Journal of Orthopaedic Science最新文献_第9页

The incidence and cause of reoperation for complications after volar locking plate fixation of distal radial fractures 桡骨远端掌侧锁定钢板内固定术后并发症的发生率及原因分析。

IF 1.4 4区医学 Q3 ORTHOPEDICS

Journal of Orthopaedic Science

Pub Date : 2025-11-01 DOI: 10.1016/j.jos.2025.02.006

Ching-Chieh Hung , Chin-Hsien Wu , Ching-Hou Ma , I-Ming Jou , Yuan-Kun Tu

Background

Distal radial fractures are the most common upper extremity fractures. Volar locking plate fixation has become the standard surgical treatment, providing stable angular fixation, early rehabilitation, and effective support for comminuted and osteopenic bones. This study aimed to analyze the incidence and causes of major complications requiring secondary surgeries following volar plating for distal radial fractures and to investigate the correlation between demographic factors and postoperative outcomes, including major complications and reoperation.

Methods

This retrospective study enrolled 1073 distal radial fracture cases from 1047 patients at a trauma medical center between January 2015 and June 2021. Patients under 18 years old and whose follow-up was less than 6 months or ended before the surgeon concluded their treatment were excluded. We also examined reasons for device removal, reoperation, and complications following volar plating, specifically identifying major complications requiring additional operations.

Results

Among the 1073 distal radial fracture cases, 160 patients with 168 fractures underwent secondary orthopedic operations after volar plating. Ultimately, 33 cases required additional operations for major complications, resulting in a reoperation rate of 22 % and a major complication rate of 5.3 %. Major complications included: triangular fibrocartilage complex tear, deep infection, carpal tunnel syndrome, flexor pollicis longus injury and extensor pollicis longus injury, screw penetration or loosening, and complex regional pain syndrome. Logistic regression showed a higher reoperation incidence in males and patients under 65, although age and sex were not associated with major complications.

Conclusions

This study outlined the incidence and causes of reoperation for complications following volar plating for distal radial fractures. Surgeons could benefit from preoperative counseling on potential complications and early identification and treatment. As age and sex were unrelated to postoperative complications, surgeons may consider factors like fracture patterns, functional demands, and baseline activity when determining treatment options with patients.

背景：桡骨远端骨折是最常见的上肢骨折。掌侧锁定钢板固定已成为标准的手术治疗方法，为粉碎性和骨质减少的骨提供稳定的角度固定、早期康复和有效的支持。本研究旨在分析掌侧钢板治疗桡骨远端骨折后需要二次手术的主要并发症的发生率和原因，并探讨人口统计学因素与术后结果的相关性，包括主要并发症和再手术。方法：本回顾性研究纳入2015年1月至2021年6月创伤医疗中心1047例患者的1073例桡骨远端骨折病例。18岁以下、随访时间少于6个月或在外科医生结束治疗前结束的患者被排除在外。我们还检查了器械移除、再手术和掌侧电镀后并发症的原因，特别确定了需要额外手术的主要并发症。结果：1073例桡骨远端骨折中，160例168例骨折患者掌侧钢板后行二次骨科手术。最终，33例因主要并发症需要额外手术，导致再手术率为22%，主要并发症率为5.3%。主要并发症有：三角纤维软骨复合体撕裂、深部感染、腕管综合征、拇长屈肌损伤、拇长伸肌损伤、螺钉穿透或松动、复杂的局部疼痛综合征。Logistic回归显示男性和65岁以下患者的再手术发生率较高，但年龄和性别与主要并发症无关。结论：本研究概述了掌侧钢板治疗桡骨远端骨折后再手术并发症的发生率和原因。外科医生可以从术前关于潜在并发症的咨询和早期识别和治疗中获益。由于年龄和性别与术后并发症无关，外科医生在确定治疗方案时可能会考虑骨折类型、功能需求和基线活动等因素。

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引用次数: 0

Optimizing S1 nerve root block using three-dimensional computed tomography imaging: Identifying the ideal fluoroscopic angle and predicting S1 neural foramen position 利用三维计算机断层成像优化S1神经根阻滞：确定理想透视角度并预测S1神经孔位置。

IF 1.4 4区医学 Q3 ORTHOPEDICS

Journal of Orthopaedic Science

Pub Date : 2025-11-01 DOI: 10.1016/j.jos.2025.02.008

Noritaka Suzuki , Toshiaki Kotani , Shuhei Ohyama , Kotaro Sakashita , Shun Okuwaki , Shuhei Iwata , Yasushi Iijima , Masaya Mizutani , Tsuyoshi Sakuma , Sumihisa Orita , Kazuhide Inage , Yasuhiro Shiga , Masahiro Inoue , Shohei Minami , Seiji Ohtori

Background

S1 nerve root block (S1NRB) is frequently used to diagnose and treat lumbosacral and lower limb pain. However, the visibility of the S1 neural foramen can be obscured by factors including intestinal gas, increasing the procedure's technical difficulty. This study identified the optimal fluoroscopic angle for S1NRB and standardized the technique using three-dimensional (3D) computed tomography (CT) images.

Methods

We analyzed 3D CT images of 101 patients with lumbar degenerative diseases (lumbar disc herniation and lumbar spinal canal stenosis). The reference position angle (RPA) was defined as the angle where the superior endplate of the sacrum appears straight, whereas the tunnel view angle (TVA) was defined as the angle where the anterior and posterior S1 neural foramina coincide. We evaluated the relationship between the RPA and TVA, measured the position of the S1 neural foramen at the RPA using the S1 spinous process and sacroiliac joint as landmarks, and analyzed correlations with sex and body size.

Results

The mean RPA and TVA were 32.4 ± 6.4° and 34.0 ± 6.2°, respectively, with a mean difference of 1.5 ± 2.8° (r = 0.897, p < 0.0001). The horizontal distance from the S1 spinous process to the S1 neural foramen was 23.1 ± 2.1 mm, and to the sacroiliac joint was 52.0 ± 4.3 mm, with a ratio of 44.5 ± 3.4 %. The vertical distance from the S1 spinous process to the S1 neural foramen was −1.2 ± 1.7 mm caudally. In 84.2 % of the cases, the S1 neural foramen was located 0–4 mm caudal to the S1 spinous process and at 40–50 % of the horizontal distance between these landmarks. These parameters showed no significant differences based on sex or body size.

Conclusions

RPA, using the superior endplate of the sacrum as a reference, closely approximates the TVA and is a useful indicator of the optimal fluoroscopic angle for S1NRB. The S1 neural foramen position can be predicted using anatomical landmarks, irrespective of patient characteristics.

背景：S1神经根阻滞（S1NRB）常用于诊断和治疗腰骶和下肢疼痛。然而，S1神经孔的可见性可能被肠道气体等因素遮挡，增加了手术的技术难度。本研究确定了S1NRB的最佳透视角度，并使用三维（3D）计算机断层扫描（CT）图像对技术进行了标准化。方法：对101例腰椎退行性疾病（腰椎间盘突出和腰椎管狭窄）的三维CT图像进行分析。参考位角（RPA）定义为骶骨上终板呈直的角度，而隧道视角（TVA）定义为S1神经孔前后重合的角度。我们评估了RPA和TVA之间的关系，以S1棘突和骶髂关节为标志测量了RPA处S1神经孔的位置，并分析了与性别和体型的相关性。结果：RPA和TVA的平均值分别为32.4±6.4°和34.0±6.2°，平均差为1.5±2.8°（r = 0.897, p）。结论：RPA以骶骨上终板为参照，与TVA非常接近，是S1NRB最佳透视角度的一个有用指标。S1神经孔的位置可以通过解剖标志来预测，而不考虑患者的特征。

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引用次数: 0

A look back at lumbar spinal stenosis cases in older adults during the COVID-19 pandemic 回顾2019冠状病毒病大流行期间老年人腰椎管狭窄病例

IF 1.4 4区医学 Q3 ORTHOPEDICS

Journal of Orthopaedic Science

Pub Date : 2025-11-01 DOI: 10.1016/j.jos.2025.04.007

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

Background

The management of elective surgeries during the COVID-19 pandemic was controversial, and the impact on lumbar spinal stenosis (LSS) surgery outcomes remains unclear. This study aimed to retrospectively analyze older adults who underwent LSS surgery during the pandemic and compare cases from its early and late phases.

Methods

Medical records of patients aged 65 and older who underwent LSS surgery between April 2020 and April 2023 were reviewed. The Zurich Claudication Questionnaire and Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ) were administered preoperatively and at 6 months and 1 year postoperatively.

Results

The period from April 2020 to September 2021 was classified as the early phase, while October 2021 to April 2023 was classified as the late phase. This study evaluated a total of 267 older patients with LSS, with 138 undergoing surgery during the early phase and 129 during the late phase. There was one case of COVID-19 infection during hospitalization in the early phase and none in the late phase. Significant differences were found between the early and late phases in the distribution of American Society of Anesthesiologists physical status (ASA) and frequency of degenerative lumbar scoliosis (DLS). When the association between the COVID-19 pandemic phase and effective case of surgery treatment on JOABPEQ was examined, the multivariable adjusted relative risks of effective case in social life domain for the late-stage group were 0.7 (95 % CI = 0.5–0.9) at both 6 months and 1 year postoperatively using the early-phase group as the reference. No significant differences were found in the other four domains at either 6 months or 1 year postoperatively.

Conclusions

Poorer social life outcomes in the late-phase patients with LSS surgery may be attributed to worse preoperative ASA scores and changes in social life during different pandemic phases.

背景：COVID-19大流行期间择期手术的管理存在争议，对腰椎管狭窄（LSS）手术结果的影响尚不清楚。本研究旨在回顾性分析大流行期间接受LSS手术的老年人，并比较其早期和晚期的病例。方法：回顾2020年4月至2023年4月期间65岁及以上LSS手术患者的医疗记录。术前、术后6个月和1年分别进行苏黎世跛行问卷和日本骨科协会背痛评估问卷（JOABPEQ）。结果：2020年4月至2021年9月为前期，2021年10月至2023年4月为后期。本研究共评估了267例老年LSS患者，其中138例在早期接受手术，129例在晚期接受手术。早期住院期间感染1例，晚期无感染。美国麻醉医师协会生理状态（ASA）的分布和退行性腰椎侧凸（DLS）的频率在早期和晚期之间存在显著差异。当检验COVID-19大流行阶段与JOABPEQ手术治疗有效病例之间的相关性时，以早期组为参照，晚期组在术后6个月和1年的社会生活领域有效病例的多变量调整相对风险为0.7 （95% CI = 0.5-0.9）。术后6个月或1年，其他4个领域无明显差异。结论：晚期LSS手术患者较差的社会生活结果可能归因于术前ASA评分较差和不同流行阶段社会生活的变化。

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引用次数: 0

The efficacy of home-based remote rehabilitation versus usual rehabilitation for patients with knee osteoarthritis: A systematic review and meta-analysis 基于家庭的远程康复与常规康复对膝骨关节炎患者的疗效：一项系统回顾和荟萃分析。

IF 1.4 4区医学 Q3 ORTHOPEDICS

Journal of Orthopaedic Science

Pub Date : 2025-11-01 DOI: 10.1016/j.jos.2025.04.003

Eric Pasqualotto , Rafael Oliva Morgado Ferreira , Leonardo Salvatore Migliardi , Pedro Henrique Felisbino Silva , Tales Pasqualotto , Joyce Cristina Campos , Julia de Lira Kaszubowski , Sabrina da Silva , Serafim Barros , Luis Fernando Z. Funchal

Purpose

To compare home-based remote rehabilitation with usual rehabilitation care for knee osteoarthritis (OA).

Methods

PubMed, Cochrane, and Embase databases were searched for randomized controlled trials (RCTs) comparing home-based remote rehabilitation (telephone calls, video calls, apps, or websites) with usual in-person rehabilitation in patients with knee OA. Mean differences (MDs) or standardized mean differences (SMDs) were calculated for continuous outcomes and risk ratios (RRs) for binary outcomes, with 95 % confidence intervals (CIs). Statistical analyses were performed using R Software, version 4.4.1.

Results

A total of 9 RCTs were included, comprising 974 patients with knee OA, of whom 483 (49.6 %) were randomized to home-based remote rehabilitation. Compared with usual rehabilitation, home-based remote rehabilitation significantly reduced pain severity (SMD -0.34; 95 % CI -0.67 to −0.02) and significantly improved physical activity levels (SMD -0.45; 95 % CI -0.85 to −0.05). Furthermore, the home-based remote rehabilitation group showed a significant reduction in pain assessed with the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) (MD -0.95 points; 95 % CI -1.84 to −0.06), an improvement in functionality assessed with the Timed Up and Go test (MD -0.83 s; 95 % CI -1.64 to −0.02), and a greater patient satisfaction (RR 2.01; 95 % CI 1.46 to 2.76).

Conclusion

The results demonstrated that home-based remote rehabilitation reduced pain and increased patient satisfaction, however, there is insufficient evidence to state that remote rehabilitation significantly improved physical activity and functionality. Home-based remote rehabilitation appears to be a viable and effective alternative for patients with knee OA.

目的：比较家庭远程康复与常规康复治疗对膝骨关节炎（OA）的影响。方法：检索PubMed、Cochrane和Embase数据库，比较基于家庭的远程康复（电话、视频通话、应用程序或网站）与膝关节OA患者通常的面对面康复的随机对照试验（rct）。计算连续结局的平均差异（md）或标准化平均差异（SMDs），以及二元结局的风险比（rr），置信区间为95% （ci）。采用R软件4.4.1版本进行统计分析。结果：共纳入9项随机对照试验，共纳入974例膝关节OA患者，其中483例（49.6%）随机接受家庭远程康复治疗。与常规康复相比，居家远程康复显著降低疼痛严重程度(SMD -0.34；95% CI -0.67至-0.02)和显著改善的身体活动水平(SMD -0.45；95% CI -0.85 ~ -0.05)。此外，根据西安大略省和麦克马斯特大学骨关节炎指数（WOMAC）评估，以家庭为基础的远程康复组疼痛显著减轻(MD -0.95分；95% CI -1.84至-0.06)，通过Timed Up and Go测试评估的功能改善(MD -0.83 s；95% CI -1.64 ~ -0.02)，患者满意度更高(RR 2.01；95% CI 1.46 - 2.76)。结论：结果表明，以家庭为基础的远程康复减轻了疼痛，提高了患者满意度，然而，没有足够的证据表明远程康复显著改善了身体活动和功能。以家庭为基础的远程康复似乎是一个可行的和有效的替代膝关节OA患者。

{"title":"The efficacy of home-based remote rehabilitation versus usual rehabilitation for patients with knee osteoarthritis: A systematic review and meta-analysis","authors":"Eric Pasqualotto , Rafael Oliva Morgado Ferreira , Leonardo Salvatore Migliardi , Pedro Henrique Felisbino Silva , Tales Pasqualotto , Joyce Cristina Campos , Julia de Lira Kaszubowski , Sabrina da Silva , Serafim Barros , Luis Fernando Z. Funchal","doi":"10.1016/j.jos.2025.04.003","DOIUrl":"10.1016/j.jos.2025.04.003","url":null,"abstract":"<div><h3>Purpose</h3><div>To compare home-based remote rehabilitation<span> with usual rehabilitation care for knee osteoarthritis (OA).</span></div></div><div><h3>Methods</h3><div><span>PubMed, Cochrane, and Embase databases were searched for </span>randomized controlled trials<span> (RCTs) comparing home-based remote rehabilitation (telephone calls, video calls, apps, or websites) with usual in-person rehabilitation in patients with knee OA. Mean differences (MDs) or standardized mean differences (SMDs) were calculated for continuous outcomes and risk ratios (RRs) for binary outcomes, with 95 % confidence intervals (CIs). Statistical analyses were performed using R Software, version 4.4.1.</span></div></div><div><h3>Results</h3><div><span><span>A total of 9 RCTs were included, comprising 974 patients with knee OA, of whom 483 (49.6 %) were randomized to home-based remote rehabilitation. Compared with usual rehabilitation, home-based remote rehabilitation significantly reduced pain severity (SMD -0.34; 95 % CI -0.67 to −0.02) and significantly improved </span>physical activity levels (SMD -0.45; 95 % CI -0.85 to −0.05). Furthermore, the home-based remote rehabilitation group showed a significant reduction in pain assessed with the </span>Western Ontario and McMaster Universities Osteoarthritis Index<span> (WOMAC) (MD -0.95 points; 95 % CI -1.84 to −0.06), an improvement in functionality assessed with the Timed Up and Go test (MD -0.83 s; 95 % CI -1.64 to −0.02), and a greater patient satisfaction (RR 2.01; 95 % CI 1.46 to 2.76).</span></div></div><div><h3>Conclusion</h3><div>The results demonstrated that home-based remote rehabilitation reduced pain and increased patient satisfaction, however, there is insufficient evidence to state that remote rehabilitation significantly improved physical activity and functionality. Home-based remote rehabilitation appears to be a viable and effective alternative for patients with knee OA.</div></div>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":"30 6","pages":"Pages 1073-1080"},"PeriodicalIF":1.4,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144016656","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

Body weight is associated with the ability to perform deep squats in school-aged Japanese children and adolescents: A retrospective cohort study 体重与日本学龄儿童和青少年深蹲能力有关：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.2025.03.004

Manato Horii , Kohei Takahashi , Seiji Kimura , Ryuichiro Akagi , Shotaro Watanabe , Satoshi Yamaguchi , Yoshihito Ozawa , Seiji Ohtori , Takahisa Sasho

Background

The ability to perform deep squats in children and adolescents is an essential component of lower extremity function. Especially for school-aged children and adolescents, the ability to perform deep squats is related to their daily life and school activities. Few reports have investigated the factors associated with deep squats ability in this population. This study aimed to identify the factors associated with deep squat ability in healthy Japanese children and adolescents.

Methods

A retrospective cohort study was conducted with children and adolescents aged 8–14 years in Japan from 2017 to 2019. Data on height, weight, ability to perform deep squats, general joint laxity, lower limb tightness, and the Hospital for Special Surgery Pediatric Functional Activity Brief Scale score were collected at the beginning of each year. Participants who were able to squat during their musculoskeletal screening were divided into two groups: those who could deep squat the following year and those who could not. Logistic regression analysis with variable selection was performed to calculate the odds ratio for each predicted risk factor associated with the inability to perform a deep squat.

Results

A total of 636 children and adolescents were included in the analysis, with 7.5 % of them being unable to perform deep squats the following year. The risk of being unable to deep squats significantly decreased with increasing age (odds ratio 0.66, 95 % confidence interval 0.50–0.87). In addition, higher weight (odds ratio 1.12, 95 % confidence interval 1.07–1.17) and higher Hospital for Special Surgery Pediatric Functional Activity Brief Scale score (odds ratio 1.05, 95 % confidence interval 1.01–1.10) were identified as risk factors associated with the inability to perform a deep squat. Other physical factors did not significantly contribute to the occurrence of deep squat abnormalities.

Conclusions

Age, body weight, and physical activity levels were found to be associated with the ability to perform deep squats in healthy Japanese children and adolescents.

背景：儿童和青少年进行深蹲的能力是下肢功能的重要组成部分。尤其是学龄儿童和青少年，深蹲的能力与他们的日常生活和学校活动息息相关。很少有报道调查了与该人群深蹲能力相关的因素。本研究旨在确定与健康日本儿童和青少年深蹲能力相关的因素。方法：对2017 - 2019年日本8-14岁儿童和青少年进行回顾性队列研究。每年年初收集身高、体重、深蹲能力、一般关节松弛度、下肢松紧度和特种外科医院儿科功能活动简要量表评分。在肌肉骨骼筛查期间能够深蹲的参与者被分为两组：第二年能够深蹲的一组和不能深蹲的一组。采用Logistic回归分析和变量选择来计算与无法深蹲相关的每个预测风险因素的比值比。结果：共有636名儿童和青少年被纳入分析，其中7.5%的人在第二年无法进行深蹲。不能深蹲的风险随着年龄的增长而显著降低（优势比0.66,95%可信区间0.50-0.87）。此外，体重较高（优势比1.12,95%可信区间1.07-1.17）和特殊外科医院儿童功能活动简短量表得分较高（优势比1.05,95%可信区间1.01-1.10）被确定为无法进行深蹲的危险因素。其他物理因素对深蹲异常的发生没有显著影响。结论：年龄、体重和体力活动水平与健康的日本儿童和青少年深蹲能力有关。

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引用次数: 0

Biomechanical study of internal fixation methods for undisplaced femoral neck fractures with osteoporosis based on the Pauwels angle: Fixed angle device versus three cannulated screws 基于Pauwels角度的未移位股骨颈骨折伴骨质疏松内固定方法的生物力学研究：固定角度装置与三枚空心螺钉。

IF 1.4 4区医学 Q3 ORTHOPEDICS

Journal of Orthopaedic Science

Pub Date : 2025-11-01 DOI: 10.1016/j.jos.2025.04.001

Sakura Kuniyoshi, Satoshi Nakasone, Mika Takaesu, Takahiro Igei, Fumiyuki Washizaki, Kotaro Nishida

Background

This study compared the biomechanical properties of three cannulated screws (3-CSs) and a fixed angle device (FAD) for treating undisplaced femoral neck fracture (FNF) Pauwels types I and III, using finite element analysis (FEA) models created with nonlinear material properties; accurately reflecting the bone quality of osteoporotic patients.

Materials and methods

FEA involved three patients with a history of undisplaced FNF. Mesh generation was performed using the preoperative CT data. Two internal fixation models:3-CSs and FAD were created for Pauwels type I and III models with a fracture angle of 30° and 70°, respectively. Compression force and relative displacement of the fracture site, and von Mises stress (VMS) of the implants were evaluated. Data analysis involved paired t-test at p < 0.05 statistical level of significance.

Results

No significant difference was seen in the compression force between the two implants for Pauwels 30° and 70°models. There was no significant difference in the relative displacement and VMS between the two implants for Pauwels 30° model. However, both relative displacement and VMS were significantly higher in 3-CSs than in FAD for Pauwels 70° model.

Conclusion

Results indicate the need for FAD when treating Pawels Type III FNF with osteoporosis, since FAD fixation exhibited superior mechanical stability compared to 3-CSs. However, for the Pauwels Type I FNF, both fixation methods provided comparable stability. When considering the implant's simple and minimally invasive features, the clinical use of 3-CSs may be applicable. These findings highlight the importance of evaluating the Pauwels angle when determining the optimal fixation method for undisplaced FNF.

背景：本研究利用非线性材料特性建立的有限元分析（FEA）模型，比较了三枚空心螺钉（3-CSs）和固定角度装置（FAD）治疗未移位型股骨颈骨折（Pauwels I型和III型）的生物力学性能；准确反映骨质疏松患者的骨质量。材料和方法：对3例有移位性FNF病史的患者进行有限元分析。利用术前CT数据进行网格生成。对骨折角度为30°和70°的Pauwels I型和III型模型分别制作3-CSs和FAD两种内固定模型。评估骨折部位的压缩力、相对位移、von Mises应力（VMS）。数据分析采用配对t检验p。结果：在30°和70°paulwels模型中，两种种植体的压缩力无显著差异。在Pauwels 30°模型中，两种种植体的相对位移和vm无显著差异。然而，对于Pauwels 70°模型，3-CSs的相对位移和VMS均显著高于FAD。结论：结果表明，在治疗Pawels III型FNF合并骨质疏松症时，FAD是必要的，因为FAD固定比3-CSs具有更好的机械稳定性。然而，对于Pauwels I型FNF，两种固定方法的稳定性相当。考虑到种植体的简单和微创的特点，临床上使用3-CSs可能是可行的。这些发现强调了在确定未移位FNF的最佳固定方法时评估Pauwels角的重要性。

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引用次数: 0

Constant-Murley score categorization to assess outcomes after reverse shoulder arthroplasty following complex proximal humeral fracture 用Constant-Murley评分法评估复杂肱骨近端骨折后反向肩关节置换术的疗效。

IF 1.4 4区医学 Q3 ORTHOPEDICS

Journal of Orthopaedic Science

Pub Date : 2025-11-01 DOI: 10.1016/j.jos.2025.03.011

Francisco Antonio Miralles-Muñoz, Emilio Sebastiá-Forcada

Background

The Constant-Murley (CM) score is considered the gold standard of shoulder scoring systems. However, it does not include scoring categorization, and in some acute traumatic processes, a paired comparative analysis is not feasible. The purpose of this study was to determine cutoff values for the CM score that indicate a specific category on the outcome score following reverse total shoulder arthroplasty (rTSA) for fracture.

Methods

Consecutive patients with complex proximal humeral fracture who underwent rTSA from 2010 to 2022, were included in the study. Two years of postoperative follow-up was required. Postoperative clinical evaluations were conducted using the CM and University of California, Los Angeles (UCLA) scores. The correlation between CM and UCLA scores was analyzed. Then, the receiver-operating characteristic (ROC) curve was utilized to determine the cutoff points in CM scores that most effectively distinguished between categories. The UCLA categories were used as the external criterion.

Results

132 patients completed the evaluations at the 2-year follow-up. Among them, 112 (84.8 %) were females and 20 (15.2 %) were males, with a mean age of 73.5 years. The UCLA score showed a strong correlation with the CM score (r = 0.936; 95% CI 0.911–0.954; p = 0.000).

For the CM score, the cutoff for an excellent outcome was 67.5 (AUC 0.963, 95% CI 0.925–1.000), 56.5 (AUC 0.920, 95% CI 0.872–0.969) for good, 41.5 (AUC 0.701, 95% CI 0.617–0.784) for fair, and <41.5 (AUC 0.965, 95% CI 0.939–0.990) for poor.

Discussion

According to the cut-off values in the CM score used to categorize the outcomes after rTSA in proximal humeral fractures, an excellent outcome was considered a score equal to or greater than 68, good between 57 and 67 points, fair between 41 and 56 points, and a poor outcome with a score equal to or less than 40 points.

Level of evidence

III.

背景：Constant-Murley （CM）评分被认为是肩部评分系统的金标准。然而，它不包括评分分类，在一些急性创伤过程中，配对比较分析是不可行的。本研究的目的是确定CM评分的截止值，该值表示骨折反向全肩关节置换术（rTSA）后结果评分的特定类别。方法：选取2010 - 2022年连续行肱骨近端复杂骨折rTSA的患者为研究对象。术后随访2年。术后临床评估采用CM和加州大学洛杉矶分校（UCLA）评分。分析CM与UCLA评分之间的相关性。然后，利用受试者工作特征（ROC）曲线确定CM评分中最有效区分类别的截止点。UCLA分类被用作外部标准。结果：随访2年，132例患者完成评估。其中女性112例（84.8%），男性20例（15.2%），平均年龄73.5岁。UCLA评分与CM评分有很强的相关性(r = 0.936；95% ci 0.911-0.954；p = 0.000)。对于CM评分，优秀结局的临界值为67.5 (AUC 0.963, 95% CI 0.925-1.000)，良好结局的临界值为56.5 (AUC 0.920, 95% CI 0.872-0.969)，一般结局的临界值为41.5 （AUC 0.701, 95% CI 0.617-0.784）。根据用于肱骨近端骨折rTSA后预后分类的CM评分的临界值，评分≥68分为优，评分≥57 ~ 67分为良，评分≥41 ~ 56分为一般，评分≥40分为差。证据水平：III。

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引用次数: 0

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