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Liposomal Bupivacaine Does Not Decrease Postoperative Pain in Patients with Intracapsular Femoral Neck Fracture Treated with Hemiarthroplasty: HEAT-A Randomized, Controlled Trial. 脂质体布比卡因不会减轻接受半关节成形术治疗的股骨颈囊内骨折患者的术后疼痛:HEAT--一项随机对照试验。
Pub Date : 2024-09-18 DOI: 10.2106/jbjs.23.01344
Kevin K Kang,Lucas Voyvodic,Daniel Komlos,Samuel Swiggett,Mitchell K Ng
BACKGROUNDLiposomal bupivacaine (LB) is a long-lasting local anesthetic agent that was developed for use in the surgical setting to help manage postoperative pain. The objective of this study was to evaluate the effect of LB on postoperative pain, function, and overall hospital course in patients with intracapsular hip fractures who were treated with hip hemiarthroplasty.METHODSThis was a single-center, randomized prospective double-blinded study of 50 patients with an isolated intracapsular femoral neck fracture who were treated with hip hemiarthroplasty from 2018 to 2022. The study group consisted of 25 patients who were treated with intraoperative LB and bupivacaine hydrochloride injections, while the control group consisted of 25 patients who were treated with intraoperative bupivacaine hydrochloride injections only. Primary outcomes were a visual analog scale (VAS) score for pain, total morphine milligram equivalents (MME), delirium, and time to ambulation with physical therapy.RESULTSNo significant differences between the study and control groups were found in any of the outcomes measured. Most notably, there were no differences in the average postoperative pain score (VAS, 2.26 versus 2.7; p = 0.34), total MME used postoperatively (11.73 versus 9.98 MME; p = 0.71), and postoperative day of discharge (4.00 versus 3.88 days; p = 0.82).CONCLUSIONSThe results of our study suggest that use of LB is not associated with substantially improved postoperative pain or function or with a shorter hospital course following hip hemiarthroplasty for a femoral neck fracture. Given the higher cost of LB compared with standard postoperative pain modalities, it is worth questioning its use in the setting of geriatric hip fractures.LEVEL OF EVIDENCETherapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
背景脂质体布比卡因(LB)是一种长效局麻药,开发用于外科手术环境,以帮助控制术后疼痛。本研究的目的是评估 LB 对接受髋关节半置换术治疗的囊内髋部骨折患者术后疼痛、功能和总体住院过程的影响。方法这是一项单中心、随机前瞻性双盲研究,研究对象为 2018 年至 2022 年接受髋关节半置换术治疗的 50 例孤立性股骨颈囊内骨折患者。研究组由 25 名接受术中 LB 和盐酸布比卡因注射治疗的患者组成,对照组由 25 名仅接受术中盐酸布比卡因注射治疗的患者组成。主要结果为疼痛视觉模拟量表(VAS)评分、吗啡毫克当量(MME)总量、谵妄和接受物理治疗后的活动时间。最值得注意的是,研究组和对照组在术后平均疼痛评分(VAS,2.26 对 2.7;P = 0.34)、术后使用的 MME 总量(11.73 对 9.98 MME;P = 0.71)和术后出院天数(4.00 对 3.88 天;P = 0.82)方面没有差异。结论我们的研究结果表明,使用 LB 与股骨颈骨折髋关节半关节置换术后疼痛或功能的显著改善或住院时间的缩短无关。考虑到枸橼酸髋关节置换术的成本高于标准术后止痛方式,在老年髋部骨折中使用枸橼酸髋关节置换术值得商榷。
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引用次数: 0
Don't Just Stand There; Do Something: Commentary on an article by Braeden Benedict, MS, et al.: "Using Multimodal Assessments to Reevaluate Depression Designations for Spine Surgery Candidates". 不要只是站在那里;做点什么:Braeden Benedict, MS, et al.的一篇文章的评论:"使用多模态评估重新评估脊柱手术候选者的抑郁指征"。
Pub Date : 2024-09-18 DOI: 10.2106/jbjs.24.00578
James B Talmage,Les P Kertay
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引用次数: 0
Minimally Invasive Surgery for Posterior Atlantoaxial Lateral Mass Joint Fusion (MIS-PALF): A Muscle-Sparing Procedure for Atlantoaxial Instability or Dislocation. 寰枢椎后侧肿块关节融合微创手术(MIS-PALF):治疗寰枢椎失稳或脱位的少用肌肉手术。
Pub Date : 2024-09-18 DOI: 10.2106/jbjs.23.01464
Kan-Lin Hung,Yong Lu,Yinglun Tian,Shilin Xue,Guodong Gao,Qiyue Gao,Nanfang Xu,Shenglin Wang
BACKGROUNDConventional surgical procedures for atlantoaxial instability or dislocation (AAI/D) have been associated with a high prevalence of postoperative occipitocervical pain and dysfunction, as well as substantial perioperative blood loss. We hypothesized that minimally invasive surgery for posterior atlantoaxial lateral mass joint fusion (MIS-PALF), a procedure that can largely avoid disruption of suboccipital musculature, would be superior to the standard Goel-Harms technique in terms of postoperative pain and perioperative blood loss.METHODSThis was a prospective cohort study of patients undergoing MIS-PALF for AAI/D at Peking University Third Hospital's Department of Orthopaedics from January 2021 to December 2021 and a historical control group of patients with the same diagnoses who were treated with the Goel-Harms technique. The duration of surgery, perioperative blood loss, postoperative length of hospital stay, postoperative body temperature, pain, supplementary use of narcotics, spinal cord function/improvement (assessed using the Japanese Orthopaedic Association [JOA] scores), reduction of AAI/D (determined based on radiographic parameters), rate of successful fusion, and complication rate were all compared between the 2 groups.RESULTSNo significant differences were noted between the groups (43 MIS-PALF cases, 86 control cases) regarding baseline data, operative time, spinal cord function or improvement, reduction of AAI/D, rate of successful fusion, and complication rate. MIS-PALF was associated with significantly less perioperative blood loss, a shorter postoperative hospital stay (decreased by 30.8%), lower intensity and frequency of postoperative pain (decreased by 10.6% and 61.9%, respectively), less need for supplementary narcotics, and less frequent postoperative fever (decreased by 48.7%).CONCLUSIONSThis was the first prospective cohort study of which we are aware on minimally invasive procedures for atlantoaxial fusion. Clinical efficacy (AAI/D reduction, rate of successful atlantoaxial fusion, JOA score improvement), efficiency (operative time), and safety (complications) of MIS-PALF appeared to be noninferior to those of the Goel-Harms technique. MIS-PALF was superior in terms of postoperative occipitocervical pain and length of hospital stay, both of which directly affect overall patient satisfaction and postoperative recovery of quality of life.LEVEL OF EVIDENCETherapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
背景寰枢椎不稳或脱位(AAI/D)的传统手术治疗与术后枕颈部疼痛和功能障碍的高发生率以及大量围手术期失血有关。我们假设,后方寰枢椎外侧肿块关节融合术(MIS-PALF)的微创手术能在很大程度上避免破坏枕下肌肉组织,在术后疼痛和围手术期失血方面将优于标准的 Goel-Harms 技术。方法:这是一项前瞻性队列研究,研究对象是2021年1月至2021年12月在北京大学第三医院骨科接受MIS-PALF治疗AAI/D的患者,以及采用Goel-Harms技术治疗的具有相同诊断的历史对照组患者。两组患者的手术时间、围手术期失血量、术后住院时间、术后体温、疼痛、辅助麻醉剂使用、脊髓功能/改善(使用日本骨科协会[JOA]评分进行评估)、AAI/D降低(根据放射学参数确定)、融合成功率和并发症发生率均进行了比较。结果 两组(43 例 MIS-PALF 病例,86 例对照组病例)在基线数据、手术时间、脊髓功能或改善程度、AAI/D 降低程度、融合成功率和并发症发生率方面均无明显差异。MIS-PALF与围手术期失血量明显减少、术后住院时间缩短(减少了30.8%)、术后疼痛强度和频率降低(分别减少了10.6%和61.9%)、对辅助麻醉剂的需求减少以及术后发热频率降低(减少了48.7%)相关。MIS-PALF的临床疗效(AAI/D降低率、寰枢关节融合成功率、JOA评分改善率)、效率(手术时间)和安全性(并发症)似乎不逊于Goel-Harms技术。MIS-PALF在术后枕颈部疼痛和住院时间方面更胜一筹,而这两方面都会直接影响患者的整体满意度和术后生活质量的恢复。有关证据等级的完整描述,请参阅 "作者须知"。
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引用次数: 0
The T4-L1-Hip Axis: Sagittal Spinal Realignment Targets in Long-Construct Adult Spinal Deformity Surgery: Early Impact. T4-L1-髋轴:长结构成人脊柱畸形手术中的矢状脊柱重新对位目标:早期影响。
Pub Date : 2024-09-18 DOI: 10.2106/jbjs.23.00372
Jeffrey Hills,Gregory M Mundis,Eric O Klineberg,Justin S Smith,Breton Line,Jeffrey L Gum,Themistocles S Protopsaltis,D Kojo Hamilton,Alex Soroceanu,Robert Eastlack,Pierce Nunley,Khaled M Kebaish,Lawrence G Lenke,Richard A Hostin,Munish C Gupta,Han Jo Kim,Christopher P Ames,Douglas C Burton,Christopher I Shaffrey,Frank J Schwab,Virginie Lafage,Renaud Lafage,Shay Bess,Michael P Kelly,
BACKGROUNDOur understanding of the relationship between sagittal alignment and mechanical complications is evolving. In normal spines, the L1-pelvic angle (L1PA) accounts for the magnitude and distribution of lordosis and is strongly associated with pelvic incidence (PI), and the T4-pelvic angle (T4PA) is within 4° of the L1PA. We aimed to examine the clinical implications of realignment to a normal L1PA and T4-L1PA mismatch.METHODSA prospective multicenter adult spinal deformity registry was queried for patients who underwent fixation from the T1-T5 region to the sacrum and had 2-year radiographic follow-up. Normal sagittal alignment was defined as previously described for normal spines: L1PA = PI × 0.5 - 21°, and T4-L1PA mismatch = 0°. Mechanical failure was defined as severe proximal junctional kyphosis (PJK), displaced rod fracture, or reoperation for junctional failure, pseudarthrosis, or rod fracture within 2 years. Multivariable nonlinear logistic regression was used to define target ranges for L1PA and T4-L1PA mismatch that minimized the risk of mechanical failure. The relationship between changes in T4PA and changes in global sagittal alignment according to the C2-pelvic angle (C2PA) was determined using linear regression. Lastly, multivariable regression was used to assess associations between initial postoperative C2PA and patient-reported outcomes at 1 year, adjusting for preoperative scores and age.RESULTSThe median age of the 247 included patients was 64 years (interquartile range, 57 to 69 years), and 202 (82%) were female. Deviation from a normal L1PA or T4-L1PA mismatch in either direction was associated with a significantly higher risk of mechanical failure, independent of age. Risk was minimized with an L1PA of PI × 0.5 - (19° ± 2°) and T4-L1PA mismatch between -3° and +1°. Changes in T4PA and in C2PA at the time of final follow-up were strongly associated (r2 = 0.96). Higher postoperative C2PA was independently associated with more disability, more pain, and worse self-image at 1 year.CONCLUSIONSWe defined sagittal alignment targets using L1PA (relative to PI) and the T4-L1PA mismatch, which are both directly modifiable during surgery. In patients undergoing long fusion to the sacrum, realignment based on these targets may lead to fewer mechanical failures.LEVEL OF EVIDENCETherapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
背景我们对矢状对齐与机械并发症之间关系的认识正在不断发展。在正常脊柱中,L1-骨盆角(L1PA)决定了脊柱前凸的程度和分布,并与骨盆入射角(PI)密切相关,而 T4-骨盆角(T4PA)与 L1PA 的夹角在 4° 以内。我们的目的是研究重新对齐正常 L1PA 和 T4-L1PA 错位的临床影响。方法我们查询了前瞻性多中心成人脊柱畸形登记处,以了解从 T1-T5 区域到骶骨接受固定术并接受 2 年影像学随访的患者。正常矢状线的定义与之前描述的正常脊柱相同:L1PA = PI × 0.5 - 21°,T4-L1PA错位 = 0°。机械性失败的定义为严重的近端交界性后凸(PJK)、移位的杆骨折,或在两年内因交界性失败、假关节或杆骨折而再次手术。多变量非线性逻辑回归被用来定义L1PA和T4-L1PA不匹配的目标范围,以最大限度地降低机械故障的风险。使用线性回归法确定了 T4PA 的变化与根据 C2-骨盆角度(C2PA)计算的整体矢状对齐变化之间的关系。最后,在调整术前评分和年龄的基础上,采用多变量回归评估术后初始 C2PA 与患者报告的 1 年预后之间的关系。结果纳入的 247 名患者的中位年龄为 64 岁(四分位间范围为 57 至 69 岁),202 名(82%)为女性。L1PA偏离正常值或T4-L1PA不匹配与机械故障的风险显著增加有关,与年龄无关。当 L1PA 为 PI × 0.5 - (19° ± 2°),T4-L1PA 错位在 -3° 和 +1° 之间时,风险最小。最终随访时 T4PA 和 C2PA 的变化密切相关(r2 = 0.96)。结论我们使用L1PA(相对于PI)和T4-L1PA不匹配度定义了矢状对齐目标,这两个指标在手术中均可直接修改。对于接受骶骨长融合术的患者,根据这些目标进行重新对位可能会减少机械故障。有关证据等级的完整描述,请参阅 "作者须知"。
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引用次数: 0
Patient Factors Associated with 10-Year Survival After Arthroplasty for Hip Fracture: A Population-Based Study in Ontario, Canada. 与髋部骨折关节置换术后 10 年存活率相关的患者因素:加拿大安大略省基于人口的研究。
Pub Date : 2024-09-18 DOI: 10.2106/jbjs.24.00379
Mina Tohidi,George Grammatopoulos,Stephen M Mann,Alexandra Pysklywec,Patti A Groome
BACKGROUNDThe aim of this study was to describe long-term (10-year) patient survival after arthroplasty for hip fracture and to determine what patient factors are associated with that outcome.METHODSWe performed a retrospective cohort analysis of patients ≥60 years old who underwent either hemiarthroplasty or total hip arthroplasty for femoral neck fracture between 2002 and 2009. We used routinely collected, validated health-care databases linked through ICES (formerly known as the Institute for Clinical Evaluative Sciences). We estimated the association between baseline variables and survival 10 years post-fracture using Poisson regression. Restricted cubic spline functions modeled the probability of 10-year survival by age and tested whether there was an inflection point after which the probability of 10-year survival decreased more rapidly. We estimated 10-year survival probabilities for different patient groups.RESULTSThere were 19,659 patients in the final cohort. Eighteen percent (3,564) of the patients were alive at 10 years postoperatively. Factors associated with a higher likelihood of 10-year survival included younger age, female sex (risk ratio [RR] = 1.56, 95% confidence interval [CI] = 1.46 to 1.68), lower American Society of Anesthesiologists (ASA) class (ASA I or II versus IV or V: RR = 1.96, 95% CI = 1.76 to 2.19), independent living status (RR = 2.68, 95% CI = 2.23 to 3.22), and fewer specific comorbidities. A threshold age of 73 years was the inflection point after which the probability of 10-year survival decreased more rapidly in females. Estimated 10-year survival probabilities ranged from 79.0% (95% CI = 75.5% to 82.5%) to 0.8% (95% CI = 0.6% to 1.0%).CONCLUSIONSApproximately 1 in 6 patients live at least 10 years following a hip fracture. This study identifies baseline characteristics that predict survival greater than 10 years, including an age of <75 years, an ASA class of I or II, and independent living status prior to the hip fracture. Results can inform discussions around treatment choices, anticipated outcomes, and the natural history of hip fractures.LEVEL OF EVIDENCEPrognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
背景本研究旨在描述髋部骨折关节置换术后患者的长期(10 年)存活率,并确定哪些患者因素与这一结果相关。方法我们对 2002 年至 2009 年期间因股骨颈骨折接受半关节置换术或全髋关节置换术的年龄≥60 岁的患者进行了回顾性队列分析。我们使用的是通过 ICES(前身为临床评价科学研究所)链接的常规收集的、经过验证的医疗保健数据库。我们使用泊松回归估算了基线变量与骨折后 10 年生存率之间的关系。限制立方样条函数按年龄对 10 年存活概率进行建模,并检验是否存在一个拐点,在该拐点之后,10 年存活概率下降得更快。我们估算了不同患者群体的 10 年生存概率。18%的患者(3,564 人)在术后 10 年仍然存活。10年存活率较高的相关因素包括年龄较小、性别为女性(风险比 [RR] = 1.56,95% 置信区间 [CI] = 1.46 至 1.68)、美国麻醉医师协会(ASA)等级较低(ASA I 或 II 与 IV 或 V 相比:RR = 1.96,95% CI = 1.76 至 2.19)、独立生活状态(RR = 2.68,95% CI = 2.23 至 3.22)以及特定合并症较少。73 岁是一个拐点,在这之后,女性的 10 年生存概率下降得更快。估计的 10 年生存概率从 79.0% (95% CI = 75.5% 到 82.5%) 到 0.8% (95% CI = 0.6% 到 1.0%) 不等。本研究确定了可预测存活期超过 10 年的基线特征,包括年龄小于 75 岁、ASA 分级为 I 级或 II 级以及髋部骨折前的独立生活状态。研究结果可为有关治疗选择、预期结果和髋部骨折自然史的讨论提供参考。有关证据等级的完整描述,请参阅 "作者须知"。
{"title":"Patient Factors Associated with 10-Year Survival After Arthroplasty for Hip Fracture: A Population-Based Study in Ontario, Canada.","authors":"Mina Tohidi,George Grammatopoulos,Stephen M Mann,Alexandra Pysklywec,Patti A Groome","doi":"10.2106/jbjs.24.00379","DOIUrl":"https://doi.org/10.2106/jbjs.24.00379","url":null,"abstract":"BACKGROUNDThe aim of this study was to describe long-term (10-year) patient survival after arthroplasty for hip fracture and to determine what patient factors are associated with that outcome.METHODSWe performed a retrospective cohort analysis of patients ≥60 years old who underwent either hemiarthroplasty or total hip arthroplasty for femoral neck fracture between 2002 and 2009. We used routinely collected, validated health-care databases linked through ICES (formerly known as the Institute for Clinical Evaluative Sciences). We estimated the association between baseline variables and survival 10 years post-fracture using Poisson regression. Restricted cubic spline functions modeled the probability of 10-year survival by age and tested whether there was an inflection point after which the probability of 10-year survival decreased more rapidly. We estimated 10-year survival probabilities for different patient groups.RESULTSThere were 19,659 patients in the final cohort. Eighteen percent (3,564) of the patients were alive at 10 years postoperatively. Factors associated with a higher likelihood of 10-year survival included younger age, female sex (risk ratio [RR] = 1.56, 95% confidence interval [CI] = 1.46 to 1.68), lower American Society of Anesthesiologists (ASA) class (ASA I or II versus IV or V: RR = 1.96, 95% CI = 1.76 to 2.19), independent living status (RR = 2.68, 95% CI = 2.23 to 3.22), and fewer specific comorbidities. A threshold age of 73 years was the inflection point after which the probability of 10-year survival decreased more rapidly in females. Estimated 10-year survival probabilities ranged from 79.0% (95% CI = 75.5% to 82.5%) to 0.8% (95% CI = 0.6% to 1.0%).CONCLUSIONSApproximately 1 in 6 patients live at least 10 years following a hip fracture. This study identifies baseline characteristics that predict survival greater than 10 years, including an age of <75 years, an ASA class of I or II, and independent living status prior to the hip fracture. Results can inform discussions around treatment choices, anticipated outcomes, and the natural history of hip fractures.LEVEL OF EVIDENCEPrognostic Level III. See Instructions for Authors for a complete description of levels of evidence.","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"75 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142246983","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Prognosticating Residual Dysplasia at Skeletal Maturity Following Closed Reduction for Developmental Dysplasia of the Hip: A Long-Term Study with an Average 20-Year Follow-up. 髋关节发育不良闭合复位术后骨骼成熟期残余发育不良的预后:一项平均随访 20 年的长期研究。
Pub Date : 2024-09-18 DOI: 10.2106/jbjs.23.01484
Janus Siu Him Wong,Evelyn Eugenie Kuong,Michael Kai Tsun To,Alfred Lok Hang Lee,Noah Lok Wah So,Wang Chow
BACKGROUNDPatients with developmental dysplasia of the hip (DDH) are at risk for residual acetabular dysplasia even after successful closed reduction. The aim of this study was to identify predictors of long-term outcomes in order to guide prognostication and management.METHODSPatients who were treated for DDH at 2 institutions between 1970 and 2010 and had follow-up until skeletal maturity were screened for inclusion. Hips that underwent open reduction were excluded to reduce iatrogenic confounding. Syndromal (including neuromuscular and arthrogrypotic) hip instability with collagenopathies were excluded. Demographic characteristics, Tönnis grade, age at the time of the reduction, surgical treatment, acetabular index, lateral center-edge angle, residual dysplasia graded using the Severin classification, and the presence and type of proximal femoral growth disturbance categorized using the Bucholz and Ogden classification were assessed. In addition, the the acetabular angle was recorded at the latest follow-up before secondary procedures, and the Oxford Hip Score and 5-level EuroQoL (EQ)-5 Dimension score were recorded at the latest follow-up. To account for repeated measures, generalized estimating equations (GEE) logistic regression was utilized for the multivariable analysis. A support vector machine model and a receiver operating characteristic curve analysis were utilized to identify prognostication thresholds.RESULTSOne hundred and seven hips (96 female, 11 male) that were followed to skeletal maturity, with a mean follow-up of 20 years (range, 10 to 54 years), were included in the analysis. Eighty-nine hips (83%) demonstrated a good outcome at skeletal maturity, with a Severin grade of I or II. Major growth disturbances of Bucholz and Ogden types II, III, or IV were present in 13 hips (12%). At the latest follow-up after skeletal maturity (before any secondary procedures), the mean acetabular angle was 45° ± 4° and the mean lateral center-edge angle was 26° ± 8°. The mean Oxford Hip Score and EQ visual analog scale values were 47 and 86, respectively. A GEE logistic regression analysis of 1,135 observations revealed that the acetabular index (odds ratio [OR], 1.16 per degree; p < 0.001) and age (OR, 1.20 per year; p = 0.003) were significant predictors of a poor outcome (i.e., Severin grade III, IV, or V). Significant differences in acetabular indices across all age groups were found between hips with a good outcome and those with a poor outcome. Age-specific acetabular index prognostication cutoff values are presented.CONCLUSIONSThis long-term follow-up study demonstrated that the age-specific acetabular index remains an important predictor of residual dysplasia at skeletal maturity. The proposed prognostication chart and thresholds herein can help to guide orthopaedic surgeons and parents when contemplating the use of an intervention versus surveillance to optimize long-term outcomes.LEVEL OF EVIDENCEPrognostic Level III. See Instruction
背景髋关节发育不良(DDH)患者即使在成功闭合复位后仍有残留髋臼发育不良的风险。方法筛选1970年至2010年间在两家医疗机构接受DDH治疗并随访至骨骼发育成熟的患者。为减少先天性混杂因素,排除了接受开颅手术的髋部患者。排除了胶原病综合征(包括神经肌肉和关节畸形)髋关节不稳。此外,还评估了人口统计学特征、Tönnis分级、髋关节切开术时的年龄、手术治疗、髋臼指数、外侧中心-边缘角、采用Severin分类法分级的残余发育不良,以及采用Bucholz和Ogden分类法分级的股骨近端生长障碍的存在和类型。此外,在二次手术前的最近一次随访中记录了髋臼角,在最近一次随访中记录了牛津髋关节评分和5级欧洲生活质量(EQ)-5维度评分。为了考虑重复测量,多变量分析采用了广义估计方程(GEE)逻辑回归。支持向量机模型和接收器操作特征曲线分析被用来确定预后阈值。结果 有 177 个髋关节(96 个女性,11 个男性)被纳入分析,这些髋关节随访至骨骼成熟,平均随访时间为 20 年(范围为 10 至 54 年)。89个髋关节(83%)在骨骼发育成熟时结果良好,塞弗林分级为I级或II级。13个髋关节(12%)存在布霍尔茨和奥格登II、III或IV型严重生长障碍。在骨骼成熟后的最近一次随访中(任何二次手术之前),平均髋臼角为 45° ± 4°,平均外侧中心边缘角为 26° ± 8°。牛津髋关节评分和EQ视觉模拟量表的平均值分别为47和86。对1135个观察值进行的GEE逻辑回归分析显示,髋臼指数(几率比[OR],每度1.16;p < 0.001)和年龄(OR,每年1.20;p = 0.003)是不良预后(即Severin III、IV或V级)的重要预测因素。在所有年龄组的髋臼指数中,预后良好的髋关节与预后不良的髋关节之间存在显著差异。结论这项长期随访研究表明,年龄特异性髋臼指数仍是预测骨骼成熟时残余发育不良的重要指标。本文提出的预后图和阈值有助于指导骨科医生和家长在考虑使用干预或监测以优化长期预后时使用。有关证据等级的完整描述,请参阅 "作者须知"。
{"title":"Prognosticating Residual Dysplasia at Skeletal Maturity Following Closed Reduction for Developmental Dysplasia of the Hip: A Long-Term Study with an Average 20-Year Follow-up.","authors":"Janus Siu Him Wong,Evelyn Eugenie Kuong,Michael Kai Tsun To,Alfred Lok Hang Lee,Noah Lok Wah So,Wang Chow","doi":"10.2106/jbjs.23.01484","DOIUrl":"https://doi.org/10.2106/jbjs.23.01484","url":null,"abstract":"BACKGROUNDPatients with developmental dysplasia of the hip (DDH) are at risk for residual acetabular dysplasia even after successful closed reduction. The aim of this study was to identify predictors of long-term outcomes in order to guide prognostication and management.METHODSPatients who were treated for DDH at 2 institutions between 1970 and 2010 and had follow-up until skeletal maturity were screened for inclusion. Hips that underwent open reduction were excluded to reduce iatrogenic confounding. Syndromal (including neuromuscular and arthrogrypotic) hip instability with collagenopathies were excluded. Demographic characteristics, Tönnis grade, age at the time of the reduction, surgical treatment, acetabular index, lateral center-edge angle, residual dysplasia graded using the Severin classification, and the presence and type of proximal femoral growth disturbance categorized using the Bucholz and Ogden classification were assessed. In addition, the the acetabular angle was recorded at the latest follow-up before secondary procedures, and the Oxford Hip Score and 5-level EuroQoL (EQ)-5 Dimension score were recorded at the latest follow-up. To account for repeated measures, generalized estimating equations (GEE) logistic regression was utilized for the multivariable analysis. A support vector machine model and a receiver operating characteristic curve analysis were utilized to identify prognostication thresholds.RESULTSOne hundred and seven hips (96 female, 11 male) that were followed to skeletal maturity, with a mean follow-up of 20 years (range, 10 to 54 years), were included in the analysis. Eighty-nine hips (83%) demonstrated a good outcome at skeletal maturity, with a Severin grade of I or II. Major growth disturbances of Bucholz and Ogden types II, III, or IV were present in 13 hips (12%). At the latest follow-up after skeletal maturity (before any secondary procedures), the mean acetabular angle was 45° ± 4° and the mean lateral center-edge angle was 26° ± 8°. The mean Oxford Hip Score and EQ visual analog scale values were 47 and 86, respectively. A GEE logistic regression analysis of 1,135 observations revealed that the acetabular index (odds ratio [OR], 1.16 per degree; p &lt; 0.001) and age (OR, 1.20 per year; p = 0.003) were significant predictors of a poor outcome (i.e., Severin grade III, IV, or V). Significant differences in acetabular indices across all age groups were found between hips with a good outcome and those with a poor outcome. Age-specific acetabular index prognostication cutoff values are presented.CONCLUSIONSThis long-term follow-up study demonstrated that the age-specific acetabular index remains an important predictor of residual dysplasia at skeletal maturity. The proposed prognostication chart and thresholds herein can help to guide orthopaedic surgeons and parents when contemplating the use of an intervention versus surveillance to optimize long-term outcomes.LEVEL OF EVIDENCEPrognostic Level III. See Instruction","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"7 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142246908","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Levels of Synovial Fluid Inflammatory Biomarkers on Day of Arthroscopic Partial Meniscectomy Predict Long-Term Outcomes and Conversion to TKA: A 10-Year Mean Follow-up Study. 关节镜下半月板部分切除术当日滑膜液炎性生物标志物水平预测长期疗效和转为全膝关节置换术:一项为期 10 年的平均随访研究。
Pub Date : 2024-09-12 DOI: 10.2106/jbjs.23.01392
Michael R Moore,Brittany DeClouette,Isabel Wolfe,Matthew T Kingery,Carlos Sandoval-Hernandez,Ryan Isber,Thorsten Kirsch,Eric J Strauss
BACKGROUNDThe purpose of the present study was to evaluate the relationships of the concentrations of pro- and anti-inflammatory biomarkers in the knee synovial fluid at the time of arthroscopic partial meniscectomy (APM) to long-term patient-reported outcomes (PROs) and conversion to total knee arthroplasty (TKA).METHODSA database of patients who underwent APM for isolated meniscal injury was analyzed. Synovial fluid had been aspirated from the operatively treated knee prior to the surgical incision, and concentrations of pro- and anti-inflammatory biomarkers (RANTES, IL-6, MCP-1, MIP-1β, VEGF, TIMP-1, TIMP-2, IL-1RA, MMP-3, and bFGF) were quantified. Prior to surgery and again at the time of final follow-up, patients were asked to complete a survey that included a visual analog scale (VAS) for pain and Lysholm, Tegner, and Knee injury and Osteoarthritis Outcome Score-Physical Function Short Form (KOOS-PS) questionnaires. Clustering analysis of the 10 biomarkers of interest was carried out with the k-means algorithm.RESULTSOf the 82 patients who met the inclusion criteria for the study, 59 had not undergone subsequent ipsilateral TKA or APM, and 43 (73%) of the 59 completed PRO questionnaires at long-term follow-up. The mean follow-up time was 10.6 ± 1.3 years (range, 8.7 to 12.4 years). Higher concentrations of individual pro-inflammatory biomarkers including MCP-1 (β = 13.672, p = 0.017) and MIP-1β (β = -0.385, p = 0.012) were associated with worse VAS pain and Tegner scores, respectively. K-means clustering analysis separated the cohort of 82 patients into 2 groups, one with exclusively higher levels of pro-inflammatory biomarkers than the second group. The "pro-inflammatory phenotype" cohort had a significantly higher VAS pain score (p = 0.024) and significantly lower Lysholm (p = 0.022), KOOS-PS (p = 0.047), and Tegner (p = 0.009) scores at the time of final follow-up compared with the "anti-inflammatory phenotype" cohort. The rate of conversion to TKA was higher in the pro-inflammatory cohort (29.4% versus 12.2%, p = 0.064). Logistic regression analysis demonstrated that the pro-inflammatory phenotype was significantly correlated with conversion to TKA (odds ratio = 7.220, 95% confidence interval = 1.028 to 50.720, p = 0.047).CONCLUSIONSThe concentrations of synovial fluid biomarkers on the day of APM can be used to cluster patients into pro- and anti-inflammatory cohorts that are predictive of PROs and conversion to TKA at long-term follow-up.LEVEL OF EVIDENCEPrognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
背景本研究旨在评估关节镜半月板部分切除术(APM)时膝关节滑液中促炎和抗炎生物标志物的浓度与长期患者报告结果(PROs)和转为全膝关节置换术(TKA)的关系。在手术切口前从接受手术治疗的膝关节中抽取滑膜液,并量化促炎和抗炎生物标志物(RANTES、IL-6、MCP-1、MIP-1β、VEGF、TIMP-1、TIMP-2、IL-1RA、MMP-3 和 bFGF)的浓度。在手术前和最后随访时,患者被要求完成一项调查,包括疼痛视觉模拟量表(VAS)和Lysholm、Tegner、膝关节损伤和骨关节炎结果评分--物理功能简表(KOOS-PS)问卷。结果 在符合研究纳入标准的82名患者中,有59名患者随后没有接受同侧TKA或APM手术,59名患者中有43名(73%)在长期随访时完成了PRO问卷调查。平均随访时间为 10.6 ± 1.3 年(8.7 至 12.4 年不等)。包括 MCP-1 (β = 13.672, p = 0.017) 和 MIP-1β (β = -0.385, p = 0.012) 在内的单个促炎生物标记物浓度较高分别与 VAS 疼痛和 Tegner 评分较差有关。K-means 聚类分析将 82 名患者分为两组,其中一组的促炎生物标志物水平完全高于第二组。与 "抗炎表型 "组相比,"促炎表型 "组的 VAS 疼痛评分明显更高(p = 0.024),最终随访时的 Lysholm(p = 0.022)、KOOS-PS(p = 0.047)和 Tegner(p = 0.009)评分明显更低。促炎症队列中转为 TKA 的比例更高(29.4% 对 12.2%,p = 0.064)。逻辑回归分析表明,促炎表型与转为 TKA 显著相关(几率比 = 7.220,95% 置信区间 = 1.028 至 50.720,p = 0.047)。结论APM 当天滑液生物标志物的浓度可用于将患者分为促炎和抗炎队列,这两个队列可预测 PROs 和长期随访时转为 TKA 的情况。有关证据级别的完整描述,请参阅 "作者须知"。
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引用次数: 0
Thirty-five Years of Reporting of Sex and Race in Clinical Studies of U.S. FDA-Authorized Orthopaedic Devices. 美国 FDA 批准的矫形器临床研究中的性别和种族报告三十五年》(Thirty-five Years of Reporting of Sex and Race in Clinical Studies of U.S. FDA-Authorized Orthopaedic Devices)。
Pub Date : 2024-09-12 DOI: 10.2106/jbjs.24.00201
Hongying Jiang,Katherine Kavlock,Qin Li,Shruti Mistry,Valerie Hermes,Alonza Gibbs,Elizabeth Adegboyega-Panox,Raquel Peat
BACKGROUNDAt the U.S. Food and Drug Administration (FDA), the mission of the Center for Devices and Radiological Health (CDRH) is to ensure that all patients and providers have timely and continued access to safe, effective, and high-quality medical devices and safe radiation-emitting products. Although the CDRH has observed enrollment differences in some clinical trials, no systematic analysis has been conducted regarding enrollment differences in baseline demographics, to our knowledge.METHODSThe CDRH has summarized information on study participants and their baseline demographics in public-facing documentation for all authorized medical devices that involved orthopaedic clinical studies from 1985 to 2020. Descriptive analyses and exploratory statistical testing have been conducted to investigate the reported percentages by sex and race compared with those reported in the U.S. National Census and the American Joint Replacement Registry (AJRR), respectively.RESULTSWe identified 94 submissions and corresponding combined clinical trials from 261 original clinical study arms with 34,193 participants. Most of the submissions reported age and sex, while only 36 submissions (38.3%) reported racial demographics. Among the 88 trials providing enrollment by sex, the female enrollment percentage ranged from 22.2% to 88.7%, with a mean of 55.0%. In the submissions that reported racial data (38.3%), White and Black patients had a mean enrollment of 89.2% (range, 64.8% to 98.7%) and 6.2% (range, 0.4% to 20.7%), respectively. The enrollment for other minority groups ranged from 0% to 3.0%. These clinical trials have shown numerically lower female representation (55.0%) but higher White representation (89.2%) than what has been reported in the AJRR. The other racial groups have participated much less than their corresponding percentages in the U.S. population, but they are similarly represented in the AJRR.CONCLUSIONSThe clinical trials supporting the FDA's authorization of orthopaedic devices had a wide range of sex and racial enrollments. It appears that female enrollment mirrors the percentage of women in the U.S. population. However, despite prior efforts, some racial groups are still underrepresented. The FDA has made a commitment to advancing health equity as part of the 2022-2025 Strategic Priorities of the CDRH. We hope that the results of this study will help health-care professionals make informed clinical decisions when using medical devices.
背景在美国食品和药物管理局(FDA),器械和放射卫生中心(CDRH)的使命是确保所有患者和医疗服务提供者都能及时、持续地获得安全、有效、高质量的医疗器械和安全的放射产品。据我们所知,虽然 CDRH 在一些临床试验中观察到了入组差异,但还没有对基线人口统计学方面的入组差异进行过系统分析。方法CDRH 在面向公众的文件中汇总了 1985 年至 2020 年期间涉及骨科临床研究的所有授权医疗器械的研究参与者及其基线人口统计学信息。我们进行了描述性分析和探索性统计检验,以调查报告的性别和种族百分比与美国全国人口普查和美国关节置换注册表(AJRR)中报告的百分比的比较。大多数试验报告了年龄和性别,只有 36 项试验(38.3%)报告了种族人口统计数据。在 88 项提供性别注册人数的试验中,女性注册人数的比例从 22.2% 到 88.7% 不等,平均比例为 55.0%。在报告种族数据(38.3%)的呈文中,白人和黑人患者的平均入组比例分别为 89.2%(范围为 64.8% 到 98.7%)和 6.2%(范围为 0.4% 到 20.7%)。其他少数族裔群体的注册率从 0% 到 3.0% 不等。与 AJRR 的报告相比,这些临床试验中女性的比例较低(55.0%),但白人的比例较高(89.2%)。结论:支持 FDA 批准矫形设备的临床试验在性别和种族方面的注册人数范围很广。女性注册人数似乎反映了美国人口中女性的比例。然而,尽管此前做出了努力,但一些种族群体的代表性仍然不足。作为 2022-2025 年 CDRH 战略重点的一部分,FDA 已承诺推进健康公平。我们希望这项研究的结果能帮助医疗保健专业人员在使用医疗器械时做出明智的临床决策。
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引用次数: 0
Feasibility of the Non-Window-Type 3D-Printed Porous Titanium Cage in Posterior Lumbar Interbody Fusion: A Randomized Controlled Multicenter Trial. 非窗口型三维打印多孔钛笼在后腰椎椎间融合术中的可行性:随机对照多中心试验。
Pub Date : 2024-09-11 DOI: 10.2106/jbjs.23.01245
Dae-Woong Ham,Sang-Min Park,Youngbae B Kim,Dong-Gune Chang,Jae Jun Yang,Byung-Taek Kwon,Kwang-Sup Song
BACKGROUNDThree-dimensionally printed titanium (3D-Ti) cages can be divided into 2 types: window-type cages, which have a void for bone graft, and non-window-type cages without a void. Few studies have investigated the necessity of a void for bone graft in fusion surgery. Therefore, the present study assessed the clinical and radiographic outcomes of window and non-window-type 3D-Ti cages in single-level posterior lumbar interbody fusion.METHODSA total of 70 patients were randomly assigned to receive either a window or non-window cage; 61 patients (87%) completed final follow-up (32 from the window cage group, 29 from the non-window cage group). Radiographic outcomes, including fusion rates, subsidence, and intra-cage osseointegration patterns, were assessed. Intra-cage osseointegration was measured using the intra-cage bridging bone score for the window cage group and the surface osseointegration ratio score for the non-window cage group. Additionally, we looked for the presence of the trabecular bone remodeling (TBR) sign on computed tomography (CT) images.RESULTSOf the 61 patients, 58 achieved interbody fusion, resulting in a 95.1% fusion rate. The fusion rate in the non-window cage group was comparable to, and not significantly different from, that in the window cage group (96.6% and 93.8%, p > 0.99). The subsidence rate showed no significant difference between the window and non-window cage groups (15.6% and 3.4%, respectively; p = 0.262). The intra-cage osseointegration scores showed a significant difference between the groups (p = 0.007), with the non-window cage group having a higher proportion of cases with a score of 4 compared with the window cage group. The TBR sign was observed in 87.9% of patients who achieved interbody fusion, with a higher rate in the non-window cage group across the entire cohort although the difference was not significant (89.7% versus 78.1%, p = 0.385).CONCLUSIONSNon-window-type 3D-Ti cages showed equivalent clinical outcomes compared with window-type cages and comparable interbody fusion rates. These results suggest that the potential advantages of 3D-Ti cages could be optimized in the absence of a void for bone graft by providing a larger contact surface for osseointegration.LEVEL OF EVIDENCETherapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
背景三维打印钛(3D-Ti)保持架可分为两种类型:有空隙的窗口型保持架和无空隙的非窗口型保持架。很少有研究探讨在融合手术中是否有必要为植骨留出空隙。因此,本研究评估了开窗型和非开窗型 3D-Ti椎间融合器在单层腰椎后路椎体间融合术中的临床和放射学结果。方法共有 70 名患者被随机分配接受开窗型或非开窗型椎间融合器,其中 61 名患者(87%)完成了最终随访(开窗型椎间融合器组 32 人,非开窗型椎间融合器组 29 人)。评估了包括融合率、下沉和笼内骨结合模式在内的放射学结果。对于开窗骨架组,我们使用骨架内桥骨评分来测量骨架内骨整合情况;对于非开窗骨架组,我们使用表面骨整合率评分来测量骨架内骨整合情况。此外,我们还观察了计算机断层扫描(CT)图像上是否出现骨小梁重塑(TBR)征象。结果 61例患者中,58例实现了椎间融合,融合率为95.1%。非开窗椎体笼组的融合率与开窗椎体笼组相当,无显著差异(96.6% 和 93.8%,P > 0.99)。开窗笼组和非开窗笼组的下沉率无明显差异(分别为 15.6% 和 3.4%;P = 0.262)。笼内骨结合评分在两组之间有显著差异(p = 0.007),与开窗笼组相比,非开窗笼组的 4 分病例比例更高。结论非开窗型 3D-Ti椎间融合器与开窗型椎间融合器相比,临床效果相当,椎间融合率也相当。这些结果表明,通过提供更大的骨结合接触面,3D-Ti 骨架的潜在优势可以在没有骨移植空隙的情况下得到优化。有关证据等级的完整描述,请参阅 "作者须知"。
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引用次数: 0
What's Important: Engaging Meaningfully with Sustainability Efforts as an Orthopaedic Surgeon. 重要的是:作为一名矫形外科医生,有意义地参与可持续发展工作。
Pub Date : 2024-09-11 DOI: 10.2106/jbjs.24.00641
Laura L Bellaire
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引用次数: 0
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The Journal of Bone & Joint Surgery
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