Journal of Orthopaedic Science最新文献_第3页

Outcomes and complications after treatment for anteromedial facet fracture of the coronoid process: A systematic review 冠状突前内侧小关节骨折治疗后的结果和并发症：一项系统综述。

IF 1.5 4区医学 Q3 ORTHOPEDICS

Journal of Orthopaedic Science

Pub Date : 2024-11-01 DOI: 10.1016/j.jos.2023.11.002

Du-Han Kim, Beom-Soo Kim, Ji-Hoon Kim, Chul-Hyun Cho

Background

Fracture of the anteromedial facet (AMF) of the coronoid process is associated with varus posteromedial rotatory instability (VPMRI). However, there is still controversy regarding the optimal treatment for AMF fracture. The purpose of this study is to report on a systematic review of the outcomes and complications after treatment for AMF fracture.

Methods

This study was conducted using electronic databases, PubMed, EMBASE and Scopus. Studies reporting outcome scores and complications were included. Studies that did not utilize O'Driscoll classification for AMF fractures were excluded. Through conduct of a thorough review of included studies, definite VPMRI were identified and cases involving other injury mechanisms were excluded.

Results

Fifteen articles reporting on 246 patients were included. According to O'Driscoll classification, 6.2% of cases were anteromedial subtype I, 73.7% were subtype II, and 20.1% were subtype III. Two-hundred sixteen patients (87.8%) were treated surgically and 30 patients (12.2%) were treated conservatively. Lateral collateral ligament (LCL) injuries were 76.2% (157/206) and medial collateral ligament injuries were 16.9% (33/195). Among 216 cases who underwent surgical treatment, depending on the fragment size, displacement, and instability, coronoid fixation was performed in 189 cases and LCL repair alone was performed in 27 cases. The mean final Mayo Elbow Performance Score was 92.1 and the Broberg & Morrey score was 89.5. The overall complication and reoperation rates were 17.7% (41/232) and 12.9% (26/202).

Conclusions

Both surgical and conservative treatment for AMF fractures resulted in satisfactory final clinical outcomes. However, high complication and reoperation rates were observed.

背景：冠状突前内侧小关节（AMF）骨折与内翻性后内侧旋转不稳定性（VPMRI）有关。然而，对于AMF骨折的最佳治疗方法仍存在争议。本研究的目的是报告AMF骨折治疗后的结果和并发症的系统回顾。方法：采用电子数据库PubMed、EMBASE和Scopus进行研究。报告结果评分和并发症的研究也包括在内。未对AMF骨折采用奥氏分类的研究被排除在外。通过对纳入的研究进行彻底审查，确定了明确的VPMRI，并排除了涉及其他损伤机制的病例。结果：纳入了15篇报道246名患者的文章。根据O’Driscoll分类，6.2%的病例为前内侧亚型I，73.7%为亚型II，20.1%为亚型III。216名患者（87.8%）接受了手术治疗，30名患者（12.2%）接受了保守治疗。外侧副韧带（LCL）损伤占76.2%（157/206），内侧副韧带损伤占16.9%（33/195）。在216例接受手术治疗的病例中，根据碎片大小、移位和不稳定性，189例进行了冠状骨内固定，27例单独进行了LCL修复。梅奥肘部表现的平均最终得分为92.1，Broberg&Morrey得分为89.5。总并发症和再次手术率分别为17.7%（41/232）和12.9%（26/202）。然而，观察到高并发症和再次手术率。

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引用次数: 0

Digital skin defect management: Hand and wrist volar flap solutions 手指皮肤缺损的处理:手腕掌侧皮瓣解决方案。

IF 1.5 4区医学 Q3 ORTHOPEDICS

Journal of Orthopaedic Science

Pub Date : 2024-11-01 DOI: 10.1016/j.jos.2023.11.009

Takuya Tsumura , Taiichi Matsumoto , Toshihide Imanaka , Hiromu Ito

Background

Selecting the optimal flap for managing digit skin defects is challenging, particularly for inexperienced surgeons, given the numerous reconstructive options and insufficient evidence supporting one flap type's superiority over another. This retrospective study introduces four efficacious hand flaps to address volar skin defects and transverse and oblique cuts, examines the optimal flap advancement distance, and discusses effective management.

Methods

Patients with digit skin defects who underwent flap surgery between 2009 and 2022 were included. Fifty-four patients treated with oblique triangular, volar VY advancement (unilateral and bilateral pedicled volar VY advancement flaps for fingers and thumbs, respectively), reverse homodigital island, and radial artery superficial palmar branch flaps were included. We evaluated the flap advancement distance, flap length, range of motion, complications, and Semmes–Weinstein monofilament test and Disabilities of the Arm, Shoulder, and Hand questionnaire results.

Results

The median flap advancement distances for triangular oblique (19 patients), unilateral (11 patients), and bilateral pedicled (5 patients) volar VY advancement flaps were 1.3, 1.8, and 2.0 cm, respectively. The flap lengths for the reverse digital island (8 patients) and radial artery superficial palmar branch (11 patients) flaps were 2.4 and 5.0 cm, respectively. Five, three, and one cases of proximal interphalangeal flexion contractures of ≥ -20° were observed in the VY advancement, reverse digital island, and radial artery superficial palmar branch flaps, respectively. One unilateral VY advancement flap case caused severe numbness and neuroma. All complication cases featured >15 and > 20 mm defect lengths on the fingers and thumb, respectively.

Conclusions

To minimize sensory disruption and contractures, we recommend oblique triangular and unilateral pedicle volar VY advancement flaps for finger skin defects up to 12 mm and defects sized 12–15 mm, respectively. Advancement flaps are unsuitable for >15 and > 20–25 mm defects on the fingers and thumb, respectively.

背景:选择最佳皮瓣治疗手指皮肤缺损是具有挑战性的，特别是对于缺乏经验的外科医生，考虑到许多重建选择和证据不足支持一种皮瓣类型优于另一种。本回顾性研究介绍了四种有效的手部皮瓣治疗掌侧皮肤缺损和横斜切口，探讨了皮瓣的最佳推进距离，并讨论了有效的管理。方法:选取2009 ~ 2022年间行皮瓣手术的手指皮肤缺损患者为研究对象。54例患者采用斜三角形、掌侧VY推进皮瓣(分别为手指和拇指单侧和双侧带蒂掌侧VY推进皮瓣)、同指逆行岛状皮瓣和桡动脉掌浅支皮瓣治疗。我们评估皮瓣推进距离、皮瓣长度、活动范围、并发症、semes - weinstein单丝试验和手臂、肩部和手部残疾问卷调查结果。结果:三角形斜向(19例)、单侧(11例)、双侧带蒂(5例)掌侧VY推进皮瓣中位推进距离分别为1.3、1.8、2.0 cm。逆行指岛皮瓣(8例)和桡动脉掌浅支皮瓣(11例)皮瓣长度分别为2.4和5.0 cm。VY推进皮瓣、逆行指岛皮瓣和桡动脉掌浅支皮瓣分别出现5例、3例和1例近端指间屈曲挛缩≥-20°。1例单侧VY推进皮瓣引起严重麻木和神经瘤。所有并发症的手指和拇指缺损长度分别为>15和> 20 mm。结论:为了减少感觉障碍和挛缩，我们推荐斜三角形和单侧蒂掌侧VY推进皮瓣分别用于12 mm和12-15 mm的手指皮肤缺损。推进皮瓣分别不适用于手指和拇指上>15和> 20-25 mm的缺损。

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引用次数: 0

Differences in the microstructural and mechanical qualities of semitendinosus tendon grafts between skeletally immature and mature patients in anterior cruciate ligament reconstruction 前交叉韧带重建中骨未成熟与成熟患者半腱肌腱移植物显微结构和力学质量的差异。

IF 1.5 4区医学 Q3 ORTHOPEDICS

Journal of Orthopaedic Science

Pub Date : 2024-11-01 DOI: 10.1016/j.jos.2023.11.004

Kazuki Asai , Junsuke Nakase , Toru Kuzumaki , Tatsuya Ishikawa , Noriyuki Ozaki , Hiroyuki Tsuchiya

Background

This study aimed to investigate the microstructural and mechanical properties of semitendinosus tendon graft tissues during anterior cruciate ligament reconstruction and the clinical outcomes in skeletally immature and mature patients.

Methods

Twenty-two patients who underwent primary anterior cruciate ligament reconstruction using a hamstring tendon graft were analyzed and divided into skeletally immature (n = 7) and mature groups (n = 15) based on magnetic resonance imaging findings of the epiphyseal plate of the distal femur. Tissue samples were collected from the mid-portion of the semitendinosus tendon. The collagen fibril diameter, maximum stress, and strain at maximum stress point in the semitendinosus tendon tissues were calculated for comparison of the microstructural and mechanical properties between the two groups. Postoperative outcomes were also assessed between the two groups.

Results

The mean and 60th and 80th percentiles of fibril diameters in the skeletally immature group were significantly smaller than those in the mature group (65.9 ± 13.0, 73.5 ± 19.3, and 91.3 ± 27.4 nm in the skeletally immature group; and 90.3 ± 14.7, 94.0 ± 18.4, and 125.3 ± 19.9 nm in the skeletally immature group; p = 0.001, 0.024, and 0.004, respectively). Additionally, the strain at maximum stress was higher in the skeletally immature group (237.2 ± 102.4% vs. 121.5 ± 51.9%, p = 0.024). However, there was no difference in maximum stress between the skeletally immature and mature groups (19.9 ± 14.3 MPa vs. 24.5 ± 23.4 MPa, p = 0.578). Strain was negatively correlated with the mean fibril diameter and the 60th and 80th percentiles of fibril diameters, whereas stress was positively correlated with the mean fibril diameter. The skeletally immature group had a higher pivot shift test-positive rate than the mature group at the last follow-up (p = 0.023).

Conclusion

Semitendinosus tendon graft tissues differed microstructurally and mechanically between skeletally immature and mature patients.

Level of evidence

Level Ⅳ

背景:本研究旨在探讨半腱肌腱移植组织在前交叉韧带重建中的显微结构和力学特性以及骨骼未成熟和成熟患者的临床结果。方法:根据股骨远端骺板的磁共振成像结果，对22例行腘绳肌腱重建的患者进行分析，并将其分为骨未成熟组(n = 7)和成熟组(n = 15)。从半腱肌腱中部收集组织样本。计算半腱肌腱组织的胶原纤维直径、最大应力和最大应力点应变，比较两组的显微结构和力学性能。同时对两组患者的术后结果进行评估。结果:骨未成熟组原纤维直径均值及60、80百分位数均明显小于成熟组(65.9±13.0 nm, 73.5±19.3 nm, 91.3±27.4 nm);骨未成熟组为90.3±14.7、94.0±18.4、125.3±19.9 nm;P分别= 0.001、0.024和0.004)。在最大应力下，骨未成熟组的应变更高(237.2±102.4%比121.5±51.9%，p = 0.024)。然而，骨未成熟组和骨未成熟组的最大应力没有差异(19.9±14.3 MPa vs. 24.5±23.4 MPa, p = 0.578)。应变与平均原纤维直径及第60、80百分位呈负相关，而应力与平均原纤维直径呈正相关。末次随访时，骨未成熟组pivot shift检测阳性率高于成熟组(p = 0.023)。结论:半腱肌腱移植组织在骨未成熟和成熟患者之间存在显微结构和力学差异。证据等级:Ⅳ级。

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引用次数: 0

Hip joint stress distribution changes depending on three-dimensional pelvic orientation: Finite-element analysis 髋关节应力分布随骨盆三维方向的变化而变化：有限元分析

IF 1.5 4区医学 Q3 ORTHOPEDICS

Journal of Orthopaedic Science

Pub Date : 2024-11-01 DOI: 10.1016/j.jos.2023.11.015

Yumiko Ojima , Yusuke Matsuura , Sei Yano , Seiji Ohtori

Background

Pelvis experiences changes in its orientation due to the alignment of the hip joint and spine, and its orientation might affect both joints. Pelvic tilt on the sagittal plane has been widely discussed; however, the pelvis is oriented also on the coronal and horizontal planes. This study aimed to examine how stress distribution on intact hip joint changes under the three-dimensional pelvic orientation.

Methods

Computed tomography data of five patients with unilateral pelvic girdle were analyzed. Thirteen models were evaluated by the MECHANICAL FINDER: neutral position at 0°; 10° and 20° anterior and posterior pelvic tilt; 10° and 20° pelvic hike and drop; 10° and 20° pelvic forward and backward rotation. Stress assessment was performed in four parts of the acetabulum: anterosuperior, posterosuperior, posteroinferior, and central parts.

Results

Compared with the neutral position, the mean value of the equivalent stress and maximum principal stress in the anterosuperior part significantly increased by 1.51 times and 1.57 times at 20° posterior tilt, respectively. The maximum principal stress in the anterosuperior part significantly increased by 1.44 times at 20° hike. A significant increase of 1.45 times was found in the maximum principal stress in the anterosuperior part at 20° forward rotation.

Conclusions

Local stress accumulated in the anterosuperior acetabulum at the posterior pelvic tilt, pelvic hike, and pelvic forward rotation, which might lead to hip overload. The effect of posterior pelvic tilt appears to be greater for the hip joint than at the pelvic hike or forward rotation.

背景骨盆的方向会因髋关节和脊柱的排列而发生变化，其方向可能会影响到两个关节。骨盆在矢状面上的倾斜已被广泛讨论，但骨盆在冠状面和水平面上也有定向。本研究旨在探讨完整髋关节的应力分布在骨盆三维方向上的变化情况。方法分析了五名单侧骨盆腰椎患者的计算机断层扫描数据。用 MECHANICAL FINDER 评估了 13 个模型：0°中立位；10°和 20°骨盆前后倾斜；10°和 20°骨盆前倾和后倾；10°和 20°骨盆前旋和后旋。结果与中立位相比，后倾20°时，前上部分的等效应力和最大主应力的平均值分别显著增加了1.51倍和1.57倍。徒步 20°时，前上部分的最大主应力明显增加了 1.44 倍。结论骨盆后倾、骨盆徒步旅行和骨盆前旋时，髋臼前上方的局部应力累积，可能导致髋关节超负荷。骨盆后倾对髋关节的影响似乎大于骨盆前倾或前旋。

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引用次数: 0

Superior gluteal artery injury in pelvic ring injury and acetabular fracture: Single center observational study 骨盆环损伤和髋臼骨折中的臀上动脉损伤：单中心观察研究。

IF 1.5 4区医学 Q3 ORTHOPEDICS

Journal of Orthopaedic Science

Pub Date : 2024-11-01 DOI: 10.1016/j.jos.2023.10.007

Hoon Kwon , Jae Hoon Jang , Nam Hoon Moon , Seung Joon Rhee , Dong Yeon Ryu , Tae Young Ahn

Background

Intrapelvic hemorrhage following pelvic fractures, including pelvic ring and acetabular fractures, originates from the venous system and the fracture. Arterial injury often causes significant bleeding and hemodynamic instability. The superior gluteal artery (SGA) is a frequently injured artery in patients with pelvic fractures. This study investigated the incidence and pattern of SGA injuries associated with pelvic fractures.

Methods

We retrospectively reviewed the medical records of patients with pelvic fractures who visited our institution between January 2016 and April 2022. Patients who underwent angiography for suspected arterial injury and SGA embolization were identified. Furthermore, the demographics and patterns of pelvic fractures were evaluated.

Results

In total, 2042 patients with pelvic fractures visited our trauma emergency department and 498 patients (24.4%) underwent embolization for arterial injuries. Of these, 30 patients (1.5% of the total and 6.0% of the patients who underwent procedures) received embolization therapy of the main trunk of the SGA. The mean age of patients was 51.2 (23–85 years), and the injury mechanisms were all high-energy injuries. There were 19 pelvic ring injuries, eight acetabular fractures, and three combined injuries. Acetabular fractures involved mostly both columns. The three combined injuries were lateral compression involving both columns, vertical shear involving both columns, and lateral compression with T-type fractures. Twelve (40.0%) occurred through the sciatic notch of different patterns.

Conclusions

SGA injury occurred in 1.5% of all pelvic fractures and was identified in 6% of patients receiving embolization. SGA injury occurs through various injury mechanisms and fracture patterns, even in the absence of a fracture in the sciatic notch. However, no conclusions could be drawn in this study on the association between SGA injuries, injury mechanisms, and fracture patterns. Since the prediction of SGA injury by fracture pattern is limited, angiography should be performed regardless of fracture pattern when an injury is suspected.

背景：骨盆骨折后的骨盆内出血，包括骨盆环和髋臼骨折，源于静脉系统和骨折。动脉损伤通常会导致严重出血和血流动力学不稳定。臀上动脉（SGA）是骨盆骨折患者常见的损伤动脉。本研究调查了与骨盆骨折相关的SGA损伤的发生率和模式。方法：我们回顾性回顾了2016年1月至2022年4月期间到访我院的骨盆骨折患者的医疗记录。确定了因疑似动脉损伤而接受血管造影术和SGA栓塞的患者。此外，对骨盆骨折的人口统计学和模式进行了评估。结果：总共有2042名骨盆骨折患者到我们的创伤急诊科就诊，498名患者（24.4%）因动脉损伤接受了栓塞治疗。其中，30名患者（占总患者的1.5%和接受手术的患者的6.0%）接受了SGA主干的栓塞治疗。患者平均年龄51.2岁（23-85岁），损伤机制均为高能损伤。骨盆环损伤19例，髋臼骨折8例，合并损伤3例。髋臼骨折主要累及两列。三种复合损伤分别为双柱侧压伤、双柱垂直剪切伤和T型骨折侧压伤。12例（40.0%）发生于不同形态的坐骨神经切迹。结论：SGA损伤发生在所有骨盆骨折中的1.5%，在接受栓塞的患者中有6%被发现。SGA损伤通过各种损伤机制和骨折模式发生，即使在坐骨切口没有骨折的情况下也是如此。然而，在这项研究中，还没有得出SGA损伤、损伤机制和骨折模式之间的关系的结论。由于骨折模式对SGA损伤的预测是有限的，当怀疑损伤时，无论骨折模式如何，都应进行血管造影术。

{"title":"Superior gluteal artery injury in pelvic ring injury and acetabular fracture: Single center observational study","authors":"Hoon Kwon , Jae Hoon Jang , Nam Hoon Moon , Seung Joon Rhee , Dong Yeon Ryu , Tae Young Ahn","doi":"10.1016/j.jos.2023.10.007","DOIUrl":"10.1016/j.jos.2023.10.007","url":null,"abstract":"<div><h3>Background</h3><div><span><span><span><span>Intrapelvic hemorrhage following pelvic fractures, including pelvic ring and </span>acetabular fractures, originates from the </span>venous system and the fracture. </span>Arterial injury often causes significant bleeding and </span>hemodynamic instability. The superior gluteal artery (SGA) is a frequently injured artery in patients with pelvic fractures. This study investigated the incidence and pattern of SGA injuries associated with pelvic fractures.</div></div><div><h3>Methods</h3><div><span>We retrospectively reviewed the medical records<span> of patients with pelvic fractures who visited our institution between January 2016 and April 2022. Patients who underwent angiography for suspected arterial injury and </span></span>SGA embolization were identified. Furthermore, the demographics and patterns of pelvic fractures were evaluated.</div></div><div><h3>Results</h3><div>In total, 2042 patients with pelvic fractures visited our trauma emergency department<span> and 498 patients (24.4%) underwent embolization for arterial injuries. Of these, 30 patients (1.5% of the total and 6.0% of the patients who underwent procedures) received embolization therapy of the main trunk of the SGA. The mean age of patients was 51.2 (23–85 years), and the injury mechanisms were all high-energy injuries. There were 19 pelvic ring injuries, eight acetabular fractures, and three combined injuries. Acetabular fractures involved mostly both columns. The three combined injuries were lateral compression involving both columns, vertical shear involving both columns, and lateral compression with T-type fractures. Twelve (40.0%) occurred through the sciatic notch of different patterns.</span></div></div><div><h3>Conclusions</h3><div>SGA injury occurred in 1.5% of all pelvic fractures and was identified in 6% of patients receiving embolization. SGA injury occurs through various injury mechanisms and fracture patterns, even in the absence of a fracture in the sciatic notch. However, no conclusions could be drawn in this study on the association between SGA injuries, injury mechanisms, and fracture patterns. Since the prediction of SGA injury by fracture pattern is limited, angiography should be performed regardless of fracture pattern when an injury is suspected.</div></div>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":"29 6","pages":"Pages 1483-1488"},"PeriodicalIF":1.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49691066","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

The survey of bone allograft transplantation in a Japanese regional bone bank 日本某地区骨库同种异体骨移植情况调查。

IF 1.5 4区医学 Q3 ORTHOPEDICS

Journal of Orthopaedic Science

Pub Date : 2024-11-01 DOI: 10.1016/j.jos.2023.11.001

Takamune Asamoto , Yusuke Osawa , Yasuhiko Takegami , Genta Takemoto , Daigo Komatsu , Taisuke Seki , Shiro Imagama

Background

In reconstructive surgery for large bone defects, the demand for bone allografts has increased over the years; however, it is unclear how the supply and demand in Japanese regional bone banks have evolved over time. This study investigated the 15-year supply and demand of bone allografts stored in a regional bone bank, along with assessing the screening process's effectiveness.

Methods

The target period was 15 years from April 2005 to March 2020. The period was subdivided into three 5-year periods: first, second, and third. The study items included the number of bone allografts donated, the number of bone allografts used, donor and user facilities, surgical methods using bone allografts, and the number of bone allografts discarded. We used the Cochran-Armitage test for statistical analysis.

Results

A total of 1852 bone allografts were donated to the bone bank, and a total of 1721 were used. A total of 677 bone allografts grafts were provided in the first period, 738 in the second period, and 525 in the third period, indicating a decreasing trend. The average number of allografts per surgery was 2.8 in the first, 3.1 in the second, and 1.7 in the third, showing a decreasing trend. Concerning the percentage of each surgery using bone allografts, spine fusion decreased in the third period but not significantly, whereas primary hip arthroplasty increased significantly in the third period. The total number of discarded bone allografts was 4.8% of the total number of donated bone allografts, largely because of a lack of screening tests.

Conclusion

Although the number of allogeneic bone surgeries has been increasing over time, the number of allogeneic bone donations has shown a decreasing trend, and there is a need to develop a system that can provide surgeons with sufficient bone allografts.

背景:在大型骨缺损重建手术中，近年来对同种异体骨移植的需求不断增加;然而，目前还不清楚日本地区骨库的供需是如何随着时间的推移而演变的。本研究调查了地区骨库中储存的同种异体骨移植15年的供应和需求，并评估了筛选过程的有效性。方法:目标期为2005年4月至2020年3月，共15年。这一时期被细分为三个5年期:第一、第二和第三。研究项目包括捐赠的同种异体骨移植数量、使用的同种异体骨移植数量、供体和使用者的设施、使用同种异体骨移植的手术方法以及丢弃的同种异体骨移植数量。采用Cochran-Armitage检验进行统计分析。结果:共向骨库捐献同种异体骨1852块，使用1721块。第一期共提供同种异体骨移植677例，第二期738例，第三期525例，呈下降趋势。第一次手术平均每次移植同种异体器官2.8例，第二次手术平均每次移植3.1例，第三次手术平均每次移植1.7例，呈下降趋势。关于使用同种异体骨移植的每次手术的百分比，脊柱融合在第三期减少但不明显，而原发性髋关节置换术在第三期显著增加。丢弃的同种异体骨移植总数占捐献同种异体骨移植总数的4.8%，主要原因是缺乏筛选试验。结论:虽然同种异体骨手术数量不断增加，但同种异体骨供体数量呈下降趋势，需要开发一种系统，为外科医生提供足够的同种异体骨移植。

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引用次数: 0

Lateral ulnar collateral ligament reconstruction enhancing secondary stabilizers in chronic PLRI of the elbow provides good to excellent clinical results with no recurrent instability 肘关节慢性PLRI的尺侧副韧带重建增强二级稳定剂提供了良好到优异的临床效果，无复发性不稳定。

IF 1.5 4区医学 Q3 ORTHOPEDICS

Journal of Orthopaedic Science

Pub Date : 2024-11-01 DOI: 10.1016/j.jos.2023.11.013

Nikolay Dimitrov, Tsvetan Tsenkov

Purpose

The adopted treatment for chronic elbow PLRI is lateral ulnar collateral ligament reconstruction. However, the most frequently reported complication after primary reconstruction is recurrent instability – up to 25 %. It was thus hypothesized that enhancing the secondary stabilizers will provide successful results with a lower rate of recurrent instability in comparison to techniques with primary reconstruction only. This study aimed to demonstrate a novel surgical technique involving secondary stabilizers.

Methods

In this retrospective study of 29 cases with chronic PLRI the mean duration of symptoms was 39.6 ± 4.9 months. The mean age was 47.9 years with mainly male patients. The surgeries were performed by one senior surgeon at a single institution. The Mayo Elbow Performance Score (MEPS) and the Disabilities of the Arm, Shoulder and Hand questionnaire (DASH) were recorded.

Results

The mean follow-up was 36.8 ± 7.7 months. The MEPS score improved significantly from 59.8 ± 13.1 to 84.7 ± 7.6 (p < 0.001). 23/29 patients (79.2 %) had converted to good and excellent results (MEPS >75 points). The DASH score improved from 40.8 ± 4.6 to 20.9 ± 7.2 (p < 0.001). The total complication rate was 10.3 % (N = 3). No recurrent instability was recorded in comparison to 12.2 % for primary reconstruction only, as reported in the literature (p < 0.05).

Conclusion

Enhancing the secondary stabilizers by utilizing an adjacently located autograft provided good and excellent results with no recurrent instability. This novel surgical procedure is easy to reproduce and provides a safe and reliable alternative in cases of chronic PLRI when compared to techniques with primary reconstruction only.

目的:慢性肘关节PLRI采用尺外侧副韧带重建术治疗。然而，初次重建后最常见的并发症是复发性不稳定-高达25%。因此，我们假设，与仅进行一次重建的技术相比，增强二次稳定剂将提供成功的结果，并且复发不稳定性的发生率更低。本研究旨在展示一种涉及二级稳定剂的新型手术技术。方法:对29例慢性PLRI患者进行回顾性研究，平均症状持续时间为39.6±4.9个月。平均年龄47.9岁，以男性为主。手术由同一家机构的一位资深外科医生进行。记录Mayo肘部功能评分(MEPS)和臂、肩、手残疾问卷(DASH)。结果:平均随访36.8±7.7个月。MEPS评分由59.8±13.1分提高至84.7±7.6分(p 75分)。DASH评分从40.8±4.6提高到20.9±7.2 (p)。结论:采用邻接自体移植物增强二级稳定剂效果良好，无复发性不稳定。这种新颖的手术方法易于复制，与仅进行初级重建的技术相比，在慢性PLRI病例中提供了一种安全可靠的替代方法。

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引用次数: 0

Wrong-level spine surgery: A multicenter retrospective study 错误水平的脊柱手术:一项多中心回顾性研究。

IF 1.5 4区医学 Q3 ORTHOPEDICS

Journal of Orthopaedic Science

Pub Date : 2024-11-01 DOI: 10.1016/j.jos.2023.11.005

Ryohei Saito , Shunsuke Fujibayashi , Takayoshi Shimizu , Koichi Murata , Bungo Otsuki , Eijiro Onishi , Shuichi Matsuda , Tadashi Yasuda

Background

Wrong-level spine surgery is a rare but serious complication of spinal surgery that increases patient harm and legal risks. Although such surgeries have been reported by many spine surgeons, they have not been adequately investigated. Therefore, this study aimed to examine the causes and preventive measures for wrong-level spine surgeries.

Methods

This study analyzed cases of wrong-level spine surgeries from 10 medical centers. Factors such as age, sex, body mass index, preoperative diagnosis, surgical details, surgeon’s experience, anatomical variations, responses, and causes of the wrong-level spine surgeries were studied. The methods used by the surgeons to confirm the surgical level were also surveyed using a questionnaire for each surgical procedure and site.

Results

Eighteen cases (13 men and 5 women; mean age, 61.2 years; mean body mass index, 24.5 kg/m²) of wrong-level spine surgeries were evaluated in the study. Two cases involved emergency surgeries, three involved newly introduced procedures, and five showed anatomical variations. Wrong-level spine surgeries occurred more frequently in patients who underwent posterior thoracic surgery than in those who underwent other techniques (p < 0.01). Twenty-two spinal surgeons described the methods used to confirm the levels preoperatively and intraoperatively. In posterior thoracic laminectomies, half of the surgeons used preoperative markers to confirm the surgical level and did not perform intraoperative fluoroscopy. In posterior thoracic fusion, all surgeons confirmed the level using fluoroscopy preoperatively and intraoperatively.

Conclusions

Wrong-level spine surgeries occurred more frequently in posterior thoracic surgeries. The thoracic spine lacks the anatomical characteristics observed in the cervical and lumbar spine. The large drop in the spinous process can make it challenging for surgeons to determine the positional relationship between the spinous process and the vertebral body. Moreover, unfamiliarity with the technique and anatomical variations were also risk factors for wrong-level spine surgeries.

背景:错误水平的脊柱手术是脊柱手术中一种罕见但严重的并发症，它增加了患者的伤害和法律风险。尽管许多脊柱外科医生都报道过这种手术，但它们并没有得到充分的调查。因此，本研究旨在探讨错误水平脊柱手术的原因及预防措施。方法:对10家医疗中心的脊柱错位手术病例进行分析。研究了年龄、性别、体重指数、术前诊断、手术细节、外科医生经验、解剖变异、反应和错误水平脊柱手术的原因等因素。对外科医生确定手术水平的方法也进行了调查，对每个手术过程和部位进行了问卷调查。结果:18例(男13例，女5例);平均年龄61.2岁;研究评估了错误水平脊柱手术的平均体重指数(24.5 kg/m2)。2例涉及紧急手术，3例涉及新引入的程序，5例显示解剖变异。错误水平的脊柱手术在后路胸外科患者中比在其他手术中更常见(p结论:错误水平的脊柱手术在后路胸外科中更常见。胸椎缺乏颈椎和腰椎的解剖特征。棘突的大落差使得外科医生很难确定棘突与椎体之间的位置关系。此外，对技术的不熟悉和解剖结构的变化也是错误水平脊柱手术的危险因素。

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引用次数: 0

Circulating miRNA-122 is associated with knee osteoarthritis progression: A 6-year longitudinal cohort study in the Yakumo study 循环miRNA-122与膝骨关节炎进展相关：雅库莫研究中的一项6年纵向队列研究。

IF 1.5 4区医学 Q3 ORTHOPEDICS

Journal of Orthopaedic Science

Pub Date : 2024-11-01 DOI: 10.1016/j.jos.2023.10.004

Hiroto Funahashi , Yasuhiko Takegami , Yusuke Osawa , Hiroaki Nakashima , Shinya Ishizuka , Ryosuke Fujii , Hiroya Yamada , Koji Suzuki , Yukiharu Hasegawa , Shiro Imagama

Objective

The association between knee osteoarthritis (OA) and miRNAs has been widely reported. However, the utility of miRNAs as predictors of knee osteoarthritis (KOA) progression in longitudinal studies has not been reported. We aimed to identify circulating miRNAs (c-miRNAs) associated with KOA progression in the general population and to examine their potential use as predictors of KOA progression.

Methods

In 2012 and 2018, 66 participants (128 knees) took part in a resident health check-up in the Yakumo study. If the KL classification progressed two or more levels, the patient was classified as having progressive OA. Quantitative real-time polymerase chain reaction was used to screen 21 c-miRNAs. The expression levels of those c-miRNAs were compared between the progressive OA group and non-progressive OA group using student-t-test. Logistic analysis was performed in c-miRNAs less than p < 0.10 in univariate analysis.

Results

The progressive OA group consisted of 78 knees. The results of the comparison between the progressive OA group and the non-progressive OA group showed that six c-miRNAs as follows; let7d (p = 0.030), c-miRNA-122 (p < 0.001), 150 (p = 0.070), 199 (p = 0.078), 21 (p = 0.016) and 320 (p = 0.093) were extracted as factors related to the progression of knee OA. In addition, logistic regression analysis identified c-miRNA-122 as an independent factor involved in the progression of knee osteoarthritis (odds ratio: 1.510, 95% confidence interval: 1.060–2.140, p = 0.023). The ROC curve showed by c-miRNA-122 for the progression of OA risk had an area under the curve of 0.702 (95% CI: 0.609–0.795). The threshold of c-miRNA-122 was −4.609.

Conclusion

The expression level of c-miRNA-122 was associated with the risk of KOA progression in community dwelling Japanese people.

目的：膝骨关节炎（OA）与miRNA之间的关系已被广泛报道。然而，在纵向研究中，miRNA作为膝骨关节炎（KOA）进展的预测因子的效用尚未报道。我们的目的是在普通人群中识别与KOA进展相关的循环miRNA（c-miRNA），并检查其作为KOA进展预测因子的潜在用途。方法：2012年和2018年，66名参与者（128个膝盖）参加了雅库莫研究的住院健康检查。如果KL分类进展到两个或两个以上水平，则患者被归类为进行性OA。采用实时定量聚合酶链反应筛选21个c-miRNA。使用student-test比较进行性OA组和非进行性OA的c-miRNA的表达水平。对小于p的c-miRNA进行Logistic分析结果：进行性OA组由78个膝关节组成。进行性OA组和非进行性OA的比较结果显示，6个c-miRNA如下；let7d（p=0.030）、c-miRNA-122（p结论：c-miRNA-12的表达水平与居住在社区的日本人KOA进展的风险相关。

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引用次数: 0

Characteristics of back pain in patients with adolescent idiopathic scoliosis: Considerations in candidates for corrective surgery 青少年特发性脊柱侧凸患者背痛的特点：矫正手术候选者的考虑因素

IF 1.5 4区医学 Q3 ORTHOPEDICS

Journal of Orthopaedic Science

Pub Date : 2024-11-01 DOI: 10.1016/j.jos.2023.11.014

Yuta Kusabe , Toru Hirano , Ren Kikuchi , Masayuki Ohashi , Hideki Tashi , Yohei Shibuya , Tatsuo Makino , Kazuhiro Hasegawa , Naohito Tanabe , Kei Watanabe

Background

Previous studies have demonstrated that the point prevalence of back pain ranges from 12 % to 33 % and that the lifetime prevalence of back pain ranges from 28 % to 51 % in adolescents. However, few studies on back pain in patients with Adolescent idiopathic scoliosis (AIS) have been conducted, and these studies had significant limitations, including a lack of comparative controls and detailed information about scoliotic deformity or pain location. This study aimed to determine whether adolescents with AIS experience back pain in specific regions.

Methods

This retrospective case-control study included 189 female adolescents with AIS who underwent corrective fusion from 2008 to 2020. Questionnaires on back pain and health-related quality of life (HRQOL) using the Scoliosis Research Society Outcomes Instrument-22 (SRS-22) were conducted preoperatively. The control group included 2909 general female adolescents.

Results

The mean Cobb angles in the main thoracic and thoracolumbar/lumbar curves were 51.4 ± 15.3° and 40.4 ± 12.9°. Back pain characteristics included higher point prevalence (25.9 %) and lifetime prevalence (64.6 %) compared to healthy controls. Adolescents with back pain showed lower scores in the pain and mental health domains of the SRS-22. Adolescents with major thoracic AIS showed more back pain in the upper and middle right back compared to adolescents with major thoracolumbar/lumbar AIS.

Conclusion

The point and lifetime prevalence of back pain were definitely higher in patients with AIS, which affected their HRQOL. There was a relationship between pain around the right scapula and the right major thoracic curve with a rib hump deformity.

背景以往的研究表明，青少年背部疼痛的点患病率为12%至33%，终生患病率为28%至51%。然而，关于青少年特发性脊柱侧弯症（AIS）患者背痛的研究却很少，而且这些研究都有很大的局限性，包括缺乏对比对照和有关脊柱侧弯畸形或疼痛部位的详细信息。本研究旨在确定患有AIS的青少年是否会在特定区域出现背痛。方法这项回顾性病例对照研究纳入了189名患有AIS的女性青少年，她们在2008年至2020年间接受了矫正融合手术。术前使用脊柱侧凸研究学会结果工具-22（SRS-22）进行背痛和健康相关生活质量（HRQOL）问卷调查。结果主要胸椎和胸腰椎/腰椎曲线的平均Cobb角分别为51.4 ± 15.3°和40.4 ± 12.9°。与健康对照组相比，背痛的特征包括更高的点患病率（25.9%）和终生患病率（64.6%）。背痛青少年在 SRS-22 疼痛和心理健康领域的得分较低。患有严重胸椎AIS的青少年与患有严重胸腰/腰椎AIS的青少年相比，右背中上部的背痛更严重。右肩胛骨周围的疼痛与带有肋骨驼峰畸形的右胸大弯之间存在关系。

{"title":"Characteristics of back pain in patients with adolescent idiopathic scoliosis: Considerations in candidates for corrective surgery","authors":"Yuta Kusabe , Toru Hirano , Ren Kikuchi , Masayuki Ohashi , Hideki Tashi , Yohei Shibuya , Tatsuo Makino , Kazuhiro Hasegawa , Naohito Tanabe , Kei Watanabe","doi":"10.1016/j.jos.2023.11.014","DOIUrl":"10.1016/j.jos.2023.11.014","url":null,"abstract":"<div><h3>Background</h3><div>Previous studies have demonstrated that the point prevalence of back pain<span><span> ranges from 12 % to 33 % and that the lifetime prevalence of back pain ranges from 28 % to 51 % in adolescents. However, few studies on back pain in patients with </span>Adolescent idiopathic scoliosis (AIS) have been conducted, and these studies had significant limitations, including a lack of comparative controls and detailed information about scoliotic deformity or pain location. This study aimed to determine whether adolescents with AIS experience back pain in specific regions.</span></div></div><div><h3>Methods</h3><div><span>This retrospective case-control study included 189 female adolescents with AIS who underwent corrective fusion from 2008 to 2020. Questionnaires on back pain and health-related quality of life (HRQOL) using the </span>Scoliosis Research Society Outcomes Instrument-22 (SRS-22) were conducted preoperatively. The control group included 2909 general female adolescents.</div></div><div><h3>Results</h3><div>The mean Cobb angles in the main thoracic and thoracolumbar/lumbar curves were 51.4 ± 15.3° and 40.4 ± 12.9°. Back pain characteristics included higher point prevalence (25.9 %) and lifetime prevalence (64.6 %) compared to healthy controls. Adolescents with back pain showed lower scores in the pain and mental health domains of the SRS-22. Adolescents with major thoracic AIS showed more back pain in the upper and middle right back compared to adolescents with major thoracolumbar/lumbar AIS.</div></div><div><h3>Conclusion</h3><div>The point and lifetime prevalence of back pain were definitely higher in patients with AIS, which affected their HRQOL. There was a relationship between pain around the right scapula and the right major thoracic curve with a rib hump deformity.</div></div>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":"29 6","pages":"Pages 1364-1369"},"PeriodicalIF":1.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138568240","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