Journal of Orthopaedic Science最新文献_第3页

Clinical characteristics of and risk factors for poor outcomes in children with bacterial culture-negative septic arthritis of the hip 细菌培养阴性髋关节化脓性关节炎患儿的临床特征和不良后果的风险因素

IF 1.5 4区医学 Q3 ORTHOPEDICS

Journal of Orthopaedic Science

Pub Date : 2024-09-01 DOI: 10.1016/j.jos.2023.08.009

Background

Septic arthritis of the hip is a serious infection in children. However, blood and joint fluid cultures are often negative, which makes the diagnosis and treatment challenging. We analyzed the clinical features of children with septic arthritis of the hip with negative bacterial cultures and identified the risk factors for poor outcomes.

Methods

The clinical data of children with septic arthritis of the hip with negative bacterial cultures who were treated at our hospital from January 2010 to December 2020 were retrospectively analyzed. The clinical characteristics and outcomes of the culture-negative cohort were compared with those of children with positive bacterial cultures treated during the same period. Culture-negative patients were divided into a group with good outcomes and a group with poor outcomes. The differences between the two groups were compared.

Results

Thirty-nine children with culture-negative septic arthritis of the hip were compared with 37 children with culture-positive sepsis. Compared with the culture-positive group, the culture-negative group had a significantly younger mean age and a significantly lower mean serum C-reactive protein concentration. Logistic regression analysis of culture-negative patients with good versus poor outcomes revealed that the independent risk factors for poor outcomes were an increased serum C-reactive protein concentration and prolonged time from onset to surgery. The cut-off values for predicting a poor outcome in the culture-negative group were a time from onset to surgery of greater than 21 days and a C-reactive protein concentration of greater than 23 mg/L.

Conclusions

Culture-negative septic arthritis of the hip has similar clinical features to culture-positive septic arthritis of the hip and can result in sequelae of varying severity. Therefore, active anti-infective and hip drainage therapy should be performed when children present with clinical symptoms, inflammatory marker concentrations, and imaging findings that are clinically diagnostic for septic arthritis of the hip.

Level of evidence

Level II, retrospective study.

背景髋关节化脓性关节炎是儿童的一种严重感染。然而，血液和关节液培养往往呈阴性，这给诊断和治疗带来了挑战。我们分析了细菌培养阴性的髋关节化脓性关节炎患儿的临床特征，并确定了不良预后的风险因素。方法回顾性分析了 2010 年 1 月至 2020 年 12 月期间在我院接受治疗的细菌培养阴性的髋关节化脓性关节炎患儿的临床数据。将细菌培养阴性患儿的临床特征和疗效与同期细菌培养阳性患儿的临床特征和疗效进行比较。培养阴性患者被分为疗效好的一组和疗效差的一组。结果39名髋关节化脓性关节炎细菌培养阴性患儿与37名败血症细菌培养阳性患儿进行了比较。与培养阳性组相比，培养阴性组的平均年龄明显更小，平均血清 C 反应蛋白浓度明显更低。通过对培养阴性患者良好与不良预后的逻辑回归分析发现，不良预后的独立风险因素是血清C反应蛋白浓度升高和从发病到手术时间延长。在培养阴性组中，预测不良预后的临界值是发病到手术时间超过 21 天和 C 反应蛋白浓度超过 23 mg/L。因此，当儿童出现临床症状、炎症标记物浓度和影像学检查结果，临床诊断为髋关节化脓性关节炎时，应积极进行抗感染和髋关节引流治疗。

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引用次数: 0

Error of intraoperative measurement of stem anteversion is decreased by measuring in neutral hip position during total hip arthroplasty 在全髋关节置换术中保持髋关节中立位进行测量，可减少术中测量髋干内翻的误差

IF 1.5 4区医学 Q3 ORTHOPEDICS

Journal of Orthopaedic Science

Pub Date : 2024-09-01 DOI: 10.1016/j.jos.2023.08.008

Background

Intraoperative stem anteversion, which is the angle between the lower leg axis and the trial-stem axis with hip flexion and adduction, is generally evaluated by the surgeon's visual estimation during total hip arthroplasty (THA). However, the conventional approach can be influenced by knee osteoarthritis or uncertain surgeon's observation point. Therefore, we developed a new method for measuring the stem anteversion angle in the neutral hip position using an original rod attached to the trial-stem perpendicular to the long axis and parallel to the stem neck. This study aimed to assess the accuracy of our method in comparison with the conventional method of measuring intraoperative stem anteversion angle.

Methods

We measured the intraoperative stem anteversion angle in consecutive 106 hips of 106 patients who underwent cementless primary THA with a tapered wedge stem. Absolute error in the stem anteversion angle was expressed as the difference between intraoperative (common vs. neutral hip positions) and postoperative computed tomography measurements, i.e., true stem anteversion. Additionally, we investigated the factors affecting these errors.

Results

The absolute error of measurement was significantly smaller in the neutral hip position than in the common position (3.0° ± 2.5° vs. 8.0° ± 3.9°; p < 0.0001). The factor associated with the error was advanced knee osteoarthritis in the common position, whereas it was not statistically significant in the neutral hip position.

Conclusions

This study suggests that the error in the intraoperative measurement of stem anteversion is decreased by measuring in the neutral hip position during THA.

背景在全髋关节置换术（THA）中，通常由外科医生目测评估术中髋关节柄内翻，即髋关节屈曲和内收时小腿轴线与试行髋关节柄轴线之间的角度。然而，传统方法可能会受到膝关节骨关节炎或外科医生观察点不确定的影响。因此，我们开发了一种新方法，在髋关节中立位时使用一根原始杆测量茎干内翻角，该杆与试验茎干的长轴垂直，与茎干颈平行。本研究旨在评估我们的方法与测量术中柄内翻角的传统方法相比的准确性。方法我们测量了连续106例使用锥形楔形柄进行无骨水泥初级THA的患者的术中柄内翻角。柄内翻角度的绝对误差表示为术中（普通髋关节位置与中立髋关节位置）和术后计算机断层扫描测量值之间的差异，即真正的柄内翻。此外，我们还研究了影响这些误差的因素。结果髋关节中立位测量的绝对误差明显小于普通位（3.0° ± 2.5° vs. 8.0° ± 3.9°；p < 0.0001）。在普通体位中，与误差相关的因素是晚期膝关节骨性关节炎，而在中立髋位中，该因素无统计学意义。

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引用次数: 0

Chronological changes in the rate of surgical field contamination in the shoulder joint 肩关节手术野污染率的时间变化。

IF 1.5 4区医学 Q3 ORTHOPEDICS

Journal of Orthopaedic Science

Pub Date : 2024-09-01 DOI: 10.1016/j.jos.2023.09.008

Background

In shoulder surgery, low-virulence bacteria such as Cutibacterium acnes and coagulase-negative staphylococci can cause postoperative infection. However, the degree of sterility during surgery after disinfection is not known, and the efficacy of double skin preparation for such bacteria is unclear. This study aimed to evaluate chronological changes in the surgical field contamination rate in the shoulder joint and to compare single and double skin preparation.

Methods

In total, 126 shoulders in 121 patients undergoing shoulder surgery (64 men, 62 women; mean age 64 years) were enrolled. Patients were divided into two groups: single skin preparation, where the site was painted with 10% povidone iodine, and double skin preparation, where the site was treated with 1% chlorhexidine gluconate/83% isopropyl alcohol and painted 10% povidone iodine. Swab samples from the axillary and proximal areas in the surgical field were collected chronologically before starting surgery and at 30, 60, and 120 min after starting surgery (MAS). The contamination rate of each sample was compared and detected species were evaluated.

Results

The contamination rate for the axillary area was 48.4%, 85.9%, 95.3%, and 97.1% in the single-preparation group and 32.3%, 72.6%, 87.1%, and 91.2% in the double-preparation group before starting surgery and 30, 60, and 120 MAS, respectively, and that the proximal area was 12.5%, 26.6%, 29.7%, and 35.3% in the single-preparation group and 16.1%, 19.4%, 27.4%, and 38.2% in the double-preparation group, respectively. Significant differences were not seen between the groups by area or time point. Most detected species were Cutibacterium acnes and coagulase-negative staphylococci.

Conclusions

The incidence of surgical field contamination in shoulder joint was high from immediately after starting surgery. In the axillary area, the contamination rates exceeded 70% from 30 MAS in both groups. Measures against infection should be instituted considering these findings when performing shoulder surgery.

背景：在肩部手术中，低毒力细菌如痤疮杆菌和凝固酶阴性葡萄球菌可引起术后感染。然而，消毒后手术期间的无菌程度尚不清楚，双皮制剂对此类细菌的疗效也不清楚。本研究旨在评估肩关节手术现场污染率的时间变化，并比较单层和双层皮肤的准备情况。方法：共有121名接受肩部手术的患者（64名男性，62名女性；平均年龄64岁）中的126名肩部被纳入研究。患者被分为两组：单次皮肤制剂，用10%聚维酮碘涂抹，双次皮肤制剂用1%葡萄糖酸氯己定/83%异丙醇治疗，用10%聚维酮碘涂。在开始手术前以及在开始手术后30、60和120分钟（MAS）按时间顺序收集手术区腋窝和近端区域的拭子样本。对每个样品的污染率进行比较，并对检测到的物种进行评估。结果：术前30、60和120 MAS，单制剂组腋窝污染率分别为48.4%、85.9%、95.3%和97.1%，双制剂组分别为32.3%、72.6%、87.1%和91.2%，双制剂组分别为38.2%。两组之间在区域或时间点上没有发现显著差异。检出最多的是痤疮杆菌和凝固酶阴性葡萄球菌。结论：肩关节手术区污染的发生率从术后即刻开始就很高。在腋窝区域，两组的污染率均从30 MAS超过70%。在进行肩部手术时，应考虑到这些发现，制定预防感染的措施。

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引用次数: 0

Cyclic testing of six-strand suture techniques for zone 2 flexor tendon lacerations 屈肌腱2区撕裂伤六股缝合技术的循环试验。

IF 1.5 4区医学 Q3 ORTHOPEDICS

Journal of Orthopaedic Science

Pub Date : 2024-09-01 DOI: 10.1016/j.jos.2023.09.007

Background

Biomechanical analysis using cyclic testing for repaired flexor tendons is a clinically relevant method. The aim of this study was to evaluate the tensile properties of two six-strand suture techniques, the triple looped suture and Yoshizu #1 suture techniques using cyclic testing under simulating early active mobilization conditions.

Methods

Twenty-five flexor digitorum profundus tendons harvested from fresh frozen human cadaver hands were repaired in zone 2 utilizing one of three repair techniques: the 2-strand modified Kessler (MK) technique as a control, the triple looped suture (TLS) and Yoshizu #1 suture (Y1) techniques. In each suture technique, 4-0 monofilament nylon sutures were used for core sutures and 6-0 monofilament nylon sutures for circumferential running sutures. Cyclic testing was performed using 20 N with 600 cycles at 1 Hz.

Results

Five out of eight specimens in the MK group ruptured during cyclic testing. Thus, this group was excluded from analysis. On the other hand, all tendons in the TLS and Y1 groups tolerated cyclic testing. Average gaps of the TLS and Y1 groups were 0.5 ± 0.8 mm and 1.9 ± 2.2 mm, respectively. All tendons in the TLS group and six out of nine tendons in the Y1 group formed gaps less than 2 mm. Two tendons in the Y1 group formed a gap of 3.8 and 6.6 mm had breakage of peripheral sutures at the first cycle. Mean ultimate tensile force of the TLS and Y1 group measured after cyclic tensing, were 66.2 ± 9.0 N and 65.9 ± 13.1 N, respectively. No statistical difference between the two groups was found in gap and ultimate tensile forces.

Conclusions

This study suggested that the TLS and Y1 techniques have tensile properties to allow early active mobilization. None of tendons repaired with the TLS technique had gaps more than 2 mm.

背景：使用循环测试对修复屈肌腱进行生物力学分析是一种临床相关方法。本研究的目的是在模拟早期主动动员条件下，使用循环测试来评估两种六股缝合技术，即三环缝合和Yoshizu#1缝合技术的拉伸性能。方法：采用两股改良Kessler（MK）技术作为对照，三股三环缝线（TLS）和Yoshizu#1缝线（Y1）技术对新鲜冷冻人尸手上采集的25根指深屈肌肌腱进行2区修复。在每种缝合技术中，4-0单丝尼龙缝合线用于核心缝合，6-0单丝尼龙缝线用于环形运行缝合。使用20N在1Hz下进行600次循环的循环试验。结果：MK组中八分之五的试样在循环试验中破裂。因此，该组被排除在分析之外。另一方面，TLS和Y1组中的所有肌腱都能耐受循环测试。TLS组和Y1组的平均间隙分别为0.5±0.8 mm和1.9±2.2 mm。TLS组中的所有肌腱和Y1组中九根肌腱中的六根肌腱形成的间隙小于2mm。Y1组中的两个肌腱形成3.8和6.6mm的间隙，在第一个循环时，外周缝合线断裂。TLS组和Y1组在循环张紧后测得的平均极限拉力分别为66.2±9.0N和65.9±13.1N。两组之间在间隙和极限拉力方面没有发现统计学差异。结论：本研究表明TLS和Y1技术具有早期主动动员的拉伸性能。用TLS技术修复的肌腱中没有一根的间隙超过2毫米。

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引用次数: 0

Predicting fracture classification and prognosis with hounsfield units and femoral cortical index: A simple and cost-effective approach 用hounsfield单位和股骨皮质指数预测骨折分类和预后：一种简单且成本效益高的方法。

IF 1.5 4区医学 Q3 ORTHOPEDICS

Journal of Orthopaedic Science

Pub Date : 2024-09-01 DOI: 10.1016/j.jos.2023.08.020

Background

The relationship between bone density and fracture has been widely studied and recognized, and the role of cortical bone in proximal femoral fractures has also been increasingly studied. However, both the determination of bone mineral density (BMD) and the determination of cortical mass are expensive and cumbersome. The purpose of this study is to investigate whether two readily available indicators, Hounsfield Units (HUs) and femoral cortical index (FCI), can be used to predict hip fracture classification and prognosis.

Methods

A retrospective study was conducted on 110 patients with hip fragility fractures. Cortical index was calculated on fractured and contralateral femur FCI, with HUs calculated on the proximal femur. The correlation of the FCI and HU with diabetes, hypertension, and related indicators, such as albumin, creatinine, and urea nitrogen levels, were also analyzed in the study.

Results

Both the Evans classification of intertrochanteric fractures and the Garden and Pauwels classifications of femoral neck fractures showed that as the severity of the fracture increased, the HUs and FCI decreased. Age and albumin level also had a negative correlation with HUs and FCI. There was also a significant correlation between HUs and FCI.

Conclusions

The HUs and FCI, which can be easily and quickly obtained, can be used to predict the classification and prognosis of hip fractures.

背景：骨密度与骨折之间的关系已经得到了广泛的研究和认可，皮质骨在股骨近端骨折中的作用也得到了越来越多的研究。然而，骨密度（BMD）的测定和皮质质量的测定都是昂贵和繁琐的。本研究的目的是研究两个现成的指标，Hounsfield单位（HUs）和股骨皮质指数（FCI），是否可以用于预测髋部骨折的分类和预后。方法：对110例髋部脆性骨折患者进行回顾性分析。计算骨折和对侧股骨FCI的皮质指数，计算股骨近端的HU。研究中还分析了FCI和HU与糖尿病、高血压和相关指标（如白蛋白、肌酐和尿素氮水平）的相关性。结果：股骨粗隆间骨折的Evans分类和股骨颈骨折的Garden和Pauwels分类均显示，随着骨折严重程度的增加，HUs和FCI降低。年龄和白蛋白水平也与HUs和FCI呈负相关。HUs与FCI之间也存在显著相关性。结论：HUs和FCI可以很容易、快速地获得，可用于预测髋部骨折的分类和预后。

{"title":"Predicting fracture classification and prognosis with hounsfield units and femoral cortical index: A simple and cost-effective approach","authors":"","doi":"10.1016/j.jos.2023.08.020","DOIUrl":"10.1016/j.jos.2023.08.020","url":null,"abstract":"<div><h3>Background</h3><p><span>The relationship between bone density and fracture has been widely studied and recognized, and the role of cortical bone in proximal </span>femoral fractures<span> has also been increasingly studied. However, both the determination of bone mineral density (BMD) and the determination of cortical mass are expensive and cumbersome. The purpose of this study is to investigate whether two readily available indicators, Hounsfield Units (HUs) and femoral cortical index (FCI), can be used to predict hip fracture classification and prognosis.</span></p></div><div><h3>Methods</h3><p><span>A retrospective study was conducted on 110 patients with hip fragility fractures. Cortical index was calculated on fractured and </span>contralateral<span> femur FCI, with HUs calculated on the proximal femur. The correlation of the FCI and HU with diabetes, hypertension, and related indicators, such as albumin, creatinine, and urea nitrogen levels, were also analyzed in the study.</span></p></div><div><h3>Results</h3><p><span>Both the Evans classification of intertrochanteric fractures and the Garden and Pauwels classifications of </span>femoral neck fractures<span> showed that as the severity of the fracture increased, the HUs and FCI decreased. Age and albumin level also had a negative correlation with HUs and FCI. There was also a significant correlation between HUs and FCI.</span></p></div><div><h3>Conclusions</h3><p>The HUs and FCI, which can be easily and quickly obtained, can be used to predict the classification and prognosis of hip fractures.</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":"41236244","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

Improved responsiveness for JKOOS+ compared to KOOS in Japanese patients undergoing total knee arthroplasty 在接受全膝关节置换术的日本患者中，与KOOS相比，JKOOS+的反应性有所改善。

IF 1.5 4区医学 Q3 ORTHOPEDICS

Journal of Orthopaedic Science

Pub Date : 2024-09-01 DOI: 10.1016/j.jos.2023.08.021

Background

Existing knee related patient reported outcome measurements (PROMs) have overwhelmingly been developed and validated in western chair-based societies, suggesting a potential for a western bias in PROMs evaluation of patients with knee conditions. We, therefore, endeavor to evaluate the responsiveness of the previously developed culturally relevant Japanese version of the knee injury and osteoarthritis outcome score (JKOOS+).

Methods

We enrolled 114 patients scheduled for total knee arthroplasty (TKA) across 8 knee clinics in Japan. Patients completed the Oxford Knee Score (OKS) and JKOOS + both at the time of enrollment and again 1-year post-TKA. Responsiveness was evaluated using effect size and standardized response mean (SRM). An effect size or SRM >0.8 is considered adequately responsive. We further tested the difference in responsiveness between the original Japanese language KOOS activities of daily living (ADL) domain and the novel Japanese ADL (JADL) domain using the modified Jacknife test.

Results

All domains were adequately responsive with the exception of the KOOS sports and recreation domain, which has previously been ignored by TKA researchers due to its lack of applicability to elderly patients undergoing TKA. The JADL domain outperformed the ADL domain in both effect size (1.51 v. 1.45) and SRM (1.67 v. 1.57) (p < 0.001). The novel Knee Flexion (KF) domain was adequately responsive, though less responsive than other domains except sports and recreation (p < 0.01 v. all other PROMs domains).

Conclusions

The JKOOS+ JADL domain is significantly more responsive than the Europe-developed ADL domain to TKA in Japanese knee patients suffering from knee osteoarthritis (OA). The KF domain, unique to the JKOOS+ and intended to assess difficulty with knee flexion, is adequately responsive to TKA in Japanese patients suffering from OA.

背景：现有的膝关节相关患者报告的结果测量（PROM）绝大多数是在西方以椅子为基础的社会中开发和验证的，这表明西方在评估膝关节疾病患者的PROM时可能存在偏见。因此，我们努力评估先前开发的与文化相关的日本版膝关节损伤和骨关节炎结果评分（JKOOS+）的反应性。方法：我们在日本的8家膝关节诊所招募了114名计划进行全膝关节置换术（TKA）的患者。患者在入组时和TKA后1年再次完成了牛津膝关节评分（OKS）和JKOOS+。使用效应大小和标准化反应平均值（SRM）评估反应性。效应大小或SRM>0.8被认为是充分响应。我们使用改进的Jacknife检验进一步测试了原始日语KOOS日常生活活动（ADL）域和新日语ADL（JADL）域之间的反应性差异。结果：除KOOS运动和娱乐领域外，所有领域都有充分的反应，该领域此前因不适用于接受TKA的老年患者而被TKA研究人员忽视。JADL结构域在效应大小（1.51 vs.1.45）和SRM（1.67 vs.1.57）方面均优于ADL结构域（p结论：在患有膝骨关节炎（OA）的日本膝关节患者中，JKOOS+JADL结构区对TKA的反应明显高于欧洲开发的ADL结构区。KF域是JKOOS+独有的，旨在评估膝关节屈曲的困难，在患有OA的日本患者中对TKA有充分的反应。

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引用次数: 0

Comment on Yokoya et al. : Factors affecting stress shielding and osteolysis after reverse shoulder arthroplasty: A multicenter study in a Japanese population 评论 Yokoya 等人：影响反向肩关节置换术后应力屏蔽和骨溶解的因素：一项针对日本人群的多中心研究。

IF 1.5 4区医学 Q3 ORTHOPEDICS

Journal of Orthopaedic Science

Pub Date : 2024-09-01 DOI: 10.1016/j.jos.2024.04.013

引用次数: 0

Readability and quality of online patient resources regarding knee osteoarthritis and lumbar spinal stenosis in Japan 日本有关膝关节骨关节炎和腰椎管狭窄症的在线患者资源的可读性和质量

IF 1.5 4区医学 Q3 ORTHOPEDICS

Journal of Orthopaedic Science

Pub Date : 2024-09-01 DOI: 10.1016/j.jos.2023.08.003

Background

This study aimed to quantify the readability and quality of online patient resources on knee osteoarthritis and lumbar spinal stenosis in Japan.

Methods

Three search engines (Google, Yahoo, and Bing) were searched for the terms knee osteoarthritis and lumbar spinal stenosis. The first 30 websites of each search were screened. Duplicate websites and those unrelated to the searched diseases were excluded. The remaining 125 websites (62 on knee osteoarthritis, 63 on lumbar spinal stenosis) were analyzed. The text readability was assessed using two web-based programs (Obi-3 and Readability Research Lab) and lexical density. Website quality was evaluated using the DISCERN score, Clear Communication Index, and Journal of American Medical Association benchmark criteria.

Results

Readability scores were high, indicating that the texts were difficult to understand. Only 24 (19%) and six (5%) websites were classified as average difficulty readability according to Obi-3 and Readability Research Lab, respectively. The overall quality of information was low, with only four (3%) being rated as having sufficient quality based on the Clear Communication Index and Journal of American Medical Association benchmark criteria. None of the websites satisfied the DISCERN quality criteria.

Conclusions

Patient information on Japanese websites regarding knee osteoarthritis and lumbar spinal stenosis were difficult to understand. Moreover, the quality of the websites was insufficient. Orthopaedic surgeons should contribute to the creation of high-quality easy-to-read websites to facilitate patient-physician communication.

背景本研究旨在量化日本有关膝关节骨关节炎和腰椎管狭窄症的在线患者资源的可读性和质量。方法在三个搜索引擎（谷歌、雅虎和必应）上搜索膝关节骨关节炎和腰椎管狭窄症这两个词。对每次搜索的前 30 个网站进行筛选。排除了重复网站和与搜索疾病无关的网站。对剩余的 125 个网站（62 个关于膝关节骨关节炎，63 个关于腰椎管狭窄症）进行了分析。使用两个基于网络的程序（Obi-3 和可读性研究实验室）和词汇密度评估了文本的可读性。使用 DISCERN 分数、清晰交流指数和《美国医学会杂志》基准标准对网站质量进行了评估。根据 Obi-3 和可读性研究实验室的标准，只有 24 个网站（19%）和 6 个网站（5%）被评为可读性一般。信息的整体质量较低，根据清晰交流指数和《美国医学会杂志》基准标准，只有 4 个网站（3%）被评为质量足够高。结论日本网站上有关膝关节骨关节炎和腰椎管狭窄症的患者信息难以理解。此外，网站的质量也不够高。矫形外科医生应为创建高质量、易于阅读的网站做出贡献，以促进患者与医生之间的交流。

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引用次数: 0

Development of osteophytes and joint space narrowing is associated with cartilage degeneration of the osteochondral fragment in the osteochondral lesion of the talus 骨赘和关节间隙变窄的发展与距骨骨软骨病变中骨软骨碎片的软骨变性有关。

IF 1.5 4区医学 Q3 ORTHOPEDICS

Journal of Orthopaedic Science

Pub Date : 2024-09-01 DOI: 10.1016/j.jos.2023.08.013

Background

During surgery for osteochondral lesions of the talus (OLT), preservation or excision of the osteochondral fragment is chosen based on the cartilage condition which influences the indication and clinical outcomes of surgical treatments. However, it is difficult to predict arthroscopic and histological findings of the cartilage on osteochondral fragments by radiographic evaluation. We focused on osteoarthritis (OA) changes on plain radiographs to predict the cartilage condition of the OLT. This study aimed to evaluate whether OA changes, including osteophyte and joint space narrowing, could predict arthroscopic and histological findings of the cartilage in OLT.

Methods

Seventy ankles with OLT were included in this study. Osteophytes and joint space narrowing were scored on plain radiographs. Lesion sizes were measured on computed tomography images. The cartilage surfaces of fragments were arthroscopically assessed using the International Cartilage Repair Society (ICRS) grade. Biopsy specimens from 32 ankles were histologically analyzed using the Mankin score. The relationships between OA scores, lesion size, ICRS grades, and Mankin score were analyzed.

Results

OA changes were frequently observed with increasing ICRS grades, especially in the medial tibiotalar joint. OA scores in patients with ICRS grade 1 were significantly lower than those in ICRS grades 2,3, and 4. The lesion sizes in patients with ICRS grade 3 and 4 were significantly smaller than those in patients with ICRS grade 1 and 2. Histological analysis showed increasing Mankin scores as the ICRS grade worsened. A mild correlation existed between the OA and Mankin scores (rs = 0.494).

Conclusions

OA changes, such as osteophyte formation and joint space narrowing, are associated with arthroscopic findings of the articular surface and cartilage degeneration in osteochondral fragment in OLT. Articular cartilage conditions can be predicted by OA changes on plain radiographs, which is useful for choosing the appropriate treatment for patients with OLT.

Level of evidence

Level Ⅳ, case series.

背景：在距骨骨软骨损伤（OLT）的手术过程中，根据影响手术治疗指征和临床结果的软骨状况，选择保留或切除骨软骨碎片。然而，通过放射学评估很难预测骨软骨碎片上软骨的关节镜和组织学表现。我们关注骨关节炎（OA）在平片上的变化，以预测OLT的软骨状况。本研究旨在评估OA的变化，包括骨赘和关节间隙变窄，是否可以预测OLT软骨的关节镜和组织学表现。方法：本研究包括70例OLT患者。在平片上对骨赘和关节间隙狭窄进行评分。在计算机断层扫描图像上测量病变大小。使用国际软骨修复学会（ICRS）等级对碎片的软骨表面进行关节镜评估。使用Mankin评分对32个脚踝的活检标本进行组织学分析。分析OA评分、病变大小、ICRS分级和Mankin评分之间的关系。结果：随着ICRS分级的增加，OA变化频繁，尤其是在胫腓内侧关节。ICRS 1级患者的OA评分显著低于ICRS 2、3和4级患者。ICRS 3级和4级患者的病变大小明显小于ICRS 1级和2级患者。组织学分析显示，随着ICRS等级的恶化，Mankin评分不断增加。结论：膝关节骨性关节炎的改变，如骨赘形成和关节间隙变窄，与关节镜下OLT关节表面和骨软骨碎片软骨变性有关。关节软骨状况可以通过平片上OA的变化来预测，这有助于OLT患者选择合适的治疗方法。证据等级：Ⅳ级，系列案件。

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引用次数: 0

Usefulness and limitations of intraoperative pathological diagnosis using frozen sections for spinal cord tumors 使用冰冻切片进行脊髓肿瘤术中病理诊断的实用性和局限性

IF 1.5 4区医学 Q3 ORTHOPEDICS

Journal of Orthopaedic Science

Pub Date : 2024-09-01 DOI: 10.1016/j.jos.2023.08.011

Background

Intraoperative pathological diagnosis has a major influence on the intra- and postoperative management of spinal cord tumors. Thus, the aim of this study was to assess the reliability of intraoperative pathological diagnosis for spinal cord lesions by comparing it with the final pathological diagnosis and to determine its usefulness and limitations.

Method

Three-hundred and three consecutive patients (mean age, 53.9 years) with neoplastic spinal cord lesions who underwent initial surgery between 2000 and 2021 were included. The anatomical locations of the spinal cord tumors and the implementation rate of intraoperative pathological diagnosis in each tumor type were evaluated. As the primary outcome, we determined the concordance rates between the intraoperative pathological diagnosis and the final diagnosis. When the intraoperative pathological diagnosis and final diagnosis were the same, the diagnosis was defined as a “match.” Otherwise, the diagnosis was defined as a “mismatch.”

Results

The overall implementation rate of intraoperative pathological diagnosis was 53%, with implementation rates of 71%, 45%, 47%, and 50% for intramedullary, intradural extramedullary, extradural, and dumbbell tumors, respectively. The overall concordance rate was 87.6%, with concordance rates of 80%, 95%, 75%, and 90% for intramedullary, intradural extramedullary, extradural, and dumbbell tumors, respectively (p < 0.05). The diagnoses of ependymomas, low-grade astrocytomas, and high-grade astrocytomas was occasionally difficult among intramedullary tumors. Among intradural extramedullary tumors, differentiation between grade 1 meningioma and high-grade meningioma was difficult using intraoperative pathological diagnosis.

Conclusions

Surgeons must recognize the lower accuracy of intraoperative pathological diagnosis for intramedullary and extradural lesions and make a final decision by considering the intraoperative gross findings, preoperative clinical course, and imaging.

背景术中病理诊断对脊髓肿瘤的术中和术后处理有重大影响。本研究旨在通过比较脊髓肿瘤术中病理诊断与最终病理诊断，评估术中病理诊断的可靠性，并确定其实用性和局限性。方法纳入 2000 年至 2021 年间接受初次手术的三百零三名脊髓肿瘤患者（平均年龄 53.9 岁）。我们对脊髓肿瘤的解剖位置和每种肿瘤类型的术中病理诊断实施率进行了评估。作为主要结果，我们确定了术中病理诊断与最终诊断的吻合率。当术中病理诊断与最终诊断相同时，诊断被定义为 "匹配"。结果术中病理诊断的总体执行率为 53%，髓内肿瘤、髓外肿瘤、硬膜外肿瘤和哑铃型肿瘤的执行率分别为 71%、45%、47% 和 50%。总体吻合率为 87.6%，髓内肿瘤、髓外肿瘤、硬膜外肿瘤和哑铃状肿瘤的吻合率分别为 80%、95%、75% 和 90%（p <0.05）。在髓内肿瘤中，上皮瘤、低级别星形细胞瘤和高级别星形细胞瘤的诊断偶有困难。结论外科医生必须认识到髓内和髓外病变术中病理诊断的准确性较低，并通过术中大体检查结果、术前临床过程和影像学检查做出最终决定。

{"title":"Usefulness and limitations of intraoperative pathological diagnosis using frozen sections for spinal cord tumors","authors":"","doi":"10.1016/j.jos.2023.08.011","DOIUrl":"10.1016/j.jos.2023.08.011","url":null,"abstract":"<div><h3>Background</h3><p>Intraoperative pathological diagnosis has a major influence on the intra- and postoperative management<span> of spinal cord tumors<span>. Thus, the aim of this study was to assess the reliability of intraoperative pathological diagnosis for spinal cord lesions by comparing it with the final pathological diagnosis and to determine its usefulness and limitations.</span></span></p></div><div><h3>Method</h3><p>Three-hundred and three consecutive patients (mean age, 53.9 years) with neoplastic spinal cord lesions who underwent initial surgery between 2000 and 2021 were included. The anatomical locations of the spinal cord tumors and the implementation rate of intraoperative pathological diagnosis in each tumor type were evaluated. As the primary outcome, we determined the concordance rates between the intraoperative pathological diagnosis and the final diagnosis. When the intraoperative pathological diagnosis and final diagnosis were the same, the diagnosis was defined as a “match.” Otherwise, the diagnosis was defined as a “mismatch.”</p></div><div><h3>Results</h3><p><span>The overall implementation rate of intraoperative pathological diagnosis was 53%, with implementation rates of 71%, 45%, 47%, and 50% for intramedullary, intradural extramedullary, extradural, and dumbbell tumors, respectively. The overall concordance rate was 87.6%, with concordance rates of 80%, 95%, 75%, and 90% for intramedullary, intradural extramedullary, extradural, and dumbbell tumors, respectively (p < 0.05). The diagnoses of ependymomas, low-grade </span>astrocytomas, and high-grade astrocytomas was occasionally difficult among intramedullary tumors. Among intradural extramedullary tumors, differentiation between grade 1 meningioma and high-grade meningioma was difficult using intraoperative pathological diagnosis.</p></div><div><h3>Conclusions</h3><p>Surgeons must recognize the lower accuracy of intraoperative pathological diagnosis for intramedullary and extradural lesions and make a final decision by considering the intraoperative gross findings, preoperative clinical course, and imaging.</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":"10087576","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}

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