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Atypical Mycobacterial Infections of the Spine: Evaluation and Management. 脊柱非典型分枝杆菌感染:评估与管理》。
IF 1.1 4区 医学 Q2 Medicine Pub Date : 2024-03-01 Epub Date: 2024-01-25 DOI: 10.3928/01477447-20240122-05
Nolan M Wessell, Brandi Krieg, Laura Damioli, Christopher J Kleck

Background: Atypical mycobacterial infections of the spine can be difficult to treat and represent a subset of the vertebral osteomyelitis and diskitis spectrum often requiring early and aggressive surgical intervention. The purpose of this review is to improve the understanding of and approach to disease management from the perspective of the spine surgeon.

Materials and methods: Debridement or excision of the affected levels may be necessary to decrease mycobacterial loads and restore biomechanics. A close relationship with the patient's internal medicine and infectious disease specialists should be maintained to ensure disease eradication or remission. Long-term suppressive antibiotic therapy may be required for infection control.

Results and conclusion: Atypical mycobacterial spine infections are rare, complex, and difficult to eradicate. Our institution proposes a collaborative effort among the spine surgeon, infectious disease specialists, and internal medicine specialists to best approach the work-up, diagnosis, and treatment of these infections. [Orthopedics. 2024;47(2):e61-e66.].

背景:脊柱非典型分枝杆菌感染可能很难治疗,它是椎体骨髓炎和椎间盘炎的一个分支,通常需要早期积极的手术干预。本综述旨在从脊柱外科医生的角度加深对疾病治疗的理解和方法:可能需要对受影响的椎间盘进行清创或切除,以减少霉菌负荷并恢复生物力学。应与患者的内科和传染病专家保持密切联系,以确保疾病得到根除或缓解。为控制感染,可能需要长期抑制性抗生素治疗:结果和结论:脊柱非典型分枝杆菌感染罕见、复杂且难以根除。本院建议脊柱外科医生、传染病专家和内科专家通力合作,以最佳方式对这些感染进行检查、诊断和治疗。[骨科。202x;4x(x):xx-xx]。
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引用次数: 0
Medicaid and Indigent Patients Experience Delayed Fixation of Distal Radius Fractures, Resulting in Worse Consequential Radiographic Outcomes. 医疗补助和贫困患者桡骨远端骨折固定时间延迟,导致放射学后果恶化。
IF 1.1 4区 医学 Q2 Medicine Pub Date : 2024-03-01 Epub Date: 2023-06-21 DOI: 10.3928/01477447-20230616-04
Cristina T Graphia, Samuel H Klatman, Rachel E Hein, Claudia Leonardi, Robert D Zura, Marc J Richard

Distal radius fractures are the most common upper extremity injury. Patients referred to safety-net tertiary facilities following a fracture experience significant delays in treatment because of financial and language barriers as well as poor access to care at outlying community hospitals. This delay in treatment can affect postoperative functional outcomes and complication rates because of failure to restore anatomic alignment. The purpose of this multicenter study was to assess for risk factors associated with delayed fixation of distal radius fractures and evaluate the impact of delayed treatment on radiographic alignment. Patients with a distal radius fracture treated surgically during a 2-year period were identified. Measures included time from injury to surgery, demographic information, fracture classification, and radiographic parameters. The effect of surgery delay on radiographic outcomes was assessed with delayed surgery defined as 11 or more days out from injury. A total of 183 patients met study inclusion criteria. Medicaid and indigent patients were more likely to experience a delay in surgical treatment. Specifically, 70% of these patients were treated in a delayed fashion. Delayed treatment of 11 days or more was associated with worse radial height and inclination on postoperative radiographic imaging. Medicaid and indigent patients are more likely to experience delayed fixation in the treatment of distal radius fractures. This delayed surgery negatively affects postoperative radiographic outcomes. These findings suggest a need to improve access to care for Medicaid and indigent patients and to proceed with operative intervention within 10 days for distal radius fractures. [Orthopedics. 2024;47(2):e93-e97.].

桡骨远端骨折是最常见的上肢损伤。由于经济和语言障碍,以及外围社区医院的医疗条件较差,骨折后转诊至安全网三级医疗机构的患者在接受治疗时会遇到严重的延误。这种治疗延误可能会影响术后功能结果和并发症发生率,因为无法恢复解剖对位。这项多中心研究旨在评估与桡骨远端骨折延迟固定相关的风险因素,并评估延迟治疗对放射学对位的影响。研究对象为两年内接受过手术治疗的桡骨远端骨折患者。测量指标包括从受伤到手术的时间、人口统计学信息、骨折分类和放射学参数。评估了手术延迟对放射学结果的影响,延迟手术的定义是受伤后 11 天或 11 天以上。共有 183 名患者符合研究纳入标准。医疗补助和贫困患者更有可能经历手术治疗延迟。具体来说,这些患者中有 70% 接受了延迟治疗。延迟治疗 11 天或更长时间与术后放射成像中桡骨高度和倾斜度的恶化有关。医疗补助和贫困患者在治疗桡骨远端骨折时更有可能经历延迟固定。这种延迟手术会对术后放射成像结果产生负面影响。这些研究结果表明,有必要改善医疗补助和贫困患者的就医条件,并在 10 天内对桡骨远端骨折进行手术干预。[Orthopedics. 2024;47(2):e93-e97.].
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引用次数: 0
Large Femoral Heads With Small Acetabular Components: An Examination of 10-Year Polyethylene Wear. 大股骨头配小髋臼组件:10 年聚乙烯磨损检验。
IF 1.1 4区 医学 Q2 Medicine Pub Date : 2024-03-01 Epub Date: 2023-08-09 DOI: 10.3928/01477447-20230804-07
Hope S Thalody, Danielle Y Ponzio, Adam J Santoro, Tyler M Radack, Zachary D Post, Alvin C Ong

Highly cross-linked polyethylene (HXLPE) has improved polyethylene (PE) wear rates while decreasing osteolysis and aseptic loosening. However, concerns exist regarding the risk of mechanical failure with thin HXLPE liners in total hip arthroplasty (THA). Our purpose was to evaluate long-term outcomes and PE wear rates in primary THAs pairing large femoral heads with small acetabular components and thin HXLPE liners. We retrospectively reviewed 29 patients who underwent 33 primary THAs using large femoral heads (32 or 36 mm) with small acetabular components (48 or 50 mm) and thin HXLPE liners (3.9 or 5.9 mm) at minimum 10-year follow-up. PE liner wear was measured using a validated radiographic technique. Mean age was 66 years, 97% of the patients were women, and mean body mass index was 26.3 kg/m2. Thirty hips (90.9%) had ceramic femoral heads, and 13 hips (39%) had 36-mm femoral heads with 3.9-mm HXLPE liners. All cases used a neutral PE design. Mean linear wear rate and volumetric wear rate were 0.04 mm/year and 39.6 mm3/year, respectively, at mean 10.9-year follow-up. There were no instances of liner fracture, liner dissociation, or revision. Mean Hip disability and Osteoarthritis Outcome Score for Joint Replacement (HOOS, JR) was 92.1. In the largest long-term study of primary THAs using large femoral heads with small acetabular components and thin HXLPE liners, we found low linear and volumetric wear rates and no cases of liner mechanical failures. Thin HXLPE liners are a safe and viable option for THA surgeons. [Orthopedics. 2024;47(2):118-122.].

高交联聚乙烯(HXLPE)提高了聚乙烯(PE)的磨损率,同时减少了骨溶解和无菌性松动。然而,在全髋关节置换术(THA)中使用薄型 HXLPE 内衬的机械故障风险仍令人担忧。我们的目的是评估配用大股骨头、小髋臼组件和薄 HXLPE 内衬的初级全髋关节置换术的长期疗效和 PE 磨损率。我们对 29 名患者进行了回顾性研究,这些患者在至少 10 年的随访中接受了 33 次初级 THAs,使用的是大股骨头(32 或 36 毫米)、小髋臼组件(48 或 50 毫米)和薄 HXLPE 衬里(3.9 或 5.9 毫米)。聚乙烯衬垫的磨损情况采用经过验证的放射学技术进行测量。平均年龄为66岁,97%的患者为女性,平均体重指数为26.3 kg/m2。30个髋关节(90.9%)采用陶瓷股骨头,13个髋关节(39%)采用36毫米股骨头和3.9毫米HXLPE衬垫。所有病例均采用中性聚乙烯设计。在平均10.9年的随访中,线性磨损率和体积磨损率分别为0.04毫米/年和39.6立方毫米/年。没有出现衬垫断裂、衬垫分离或翻修的情况。髋关节残疾和关节置换骨关节炎结果评分(HOOS,JR)的平均值为92.1。在对使用大股骨头、小髋臼组件和薄 HXLPE 内衬的初次全髋关节置换术进行的最大规模的长期研究中,我们发现线性磨损率和体积磨损率都很低,而且没有发生内衬机械故障的病例。对于 THA 外科医生来说,薄 HXLPE 内衬是一种安全可行的选择。[Orthopedics. 2024;47(2):118-122.].
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引用次数: 0
Influence of Anxiety and Depression on Opioid Use After Cervical Spine Fusion: An Analysis of a National Claims Database. 焦虑和抑郁对颈椎融合术后阿片类药物使用的影响:对国家索赔数据库的分析。
IF 1.1 4区 医学 Q2 Medicine Pub Date : 2024-03-01 Epub Date: 2023-09-27 DOI: 10.3928/01477447-20230922-03
Heeren Makanji, Matthew J Solomito, Regina Kostyun, Sean Esmende

Patients with spine pathology demonstrate an above average rate of active psychiatric disorders, which can influence their recovery. This study was designed to understand how mental health diagnoses (ie, anxiety and depression) influence a patient's postoperative need for opioids after a single level cervical spine fusion. The PearlDiver database was used to identify patients. Patients were placed into one of four groups: those with a diagnosis of depression, those with a diagnosis of anxiety, those with a diagnosis of both anxiety and depression, and a control group. Chi-square tests were used to assess differences in the number of patients filling initial and additional opioid prescriptions for up to 90 days after their fusion. A total of 168,967 patients who underwent an elective cervical spine fusion in the United States between 2010 and 2021 were included in this study. The control group filled significantly more opioid prescriptions within the first 90 days after their cervical fusion (P<.001). There was no difference among the study groups regarding the need to fill additional opioid prescriptions. Patients with a diagnosis of depression and/or anxiety may present as complex patients; however, results suggest they do not need additional opioids for pain control after a single level cervical spine fusion. [Orthopedics. 2024;47(2):89-94.].

脊柱病变患者的活动性精神障碍发生率高于平均水平,这可能会影响他们的康复。这项研究旨在了解心理健康诊断(即焦虑和抑郁)如何影响患者在单级颈椎融合术后对阿片类药物的术后需求。PearlDiver数据库用于识别患者。患者被分为四组之一:诊断为抑郁症的患者、诊断为焦虑症的患者、同时诊断为焦虑和抑郁的患者以及对照组。卡方检验用于评估患者在融合后90天内首次和额外开具阿片类药物处方的人数差异。本研究纳入了2010年至2021年间在美国接受选择性颈椎融合术的168967名患者。对照组在宫颈融合后的前90天内服用了明显更多的阿片类药物处方(POrthopedics.202x;4x(x):xx-xx.]。
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引用次数: 0
Return to Play Rates Following Operative Ankle Fractures Differ Between High- and Low-Performing National Football League Athletes. 全国橄榄球联盟中成绩优秀和成绩较差的运动员在踝关节骨折手术后的重返赛场率存在差异。
IF 1.1 4区 医学 Q2 Medicine Pub Date : 2024-01-01 Epub Date: 2023-05-23 DOI: 10.3928/01477447-20230517-05
Jordan B Robbins, Daniel C Jupiter, Vinod K Panchbhavi, William M Weiss, John C Hagedorn, Jie Chen

This study investigated predictive factors for return to play among National Football League athletes after operative treatment of ankle fractures and the impacts of these injuries on career longevity and player performance. Athletes who underwent surgery to repair ankle fractures from the 2013 to 2017 seasons were identified from injury reserve lists and press releases. Demographics and season metrics were collected before and after the injury. Statistical analysis assessed for differences in recorded variables between injured and uninjured players. Thirty-one players met study inclusion criteria. Twenty-two (71%) athletes successfully returned to play. Players who did not return showed no significant differences (P>.05) in position, age, body mass index, number of games or seasons played preinjury, or snaps per game the season prior to injury and had a significantly lower (42.6%, P=.013) preinjury season approximate value (SAV) compared with returning players. Returning athletes showed no significant differences (P>.05) in SAV or snaps per game compared with their preinjury season or with uninjured controls. A high preinjury SAV is associated with successful return to play. No difference in game time or performance metrics was detectable between returning players and uninjured controls, or between preinjury and postinjury seasons. [Orthopedics. 2024;47(1):22-27.].

本研究调查了美国国家橄榄球联盟运动员在接受踝关节骨折手术治疗后重返赛场的预测因素,以及这些损伤对职业生涯寿命和球员表现的影响。研究人员从伤病储备名单和新闻稿中找出了 2013 至 2017 赛季接受踝关节骨折修复手术的运动员。收集了受伤前后的人口统计数据和赛季指标。统计分析评估了受伤和未受伤球员之间记录变量的差异。31 名球员符合研究纳入标准。22名运动员(71%)成功重返赛场。未复出的球员在位置、年龄、体重指数、受伤前的比赛场次或赛季数、受伤前赛季的每场比赛抢断数等方面与复出的球员无明显差异(P>.05),但受伤前的赛季近似值(SAV)明显低于复出的球员(42.6%,P=.013)。与受伤前赛季或未受伤的对照组相比,复出运动员在每场比赛的近似值或出场次数方面没有明显差异(P>.05)。受伤前的高SAV与成功重返赛场有关。复出球员与未受伤的对照组之间,或受伤前与受伤后赛季之间,在比赛时间或表现指标方面均未发现差异。[Orthopedics. 2024;47(1):22-27.].
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引用次数: 0
Quantification of the Safe Zone of the First to Third Sacral Segments for Transiliac-Transsacral Screw Fixation in Normal and Dysmorphic Sacra. 正常和畸形骶骨经髂胫螺钉固定第一至第三骶骨节段安全区的量化。
IF 1.1 4区 医学 Q2 Medicine Pub Date : 2024-01-01 Epub Date: 2023-06-05 DOI: 10.3928/01477447-20230531-06
Po-Hsiang Chen, Chun-Yu Chen, Kai-Cheng Lin, Chien-Jen Hsu

Transiliac-transsacral screw fixation is widely used to stabilize unstable posterior pelvic ring injuries. Preoperative radiographic assessment of the safe osseous corridor is necessary because the safe space of sacrum is narrower for transiliac-transsacral screw placement than for traditional iliosacral screw placement. However, the radiographic assessment has rarely been studied in the Taiwanese population. We retrospectively analyzed 100 patients with pelvic computed tomography images and divided them into normal and dysmorphic pelvis groups. To determine the safe osseous space, we recorded cross-section area, cross-sectional diameter of the safe zone (CS-szD), and safe zone width on axial view (Ax-szW) in the S1 to S3 segments. The prevalence of dysmorphic pelvis was 48% among all patients. In the S1 segment, no differences were found in the cross-section area and CS-szD been the two groups. However, the Ax-szW was significantly smaller in the dysmorphic pelvis group. In the S2 segment, the cross-section area, CS-szD, and Ax-szW were all significantly larger in the dysmorphic pelvis group. In the S3 segment, the cross-section area and CS-szD of the normal pelvis group were both significantly smaller. No differences were found in the Ax-szW between the two groups. Based on our findings in a Taiwanese population, S1 was the most suitable segment for transiliac-transsacral screw fixation in a normal pelvis, whereas S2, followed by S3, was most suitable in a dysmorphic pelvis. This study offers surgeons information on identifying the optimal sacral segment for transiliac-transsacral screw placement for each pelvic morphology. [Orthopedics. 2024;47(1):e13-e18.].

经髂骨-骶骨螺钉固定术被广泛用于稳定不稳定的骨盆后环损伤。由于经髂横骶螺钉固定的骶骨安全空间比传统的髂骶螺钉固定狭窄,因此术前必须对安全骨走廊进行影像学评估。然而,在台湾人群中很少有人对放射学评估进行研究。我们回顾性分析了 100 名患者的骨盆计算机断层扫描图像,并将其分为正常骨盆组和骨盆畸形组。为了确定安全骨空间,我们记录了 S1 至 S3 段的横截面积、安全区横截面直径(CS-szD)和轴向视图上的安全区宽度(Ax-szW)。在所有患者中,骨盆畸形的发生率为 48%。在 S1 节段,两组患者的横截面积和 CS-szD 均无差异。然而,骨盆畸形组的 Ax-szW 明显较小。在 S2 节段,畸形骨盆组的横截面积、CS-szD 和 Ax-szW 都明显较大。在 S3 段,正常骨盆组的横截面积和 CS-szD 都明显较小。两组的 Ax-szW 没有发现差异。根据我们在台湾人群中的研究结果,在正常骨盆中,S1 是最适合经髂胫螺钉固定的节段,而在畸形骨盆中,S2 最适合,其次是 S3。这项研究为外科医生提供了信息,帮助他们根据不同的骨盆形态确定经髂-经骶螺钉固定的最佳骶骨节段。[Orthopedics. 2024;47(1):e13-e18.].
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引用次数: 0
Analysis of Academic Accomplishments and Demographics for Elected Presidents of National Orthopedic Surgery Organizations in the United States. 美国全国矫形外科组织当选主席的学术成就和人口统计学分析。
IF 1.1 4区 医学 Q2 Medicine Pub Date : 2024-01-01 Epub Date: 2023-06-21 DOI: 10.3928/01477447-20230616-02
Jason Silvestre, Sanjum Singh, John D Kelly, Charles L Nelson, Terry L Thompson, James D Kang

This study analyzed the academic accomplishments and demographics of elected presidents of the American Academy of Orthopaedic Surgeons (AAOS), American Orthopaedic Association (AOA), and American Board of Orthopaedic Surgery (ABOS). Curriculum vitae and internet-based resources were reviewed to collect demographics, training characteristics, bibliometrics, and National Institutes of Health (NIH) research funding of contemporary presidents (1990-2020). Eighty presidents were included. Most presidents were men (97%), and 4% of presidents were non-White (3% Black and 1% Hispanic). Few had an additional graduate degree (4% MBA, 3% MS, 1% MPH, 1% PhD). Ten orthopedic surgery residency programs trained 47% of these presidents. Most had fellowship training (59%), and the top three were hand surgery (11%), pediatric orthopedics (11%), and adult reconstruction (10%). Twenty-nine presidents (36%) participated in a traveling fellowship. The mean age at appointment was 58±5 years, which was 27 years since residency graduation. The mean h-index was 36±23, resulting from 150±126 peer-reviewed manuscripts. Orthopedic surgery presidents had more peer-reviewed manuscripts (150±126) than chairs (73±81) and program directors (27±32) (P<.001). AOA presidents had the highest mean h-index (42±21) compared with AAOS (38±27) and ABOS (25±16) presidents (P=.035). Nineteen presidents had NIH funding (24%). More presidents had NIH funding in the AOA (39%) and AAOS (25%) than the ABOS (0%) (P=.007). Orthopedic surgery presidents possess high levels of scholarly output. AOA presidents had the highest h-index values and prevalence of NIH funding. Females and racial minorities remain underrepresented at the highest levels of leadership. [Orthopedics. 2024;47(1):e45-e51.].

本研究分析了美国矫形外科医师学会(AAOS)、美国矫形外科协会(AOA)和美国矫形外科委员会(ABOS)当选主席的学术成就和人口统计学特征。通过查阅简历和互联网资源,收集了当代主席(1990-2020 年)的人口统计学特征、培训特征、文献计量学和美国国立卫生研究院 (NIH) 的研究经费。其中包括 80 位校长。大多数校长为男性(97%),4%的校长为非白人(3%为黑人,1%为西班牙裔)。很少有人拥有额外的研究生学位(4% MBA、3% MS、1% MPH、1% PhD)。十个矫形外科住院医师培训项目培养了其中 47% 的院长。大多数人都接受过研究员培训(59%),排名前三位的分别是手外科(11%)、小儿骨科(11%)和成人重建(10%)。有 29 位院长(36%)参加过巡回奖学金培训。任命时的平均年龄为 58±5 岁,距住院医师毕业已有 27 年。平均 h 指数为(36±23),共发表了 150±126 篇同行评审稿件。骨科外科主任的同行评审手稿数(150±126)多于主任(73±81)和项目主任(27±32)(PP=0.035)。19位院长获得了美国国立卫生研究院的资助(24%)。AOA(39%)和AAOS(25%)中获得NIH资助的院长人数多于ABOS(0%)(P=.007)。矫形外科主席拥有高水平的学术成果。AOA 主席的 h 指数值最高,获得美国国立卫生研究院(NIH)资助的比例也最高。女性和少数种族在最高领导层的代表性仍然不足。[Orthopedics. 2024;47(1):e45-e51.].
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引用次数: 0
Assessing the Diagnostic Accuracy of Next-Generation Sequencing in Patients With Antibiotic Spacers Before Reimplantation. 评估下一代测序对再植前使用抗生素间隔物患者的诊断准确性。
IF 1.1 4区 医学 Q2 Medicine Pub Date : 2024-01-01 Epub Date: 2023-05-02 DOI: 10.3928/01477447-20230426-09
Beau J Kildow, Niall Cochrane, Patrick J Kelly, Jeffrey A O'Donnell, Mark Wu, Elizabeth Lyden, William A Jiranek, Thorsten M Seyler

Use of molecular sequencing modalities in periprosthetic joint infection diagnosis and organism identification has gained popularity recently. To date, there is no diagnostic test that reliably predicts infection eradication in patients with antibiotic spacers. The purpose of this study was to compare the diagnostic accuracy of next-generation sequencing (NGS), culture, the Musculoskeletal Infection Society (MSIS) criteria, and the criteria by Parvizi et al in patients with antibiotic spacers. In this retrospective study, aspirate or tissue samples were collected from 38 knee and 19 hip antibiotic spacers for routine diagnostic workup for the presence of persistent infection and sent to the laboratory for NGS. The kappa statistic along with statistical differences between diagnostic studies were calculated using the chi-square test for categorical data. The kappa coefficient for agreement between NGS and culture was 0.27 (fair agreement). The percentages of positive and negative agreement were 22.8% and 42.1%, respectively, with a total concordance of 64.9%. There were 12 samples that were culture positive and NGS negative. Eight samples were NGS positive but culture negative. The kappa coefficient was 0.42 (moderate agreement) when comparing NGS with MSIS criteria. In our series, NGS did not provide sufficient agreement compared with culture or MSIS criteria in the setting of an antibiotic spacer. A reliable diagnostic indicator for reimplantation has yet to be identified. [Orthopedics. 2024;47(1);46-51.].

在假体周围关节感染诊断和病原体鉴定中使用分子测序模式近来越来越受欢迎。迄今为止,还没有一种诊断测试能可靠地预测使用抗生素垫片患者的感染根除情况。本研究旨在比较新一代测序(NGS)、培养、肌肉骨骼感染协会(MSIS)标准和 Parvizi 等人的标准对抗生素垫片患者的诊断准确性。在这项回顾性研究中,从 38 名膝关节和 19 名髋关节抗生素垫块患者身上采集了抽吸物或组织样本,用于常规诊断是否存在持续性感染,并送往实验室进行 NGS 检测。对分类数据采用卡方检验(chi-square test)计算卡方统计量以及诊断研究之间的统计差异。NGS 与培养之间的卡帕系数为 0.27(相当一致)。阳性一致率为 22.8%,阴性一致率为 42.1%,总一致率为 64.9%。有 12 份样本的培养阳性而 NGS 阴性。8 个样本 NGS 阳性,但培养阴性。将 NGS 与 MSIS 标准进行比较,卡帕系数为 0.42(中度一致)。在我们的系列研究中,在使用抗生素垫片的情况下,NGS 与培养或 MSIS 标准相比并不能提供足够的一致性。再植的可靠诊断指标尚未确定。[Orthopedics. 2024;47(1);46-51.].
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引用次数: 0
The Effect of Povidone-Iodine Irrigation on the Efficacy of Antibiotic Cement In Vitro. 聚维酮碘冲洗对体外抗生素骨水泥疗效的影响
IF 1.1 4区 医学 Q3 ORTHOPEDICS Pub Date : 2024-01-01 Epub Date: 2023-06-21 DOI: 10.3928/01477447-20230616-01
Grant R McChesney, Marisa C Nielsen, Rong Fang, Natalie Williams-Bouyer, Ronald W Lindsey

Povidone-iodine is a common antiseptic demonstrating success in reducing infection rates in primary arthroplasty; however, recent data suggest that its use in revision arthroplasty may increase infection rates. This study evaluated the effect of povidone-iodine solution on antibiotic cement and investigated the connection between povidone-iodine and increased infection rates in revision arthroplasty. Sixty antibiotic cement samples (ACSs) were formed using gentamicin-impregnated cement. The ACSs were divided into three groups: group A (n=20) was subject to a 3-minute povidone-iodine soak followed by a saline rinse; group B (n=20) underwent a 3-minute saline soak; and group C (n=20) underwent only a saline rinse. The antimicrobial activity of the samples was tested using a Kirby-Bauer-like assay using Staphylococcus epidermidis. The zone of inhibition (ZOI) was measured every 24 hours for 7 days. All groups possessed the greatest antimicrobial activity at 24 hours. Group C displayed a mass-corrected ZOI of 395.2 mm/g, which was statistically greater than the group B ZOI (313.2 mm/g, P<.05) but not the group A ZOI (346.5 mm/g, P>.05). All groups demonstrated a decrease in antimicrobial activity at 48 through 96 hours, with no significant difference at any time point. Prolonged soaking of antibiotic cement in a povidone-iodine or saline solution results in elution of the antibiotic into the irrigation solution, blunting initial antibiotic concentration. When using antibiotic cement, antiseptic soaks or irrigation should be focused prior to cementation. [Orthopedics. 2024;47(1):10-14.].

聚维酮碘是一种常见的防腐剂,在初次关节置换术中成功地降低了感染率;但最近的数据表明,在翻修关节置换术中使用聚维酮碘可能会增加感染率。本研究评估了聚维酮碘溶液对抗生素骨水泥的影响,并调查了聚维酮碘与翻修关节成形术中感染率增加之间的联系。使用庆大霉素浸渍的骨水泥制作了 60 个抗生素骨水泥样本(ACS)。这些 ACS 被分为三组:A 组(20 人)先用聚维酮碘浸泡 3 分钟,再用生理盐水冲洗;B 组(20 人)先用生理盐水浸泡 3 分钟;C 组(20 人)只用生理盐水冲洗。样品的抗菌活性采用类似柯比鲍尔法的表皮葡萄球菌试验进行检测。每 24 小时测量一次抑菌区(ZOI),持续 7 天。所有组别在 24 小时内都具有最强的抗菌活性。C 组的质量校正 ZOI 为 395.2 mm/g,在统计学上高于 B 组的 ZOI(313.2 mm/g,PP>.05)。所有组的抗菌活性在 48 至 96 小时内均有所下降,在任何时间点均无显著差异。抗生素骨水泥在聚维酮碘或生理盐水溶液中长时间浸泡会导致抗生素洗脱到灌洗液中,从而降低初始抗生素浓度。使用抗生素骨水泥时,应在骨水泥粘接前集中进行消毒浸泡或冲洗。[Orthopedics. 2024;47(1):10-14.].
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引用次数: 0
Trends in ACGME Accreditation of Orthopedic Surgery Fellowship Training. ACGME 整形外科研究员培训认证趋势。
IF 1.1 4区 医学 Q2 Medicine Pub Date : 2024-01-01 Epub Date: 2023-05-02 DOI: 10.3928/01477447-20230426-06
Jason Silvestre, Charles L Nelson, Terry L Thompson, James D Kang

Currently, most surgeons pursue subspecialty fellowship training. This study answers the following questions: (1) How does the rate of fellowship training in orthopedic surgery compare with that in other surgical specialties? (2) To what extent did adoption of Accreditation Council for Graduate Medical Education (ACGME) accreditation change from 2013 to 2021? Orthopedic subspecialties were analyzed for total number of fellowship programs and positions in the 2013 and 2021 Match. Rates of ACGME accreditation were analyzed via chi-square tests. In 2021, orthopedic surgery had the highest rate of fellowship selection (94%) relative to general surgery (77%), ophthalmology (66%), plastic surgery (63%), and otolaryngology (55%). Across all orthopedic subspecialties, the percentage of ACGME accreditation decreased among fellowship programs (53% in 2013 to 48% in 2021, P=.166) and positions (58% in 2013 to 50% in 2021, P<.001). Orthopedic sports medicine had the highest adoption of ACGME accreditation (100%), followed by hand surgery (99%), musculoskeletal oncology (67%), and pediatric orthopedics (56%). Significant increases in the adoption of ACGME accreditation were noted for orthopedic sports medicine (93% in 2013 to 100% in 2021, P=.016) and hand surgery (81% in 2013 to 99% in 2021, P<.001). There was a significant decrease in ACGME accreditation for adult reconstructive orthopedics (40% in 2013 to 24% in 2021, P=.042), driven by the increase in unaccredited fellowship programs. Accreditation of orthopedic subspecialty fellowship training has decreased with respect to the proportion of accredited training positions. More research is needed to understand the benefits of ACGME accreditation for fellowship training in orthopedic surgery. [Orthopedics. 2024;47(1):57-63.].

目前,大多数外科医生都在接受亚专科研究员培训。本研究回答了以下问题:(1)与其他外科专科相比,骨科外科的研究员培训率如何?(2)从 2013 年到 2021 年,毕业后医学教育认证委员会(ACGME)认证的通过率发生了多大变化?分析了骨科亚专科在 2013 年和 2021 年匹配中的研究金项目和职位总数。ACGME 评审率通过卡方检验进行分析。在 2021 年,骨科手术的研究金选择率最高(94%),而普外科(77%)、眼科(66%)、整形外科(63%)和耳鼻喉科(55%)则相对较低。在所有骨科亚专科中,获得ACGME认证的研究金项目比例有所下降(2013年为53%,2021年为48%,P=.166),职位(2013年为58%,2021年为50%,PP=.016)和手外科(2013年为81%,2021年为99%,PP=.042)也有所下降,原因是未获认证的研究金项目有所增加。骨科亚专科研究金培训的认证比例与认证培训职位的比例相比有所下降。需要进行更多的研究来了解 ACGME 认证对骨科手术研究员培训的益处。[Orthopedics. 2024;47(1):57-63.].
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Orthopedics
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