Journal of Orthopaedic Science最新文献_第2页

Morphology and deformity of the distal phalanx in hallux valgus 拇外翻远端指骨的形态和畸形。

IF 1.5 4区医学 Q3 ORTHOPEDICS

Journal of Orthopaedic Science

Pub Date : 2024-09-01 DOI: 10.1016/j.jos.2023.09.010

Background

Studies have shown that the first metatarsal contributes to hallux valgus. The proximal phalanx, another factor that defines the hallux valgus angle, also contributes to the development of hallux valgus. There have been no reports on the use of computed tomography to evaluate bone morphology of the proximal phalanx. The purpose of this study was to analyze the morphology and deformity of the proximal phalanx and its relationship to hallux valgus using computed tomography, and to consider the indications for proximal phalanx surgery in hallux valgus.

Methods

Patients who consulted at our clinic for foot and ankle disorders and underwent both weight-bearing radiography and computed tomography between May 2019 and March 2022 were included in the study. The hallux valgus angle, sesamoid subluxation, first metatarsal length, proximal phalanx length, metatarsal-proximal phalanx ratio, proximal phalanx valgus angle, metatarsal-proximal phalanx angle, proximal phalanx rotation angle, and distal phalanx-proximal phalanx angle were measured. These parameters were compared between the hallux valgus and control groups. In the hallux valgus group, the hallux valgus and proximal phalanx valgus angles were measured and compared using weight-bearing radiographs.

Results

A total of 83 feet in 65 patients were diagnosed with hallux valgus (hallux valgus group; mean age of 68.0 ± 13.8 years) and 30 feet in 22 patients without hallux valgus (control group; mean age of 67.0 ± 25.8 years) were included in the study. The proximal phalanx length, metatarsal-proximal phalanx ratio and angle, and distal phalanx-proximal phalanx angle were significantly greater in the hallux valgus group than in the control group. However, the proximal phalanx valgus and rotation angles were not significantly different between the groups.

Conclusion

Since there was no significant difference in the proximal phalanx morphology, except length, between the hallux valgus and control groups, the indications for osteotomy of the proximal phalanx should be carefully considered.

背景：研究表明，第一跖骨导致拇外翻。近节指骨是定义拇外翻角的另一个因素，也有助于拇外翻的发展。目前还没有使用计算机断层扫描来评估近节指骨的骨形态的报告。本研究的目的是利用计算机断层扫描分析近节指骨的形态和畸形及其与拇外翻的关系，并考虑拇外翻近节指指骨手术的适应证。方法：在2019年5月至2022年3月期间，在我们诊所咨询足部和踝关节疾病并接受了负重放射照相术和计算机断层扫描的患者被纳入研究。测量拇外翻角、籽骨半脱位、第一跖骨长度、近节指骨长度、跖骨-近节指节比、近节趾骨外翻角、跖骨近节趾角、近节趾旋转角和远节趾骨-近趾骨角。将这些参数在拇外翻组和对照组之间进行比较。在拇外翻组中，测量拇外翻角和近节指骨外翻角，并使用负重X线片进行比较。结果：65例患者中有83只脚被诊断为拇外翻（拇外翻组，平均年龄68.0±13.8岁），22例无拇外翻患者中有30只脚被纳入研究（对照组，平均岁67.0±25.8岁）。拇外翻组的近节指骨长度、跖骨-近节指指骨比例和角度以及远节指骨-近指骨角度均显著大于对照组。然而，近节指骨外翻和旋转角度在两组之间没有显著差异。结论：拇外翻组和对照组除长度外，近节指骨形态无显著差异，应仔细考虑近节指节骨截骨的适应证。

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引用次数: 0

Effect of lumbar lordosis angle on the development of lumbar spondylolysis in adolescent baseball players: A cross-sectional study 腰椎前凸角度对青少年棒球运动员腰椎峡部裂发展的影响：一项横断面研究。

IF 1.5 4区医学 Q3 ORTHOPEDICS

Journal of Orthopaedic Science

Pub Date : 2024-09-01 DOI: 10.1016/j.jos.2023.09.004

Background

Lumbar spondylolysis (LS) is a lumbar vertebral arch stress fracture that often occurs in adolescent athletes, especially baseball players. An increase in lumbar lordosis angle (LLA) increases the compressive stress on the vertebral arch, influencing the development of LS. However, the effect of LLA on LS development in adolescent baseball players is unknown. Therefore, it is necessary to elucidate the risk factors that influence the development of LS. This cross-sectional study aimed investigate the effect of LLA on LS development in adolescent baseball players.

Methods

Patients were male baseball players aged 11–18 years who visited an orthopedic clinic with a chief complaint of lumbar pain and underwent a magnetic resonance imaging (MRI) examination between January 1, 2018, and October 31, 2021. LLA was defined as the angle formed by the line parallel to the superior endplate of the L1 and S1. A person other than the data analyst measured LLA three times from the MRI, and the average value was used for data analysis. Logistic regression analysis was performed, with the presence or absence of LS as the objective variable and LLA, age, and previous pitching experience as explanatory variables.

Results

Of the 112 subjects included, 79 were in the LS group and 33 in the non-LS group. The LLA was 45.42 ± 8.19° in the LS group and 36.68 ± 8.26° in the non-LS group, with significant differences between the groups. Logistic regression analysis showed that LLA significantly differed with an odds ratio of 1.140 (95% confidence interval: 1.070–1.21), even after adjusting for age and previous pitching experience.

Conclusions

LLA in adolescent baseball players was significantly greater in the LS group than in the non-LS group, which may influence the development of LS.

背景：腰椎峡部裂是一种常见于青少年运动员，尤其是棒球运动员的腰椎弓应力性骨折。腰椎前凸角（LLA）的增加会增加椎弓上的压缩应力，影响LS的发展。然而，LLA对青少年棒球运动员LS发展的影响尚不清楚。因此，有必要阐明影响LS发展的危险因素。本横断面研究旨在调查LLA对青少年棒球运动员LS发展的影响。方法：患者为11-18岁的男性棒球运动员，他们在2018年1月1日至2021年10月31日期间以腰椎疼痛为主要主诉前往骨科诊所，并接受了核磁共振成像（MRI）检查。LLA定义为由平行于L1和S1的上终板的线形成的角度。数据分析师以外的其他人从MRI中测量了三次LLA，平均值用于数据分析。进行Logistic回归分析，以LS的存在或不存在为目标变量，LLA、年龄和以前的投球经验为解释变量。结果：在纳入的112名受试者中，LS组79名，非LS组33名。LS组的LLA为45.42±8.19°，非LS组为36.68±8.26°，两组之间存在显著差异。逻辑回归分析显示，即使在调整了年龄和以前的投球经验后，LLA也存在显著差异，优势比为1.140（95%置信区间：1.070-1.21）。结论：LS组青少年棒球运动员的LLA明显高于非LS组，这可能影响LS的发展。

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引用次数: 0

Comment on Yamato et al.: Impact of multi-rod reinforcement on rod fractures in adult spinal deformity: A retrospective case series with a minimum follow up of 5 years 对 Yamato 等人的评论多棒加固对成人脊柱畸形中棒骨折的影响：至少随访 5 年的回顾性病例系列。

IF 1.5 4区医学 Q3 ORTHOPEDICS

Journal of Orthopaedic Science

Pub Date : 2024-09-01 DOI: 10.1016/j.jos.2024.05.006

引用次数: 0

Effect of pre-operative HbA1c and blood glucose level on the surgical site infection after lumbar instrumentation surgery 术前HbA1c和血糖水平对腰椎器械手术后手术部位感染的影响。

IF 1.5 4区医学 Q3 ORTHOPEDICS

Journal of Orthopaedic Science

Pub Date : 2024-09-01 DOI: 10.1016/j.jos.2023.08.015

Background

This study aims to investigate the effect of pre-operative hemoglobin A1c (HbA1c) and pre-operative blood glucose control on the rate of surgical site infection (SSI) after posterior lumbar instrumentation surgery in diabetes mellitus (DM) patients.

Methods

A total of 1046 patients who had undergone posterior lumbar instrumentation surgery were reviewed. Based on pre-operative HbA1c, patients were divided into three groups: non-DM group, low HbA1c group (HbA1c < 7.0 % in DM) and high HbA1c group (≥7.0). As well, based on the status of blood glucose control in DM patients immediately before surgery, patients were divided into two groups: good control group (post-prandial blood glucose [PBG] < 200 mg/dl) and poor control group (≥200). The rate of SSI was compared among these groups.

Results

SSI occurred in 1.9 % in non-DM group, 2.4 % in low HbA1c group, and 9.3 % in high HbA1c group. Compared with non-DM group, high HbA1c group had significantly higher rate of SSI (p = 0.001). There was not statistically different between non-DM and low HbA1c groups (p = 0.550). SSI occurred in 2.2 % in good control group, and 10.2 % in poor control group. The rate of SSI was significantly lower in good control group (p = 0.013).

Conclusion

This study showed that the rate of SSI after posterior lumbar instrumentation surgery tend to be higher in DM patients with high HbA1c. However, the rate might be reduced to the same level as that of non-DM group by lowering PBG to <200 mg/dl immediately before surgery.

背景：本研究旨在探讨糖尿病（DM）患者术前血红蛋白A1c（HbA1c）和术前血糖控制对腰椎后融合术后手术部位感染率（SSI）的影响。方法：对1046例接受过腰椎后路内固定手术的患者进行回顾性分析。根据术前HbA1c将患者分为三组：非糖尿病组，低HbA1c组（HbA1c结果：非糖尿病组SSI发生率为1.9%，低HbA1c2.4%，高HbA1c 9.3%。与非糖尿病组相比，高HbAlc组SSI的发生率显著较高（p=0.001）。非糖尿病组与低HbA1c组之间无统计学差异（p=0.050）。良好对照组SSI出现率为2.2%，不良对照组为10.2%。良好对照组SSI发生率明显较低（p=0.013）。然而，通过将PBG降低到

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引用次数: 0

Reply to letter to the editor by Li et al. 回复 Li 等人致编辑的信

IF 1.5 4区医学 Q3 ORTHOPEDICS

Journal of Orthopaedic Science

Pub Date : 2024-09-01 DOI: 10.1016/j.jos.2024.06.001

引用次数: 0

Comparison of the radiological and functional results of a plaster splint and dynamic stabilization splint for Boxer's fractures: A prospective randomized controlled study 比较石膏夹板和动态稳定夹板治疗拳击手骨折的放射学和功能效果：前瞻性随机对照研究

IF 1.5 4区医学 Q3 ORTHOPEDICS

Journal of Orthopaedic Science

Pub Date : 2024-09-01 DOI: 10.1016/j.jos.2023.08.004

Purpose

This study compared the clinical and radiological results of fifth metacarpal neck fractures treated with a short-arm plaster splint (SAPS) versus a dynamic metacarpal stabilization splint (DMSS).

Materials and methods

The 119 patients were referred to our institute between 2018 and 2019 and treated with SAPS or DMSS after appropriate initial closed reduction. Follow-up examinations were conducted at days 10 and 20, and at 1, 2, and 3 months after treatment. Alignment of the fracture, range of motion (ROM), and complications were evaluated during each visit. Grip strength was evaluated using a dynamometer. Self-care, usual daily activities, pain/discomfort, and anxiety/depression were evaluated using the EuroQol 5-Dimension 5-Level (EQ-5D-5L) and a VAS.

Results

Of the 119 patients, 103 completed all follow up examinations. In total, 51 patients were treated with SAPS and 52 with DMSS. Skin lesions were detected in five patients in the DMSS group, but none in the SAPS group (p = 0.008). The grip strength of patients in the DMSS group was statistically better at the 1-, 2-month and 3-month follow-up visits (p < 0.001). ROM of the interphalangeal and metacarpophalangeal joints were statistically better in the DMSS group at the 1-month visit (p < 0.001) but similar at the 3-month visit (p = 0.27). Wrist ROM was statistically higher in the DMSS group at the 3-month visit (p < 0.05). Self-care, usual daily activities, pain/discomfort, and anxiety/depression were statistically better in the DMSS group at all follow-up visits (p < 0.05), as determined by the EQ-5D-5L.

Conclusion

Dynamic stabilization of a stable boxer's fracture with DMSS is as effective as static stabilization with SAPS for maintaining the reduction and ensuring union. However, DMSS provides better early ROM, comfort, and muscle strength, as well as an earlier return to usual daily activities despite the occasional skin lesions happened.

目的本研究比较了采用短臂石膏夹板（SAPS）和动态掌骨稳定夹板（DMSS）治疗第五掌骨颈骨折的临床和放射学结果。材料和方法 2018年至2019年期间，119例患者转诊至我院，在适当的初次闭合复位后采用SAPS或DMSS治疗。在治疗后第10天、第20天、第1个月、第2个月和第3个月进行随访检查。每次就诊都会对骨折对位、活动范围（ROM）和并发症进行评估。使用测力计评估握力。此外，还使用EQ-5D-5L（EuroQol 5-Dimension 5-Level）和VAS对自我护理、日常活动、疼痛/不适以及焦虑/抑郁进行了评估。共有 51 名患者接受了 SAPS 治疗，52 名患者接受了 DMSS 治疗。DMSS 组有 5 名患者发现皮肤损伤，而 SAPS 组无皮肤损伤（P = 0.008）。在 1 个月、2 个月和 3 个月的随访中，DMSS 组患者的握力在统计学上更好（p < 0.001）。在1个月的随访中，DMSS组患者的指间关节和掌指关节的活动度在统计学上更佳（p <0.001），但在3个月的随访中情况相似（p = 0.27）。DMSS组的腕关节活动度在3个月访视时显著高于DMSS组（p <0.05）。根据EQ-5D-5L的测定，DMSS组在所有随访中的自理能力、日常活动、疼痛/不适以及焦虑/抑郁方面均优于DMSS组（p <0.05）。然而，DMSS能提供更好的早期活动度、舒适度和肌力，并能更早地恢复正常的日常活动，尽管偶尔会发生皮肤损伤。

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引用次数: 0

Microbiome of infected fracture nonunion: Does it affect outcomes? 感染性骨折不愈合的微生物组：是否影响疗效？

IF 1.5 4区医学 Q3 ORTHOPEDICS

Journal of Orthopaedic Science

Pub Date : 2024-09-01 DOI: 10.1016/j.jos.2023.08.018

Background

Infected fracture nonunions often require prolonged treatment and recovery courses. It is unclear whether the bacterial microbiome influences the time to healing as well as the eradication of infection. The goals of this study are (1) to assess the bacterial microbiome affecting infected nonunions and (2) to evaluate the effects of bacterial speciation on associated outcomes.

Methods

Between 2006 and 2022, data from 551 adult patients from a single academic institution who presented with a fracture nonunion were analyzed retrospectively for infection. All patients underwent revision surgery with three sets of cultures obtained intra-operatively. Patients with significant intra-operative cultures were grouped into gram-positive and gram-negative culture cohorts. These patients were managed with a standardized protocol involving surgical debridement, nonunion site fixation, and culture-directed antibiotic treatment. Primary outcome was time to fracture union. Secondary outcomes included number of re-operations and eventual amputation or reconstructive surgery.

Results

56 nonunion patients (10 %) were diagnosed with an infected nonunion (44 g-positive, 12 g-negative). Of these, 3 g-positive patients received an amputation or arthroplasty procedure prior to fracture union, and seven were lost to follow-up. There were no significant differences in age, gender, or nonunion site between cohorts. Most nonunions occurred in the lower extremity. The most common bacteria were staph species (54.3 %). 36 g-positive and 10 g-negative patients achieved fracture union. Time to union was on average 158.4 days longer in the gram-negative cohort—but did not reach statistical significance (446.8 days gram-positive, 662.3 days gram-negative, p = 0.69). There was no difference in re-operation rates (1.9 % gram-positive, 2.2 % gram-negative, p = 0.84).

Conclusions

Patients with infected nonunions had wide-ranging bacterial contamination that were treated successfully using a standardized protocol. However, patients with any gram-negative culture trended toward a delay in time to union.

背景：感染性骨折不愈合通常需要延长治疗和恢复时间。目前尚不清楚细菌微生物组是否会影响愈合时间以及感染的根除。这项研究的目标是（1）评估影响感染非尼翁的细菌微生物组，以及（2）评估细菌物种形成对相关结果的影响。方法：回顾性分析2006年至2022年间，来自一家学术机构的551名出现骨折不愈合的成年患者的感染数据。所有患者均接受了翻修手术，术中获得了三组培养物。术中培养显著的患者被分为革兰氏阳性和革兰氏阴性培养组。这些患者采用标准化方案进行治疗，包括手术清创、骨不连部位固定和培养导向的抗生素治疗。主要结果是骨折愈合时间。次要结果包括多次再次手术和最终的截肢或重建手术。结果：56例骨不连患者（10%）被诊断为感染性骨不连（44g阳性，12g阴性）。其中，3例g阳性患者在骨折愈合前接受了截肢或关节成形术，7例失访。队列之间在年龄、性别或骨不连部位方面没有显著差异。大多数骨不连发生在下肢。最常见的细菌是葡萄球菌（54.3%）。36例g阳性和10例g阴性患者实现了骨折愈合。在革兰氏阴性队列中，愈合时间平均延长158.4天，但没有达到统计学意义（446.8天革兰氏阳性，662.3天革兰氏阴性，p=0.69）。再次手术率没有差异（1.9%革兰氏阳性，2.2%革兰氏阴性，p=0.84）成功地使用了标准化协议。然而，任何革兰氏阴性培养的患者都倾向于延迟愈合时间。

{"title":"Microbiome of infected fracture nonunion: Does it affect outcomes?","authors":"","doi":"10.1016/j.jos.2023.08.018","DOIUrl":"10.1016/j.jos.2023.08.018","url":null,"abstract":"<div><h3>Background</h3><p>Infected fracture nonunions<span> often require prolonged treatment and recovery courses. It is unclear whether the bacterial microbiome<span> influences the time to healing as well as the eradication of infection. The goals of this study are (1) to assess the bacterial microbiome affecting infected nonunions and (2) to evaluate the effects of bacterial speciation on associated outcomes.</span></span></p></div><div><h3>Methods</h3><p><span>Between 2006 and 2022, data from 551 adult patients from a single academic institution who presented with a fracture nonunion were analyzed retrospectively for infection. All patients underwent revision surgery with three sets of cultures obtained intra-operatively. Patients with significant intra-operative cultures were grouped into gram-positive and gram-negative culture cohorts. These patients were managed with a standardized protocol involving surgical debridement, nonunion site fixation, and culture-directed </span>antibiotic<span> treatment. Primary outcome was time to fracture union<span>. Secondary outcomes included number of re-operations and eventual amputation or reconstructive surgery.</span></span></p></div><div><h3>Results</h3><p><span>56 nonunion patients (10 %) were diagnosed with an infected nonunion (44 g-positive, 12 g-negative). Of these, 3 g-positive patients received an amputation or arthroplasty procedure prior to </span>fracture union, and seven were lost to follow-up. There were no significant differences in age, gender, or nonunion site between cohorts. Most nonunions occurred in the lower extremity. The most common bacteria were staph species (54.3 %). 36 g-positive and 10 g-negative patients achieved fracture union. Time to union was on average 158.4 days longer in the gram-negative cohort—but did not reach statistical significance (446.8 days gram-positive, 662.3 days gram-negative, p = 0.69). There was no difference in re-operation rates (1.9 % gram-positive, 2.2 % gram-negative, p = 0.84).</p></div><div><h3>Conclusions</h3><p>Patients with infected nonunions had wide-ranging bacterial contamination that were treated successfully using a standardized protocol. However, patients with any gram-negative culture trended toward a delay in time to union.</p></div>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41236242","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"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

Initial patient demographics affecting return to original work after traumatic hand injury in a rural area in Japan: A retrospective single-center study 日本农村地区手部创伤后影响恢复原工作的初始患者人口统计：一项回顾性单中心研究。

IF 1.5 4区医学 Q3 ORTHOPEDICS

Journal of Orthopaedic Science

Pub Date : 2024-09-01 DOI: 10.1016/j.jos.2023.09.002

Background

Time off work after traumatic hand injury not only affects individuals but also has socioeconomic repercussions, becoming a serious problem from the viewpoint of labor shortages. In depopulated rural areas, the impact of labor shortages due to time off work is more serious than in urban areas; however, few studies have examined return to original work in rural areas. The purpose of this study was to investigate the patient demographics at the time of hand injury that affect return to original work in a rural area of Japan.

Methods

We retrospectively examined 246 patients with traumatic hand and/or forearm injuries who were working at the time of injury, and who underwent surgical operations and postoperative rehabilitation in a level II hospital in a rural agricultural area. We examined patients' initial demographic data, including gender, age, occupation (white or blue collar), employment status (self-employed, full-time, or part-time workers), complications other than hand injury, workers’ compensation, dominant hand injury, and injury severity as determined using the modified Hand Injury Severity Score. Multivariate logistic regression analysis examined the association between initial patient demographics and return to original work within 150 days after injury.

Results

In total, 186 patients (76 %) were able to return to original work within 150 days. A multivariate logistic regression analysis showed that three explanatory variables (i.e., severity of injury, complications other than hand injury, and female gender) significantly compromised return to original work.

Conclusions

In the treatment of traumatic hand injury, intensive support should be provided for return to original work for patients who are expected to have difficulty returning to work quickly. In addition, labor shortages can be mitigated by sharing information with the workplace about patients’ prospects of return to original work.

背景：从劳动力短缺的角度来看，手外伤后的休假不仅影响个人，而且会产生社会经济影响，成为一个严重的问题。在人口减少的农村地区，由于休假造成的劳动力短缺的影响比城市地区更严重；然而，很少有研究考察农村地区的重返原始工作。本研究的目的是调查日本农村地区手部受伤时影响恢复原工作的患者人口统计数据。方法：我们回顾性检查了246名受伤时正在工作的手部和/或前臂创伤患者，在一个农村农业地区的二级医院接受了外科手术和术后康复。我们检查了患者的初始人口统计数据，包括性别、年龄、职业（白领或蓝领）、就业状况（自营职业者、全职或兼职工人）、手部损伤以外的并发症、工人补偿、主要手部损伤和使用修改的手部损伤严重程度评分确定的损伤严重程度。多变量逻辑回归分析检查了初始患者人口统计数据与受伤后150天内恢复原始工作之间的相关性。结果：总共186名患者（76%）能够在150天内恢复正常工作。多变量逻辑回归分析显示，三个解释变量（即损伤的严重程度、手部损伤以外的并发症和女性）显著影响了重返原工作。结论：在外伤性手部损伤的治疗中，对于预计难以快速返回工作岗位的患者，应为其返回原工作岗位提供强化支持。此外，可以通过与工作场所分享有关患者重返原工作前景的信息来缓解劳动力短缺。

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引用次数: 0

A novel diagnostic examination for dropped head syndrome (DHS) (Prone position cervical extension test; DHS test) 一种新的垂头综合征（DHS）诊断检查（俯卧位颈椎伸展试验；DHS试验）。

IF 1.5 4区医学 Q3 ORTHOPEDICS

Journal of Orthopaedic Science

Pub Date : 2024-09-01 DOI: 10.1016/j.jos.2023.09.003

Background

Dropped head syndrome (DHS) is followed by severe cervical extension muscle weakness that results in chin-on chest deformity. However, maintaining a neutral cervical position can be temporarily possible, and the diagnosis of DHS might sometimes be difficult. The purpose of the present study is to examine a novel clinical test (DHS test) as the diagnostic utility for objective evaluation that focuses on cervical extension condition in the prone position.

Methods

One hundred subjects were diagnosed with isolated neck extensor myopathy (INEM)-DHS at our hospital (17 men and 83 women, mean age 75.0 ± 8.5 years), and 62 subjects were enrolled as age-matched controls. The DHS test consisted of three examinations; the first was “Ceiling gazing test” in standing position, the second was horizontal gazing in “Sphinx prone position test”, and the third was horizontal gazing in “Hands and knees prone position test”. We investigated the sensitivity and specificity of the DHS test for DHS.

Results

The patients showing positive in the INEM-DHS group were 63/100 in Ceiling gaze test, 73/100 in the Sphinx prone position test, and 91/100 in the Hands and knees prone position test. In the control group, 0/62 patients presented positive in the Ceiling gaze test, 4/62 in the Sphinx prone position test, and 0/62 in the Hands and knees prone position test. Sensitivity and specificity of the DHS test were 63.0%/100%, 73.0%/93.5%, and 91.0%/100% in the Ceiling gaze test, Sphinx position prone position test, and Hands and knees prone position test, respectively.

Conclusion

The prone position cervical extension test (DHS test) would be useful as a novel objective diagnostic tool for INEM-DHS.

背景：垂头综合征（DHS）之后是严重的颈部伸展肌无力，导致下巴对胸部畸形。然而，保持中立的宫颈位置可能是暂时的，并且DHS的诊断有时可能很困难。本研究的目的是检验一种新的临床试验（DHS试验），作为客观评估的诊断工具，该试验侧重于俯卧位的颈部伸展状况。方法：在我院诊断为孤立性颈伸肌肌病（INEM）-DHS的100例受试者（17名男性和83名女性，平均年龄75.0±8.5岁），62名受试者作为年龄匹配的对照。DHS测试包括三项考试；第一项是站姿的“天花板凝视测试”，第二项是“狮身人面像俯卧位测试”的水平凝视，第三项是“手脚俯卧位”的水平注视。我们研究了DHS测试对DHS的敏感性和特异性。结果：INEM-DHS组的阳性患者在天花板凝视测试中为63/100，在狮身人面像俯卧位测试中为73/100，在手脚俯卧位试验中为91/100。在对照组中，0/62名患者在天花板凝视测试中呈阳性，4/62名患者在狮身人面像俯卧位测试中呈阴性，0/62例患者在手和膝盖俯卧位试验中呈阳性。DHS测试的敏感性和特异性在天花板凝视测试、狮身人面像俯卧位测试和手脚俯卧位试验中分别为63.0%/100%、73.0%/93.5%和91.0%/100%。结论：俯卧位颈椎伸展试验（DHS试验）是一种新的客观诊断INEM-DHS的工具。

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引用次数: 0

Observational study of ropivacaine and compound betamethasone mixture for analgesia after triangular fibrocartilage complex repair under wrist arthroscopy: A single-center randomized double-blind controlled trial 罗哌卡因和复方倍他米松混合物用于腕关节镜下三角纤维软骨复合体修复术后镇痛的观察研究：一项单中心随机双盲对照试验。

IF 1.5 4区医学 Q3 ORTHOPEDICS

Journal of Orthopaedic Science

Pub Date : 2024-09-01 DOI: 10.1016/j.jos.2023.08.017

Background

The purpose of this study was to investigate the clinical effect of an intra-articular and local infiltration injection of a compound analgesic mixture of ropivacaine and compound betamethasone on the repair of the triangular fibrocartilage complex under wrist arthroscopy.

Methods

This prospective, double-blind, randomized study involved 20 patients with Atzei type 2 or 3 injuries of the triangular fibrocartilage complex who underwent repair under wrist arthroscopy. Patients were divided into two groups (n = 10) according to the systematic random sampling method. The test group was injected with a “cocktail” mixture for pain relief. The control group was injected with normal saline. The visual analog scale (VAS) pain score, pinch force, wrist joint mobility, wrist joint function score (PRWE score), occurrence of adverse reactions and dosage of analgesic drugs were evaluated before and after the operation in the two groups.

Results

The resting pain of the patients in the test group was less severe than that of the control group at 12 h, 24 h and 48 h after the operation (P < 0.05), and the pinch force of the patients in the test group was significantly greater than that of the control group at 1 d, 2 d and 3 d after the operation (P < 0.01). The amount of postoperative analgesics used in the test group was significantly lower than that in the control group (P < 0.01), and the patient satisfaction rate in the test group was higher than that in the control group (P < 0.05). There were no postoperative adverse effects in either group.

Conclusion

An intra-articular and local infiltration injection of a “cocktail” analgesic mixture in the repair of triangular fibrocartilage complex under wrist arthroscopy can provide good pain control in the early postoperative period and reduce the amount of postoperative analgesic drugs administered, thus improving clinical safety.

Level of evidence

Level II; Randomized Controlled Trial; Treatment Study.

背景：本研究的目的是在腕关节镜下，研究关节内和局部浸润注射罗哌卡因和复方倍他米松的复合镇痛混合物对三角纤维软骨复合体修复的临床效果。方法：这项前瞻性、双盲、随机研究涉及20名Atzei 2型或3型三角纤维软骨复合体损伤患者，他们在腕关节镜下接受了修复。根据系统随机抽样方法将患者分为两组（n=10）。试验组注射了一种“鸡尾酒”混合物来缓解疼痛。对照组注射生理盐水。观察两组患者术前、术后视觉模拟量表（VAS）疼痛评分、握力、腕关节活动度、腕关节功能评分（PRWE）、不良反应发生率及镇痛药物用量。结果：试验组12 h静息痛较对照组减轻，术后24小时和48小时（P结论：关节内和局部浸润注射“鸡尾酒”腕关节镜下应用复合镇痛剂修复三角纤维软骨复合体可以在术后早期提供良好的疼痛控制，减少术后镇痛药物的用量，从而提高临床安全性。证据级别：二级；随机对照试验；治疗研究。

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引用次数: 0