首页 > 最新文献

Orthopedics最新文献

英文 中文
Early Postoperative Change in Hip Rotation Angle and Factors Contributing to It for Patients Undergoing Total Hip Arthroplasty. 全髋关节置换术患者术后早期髋关节旋转角度的变化及其影响因素。
IF 1.1 4区 医学 Q2 Medicine Pub Date : 2024-05-01 Epub Date: 2023-12-28 DOI: 10.3928/01477447-20231220-01
Toshiyuki Tateiwa, Toshinori Masaoka, Yasuhito Takahashi, Tsunehito Ishida, Takaaki Shishido, Kengo Yamamoto

Objective: A possible impairment in hip proprioception after total hip arthroplasty (THA) has been an issue of concern. The aims of this study were to investigate the extent of early postoperative change in standing hip rotation angle (HRAng) in patients with osteoarthritis (OA) undergoing THA and to consider a possible mechanism behind this.

Materials and methods: A total of 82 hips (82 patients; 63 women and 19 men) undergoing unilateral primary THA with total capsulectomy were included. We characterized the standing HRAng and internal/external range of motion (ROM) in the prone position before THA and 2 weeks after THA. Acetabular/cup and femoral/stem anteversion, combined anteversion (CA), and leg length discrepancy were also characterized. Correlations were examined postoperatively between the HRAng and the other analyzed variables.

Results: The median standing HRAng showed a significant internal shift from external to more medial position (6.3° to 1.7°) 2 weeks after THA (P<.0001). The postoperative change in standing HRAng was significantly negatively correlated with the difference between the postoperative femoral anteversion and the stem anteversion (rs=-0.429, P<.0001) and with the pre- to postoperative change in CA (rs=-0.3012, P=.0063).

Conclusion: This study demonstrated that the extent of the rotational shift of the distal femur toward medial direction was significantly associated with increasing stem anteversion and CA. This phenomenon can be interpreted as a compensatory mechanism for maintaining the relative positional relationship between the pelvis and the proximal femur using proprioception. Therefore, we conclude that the extracapsular/extra-articular components may be prominent determinants of joint position sense. [Orthopedics. 2024;47(3):e114-e118.].

目的:全髋关节置换术(THA)后髋关节本体感觉可能受损一直是人们关注的问题。本研究旨在调查接受全髋关节置换术的骨关节炎(OA)患者术后早期站立时髋关节旋转角度(HRAng)的变化程度,并考虑其背后的可能机制:共纳入了 82 例髋关节(82 例患者,其中 63 例为女性,19 例为男性),这些患者均接受了单侧原发性全髋关节置换术(THA)和全帽切除术。我们对髋关节置换术前和术后两周内的站立位 HRAng 和俯卧位内/外侧活动范围 (ROM) 进行了分析。我们还对髋臼/髋臼杯和股骨/股骨干内翻、合并内翻(CA)以及腿长差异进行了分析。术后研究了HRAng与其他分析变量之间的相关性:结果:THA术后2周,中位站立位HRAng显示出明显的内侧移位,从外侧移至更内侧的位置(6.3°至1.7°)(Prs=-0.429,Prs=-0.3012,P=.0063):本研究表明,股骨远端向内侧旋转移位的程度与骨干内翻和CA的增加显著相关。这一现象可解释为利用本体感觉维持骨盆与股骨近端之间相对位置关系的一种补偿机制。因此,我们得出结论,囊外/关节外组件可能是关节位置感的主要决定因素。[骨科。202x;4x(x):xx-xx]。
{"title":"Early Postoperative Change in Hip Rotation Angle and Factors Contributing to It for Patients Undergoing Total Hip Arthroplasty.","authors":"Toshiyuki Tateiwa, Toshinori Masaoka, Yasuhito Takahashi, Tsunehito Ishida, Takaaki Shishido, Kengo Yamamoto","doi":"10.3928/01477447-20231220-01","DOIUrl":"10.3928/01477447-20231220-01","url":null,"abstract":"<p><strong>Objective: </strong>A possible impairment in hip proprioception after total hip arthroplasty (THA) has been an issue of concern. The aims of this study were to investigate the extent of early postoperative change in standing hip rotation angle (HRAng) in patients with osteoarthritis (OA) undergoing THA and to consider a possible mechanism behind this.</p><p><strong>Materials and methods: </strong>A total of 82 hips (82 patients; 63 women and 19 men) undergoing unilateral primary THA with total capsulectomy were included. We characterized the standing HRAng and internal/external range of motion (ROM) in the prone position before THA and 2 weeks after THA. Acetabular/cup and femoral/stem anteversion, combined anteversion (CA), and leg length discrepancy were also characterized. Correlations were examined postoperatively between the HRAng and the other analyzed variables.</p><p><strong>Results: </strong>The median standing HRAng showed a significant internal shift from external to more medial position (6.3° to 1.7°) 2 weeks after THA (<i>P</i><.0001). The postoperative change in standing HRAng was significantly negatively correlated with the difference between the postoperative femoral anteversion and the stem anteversion (<i>r</i><sub>s</sub>=-0.429, <i>P</i><.0001) and with the pre- to postoperative change in CA (<i>r</i><sub>s</sub>=-0.3012, <i>P</i>=.0063).</p><p><strong>Conclusion: </strong>This study demonstrated that the extent of the rotational shift of the distal femur toward medial direction was significantly associated with increasing stem anteversion and CA. This phenomenon can be interpreted as a compensatory mechanism for maintaining the relative positional relationship between the pelvis and the proximal femur using proprioception. Therefore, we conclude that the extracapsular/extra-articular components may be prominent determinants of joint position sense. [<i>Orthopedics</i>. 2024;47(3):e114-e118.].</p>","PeriodicalId":19631,"journal":{"name":"Orthopedics","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139040335","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
Establishment of a Rabbit Model of Adjacent Intervertebral Disk Degeneration After Lumbar Fusion and Fixation and Evaluation of Autophagy Factor Expression in Nucleus Pulposus Cells 建立腰椎融合固定术后相邻椎间盘退变兔模型并评估髓核细胞中自噬因子的表达情况
IF 1.1 4区 医学 Q2 Medicine Pub Date : 2024-05-01 DOI: 10.3928/01477447-20240424-04
Jiawen Sun, MMed, Fuyu Chen, MMed, Xiaodong Wei, MMed, Yufu Ou, MD

Background:

The objectives of this research were to establish an animal model of adjacent segment degeneration (ASD) bordering lumbar fusion and to investigate the expression of autophagy factors in nucleus pulposus cells of adjacent intervertebral disks.

Materials and Methods:

Twenty-four adult New Zealand white rabbits were enrolled and divided into two groups: group A (n=12) and group B (n=12). Posterolateral fusion and fixation were performed after intervertebral disk degeneration occurred in group A, and the rabbits were monitored for 6 months. Group B was the control group and did not undergo fusion surgery. These rabbits were monitored for 6 months. Real-time quantitative polymerase chain reaction and immunohistochemistry were performed to detect the mRNA and protein expressions of PTEN-induced kinase 1 (PINK1), Parkin, ADAMTS-4, and MMP-3. An external database, the GEO database, was used to examine the expression of these genes and analyze them for differential expression.

Results:

After lumbar fusion in rabbits, the animal model of ASD exhibited gradual degeneration of adjacent intervertebral disks over time. Group A displayed significantly higher mRNA and protein expressions of PINK1 and MMP-3 but lower expression of ADAMTS-4 compared with group B (P<.05). The results analyzed in the GEO database showed that the expression of PINK1 was higher in group A than in group B, while the expression of ADAMTS-4 was lower in group A than in group B.

Conclusion:

After posterolateral lumbar fusion in rabbits, the animal ASD model showed gradual deterioration of adjacent intervertebral disks with prolonged follow-up. The findings indicate the important role of autophagy in the apoptosis of nucleus pulposus cells in adjacent intervertebral disks. [Orthopedics. 202x;4x(x):xx–xx.]

背景:本研究的目的是建立腰椎融合术邻近节段退变(ASD)的动物模型,并研究自噬因子在邻近椎间盘髓核细胞中的表达。A 组在椎间盘发生退变后进行后外侧融合固定,观察 6 个月。B 组为对照组,未进行融合手术。对这些兔子进行了为期 6 个月的监测。采用实时定量聚合酶链反应和免疫组织化学方法检测 PTEN 诱导的激酶 1 (PINK1)、Parkin、ADAMTS-4 和 MMP-3 的 mRNA 和蛋白表达。结果表明:兔腰椎融合术后,ASD动物模型的相邻椎间盘随着时间的推移逐渐退化。与 B 组相比,A 组 PINK1 和 MMP-3 的 mRNA 和蛋白表达量明显较高,但 ADAMTS-4 的表达量较低(P< .05)。在 GEO 数据库中分析的结果显示,A 组中 PINK1 的表达高于 B 组,而 A 组中 ADAMTS-4 的表达低于 B 组。研究结果表明,自噬在相邻椎间盘髓核细胞凋亡过程中发挥了重要作用。[骨科。202x;4x(x):xx-xx。]
{"title":"Establishment of a Rabbit Model of Adjacent Intervertebral Disk Degeneration After Lumbar Fusion and Fixation and Evaluation of Autophagy Factor Expression in Nucleus Pulposus Cells","authors":"Jiawen Sun, MMed, Fuyu Chen, MMed, Xiaodong Wei, MMed, Yufu Ou, MD","doi":"10.3928/01477447-20240424-04","DOIUrl":"https://doi.org/10.3928/01477447-20240424-04","url":null,"abstract":"<section><h3>Background:</h3><p>The objectives of this research were to establish an animal model of adjacent segment degeneration (ASD) bordering lumbar fusion and to investigate the expression of autophagy factors in nucleus pulposus cells of adjacent intervertebral disks.</p></section><section><h3>Materials and Methods:</h3><p>Twenty-four adult New Zealand white rabbits were enrolled and divided into two groups: group A (n=12) and group B (n=12). Posterolateral fusion and fixation were performed after intervertebral disk degeneration occurred in group A, and the rabbits were monitored for 6 months. Group B was the control group and did not undergo fusion surgery. These rabbits were monitored for 6 months. Real-time quantitative polymerase chain reaction and immunohistochemistry were performed to detect the mRNA and protein expressions of PTEN-induced kinase 1 (PINK1), Parkin, ADAMTS-4, and MMP-3. An external database, the GEO database, was used to examine the expression of these genes and analyze them for differential expression.</p></section><section><h3>Results:</h3><p>After lumbar fusion in rabbits, the animal model of ASD exhibited gradual degeneration of adjacent intervertebral disks over time. Group A displayed significantly higher mRNA and protein expressions of PINK1 and MMP-3 but lower expression of ADAMTS-4 compared with group B (<i>P</i>&lt;.05). The results analyzed in the GEO database showed that the expression of PINK1 was higher in group A than in group B, while the expression of ADAMTS-4 was lower in group A than in group B.</p></section><section><h3>Conclusion:</h3><p>After posterolateral lumbar fusion in rabbits, the animal ASD model showed gradual deterioration of adjacent intervertebral disks with prolonged follow-up. The findings indicate the important role of autophagy in the apoptosis of nucleus pulposus cells in adjacent intervertebral disks. [<i>Orthopedics</i>. 202x;4x(x):xx–xx.]</p></section>","PeriodicalId":19631,"journal":{"name":"Orthopedics","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140832313","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
Four-Year Outcomes of Cementless Versus Cemented Fixation of a Newly Introduced Total Knee Arthroplasty Design. 一种新推出的全膝关节置换术设计的无骨水泥固定与有骨水泥固定的四年疗效对比。
IF 1.1 4区 医学 Q2 Medicine Pub Date : 2024-05-01 Epub Date: 2024-01-25 DOI: 10.3928/01477447-20240122-02
Timothy G Costales, David F Dalury

Background: Aseptic loosening continues to be a major cause of failure of total knee arthroplasty (TKA). Although cemented fixation remains the gold standard, there is renewed interest in cementless fixation as a means of decreasing this risk via biologic fixation. The purpose of this study was to evaluate the clinical outcomes of cemented and cementless versions of a newly introduced TKA design at an average of 4 years postoperatively.

Materials and methods: This was a retrospective case-control study of 100 primary TKAs comparing cementless vs cemented TKAs using the same cruciate-retaining implant design (ATTUNE Knee System; DePuy Synthes). Fifty patients undergoing cementless TKA with a mean age of 60.8 years (range, 48-71 years) and body mass index (BMI) of 31.6 kg/m2 (range, 23.7-41.9 kg/m2) were matched to 50 patients undergoing primary cemented TKA with a mean age of 62.7 years (range, 51-73 years) and BMI of 30.1 kg/m2 (range, 24.6-43.9 kg/m2). The mean follow-up was 4.2 years (range, 4.0-4.4 years) in the cementless group and 7.6 years (range, 7.5-7.7 years) in the cemented group. Complications, clinical outcomes using the Knee Society Score (KSS), and radiographic analyses were evaluated at final follow-up. Student's t tests were used for statistical analyses.

Results: There was no statistical difference in age, BMI, and preoperative KSS between the two groups (P=.12, P=.15, and P=.55, respectively). There were no complications or reoperations in either cohort. There were no statistical differences in range of motion and total KSS at final follow-up between the two groups. Final total KSS had a mean of 91.1 for the cementless group and 93.7 for the cemented group. There was no radiographic evidence of component subsidence or loosening in either cohort.

Conclusion: When compared with its cemented counterpart, the newly introduced cementless TKA design had similar excellent clinical improvements and radiologic results at an average of 4 years of follow-up. [Orthopedics. 2024;47(3):161-166.].

背景:无菌性松动仍然是全膝关节置换术(TKA)失败的主要原因。尽管骨水泥固定仍是金标准,但无骨水泥固定作为通过生物固定降低这一风险的一种手段,再次引起了人们的兴趣。本研究的目的是评估一种新引进的 TKA 设计的有骨水泥和无骨水泥版本在术后平均 4 年的临床效果:这是一项回顾性病例对照研究,对 100 例使用相同十字韧带固定假体设计(ATTUNE 膝关节系统;DePuy Synthes)的初次 TKA 进行了无骨水泥与有骨水泥 TKA 的比较。接受无骨水泥 TKA 治疗的 50 名患者的平均年龄为 60.8 岁(范围为 48-71 岁),体重指数 (BMI) 为 31.6 kg/m2(范围为 23.7-41.9 kg/m2);接受初次骨水泥 TKA 治疗的 50 名患者的平均年龄为 62.7 岁(范围为 51-73 岁),体重指数 (BMI) 为 30.1 kg/m2(范围为 24.6-43.9 kg/m2)。无骨水泥组的平均随访时间为4.2年(范围为4.0-4.4年),有骨水泥组的平均随访时间为7.6年(范围为7.5-7.7年)。在最终随访时对并发症、膝关节社会评分(KSS)的临床结果和放射学分析进行了评估。统计分析采用学生 t 检验:两组患者的年龄、体重指数和术前 KSS 均无统计学差异(分别为 P=.12、P=.15 和 P=.55)。两组患者均未出现并发症或再次手术。两组患者在最终随访时的活动范围和总 KSS 均无统计学差异。无骨水泥组的最终总 KSS 平均值为 91.1,有骨水泥组为 93.7。两组患者均未出现组件下沉或松动的影像学证据:结论:新引进的无骨水泥 TKA 与有骨水泥 TKA 相比,在平均 4 年的随访中具有相似的出色临床改善和放射学结果。[骨科。202x;4x(x):xx-xx]。
{"title":"Four-Year Outcomes of Cementless Versus Cemented Fixation of a Newly Introduced Total Knee Arthroplasty Design.","authors":"Timothy G Costales, David F Dalury","doi":"10.3928/01477447-20240122-02","DOIUrl":"10.3928/01477447-20240122-02","url":null,"abstract":"<p><strong>Background: </strong>Aseptic loosening continues to be a major cause of failure of total knee arthroplasty (TKA). Although cemented fixation remains the gold standard, there is renewed interest in cementless fixation as a means of decreasing this risk via biologic fixation. The purpose of this study was to evaluate the clinical outcomes of cemented and cementless versions of a newly introduced TKA design at an average of 4 years postoperatively.</p><p><strong>Materials and methods: </strong>This was a retrospective case-control study of 100 primary TKAs comparing cementless vs cemented TKAs using the same cruciate-retaining implant design (ATTUNE Knee System; DePuy Synthes). Fifty patients undergoing cementless TKA with a mean age of 60.8 years (range, 48-71 years) and body mass index (BMI) of 31.6 kg/m<sup>2</sup> (range, 23.7-41.9 kg/m<sup>2</sup>) were matched to 50 patients undergoing primary cemented TKA with a mean age of 62.7 years (range, 51-73 years) and BMI of 30.1 kg/m<sup>2</sup> (range, 24.6-43.9 kg/m<sup>2</sup>). The mean follow-up was 4.2 years (range, 4.0-4.4 years) in the cementless group and 7.6 years (range, 7.5-7.7 years) in the cemented group. Complications, clinical outcomes using the Knee Society Score (KSS), and radiographic analyses were evaluated at final follow-up. Student's <i>t</i> tests were used for statistical analyses.</p><p><strong>Results: </strong>There was no statistical difference in age, BMI, and preoperative KSS between the two groups (<i>P</i>=.12, <i>P</i>=.15, and <i>P</i>=.55, respectively). There were no complications or reoperations in either cohort. There were no statistical differences in range of motion and total KSS at final follow-up between the two groups. Final total KSS had a mean of 91.1 for the cementless group and 93.7 for the cemented group. There was no radiographic evidence of component subsidence or loosening in either cohort.</p><p><strong>Conclusion: </strong>When compared with its cemented counterpart, the newly introduced cementless TKA design had similar excellent clinical improvements and radiologic results at an average of 4 years of follow-up. [<i>Orthopedics</i>. 2024;47(3):161-166.].</p>","PeriodicalId":19631,"journal":{"name":"Orthopedics","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139576153","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
Multiligament Knee Reconstruction With Suture Tape Augmentation: Patient-Reported Outcomes at Minimum 2-Year Follow-up 缝合带增强多韧带膝关节重建术:至少 2 年随访的患者报告结果
IF 1.1 4区 医学 Q2 Medicine Pub Date : 2024-05-01 DOI: 10.3928/01477447-20240424-02
Brian Panish, MD, Jonathan J. Lawson, MS, Seleem Elkadi, MD, Eliana Schaefer, MD, Gregory Perraut, MD, Evan H. Argintar, MD

Background:

Multiligament knee injury (MLKI) is a severe subclass of orthopedic injury and can result in significant functional impairment. Novel MLKI graft constructs such as suture augmentation aim to enhance graft strength and optimize knee stability. The purpose of this study was to present patient-reported outcome measurements of a cohort at a minimum follow-up of 2 years after multiligament knee reconstruction (MLKR) with suture augmentation.

Materials and Methods:

A retrospective chart review was performed to identify patients who underwent MLKR with suture augmentation. Demographic and injury-specific variables were gathered preoperatively and postoperatively. Patients were contacted at a minimum of 2 years postoperatively to collect Patient-Reported Outcomes Measurement Information System, Multiligament Quality of Life, and Lysholm knee scores.

Results:

Twenty-seven patients underwent MLKR with suture augmentation, with 15 being female (55.6%) and 12 being male (44.4%). The mean pain score was 49.93±9.96, the mean physical function score was 49.56±10.94, and the mean mobility score was 47.56±8.58. The mean physical impairment score was 33.96±23.69, the mean emotional impairment score was 36.55±26.60, the mean activity limitation score was 28.00±25.61, and the mean societal involvement score was 30.09±27.45. The mean Lysholm knee score for the cohort was 67.93±22.36.

Conclusion:

Patients who underwent MLKR with suture augmentation had satisfactory scores across all patient-reported outcome measurements. On the basis of these criteria, the average patient achieved an acceptable clinical outcome, demonstrating that MLKR with suture augmentation is a safe and efficacious surgical technique for the treatment of MLKI. [Orthopedics. 202x;4x(x):xx–xx.]

背景:多韧带膝关节损伤(MLKI)是骨科损伤的一个严重亚类,可导致严重的功能障碍。缝合增强等新的多韧带膝关节损伤移植物结构旨在增强移植物强度并优化膝关节稳定性。本研究的目的是对缝合增强多韧带膝关节重建(MLKR)术后至少随访2年的患者报告结果进行测量。收集了术前和术后的人口统计学变量和损伤特异性变量。术后至少2年与患者联系,收集患者报告结果测量信息系统、多韧带生活质量和Lysholm膝关节评分。结果:27名患者接受了MLKR缝合增强术,其中15名为女性(55.6%),12名为男性(44.4%)。平均疼痛评分为(49.93±9.96)分,平均身体功能评分为(49.56±10.94)分,平均活动能力评分为(47.56±8.58)分。肢体功能障碍平均得分为(33.96±23.69)分,情感障碍平均得分为(36.55±26.60)分,活动受限平均得分为(28.00±25.61)分,社会参与平均得分为(30.09±27.45)分。结论:接受 MLKR 和缝合增量术的患者在所有患者报告的结果测量中都获得了令人满意的分数。根据这些标准,平均每位患者都获得了可接受的临床结果,这表明缝合增高的 MLKR 是治疗 MLKI 的一种安全有效的手术技术。[骨科。202x;4x(x):xx-xx。]
{"title":"Multiligament Knee Reconstruction With Suture Tape Augmentation: Patient-Reported Outcomes at Minimum 2-Year Follow-up","authors":"Brian Panish, MD, Jonathan J. Lawson, MS, Seleem Elkadi, MD, Eliana Schaefer, MD, Gregory Perraut, MD, Evan H. Argintar, MD","doi":"10.3928/01477447-20240424-02","DOIUrl":"https://doi.org/10.3928/01477447-20240424-02","url":null,"abstract":"<section><h3>Background:</h3><p>Multiligament knee injury (MLKI) is a severe subclass of orthopedic injury and can result in significant functional impairment. Novel MLKI graft constructs such as suture augmentation aim to enhance graft strength and optimize knee stability. The purpose of this study was to present patient-reported outcome measurements of a cohort at a minimum follow-up of 2 years after multiligament knee reconstruction (MLKR) with suture augmentation.</p></section><section><h3>Materials and Methods:</h3><p>A retrospective chart review was performed to identify patients who underwent MLKR with suture augmentation. Demographic and injury-specific variables were gathered preoperatively and postoperatively. Patients were contacted at a minimum of 2 years postoperatively to collect Patient-Reported Outcomes Measurement Information System, Multiligament Quality of Life, and Lysholm knee scores.</p></section><section><h3>Results:</h3><p>Twenty-seven patients underwent MLKR with suture augmentation, with 15 being female (55.6%) and 12 being male (44.4%). The mean pain score was 49.93±9.96, the mean physical function score was 49.56±10.94, and the mean mobility score was 47.56±8.58. The mean physical impairment score was 33.96±23.69, the mean emotional impairment score was 36.55±26.60, the mean activity limitation score was 28.00±25.61, and the mean societal involvement score was 30.09±27.45. The mean Lysholm knee score for the cohort was 67.93±22.36.</p></section><section><h3>Conclusion:</h3><p>Patients who underwent MLKR with suture augmentation had satisfactory scores across all patient-reported outcome measurements. On the basis of these criteria, the average patient achieved an acceptable clinical outcome, demonstrating that MLKR with suture augmentation is a safe and efficacious surgical technique for the treatment of MLKI. [<i>Orthopedics</i>. 202x;4x(x):xx–xx.]</p></section>","PeriodicalId":19631,"journal":{"name":"Orthopedics","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140832341","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
Performance of Two Artificial Intelligence Generative Language Models on the Orthopaedic In-Training Examination. 两种人工智能生成语言模型在骨科内训考试中的表现。
IF 1.1 4区 医学 Q2 Medicine Pub Date : 2024-05-01 Epub Date: 2024-03-12 DOI: 10.3928/01477447-20240304-02
Marc Lubitz, Luke Latario

Background: Artificial intelligence (AI) generative large language models are powerful and increasingly accessible tools with potential applications in health care education and training. The annual Orthopaedic In-Training Examination (OITE) is widely used to assess resident academic progress and preparation for the American Board of Orthopaedic Surgery Part 1 Examination.

Materials and methods: Open AI's ChatGPT and Google's Bard generative language models were administered the 2022 OITE. Question stems that contained images were input without and then with a text-based description of the imaging findings.

Results: ChatGPT answered 69.1% of questions correctly. When provided with text describing accompanying media, this increased to 77.8% correct. In contrast, Bard answered 49.8% of questions correctly. This increased to 58% correct when text describing imaging in question stems was provided (P<.0001). ChatGPT was most accurate in questions within the shoulder category, with 90.9% correct. Bard performed best in the sports category, with 65.4% correct. ChatGPT performed above the published mean of Accreditation Council for Graduate Medical Education orthopedic resident test-takers (66%).

Conclusion: There is significant variability in the accuracy of publicly available AI models on the OITE. AI generative language software may play numerous potential roles in the future in orthopedic education, including simulating patient presentations and clinical scenarios, customizing individual learning plans, and driving evidence-based case discussion. Further research and collaboration within the orthopedic community is required to safely adopt these tools and minimize risks associated with their use. [Orthopedics. 2024;47(3):e146-e150.].

背景:人工智能(AI)生成大语言模型是一种功能强大且日益普及的工具,在医疗保健教育和培训中具有潜在的应用价值。一年一度的矫形外科在岗培训考试(OITE)被广泛用于评估住院医师的学习进度和美国矫形外科委员会第一部分考试的准备情况:对 Open AI 的 ChatGPT 和谷歌的 Bard 生成语言模型进行了 2022 年 OITE 测试。在输入包含图像的题干时,先不输入图像,然后再输入基于文本的成像结果描述:结果:ChatGPT 正确回答了 69.1% 的问题。当提供随附媒体的文字描述时,正确率提高到 77.8%。相比之下,Bard 回答的问题正确率为 49.8%。当在问题题干中提供描述成像的文字时,正确率上升到 58%(PC 结论:在 OITE 上公开提供的人工智能模型的准确性存在很大差异。人工智能生成语言软件未来可能会在骨科教育中发挥许多潜在作用,包括模拟患者陈述和临床场景、定制个人学习计划以及推动循证病例讨论。要安全地采用这些工具并最大限度地降低与使用这些工具相关的风险,还需要在骨科界开展进一步的研究与合作。[骨科。202x;4x(x):xx-xx]。
{"title":"Performance of Two Artificial Intelligence Generative Language Models on the Orthopaedic In-Training Examination.","authors":"Marc Lubitz, Luke Latario","doi":"10.3928/01477447-20240304-02","DOIUrl":"10.3928/01477447-20240304-02","url":null,"abstract":"<p><strong>Background: </strong>Artificial intelligence (AI) generative large language models are powerful and increasingly accessible tools with potential applications in health care education and training. The annual Orthopaedic In-Training Examination (OITE) is widely used to assess resident academic progress and preparation for the American Board of Orthopaedic Surgery Part 1 Examination.</p><p><strong>Materials and methods: </strong>Open AI's ChatGPT and Google's Bard generative language models were administered the 2022 OITE. Question stems that contained images were input without and then with a text-based description of the imaging findings.</p><p><strong>Results: </strong>ChatGPT answered 69.1% of questions correctly. When provided with text describing accompanying media, this increased to 77.8% correct. In contrast, Bard answered 49.8% of questions correctly. This increased to 58% correct when text describing imaging in question stems was provided (<i>P</i><.0001). ChatGPT was most accurate in questions within the shoulder category, with 90.9% correct. Bard performed best in the sports category, with 65.4% correct. ChatGPT performed above the published mean of Accreditation Council for Graduate Medical Education orthopedic resident test-takers (66%).</p><p><strong>Conclusion: </strong>There is significant variability in the accuracy of publicly available AI models on the OITE. AI generative language software may play numerous potential roles in the future in orthopedic education, including simulating patient presentations and clinical scenarios, customizing individual learning plans, and driving evidence-based case discussion. Further research and collaboration within the orthopedic community is required to safely adopt these tools and minimize risks associated with their use. [<i>Orthopedics</i>. 2024;47(3):e146-e150.].</p>","PeriodicalId":19631,"journal":{"name":"Orthopedics","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140102090","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
A Cost Analysis of Surgical Approach in Total Hip Arthroplasty. 全髋关节置换术手术方法成本分析。
IF 1.1 4区 医学 Q2 Medicine Pub Date : 2024-05-01 Epub Date: 2024-03-12 DOI: 10.3928/01477447-20240304-03
Niall H Cochrane, Colleen Wixted, Billy Kim, Patrick J Kelly, Michael P Bolognesi, David Holst, Samuel Wellman, Sean P Ryan

Background: With pressures to decrease the financial burden of total hip arthroplasty (THA), it is imperative to understand the cost drivers of this procedure. This study evaluated operative and total encounter costs for two surgical approaches to THA-posterior (P) and direct anterior (DA).

Materials and methods: A total of 233 THAs (134 P and 99 DA) performed by two fellowship-trained arthroplasty surgeons from 2017 to 2022 were reviewed. Demographics, comorbidities, mobility status, operative time, length of stay, implants used, discharge location, and complications until final follow-up were recorded. Total encounter cost was collected and itemized. Multivariable regression analyses evaluated predictors of cost.

Results: There were differences in age (67 years for DA and 63 years for P; P=.03), body mass index (28.0 kg/m2 for DA and 33.8 kg/m2 for P; P<.01), Elixhauser Comorbidity Index score (4.6 for DA and 5.6 for P; P=.04), and operative time (2.1 hours for DA and 1.9 hours for P; P<.01) between the two cohorts. The DA cohort trended toward shorter length of stay, with the highest percentage of patients discharged home (86.9%; P=.02). The P cohort had the lowest encounter ($9601 for DA and $9100 for P; P=.20) and intraoperative (including implant used) ($7268 for DA and $6792 for P; P<.01) costs. The DA cohort had a significantly higher cost of radiology during the encounter ($244; P<.01). Regression analysis demonstrated that length of stay and DA approach were both predictors of increased encounter cost.

Conclusion: The DA cohort had improved measures of health; however, this approach was associated with a higher operative cost and was predictive of increased encounter cost despite a shorter length of stay. [Orthopedics. 2024;47(3):e151-e156.].

背景:在减少全髋关节置换术(THA)经济负担的压力下,了解该手术的成本动因势在必行。本研究评估了THA的两种手术方式--后路(P)和直接前路(DA)的手术成本和总就诊成本:研究回顾了 2017 年至 2022 年期间由两名经过研究员培训的关节置换外科医生实施的 233 例 THA(134 例 P 和 99 例 DA)。记录了直至最终随访的人口统计学、合并症、活动状况、手术时间、住院时间、使用的植入物、出院地点和并发症。此外,还收集并逐项记录了手术总费用。多变量回归分析评估了费用的预测因素:年龄(DA为67岁,P为63岁;P=0.03)、体重指数(DA为28.0 kg/m2,P为33.8 kg/m2;PP=0.04)和手术时间(DA为2.1小时,P为1.9小时;PP=0.02)存在差异。P队列的手术费用(DA为9601美元,P为9100美元;P=.20)和术中费用(包括使用的植入物)(DA为7268美元,P为6792美元;PPC结论:DA队列的健康状况有所改善;但是,这种方法的手术费用较高,而且尽管住院时间较短,但预计会增加就诊费用。[骨科。202;4x(x):xx-xx]。
{"title":"A Cost Analysis of Surgical Approach in Total Hip Arthroplasty.","authors":"Niall H Cochrane, Colleen Wixted, Billy Kim, Patrick J Kelly, Michael P Bolognesi, David Holst, Samuel Wellman, Sean P Ryan","doi":"10.3928/01477447-20240304-03","DOIUrl":"10.3928/01477447-20240304-03","url":null,"abstract":"<p><strong>Background: </strong>With pressures to decrease the financial burden of total hip arthroplasty (THA), it is imperative to understand the cost drivers of this procedure. This study evaluated operative and total encounter costs for two surgical approaches to THA-posterior (P) and direct anterior (DA).</p><p><strong>Materials and methods: </strong>A total of 233 THAs (134 P and 99 DA) performed by two fellowship-trained arthroplasty surgeons from 2017 to 2022 were reviewed. Demographics, comorbidities, mobility status, operative time, length of stay, implants used, discharge location, and complications until final follow-up were recorded. Total encounter cost was collected and itemized. Multivariable regression analyses evaluated predictors of cost.</p><p><strong>Results: </strong>There were differences in age (67 years for DA and 63 years for P; <i>P</i>=.03), body mass index (28.0 kg/m<sup>2</sup> for DA and 33.8 kg/m<sup>2</sup> for P; <i>P</i><.01), Elixhauser Comorbidity Index score (4.6 for DA and 5.6 for P; <i>P</i>=.04), and operative time (2.1 hours for DA and 1.9 hours for P; <i>P</i><.01) between the two cohorts. The DA cohort trended toward shorter length of stay, with the highest percentage of patients discharged home (86.9%; <i>P</i>=.02). The P cohort had the lowest encounter ($9601 for DA and $9100 for P; <i>P</i>=.20) and intraoperative (including implant used) ($7268 for DA and $6792 for P; <i>P</i><.01) costs. The DA cohort had a significantly higher cost of radiology during the encounter ($244; <i>P</i><.01). Regression analysis demonstrated that length of stay and DA approach were both predictors of increased encounter cost.</p><p><strong>Conclusion: </strong>The DA cohort had improved measures of health; however, this approach was associated with a higher operative cost and was predictive of increased encounter cost despite a shorter length of stay. [<i>Orthopedics</i>. 2024;47(3):e151-e156.].</p>","PeriodicalId":19631,"journal":{"name":"Orthopedics","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140102088","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
An Inclusive Analysis of Racial and Ethnic Disparities in Orthopedic Surgery Outcomes. 骨科手术结果中种族和民族差异的包容性分析。
IF 1.1 4区 医学 Q3 ORTHOPEDICS Pub Date : 2024-05-01 Epub Date: 2024-01-25 DOI: 10.3928/01477447-20240122-01
Maveric K I L Abella, Tyler Thorne, Jeffrey Hayashi, Andrea K Finlay, Steven Frick, Derek F Amanatullah

Background: Despite increasing attention, disparities in outcomes for Black and Hispanic patients undergoing orthopedic surgery are widening. In other racial-ethnic minority groups, outcomes often go unreported. We sought to quantify disparities in surgical outcomes among Asian, American Indian or Alaskan Native, and Native Hawaiian or Pacific Islander patients across multiple orthopedic subspecialties.

Materials and methods: The National Surgical Quality Improvement Program was queried to identify all surgical procedures performed by an orthopedic surgeon from 2014 to 2020. Multivariable logistic regression models were used to investigate the impact of race and ethnicity on 30-day medical complications, readmission, reoperation, and mortality, while adjusting for orthopedic subspecialty and patient characteristics.

Results: Across 1,512,480 orthopedic procedures, all patients who were not White were less likely to have arthroplasty-related procedures (P<.001), and Hispanic, Asian, and American Indian or Alaskan Native patients were more likely to have trauma-related procedures (P<.001). American Indian or Alaskan Native (adjusted odds ratio [AOR], 1.005; 95% CI, 1.001-1.009; P=.011) and Native Hawaiian or Pacific Islander (AOR, 1.009; 95% CI, 1.005-1.014; P<.001) patients had higher odds of major medical complications compared with White patients. American Indian or Alaskan Native patients had higher risk of reoperation (AOR, 1.005; 95% CI, 1.002-1.008; P=.002) and Native Hawaiian or Pacific Islander patients had higher odds of mortality (AOR, 1.003; 95% CI, 1.000-1.005; P=.019) compared with White patients.

Conclusion: Disparities regarding surgical outcome and utilization rates persist across orthopedic surgery. American Indian or Alaskan Native and Native Hawaiian or Pacific Islander patients, who are under-represented in research, have lower rates of arthroplasty but higher odds of medical complication, reoperation, and mortality. This study highlights the importance of including these patients in orthopedic research to affect policy-related discussions. [Orthopedics. 2024;47(3):e131-e138.].

背景:尽管受到越来越多的关注,但接受骨科手术的黑人和西班牙裔患者的治疗效果差距却在不断扩大。在其他少数种族-族裔群体中,手术结果往往没有报告。我们试图量化亚裔、美国印第安人或阿拉斯加原住民、夏威夷原住民或太平洋岛民患者在多个骨科亚专科的手术结果差异:通过查询 "国家外科质量改进计划"(National Surgical Quality Improvement Program),确定了从 2014 年到 2020 年由骨科医生实施的所有外科手术。采用多变量逻辑回归模型研究种族和民族对 30 天医疗并发症、再入院、再手术和死亡率的影响,同时对骨科亚专科和患者特征进行调整:在1,512,480例骨科手术中,与白人患者相比,所有非白人患者接受关节成形术相关手术的可能性较低(PPP=.011),夏威夷原住民或太平洋岛民患者(AOR,1.009;95% CI,1.005-1.014;PP=.002)和夏威夷原住民或太平洋岛民患者的死亡率较高(AOR,1.003;95% CI,1.000-1.005;P=.019):结论:骨科手术在手术效果和使用率方面仍存在差异。美国印第安人或阿拉斯加原住民以及夏威夷原住民或太平洋岛民患者在研究中的代表性不足,他们接受关节置换术的比例较低,但出现医疗并发症、再次手术和死亡率的几率较高。这项研究强调了将这些患者纳入骨科研究以影响政策相关讨论的重要性。[骨科。202x;4x(x):xx-xx]。
{"title":"An Inclusive Analysis of Racial and Ethnic Disparities in Orthopedic Surgery Outcomes.","authors":"Maveric K I L Abella, Tyler Thorne, Jeffrey Hayashi, Andrea K Finlay, Steven Frick, Derek F Amanatullah","doi":"10.3928/01477447-20240122-01","DOIUrl":"10.3928/01477447-20240122-01","url":null,"abstract":"<p><strong>Background: </strong>Despite increasing attention, disparities in outcomes for Black and Hispanic patients undergoing orthopedic surgery are widening. In other racial-ethnic minority groups, outcomes often go unreported. We sought to quantify disparities in surgical outcomes among Asian, American Indian or Alaskan Native, and Native Hawaiian or Pacific Islander patients across multiple orthopedic subspecialties.</p><p><strong>Materials and methods: </strong>The National Surgical Quality Improvement Program was queried to identify all surgical procedures performed by an orthopedic surgeon from 2014 to 2020. Multivariable logistic regression models were used to investigate the impact of race and ethnicity on 30-day medical complications, readmission, reoperation, and mortality, while adjusting for orthopedic subspecialty and patient characteristics.</p><p><strong>Results: </strong>Across 1,512,480 orthopedic procedures, all patients who were not White were less likely to have arthroplasty-related procedures (<i>P</i><.001), and Hispanic, Asian, and American Indian or Alaskan Native patients were more likely to have trauma-related procedures (<i>P</i><.001). American Indian or Alaskan Native (adjusted odds ratio [AOR], 1.005; 95% CI, 1.001-1.009; <i>P</i>=.011) and Native Hawaiian or Pacific Islander (AOR, 1.009; 95% CI, 1.005-1.014; <i>P</i><.001) patients had higher odds of major medical complications compared with White patients. American Indian or Alaskan Native patients had higher risk of reoperation (AOR, 1.005; 95% CI, 1.002-1.008; <i>P</i>=.002) and Native Hawaiian or Pacific Islander patients had higher odds of mortality (AOR, 1.003; 95% CI, 1.000-1.005; <i>P</i>=.019) compared with White patients.</p><p><strong>Conclusion: </strong>Disparities regarding surgical outcome and utilization rates persist across orthopedic surgery. American Indian or Alaskan Native and Native Hawaiian or Pacific Islander patients, who are under-represented in research, have lower rates of arthroplasty but higher odds of medical complication, reoperation, and mortality. This study highlights the importance of including these patients in orthopedic research to affect policy-related discussions. [<i>Orthopedics</i>. 2024;47(3):e131-e138.].</p>","PeriodicalId":19631,"journal":{"name":"Orthopedics","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139576088","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
Zone I Revision Finger Amputations Performed in the Emergency Department Compared With Those Performed in the Operating Room. 急诊科进行的I区翻修手指截肢与手术室进行的比较。
IF 1.1 4区 医学 Q2 Medicine Pub Date : 2024-05-01 Epub Date: 2023-11-01 DOI: 10.3928/01477447-20231027-04
Michael J Anderson, Brett R Campbell, Brittany E Homcha, Susan J Boehmer, Kenneth F Taylor

Finger amputations are commonly encountered. These may be revised in the emergency department (ED) or the operating room (OR). Previous studies have demonstrated the cost-effectiveness associated with procedures performed in the ED. Patient outcomes have not been described. We retrospectively reviewed patients who presented to our level 1 trauma center with a traumatic partial or complete finger amputation through flexor tendon zone I. All were treated with revision amputation performed in either the ED or the OR between January 2012 and December 2017. A total of 172 patient charts were included. Ninety-three of the revision amputations were performed in the ED, while 79 were performed in the OR. There was no difference in age, race, sex, having a manual labor job, medical comorbidities, or mechanism of injury between the groups. Compared with procedures performed in the ED, procedures performed in the OR had a higher rate of delayed healing, a longer stay in the hospital, and a higher referral to therapy postoperatively. Length of follow-up and number of follow-up visits were not statistically different based on location of procedure. There was no difference in post-procedural infection rate or need for revision procedure between the groups. Our data support the efficacy of performing revision amputation procedures in the ED. Recorded patient complications and subsequent treatment after revision amputations performed in the ED vs the OR were comparable. Those performed in the ED potentially decrease the burden placed on the patient and the health care system. [Orthopedics. 2024;47(3):152-156.].

手指截肢是常见的。这些可以在急诊科(ED)或手术室(or)进行修订。先前的研究已经证明了ED手术的成本效益。患者的结果尚未描述。我们回顾性回顾了2012年1月至2017年12月期间,在我们的一级创伤中心接受屈肌腱I区创伤性部分或完全手指截肢的患者。所有患者都接受了ED或or的翻修截肢治疗。共纳入172张病历。93例翻修截肢手术在急诊室进行,79例在手术室进行。两组之间在年龄、种族、性别、从事体力劳动、医疗合并症或损伤机制方面没有差异。与ED手术相比,OR手术的延迟愈合率更高,住院时间更长,术后转诊治疗的次数也更多。随访时间和随访次数根据手术地点没有统计学差异。两组患者术后感染率或是否需要翻修手术没有差异。我们的数据支持在ED中进行翻修截肢手术的疗效。记录的患者并发症和在ED和OR中进行翻修后的后续治疗具有可比性。在ED中进行的手术可能会减轻患者和医疗保健系统的负担。[骨科.202x;4x(x):xx-xx.]。
{"title":"Zone I Revision Finger Amputations Performed in the Emergency Department Compared With Those Performed in the Operating Room.","authors":"Michael J Anderson, Brett R Campbell, Brittany E Homcha, Susan J Boehmer, Kenneth F Taylor","doi":"10.3928/01477447-20231027-04","DOIUrl":"10.3928/01477447-20231027-04","url":null,"abstract":"<p><p>Finger amputations are commonly encountered. These may be revised in the emergency department (ED) or the operating room (OR). Previous studies have demonstrated the cost-effectiveness associated with procedures performed in the ED. Patient outcomes have not been described. We retrospectively reviewed patients who presented to our level 1 trauma center with a traumatic partial or complete finger amputation through flexor tendon zone I. All were treated with revision amputation performed in either the ED or the OR between January 2012 and December 2017. A total of 172 patient charts were included. Ninety-three of the revision amputations were performed in the ED, while 79 were performed in the OR. There was no difference in age, race, sex, having a manual labor job, medical comorbidities, or mechanism of injury between the groups. Compared with procedures performed in the ED, procedures performed in the OR had a higher rate of delayed healing, a longer stay in the hospital, and a higher referral to therapy postoperatively. Length of follow-up and number of follow-up visits were not statistically different based on location of procedure. There was no difference in post-procedural infection rate or need for revision procedure between the groups. Our data support the efficacy of performing revision amputation procedures in the ED. Recorded patient complications and subsequent treatment after revision amputations performed in the ED vs the OR were comparable. Those performed in the ED potentially decrease the burden placed on the patient and the health care system. [<i>Orthopedics</i>. 2024;47(3):152-156.].</p>","PeriodicalId":19631,"journal":{"name":"Orthopedics","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71425736","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
Endoscopic Versus Open In Situ Decompression for the Management of Cubital Tunnel Syndrome. 内镜与开放式原位减压治疗肘管综合征。
IF 1.1 4区 医学 Q2 Medicine Pub Date : 2024-05-01 Epub Date: 2023-11-01 DOI: 10.3928/01477447-20231027-06
Byung-Sung Kim, Ki Jin Jung, Jae-Hwi Nho, Joo Young Cha

This study compared the results of endoscopic cubital tunnel release (eCuTR) with those of open cubital tunnel release (oCuTR) for the management of cubital tunnel syndrome (CuTS). In this retrospective study, 35 patients underwent eCuTR or oCuTR. Group I and group II consisted of 16 patients undergoing eCuTR and 19 patients undergoing oCuTR, respectively. Patients were asked to report paresthesia and pain, and electromyography was performed. The Dellon and Bishop classifications were used. The Disabilities of the Arm, Shoulder and Hand (DASH) and visual analog scale (VAS) pain scores were recorded, as well as the key pinch strength and two-point discrimination. The incision length and operation duration were noted. The mean follow-up was 39 months. The mean operating time was longer in the endoscopy group (43 vs 22 minutes). Overall, 34.3% (n=12) of the cases were classified as Dellon grade II and 65.7% (n=23) were classified as Dellon grade III. According to the Bishop score, excellent or good results were obtained for 75% of the patients in the eCuTR group and 78.9% of the patients in the oCuTR group. In the eCuTR and oCuTR groups, all outcome measures improved after surgery: DASH score (preoperative, 37.7 vs 30.7; postoperative, 15.4 vs 20), VAS score (preoperative, 7.8 vs 7.3; postoperative, 4.3 vs 4.1), pinch strength (preoperative, 74 vs 66; postoperative, 93 vs 84), and two-point discrimination (preoperative, 5.6 vs 6.6; postoperative, 4.9 vs 4.5). No significant difference was apparent between the two techniques in outcomes. However, the endoscopic release had a higher reoperation rate and took twice as long to perform despite having a shorter incision. [Orthopedics. 2024;47(3):e119-e124.].

本研究比较了内镜下肘管松解术(eCuTR)和开放式肘管松脱术(oCuTR)治疗肘管综合征(CuTS)的结果。在这项回顾性研究中,35名患者接受了eCuTR或oCuTR。第一组和第二组分别由16名接受eCuTR的患者和19名接受oCuTR的患者组成。患者被要求报告感觉异常和疼痛,并进行肌电图检查。使用了Dellon和Bishop分类法。记录手臂、肩膀和手部残疾(DASH)和视觉模拟量表(VAS)疼痛评分,以及关键握力和两点辨别力。记录切口长度和手术时间。平均随访39个月。内窥镜检查组的平均手术时间更长(43分钟vs 22分钟)。总体而言,34.3%(n=12)的病例被归类为Dellon II级,65.7%(n=23)被归类为Dell III级。根据Bishop评分,eCuTR组75%的患者和oCuTR组78.9%的患者获得了优异或良好的结果。在eCuTR和oCuTR组中,术后所有结果指标均有所改善:DASH评分(术前37.7 vs 30.7;术后15.4 vs 20)、VAS评分(术后7.8 vs 7.3;术后4.3 vs 4.1)、握力(术前74 vs 66;术后93 vs 84),和两点判别(术前,5.6比6.6;术后,4.9比4.5)。两种技术在结果上没有明显差异。然而,内镜下松解术的再次手术率更高,尽管切口更短,但手术时间是原来的两倍。[骨科.202x;4x(x):xx-xx.]。
{"title":"Endoscopic Versus Open In Situ Decompression for the Management of Cubital Tunnel Syndrome.","authors":"Byung-Sung Kim, Ki Jin Jung, Jae-Hwi Nho, Joo Young Cha","doi":"10.3928/01477447-20231027-06","DOIUrl":"10.3928/01477447-20231027-06","url":null,"abstract":"<p><p>This study compared the results of endoscopic cubital tunnel release (eCuTR) with those of open cubital tunnel release (oCuTR) for the management of cubital tunnel syndrome (CuTS). In this retrospective study, 35 patients underwent eCuTR or oCuTR. Group I and group II consisted of 16 patients undergoing eCuTR and 19 patients undergoing oCuTR, respectively. Patients were asked to report paresthesia and pain, and electromyography was performed. The Dellon and Bishop classifications were used. The Disabilities of the Arm, Shoulder and Hand (DASH) and visual analog scale (VAS) pain scores were recorded, as well as the key pinch strength and two-point discrimination. The incision length and operation duration were noted. The mean follow-up was 39 months. The mean operating time was longer in the endoscopy group (43 vs 22 minutes). Overall, 34.3% (n=12) of the cases were classified as Dellon grade II and 65.7% (n=23) were classified as Dellon grade III. According to the Bishop score, excellent or good results were obtained for 75% of the patients in the eCuTR group and 78.9% of the patients in the oCuTR group. In the eCuTR and oCuTR groups, all outcome measures improved after surgery: DASH score (preoperative, 37.7 vs 30.7; postoperative, 15.4 vs 20), VAS score (preoperative, 7.8 vs 7.3; postoperative, 4.3 vs 4.1), pinch strength (preoperative, 74 vs 66; postoperative, 93 vs 84), and two-point discrimination (preoperative, 5.6 vs 6.6; postoperative, 4.9 vs 4.5). No significant difference was apparent between the two techniques in outcomes. However, the endoscopic release had a higher reoperation rate and took twice as long to perform despite having a shorter incision. [<i>Orthopedics</i>. 2024;47(3):e119-e124.].</p>","PeriodicalId":19631,"journal":{"name":"Orthopedics","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71425731","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
A Novel Digital Templating Method for Total Hip Arthroplasty in Patients With Unilateral Hip Arthrosis. 用于单侧髋关节病变患者全髋关节置换术的新型数字模板法。
IF 1.1 4区 医学 Q2 Medicine Pub Date : 2024-05-01 Epub Date: 2023-12-28 DOI: 10.3928/01477447-20231220-04
Matthew Mazur, Ishan Patel, Abdul K Zalikha, Guillermo Rodriguez, Hussein Darwiche, Rahul Vaidya

Background: Identification of the hip center of rotation (HCOR) before total hip arthroplasty (THA) is crucial for achieving optimal implant position and size, and for restoring native biomechanics around the hip joint. Current techniques for determining the HCOR in cases of abnormal hip anatomy are limited and unreliable. This study presents a novel technique using open-access software for preoperative THA templating for patients with significantly abnormal hip anatomy due to unilateral hip arthrosis. The aim is to reliably predict the HCOR and acetabular implant size compared with a traditional intraoperative method.

Materials and methods: This retrospective study involved 20 patients with unilateral hip arthrosis who underwent THA. Preoperative templating was performed using the experimental technique, and the position of the HCOR was measured on preoperative and postoperative radiographs. The positions of the predicted and actual HCOR were compared, along with the inclination and size of the acetabular component.

Results: The difference between the predicted and actual HCOR positions was insignificant (0.43±0.22 mm vertically and 0.18±0.20 mm horizontally), and there was a positive correlation between them (r=0.78, P<.005; r=0.72, P<.005). The agreement between the predicted and actual acetabular implant sizes was 85%, with near-perfect interobserver agreement (Cohen's kappa=0.827).

Conclusion: This novel technique provides a reliable method for predicting HCOR and acetabular implant size for THA in cases of unilateral hip arthrosis. This technique may help optimize biomechanics and improve outcomes in challenging cases. Further research and validation are warranted to establish its broader applicability. [Orthopedics. 2024;47(3):e139-e145.].

背景:在全髋关节置换术(THA)前确定髋关节旋转中心(HCOR)对于获得最佳植入位置和尺寸以及恢复髋关节周围的原生生物力学至关重要。目前在髋关节解剖异常的情况下确定 HCOR 的技术有限且不可靠。本研究提出了一种新技术,使用开放式访问软件为因单侧髋关节病导致髋关节解剖结构明显异常的患者进行术前 THA 模板设计。与传统的术中方法相比,其目的是可靠地预测 HCOR 和髋臼植入物的大小:这项回顾性研究涉及 20 名接受全髋关节置换术的单侧髋关节炎患者。采用实验技术进行术前模板制作,并通过术前和术后X光片测量HCOR的位置。对预测的 HCOR 位置和实际的 HCOR 位置以及髋臼组件的倾斜度和尺寸进行了比较:结果:预测的 HCOR 位置与实际的 HCOR 位置差异不大(垂直方向为 0.43±0.22 mm,水平方向为 0.18±0.20 mm),两者之间存在正相关性(r=0.78,Pr=0.72,PC结论:这项新技术为预测单侧髋关节病例中 THA 的 HCOR 和髋臼假体尺寸提供了一种可靠的方法。该技术可帮助优化生物力学,改善高难度病例的治疗效果。需要进一步研究和验证,以确定其更广泛的适用性。[202x;4x(x):xx-xx]。
{"title":"A Novel Digital Templating Method for Total Hip Arthroplasty in Patients With Unilateral Hip Arthrosis.","authors":"Matthew Mazur, Ishan Patel, Abdul K Zalikha, Guillermo Rodriguez, Hussein Darwiche, Rahul Vaidya","doi":"10.3928/01477447-20231220-04","DOIUrl":"10.3928/01477447-20231220-04","url":null,"abstract":"<p><strong>Background: </strong>Identification of the hip center of rotation (HCOR) before total hip arthroplasty (THA) is crucial for achieving optimal implant position and size, and for restoring native biomechanics around the hip joint. Current techniques for determining the HCOR in cases of abnormal hip anatomy are limited and unreliable. This study presents a novel technique using open-access software for preoperative THA templating for patients with significantly abnormal hip anatomy due to unilateral hip arthrosis. The aim is to reliably predict the HCOR and acetabular implant size compared with a traditional intraoperative method.</p><p><strong>Materials and methods: </strong>This retrospective study involved 20 patients with unilateral hip arthrosis who underwent THA. Preoperative templating was performed using the experimental technique, and the position of the HCOR was measured on preoperative and postoperative radiographs. The positions of the predicted and actual HCOR were compared, along with the inclination and size of the acetabular component.</p><p><strong>Results: </strong>The difference between the predicted and actual HCOR positions was insignificant (0.43±0.22 mm vertically and 0.18±0.20 mm horizontally), and there was a positive correlation between them (<i>r</i>=0.78, <i>P</i><.005; <i>r</i>=0.72, <i>P</i><.005). The agreement between the predicted and actual acetabular implant sizes was 85%, with near-perfect interobserver agreement (Cohen's kappa=0.827).</p><p><strong>Conclusion: </strong>This novel technique provides a reliable method for predicting HCOR and acetabular implant size for THA in cases of unilateral hip arthrosis. This technique may help optimize biomechanics and improve outcomes in challenging cases. Further research and validation are warranted to establish its broader applicability. [<i>Orthopedics</i>. 2024;47(3):e139-e145.].</p>","PeriodicalId":19631,"journal":{"name":"Orthopedics","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139040334","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
期刊
Orthopedics
全部 Acc. Chem. Res. ACS Applied Bio Materials ACS Appl. Electron. Mater. ACS Appl. Energy Mater. ACS Appl. Mater. Interfaces ACS Appl. Nano Mater. ACS Appl. Polym. Mater. ACS BIOMATER-SCI ENG ACS Catal. ACS Cent. Sci. ACS Chem. Biol. ACS Chemical Health & Safety ACS Chem. Neurosci. ACS Comb. Sci. ACS Earth Space Chem. ACS Energy Lett. ACS Infect. Dis. ACS Macro Lett. ACS Mater. Lett. ACS Med. Chem. Lett. ACS Nano ACS Omega ACS Photonics ACS Sens. ACS Sustainable Chem. Eng. ACS Synth. Biol. Anal. Chem. BIOCHEMISTRY-US Bioconjugate Chem. BIOMACROMOLECULES Chem. Res. Toxicol. Chem. Rev. Chem. Mater. CRYST GROWTH DES ENERG FUEL Environ. Sci. Technol. Environ. Sci. Technol. Lett. Eur. J. Inorg. Chem. IND ENG CHEM RES Inorg. Chem. J. Agric. Food. Chem. J. Chem. Eng. Data J. Chem. Educ. J. Chem. Inf. Model. J. Chem. Theory Comput. J. Med. Chem. J. Nat. Prod. J PROTEOME RES J. Am. Chem. Soc. LANGMUIR MACROMOLECULES Mol. Pharmaceutics Nano Lett. Org. Lett. ORG PROCESS RES DEV ORGANOMETALLICS J. Org. Chem. J. Phys. Chem. J. Phys. Chem. A J. Phys. Chem. B J. Phys. Chem. C J. Phys. Chem. Lett. Analyst Anal. Methods Biomater. Sci. Catal. Sci. Technol. Chem. Commun. Chem. Soc. Rev. CHEM EDUC RES PRACT CRYSTENGCOMM Dalton Trans. Energy Environ. Sci. ENVIRON SCI-NANO ENVIRON SCI-PROC IMP ENVIRON SCI-WAT RES Faraday Discuss. Food Funct. Green Chem. Inorg. Chem. Front. Integr. Biol. J. Anal. At. Spectrom. J. Mater. Chem. A J. Mater. Chem. B J. Mater. Chem. C Lab Chip Mater. Chem. Front. Mater. Horiz. MEDCHEMCOMM Metallomics Mol. Biosyst. Mol. Syst. Des. Eng. Nanoscale Nanoscale Horiz. Nat. Prod. Rep. New J. Chem. Org. Biomol. Chem. Org. Chem. Front. PHOTOCH PHOTOBIO SCI PCCP Polym. Chem.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
0
微信
客服QQ
Book学术公众号 扫码关注我们
反馈
×
意见反馈
请填写您的意见或建议
请填写您的手机或邮箱
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
现在去查看 取消
×
提示
确定
Book学术官方微信
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术
文献互助 智能选刊 最新文献 互助须知 联系我们:info@booksci.cn
Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。
Copyright © 2023 Book学术 All rights reserved.
ghs 京公网安备 11010802042870号 京ICP备2023020795号-1