Arthroplasty Today最新文献_第7页

Comparison of the Unipolar Electrocautery and the Bipolar Sealer in Reducing Blood Loss in Total Knee Arthroplasty: A Prospective, Randomized, Noninferiority Study 单极电烧与双极封口器在减少全膝关节置换术失血量方面的比较：前瞻性、随机、非劣效性研究

IF 1.5 Q3 ORTHOPEDICS

Arthroplasty Today

Pub Date : 2024-09-23 DOI: 10.1016/j.artd.2024.101509

Background

This was a noninferiority trial to evaluate blood loss during total knee arthroplasty (TKA) when using the unipolar electrocautery system compared to the saline coupled bipolar sealer system in primary TKA.

Methods

One hundred sixty-four patients were randomly assigned by a 1:1 ratio to either the unipolar electrocautery system (N = 82) or bipolar sealer system (N = 82). Inclusion criteria included patients scheduled for primary unilateral TKA, preoperative hemoglobin ≥11 mg/dL, preoperative platelet count ≥150,000, age >18 years, and patient willing to complete all study-related procedures. The primary efficacy outcome was estimated blood loss on morning of postoperative day. Secondary efficacy outcomes were comparison between the preoperative hemoglobin and postoperative day 1 hemoglobin, and allogeneic blood transfusions. Additionally, the study collected objective and functional outcomes using the postoperative 2011 Knee Society Score.

Results

The unipolar electrocautery system was not found to be less efficacious than the bipolar sealer system. Mean blood loss for the unipolar electrocautery system was 1062.0 cubic centimeters (cc) (95% confidence limit for the mean: 985.2, 1138.7), and for the bipolar sealer system was 929.4 cc (95% confidence limit for the mean: 841.9, 1016.8). The mean difference in blood loss was 132.6 cc, below the margin of inferiority set at 200 cc. Additionally, there was no difference in patient outcomes as measured by the Knee Society Score.

Conclusions

The safety, efficacy, and outcomes profile of the unipolar electrocautery system compared to the bipolar sealer system were similar. Use of the bipolar sealer system significantly increases surgical cost without any added benefits.

背景这是一项非劣效性试验，目的是评估在全膝关节置换术（TKA）中使用单极电烧系统与生理盐水耦合双极封片系统相比的失血量。纳入标准包括计划接受单侧 TKA 手术的患者、术前血红蛋白≥11 mg/dL、术前血小板计数≥150,000、年龄 18 岁、愿意完成所有与研究相关的手术。主要疗效指标是术后第二天早上的估计失血量。次要疗效指标是术前血红蛋白与术后第 1 天血红蛋白的比较，以及异体输血。此外，该研究还使用术后 2011 年膝关节协会评分收集了客观和功能性结果。结果未发现单极电烧系统的疗效低于双极封口系统。单极电烧系统的平均失血量为1062.0立方厘米（95%置信区间：985.2, 1138.7），双极封闭系统的平均失血量为929.4立方厘米（95%置信区间：841.9, 1016.8）。失血量的平均差异为 132.6 毫升，低于设定的 200 毫升的劣评值。结论单极电烧系统与双极封孔器系统相比，安全性、有效性和结果均相似。使用双极封片系统会显著增加手术成本，却没有任何额外的益处。

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引用次数: 0

Analyzing Racial Differences in Imaging Joint Replacement Registries Using Generative Artificial Intelligence: Advancing Orthopaedic Data Equity 利用生成式人工智能分析影像关节置换登记中的种族差异：促进骨科数据公平

IF 1.5 Q3 ORTHOPEDICS

Arthroplasty Today

Pub Date : 2024-09-23 DOI: 10.1016/j.artd.2024.101503

Background

Discrepancies in medical data sets can perpetuate bias, especially when training deep learning models, potentially leading to biased outcomes in clinical applications. Understanding these biases is crucial for the development of equitable healthcare technologies. This study employs generative deep learning technology to explore and understand radiographic differences based on race among patients undergoing total hip arthroplasty.

Methods

Utilizing a large institutional registry, we retrospectively analyzed pelvic radiographs from total hip arthroplasty patients, characterized by demographics and image features. Denoising diffusion probabilistic models generated radiographs conditioned on demographic and imaging characteristics. Fréchet Inception Distance assessed the generated image quality, showing the diversity and realism of the generated images. Sixty transition videos were generated that showed transforming White pelvises to their closest African American counterparts and vice versa while controlling for patients’ sex, age, and body mass index. Two expert surgeons and 2 radiologists carefully studied these videos to understand the systematic differences that are present in the 2 races’ radiographs.

Results

Our data set included 480,407 pelvic radiographs, with a predominance of White patients over African Americans. The generative denoising diffusion probabilistic model created high-quality images and reached an Fréchet Inception Distance of 6.8. Experts identified 6 characteristics differentiating races, including interacetabular distance, osteoarthritis degree, obturator foramina shape, femoral neck-shaft angle, pelvic ring shape, and femoral cortical thickness.

Conclusions

This study demonstrates the potential of generative models for understanding disparities in medical imaging data sets. By visualizing race-based differences, this method aids in identifying bias in downstream tasks, fostering the development of fairer healthcare practices.

背景医疗数据集中的差异会使偏差长期存在，尤其是在训练深度学习模型时，有可能导致临床应用中出现有偏差的结果。了解这些偏差对于开发公平的医疗保健技术至关重要。本研究利用生成式深度学习技术来探索和理解接受全髋关节置换术的患者中基于种族的放射学差异。方法我们利用大型机构登记册，回顾性地分析了全髋关节置换术患者的骨盆放射照片，这些照片具有人口统计学和图像特征。去噪扩散概率模型生成了以人口统计学和成像特征为条件的X光片。弗雷谢特起始距离评估了生成图像的质量，显示了生成图像的多样性和真实性。在控制患者性别、年龄和体重指数的情况下，生成的 60 个过渡视频显示了白人骨盆向最接近的非裔美国人骨盆的转变，反之亦然。两名外科医生专家和两名放射科医生仔细研究了这些视频，以了解两个种族的放射照片中存在的系统性差异。结果我们的数据集包括 480,407 张骨盆放射照片，其中白人患者多于非裔美国人。生成式去噪扩散概率模型生成了高质量的图像，弗雷谢特起始距离（Fréchet Inception Distance）达到 6.8。专家们确定了区分种族的 6 个特征，包括髋臼间距、骨关节炎程度、闭孔形状、股骨颈轴角、骨盆环形状和股骨皮质厚度。通过将基于种族的差异可视化，该方法有助于识别下游任务中的偏差，从而促进更公平的医疗保健实践的发展。

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引用次数: 0

Liver Disease Increases the Risk of Postoperative Complications in Patients Undergoing Aseptic Revision Total Hip and Knee Arthroplasty 肝病会增加无菌翻修全髋关节和膝关节置换术患者术后并发症的风险

IF 1.5 Q3 ORTHOPEDICS

Arthroplasty Today

Pub Date : 2024-09-21 DOI: 10.1016/j.artd.2024.101516

Background

Due to the multiorgan effects of liver disease, surgical patients with liver disease have an increased risk of perioperative complications. With revision total hip and knee arthroplasty surgeries increasing, it is important to determine the effects of liver disease in this patient population. The purpose of this study was to evaluate the impact of underlying liver disease on postoperative outcomes following revision total joint arthroplasty (TJA).

Methods

The National Surgical Quality Improvement Program database was used to identify patients undergoing aseptic revision TJA from 2006-2019 and group them based on liver disease. The presence of liver disease was assessed by calculating the Model for End-Stage Liver Disease–Sodium score. Patients with a Model for End-Stage Liver Disease–Sodium score of > 10 were classified as having underlying liver disease. In this analysis, differences in demographics, comorbidities, and postoperative complications were assessed.

Results

Of 7102 patients undergoing revision total hip arthroplasty, 11.6% of the patients had liver disease. Of 8378 patients undergoing revision total knee arthroplasty, 8.4% of the patients had liver disease. Following adjustment on multivariable regression analysis, patients with liver disease undergoing revision total hip arthroplasty or revision total knee arthroplasty had an increased risk of major complications, wound complications, septic complications, bleeding requiring transfusion, extended length of stay, and readmission compared to those without liver disease.

Conclusions

Patients with liver disease have an increased risk of complications following revision TJA. A multidisciplinary team approach should be employed for preoperative optimization and postoperative management of these vulnerable patients to improve outcomes and decrease the incidence and severity of complications.

Level of evidence

This is retrospective cohort study and is level 3 evidence.

背景由于肝脏疾病对多器官的影响，患有肝脏疾病的手术患者围手术期并发症的风险增加。随着翻修全髋关节和膝关节置换手术的增加，确定肝病对这类患者的影响非常重要。本研究的目的是评估潜在肝病对翻修全关节成形术（TJA）术后结果的影响。方法利用国家外科质量改进计划数据库识别2006-2019年间接受无菌翻修TJA手术的患者，并根据肝病对其进行分组。通过计算终末期肝病模型-钠评分来评估是否存在肝病。终末期肝病模型-钠评分为> 10的患者被归类为患有基础肝病。结果在接受翻修全髋关节置换术的7102名患者中，11.6%的患者患有肝病。在接受翻修全膝关节置换术的8378名患者中，8.4%的患者患有肝病。经多变量回归分析调整后，与无肝病患者相比，接受翻修全髋关节置换术或翻修全膝关节置换术的肝病患者发生主要并发症、伤口并发症、化脓性并发症、需要输血的出血、住院时间延长和再次入院的风险增加。结论肝病患者在翻修TJA术后并发症风险增加，应采用多学科团队方法对这些易感患者进行术前优化和术后管理，以改善预后，降低并发症的发生率和严重程度。

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引用次数: 0

A Comparison of Postoperative Outcomes Between Supine and Lateral Patient Positioning in Total Hip Arthroplasty Using the Anterior-Based Muscle Sparing Surgical Approach 采用前路肌肉疏通手术方法进行全髋关节置换术时患者仰卧位和侧卧位的术后效果比较

IF 1.5 Q3 ORTHOPEDICS

Arthroplasty Today

Pub Date : 2024-09-21 DOI: 10.1016/j.artd.2024.101515

Background

To determine any differences in clinical outcomes between patients in the supine vs the lateral position during anterior-based muscle sparing (ABMS) total hip arthroplasty (THA).

Methods

A retrospective review was performed of 368 patients undergoing THA via the ABMS approach (201 lateral vs 167 supine position) at our institution (2015-2019) with a minimum follow-up of 12 months. Inclusion criteria were all patients undergoing primary THA. Exclusion criteria were any revision surgeries and patients who did not undergo the ABMS THA. Outcomes assessed were postoperative complication rates, ambulation distance, length of stay, and Western Ontario and McMaster Universities Osteoarthritis Index pain, stiffness, and physical function scores at 3 time periods (preoperative, 3 months postoperative, and 1 year postoperative).

Results

The supine group had significantly greater postoperative day 0 ambulation distance (150 vs 60 meters; P < .001), while no difference was observed on postoperative day 1 (210 meters in supine vs 200 in lateral; P = .921). Median length of stay was significantly shorter in the supine group (1; interquartile range 0-1) with respect to the lateral group (1; interquartile range 0-2; P < .001). The in-hospital complication rates (2.4% in supine vs 1.5% in lateral; P = .780), return to operating room rates (2.4% in supine vs 1.5% in lateral; P = .780), and readmission rates (5.4% in supine vs 5.0% in lateral; P = .631) were not significantly different between the groups. No significant differences were observed across any Western Ontario and McMaster Universities Osteoarthritis Index scores.

Conclusions

Both supine and lateral patient positioning provide acceptable early surgical outcomes, suggesting that satisfactory results can be obtained via both positions in THAs.

背景为了确定在前路肌肉疏松（ABMS）全髋关节置换术（THA）过程中，仰卧位与侧卧位患者的临床结果是否存在差异。方法对本机构（2015-2019 年）接受 ABMS 方法全髋关节置换术的 368 例患者（201 例侧卧位患者与 167 例仰卧位患者）进行了回顾性研究，随访至少 12 个月。纳入标准为所有接受初次 THA 手术的患者。排除标准为任何翻修手术和未接受 ABMS THA 的患者。评估结果包括术后并发症发生率、行走距离、住院时间，以及西安大略和麦克马斯特大学骨关节炎指数在3个时间段（术前、术后3个月和术后1年）的疼痛、僵硬和身体功能评分。结果仰卧组术后第0天的行走距离明显更大（150米 vs 60米；P < .001），而术后第1天没有观察到差异（仰卧210米 vs 侧卧200米；P = .921）。仰卧组的中位住院时间（1；四分位间范围 0-1）明显短于侧卧组（1；四分位间范围 0-2；P < .001）。两组的院内并发症发生率（仰卧位 2.4% vs 侧卧位 1.5%；P = .780）、返回手术室率（仰卧位 2.4% vs 侧卧位 1.5%；P = .780）和再入院率（仰卧位 5.4% vs 侧卧位 5.0%；P = .631）无显著差异。西安大略大学和麦克马斯特大学骨关节炎指数评分均无明显差异。结论仰卧位和侧卧位患者的早期手术效果均可接受，这表明这两种体位在 THAs 中均可获得令人满意的结果。

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引用次数: 0

Fracture of an Exeter Femoral Stem With Extensive Ipsilateral Periacetabular Osteolysis 埃克塞特股骨柄骨折伴同侧髋臼周围广泛骨溶解

IF 1.5 Q3 ORTHOPEDICS

Arthroplasty Today

Pub Date : 2024-09-19 DOI: 10.1016/j.artd.2024.101436

The Stryker Exeter stem (Stryker, Kalamazoo, MI) has been in service for over 50 years and remains the most widely used cemented stem. Stem fracture is a rare complication, with recently reported rates of 1 in 10,000. We present a case of Exeter stem fracture 25 years following initial implantation as well as a large periacetabular defect secondary to osteolysis. A revision total hip arthroplasty was performed, including periacetabular bone grafting for extensive osteolysis along with retention of a stable acetabular component. This case highlights the rare complication of Exeter stem fracture as well as the technique of bone grafting a large periacetabular defect with a retained acetabular component. This is of particular interest given the rarity of this event and the resurgence in North America of cemented femoral components in total hip arthroplasty.

史赛克Exeter骨干（史赛克，密歇根州卡拉马祖）已经使用了50多年，仍然是使用最广泛的骨水泥骨干。柄断裂是一种罕见的并发症，最近报道的发生率为万分之一。我们介绍了一例初次植入后25年的Exeter柄骨折病例，以及继发于骨溶解的巨大髋臼周围缺损。患者接受了翻修全髋关节置换术，包括髋臼周围大面积骨溶解植骨，并保留了稳定的髋臼组件。该病例强调了Exeter骨干骨折这一罕见并发症，以及在保留髋臼组件的情况下对大面积髋臼周围缺损进行植骨的技术。鉴于这种情况的罕见性，以及北美地区在全髋关节置换术中再次使用骨水泥股骨组件，该病例尤其值得关注。

引用次数: 0

Ninety-Day Outcomes in Primary Hypercoagulable Disease Patients Undergoing Total Joint Arthroplasty Vs Normal: A Matched Case-Control Series 接受全关节置换术的原发性高凝状态患者与正常患者的九十天疗效对比：匹配病例对照系列

IF 1.5 Q3 ORTHOPEDICS

Arthroplasty Today

Pub Date : 2024-09-18 DOI: 10.1016/j.artd.2024.101424

Background

Perioperative complications of deep vein thrombosis are well described in the total joint arthroplasty (TJA) literature. Few studies have investigated short-term perioperative outcomes of patients with primary hypercoagulable diseases (PHDs). Optimal perioperative management of PHD patients remains unknown, and they are often referred to tertiary centers for care. We investigated the influence perioperative hematology consultation and anti-coagulation use had on PHD patient outcomes following TJA surgery within the 90-day postoperative period.

Methods

This retrospective cohort study examined perioperative outcomes of PHD patients undergoing TJA. Thirty-eight PHD patients were identified and compared to a 3:1 matched control group in a consecutive series of 6568 cases (2007-2019). Perioperative hematology consultations, use of anticoagulants (AC) or antiplatelet therapy, emergency department (ED) visits, readmissions, and complications within 90 days of surgery were determined.

Results

The PHD cohort exhibited more frequent hematology consultations (odds ratio 5.88, 95% confidence interval: 2.59-16.63) and AC use (odds ratio 7.9, 95% confidence interval: 3.38-23.80) than controls. PHD patients did not show significantly greater rates of deep vein thrombosis, transfusion, infection, ED visits, or need for operative intervention. Similarly, AC vs antiplatelet therapy yielded comparable ED visits and readmissions within 90 days postoperatively (11.0% vs 9.7%, P = .85 and 5.5% vs 5.5%, P = 1, respectively).

Conclusions

These findings suggest that despite increased hematology consultation and AC use, PHD patients do not demonstrate significantly elevated perioperative risks post-TJA, favoring careful preoperative workup and outpatient postoperative follow-up.

背景深静脉血栓形成的围手术期并发症在全关节成形术（TJA）文献中已有详细描述。很少有研究对原发性高凝疾病（PHD）患者的短期围手术期结果进行调查。PHD患者的最佳围手术期管理仍是未知数，他们通常被转到三级中心接受治疗。我们研究了 TJA 手术后 90 天内，围手术期血液科会诊和抗凝药物的使用对 PHD 患者预后的影响。在连续 6568 例病例（2007-2019 年）中，确定了 38 例 PHD 患者，并与 3:1 匹配的对照组进行了比较。结果与对照组相比，PHD 组群表现出更频繁的血液咨询（几率比 5.88，95% 置信区间：2.59-16.63）和使用抗凝剂（几率比 7.9，95% 置信区间：3.38-23.80）。PHD 患者的深静脉血栓形成率、输血率、感染率、急诊室就诊率或手术干预需求均未明显增加。同样，AC 与抗血小板治疗的 ED 就诊率和术后 90 天内的再入院率相当（分别为 11.0% vs 9.7%，P = .85 和 5.5% vs 5.5%，P = 1）。

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引用次数: 0

Preoperative Three-Dimensional Planning Using Computed Tomography Improves Screw Placement in Patients Undergoing Acetabular Revision Surgery 使用计算机断层扫描进行术前三维规划可改善髋臼翻修手术患者的螺钉置放效果

IF 1.5 Q3 ORTHOPEDICS

Arthroplasty Today

Pub Date : 2024-09-18 DOI: 10.1016/j.artd.2024.101431

Background

Stable fixation of joint replacement implants is essential to achieve osseointegration in uncemented implants. In acetabular revisions, screws often need to be utilized in quadrants other than the historically so-called “safe” zones to attain sufficient stability. The primary aim of this study was to determine whether preoperative three-dimensional (3D) planning for acetabular revision surgery influences screw length, specifically in the superior pubic ramus (SPR).

Methods

Between March 2017 and December 2021, 20 patients underwent preoperative two-dimensional (2D) planning (2D group), and 30 patients underwent 3D planning following the implementation of a new 3D planning software into clinical practice in September 2019 (3D group). Two observers, blinded to the groups, measured the total screw length, screw penetration depth, and cup position on available postoperative computed tomography examinations. For statistical comparisons, the mean measurement from the 2 observers was used.

Results

The median total screw lengths in the SPR were 16 mm in the 2D group and 25 mm in the 3D group (P = .004) and 40.5 mm compared with 50.5 mm in the ilium (P = .019). Median screw penetration depths in the SPR were 0 mm in the 2D group and 1.25 mm in the 3D group (P = .049).

Conclusion

Longer screws were used in the SPR and ilium when preoperative 3D planning was conducted. Due to the study design, we were not able to evaluate whether longer screws lead to better fixation. Further studies are needed to elucidate this question.

背景关节置换植入物的稳定固定对于实现非骨水泥植入物的骨结合至关重要。在髋臼翻修术中，为了获得足够的稳定性，通常需要在历史上所谓的 "安全 "区域以外的象限使用螺钉。本研究的主要目的是确定髋臼翻修手术的术前三维（3D）规划是否会影响螺钉长度，尤其是耻骨上隆突（SPR）的螺钉长度。方法在2017年3月至2021年12月期间，20名患者接受了术前二维（2D）规划（2D组），30名患者在2019年9月新的3D规划软件应用于临床实践后接受了3D规划（3D组）。两名观察者对各组进行了盲法操作，在现有的术后计算机断层扫描检查中测量了螺钉总长度、螺钉穿透深度和髋臼杯位置。结果 SPR 中位螺钉总长度二维组为 16 毫米，三维组为 25 毫米（P = .004），髂骨中位螺钉总长度为 40.5 毫米，三维组为 50.5 毫米（P = .019）。在 SPR 中，2D 组的中位螺钉穿透深度为 0 毫米，3D 组为 1.25 毫米（P = 0.049）。由于研究设计的原因，我们无法评估更长的螺钉是否能带来更好的固定效果。需要进一步研究来阐明这一问题。

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引用次数: 0

Correlation of Acetabular Cup Placement Angles Between an Artificial Intelligence-Powered System Using a Smartphone and Human Measurements 使用智能手机的人工智能系统与人体测量结果之间的髋臼杯置入角度相关性

IF 1.5 Q3 ORTHOPEDICS

Arthroplasty Today

Pub Date : 2024-09-18 DOI: 10.1016/j.artd.2024.101439

Background

An automated measurement system for the placement angles of acetabular cup in total hip arthroplasty prostheses was developed utilizing artificial intelligence (AI) algorithms. The AI-powered system enables immediate measurement by capturing an anteroposterior pelvic X-ray through a smartphone camera.

Methods

While developing the AI-powered measurement system, we trained AI utilizing 100 labeled anteroposterior pelvic X-rays to recognize the hip joint and 483 labeled anteroposterior pelvic X-rays to identify anatomical landmarks and the acetabular cup. To validate the AI-powered system, we measured the acetabular cup placement angles of 126 unlabeled post-total hip arthroplasty anteroposterior pelvic X-rays with both the AI-powered system and conventional measurement methods and assessed the correlation between the 2 methods.

Results

The Pearson’s correlation coefficients for the acetabular cup placement angles measured using the AI-powered system and conventional method were 0.88 (95% confidence interval, 0.84-0.92, P < .001) in inclination angle and 0.76 (95% confidence interval, 0.67-0.83, P < .001) in anteversion angle, respectively.

Conclusions

Both inclination and anteversion angles measured using the AI-powered system showed a strong correlation with angles obtained through conventional methods.

背景利用人工智能（AI）算法开发了一套全髋关节置换术假体髋臼杯置入角度自动测量系统。在开发人工智能测量系统的过程中，我们利用 100 张标记的骨盆前方 X 光片识别髋关节，并利用 483 张标记的骨盆前方 X 光片识别解剖地标和髋臼杯，对人工智能进行了训练。为了验证 AI 动力系统，我们使用 AI 动力系统和传统测量方法测量了 126 张未标记的全髋关节置换术后骨盆前方 X 光片的髋臼杯置入角，并评估了这两种方法之间的相关性。结果使用 AI 动力系统和传统方法测量的髋臼杯置入角的皮尔逊相关系数为 0.88 (95% confidence interval, 0.84-0.92, P <.001)，内翻角的相关系数为 0.76 (95% confidence interval, 0.67-0.83, P <.001)。

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引用次数: 0

The Impact of Spinopelvic and Hip Mobility on Passive Hip Flexion Range of Motion Assessment 脊柱骨和髋关节活动度对被动髋关节屈伸活动范围评估的影响

IF 1.5 Q3 ORTHOPEDICS

Arthroplasty Today

Pub Date : 2024-09-18 DOI: 10.1016/j.artd.2024.101429

Background

Measuring passive hip flexion range of motion (ROM) is challenging due to compensatory movements. Despite the interest in using functional lateral radiographs for assessing hip mobility, the relationship with passive hip flexion ROM remains unclear. This study aims to elucidate this relationship and clarify spinopelvic parameters and mobility factors influencing variations in passive and radiographic hip flexion ROM.

Methods

A retrospective cross-sectional study was conducted on 154 preoperative patients undergoing primary total hip arthroplasty. Passive and radiographic hip flexion ROM were assessed to clarify these relationships, and these differences were classified into 3 groups (O, A and U). Spinopelvic and hip parameters were assessed in standing, relaxed-seated and flexed-seated positions, as well as lumbar, pelvis, and hip mobility between each position to identify factors influencing differences.

Results

There was a moderate correlation between passive and radiographic hip flexion ROM (R² = 0.48, P < .01). A significant difference was found in pelvic and hip alignment in the flexed-seated position between all groups. In postural changes, the O group, which had more patients with relatively low hip mobility, showed greater lumbar spine and pelvic movement, while the U group, which had more patients with relatively high hip mobility, showed less lumbar spine and pelvic movement.

Conclusions

This study confirmed that passive hip flexion ROM and radiographic hip flexion ROM correlate and that spinopelvic and hip alignment and mobility influence these differences. This result suggests that clinicians should consider lumbar and pelvic alignment and mobility in clinical practice to improve the accuracy of passive hip flexion ROM measurements.

背景由于代偿运动的存在，测量髋关节被动屈曲活动范围（ROM）具有一定的难度。尽管人们对使用功能性侧位片来评估髋关节活动度很感兴趣，但其与被动髋关节屈曲活动度之间的关系仍不清楚。本研究旨在阐明这种关系，并明确影响被动和放射学髋关节屈曲 ROM 变化的脊柱骨盆参数和活动度因素。方法对 154 名接受初级全髋关节置换术的术前患者进行了回顾性横断面研究。对被动和影像学髋关节屈曲 ROM 进行评估，以明确这些关系，并将这些差异分为 3 组（O、A 和 U）。评估了站立、放松坐位和屈曲坐位时的脊柱骨盆和髋关节参数，以及每个体位之间的腰部、骨盆和髋关节活动度，以确定影响差异的因素。所有组别在屈膝坐位时的骨盆和髋关节对齐情况存在明显差异。在体位变化方面，O 组中髋关节活动度相对较低的患者较多，腰椎和骨盆活动度较大；而 U 组中髋关节活动度相对较高的患者较多，腰椎和骨盆活动度较小。这一结果表明，临床医生在临床实践中应考虑腰椎和骨盆的排列和活动度，以提高被动髋关节屈曲 ROM 测量的准确性。

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引用次数: 0

Who Is Treating Periprosthetic Femur Fractures? An Analysis of the Periprosthetic Research Consortium 谁在治疗股骨假体周围骨折？假体周围研究联盟分析

IF 1.5 Q3 ORTHOPEDICS

Arthroplasty Today

Pub Date : 2024-08-13 DOI: 10.1016/j.artd.2024.101428

Background

Periprosthetic femur fractures (PPFFs) following total hip arthroplasty (THA) have increased in the past decade as the demand for primary surgery continues to grow. Although there is now more evidence to describe the treatment of Vancouver B fractures, there is still limited knowledge regarding factors that cause surgeons to perform either an open reduction and internal fixation (ORIF) or revision THA (rTHA). The purpose of this study was to determine what type of surgeons treat Vancouver B PPFFs at 11 major academic institutions and if there are trends in treatment decision-making regarding the use of ORIF or rTHA based on surgical training or patient factors.

Methods

This multicenter retrospective study evaluated patients surgically treated for Vancouver B PPFF after THA between 2014 and 2019. Patients from 11 academic centers located in the United States were included in this study. Surgical outcomes and patient demographics were evaluated based on surgeon training, surgical treatment type, and institution.

Results

Presence of Vancouver B2 (odds ratio [OR]: 0.02, P < .001) or B3 (OR: 0.04, P < .001) fractures were independent risk factors for treatment with rTHA. Treatment by a trauma (OR: 12.49, P < .001) or other-specified surgeon (OR: 13.63, P < .001) were independent risk factors for ORIF repair of Vancouver B fractures. There were no differences in outcomes based on surgeon subspecialty training.

Conclusions

This study showed the trends in surgeons who surgically manage Vancouver B fractures at 11 major academic institutions and highlighted that regardless of surgical training or surgical treatment type, postoperative outcomes following management of PPFF were similar.

背景全髋关节置换术（THA）后股骨假体骨折（PPFF）在过去十年中有所增加，因为对初次手术的需求持续增长。尽管现在有更多的证据来描述范库弗B型骨折的治疗方法，但对于导致外科医生实施开放复位内固定术（ORIF）或翻修THA（rTHA）的因素，人们的了解仍然有限。本研究的目的是确定 11 家主要学术机构中治疗温哥华 B 型 PPFF 的外科医生类型，以及是否存在基于外科培训或患者因素的 ORIF 或 rTHA 治疗决策趋势。方法这项多中心回顾性研究评估了 2014 年至 2019 年间 THA 后接受手术治疗的温哥华 B 型 PPFF 患者。本研究纳入了来自美国 11 个学术中心的患者。根据外科医生培训、手术治疗类型和机构对手术结果和患者人口统计学进行了评估。结果存在温哥华 B2（几率比 [OR]：0.02，P < .001）或 B3（OR：0.04，P < .001）骨折是使用 rTHA 治疗的独立风险因素。由外伤（OR：12.49，P < .001）或其他指定外科医生（OR：13.63，P < .001）治疗是温哥华 B 型骨折 ORIF 修复的独立危险因素。结论这项研究显示了 11 家主要学术机构中对温哥华 B 型骨折进行手术治疗的外科医生的趋势，并强调无论外科培训或手术治疗类型如何，PPFF 治疗后的术后结果都是相似的。

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