和IKDC评分评估功能恢复。ACL平均长度28.08±1.01 mm。股骨附着体长度为14.19±1.87 × 11.24±1.76 mm；中心距居民脊、后软骨、远端软骨的距离分别为5.67±0.11 mm、8.26±0.55 mm、12.54±0.52 mm。胫骨附着体尺寸为13.59±1.57 × 10.67±1.34 mm，与RER脊和ACL脊的距离分别为11.63±0.55 mm和9.46±0.41 mm。临床Lysholm评分从术前的58.84±6.79提高到最终随访时的97.8±5.73。IKDC结果显示54例A级，11例B级，3例C级，无复发。在全内重建中应用越南特有的ACL解剖获得了良好的临床结果，代表了越南ACL损伤的有希望的方法。

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引用次数: 0

Initial safety outcomes of adipose-derived mesenchymal stem cell for rotator cuff tear: A 3-year pilot trial 脂肪来源间充质干细胞治疗肩袖撕裂的初步安全性结果：一项为期3年的试点试验

IF 1.5 Q3 ORTHOPEDICS

Journal of orthopaedics

Pub Date : 2025-12-12 DOI: 10.1016/j.jor.2025.12.025

Parisa Nejati , Nahid Masoumi Shahre Babak , Amir Sobhani Eraghi , Lida Nejati , Kimia Didehvar , Ali Mazaherinezhad , Nahid Nafisi , Naser Amini , Mohammad Taghi Joghataei

Background

Rotator cuff injuries are the underlying cause of shoulder pain in 65–70 % of the patients over the age of 50. A novel therapeutic approach is stem cell therapy, which promises to heal. This study represents one of the first long-term safety evaluations of autologous adipose-derived mesenchymal stem cells (MSCs) in human subjects with total rotator cuff tear, with a specific focus on potential adverse effects.

Methods

This study was designed as a pilot safety phase within a broader clinical trial framework. Ten patients with full-thickness rotator cuff tears were enrolled. Autologous mesenchymal stem cells (MSCs), derived from adipose tissue, were injected directly into the torn tendons under ultrasound guidance. Patients were monitored over a 36-month period to assess safety outcomes. These included complete blood count (CBC), inflammatory markers—erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP)—radiological imaging (X-ray and MRI), pain assessment via visual analog scale (VAS), and functional status through validated questionnaires.

Results

No systemic or local adverse events were reported during the 36-month follow-up, indicating a favorable safety profile. The CBC parameters after three years compared to the baseline measurement: hemoglobin [mean = 13.92 (SD = 1.32) vs. 13.85 (1.34)], red blood cells [mean = 4.97 (SD = 0.31) vs. 5.11 (0.31)], white blood cells [mean = 6.05 (SD = 2.06) vs. 6.01 (1.70)], platelets [mean = 248.8 (SD = 2.76) vs. 246.9 (2.50)]. The inflammatory markers were also within the normal range as following: ESR [mean = 7 (SD = 1.22) vs. 6.4 (2.48)] and CRP [mean = 0.2 (SD = 0.70) vs. 0.3 (SD = 0.89)]. Pain intensity and functional status improved compared to baseline: VAS [3.6 (SD = 1.17) vs 8.5 (1.93)], WORC [34.17 (SD = 3.31) vs 47.53 (SD = 2.56)], DASH [32.95 (SD = 2.45) vs 50.71 (SD = 4.34)].The shoulder X-ray and MRI did not show any significant pathology in the soft or bony tissues of the shoulder joint over the follow-ups.

Conclusion

Injection of autologous MSCs derived from adipose tissue is safe in treating total rotator cuff tear. These findings support the initiation of larger-scale trials to further investigate the therapeutic potential and efficacy of MSCs in tendon regeneration.

背景：在65 - 70%的50岁以上患者中，肩袖损伤是导致肩痛的根本原因。一种新的治疗方法是干细胞疗法，它有望治愈。本研究代表了自体脂肪源性间充质干细胞（MSCs）用于完全性肩袖撕裂患者的首次长期安全性评估之一，并特别关注了潜在的不良反应。方法本研究被设计为一个更广泛的临床试验框架内的试点安全阶段。纳入10例全层肩袖撕裂患者。在超声引导下，将取自脂肪组织的自体间充质干细胞（MSCs）直接注入撕裂肌腱。对患者进行为期36个月的监测，以评估安全性结果。这些包括全血细胞计数（CBC），炎症标志物-红细胞沉降率（ESR）和c反应蛋白(CRP) -放射成像（x射线和MRI），通过视觉模拟量表（VAS）进行疼痛评估，以及通过有效问卷进行功能状态评估。结果在36个月的随访中，未报告全身或局部不良事件，表明良好的安全性。与基线测量相比，三年后的CBC参数：血红蛋白[平均= 13.92 (SD = 1.32) vs. 13.85(1.34)]，红细胞[平均= 4.97 (SD = 0.31) vs. 5.11(0.31)]，白细胞[平均= 6.05 (SD = 2.06) vs. 6.01(1.70)]，血小板[平均= 248.8 (SD = 2.76) vs. 246.9(2.50)]。炎症指标也在正常范围内：ESR[平均= 7 (SD = 1.22) vs. 6.4(2.48)]和CRP[平均= 0.2 (SD = 0.70) vs. 0.3 (SD = 0.89)]。与基线相比，疼痛强度和功能状态有所改善：VAS [3.6 (SD = 1.17) vs 8.5 (1.93)], WORC [34.17 (SD = 3.31) vs 47.53 (SD = 2.56)], DASH [32.95 (SD = 2.45) vs 50.71 (SD = 4.34)]。在随访期间，肩部x线和MRI未显示肩关节软组织或骨组织有任何明显的病理变化。结论自体脂肪源性间充质干细胞注射治疗肩袖全撕裂是安全的。这些发现支持开展更大规模的试验，以进一步研究MSCs在肌腱再生中的治疗潜力和功效。

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引用次数: 0

mModPoEs: Multimodal posture estimation and feedback-driven correction of load-bearing human movements using wearable sensors and computer vision mModPoEs：使用可穿戴传感器和计算机视觉对负重人体运动进行多模态姿态估计和反馈驱动校正

IF 1.5 Q3 ORTHOPEDICS

Journal of orthopaedics

Pub Date : 2025-12-12 DOI: 10.1016/j.jor.2025.12.024

P. Gokul Thilaak , G. Malathi , D. Thiagarajan

Objective

Improper spinal posture during activities of daily living such as seated posture, upright stance, and ambulation, particularly under load-bearing conditions, has been recognized as a major contributor to musculoskeletal disorders, including chronic back pain and disc degeneration. This study presents a multimodal posture estimation and feedback framework that integrates wearable-sensor data and computer-vision analysis to support spinal health.

Methods

The system integrates data from Inertial Measurement Units (IMUs) and flex sensors to quantify postural angles which acts as sensor data, while concurrently extracting key visual features from multi-view (frontal and lateral) video recordings and photographs using the MediaPipe framework. A control group was formed under the guidance of physiotherapist and the data was collected at Tagore College of Physiotherapy located in Chennai, India. This control group comprises of 40 subjects, selected without gender bias, aged between 19 and 22 years. The analysis on multimodal data incorporated specifically, logistic regression (LR), decision tree (DT), random forest (RF), KNN and SVM.

Results

Among all evaluated models, the RF algorithm, showed effective performance and balance in all activities of both male and female subjects. The dataset used was a composite collection of both genders, resulting in accuracy rates of 75 %, 95 % and 63 % for sitting, standing, and walking, respectively.

Conclusion

The findings highlight that integrating wearable and visual modalities enhances posture classification accuracy. While the findings are preliminary, they establish a methodological foundation for future development of multimodal, feedback-based posture assessment systems.

在日常生活活动中，如坐姿、直立站立和行走时，特别是在负重条件下，不正确的脊柱姿势已被认为是肌肉骨骼疾病（包括慢性背痛和椎间盘退变）的主要原因。本研究提出了一个多模态姿势估计和反馈框架，该框架集成了可穿戴传感器数据和计算机视觉分析，以支持脊柱健康。方法该系统集成了惯性测量单元（imu）和弯曲传感器的数据，量化姿态角度作为传感器数据，同时使用MediaPipe框架从多视角（正面和侧面）视频记录和照片中提取关键视觉特征。在物理治疗师的指导下组成对照组，数据收集于印度金奈泰戈尔物理治疗学院。该对照组包括40名受试者，年龄在19至22岁之间，无性别偏见。对多模态数据的分析包括逻辑回归（LR）、决策树（DT）、随机森林（RF）、KNN和支持向量机（SVM）。结果在所有评估模型中，RF算法在男性和女性受试者的所有活动中都表现出有效的性能和平衡。使用的数据集是两种性别的合成集合，坐姿、站立和行走的准确率分别为75%、95%和63%。结论结合可穿戴和视觉模式可提高姿势分类的准确性。虽然这些发现是初步的，但它们为未来多模式、基于反馈的姿势评估系统的发展奠定了方法学基础。

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引用次数: 0

Primary immunodeficiency disorders increase the risk of postoperative complications following total hip and knee arthroplasty: A national matched cohort study 原发性免疫缺陷疾病增加全髋关节和膝关节置换术后并发症的风险：一项国家匹配队列研究

IF 1.5 Q3 ORTHOPEDICS

Journal of orthopaedics

Pub Date : 2025-12-12 DOI: 10.1016/j.jor.2025.12.023

Jared Sasaki , Catherine Hand , Francisco Oh , Yuan Liu , Margot Richards , Kyleen Jan , Morgan Angotti , Brian Forsythe

Introduction

Total hip (THA) and knee arthroplasty (TKA) are widely successful procedures but remain susceptible to complications. Patients with primary immunodeficiency (PI) conditions may face increased postoperative risks, though data is limited. This study evaluated postoperative outcomes after THA and TKA in PI patients, hypothesizing higher complication rates compared with matched controls.

Methods

A retrospective cohort study was conducted using the PearlDiver Mariner database (2010–2020). Patients undergoing primary THA or TKA were identified by CPT codes and matched 1:1 by age, sex, and Charlson Comorbidity Index, obesity, tobacco use, alcohol abuse, and osteoarthritis. Patients with PI conditions were identified with a comprehensive list of International Classification of Diseases (ICD) 9/10 codes. Postoperative complications were assessed at 90 days, 1 year, and 2 years. Multivariable logistic regression was used to identify independent associations with PI status.

Results

After 1:1 matching, PI patients had significantly higher 90-day postoperative incidence of deep vein thrombosis (DVT), pneumonia, urinary tract infection (UTI), and any complication following THA. At 1 year, PI patients were found to have increased odds of periprosthetic joint infection (PJI), DVT, acute kidney injury (AKI), pneumonia, UTI, and any complication. 2 years postoperatively, PI was associated with increased odds of PJI revision. Within 90 days of TKA, PI patients displayed a higher incidence of surgical site infection (SSI), AKI, wound disruption, pneumonia, UTI, readmission, and any complication. After one year, PI patients had higher rates of PJI, SSI, DVT, AKI, wound disruption, pneumonia, UTI, readmission, and any complication. At 2 years follow up, there were no significant differences between groups.

Conclusions

In patients undergoing THA and TKA, PI was associated with significantly higher odds of infectious and medical complications, despite lower overall rates of metabolic comorbidities. These findings highlight the need for PI-specific perioperative protocols to improve both clinical outcomes and economic benefits.

全髋关节（THA）和膝关节置换术（TKA）是广泛成功的手术，但仍然容易发生并发症。原发性免疫缺陷（PI）患者可能面临更高的术后风险，尽管数据有限。本研究评估了PI患者THA和TKA后的术后结果，假设与匹配对照组相比，并发症发生率更高。方法采用PearlDiver Mariner数据库（2010-2020）进行回顾性队列研究。接受原发性THA或TKA的患者通过CPT代码进行识别，并按年龄、性别、Charlson合并症指数、肥胖、吸烟、酗酒和骨关节炎进行1:1匹配。使用国际疾病分类（ICD） 9/10代码的综合清单确定PI患者。术后90天、1年和2年评估并发症。使用多变量逻辑回归来确定与PI状态的独立关联。结果经1:1匹配后，PI患者术后90天深静脉血栓形成（DVT）、肺炎、尿路感染（UTI）及THA术后并发症发生率均显著增高。1年后，PI患者发现假体周围关节感染（PJI）、DVT、急性肾损伤（AKI）、肺炎、UTI和任何并发症的几率增加。术后2年，PI与PJI翻修的几率增加相关。在TKA的90天内，PI患者表现出较高的手术部位感染（SSI）、AKI、伤口破裂、肺炎、UTI、再入院和任何并发症的发生率。一年后，PI患者的PJI、SSI、DVT、AKI、伤口破裂、肺炎、UTI、再入院和任何并发症的发生率更高。随访2年，两组间无明显差异。结论在接受全髋关节置换术和全髋关节置换术的患者中，尽管总体代谢合并症发生率较低，但PI与感染和医学并发症的发生率显著升高相关。这些发现强调需要针对pi的围手术期方案来改善临床结果和经济效益。

{"title":"Primary immunodeficiency disorders increase the risk of postoperative complications following total hip and knee arthroplasty: A national matched cohort study","authors":"Jared Sasaki , Catherine Hand , Francisco Oh , Yuan Liu , Margot Richards , Kyleen Jan , Morgan Angotti , Brian Forsythe","doi":"10.1016/j.jor.2025.12.023","DOIUrl":"10.1016/j.jor.2025.12.023","url":null,"abstract":"<div><h3>Introduction</h3><div>Total hip (THA) and knee arthroplasty (TKA) are widely successful procedures but remain susceptible to complications. Patients with primary immunodeficiency (PI) conditions may face increased postoperative risks, though data is limited. This study evaluated postoperative outcomes after THA and TKA in PI patients, hypothesizing higher complication rates compared with matched controls.</div></div><div><h3>Methods</h3><div>A retrospective cohort study was conducted using the PearlDiver Mariner database (2010–2020). Patients undergoing primary THA or TKA were identified by CPT codes and matched 1:1 by age, sex, and Charlson Comorbidity Index, obesity, tobacco use, alcohol abuse, and osteoarthritis. Patients with PI conditions were identified with a comprehensive list of International Classification of Diseases (ICD) 9/10 codes. Postoperative complications were assessed at 90 days, 1 year, and 2 years. Multivariable logistic regression was used to identify independent associations with PI status.</div></div><div><h3>Results</h3><div>After 1:1 matching, PI patients had significantly higher 90-day postoperative incidence of deep vein thrombosis (DVT), pneumonia, urinary tract infection (UTI), and any complication following THA. At 1 year, PI patients were found to have increased odds of periprosthetic joint infection (PJI), DVT, acute kidney injury (AKI), pneumonia, UTI, and any complication. 2 years postoperatively, PI was associated with increased odds of PJI revision. Within 90 days of TKA, PI patients displayed a higher incidence of surgical site infection (SSI), AKI, wound disruption, pneumonia, UTI, readmission, and any complication. After one year, PI patients had higher rates of PJI, SSI, DVT, AKI, wound disruption, pneumonia, UTI, readmission, and any complication. At 2 years follow up, there were no significant differences between groups.</div></div><div><h3>Conclusions</h3><div>In patients undergoing THA and TKA, PI was associated with significantly higher odds of infectious and medical complications, despite lower overall rates of metabolic comorbidities. These findings highlight the need for PI-specific perioperative protocols to improve both clinical outcomes and economic benefits.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"73 ","pages":"Pages 177-183"},"PeriodicalIF":1.5,"publicationDate":"2025-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145787622","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Radiological and complication outcomes of posterior pedicle subtraction osteotomy compared with anterior column realignment in adult spinal deformity: A meta-analysis 成人脊柱畸形后路椎弓根减截骨术与前柱复位术的放射学和并发症比较：一项荟萃分析

IF 1.5 Q3 ORTHOPEDICS

Journal of orthopaedics

Pub Date : 2025-12-12 DOI: 10.1016/j.jor.2025.12.022

Johnny Abboud , Ali Ghosn , Mohammad Jaber , Anthony Chalfoun , Charbel Chaiban , Ghadi Abou Orm , Moro Chahine , Ümit Mert , Ahmad Chokr , Sadek Jaber , Alaa El Chal , Mohamed Abdelaal , Maher Ghandour , Diana Jabbour

Background

Adult spinal deformity (ASD) causes significant functional disability and pain, often necessitating surgical correction to restore sagittal balance. Posterior pedicle subtraction osteotomy (PSO) and anterior column realignment (ACR) represent two powerful but distinct strategies for sagittal correction. While PSO provides robust correction through a posterior approach, it is associated with high morbidity. ACR, performed through a minimally invasive lateral approach, offers comparable angular correction with potentially reduced blood loss and shorter recovery. This meta-analysis aimed to compare radiographic and complication outcomes between PSO and ACR in ASD surgery.

Methods

Following PRISMA guidelines, a systematic search was conducted in PubMed, Scopus, Web of Science, and Embase up to October 2025. Eligible studies directly compared ACR and PSO in adult sagittal deformity and reported postoperative lumbar lordosis or complication rates. Data were pooled using random-effects models. Continuous variables were expressed as standardized mean differences (SMDs) and dichotomous outcomes as risk ratios (RRs) with 95 % confidence intervals (CIs).

Results

Five studies (three clinical, two biomechanical) published between 2017 and 2024 met the inclusion criteria. The pooled analysis of lumbar lordosis demonstrated a significant improvement favoring ACR (SMD = 0.68, 95 % CI 0.21–1.15; p = 0.004), with substantial heterogeneity (I² = 82 %). The combined analysis of all complications revealed no significant difference between ACR and PSO (RR = 0.73, 95 % CI 0.46–1.16; p = 0.14; I² = 0 %). Among specific complications, neurologic (RR = 2.12, p = 0.20), vascular (RR = 1.97, p = 0.24), infection (RR = 0.32, p = 0.14), and mechanical (RR = 0.15, p = 0.20) risks were comparable. The rate of unplanned reoperation was significantly lower following ACR (RR = 0.18, 95 % CI 0.03–0.91; p = 0.04).

Conclusions

Both PSO and ACR achieve meaningful sagittal correction in ASD. ACR provides equivalent or superior lordosis restoration with markedly lower intraoperative blood loss and fewer reoperations, supporting its role as a less invasive alternative to PSO in selected patients.

背景：成人脊柱畸形（ASD）会导致严重的功能障碍和疼痛，通常需要手术矫正以恢复矢状面平衡。后椎弓根减截骨术（PSO）和前柱复位（ACR）是矢状面矫正的两种有效但不同的策略。虽然PSO通过后路提供了强有力的矫正，但与高发病率相关。ACR通过微创外侧入路进行，可提供类似的角度矫正，潜在地减少失血量和更短的恢复时间。本荟萃分析旨在比较PSO和ACR在ASD手术中的放射学和并发症结果。方法按照PRISMA指南，系统检索PubMed、Scopus、Web of Science和Embase，检索时间截止到2025年10月。符合条件的研究直接比较了ACR和PSO治疗成人矢状面畸形，并报告了术后腰椎前凸或并发症的发生率。使用随机效应模型汇总数据。连续变量用标准化平均差异（SMDs）表示，二分类结果用95%置信区间（ci）的风险比（rr）表示。结果2017 - 2024年间发表的5项研究（3项临床研究，2项生物力学研究）符合纳入标准。腰椎前凸的综合分析显示ACR有显著改善（SMD = 0.68, 95% CI 0.21-1.15; p = 0.004），但存在很大的异质性（I2 = 82%）。综合分析所有并发症，ACR与PSO无显著差异（RR = 0.73, 95% CI 0.46-1.16; p = 0.14; I2 = 0%）。在特定并发症中，神经系统（RR = 2.12, p = 0.20）、血管（RR = 1.97, p = 0.24）、感染（RR = 0.32, p = 0.14）和机械（RR = 0.15, p = 0.20）风险具有可比性。ACR术后非计划再手术率显著降低（RR = 0.18, 95% CI 0.03 ~ 0.91; p = 0.04）。结论PSO和ACR均可实现矢状面矫正。ACR提供相当或更好的前凸修复，术中出血量明显减少，再手术次数较少，支持其作为PSO的微创替代方案在特定患者中的作用。

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引用次数: 0