Journal of Orthopaedic Science最新文献_第5页

Potential involvement of family structure in locomotive recovery following surgery in older patients with lumbar spinal stenosis 家庭结构对老年腰椎管狭窄患者术后运动恢复的潜在影响。

IF 1.4 4区医学 Q3 ORTHOPEDICS

Journal of Orthopaedic Science

Pub Date : 2026-01-01 DOI: 10.1016/j.jos.2025.05.010

Koutaro Kageshima , Soya Kawabata , Takehiro Michikawa , Yuki Akaike , Sota Nagai , Takaya Imai , Hiroki Takeda , Kei Ito , Daiki Ikeda , Shinjiro Kaneko , Nobuyuki Fujita

Background

Surgical outcomes for lumbar spinal stenosis (LSS) are generally favorable, even in older adults, and they effectively address locomotive syndrome. In older patients with LSS, support from family members during the postoperative recovery period is expected to be helpful, but the extent to which family structure influences surgical outcomes for LSS remains unclear. Herein, this study aimed to investigate the involvement of family structure in surgical outcomes for older patients with LSS.

Methods

This retrospective study included 350 consecutive patients aged ≥65 years who underwent LSS surgery between April 2020 and December 2023. Patients were categorized by family structure into the M (living with multiple family members) or S group (living with few or no family members). Postoperative outcomes were assessed using patient-reported outcomes, including the Roland–Morris Disability Questionnaire (RDQ), Geriatric Locomotive Function Scale (GLFS-25), and Japanese Orthopaedic Association Back Pain Evaluation Questionnaire.

Results

The M group consisted of 102 participants, while the S group comprised 248 participants. Preoperatively, there were no significant differences in the scores of all patient-reported outcomes between the groups. However, even after adjusting for baseline characteristics that significantly differed between the groups, the RDQ (p = 0.018) and GLFS-25 scores (p = 0.030) were significantly better in the M group than in the S group at 1 year postoperatively. Furthermore, the proportion of patients with postoperative improvement in the locomotive syndrome stage was significantly higher in the M group than in the S group at both 6 months (p = 0.027) and 1 year (p = 0.002) postoperatively.

Conclusions

Family structure significantly affected postoperative outcomes in older adults with LSS, particularly concerning locomotive syndrome recovery. These findings highlight the potential value of involving families in healthcare planning, while recognizing that the availability and quality of support may vary across households.

背景：腰椎管狭窄症（LSS）的手术结果通常是有利的，即使在老年人中也是如此，而且它们有效地解决了运动综合征。在老年LSS患者中，家庭成员在术后恢复期的支持有望有所帮助，但家庭结构对LSS手术结果的影响程度尚不清楚。本研究旨在探讨家庭结构对老年LSS患者手术结果的影响。方法：这项回顾性研究包括350例年龄≥65岁的连续患者，他们在2020年4月至2023年12月期间接受了LSS手术。患者按家庭结构分为M组（多家庭成员）和S组（少或无家庭成员）。术后结果采用患者报告的结果进行评估，包括Roland-Morris残疾问卷（RDQ）、老年运动功能量表（GLFS-25）和日本骨科协会背痛评估问卷。结果：M组102人，S组248人。术前，两组患者报告的所有结果评分无显著差异。然而，即使在调整了两组之间显著差异的基线特征后，术后1年，M组的RDQ （p = 0.018）和GLFS-25评分（p = 0.030）明显优于S组。术后6个月（p = 0.027）和1年（p = 0.002） M组机车综合征期患者术后改善比例均显著高于S组。结论：家庭结构显著影响老年LSS患者的术后预后，尤其是机车综合征的恢复。这些发现强调了让家庭参与保健计划的潜在价值，同时认识到支持的可得性和质量可能因家庭而异。

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引用次数: 0

Lumbar apophyseal ring fracture: Prevalence and relationship with spina bifida occulta 腰椎棘环骨折：发病率及其与隐性脊柱裂的关系。

IF 1.4 4区医学 Q3 ORTHOPEDICS

Journal of Orthopaedic Science

Pub Date : 2026-01-01 DOI: 10.1016/j.jos.2025.05.009

Saori Soeda , Masatoshi Morimoto , Kosuke Sugiura , Kosaku Higashino , Shunsuke Tamaki , Keisuke Nishidono , Kiyoshi Yagi , Kazuya Kishima , Hiroaki Manabe , Koichi Sairyo

Purpose

To investigate the prevalence of apophyseal ring fracture and its association with spina bifida occulta (SBO).

Methods

A total of 973 patients (mean age 62 years [range 21–90]) with abdominal and pelvic computed tomography scans available were retrospectively evaluated. The prevalence of apophyseal ring fracture and of SBO and the association between these two entities were evaluated.

Results

The prevalence of apophyseal ring fracture was 3.8 % (n = 22) in men and 2.8 % (n = 11) in women; the difference was not statistically significant (p = 0.53). The incidence was highest at L5 in both men (58.3 %, n = 14) and women (38.5 %, n = 5). SBO was found in 92 patients (9.5 %), who comprised 75 men (12.9 %) and 17 women (4.4 %). The prevalence of SBO was 2.95-fold higher in men than in women (p < 0.0001). Apophyseal ring fracture was 2.6 times more frequent in patients who had SBO than in those who did not (7.6 % vs 3.0 %, p = 0.019).

Conclusions

This study identified the lower lumbar levels as the anatomical locations where apophyseal ring fracture was more likely to occur, particularly involving the anterior portion of the cephalad endplate at L3 and L4 and the posterior portion of the cephalad endplate at S1. This finding will be helpful for understanding the site of origin of apophyseal ring fractures, which can be easily overlooked. In addition, apophyseal ring fractures were more frequent in the presence of SBO, which may contribute to understanding their etiology.

目的：探讨棘环骨折的发病率及其与隐蔽性脊柱裂的关系。方法：回顾性分析973例患者（平均年龄62岁[范围21-90]）的腹部和骨盆计算机断层扫描结果。我们评估了棘环骨折和SBO的患病率以及两者之间的关系。结果：男性棘环骨折发生率为3.8% (n = 22)，女性为2.8% (n = 11)；差异无统计学意义（p = 0.53）。在L5时，男性（58.3%,n = 14）和女性（38.5%,n = 5）的发病率最高。92例（9.5%）患者发现SBO，其中男性75例（12.9%），女性17例（4.4%）。男性SBO患病率是女性的2.95倍（p < 0.0001）。SBO患者的肩胛环骨折发生率是无SBO患者的2.6倍（7.6% vs 3.0%, p = 0.019）。结论：本研究确定了腰椎下节段是棘环骨折更容易发生的解剖位置，特别是涉及L3和L4的头终板前部和S1的头终板后部。这一发现将有助于了解棘环骨折的起源位置，这很容易被忽视。此外，肩胛环骨折在存在SBO时更为常见，这可能有助于了解其病因。

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引用次数: 0

Slight graft laxity five months after anterior cruciate ligament reconstruction can be a risk factor for graft injury within two years in young patients 前交叉韧带重建后5个月轻微的移植物松弛可能是年轻患者2年内移植物损伤的危险因素。

IF 1.4 4区医学 Q3 ORTHOPEDICS

Journal of Orthopaedic Science

Pub Date : 2026-01-01 DOI: 10.1016/j.jos.2025.05.003

Takaki Sanada, Hiroshi Iwaso

Background

Young and highly active athletes are at high risk of second anterior cruciate ligament injuries. The high frequency of second injuries after anterior cruciate ligament reconstruction among the young population is influenced by various factors, such as sex, age, return-to-play time, and graft selection.

Methods

Between 2014 and 2019, 108 primary anterior cruciate ligament reconstructions under 20 years, involving 48 knees using a hamstring tendon autograft and 60 knees using a bone-patellar tendon autograft, were performed by a single surgeon. The incidence and risk factors affecting postoperative graft injury within two years after surgery were compared with those of non-graft injury knees. After univariate analysis, multivariate logistic regression analysis was performed to investigate the independent predictive factors.

Results

Graft rupture occurred in 11.1 % (12/108) of cases. Univariate analysis indicated that postoperative glide-grade Lachman and the pivot shift test, and tibial anterior translation with a mean of 2.7 mm at 5 months post-surgery were sustained in the graft injury group compared with the non-graft injury group with a mean of 1.2 mm. Logistic regression analysis identified that an excessive instrumental anterior tibial translation at 5 months (odds ratio = 2.67; 95 % confidence intervals = 1.45–4.91; p = 0.0016) increased the risk of graft injury. Graft selection or quadriceps and hamstring muscle strength did not influence graft injury.

Conclusion

In young patients, postoperative residual anterior tibial translation after ACL reconstruction is a risk factor for graft injury, even if the amount of graft laxity is small. Graft selection or muscle strength did not affect graft injury.

Level of evidence

Level Ⅳ

背景：年轻和高度活跃的运动员是第二次前交叉韧带损伤的高危人群。年轻人群前交叉韧带重建后二次损伤的高发生率受性别、年龄、复出时间和移植物选择等多种因素的影响。方法：2014年至2019年期间，由同一名外科医生进行了108例20岁以下原发性前交叉韧带重建手术，其中48例膝关节采用腘筋肌腱自体移植，60例膝关节采用骨-髌骨肌腱自体移植。比较膝关节术后2年内移植物损伤与非移植物损伤的发生率及危险因素。单因素分析后，进行多因素logistic回归分析，探讨独立预测因素。结果：移植血管破裂发生率为11.1%（12/108）。单因素分析表明，移植损伤组术后滑动级Lachman和枢轴移位试验，术后5个月胫骨前平移平均为2.7 mm，而非移植损伤组平均为1.2 mm。Logistic回归分析发现，5个月时过度的工具性胫骨前移位(优势比= 2.67；95%置信区间= 1.45-4.91；P = 0.0016)增加移植物损伤的风险。移植物的选择或股四头肌和腘绳肌的力量对移植物损伤没有影响。结论：在年轻患者中，ACL重建术后残留胫骨前移位是移植物损伤的危险因素，即使移植物松弛量很小。移植物选择或肌力对移植物损伤无影响。证据等级：Ⅳ级。

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引用次数: 0

Impact of potentially inappropriate medication on surgical outcomes in older patients with lumbar spinal stenosis 可能不适当的药物对老年腰椎管狭窄患者手术结果的影响。

IF 1.4 4区医学 Q3 ORTHOPEDICS

Journal of Orthopaedic Science

Pub Date : 2026-01-01 DOI: 10.1016/j.jos.2025.05.005

Yuki Akaike , Takehiro Michikawa , Takao Tobe , Risa Tobe , Soya Kawabata , Sota Nagai , Hiroki Takeda , Takaya Imai , Shinjiro Kaneko , Morio Matsumoto , Masaya Nakamura , Shigeki Yamada , Nobuyuki Fujita

Background

The administration of potentially inappropriate medications (PIMs) as well as polypharmacy in older individuals has become a medical and socioeconomic issue. Meanwhile, given that lumbar spinal stenosis (LSS) is one of the most prevalent musculoskeletal conditions, significantly affecting mobility in older adults and becoming increasingly common in aging societies, its management in this population has emerged as a critical concern. We aimed to elucidate the prevalence of PIMs among older LSS patients and identify those potentially impacting surgical outcomes.

Methods

We retrospectively analyzed 296 consecutive patients aged 65 years or older who underwent LSS surgery. Based on available guidelines, 19 medication categories were considered PIMs. Pre- and postoperative health-related quality of life was assessed using the Roland-Morris Disability Questionnaire and Japanese Orthopaedic Association Back Pain Evaluation Questionnaire.

Results

The most frequently prescribed PIMs included hypnotics, steroids, antithrombotic drugs, antidiabetic drugs, laxatives, and nonsteroidal anti-inflammatory drugs in older LSS patients. Among these medications, antithrombotic drugs showed a significant association with surgical outcomes. When the subjects were divided into antithrombotic drug users (n = 57) and non-users (n = 239), no significant difference in the incidence of postoperative complications was observed between the two groups. However, 1 year after surgery, users had significantly worse walking ability than did nonusers (adjusted p value = 0.028), despite no significant differences before and 6 months after surgery. Furthermore, nonusers showed significant improvement in walking ability (p < 0.001) and social life scores (p = 0.014) from 6 months to 1 year after surgery, whereas users exhibited no significant improvements during this period.

Conclusions

Among the PIMs, hypnotics, steroids, antithrombotic drugs, laxatives, antidiabetic drugs, and nonsteroidal anti-inflammatory drugs were commonly used by older LSS patients. Older LSS patients taking antithrombotic drugs are unlikely to have good surgical outcomes.

背景：老年人潜在不适当药物（PIMs）的管理以及多重用药已成为一个医学和社会经济问题。同时，鉴于腰椎管狭窄症（LSS）是最普遍的肌肉骨骼疾病之一，严重影响老年人的活动能力，并且在老龄化社会中变得越来越普遍，其在这一人群中的管理已成为一个关键问题。我们的目的是阐明老年LSS患者中pim的患病率，并确定那些可能影响手术结果的因素。方法：我们回顾性分析了296例65岁及以上连续接受LSS手术的患者。根据现有的指导方针，19种药物类别被认为是pim。使用Roland-Morris残疾问卷和日本骨科协会背痛评估问卷评估术前和术后与健康相关的生活质量。结果：老年LSS患者最常用的抗炎药包括催眠药、类固醇、抗血栓药、降糖药、泻药和非甾体抗炎药。在这些药物中，抗血栓药物显示出与手术结果的显著关联。将受试者分为抗栓药物使用者（n = 57）和非抗栓药物使用者（n = 239），两组术后并发症发生率无显著差异。然而，术后1年，使用者的行走能力明显差于非使用者（调整p值= 0.028），尽管术前和术后6个月无显著差异。此外，在术后6个月至1年内，非使用者的行走能力（p < 0.001）和社交生活得分（p = 0.014）均有显著改善，而使用者在此期间无显著改善。结论：PIMs中，催眠药、类固醇、抗血栓药、泻药、降糖药和非甾体抗炎药是老年LSS患者常用的药物。服用抗血栓药物的老年LSS患者不太可能有良好的手术结果。

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引用次数: 0

Effects of proprioceptive neuromuscular facilitation therapy combined with orthotic insole intervention on lower limb function improvement in children with foot drop and inversion deformity 本体感觉神经肌肉促进疗法联合矫形鞋垫干预对足下垂和内翻畸形患儿下肢功能改善的影响。

IF 1.4 4区医学 Q3 ORTHOPEDICS

Journal of Orthopaedic Science

Pub Date : 2026-01-01 DOI: 10.1016/j.jos.2025.06.012

Hong Cheng , Xiaobing Chou , Xiaoli Hou , Xinyue Wang , Yan Zhou , Yuxin Mao , Xuan Zhou

Objective

To evaluate whether combining proprioceptive neuromuscular facilitation (PNF) therapy with customized orthotic insoles leads to greater improvements in gait parameters, ankle range of motion, and lower-limb function than either intervention alone in pediatric foot drop and inversion deformity.

Methods

Ninety-seven children (aged 5–14 years) with foot drop and inversion deformity were randomized into three groups: (1) PNF plus insole, (2) insole only, and (3) PNF only. All interventions lasted 12 weeks. Gait parameters, the Gross Motor Function Measure (GMFM), ankle range of motion, muscle strength, and functional balance were assessed at baseline, immediately post-intervention, and at 1- and 3-month follow-ups.

Results

Children receiving the combined PNF plus insole intervention demonstrated significantly greater increases in gait velocity (18.5 % vs. 9.2 % and 8.7 % for insole-only and PNF-only groups, respectively) and higher improvements in GMFM scores (12-point increase vs. 6 and 5 points). Ankle dorsiflexion improved by a mean of 6.1° in the combined group (p < 0.05). Approximately 85 % of these gains were maintained at the 1-month follow-up, which exceeded the modest regression observed in the single-intervention groups.

Conclusion

Combining PNF therapy with customized orthotic insoles offers superior and more durable improvements in gait and lower-limb function compared to single interventions, suggesting a more effective rehabilitative strategy for pediatric patients with foot drop and inversion deformity.

目的：评价本体感觉神经肌肉促进（PNF）治疗与定制矫形鞋垫联合治疗对儿童足下垂和内翻畸形的步态参数、踝关节活动范围和下肢功能的改善是否比单独干预更大。方法：97例5 ~ 14岁的足下垂和内翻畸形患儿随机分为3组：(1)PNF +鞋垫组、(2)仅鞋垫组和(3)仅PNF组。所有干预持续12周。步态参数、大运动功能测量（GMFM）、踝关节活动范围、肌肉力量和功能平衡在基线、干预后立即以及1个月和3个月的随访时进行评估。结果：接受PNF +鞋垫联合干预的儿童显示出更大的步态速度增加（18.5%，鞋垫组分别为9.2%和8.7%）和GMFM评分的更高改善（12分，鞋垫组为9.2%，鞋垫组为8.7%）。联合治疗组踝关节背屈度平均改善6.1°（p < 0.05）。大约85%的收益在1个月的随访中保持不变，超过了单干预组中观察到的适度回归。结论：与单一干预相比，PNF治疗与定制矫形鞋垫相结合，对步态和下肢功能的改善更明显，更持久，为儿科足下垂和内翻畸形患者提供了更有效的康复策略。

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引用次数: 0

Reply to letter to the Editor by Andreas REHM 回复Andreas REHM给编辑的信。

IF 1.4 4区医学 Q3 ORTHOPEDICS

Journal of Orthopaedic Science

Pub Date : 2026-01-01 DOI: 10.1016/j.jos.2025.09.001

Ryo Fukagawa , Ichiro Yoshimura , Tomonobu Hagio , Tetsuro Ishimatsu , Yuki Sugino , Seiya Tomonaga , Yoshimasa Taniguchi , Takuaki Yamamoto

引用次数: 0

Minimum 10-year outcomes of a curved anatomic femoral stem designed for the Japanese femora including dysplastic hips in total hip arthroplasty 全髋关节置换术中为日本股骨设计的包括发育不良髋关节的弯曲解剖股骨干的最小10年结果。

IF 1.4 4区医学 Q3 ORTHOPEDICS

Journal of Orthopaedic Science

Pub Date : 2026-01-01 DOI: 10.1016/j.jos.2025.05.013

Sachiyuki Tsukada, Naoyuki Hirasawa, Masayoshi Saito, Masahiro Nishino, Takuya Kusakabe, Hiroyuki Ogawa

Purpose

This study aimed to evaluate the minimum 10-year outcomes of total hip arthroplasty (THA) using the CentPillar-TMZF, a curved anatomic stem developed based on anatomical data from Japanese patients including those with hip dysplasia.

Methods

Among 331 consecutive THA procedures, the CentPillar-TMZF was implanted in 80 primary THAs (24 %) following standardized selection criteria based on preoperative CT data. X-rays taken at the 10-year follow-up were assessed to evaluate stem fixation and the degree of stress shielding. Kaplan-Meier survivorship was calculated, with revision for any reason as the endpoint.

Results

Seventy-three of the 80 hips (91 %) were followed for 10 years or until revision surgery. In all hips followed more than 10 years, stem fixation was classified as bone-ingrown stable with first- or second-degree stress shielding. The survivorship rate, with revision as the endpoint, was 98 % (95 % CI 90 %–99 %) at 10 years. Before the 10-year follow-up, one patient required revision due to a periprosthetic fracture, and another required revision for dislocation.

Conclusion

In THA using CentPillar-TMZF, no aseptic loosening was observed until postoperative 10 years in patients whose femoral medullary canal shape was preoperatively determined to be compatible based on CT evaluation.

目的：本研究旨在评估使用CentPillar-TMZF的全髋关节置换术（THA）的最低10年预后，CentPillar-TMZF是一种基于日本患者（包括髋关节发育不良患者）的解剖数据开发的弯曲解剖杆。方法：在331例连续THA手术中，根据术前CT数据的标准化选择标准，将CentPillar-TMZF植入80例原发性THA（24%）。10年随访时进行x光检查，评估椎体固定和应力屏蔽程度。Kaplan-Meier生存率计算，以任何原因的修正为终点。结果：80例髋关节中有73例（91%）随访10年或直到翻修手术。在随访超过10年的所有髋关节中，骨干固定被分类为骨内生稳定，具有一度或二度应力屏蔽。10年生存率，以修订为终点，为98% （95% CI 90% - 99%）。在10年随访前，一名患者因假体周围骨折需要翻修，另一名患者因脱位需要翻修。结论：在使用centpiller - tmzf的THA中，术前通过CT评估确定股骨髓管形状相容的患者，术后10年未观察到无菌性松动。

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引用次数: 0

Current status of patients with hip fracture in Japan: A nationwide survey 日本髋部骨折患者的现状：一项全国性调查。

IF 1.4 4区医学 Q3 ORTHOPEDICS

Journal of Orthopaedic Science

Pub Date : 2026-01-01 DOI: 10.1016/j.jos.2025.05.014

Kazuhide Inage , Naoki Kondo , Satoshi Komatsubara , Yukio Nakamura , Nobukazu Okimoto , Junichi Takada , Naohisa Miyakoshi , Takeshi Miyamoto , Satoshi Mori , Hiroshi Ozawa , Satoshi Ikeda

Background

Although surgical treatment is the standard of care for most hip fractures, the post-fracture management of osteoporosis remains challenging. This study aimed to elucidate the status of osteoporosis treatment, subsequent fracture rates, mortality rates, and changes in residential status and care levels among hip fracture patients in Japan, and to explore strategies for fracture prevention and extension of healthy life expectancy.

Methods

This study included patients with hip fractures treated at approximately 3000 orthopaedic facilities nationwide during July 2020. Data was collected via web-based surveys at the time of injury and 6 and 12 months post-injury.

Results

A total of 6705 patients were registered from 1309 facilities (mean age: 82.9 ± 0.7 years; 86.4 % were female). The surgery rate was 94.8 %, with 62.1 % undergoing osteosynthesis and 37.9 % receiving hemiarthroplasty or total hip arthroplasty. Osteoporosis treatment rates gradually increased from 23.0 % at the time of injury to 44.8 % at 6 months and 47.3 % at 12 months, although the rates remained suboptimal. Active vitamin D3-based medications were the most commonly used medications, accounting for approximately 60 % of cases. The cumulative 12-month mortality rate was 10.0 %, and the incidence of new fractures was 11.0 %. The main fracture sites were the contralateral proximal femur, vertebral, and proximal humerus. The most common reason for non-treatment was "patient's decision.” Among patients who were not enrolled in long-term care insurance at the time of injury, 66.1 % had newly obtained care level certification by 12 months after injury. The proportion of patients who returned home among those living at home at the time of injury was 80.7 % at 6 months and 96.8 % at 12 months, respectively.

Conclusions

Osteoporosis treatment rates after hip fractures remain low, indicating the need for more proactive intervention, including secondary fracture prevention. This study also highlights the importance of early rehabilitation and continuous support.

背景：尽管手术治疗是大多数髋部骨折的标准治疗方法，但骨折后骨质疏松症的治疗仍然具有挑战性。本研究旨在了解日本髋部骨折患者的骨质疏松治疗状况、后续骨折发生率、死亡率、居住状况和护理水平的变化，并探讨骨折预防和延长健康预期寿命的策略。方法：本研究纳入了2020年7月在全国约3000家骨科机构接受治疗的髋部骨折患者。在受伤时以及受伤后6个月和12个月通过网络调查收集数据。结果：1309家机构共登记6705例患者(平均年龄：82.9±0.7岁；86.4%为女性)。手术率为94.8%，其中62.1%行骨融合术，37.9%行半髋关节置换术或全髋关节置换术。骨质疏松症的治愈率从损伤时的23.0%逐渐上升到6个月时的44.8%和12个月时的47.3%，尽管治愈率仍然不理想。基于活性维生素d3的药物是最常用的药物，约占病例的60%。累计12个月死亡率为10.0%，新发骨折发生率为11.0%。主要骨折部位为对侧股骨近端、椎体和肱骨近端。不接受治疗最常见的原因是“病人的决定”。在受伤时未参加长期护理保险的患者中，66.1%的患者在受伤后12个月内获得了新获得的护理水平认证。伤后6个月和12个月时，患者返回家中的比例分别为80.7%和96.8%。结论：髋部骨折后骨质疏松的治愈率仍然很低，表明需要更积极的干预，包括二级骨折预防。本研究还强调了早期康复和持续支持的重要性。

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引用次数: 0

Development and internal validation of a Cox proportional hazards model for predicting 1-year mortality in patients conservatively managed for hip fracture 用于预测髋部骨折保守治疗患者1年死亡率的Cox比例风险模型的建立和内部验证

IF 1.4 4区医学 Q3 ORTHOPEDICS

Journal of Orthopaedic Science

Pub Date : 2026-01-01 DOI: 10.1016/j.jos.2025.06.002

Keisuke Nakamura , Yasushi Kurobe , Tomohiro Sasaki , Masayuki Shimizu

Background

Hip fractures in older adults are associated with high mortality and functional decline, particularly in conservatively managed patients. However, prognostic models specific to conservatively managed patients remain scarce. We aimed to develop and internally validate a Cox proportional hazards (PH) model to predict 1-year mortality based on admission data.

Methods

We conducted a retrospective cohort study at a community hospital in Japan, including 76 patients aged ≥65 years who sustained femoral neck or trochanteric fractures and received conservative treatment between April 2018 and April 2020. The primary outcome was 1-year all-cause mortality. Variables included demographics, comorbidities, cognitive function, fracture type, and nutritional status. Missing data were imputed using a random forest algorithm. Univariable and multivariable Cox PH models were used. Internal validation was performed with bootstrap resampling (1000 iterations). Model discrimination was assessed using Harrell's C-index, and calibration was assessed using calibration plots.

Results

The Cox PH regression analysis yielded: h (t∣age, body mass index [BMI], fracture type) = h₀(t) exp (0.005 × age − 0.274 × BMI − 1.870 × fracture type) (Fracture type: 0 = femoral neck, 1 = trochanteric). Lower BMI (hazard ratio [HR] = 0.760; 95 % confidence interval [CI]: 0.637–0.908; p = 0.002) and trochanteric fractures (HR = 0.154; 95 % CI: 0.058–0.411; p < 0.001) were significant predictors of increased mortality. The model demonstrated good discrimination (Harrell's C-index: 0.774; optimism-adjusted: 0.762). Calibration was poor at early timepoints (90–270 days); however, it improved at 365 days (slope = 1.03; C-statistic = 0.83). Decision curve analysis confirmed clinical utility at threshold probabilities above 10 %.

Conclusions

We developed a Cox PH regression model with good discrimination and acceptable calibration at 1 year to predict mortality in patients with conservatively managed hip fractures. This model may assist clinicians in early risk stratification and individualized care planning.

背景：老年人髋部骨折与高死亡率和功能下降有关，特别是在保守治疗的患者中。然而，针对保守治疗患者的预后模型仍然很少。我们的目的是建立并内部验证Cox比例风险（PH）模型，以根据入院数据预测1年死亡率。方法：我们在日本一家社区医院进行了一项回顾性队列研究，纳入了2018年4月至2020年4月期间76例年龄≥65岁的持续股骨颈或股骨粗隆骨折并接受保守治疗的患者。主要终点为1年全因死亡率。变量包括人口统计学、合并症、认知功能、骨折类型和营养状况。缺失数据的输入采用随机森林算法。采用单变量和多变量Cox PH模型。内部验证通过自举重采样（1000次迭代）进行。采用Harrell’sc指数评估模型判别，采用标定图评估模型标定。结果：Cox PH回归分析得出：h （t∣年龄，体重指数[BMI]，骨折类型）= h0(t) exp （0.005 ×年龄- 0.274 × BMI - 1.870 ×骨折类型）（骨折类型：0 =股骨颈，1 =粗隆）。较低的BMI(风险比[HR] = 0.760；95%置信区间[CI]: 0.637-0.908；p = 0.002)和转子骨折(HR = 0.154；95% ci: 0.058-0.411；P < 0.001)是死亡率增加的显著预测因子。模型具有良好的判别性(Harrell’s C-index: 0.774；optimism-adjusted: 0.762)。早期时间点（90-270天）的校准较差；但在365 d时有所改善(斜率= 1.03；C-statistic = 0.83)。决策曲线分析证实了阈值概率在10%以上的临床效用。结论：我们建立了一个Cox PH回归模型，该模型具有良好的判别性和可接受的1年校正，可预测保守治疗髋部骨折患者的死亡率。该模型可以帮助临床医生进行早期风险分层和个性化护理计划。

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引用次数: 0

Evaluation of skeletal muscle metabolism during walking in symptomatic and asymptomatic patients with osteoarthritis of the knee joint using positron emission tomography 使用正电子发射断层扫描评估有症状和无症状膝关节骨关节炎患者行走时骨骼肌代谢。

IF 1.4 4区医学 Q3 ORTHOPEDICS

Journal of Orthopaedic Science

Pub Date : 2026-01-01 DOI: 10.1016/j.jos.2025.05.001

Yusuke Yanatori , Takeshi Oshima , Yasushi Takata , Junichi Taki , Takuya Sengoku , Goro Sakurai , Seigo Kinuya , Satoru Demura , Junsuke Nakase

Background

This study aimed to evaluate skeletal muscle metabolism during walking in symptomatic and asymptomatic patients with knee osteoarthritis using positron emission tomography-computed tomography with 18F-fluorodeoxyglucose. We hypothesized that quadriceps muscle metabolism during walking would vary between the groups.

Methods

Twenty-two participants (11 males and 11 females) with knee osteoarthritis (Kellgren–Lawrence grade 2) were divided into symptomatic and asymptomatic groups. The participants performed two 10-min walks on a treadmill, received an intravenous injection of 18F-fluorodeoxyglucose between sets, and underwent positron emission tomography-computed tomography. Regions of interest were manually segmented into 35 skeletal muscles from the pelvis to the foot. The standardized uptake value was calculated to quantitatively examine 18F-fluorodeoxyglucose uptake by muscle tissue.

Results

The mean standardized uptake values of the hip abductor and external rotator muscles were lower in the symptomatic group than in the asymptomatic group and displayed a medium effect size (gluteus medius, P = 0.281; d = 0.482; gluteus minimus, P = 0.079; d = 0.793; piriformis, P = 0.184; d = 0.622). Although the vastus medialis demonstrated a medium effect size (P = 0.191; d = 0.597), the rectus femoris (P = 0.454; d = 0.299), vastus lateralis (P = 0.303; d = 0.392), and vastus intermedius (P = 0.300; d = 0.434) demonstrated no significant differences and only small effect sizes. Therefore, no overall difference in quadriceps muscle metabolism was observed between the groups.

Conclusion

A trend towards lower hip abductor and external rotator muscle metabolism was observed in patients with symptomatic knee osteoarthritis, suggesting that muscle metabolism may be associated with knee symptoms.

背景：本研究旨在利用正电子发射断层扫描- 18f -氟脱氧葡萄糖计算机断层扫描评估有症状和无症状膝骨关节炎患者行走时骨骼肌代谢。我们假设走路时的股四头肌代谢在两组之间会有所不同。方法：22例膝关节骨关节炎（Kellgren-Lawrence分级2级）患者（男11例，女11例）分为有症状组和无症状组。参与者在跑步机上进行两次10分钟的步行，在两组之间接受18f -氟脱氧葡萄糖静脉注射，并接受正电子发射断层扫描-计算机断层扫描。感兴趣的区域被人工分割成从骨盆到足部的35块骨骼肌。计算标准化摄取值，定量检测肌肉组织对18f -氟脱氧葡萄糖的摄取。结果：有症状组髋外展肌和外旋肌的平均标准化摄取值低于无症状组，并显示中等效应大小(臀中肌，P = 0.281；D = 0.482；臀小肌，P = 0.079；D = 0.793；梨状肌，P = 0.184；D = 0.622)。尽管股内侧肌表现出中等效应(P = 0.191；d = 0.597)，股直肌(P = 0.454；d = 0.299)，股外侧肌(P = 0.303；d = 0.392)，股中间肌(P = 0.300；D = 0.434)无显著差异，效应量较小。因此，各组之间没有观察到股四头肌代谢的总体差异。结论：在症状性膝骨关节炎患者中观察到下髋关节外展肌和外旋肌代谢的趋势，提示肌肉代谢可能与膝关节症状有关。

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