Journal of Orthopaedic Science最新文献_第8页

Intradiscal treatment with recombinant human MMP-7 for patients with lumbar disc herniation: A sham-controlled multicenter, single-blind, dose-escalation, single-dose, phase I/IIa study 重组人MMP-7椎间盘内治疗腰椎间盘突出症患者：一项假对照、单盲、剂量递增、单剂量、I/IIa期研究

IF 1.4 4区医学 Q3 ORTHOPEDICS

Journal of Orthopaedic Science

Pub Date : 2025-11-01 DOI: 10.1016/j.jos.2025.02.002

Hirotaka Haro , Tersuro Ohba , Kota Watanabe , Daisuke Nakashima , Satoshi Funayama , Hiroshi Yokomichi , Motohiro Kobayashi , Masaru Iwasaki , Hiromichi Komori , Masaya Nakamura

Background

This sham-controlled multicenter, single-blind, dose-escalation, single-dose, phase I/IIa study aimed to validate the safety and exploratory efficacy of intradiscal administration of recombinant human (rh) MMP-7 (KTP-001) for patients with lumbar disc herniation.

Methods

The cohort consisted of three groups. Cohort 1 (C1): three patients in the Sham group, three patients in the KTP-001 X-μg group. Cohort 2 (C2): six patients in the KTP-001 2X-μg group. Cohort 3 (C3): six patients in the KTP-001 4X-μg group. Under X-ray guidance, KTP-001 was injected into center part of the intervertebral disc at the level of herniated disc. The patients between the ages of 20 and 60 years had a subligamentous extrusion type of lumbar disc herniation at the L3–L4, L4–L5, or L5–S1 level. Adverse events, vital signs, clinical tests, magnetic resonance imaging (MRI), X-ray images, and anti-KTP-001 antibodies were used as primary endpoints to evaluate the safety of the investigational drug. The secondary endpoints were low back and leg pain intensity, neurological findings, Oswestry Disability Index, serum keratan sulfate pharmacodynamics, and hernia size on MRI to evaluate exploratory efficacy. The observation period was up to 24 weeks after administration.

Results

A total of 19 patients participated in the trial. No adverse events resulted in death or led to treatment discontinuation. Furthermore, CTCAE Grade 3 or higher adverse events did not occur. No changes were observed in the intervertebral discs or endplates that could be strongly attributed to drug administration based on MRI and X-ray radiographic. All the subjects remained negative for anti-KTP-001 antibody. Early after the treatment, we observed statistically significant improvements in neurological findings, SLR test results, and ODI results.

Conclusions

Even if administered immediately after the onset of the disease and confirmation of the diagnosis, intradiscal treatment with KTP-001 may be safe and tolerable.

背景：这项假对照多中心、单盲、剂量递增、单剂量、I/IIa期研究旨在验证椎间盘内给药重组人（rh） MMP-7 （KTP-001）治疗腰椎间盘突出症患者的安全性和探索性疗效。方法：该队列分为三组。队列1 (C1): Sham组3例，KTP-001 X-μg组3例。队列2 (C2): KTP-001 2X-μg组6例患者。队列3 (C3): KTP-001 4X-μg组6例患者。在x线引导下，将KTP-001注射到椎间盘突出水平的椎间盘中心部位。年龄在20 - 60岁之间的患者在L3-L4、L4-L5或L5-S1水平有韧带下挤压型腰椎间盘突出症。不良事件、生命体征、临床试验、磁共振成像（MRI）、x射线图像和抗ktp -001抗体被用作评估研究药物安全性的主要终点。次要终点是腰痛和腿部疼痛强度、神经学表现、Oswestry残疾指数、血清硫酸角蛋白药效学和MRI上的疝大小，以评估探查效果。给药后观察期为24周。结果：共有19例患者参加了试验。没有不良事件导致死亡或导致治疗中断。此外，CTCAE 3级或更高的不良事件没有发生。基于MRI和x射线摄影，未观察到椎间盘或终板的变化，这些变化可强烈归因于药物给药。所有受试者抗ktp -001抗体均为阴性。治疗后早期，我们观察到神经学表现、SLR测试结果和ODI结果在统计学上有显著改善。结论：即使在疾病发作和确诊后立即给予治疗，用KTP-001椎间盘内治疗可能是安全且耐受的。

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引用次数: 0

A novel, easy-to-use scoring system for the diagnosis of extraforaminal stenosis of lumbosacral transition using X-ray and CT scan 一种新的，易于使用的评分系统，用于诊断椎间孔外狭窄的腰骶过渡使用x线和CT扫描。

IF 1.4 4区医学 Q3 ORTHOPEDICS

Journal of Orthopaedic Science

Pub Date : 2025-11-01 DOI: 10.1016/j.jos.2025.03.001

Kohei Takahashi , Myo Min Latt , Takumi Tsubakino , Manabu Suzuki , Takeshi Nakamura , Takeshi Hoshikawa , Tomowaki Nakagawa , Ko Hashimoto , Takahiro Onoki , Toshimi Aizawa , Yasuhisa Tanaka

Background

The diagnosis of extraforaminal stenosis of the lumbosacral transition (ESLT) using conventional two-dimensional (2D) magnetic resonance imaging (MRI) (2D-MRI) is challenging, with some overlooking of ESLT. It is desirable to have criteria for determining whether patients require additional three-dimensional MRI (3D-MRI). In this study, we created a simple scoring system to screen for ESLT using X-rays and computed tomography (CT).

Methods

Ninety-two cases with unilateral L5 radiculopathy were recruited. We used 3D-MRI to determine the presence of ESLT. X-rays and CT were assessed by two examiners. X-rays were assessed for “vertebral inclination”, “lumbosacral overlap sign”, “lordosis angle”, “disc height”, and “vacuum phenomenon”. Axial CT slices were assessed for “transverse process drooping,” “nearthrosis” between transverse process and sacral ala, “osteosclerosis” of L5 endplate, and “osteophyte”. Correlation between ESLT and each radiological variable was assessed. Reproducible variables were defined as >0.6 for both intra- and interobserver agreement. Multivariate logistic regression analysis was performed using the radiological variables that were correlated with ESLT and judged to be reproducible. Finally, a score was assigned to each selected variable considering the odds ratio (OR), and a radiological index for screening the extraforaminal stenosis (RISE) score was established. The receiver operating characteristic (ROC) curve analysis was performed for external validation.

Results

Vertebral inclination (>3°) (OR: 4.8, p = 0.003), nearthrosis (OR: 10.2, p < 0.001), and osteophyte (OR: 5.2, p = 0.002) were selected. Considering the OR, 1 point was assigned to vertebral inclination and osteophyte, and 2 points were assigned to nearthrosis, obtaining RISE score (0–4 points). The area under the ROC curve was 0.91.

Conclusions

The RISE score accurately predicted the presence of ESLT, allowing aids in the selection of cases that require 3D-MRI.

背景：使用传统的二维（2D）磁共振成像（2D-MRI）诊断腰骶过渡段椎间孔外狭窄（ESLT）具有挑战性，有些人忽视了ESLT。希望有一个标准来确定患者是否需要额外的三维MRI （3D-MRI）。在这项研究中，我们创建了一个简单的评分系统，用于使用x射线和计算机断层扫描（CT）筛查ESLT。方法：选取92例单侧L5神经根病患者。我们使用3D-MRI来确定ESLT的存在。x光和CT由两名检查人员评估。x线检查“椎体倾斜”、“腰骶重叠征”、“前凸角”、“椎间盘高度”和“真空现象”。轴向CT片评估“横突下垂”、横突与骶翼之间“近关节”、L5终板“骨硬化”、“骨赘”。评估ESLT与各放射学变量的相关性。对于观察者内部和观察者之间的一致性，可重复变量被定义为>0.6。使用与ESLT相关的放射学变量进行多因素logistic回归分析，并判断其可重复性。最后，考虑比值比（OR）对每个选定的变量进行评分，并建立椎间孔外狭窄筛查的放射学指标（RISE）评分。采用受试者工作特征（ROC）曲线分析进行外部验证。结果：椎体倾斜（>.3°）（OR: 4.8, p = 0.003），近关节（OR: 10.2, p）。结论：RISE评分准确预测ESLT的存在，有助于选择需要3D-MRI的病例。

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引用次数: 0

Evaluation of the effect of stem alignment on femoral mechanical stress using simulation models of cemented total hip arthroplasty: A finite element study 利用骨水泥全髋关节置换术模拟模型评估骨杆对准对股骨机械应力的影响：一项有限元研究。

IF 1.4 4区医学 Q3 ORTHOPEDICS

Journal of Orthopaedic Science

Pub Date : 2025-11-01 DOI: 10.1016/j.jos.2025.04.015

Fumito Kobayashi , Kenichi Oe , Daisuke Suzuki , Shohei Sogawa , Arata Kanaizumi , Takanori Saito

Background

This study investigated the effects of cemented stem alignment on the femoral mechanical stress in total hip arthroplasty (THA) simulation models using finite element analysis (FEA) and verified whether only the commonly used von Mises equivalent stress was sufficient for evaluating mechanical stress.

Methods

We performed 20 consecutive THAs using collarless, polished, tapered, and cemented stems for the Dorr classification type B of osteoarthritis in March 2022. Simulation models were created using three-dimensional imaging software using postoperative computed tomography data. Under malalignment conditions, the rate of mechanical stress change for each Gruen zone was calculated using FEA. Mechanical stress was classified into von Mises equivalent, maximum principal, and minimum principal stresses.

Results

In the anterolateral view, the rates of change in all mechanical stresses showed no significant difference between the neutral and malalignment positions. In the lateral view, however, the rates of change in the maximum principal stress at zone 12 and the minimum principal stress at zones 9 and 10 significantly differed between the neutral and flexed positions. Stress mapping revealed that the maximum principal stresses tended to be high in zones 2 and 3, whereas the minimum principal stresses tended to be high in zones 5 and 6. The locations and magnitudes of stress concentrations varied depending on the stress type—von Mises equivalent, maximum principal, or minimum principal stress.

Conclusion

FEA showed that the flexion in cemented stems increases the maximum and minimum principal stresses and should therefore be avoided. Additionally, evaluating only the von Mises equivalent stress is insufficient for fully assessing the mechanical stress acting on the femur.

背景：本研究利用有限元分析（FEA）研究了骨水泥假体对全髋关节置换术（THA）模拟模型中股骨机械应力的影响，并验证了仅使用常用的von Mises等效应力是否足以评估机械应力。方法：我们于2022年3月对Dorr分类B型骨关节炎进行了20例连续tha手术，采用无颈圈、抛光、锥形和胶结茎。利用术后计算机断层扫描数据，利用三维成像软件建立仿真模型。采用有限元法计算了各格伦区的机械应力变化率。将机械应力分为von Mises等效应力、最大主应力和最小主应力。结果：在前外侧视图中，所有机械应力的变化率在中立位置和错位位置之间没有显着差异。然而，从侧面看，在中立和屈曲位置之间，12区的最大主应力和9区和10区的最小主应力的变化率显着不同。应力图显示，2区和3区最大主应力较大，5区和6区最小主应力较大。应力集中的位置和大小取决于应力类型——von Mises等效应力、最大主应力和最小主应力。结论：有限元分析结果表明，骨水泥椎体的屈曲增加了最大和最小主应力，应避免屈曲。此外，仅评估von Mises等效应力不足以充分评估作用在股骨上的机械应力。

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引用次数: 0

Preoperative magnetic resonance imaging of lateral meniscus extrusion likely indicates posterior root tear in anterior cruciate ligament-injured knees 外侧半月板挤压的术前磁共振成像可能表明前交叉韧带损伤的膝关节后根撕裂。

IF 1.4 4区医学 Q3 ORTHOPEDICS

Journal of Orthopaedic Science

Pub Date : 2025-11-01 DOI: 10.1016/j.jos.2025.02.005

Yusuke Yanatori, Yasushi Takata, Kazuki Asai, Mitsuhiro Kimura, Rikuto Yoshimizu, Tomoyuki Kanayama, Yoshihiro Ishida, Junsuke Nakase

Background

A lateral meniscal posterior root tear (LMPRT) is a known complication of anterior cruciate ligament (ACL) injury. Complete repair of meniscal posterior root tears is essential for preventing degenerative changes in the knee that may result from meniscal extrusion and rotational instability. This study aimed to assess the relationship between LMPRT morphology and preoperative lateral meniscal extrusion (LME) and to determine the cutoff value for complete LMPRT based on preoperative LME measurements.

Methods

We retrospectively analyzed 403 patients who underwent ACL reconstruction at our hospital between 2011 and 2021. The study finally included 35 patients with LMPRT and 20 with an intact lateral meniscus (LM) as controls. Based on the arthroscopic findings during ACL reconstruction, the 35 patients were divided into two groups: partial (type 1) and complete (types 2–5) LMPRT, in accordance with the LaPrade Classification. The degree of LME was measured using magnetic resonance imaging (MRI).

Results

The partial LMPRT group comprised 17 knees (10 male and 7 female patients), and the complete LMPRT group comprised 18 knees (9 male and 9 female patients). MRI revealed notably greater preoperative LME measurements in cases of complete LMPRT than in cases of both partial LMPRT and intact LM. Receiver operating curve analysis established the optimal cutoff threshold of 2.2 mm for a preoperative LME, with a sensitivity of 78 % and specificity of 71 % for predicting complete LMPRT.

Conclusions

The findings of this study indicate a higher degree of LME in complete LMPRT than in partial LMPRT in knees with ACL injury. Additionally, in patients with ACL injuries, a preoperative MRI measurement of LME ≥2.2 mm suggests a greater likelihood of complete LMPRT.

背景：外侧半月板后根撕裂（lprt）是已知的前交叉韧带（ACL）损伤的并发症。半月板后根撕裂的完全修复对于防止因半月板挤压和旋转不稳定导致的膝关节退行性改变是必不可少的。本研究旨在评估lprt形态与术前外侧半月板挤压（LME）之间的关系，并根据术前LME测量确定完整lprt的临界值。方法：回顾性分析2011年至2021年在我院进行ACL重建的403例患者。该研究最终纳入了35例lprt患者和20例完整外侧半月板（LM）患者作为对照。根据前交叉韧带重建时的关节镜表现，将35例患者按照LaPrade分类分为部分（1型）和完全（2-5型）lprt两组。采用磁共振成像（MRI）测量LME程度。结果：部分lprt组包括17个膝关节（男性10例，女性7例），完全lprt组包括18个膝关节（男性9例，女性9例）。MRI显示，完全lprt患者术前LME测量值明显大于部分lprt和完整LM患者。受试者工作曲线分析确定术前LME的最佳截止阈值为2.2 mm，预测完全lprt的敏感性为78%，特异性为71%。结论：本研究结果表明，在ACL损伤的膝关节中，完全lprt的LME程度高于部分lprt。此外，对于ACL损伤的患者，术前MRI测量LME≥2.2 mm表明lprt完全的可能性更大。

{"title":"Preoperative magnetic resonance imaging of lateral meniscus extrusion likely indicates posterior root tear in anterior cruciate ligament-injured knees","authors":"Yusuke Yanatori, Yasushi Takata, Kazuki Asai, Mitsuhiro Kimura, Rikuto Yoshimizu, Tomoyuki Kanayama, Yoshihiro Ishida, Junsuke Nakase","doi":"10.1016/j.jos.2025.02.005","DOIUrl":"10.1016/j.jos.2025.02.005","url":null,"abstract":"<div><h3>Background</h3><div>A lateral meniscal posterior root tear (LMPRT) is a known complication of anterior cruciate ligament (ACL) injury. Complete repair of meniscal posterior root tears is essential for preventing degenerative changes in the knee that may result from meniscal extrusion and rotational instability. This study aimed to assess the relationship between LMPRT morphology and preoperative lateral meniscal extrusion (LME) and to determine the cutoff value for complete LMPRT based on preoperative LME measurements.</div></div><div><h3>Methods</h3><div>We retrospectively analyzed 403 patients who underwent ACL reconstruction at our hospital between 2011 and 2021. The study finally included 35 patients with LMPRT and 20 with an intact lateral meniscus (LM) as controls. Based on the arthroscopic findings during ACL reconstruction, the 35 patients were divided into two groups: partial (type 1) and complete (types 2–5) LMPRT, in accordance with the LaPrade Classification. The degree of LME was measured using magnetic resonance imaging (MRI).</div></div><div><h3>Results</h3><div>The partial LMPRT group comprised 17 knees (10 male and 7 female patients), and the complete LMPRT group comprised 18 knees (9 male and 9 female patients). MRI revealed notably greater preoperative LME measurements in cases of complete LMPRT than in cases of both partial LMPRT and intact LM. Receiver operating curve analysis established the optimal cutoff threshold of 2.2 mm for a preoperative LME, with a sensitivity of 78 % and specificity of 71 % for predicting complete LMPRT.</div></div><div><h3>Conclusions</h3><div>The findings of this study indicate a higher degree of LME in complete LMPRT than in partial LMPRT in knees with ACL injury. Additionally, in patients with ACL injuries, a preoperative MRI measurement of LME ≥2.2 mm suggests a greater likelihood of complete LMPRT.</div></div>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":"30 6","pages":"Pages 1117-1120"},"PeriodicalIF":1.4,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143523815","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 effect of varus deformity on rotational geometry of the distal femur in osteoarthritic knees 骨关节炎膝内翻畸形对股骨远端旋转几何形状的影响。

IF 1.4 4区医学 Q3 ORTHOPEDICS

Journal of Orthopaedic Science

Pub Date : 2025-11-01 DOI: 10.1016/j.jos.2025.04.005

Jong-Hyub Song , Sung-Sahn Lee , Dae-Hee Lee

Background

Accurate rotational positioning of the femoral component is one of the most important factors for successful total knee arthroplasty (TKA). The effect of varus deformity severity on distal femoral condylar geometry in the axial plane remains unclear. The purpose was to investigate the relationship between varus deformity severity and change in distal femoral posterior condyle phenotype.

Methods

A total 400 patients who underwent TKA for medial osteoarthritis were enrolled between August 2015 and May 2021. Preoperative computed tomography (CT) scan was used. The angle formed by surgical and clinical transepicondylar axes (TEA) and posterior condylar line (PCL) were measured: posterior condylar angle (PCA) and condylar twist angle. The anteromedial condyle, anterolateral condyle, posteromedial condyle (PMC) posterolateral condyle lengths were also measured on CT. The distal femur geometry parameters were compared between severe (hip-knee-ankle [HKA] angle ≥10°) and mild (HKA varus <10°) varus groups.

Results

The PCA angle was 0.79° smaller in the severe varus group (n = 228) than in the mild varus group (n = 172). The PMC distance was 0.86 mm lower in the severe varus group. Multiple linear regression identified the HKA angle, medial proximal tibia angle (MPTA), and PMC dimensions as predictors of the PCA. ROC analysis showed that the optimum cutoff value for a PCA <3° was an HKA angle of 8.9° (P = 0.010) and an MPTA of 85.5° (P < 0.001).

Conclusion

The PCA and PMC were smaller in severe varus than in mild varus osteoarthritic knees.

Study design

Case series; Level of Evidence IV.

背景：股骨假体的准确旋转定位是全膝关节置换术（TKA）成功的重要因素之一。内翻畸形严重程度对股骨远端髁轴面几何形状的影响尚不清楚。目的是探讨内翻畸形严重程度与股骨远端后髁表型变化之间的关系。方法：在2015年8月至2021年5月期间，共招募了400名接受TKA治疗内侧骨关节炎的患者。术前采用计算机断层扫描（CT）。测量手术和临床经髁轴（TEA）与后髁线（PCL）形成的角度：后髁角（PCA）和髁扭转角。在CT上测量前内侧髁、前外侧髁、后内侧髁（PMC）后外侧髁的长度。比较重度（髋关节-膝关节-踝关节[HKA]角度≥10°）和轻度（HKA内翻）股骨远端几何参数。结果：重度内翻组（n = 228）比轻度内翻组（n = 172） PCA角度小0.79°。严重内翻组PMC距离降低0.86 mm。多元线性回归发现HKA角、内侧胫骨近端角（MPTA）和PMC维度是PCA的预测因子。ROC分析显示PCA的最佳临界值。结论：重度内翻的PCA和PMC小于轻度内翻的骨关节炎膝关节。研究设计：病例系列；证据级别IV。

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引用次数: 0

Morphological characteristics of the flexor hallucis longus groove and tendon quality in patients with hallux rigidus: A CT-based study 拇刚性患者拇长屈肌沟的形态特征和肌腱质量：一项基于ct的研究。

IF 1.4 4区医学 Q3 ORTHOPEDICS

Journal of Orthopaedic Science

Pub Date : 2025-11-01 DOI: 10.1016/j.jos.2025.03.013

Dan Moriwaki , Tomoyuki Nakasa , Yasunari Ikuta , Shingo Kawabata , Satoru Sakurai , Saori Ishibashi , Munekazu Kanemitsu , Nobuo Adachi

Background

The etiology of hallux rigidus is still unknown and elucidating targeted factors to prevent hallux rigidus or improve treatment outcomes is essential. An association between flexor hallucis longus (FHL) tendon tightness and hallux rigidus development has been suspected; however, the characteristics of the FHL tendon in the hallux rigidus remain unclear. This study aimed to explore the quality of the FHL tendon and the morphological characteristics of the FHL tendon groove at the talus and sustentaculum tali in the pathogenesis of hallux rigidus.

Methods

Twenty-one feet with hallux rigidus and 15 feet without hallux rigidus were retrospectively reviewed. The ratio of the FHL tendon groove depth to the FHL tendon anteroposterior diameter (groove/tendon ratio), Hounsfield unit (HU) values of the cancellous bone below the FHL tendon groove to those of the navicular (groove HU ratio) were measured using computed tomography at the talus and sustentaculum tali. The ratio of HU values inside the FHL tendon to those inside the tibialis anterior tendon (tendon HU ratio) were measured at the FHL tendon groove of the talus, that of the sustentaculum tali, and below the sesamoids.

Results

The depth of the FHL tendon groove, groove/tendon ratio, and groove HU ratio were significantly larger in the hallux rigidus group; the FHL tendons of the hallux rigidus group were deeply fitted into the FHL groove than those of the control group. The tendon HU ratio was significantly smaller in the hallux rigidus group.

Conclusions

The FHL tendon in the hallux rigidus can be more constrained at the FHL groove of the talus and sustentaculum tali, and its quality can change compared to that in healthy feet. Tightness of the FHL tendon should be considered when treating hallux rigidus.

Level of evidence

Ⅲ

背景：拇趾僵硬的病因尚不清楚，阐明预防拇趾僵硬或改善治疗效果的靶向因素至关重要。拇长屈肌（FHL）肌腱紧度与拇刚性发展之间存在关联。然而，拇僵直中FHL肌腱的特征尚不清楚。本研究旨在探讨拇趾僵直的发病机制中距骨和距支撑处拇趾肌腱的质量和形态特征。方法：回顾性分析21脚拇僵直和15脚非拇僵直的临床资料。在距骨和支撑骨处使用计算机断层扫描测量FHL肌腱沟深度与FHL肌腱前后径的比值（沟/腱比值），FHL肌腱沟下方松质骨与舟骨的Hounsfield单位值（HU比值）。在距骨、距支撑骨和籽状骨以下的FHL肌腱沟处测量FHL肌腱内HU值与胫骨前肌腱内HU值之比（肌腱HU比）。结果：拇僵直组FHL肌腱沟深度、沟/腱比、沟HU比明显大于拇僵直组；拇僵直组拇前屈肌腱与拇前屈肌腱槽的贴合深度大于对照组。拇趾僵直组肌腱HU比值明显减小。结论：拇刚性足的FHL肌腱在距骨和距支撑的FHL沟处受到更多的约束，其质量与健康足相比会发生变化。治疗拇趾僵直时应考虑拇趾前屈肌腱的松紧程度。证据级别：Ⅲ。

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引用次数: 0

Regional dependency of sex differences in height-adjusted knee cartilage thickness in KL0 knees using 3D-MRI 利用3D-MRI观察KL0膝关节高度调节后膝关节软骨厚度性别差异的区域依赖性。

IF 1.4 4区医学 Q3 ORTHOPEDICS

Journal of Orthopaedic Science

Pub Date : 2025-11-01 DOI: 10.1016/j.jos.2025.04.014

Ichiro Sekiya , Hisako Katano , Hideyuki Koga , Noriya Okanouchi , Jun Masumoto , Nobutake Ozeki

Background

The prevalence of knee osteoarthritis (OA) is higher in females than in males, possibly due to cartilage characteristics. However, studies examining sex differences in normal knee cartilage thickness, particularly those that adjust for height and regional variation, remain limited. This study examined sex differences in cartilage thickness across six regions of Kellgren–Lawrence grade 0 (KL0) knees, using sex, height, and age as explanatory variables.

Methods

KLO knees in the Kanagawa Knee Study (n = 573) were analyzed using automated KL-grading software. Cartilage thickness was quantified using automated three-dimensional magnetic resonance imaging (3D-MRI) in six regions: the medial femur (MF), medial tibia (MT), lateral femur (LF), trochlear femur (TrF), lateral tibia (LT), and patella (P). Multiple regression analysis was performed using sex, height, and age as explanatory variables. Uncorrected cartilage thickness was compared among regions for each sex using one-way analysis of variance (ANOVA). Statistical significance was set at P < 0.05.

Results

The study included 306 KL0 knees (138 females, 168 males), with females being younger and shorter than males. After height adjustment, females showed significantly thinner cartilage in the MF, MT, LF, and TrF regions, while the LT and P regions showed no sex differences. All regions showed positive correlations between cartilage thickness and height. In both sexes, the P region had the thickest cartilage, followed by LT.

Conclusions

Sex differences in cartilage thickness showed regional dependency in KL0 knees. While most regions showed thinner cartilage in females after height adjustment, the LT and P regions, characterized by greater cartilage thickness, showed no sex differences.

背景：膝关节骨性关节炎（OA）的患病率女性高于男性，可能是由于软骨的特点。然而，检查正常膝关节软骨厚度的性别差异的研究，特别是那些根据身高和区域差异进行调整的研究，仍然有限。本研究使用性别、身高和年龄作为解释变量，考察了Kellgren-Lawrence分级0 （KL0）膝关节六个区域软骨厚度的性别差异。方法：使用自动kl分级软件对神奈川膝关节研究中的KLO膝关节（n = 573）进行分析。使用自动三维磁共振成像（3D-MRI）对六个区域的软骨厚度进行量化：股骨内侧（MF）、胫骨内侧（MT）、股骨外侧（LF）、股骨滑车（TrF）、胫骨外侧（LT）和髌骨(P)。以性别、身高、年龄为解释变量进行多元回归分析。使用单因素方差分析（ANOVA）比较各性别区域间未校正的软骨厚度。差异有统计学意义，P < 0.05。结果：本研究共纳入306个KL0膝关节（女性138个，男性168个），女性比男性更年轻、更矮。调整身高后，女性MF、MT、LF、TrF区软骨明显变薄，而LT、P区无性别差异。各区域软骨厚度与高度呈正相关。在两性中，P区软骨最厚，lt区次之。结论：KL0膝关节软骨厚度的性别差异具有区域依赖性。女性在调整身高后，大部分区域的软骨较薄，而以软骨厚度较大为特征的LT和P区域没有性别差异。

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引用次数: 0

Clinical comparison of modified sinus tarsi approach and L-shaped approach in open reduction and internal fixation for Sanders typeIII-IV intra-articular calcaneal fractures: Complications, security, effectiveness analysis 改良跗骨窦入路与l型入路切开复位内固定治疗Sanders iii - iv型跟骨关节内骨折的临床比较：并发症、安全性、有效性分析。

IF 1.4 4区医学 Q3 ORTHOPEDICS

Journal of Orthopaedic Science

Pub Date : 2025-11-01 DOI: 10.1016/j.jos.2025.02.004

Yang Bin , Zhang Xingguo , Li Hua , Wang Decheng

Background

L-shaped incision is the most widely used approach for treating calcaneal fracture; however, it has been associated with various complications, such as wound infection, skin edge necrosis, postoperative fracture malunion, and traumatic arthritis. Accordingly, this surgical approach should be re-examined. This study aimed to investigate the clinical effect and safety of the modified sinus tarsi approach in open reduction and internal fixation for Sanders type III-IV calcaneal fractures and compare it with the traditional L-shaped approach.

Methods

This retrospective study enrolled 72 patients with unilateral closed Sanders type III-IV calcaneal fractures treated with a modified sinus tarsi approach (38 patients) and L-shaped approach (34 patients) from May 2018 to June 2020. Postoperative complications and changes in calcaneal Böhler angle, Gissane angle, and Varus angle were observed and compared between the two groups before and 3 days, and 12 months after the operation. At 12 months after the operation, the Maryland foot function score, AOFAS score, and VAS score were used to evaluate the recovery of foot function in both groups.

Results

The modified tarsal sinus approach group had significantly shorter incision healing time (9.8 ± 1.9 d) and operation time (75.53 ± 21.12 min), as well as fewer wound-healing complications (2.6 %) compared to the L-shaped approach group (P < 0.05). There were no significant differences in the Böhler, Gissane, and Varus angles between the two groups after the operation. At 12 months after the operation, no significant differences were observed in Maryland, AOFAS, and VAS scores.

Conclusion

The modified sinus tarsi and L-shaped approaches had similar clinical effects in the treatment of Sanders type III-IV calcaneal fractures. However, the treatment of modified sinus tarsi approaches in open reduction and internal fixation for Sanders type III-IV calcaneal fractures implies small incision, low degree of soft tissue injury, and low wound-healing complications, thus resulting in an effective minimally invasive treatment for Sanders type III-IV calcaneal fractures.

背景：l形切口是治疗跟骨骨折最常用的入路；然而，它与各种并发症有关，如伤口感染、皮肤边缘坏死、术后骨折不愈合和创伤性关节炎。因此，应重新检查该手术入路。本研究旨在探讨改良跗骨窦入路在Sanders III-IV型跟骨骨折切开复位内固定中的临床疗效和安全性，并与传统l型入路进行比较。方法：本回顾性研究纳入2018年5月至2020年6月72例单侧闭合性Sanders III-IV型跟骨骨折患者，采用改良跗骨窦入路（38例）和l型入路（34例）。观察两组患者术后并发症及跟骨关节Böhler角、Gissane角、内翻角变化，并比较术前、术后3天及术后12个月的差异。术后12个月，采用Maryland足功能评分、AOFAS评分、VAS评分评价两组足功能恢复情况。结果：改良跗骨窦入路组切口愈合时间（9.8±1.9 d）和手术时间（75.53±21.12 min）明显短于l型入路组，创面愈合并发症发生率（2.6%）明显低于l型入路组(P)。结论：改良跗骨窦入路与l型入路治疗Sanders III-IV型跟骨骨折临床疗效相近。改良跗骨窦入路治疗Sanders III-IV型跟骨骨折切开复位内固定，切口小，软组织损伤程度低，创面愈合并发症少，可有效微创治疗Sanders III-IV型跟骨骨折。

{"title":"Clinical comparison of modified sinus tarsi approach and L-shaped approach in open reduction and internal fixation for Sanders typeIII-IV intra-articular calcaneal fractures: Complications, security, effectiveness analysis","authors":"Yang Bin , Zhang Xingguo , Li Hua , Wang Decheng","doi":"10.1016/j.jos.2025.02.004","DOIUrl":"10.1016/j.jos.2025.02.004","url":null,"abstract":"<div><h3>Background</h3><div>L-shaped incision<span><span> is the most widely used approach for treating calcaneal fracture; however, it has been associated with various complications, such as wound infection, skin edge necrosis, postoperative </span>fracture malunion<span><span>, and traumatic arthritis. Accordingly, this surgical approach should be re-examined. This study aimed to investigate the clinical effect and safety of the modified sinus tarsi approach in </span>open reduction and internal fixation for Sanders type III-IV calcaneal fractures and compare it with the traditional L-shaped approach.</span></span></div></div><div><h3>Methods</h3><div>This retrospective study enrolled 72 patients with unilateral closed Sanders type III-IV calcaneal fractures treated with a modified sinus tarsi approach (38 patients) and L-shaped approach (34 patients) from May 2018 to June 2020. Postoperative complications and changes in calcaneal Böhler angle, Gissane angle, and Varus angle were observed and compared between the two groups before and 3 days, and 12 months after the operation. At 12 months after the operation, the Maryland foot function score, AOFAS score, and VAS score were used to evaluate the recovery of foot function in both groups.</div></div><div><h3>Results</h3><div>The modified tarsal sinus approach group had significantly shorter incision healing time (9.8 ± 1.9 d) and operation time (75.53 ± 21.12 min), as well as fewer wound-healing complications (2.6 %) compared to the L-shaped approach group (<em>P</em> < 0.05). There were no significant differences in the Böhler, Gissane, and Varus angles between the two groups after the operation. At 12 months after the operation, no significant differences were observed in Maryland, AOFAS, and VAS scores.</div></div><div><h3>Conclusion</h3><div><span>The modified sinus tarsi and L-shaped approaches had similar clinical effects in the treatment of Sanders type III-IV calcaneal fractures. However, the treatment of modified sinus tarsi approaches in open reduction and internal fixation for Sanders type III-IV calcaneal fractures implies small incision, low degree of soft tissue injury, and low wound-healing complications, thus resulting in an effective </span>minimally invasive treatment for Sanders type III-IV calcaneal fractures.</div></div>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":"30 6","pages":"Pages 1110-1116"},"PeriodicalIF":1.4,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143523814","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

Antimicrobial prophylaxis with ampicillin/sulbactam versus cefazolin for orthopedic implant-related surgical site infections: A retrospective cohort study 氨苄西林/舒巴坦与头孢唑林预防骨科植入物相关手术部位感染：一项回顾性队列研究

IF 1.4 4区医学 Q3 ORTHOPEDICS

Journal of Orthopaedic Science

Pub Date : 2025-11-01 DOI: 10.1016/j.jos.2025.03.010

Masaki Hatano , Yusuke Sasabuchi , Shotaro Aso , Koji Yamada , Hisatoshi Ishikura , Takeyuki Tanaka , Sakae Tanaka , Hideo Yasunaga

Background

Cefazolin is widely used for surgical prophylaxis in orthopedic implant surgeries. However, there is insufficient evidence of the superiority of cefazolin over other antibiotics, such as ampicillin/sulbactam (ABPC/SBT), in reducing surgical site infection (SSI). Moreover, concerns exist regarding the adverse events associated with these antimicrobial agents, such as Clostridioides difficile infection. This study aimed to evaluate the comparative effectiveness of ABPC/SBT versus cefazolin prophylaxis in reducing SSI and all-cause mortality rates and its safety regarding Clostridioides difficile infection in major orthopedic implant surgeries.

Methods

This retrospective cohort study used data from the Diagnosis Procedure Combination database in Japan. We included adult patients who underwent a major orthopedic implant surgery between July 2010 and March 2022. Patients underwent surgery with either cefazolin or ABPC/SBT prophylaxis. The primary outcome was in-hospital SSI, whereas the secondary outcomes were 90-day SSI, 1-year SSI, in-hospital all-cause mortality, and Clostridioides difficile infection. The outcomes were compared between the two groups using propensity-score overlap weighting.

Results

We identified 440,651 eligible patients, including 17,651 in the ABPC/SBT group and 423,000 in the cefazolin group. The propensity-score overlap weighting successfully balanced patient and institutional characteristics between the groups. No significant differences were observed in in-hospital SSI (risk difference, −0.02 %; 95 % confidence interval (CI), −0.13 to 0.10 %), 90-day SSI (risk difference, 0.00 %; 95 % CI, −0.13 to 0.14 %), 1-year SSI (risk difference, −0.02 %; 95 % CI, −0.17 to 0.13 %), or in-hospital mortality (risk difference, −0.01 %; 95 % CI, −0.05 to 0.04 %) between the groups. However, the ABPC/SBT group had a significantly lower Clostridioides difficile infection (risk difference, −0.02 %; 95 % CI, −0.03 to −0.01 %) than that of the cefazolin group.

Conclusions

ABPC/SBT may be comparable to cefazolin as an alternative therapy for preventing early SSIs in patients who undergo major orthopedic implant surgery, with a lower risk of Clostridioides difficile infection.

背景：头孢唑林广泛用于骨科植入手术的手术预防。然而，没有足够的证据表明头孢唑林在减少手术部位感染（SSI）方面优于氨苄西林/舒巴坦（ABPC/SBT）等其他抗生素。此外，人们还关注与这些抗菌剂相关的不良事件，如艰难梭菌感染。本研究旨在评估ABPC/SBT与头孢唑林预防在降低主要骨科植入手术中SSI和全因死亡率方面的比较效果及其对艰难梭菌感染的安全性。方法：本回顾性队列研究使用来自日本诊断程序组合数据库的数据。我们纳入了在2010年7月至2022年3月期间接受过重大骨科植入手术的成年患者。患者接受头孢唑林或ABPC/SBT预防的手术。主要结局是院内SSI，次要结局是90天SSI、1年SSI、院内全因死亡率和艰难梭菌感染。使用倾向得分重叠加权比较两组之间的结果。结果：我们确定了440,651例符合条件的患者，其中ABPC/SBT组为17,651例，头孢唑林组为423,000例。倾向评分重叠加权成功地平衡了两组之间的患者和机构特征。院内SSI无显著性差异(风险差异- 0.02%；95%置信区间（CI）， -0.13 ~ 0.10%)， 90天SSI(风险差，0.00 %；95%可信区间-0.13 - 0.14%),1年期SSI(风险差异,-0.02%;95% CI, -0.17 ~ 0.13%)或院内死亡率(风险差异，- 0.01%；95% CI, -0.05 ~ 0.04%)。然而，ABPC/SBT组的艰难梭菌感染显著降低(风险差异为- 0.02%；95% CI（-0.03 ~ - 0.01%）高于头孢唑林组。结论：ABPC/SBT可与头孢唑林媲美，作为一种替代疗法，用于预防接受重大骨科植入手术的患者早期ssi，且艰难梭菌感染的风险较低。

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引用次数: 0

Motor-evoked potential analysis of peroneal nerve status during lateral closed wedge high tibial osteotomy 外侧闭合楔形高位胫骨截骨术中腓神经状态的运动诱发电位分析。

IF 1.4 4区医学 Q3 ORTHOPEDICS

Journal of Orthopaedic Science

Pub Date : 2025-11-01 DOI: 10.1016/j.jos.2025.04.008

Tetsuro Ishimatsu, Akira Maeyama, Taiki Matsunaga, Takuaki Yamamoto

Introduction

Common peroneal nerve (CPN) palsy has been reported as an intraoperative complication during lateral closed wedge high tibial osteotomy (CWHTO). However, various intraoperative iatrogenic causes have been reported, the specific cause of CPN palsy has not been clearly established. The present study aimed to clarify the effects of retractors on CPN status in CWHTO.

Materials and methods

23 knees of 18 patients underwent CWHTO with transcranial motor-evoked potential (MEP) analysis. The CPN integrity was tested at four time-points: preoperatively as a control (first period); just after retractor placement on the fibula for fibular osteotomy in the middle portion (second period); just after retractor placement on the posterior tibia to pull the tibialis anterior muscle (third period); and after the procedure (fourth period). Postoperative CPN damage was evaluated by the presence of paralysis and a manual muscle test (MMT) for strength of ankle dorsiflexion.

Results

There was no significant difference in the mean amplitude of the CPN between the first (100 %) and 92.6 % (range, 64–100 %) in the second periods (p = 0.53); however, the amplitude was significantly reduced from the second period to 59.0 % (range, 15–100 %) in the third period (p < 0.01), and then significantly improved to 77.4 % (range, 20–100 %) in the fourth period (p < 0.01). In 20 knees (87.0 %), the amplitude of the CPN in the third period was reduced. All 18 patients had postoperative MMT grade of 5 without paralysis of the CPN.

Conclusion

20 of 23 knees (87.0 %) revealed a significant reduction of the CPN amplitude by the retractor on the posterior tibia. Therefore, the posterior retractor should be carefully placed on the common peroneal nerve in CWHTO.

简介：腓总神经（CPN）麻痹已被报道为外侧闭合楔形高位胫骨截骨术（CWHTO）的术中并发症。然而，各种术中医源性原因已被报道，CPN麻痹的具体原因尚未明确确定。本研究旨在阐明牵开器对CWHTO中CPN状态的影响。材料与方法：18例患者23膝行经颅运动诱发电位（MEP）分析。在四个时间点检测CPN完整性：术前作为对照（第一期）；在腓骨上放置牵开器后进行腓骨中段截骨术（第二期）；将牵开器放置于胫骨后端后拉胫骨前肌（第三期）；手术后（第四期）。术后CPN损伤通过麻痹的存在和踝关节背屈强度的手动肌肉测试（MMT）来评估。结果：第一期CPN平均振幅（100%）与第二期92.6%（64 ~ 100%）无显著差异（p = 0.53）；然而，幅度从第2期明显下降到第3期59.0%（范围，15- 100%）（p < 0.01），第4期显著提高到77.4%（范围，20- 100%）（p < 0.01）。20个膝关节（87.0%）第三期CPN振幅降低。所有18例患者术后MMT评分均为5级，无CPN瘫痪。结论：23个膝关节中有20个（87.0%）表现出胫骨后端牵开器对CPN振幅的显著降低。因此，在CWHTO中，后牵开器应小心地放置在腓总神经上。

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引用次数: 0