首页 > 最新文献

The Journal of Bone & Joint Surgery最新文献

英文 中文
Arthroscopic Acromioplasty: A Comparison Between Workers' Compensation and Non-Workers' Compensation Populations 关节镜下肩峰成形术:工人补偿和非工人补偿人群的比较
Pub Date : 2003-04-01 DOI: 10.2106/00004623-200304000-00015
G. Nicholson
Background: The purpose of the present prospective study was to analyze a consecutive series of patients with subacromial impingement syndrome who were managed with arthroscopic acromioplasty by a single surgeon.Methods: A consecutive series of 106 patients (106 shoulders) with a mean age of 44.7 years (range, twenty to seventy years) was analyzed after a mean duration of follow-up of thirty-two months. The Workers' Compensation group included forty patients (twenty-five men and fifteen women) with a mean age of 41.7 years. The non-Workers' Compensation group included sixty-six patients (thirty-two men and thirty-four women) with a mean age of 46.5 years. The work-demand level was categorized according to the Dictionary of Occupational Titles from the United States Department of Labor. Previously unrecognized intra-articular pathological changes were categorized with use of consistent criteria. Workers' Compensation status, the work-demand level, and the presence of associated intra-articular pathological changes were analyzed for their effect on outcome scores and time to return to full-duty work.Results: The mean outcome scores for the entire population showed significant improvement when the preoperative values were compared with the postoperative values; specifically, the American Shoulder and Elbow Surgeons (ASES) score improved from 41.8 to 86.9, the Simple Shoulder Test (SST) score improved from 5.1 to 10.0, and the visual analog scale (VAS) for pain improved from 6.0 to 1.1 (p < 0.05). Postoperatively, there was no significant difference in the mean outcome scores between the Workers' Compensation and non-Workers' Compensation groups or between different work-demand levels. There was, however, a significant difference in the average time to return to full-duty work (13.7 weeks in the Workers' Compensation group compared with 9.1 weeks in the non-Workers' Compensation group; p = 0.0001), with the Workers' Compensation group having relatively heavier work-demand levels. Intra-articular pathological findings did not affect the outcome scores, but pathological findings that changed treatment were associated with a longer time to return to work (p = 0.04).Conclusion: Arthroscopic acromioplasty consistently provided a good surgical outcome and the ability to return to work in both the Workers' Compensation and non-Workers' Compensation populations. The work-demand level had a direct effect on the time to return to full duty, regardless of Workers' Compensation status. Patients, physicians, therapists, and employers may benefit from the knowledge of these expected outcomes and realistic time-frames for return to work.Level of Evidence: Prognostic study, Level I-1 (prospective study). See Instructions to Authors for a complete description of levels of evidence.
背景:本前瞻性研究的目的是分析一组连续的肩峰下撞击综合征患者,这些患者由一名外科医生进行关节镜下肩峰成形术。方法:对平均随访32个月、平均年龄44.7岁(20 ~ 70岁)的106例患者(106肩)进行连续分析。工人赔偿组包括40名患者(25名男性和15名女性),平均年龄为41.7岁。非工伤赔偿组包括66名患者(32名男性和34名女性),平均年龄为46.5岁。工作需求水平是根据美国劳工部的职业头衔词典进行分类的。先前未被识别的关节内病变使用一致的标准进行分类。分析了工人补偿状况、工作需求水平和相关关节内病变的存在对结果评分和恢复全职工作时间的影响。结果:术前与术后比较,整个人群的平均结局评分均有显著改善;其中,American Shoulder and Elbow Surgeons (ASES)评分从41.8分提高到86.9分,Simple Shoulder Test (SST)评分从5.1分提高到10.0分,疼痛视觉模拟评分(VAS)从6.0分提高到1.1分(p < 0.05)。术后,工伤补偿组与非工伤补偿组、不同工作需求水平组的平均结局评分无显著差异。然而,在恢复全职工作的平均时间上存在显著差异(工伤补偿组为13.7周,而非工伤补偿组为9.1周;p = 0.0001),工伤赔偿组的工作需求水平相对较高。关节内病理结果不影响预后评分,但病理结果改变治疗与更长的重返工作时间相关(p = 0.04)。结论:关节镜肩峰成形术在工伤赔偿和非工伤赔偿人群中均具有良好的手术效果和重返工作岗位的能力。工作需求水平对恢复全职工作的时间有直接影响,无论工人补偿状况如何。患者、医生、治疗师和雇主可能会从了解这些预期结果和重返工作岗位的实际时间框架中受益。证据等级:预后研究,I-1级(前瞻性研究)。有关证据水平的完整描述,请参见作者说明。
{"title":"Arthroscopic Acromioplasty: A Comparison Between Workers' Compensation and Non-Workers' Compensation Populations","authors":"G. Nicholson","doi":"10.2106/00004623-200304000-00015","DOIUrl":"https://doi.org/10.2106/00004623-200304000-00015","url":null,"abstract":"Background: The purpose of the present prospective study was to analyze a consecutive series of patients with subacromial impingement syndrome who were managed with arthroscopic acromioplasty by a single surgeon.Methods: A consecutive series of 106 patients (106 shoulders) with a mean age of 44.7 years (range, twenty to seventy years) was analyzed after a mean duration of follow-up of thirty-two months. The Workers' Compensation group included forty patients (twenty-five men and fifteen women) with a mean age of 41.7 years. The non-Workers' Compensation group included sixty-six patients (thirty-two men and thirty-four women) with a mean age of 46.5 years. The work-demand level was categorized according to the Dictionary of Occupational Titles from the United States Department of Labor. Previously unrecognized intra-articular pathological changes were categorized with use of consistent criteria. Workers' Compensation status, the work-demand level, and the presence of associated intra-articular pathological changes were analyzed for their effect on outcome scores and time to return to full-duty work.Results: The mean outcome scores for the entire population showed significant improvement when the preoperative values were compared with the postoperative values; specifically, the American Shoulder and Elbow Surgeons (ASES) score improved from 41.8 to 86.9, the Simple Shoulder Test (SST) score improved from 5.1 to 10.0, and the visual analog scale (VAS) for pain improved from 6.0 to 1.1 (p < 0.05). Postoperatively, there was no significant difference in the mean outcome scores between the Workers' Compensation and non-Workers' Compensation groups or between different work-demand levels. There was, however, a significant difference in the average time to return to full-duty work (13.7 weeks in the Workers' Compensation group compared with 9.1 weeks in the non-Workers' Compensation group; p = 0.0001), with the Workers' Compensation group having relatively heavier work-demand levels. Intra-articular pathological findings did not affect the outcome scores, but pathological findings that changed treatment were associated with a longer time to return to work (p = 0.04).Conclusion: Arthroscopic acromioplasty consistently provided a good surgical outcome and the ability to return to work in both the Workers' Compensation and non-Workers' Compensation populations. The work-demand level had a direct effect on the time to return to full duty, regardless of Workers' Compensation status. Patients, physicians, therapists, and employers may benefit from the knowledge of these expected outcomes and realistic time-frames for return to work.Level of Evidence: Prognostic study, Level I-1 (prospective study). See Instructions to Authors for a complete description of levels of evidence.","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"38 1","pages":"682–689"},"PeriodicalIF":0.0,"publicationDate":"2003-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78376307","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: 66
A Prospective Multipractice Investigation of Patients with Full-Thickness Rotator Cuff Tears: The Importance of Comorbidities, Practice, and Other Covariables on Self-Assessed Shoulder Function and Health Status 肩袖全层撕裂患者的前瞻性多诊所调查:合并症、实践和其他协变量对自评肩功能和健康状况的重要性
Pub Date : 2003-04-01 DOI: 10.2106/00004623-200304000-00016
D. T. Harryman, C. Hettrich, Kevin L. Smith, B. Campbell, J. Sidles, Frederick A Matsen
Background: Rotator cuff tears are among the most common conditions of the shoulder. One of the major difficulties in studying patients with rotator cuff tears is that the clinical expression of these tears varies widely and different practices may have substantially different patient populations. The goals of the present prospective multipractice study were to use patient self-assessment questionnaires (1) to identify some of the characteristics of patients with rotator cuff tears, other than the size of the cuff tear, that are correlated with shoulder function, and (2) to determine whether there are significant differences in these characteristics among patients from the practices of different surgeons.Methods: Ten surgeons enrolled a total of 333 patients with a full-thickness tear of the supraspinatus tendon into this prospective study. Each patient completed self-assessment questionnaires that included items regarding demographic characteristics, prior treatment, medical and social comorbidities, general health status, and shoulder function.Results: As expected, patients who had an infraspinatus tendon tear as well as a supraspinatus tendon tear had significantly worse ability to use the arm overhead compared with those who had a supraspinatus tear alone (p < 0.005). However, shoulder function and health status were correlated with patient characteristics other than the size of the rotator cuff tear. The number of shoulder functions that were performable was correlated with the subscales of the Short Form-36 and was inversely associated with medical and social comorbidities. The patients from the ten different surgeon practices showed significant differences in almost every parameter, including age, gender, method of tear documentation, tear size, prior treatment, medical and social comorbidities, general health status, and shoulder function.Conclusions: Clinical studies on the natural history of rotator cuff tears and the effectiveness of treatment must control for a wide range of variables, many of which do not pertain directly to the shoulder. Patients from the practices of different surgeons cannot be assumed to be similar with respect to these variables. Patient self-assessment questionnaires appear to offer a practical method of uniform assessment across different practices.Level of Evidence: Prognostic study, Level I-1 (prospective study). See Instructions to Authors for a complete description of levels of evidence.
背景:肩袖撕裂是最常见的肩部疾病之一。研究肩袖撕裂患者的主要困难之一是这些撕裂的临床表现差异很大,不同的做法可能有很大不同的患者群体。本前瞻性多诊所研究的目的是使用患者自我评估问卷(1)确定肩袖撕裂患者除撕裂大小外与肩功能相关的一些特征,(2)确定不同外科医生执业的患者在这些特征上是否存在显著差异。方法:10位外科医生将333例冈上肌腱全层撕裂的患者纳入这项前瞻性研究。每位患者完成自我评估问卷,包括人口学特征、既往治疗、医疗和社会合并症、一般健康状况和肩部功能。结果:正如预期的那样,冈下肌腱撕裂和冈上肌腱撕裂的患者与仅冈上肌腱撕裂的患者相比,使用臂顶的能力明显差(p < 0.005)。然而,肩功能和健康状况与患者的特征相关,而不是肩袖撕裂的大小。可执行肩功能的数量与Short Form-36的子量表相关,与医疗和社会合并症呈负相关。来自10种不同外科医生的患者在几乎所有参数上都有显著差异,包括年龄、性别、撕裂记录方法、撕裂大小、既往治疗、医疗和社会合并症、一般健康状况和肩关节功能。结论:关于肩袖撕裂的自然史和治疗效果的临床研究必须控制广泛的变量,其中许多变量与肩膀没有直接关系。不能假设不同外科医生的患者在这些变量方面是相似的。患者自我评估问卷似乎提供了一种跨不同实践统一评估的实用方法。证据等级:预后研究,I-1级(前瞻性研究)。有关证据水平的完整描述,请参见作者说明。
{"title":"A Prospective Multipractice Investigation of Patients with Full-Thickness Rotator Cuff Tears: The Importance of Comorbidities, Practice, and Other Covariables on Self-Assessed Shoulder Function and Health Status","authors":"D. T. Harryman, C. Hettrich, Kevin L. Smith, B. Campbell, J. Sidles, Frederick A Matsen","doi":"10.2106/00004623-200304000-00016","DOIUrl":"https://doi.org/10.2106/00004623-200304000-00016","url":null,"abstract":"Background: Rotator cuff tears are among the most common conditions of the shoulder. One of the major difficulties in studying patients with rotator cuff tears is that the clinical expression of these tears varies widely and different practices may have substantially different patient populations. The goals of the present prospective multipractice study were to use patient self-assessment questionnaires (1) to identify some of the characteristics of patients with rotator cuff tears, other than the size of the cuff tear, that are correlated with shoulder function, and (2) to determine whether there are significant differences in these characteristics among patients from the practices of different surgeons.Methods: Ten surgeons enrolled a total of 333 patients with a full-thickness tear of the supraspinatus tendon into this prospective study. Each patient completed self-assessment questionnaires that included items regarding demographic characteristics, prior treatment, medical and social comorbidities, general health status, and shoulder function.Results: As expected, patients who had an infraspinatus tendon tear as well as a supraspinatus tendon tear had significantly worse ability to use the arm overhead compared with those who had a supraspinatus tear alone (p < 0.005). However, shoulder function and health status were correlated with patient characteristics other than the size of the rotator cuff tear. The number of shoulder functions that were performable was correlated with the subscales of the Short Form-36 and was inversely associated with medical and social comorbidities. The patients from the ten different surgeon practices showed significant differences in almost every parameter, including age, gender, method of tear documentation, tear size, prior treatment, medical and social comorbidities, general health status, and shoulder function.Conclusions: Clinical studies on the natural history of rotator cuff tears and the effectiveness of treatment must control for a wide range of variables, many of which do not pertain directly to the shoulder. Patients from the practices of different surgeons cannot be assumed to be similar with respect to these variables. Patient self-assessment questionnaires appear to offer a practical method of uniform assessment across different practices.Level of Evidence: Prognostic study, Level I-1 (prospective study). See Instructions to Authors for a complete description of levels of evidence.","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"19 1","pages":"690–696"},"PeriodicalIF":0.0,"publicationDate":"2003-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91144346","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: 133
Tibial Osteotomy for the Treatment of Varus Gonarthrosis: Survival and Failure Analysis to Twenty-two Years 胫骨截骨术治疗关节内翻:22年生存与失败分析
Pub Date : 2003-03-01 DOI: 10.2106/00004623-200303000-00011
T. R. Sprenger, J. Doerzbacher
Background: The purpose of this retrospective study was to assess the long-term results after the treatment of medial compartment gonarthrosis with a proximal tibial osteotomy to determine whether various clinical and radiographic factors relate to the outcome. Methods: From 1972 to 1990, seventy-six valgus-producing high tibial osteotomies were performed in sixty-six patients with medial compartment gonarthrosis. Stabilization was achieved with use of a plate on the lateral side of the proximal part of the tibia and a figure-of-eight wire on the medial side. The mean age of the patients at the time of surgery was sixty-nine years, and the mean duration of follow-up was 10.8 years. The factors that were analyzed included postoperative valgus alignment; the age, gender, and weight of the patient; preoperative Ahlbäck radiographic grade; adverse events; Workers' Compensation status; and public liability. Survivorship outcome end points were conversion to arthroplasty, a Hospital for Special Surgery knee score of <70 points, and patient dissatisfaction with the procedure. Results: Ten-year survival, according to the life-table method, was 74%, 70%, and 65% with conversion to arthroplasty, a Hospital for Special Surgery knee score of <70 points, and patient dissatisfaction, respectively, as the end points. Radiographic valgus alignment that ranged between 8° and 16° at one year after the osteotomy had the most significant positive effect on survivorship for all end points (p < 0.01) compared with the other parameters. Complications occurred in sixteen (21%) of the seventy-six procedures, and they had a significant effect on survival, with all three end points (p < 0.05). Conclusions: We found that survival at ten years was 90% (95% confidence interval, 80% to 99%) when the radiographic valgus angle at one year was between 8° and 16° with arthroplasty as the end point. We believe that there is a role for tibial osteotomy, as an alternative to total knee arthroplasty, in patients who are less than sixty years old. Level of Evidence: Therapeutic study, Level III-2 (retrospective cohort study). See Instructions to Authors for a complete description of levels of evidence.
背景:本回顾性研究的目的是评估胫骨近端截骨术治疗内侧间室关节病后的长期结果,以确定各种临床和影像学因素是否与结果有关。方法:自1972年至1990年,对66例内侧腔室关节病患者行76例产生外翻的胫骨高位截骨术。通过在胫骨近端外侧使用钢板和在内侧使用8字形金属丝实现稳定。患者手术时的平均年龄为69岁,平均随访时间为10.8年。分析的因素包括:术后外翻对准;患者的年龄、性别、体重;术前Ahlbäck影像学分级;不良事件;工人赔偿状况;还有公共责任。生存结局终点为转行关节置换术,特殊外科医院膝关节评分<70分,患者对手术不满意。结果:根据生命表法,10年生存率分别为74%、70%和65%,分别以转行关节置换术、特殊外科医院膝关节评分<70分和患者不满意度为终点。与其他参数相比,截骨后一年内8°至16°的x线外翻对所有终点的生存率有最显著的积极影响(p < 0.01)。76例手术中有16例(21%)发生了并发症,它们对生存有显著影响,所有三个终点(p < 0.05)。结论:我们发现,以关节置换术为终点,当1年的x线外翻角在8°至16°之间时,10年生存率为90%(95%可信区间,80%至99%)。我们认为,对于年龄小于60岁的患者,胫骨截骨术可以替代全膝关节置换术。证据等级:治疗性研究,III-2级(回顾性队列研究)。有关证据水平的完整描述,请参见作者说明。
{"title":"Tibial Osteotomy for the Treatment of Varus Gonarthrosis: Survival and Failure Analysis to Twenty-two Years","authors":"T. R. Sprenger, J. Doerzbacher","doi":"10.2106/00004623-200303000-00011","DOIUrl":"https://doi.org/10.2106/00004623-200303000-00011","url":null,"abstract":"Background: The purpose of this retrospective study was to assess the long-term results after the treatment of medial compartment gonarthrosis with a proximal tibial osteotomy to determine whether various clinical and radiographic factors relate to the outcome. Methods: From 1972 to 1990, seventy-six valgus-producing high tibial osteotomies were performed in sixty-six patients with medial compartment gonarthrosis. Stabilization was achieved with use of a plate on the lateral side of the proximal part of the tibia and a figure-of-eight wire on the medial side. The mean age of the patients at the time of surgery was sixty-nine years, and the mean duration of follow-up was 10.8 years. The factors that were analyzed included postoperative valgus alignment; the age, gender, and weight of the patient; preoperative Ahlbäck radiographic grade; adverse events; Workers' Compensation status; and public liability. Survivorship outcome end points were conversion to arthroplasty, a Hospital for Special Surgery knee score of <70 points, and patient dissatisfaction with the procedure. Results: Ten-year survival, according to the life-table method, was 74%, 70%, and 65% with conversion to arthroplasty, a Hospital for Special Surgery knee score of <70 points, and patient dissatisfaction, respectively, as the end points. Radiographic valgus alignment that ranged between 8° and 16° at one year after the osteotomy had the most significant positive effect on survivorship for all end points (p < 0.01) compared with the other parameters. Complications occurred in sixteen (21%) of the seventy-six procedures, and they had a significant effect on survival, with all three end points (p < 0.05). Conclusions: We found that survival at ten years was 90% (95% confidence interval, 80% to 99%) when the radiographic valgus angle at one year was between 8° and 16° with arthroplasty as the end point. We believe that there is a role for tibial osteotomy, as an alternative to total knee arthroplasty, in patients who are less than sixty years old. Level of Evidence: Therapeutic study, Level III-2 (retrospective cohort study). See Instructions to Authors for a complete description of levels of evidence.","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"10 1","pages":"469–474"},"PeriodicalIF":0.0,"publicationDate":"2003-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89600582","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: 396
Outcomes of Total Hip Arthroplasty and Contralateral Bipolar Hemiarthroplasty: A Case Series 全髋关节置换术和对侧双极半关节置换术的结果:一个病例系列
Pub Date : 2003-03-01 DOI: 10.2106/00004623-200311000-00039
M. Flören, D. Lester
There is continuing controversy about whether total hip arthroplasty or bipolar hemiarthroplasty should be used for the management of displaced subcapital hip fractures or advanced avascular necrosis of the femoral head, especially in patients with normal-appearing acetabular cartilage. The decision regarding which procedure to perform may be influenced by several factors, including the underlying disease process, perioperative risks 1,2, likelihood of revision 3-5, and economic considerations 6-8. Published reports are difficult to interpret because the series differ with regard to the surgeons performing the operations, surgical approaches, methods of fixation, postoperative protocols, patient mix, and duration of follow-up 3,5,9-18. In our retrospective review, we compared the clinical and radiographic results and patient-reported outcomes of the two procedures in nine patients who had undergone a bipolar hemiarthroplasty on one side and a total hip arthroplasty on the other.We conducted a retrospective review of the records on 750 consecutive hip arthroplasties performed between 1988 and 1995, and we identified seventy-five patients (10%) who had undergone bilateral hip replacement. Of these, nine had undergone total hip arthroplasty on one side and bipolar hemiarthroplasty on the other. There were eight women and one man.The mean age (and standard deviation) at the time of the bipolar hemiarthroplasty was 74 ± 19 years (range, twenty-eight to eighty-seven years), and the mean age at the time of the total hip arthroplasty was 74 ± 18 years (range, twenty-seven to eighty-seven years). Eight bipolar hemiarthroplasties were performed because of a displaced subcapital hip fracture and one, because of avascular necrosis. Five total hip arthroplasties were performed because of a subcapital hip fracture; two, because of avascular necrosis; and two, because of osteoarthritis.All patients underwent staged bilateral hip replacement. A …
对于移位的髋关节下骨折或股骨头晚期无血管坏死患者,尤其是外观正常的髋臼软骨患者,是否应采用全髋关节置换术或双极半髋关节置换术仍存在争议。决定采用哪种手术可能受到几个因素的影响,包括潜在的疾病进程、围手术期风险1,2、翻修的可能性3-5和经济考虑6-8。已发表的报告很难解释,因为该系列在实施手术的外科医生、手术入路、固定方法、术后方案、患者组合和随访时间等方面存在差异3,5,9-18。在我们的回顾性回顾中,我们比较了9例一侧接受双极半关节置换术,另一侧接受全髋关节置换术的患者的临床和影像学结果以及患者报告的结果。我们对1988年至1995年间750例连续髋关节置换术的记录进行了回顾性回顾,我们确定了75例(10%)患者接受了双侧髋关节置换术。其中,9人一侧接受了全髋关节置换术,另一侧接受了双极半关节置换术。有八个女人和一个男人。双极半关节置换术时的平均年龄(和标准差)为74±19岁(范围,28至87岁),全髋关节置换术时的平均年龄为74±18岁(范围,27至87岁)。8例因移位性髋关节下骨折而行双极半关节置换术,1例因缺血性坏死而行双极半关节置换术。5例全髋关节置换术均因髋部下骨折;二、因无血管坏死;第二,因为骨关节炎。所有患者均分期行双侧髋关节置换术。一个……
{"title":"Outcomes of Total Hip Arthroplasty and Contralateral Bipolar Hemiarthroplasty: A Case Series","authors":"M. Flören, D. Lester","doi":"10.2106/00004623-200311000-00039","DOIUrl":"https://doi.org/10.2106/00004623-200311000-00039","url":null,"abstract":"There is continuing controversy about whether total hip arthroplasty or bipolar hemiarthroplasty should be used for the management of displaced subcapital hip fractures or advanced avascular necrosis of the femoral head, especially in patients with normal-appearing acetabular cartilage. The decision regarding which procedure to perform may be influenced by several factors, including the underlying disease process, perioperative risks 1,2, likelihood of revision 3-5, and economic considerations 6-8. Published reports are difficult to interpret because the series differ with regard to the surgeons performing the operations, surgical approaches, methods of fixation, postoperative protocols, patient mix, and duration of follow-up 3,5,9-18. In our retrospective review, we compared the clinical and radiographic results and patient-reported outcomes of the two procedures in nine patients who had undergone a bipolar hemiarthroplasty on one side and a total hip arthroplasty on the other.\u0000\u0000We conducted a retrospective review of the records on 750 consecutive hip arthroplasties performed between 1988 and 1995, and we identified seventy-five patients (10%) who had undergone bilateral hip replacement. Of these, nine had undergone total hip arthroplasty on one side and bipolar hemiarthroplasty on the other. There were eight women and one man.\u0000\u0000The mean age (and standard deviation) at the time of the bipolar hemiarthroplasty was 74 ± 19 years (range, twenty-eight to eighty-seven years), and the mean age at the time of the total hip arthroplasty was 74 ± 18 years (range, twenty-seven to eighty-seven years). Eight bipolar hemiarthroplasties were performed because of a displaced subcapital hip fracture and one, because of avascular necrosis. Five total hip arthroplasties were performed because of a subcapital hip fracture; two, because of avascular necrosis; and two, because of osteoarthritis.\u0000\u0000All patients underwent staged bilateral hip replacement. A …","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"14 1","pages":"523–526"},"PeriodicalIF":0.0,"publicationDate":"2003-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87857787","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: 4
Microcirculation Associated with Degenerative Rotator Cuff Lesions: In Vivo Assessment with Orthogonal Polarization Spectral Imaging During Arthroscopy of the Shoulder 与退行性肩袖病变相关的微循环:肩关节镜下正交偏振光谱成像的体内评估
Pub Date : 2003-03-01 DOI: 10.2106/00004623-200303000-00012
P. Biberthaler, E. Wiedemann, A. Nerlich, M. Kettler, T. Mussack, S. Deckelmann, W. Mutschler
Background: Diminished vascular supply is associated with degenerative rotator cuff lesions. Orthogonal polarization spectral imaging allows noninvasive assessment of microcirculation without application of fluorescent contrast medium. The aim of our study was to visualize and quantify in vivo the microcirculation of the rotator cuff during arthroscopic surgery and to compare the results with the number of microvessels identified in vitro by immunostaining of biopsy specimens taken from the scanned areas. Methods: Eleven patients with clinical signs of a degenerative rotator cuff lesion were studied. Prior to arthroscopic subacromial decompression, the superficial part of the supraspinatus tendon at the edge of the lesion as well as the unaffected tendon insertion was examined. Microvascular parameters established for the description of tissue perfusion with use of conventional intravital fluorescence microscopy (functional capillary density and capillary diameter) were assessed in vivo. Biopsy specimens were taken from the scanned areas, and the microvessels were localized by immunostaining for the endothelial surface marker CD31. Results: In the region of the unaffected tendon insertion, the mean baseline functional capillary density (and standard deviation) was 106 ± 13 cm/cm 2 and the mean capillary diameter was 10 ± 0.7 &mgr;m. In contrast, at the edge of the lesion, the functional capillary density was significantly reduced to 20 ± 14 cm/cm 2, whereas the diameter of the vessels that were present did not differ. The total number of vessels stained in vitro was also significantly reduced at the edge of the lesion compared with the number of vessels in the tendon insertion zone. Conclusions: Quantitative in vivo analysis of human microcirculation during arthroscopy demonstrated that the functional capillary density at the edge of a degenerative rotator cuff lesion was significantly reduced compared with that in the control tissue. The capacity to assess microcirculatory flow in vivo may help to identify specific repair strategies based on knowledge of individual perfusion patterns.
背景:血管供应减少与退行性肩袖病变有关。正交偏振光谱成像允许无创评估微循环不应用荧光造影剂。我们研究的目的是在关节镜手术中观察和量化体内旋转袖的微循环,并将结果与体外通过扫描区域活检标本的免疫染色鉴定的微血管数量进行比较。方法:对11例有退行性肩袖病变临床表现的患者进行分析。在关节镜下肩峰下减压之前,检查病变边缘冈上肌腱的浅表部分以及未受影响的肌腱止点。利用常规活体荧光显微镜建立的用于描述组织灌注的微血管参数(功能毛细血管密度和毛细血管直径)在体内进行评估。从扫描区域取活检标本,内皮表面标记物CD31免疫染色定位微血管。结果:在未受影响的肌腱止点区域,平均基线功能毛细血管密度(和标准差)为106±13 cm/ cm2,平均毛细血管直径为10±0.7 m。相比之下,在病变边缘,功能毛细血管密度显著降低至20±14 cm/ cm2,而存在的血管直径没有差异。与肌腱止点区相比,病变边缘的体外染色血管总数也明显减少。结论:关节镜下人体微循环的定量体内分析表明,与对照组织相比,退行性肩袖病变边缘的功能性毛细血管密度显著降低。评估体内微循环流量的能力可能有助于确定基于个体灌注模式知识的特定修复策略。
{"title":"Microcirculation Associated with Degenerative Rotator Cuff Lesions: In Vivo Assessment with Orthogonal Polarization Spectral Imaging During Arthroscopy of the Shoulder","authors":"P. Biberthaler, E. Wiedemann, A. Nerlich, M. Kettler, T. Mussack, S. Deckelmann, W. Mutschler","doi":"10.2106/00004623-200303000-00012","DOIUrl":"https://doi.org/10.2106/00004623-200303000-00012","url":null,"abstract":"Background: Diminished vascular supply is associated with degenerative rotator cuff lesions. Orthogonal polarization spectral imaging allows noninvasive assessment of microcirculation without application of fluorescent contrast medium. The aim of our study was to visualize and quantify in vivo the microcirculation of the rotator cuff during arthroscopic surgery and to compare the results with the number of microvessels identified in vitro by immunostaining of biopsy specimens taken from the scanned areas. Methods: Eleven patients with clinical signs of a degenerative rotator cuff lesion were studied. Prior to arthroscopic subacromial decompression, the superficial part of the supraspinatus tendon at the edge of the lesion as well as the unaffected tendon insertion was examined. Microvascular parameters established for the description of tissue perfusion with use of conventional intravital fluorescence microscopy (functional capillary density and capillary diameter) were assessed in vivo. Biopsy specimens were taken from the scanned areas, and the microvessels were localized by immunostaining for the endothelial surface marker CD31. Results: In the region of the unaffected tendon insertion, the mean baseline functional capillary density (and standard deviation) was 106 ± 13 cm/cm 2 and the mean capillary diameter was 10 ± 0.7 &mgr;m. In contrast, at the edge of the lesion, the functional capillary density was significantly reduced to 20 ± 14 cm/cm 2, whereas the diameter of the vessels that were present did not differ. The total number of vessels stained in vitro was also significantly reduced at the edge of the lesion compared with the number of vessels in the tendon insertion zone. Conclusions: Quantitative in vivo analysis of human microcirculation during arthroscopy demonstrated that the functional capillary density at the edge of a degenerative rotator cuff lesion was significantly reduced compared with that in the control tissue. The capacity to assess microcirculatory flow in vivo may help to identify specific repair strategies based on knowledge of individual perfusion patterns.","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"114 1","pages":"475–480"},"PeriodicalIF":0.0,"publicationDate":"2003-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89553950","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: 105
Femoral Anteversion in Children with Cerebral Palsy: Assessment with Two and Three-Dimensional Computed Tomography Scans 脑瘫儿童股骨前倾:二维和三维计算机断层扫描评估
Pub Date : 2003-03-01 DOI: 10.2106/00004623-200303000-00013
J. Davids, Amanda D. Marshall, E. Blocker, S. Frick, D. Blackhurst, E. Skewes
Background: Assessment of femoral anteversion in children with cerebral palsy with two or three-dimensional computed tomography scans may be limited by both positional and anatomic variables. Three-dimensional computed tomography techniques are considered to be more accurate than two-dimensional imaging when the femur is not optimally positioned in the gantry or when the neck-shaft angle is increased. Methods: Computed tomography scanning was performed on a series of nine model femora with anteversion ranging from 20° to 60° and neck-shaft angles ranging from 120° to 160°. Each femoral model was scanned in two holding devices, the first of which held the femur in optimal alignment (normal model) and the second of which held the femur in flexion, adduction, and internal rotation (cerebral palsy model) relative to the gantry. Femoral anteversion was calculated for each model from two and three-dimensional computed tomography scans by four examiners on two separate occasions. The intraobserver and interobserver reliability, the accuracy, and the effect of increasing the neck-shaft angle on the accuracy of the measurements made on the two and three-dimensional scans of the normal and cerebral palsy models were then examined. Results: The mean differences in the measurements of femoral anteversion made by the same examiner (intraobserver reliability) were <2° for the two-dimensional scans of the normal and cerebral palsy models and the three-dimensional scans of the normal models, and the mean difference was <4° for the three-dimensional scans of the cerebral palsy models. The mean differences among examiners (interobserver reliability) were <3° for the two-dimensional scans of the normal and cerebral palsy models and the three-dimensional scans of the normal models, and the mean difference was <6° for the three-dimensional scans of the cerebral palsy models. The accuracy of the assessments of femoral anteversion of the normally aligned models was comparable between the two and three-dimensional scans. However, the three-dimensional assessment was significantly more accurate than the two-dimensional assessment for measurement of anteversion of the cerebral palsy models (p = 0.003). Accuracy within 5° was comparable between the two and three-dimensional scans for measurement of the normally aligned models, with 86% of the two-dimensional measurements and 78% of the three-dimensional measurements falling within 5° of the actual measurements. However, the accuracy within 5° was significantly compromised when the models were placed in cerebral palsy alignment. Only 3% of the two-dimensional measurements and 14% of the three-dimensional measurements fell within 5° of the actual measurements, with three-dimensional assessment being significantly better than two-dimensional assessment (p = 0.006). Increasing the neck-shaft angle did not significantly compromise the accuracy of measurement of femoral anteversion with either the two-dimensional or the three-di
背景:用二维或三维计算机断层扫描评估脑瘫儿童股骨前倾可能受到位置和解剖变量的限制。三维计算机断层扫描技术被认为比二维成像更准确,当股骨没有最佳定位在龙门或当颈轴角度增加。方法:对9例股骨模型进行计算机断层扫描,股骨前倾范围为20°~ 60°,颈轴角范围为120°~ 160°。每个股骨模型在两个固定装置中扫描,第一个固定装置使股骨处于最佳对齐状态(正常模型),第二个固定装置使股骨相对于龙门处于屈曲、内收和内旋状态(脑瘫模型)。每个模型的股骨前倾由四位检查人员在两个不同的场合进行二维和三维计算机断层扫描计算。然后检查了观察者内部和观察者之间的可靠性,准确性以及增加颈轴角度对正常和脑瘫模型的二维和三维扫描测量精度的影响。结果:同一检查者股骨前倾测量的平均差异(观察者内信度)为0.05。结论:当在计算机断层扫描仪中可以对股骨进行适当的对准时,一种简单的二维技术在测试的相关解剖变异性范围内(颈轴角度为120°至160°,股骨前倾角为20°至60°)表现出出色的观察者内部和观察者之间的可靠性和临床可接受的准确性。当扫描仪无法对股骨进行最佳对准时,无论是二维还是三维技术都无法显示临床上可接受的股骨前倾测量精度。
{"title":"Femoral Anteversion in Children with Cerebral Palsy: Assessment with Two and Three-Dimensional Computed Tomography Scans","authors":"J. Davids, Amanda D. Marshall, E. Blocker, S. Frick, D. Blackhurst, E. Skewes","doi":"10.2106/00004623-200303000-00013","DOIUrl":"https://doi.org/10.2106/00004623-200303000-00013","url":null,"abstract":"Background: Assessment of femoral anteversion in children with cerebral palsy with two or three-dimensional computed tomography scans may be limited by both positional and anatomic variables. Three-dimensional computed tomography techniques are considered to be more accurate than two-dimensional imaging when the femur is not optimally positioned in the gantry or when the neck-shaft angle is increased. Methods: Computed tomography scanning was performed on a series of nine model femora with anteversion ranging from 20° to 60° and neck-shaft angles ranging from 120° to 160°. Each femoral model was scanned in two holding devices, the first of which held the femur in optimal alignment (normal model) and the second of which held the femur in flexion, adduction, and internal rotation (cerebral palsy model) relative to the gantry. Femoral anteversion was calculated for each model from two and three-dimensional computed tomography scans by four examiners on two separate occasions. The intraobserver and interobserver reliability, the accuracy, and the effect of increasing the neck-shaft angle on the accuracy of the measurements made on the two and three-dimensional scans of the normal and cerebral palsy models were then examined. Results: The mean differences in the measurements of femoral anteversion made by the same examiner (intraobserver reliability) were <2° for the two-dimensional scans of the normal and cerebral palsy models and the three-dimensional scans of the normal models, and the mean difference was <4° for the three-dimensional scans of the cerebral palsy models. The mean differences among examiners (interobserver reliability) were <3° for the two-dimensional scans of the normal and cerebral palsy models and the three-dimensional scans of the normal models, and the mean difference was <6° for the three-dimensional scans of the cerebral palsy models. The accuracy of the assessments of femoral anteversion of the normally aligned models was comparable between the two and three-dimensional scans. However, the three-dimensional assessment was significantly more accurate than the two-dimensional assessment for measurement of anteversion of the cerebral palsy models (p = 0.003). Accuracy within 5° was comparable between the two and three-dimensional scans for measurement of the normally aligned models, with 86% of the two-dimensional measurements and 78% of the three-dimensional measurements falling within 5° of the actual measurements. However, the accuracy within 5° was significantly compromised when the models were placed in cerebral palsy alignment. Only 3% of the two-dimensional measurements and 14% of the three-dimensional measurements fell within 5° of the actual measurements, with three-dimensional assessment being significantly better than two-dimensional assessment (p = 0.006). Increasing the neck-shaft angle did not significantly compromise the accuracy of measurement of femoral anteversion with either the two-dimensional or the three-di","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"31 1","pages":"481–488"},"PeriodicalIF":0.0,"publicationDate":"2003-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73728337","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: 54
Tibial Plafond Fractures: How Do These Ankles Function Over Time? 胫骨平台骨折:随着时间的推移,这些脚踝是如何起作用的?
Pub Date : 2003-02-01 DOI: 10.2106/00004623-200302000-00016
J. Marsh, Dennis P. Weigel, D. Dirschl
Background: The intermediate outcome of fractures of the tibial plafond treated with current techniques has not been reported, to our knowledge. The purpose of this study, performed at a minimum of five years after injury, was to determine the effect of these fractures on ankle function, pain, and general health status and to determine which factors predict favorable and unfavorable outcomes.Methods: Fifty-six ankles (fifty-two patients) with a tibial plafond fracture were treated with a uniform technique consisting of application of a monolateral hinged transarticular external fixator coupled with screw fixation of the articular surface. Thirty-one patients with thirty-five involved ankles returned between five and twelve years after the injury for a physical examination, assessment of ankle pain and function with the Iowa Ankle Score and Ankle Osteoarthritis Scale, assessment of general health status with the Short Form-36 (SF-36), and radiographic examination of the ankle.Results: Arthrodesis had been performed on five of the forty ankles for which the outcome was known at a minimum of five years after the injury. Other than removal of prominent screws (two patients), no other surgical procedure had been performed on any patient. The average Iowa Ankle Score was 78 points (range, 28 to 96 points). The scores on the SF-36 and Ankle Osteoarthritis Scale demonstrated a long-term negative effect of the injury on general health and on ankle pain and function when compared with those parameters in age-matched controls. The degree of osteoarthrosis was grade 0 in three ankles, grade 1 in six, grade 2 in twenty, and grade 3 in six. The majority of patients had some limitation with regard to recreational activities, with an inability to run being the most common complaint (twenty-seven of the thirty-one patients). Fourteen patients changed jobs because of the ankle injury. Fifteen ankles were rated by the patient as excellent; ten, as good; seven, as fair; and one, as poor. Nine patients with previously recorded ankle scores had better scores after the longer follow-up interval. The patients perceived that their condition had improved for an average of 2.4 years after the injury.Conclusions: Although tibial plafond fractures have an intermediate-term negative effect on ankle function and pain and on general health, few patients require secondary reconstructive procedures and symptoms tend to decrease for a long time after healing.Level of Evidence: Therapeutic study, Level IV (case series [no, or historical, control group]). See Instructions to Authors for a complete description of levels of evidence.
背景:据我们所知,目前的技术尚未报道胫骨平台骨折的中间结果。本研究在受伤后至少5年进行,目的是确定这些骨折对踝关节功能、疼痛和一般健康状况的影响,并确定哪些因素可以预测有利和不利的结果。方法:采用单侧铰接经关节外固定架联合关节面螺钉固定56例胫骨平台骨折患者。31例患者有35个受损伤踝关节,在受伤后5 - 12年内返回进行体格检查,用爱荷华踝关节评分和踝关节骨关节炎量表评估踝关节疼痛和功能,用SF-36量表评估一般健康状况,并对踝关节进行x线检查。结果:40例踝关节中有5例进行了关节融合术,其结果至少在受伤后5年内已知。除取出突出螺钉(2例)外,未对任何患者进行其他手术。爱荷华踝关节平均得分为78分(范围为28至96分)。SF-36和踝关节骨关节炎量表的得分表明,与年龄匹配的对照组相比,损伤对一般健康、踝关节疼痛和功能有长期的负面影响。骨关节病变程度为3例踝关节0级,6例为1级,20例为2级,6例为3级。大多数患者在娱乐活动方面有一定的限制,无法跑步是最常见的主诉(31例患者中有27例)。14名患者因为脚踝受伤而换了工作。15个踝关节被患者评为优秀;十、一样好;七,为公平;一个是穷的。9名先前有踝关节评分记录的患者在较长的随访间隔后得分更高。在受伤后的平均2.4年里,患者认为他们的病情得到了改善。结论:虽然胫骨平台骨折对踝关节功能、疼痛和整体健康有中期负面影响,但很少有患者需要二次重建手术,且愈合后症状往往在很长一段时间内减轻。证据级别:治疗性研究,IV级(病例系列[无,或历史对照组])。有关证据水平的完整描述,请参见作者说明。
{"title":"Tibial Plafond Fractures: How Do These Ankles Function Over Time?","authors":"J. Marsh, Dennis P. Weigel, D. Dirschl","doi":"10.2106/00004623-200302000-00016","DOIUrl":"https://doi.org/10.2106/00004623-200302000-00016","url":null,"abstract":"Background: The intermediate outcome of fractures of the tibial plafond treated with current techniques has not been reported, to our knowledge. The purpose of this study, performed at a minimum of five years after injury, was to determine the effect of these fractures on ankle function, pain, and general health status and to determine which factors predict favorable and unfavorable outcomes.Methods: Fifty-six ankles (fifty-two patients) with a tibial plafond fracture were treated with a uniform technique consisting of application of a monolateral hinged transarticular external fixator coupled with screw fixation of the articular surface. Thirty-one patients with thirty-five involved ankles returned between five and twelve years after the injury for a physical examination, assessment of ankle pain and function with the Iowa Ankle Score and Ankle Osteoarthritis Scale, assessment of general health status with the Short Form-36 (SF-36), and radiographic examination of the ankle.Results: Arthrodesis had been performed on five of the forty ankles for which the outcome was known at a minimum of five years after the injury. Other than removal of prominent screws (two patients), no other surgical procedure had been performed on any patient. The average Iowa Ankle Score was 78 points (range, 28 to 96 points). The scores on the SF-36 and Ankle Osteoarthritis Scale demonstrated a long-term negative effect of the injury on general health and on ankle pain and function when compared with those parameters in age-matched controls. The degree of osteoarthrosis was grade 0 in three ankles, grade 1 in six, grade 2 in twenty, and grade 3 in six. The majority of patients had some limitation with regard to recreational activities, with an inability to run being the most common complaint (twenty-seven of the thirty-one patients). Fourteen patients changed jobs because of the ankle injury. Fifteen ankles were rated by the patient as excellent; ten, as good; seven, as fair; and one, as poor. Nine patients with previously recorded ankle scores had better scores after the longer follow-up interval. The patients perceived that their condition had improved for an average of 2.4 years after the injury.Conclusions: Although tibial plafond fractures have an intermediate-term negative effect on ankle function and pain and on general health, few patients require secondary reconstructive procedures and symptoms tend to decrease for a long time after healing.Level of Evidence: Therapeutic study, Level IV (case series [no, or historical, control group]). See Instructions to Authors for a complete description of levels of evidence.","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"9 1","pages":"287–295"},"PeriodicalIF":0.0,"publicationDate":"2003-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84738901","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: 210
Patellar Resurfacing in Total Knee Arthroplasty: A Prospective, Randomized Study 全膝关节置换术中的髌骨置换:一项前瞻性随机研究
Pub Date : 2003-02-01 DOI: 10.2106/00004623-200312000-00039
T. Waters, G. Bentley
Background: Anterior knee pain following total knee arthroplasty is a common complaint and typically is attributed to the patellofemoral joint. The purpose of the present study was to compare the outcome of resurfacing and nonresurfacing of the patella, particularly with regard to anterior knee pain, and to clarify the indications for patellar resurfacing at the time of total knee arthroplasty.Methods: We performed a prospective, randomized study of 514 consecutive primary press-fit condylar total knee replacements. The patients were randomized to either resurfacing or retention of the patella. They were also randomized to either a cruciate-substituting or a cruciate-retaining prosthesis as part of a separate trial. The mean duration of follow-up was 5.3 years (range, two to 8.5 years), and the patients were assessed with use of the Knee Society rating, a clinical anterior knee pain score, and the British Orthopaedic Association patient-satisfaction score. The assessment was performed without the examiner knowing whether the patella had been resurfaced. At the time of follow-up, there were 474 knees. Thirty-five patients who had a bilateral knee replacement underwent resurfacing on one side only.Results: The overall prevalence of anterior knee pain was 25.1% (fifty-eight of 231 knees) in the nonresurfacing group, compared with 5.3% (thirteen of 243 knees) in the resurfacing group (p < 0.0001). There was one case of component loosening. Ten of eleven patients who underwent secondary resurfacing had complete relief of anterior knee pain. The overall postoperative knee scores were lower in the nonresurfacing group, and the difference was significant among patients with osteoarthritis (p < 0.01). There was no significant difference between the resurfacing and nonresurfacing groups with regard to the postoperative function score. Patients who had a bilateral knee replacement were more likely to prefer the resurfaced side.Conclusions: As the present study showed a significantly higher rate of anterior knee pain following arthroplasty without patellar resurfacing, we recommend patellar resurfacing at the time of total knee replacement when technically possible.Level of Evidence: Therapeutic study, Level I-1a (Randomized controlled trial [significant difference]). See Instructions to Authors for a complete description of levels of evidence.
背景:全膝关节置换术后膝关节前部疼痛是一种常见的主诉,通常归因于髌股关节。本研究的目的是比较髌骨表面置换和非髌骨表面置换的结果,特别是关于膝关节前部疼痛,并澄清全膝关节置换术时髌骨表面置换的适应症。方法:我们进行了一项前瞻性的随机研究,514例连续的初级按压式髁突全膝关节置换术。患者随机分为髌骨表面置换组和髌骨保留组。作为单独试验的一部分,他们也被随机分配到十字架替代假体或十字架保留假体。平均随访时间为5.3年(2 - 8.5年),患者通过膝关节协会评分、临床前膝关节疼痛评分和英国骨科协会患者满意度评分进行评估。评估是在审查员不知道髌骨是否已经重新表面的情况下进行的。随访时,共有474个膝关节。35例双侧膝关节置换术患者仅在一侧进行了膝关节置换术。结果:膝关节前侧疼痛的总体发生率在非置换组为25.1%(231个膝关节中58个),而置换组为5.3%(243个膝关节中13个)(p < 0.0001)。有一例部件松动。11例接受二次表面置换的患者中有10例膝关节前侧疼痛完全缓解。非表面修复组术后膝关节整体评分较低,骨关节炎组差异有统计学意义(p < 0.01)。在术后功能评分方面,表面修复组和非表面修复组没有显著差异。双侧膝关节置换术的患者更倾向于选择表面修复的一侧。结论:由于目前的研究显示关节置换术后不进行髌骨表面置换的膝关节前侧疼痛率明显更高,我们建议在技术允许的情况下在全膝关节置换术时进行髌骨表面置换。证据水平:治疗性研究,I-1a级(随机对照试验[显著差异])。有关证据水平的完整描述,请参见作者说明。
{"title":"Patellar Resurfacing in Total Knee Arthroplasty: A Prospective, Randomized Study","authors":"T. Waters, G. Bentley","doi":"10.2106/00004623-200312000-00039","DOIUrl":"https://doi.org/10.2106/00004623-200312000-00039","url":null,"abstract":"Background: Anterior knee pain following total knee arthroplasty is a common complaint and typically is attributed to the patellofemoral joint. The purpose of the present study was to compare the outcome of resurfacing and nonresurfacing of the patella, particularly with regard to anterior knee pain, and to clarify the indications for patellar resurfacing at the time of total knee arthroplasty.Methods: We performed a prospective, randomized study of 514 consecutive primary press-fit condylar total knee replacements. The patients were randomized to either resurfacing or retention of the patella. They were also randomized to either a cruciate-substituting or a cruciate-retaining prosthesis as part of a separate trial. The mean duration of follow-up was 5.3 years (range, two to 8.5 years), and the patients were assessed with use of the Knee Society rating, a clinical anterior knee pain score, and the British Orthopaedic Association patient-satisfaction score. The assessment was performed without the examiner knowing whether the patella had been resurfaced. At the time of follow-up, there were 474 knees. Thirty-five patients who had a bilateral knee replacement underwent resurfacing on one side only.Results: The overall prevalence of anterior knee pain was 25.1% (fifty-eight of 231 knees) in the nonresurfacing group, compared with 5.3% (thirteen of 243 knees) in the resurfacing group (p < 0.0001). There was one case of component loosening. Ten of eleven patients who underwent secondary resurfacing had complete relief of anterior knee pain. The overall postoperative knee scores were lower in the nonresurfacing group, and the difference was significant among patients with osteoarthritis (p < 0.01). There was no significant difference between the resurfacing and nonresurfacing groups with regard to the postoperative function score. Patients who had a bilateral knee replacement were more likely to prefer the resurfaced side.Conclusions: As the present study showed a significantly higher rate of anterior knee pain following arthroplasty without patellar resurfacing, we recommend patellar resurfacing at the time of total knee replacement when technically possible.Level of Evidence: Therapeutic study, Level I-1a (Randomized controlled trial [significant difference]). See Instructions to Authors for a complete description of levels of evidence.","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"7 1","pages":"212–217"},"PeriodicalIF":0.0,"publicationDate":"2003-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88878959","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: 283
Clinical Outcomes After Lumbar Discectomy for Sciatica: The Effects of Fragment Type and Anular Competence 坐骨神经痛腰椎间盘切除术后的临床结果:碎片类型和环形能力的影响
Pub Date : 2003-01-01 DOI: 10.2106/00004623-200301000-00016
E. Carragee, Michael Han, Patrick W. Suen, David Kim
Background: The surgical treatment of sciatica with discectomy is ineffective in a sizable percentage of patients, and reherniation occurs after 5% to 15% of such procedures. The purpose of the present study was to determine if competence of the disc anulus and the type of herniation could be used to predict postoperative clinical outcomes following lumbar discectomy.Methods: A prospective observational study of 187 consecutive patients undergoing single-level primary lumbar discectomy was conducted. A single surgeon performed all of the procedures, and an independent examiner evaluated 180 of the patients clinically at a minimum of two and a median of six years after surgery. The extent of anular deficiency and the presence of disc fragments were determined. On the basis of these intraoperative findings, disc herniations were classified into four categories: (1) Fragment-Fissure herniations (eighty-nine patients), (2) Fragment-Defect herniations (thirty-three patients), (3) Fragment-Contained herniations (forty-two patients), and (4) No Fragment-Contained herniations (sixteen patients). The effects of disc herniation morphology and preoperative variables on subsequent clinical outcome were determined with the Student t test for continuous variables and chi-square analysis for categorical variables.Results: Patients in the Fragment-Fissure group, who had disc fragments and a small anular defect, had the best overall outcomes and the lowest rates of reherniation (1%) and reoperation (1%). Patients in the Fragment-Contained group had a 10% rate of reherniation and a 5% rate of reoperation. Patients in the Fragment-Defect group, who had extruded fragments and massive posterior anular loss, had a 27% rate of reherniation and a 21% rate of reoperation. Patients in the No Fragment-Contained group did poorly: 38% had recurrent or persistent sciatica, and the standard outcomes scores were less improved compared with those in the other groups (p < 0.001).Conclusion: Intraoperative findings, as described in the present study, were more clearly associated with outcomes than were demographic, socioeconomic, or clinical variables. The degree of anular competence after discectomy and the type of herniation appear to have value for the prediction of the recurrence of sciatica, reoperation, and clinical outcome following lumbar discectomy.Level of Evidence: Prognostic study, Level I-1 (prospective study). See p. 2 for complete description of levels of evidence.
背景:坐骨神经痛的手术治疗与椎间盘切除术在相当大比例的患者中是无效的,并且在5%至15%的此类手术后发生再突出。本研究的目的是确定椎间盘环的能力和突出的类型是否可以用来预测腰椎间盘切除术后的临床结果。方法:对187例连续行单节段腰椎间盘切除术的患者进行前瞻性观察研究。一名外科医生完成了所有的手术,一名独立的审查员在手术后至少2年至中位6年的时间里对180名患者进行了临床评估。确定环状缺损的程度和椎间盘碎片的存在。根据这些术中发现,将椎间盘突出分为四类:(1)碎片-裂隙突出(89例),(2)碎片-缺陷突出(33例),(3)碎片-包含突出(42例),(4)无碎片-包含突出(16例)。连续变量采用Student t检验,分类变量采用卡方分析,确定椎间盘突出形态和术前变量对后续临床结果的影响。结果:有椎间盘碎片和小环缺损的碎裂-裂组患者总体预后最好,再疝率(1%)和再手术率(1%)最低。包含碎片组的患者再疝率为10%,再手术率为5%。碎片-缺损组患者有挤压碎片和大量后环丢失,再疝率为27%,再手术率为21%。无碎片组患者表现较差:38%的患者有复发性或持续性坐骨神经痛,与其他组相比,标准结局评分改善较少(p < 0.001)。结论:术中发现,如本研究所述,与人口统计学、社会经济或临床变量相比,更清楚地与结果相关。椎间盘切除术后的环状能力程度和突出类型似乎对预测坐骨神经痛复发、再手术和腰椎间盘切除术后的临床结果有价值。证据等级:预后研究,I-1级(前瞻性研究)。关于证据等级的完整描述见第2页。
{"title":"Clinical Outcomes After Lumbar Discectomy for Sciatica: The Effects of Fragment Type and Anular Competence","authors":"E. Carragee, Michael Han, Patrick W. Suen, David Kim","doi":"10.2106/00004623-200301000-00016","DOIUrl":"https://doi.org/10.2106/00004623-200301000-00016","url":null,"abstract":"Background: The surgical treatment of sciatica with discectomy is ineffective in a sizable percentage of patients, and reherniation occurs after 5% to 15% of such procedures. The purpose of the present study was to determine if competence of the disc anulus and the type of herniation could be used to predict postoperative clinical outcomes following lumbar discectomy.Methods: A prospective observational study of 187 consecutive patients undergoing single-level primary lumbar discectomy was conducted. A single surgeon performed all of the procedures, and an independent examiner evaluated 180 of the patients clinically at a minimum of two and a median of six years after surgery. The extent of anular deficiency and the presence of disc fragments were determined. On the basis of these intraoperative findings, disc herniations were classified into four categories: (1) Fragment-Fissure herniations (eighty-nine patients), (2) Fragment-Defect herniations (thirty-three patients), (3) Fragment-Contained herniations (forty-two patients), and (4) No Fragment-Contained herniations (sixteen patients). The effects of disc herniation morphology and preoperative variables on subsequent clinical outcome were determined with the Student t test for continuous variables and chi-square analysis for categorical variables.Results: Patients in the Fragment-Fissure group, who had disc fragments and a small anular defect, had the best overall outcomes and the lowest rates of reherniation (1%) and reoperation (1%). Patients in the Fragment-Contained group had a 10% rate of reherniation and a 5% rate of reoperation. Patients in the Fragment-Defect group, who had extruded fragments and massive posterior anular loss, had a 27% rate of reherniation and a 21% rate of reoperation. Patients in the No Fragment-Contained group did poorly: 38% had recurrent or persistent sciatica, and the standard outcomes scores were less improved compared with those in the other groups (p < 0.001).Conclusion: Intraoperative findings, as described in the present study, were more clearly associated with outcomes than were demographic, socioeconomic, or clinical variables. The degree of anular competence after discectomy and the type of herniation appear to have value for the prediction of the recurrence of sciatica, reoperation, and clinical outcome following lumbar discectomy.Level of Evidence: Prognostic study, Level I-1 (prospective study). See p. 2 for complete description of levels of evidence.","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"155 1","pages":"102–108"},"PeriodicalIF":0.0,"publicationDate":"2003-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85018182","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: 501
Sustained Spinal Cord Compression: Part II: Effect of Methylprednisolone on Regional Blood Flow and Recovery of Somatosensory Evoked Potentials 持续脊髓压迫:第二部分:甲基强的松龙对局部血流和体感诱发电位恢复的影响
Pub Date : 2003-01-01 DOI: 10.2106/00004623-200301000-00015
G. Carlson, C. Gorden, S. Nakazawa, E. Wada, Jeremy S. Smith, J. LaManna
Background: The efficacy of methylprednisolone in the treatment of traumatic spinal cord injury is controversial. We examined the effect of methylprednisolone on regional spinal cord blood flow and attempted to determine whether recovery of electrophysiological function is dependent on reperfusion, either during sustained spinal cord compression or after decompression.Methods: The effects of methylprednisolone therapy on recovery of somatosensory evoked potentials and on spinal cord blood flow were examined in a canine model of dynamic spinal cord compression. Methylprednisolone (30 mg/kg intravenous loading dose followed by 5.4 mg/kg/hr intravenous infusion) or saline solution was administered to thirty-six beagles (eighteen in each group) five minutes after cessation of dynamic spinal cord compression and loss of all somatosensory evoked potentials. After ninety minutes of sustained compression, the spinal cords were decompressed. Somatosensory evoked potentials and spinal cord blood flow were evaluated throughout the period of sustained compression and for three hours after decompression.Results: Seven dogs treated with methylprednisolone and none treated with saline solution recovered measurable somatosensory evoked potentials during sustained compression. After decompression, three more dogs treated with methylprednisolone and seven dogs treated with saline solution recovered somatosensory evoked potentials. Four dogs treated with methylprednisolone lost their previously measurable somatosensory evoked potentials. In the methylprednisolone group, spinal cord blood flow was significantly higher (p < 0.05) in the dogs that had recovered somatosensory evoked potentials than it was in the dogs that had not. Reperfusion blood flow was significantly higher (p < 0.05) in the saline-solution group than it was in the methylprednisolone group. Spinal cord blood flow in the saline-solution group returned to baseline levels within five minutes after decompression. It did not return to baseline levels in the dogs treated with methylprednisolone.Conclusions: The methylprednisolone administered in this study did not provide a large or significant lasting benefit with regard to neurological preservation or restoration. Methylprednisolone may reduce regional spinal cord blood flow through mechanisms affecting normal autoregulatory blood-flow function.Clinical Relevance: This study suggests that a major drawback of methylprednisolone therapy may be the reduction in regional spinal cord blood flow after decompression.
背景:甲基强的松龙治疗外伤性脊髓损伤的疗效存在争议。我们检查了甲基强的松龙对局部脊髓血流的影响,并试图确定电生理功能的恢复是否依赖于再灌注,无论是在持续脊髓压迫期间还是在减压后。方法:采用犬脊髓动态受压模型,观察甲基强的松龙治疗对体感诱发电位恢复和脊髓血流的影响。在停止脊髓动态压迫和所有体感诱发电位丧失后5分钟,对36只比格犬(每组18只)给予甲基强龙(30mg /kg静脉负荷剂量,然后静脉滴注5.4 mg/kg/hr)或生理盐水溶液。持续压迫90分钟后,脊髓被减压。在持续压迫期间和减压后3小时评估体感诱发电位和脊髓血流量。结果:7只接受甲基强的松龙治疗的狗在持续压迫过程中恢复了可测量的体感诱发电位,而没有一只接受生理盐水治疗的狗。减压后,3只接受甲基强的松龙治疗的狗和7只接受生理盐水治疗的狗恢复了体感诱发电位。4只接受甲基强的松龙治疗的狗失去了先前可测量的体感诱发电位。在甲基强的松龙组,恢复体感诱发电位的狗的脊髓血流量显著高于未恢复体感诱发电位的狗(p < 0.05)。盐水组再灌注血流量显著高于甲基强的松龙组(p < 0.05)。盐水组脊髓血流量在减压后5分钟内恢复到基线水平。接受甲基强的松龙治疗的狗没有恢复到基线水平。结论:本研究中使用的甲基强的松龙在神经保护或恢复方面没有提供大的或显著的持久益处。甲基强的松龙可能通过影响正常的自我调节血流功能的机制减少脊髓局部血流量。临床相关性:这项研究表明甲基强的松龙治疗的一个主要缺点可能是减压后脊髓局部血流量的减少。
{"title":"Sustained Spinal Cord Compression: Part II: Effect of Methylprednisolone on Regional Blood Flow and Recovery of Somatosensory Evoked Potentials","authors":"G. Carlson, C. Gorden, S. Nakazawa, E. Wada, Jeremy S. Smith, J. LaManna","doi":"10.2106/00004623-200301000-00015","DOIUrl":"https://doi.org/10.2106/00004623-200301000-00015","url":null,"abstract":"Background: The efficacy of methylprednisolone in the treatment of traumatic spinal cord injury is controversial. We examined the effect of methylprednisolone on regional spinal cord blood flow and attempted to determine whether recovery of electrophysiological function is dependent on reperfusion, either during sustained spinal cord compression or after decompression.Methods: The effects of methylprednisolone therapy on recovery of somatosensory evoked potentials and on spinal cord blood flow were examined in a canine model of dynamic spinal cord compression. Methylprednisolone (30 mg/kg intravenous loading dose followed by 5.4 mg/kg/hr intravenous infusion) or saline solution was administered to thirty-six beagles (eighteen in each group) five minutes after cessation of dynamic spinal cord compression and loss of all somatosensory evoked potentials. After ninety minutes of sustained compression, the spinal cords were decompressed. Somatosensory evoked potentials and spinal cord blood flow were evaluated throughout the period of sustained compression and for three hours after decompression.Results: Seven dogs treated with methylprednisolone and none treated with saline solution recovered measurable somatosensory evoked potentials during sustained compression. After decompression, three more dogs treated with methylprednisolone and seven dogs treated with saline solution recovered somatosensory evoked potentials. Four dogs treated with methylprednisolone lost their previously measurable somatosensory evoked potentials. In the methylprednisolone group, spinal cord blood flow was significantly higher (p < 0.05) in the dogs that had recovered somatosensory evoked potentials than it was in the dogs that had not. Reperfusion blood flow was significantly higher (p < 0.05) in the saline-solution group than it was in the methylprednisolone group. Spinal cord blood flow in the saline-solution group returned to baseline levels within five minutes after decompression. It did not return to baseline levels in the dogs treated with methylprednisolone.Conclusions: The methylprednisolone administered in this study did not provide a large or significant lasting benefit with regard to neurological preservation or restoration. Methylprednisolone may reduce regional spinal cord blood flow through mechanisms affecting normal autoregulatory blood-flow function.Clinical Relevance: This study suggests that a major drawback of methylprednisolone therapy may be the reduction in regional spinal cord blood flow after decompression.","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"1 1","pages":"95–101"},"PeriodicalIF":0.0,"publicationDate":"2003-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91237808","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: 34
期刊
The Journal of Bone & Joint Surgery
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