Revista Espanola de Cirugia Ortopedica y Traumatologia最新文献_第8页

Does plate fixation improve the Latarjet procedure for anterior glenohumeral instability? 钢板固定能否改善盂兰盆前关节失稳的 Latarjet 手术？

Q3 Medicine

Revista Espanola de Cirugia Ortopedica y Traumatologia

Pub Date : 2024-11-12 DOI: 10.1016/j.recot.2024.11.015

A Portes, F Santana, C Torrens

The Latarjet technique is a procedure used to treat anterior glenohumeral instability with glenoid bone loss. Various fixation systems for the coracoid have been described in the literature. This study aims to compare the results in quality of life and complications between patients treated with plate and screws (GP) and those with screws only (GSP) for coracoid fixation.

Material and methods: A retrospective study including patients with anterior glenohumeral instability and glenoid bone loss treated with Latarjet at the same center between October 2009 and February 2021. A total of 85 shoulders were analyzed, of which 64 completed at least one year of follow-up. Patients with previous surgical history in the same shoulder, bone loss <10%, ligamentous hyperlaxity (Beighton score >6), and previous infections were excluded. Complications were recorded, and the WOSI and Rowe tests were used to assess quality of life and return to sports activity.

Results: Of the 64 patients, 35 were treated with a plate (GP) and 29 with screws (GSP). The mean age was 30±8.78years. Both groups were statistically comparable. No significant differences were found in the WOSI test (P=.140), the Rowe test (P=.380) or in complications (P=.692). A higher percentage of the GP group returned to sports activity (77.1% GP vs. 51.7% GSP, P=.039).

Conclusions: No statistically differences were observed in quality of life, complications, or re-dislocations. However, the use of a plate showed a greater predisposition to return to sports activity (P=.039) in patients with anterior glenohumeral instability.

Latarjet技术是一种用于治疗盂骨缺失的盂肱前部不稳定的手术。文献中描述了多种用于固定肩胛骨的系统。本研究旨在比较使用钢板和螺钉（GP）与仅使用螺钉（GSP）进行肩胛骨固定的患者在生活质量和并发症方面的结果：2009年10月至2021年2月期间在同一中心接受Latarjet治疗的前盂肱骨不稳定和盂骨缺损患者。共分析了 85 例肩关节，其中 64 例完成了至少一年的随访。排除了曾在同一肩部接受过手术、骨丢失 6) 和曾感染的患者。并发症记录在案，WOSI和ROWE测试用于评估生活质量和运动恢复情况：64名患者中，35人使用钢板（GP）治疗，29人使用螺钉（GSP）治疗。平均年龄为（30±8.78）岁。两组患者在统计学上具有可比性。WOSI测试（P=0.140）、ROWE测试（P=0.380）和并发症（P=0.692）均无明显差异。全科医生组恢复体育活动的比例更高（77.1% 的全科医生对 51.7% 的全科医生，p=0.039）：在生活质量、并发症或再次脱位方面没有统计学差异。结论：在生活质量、并发症或再次脱位方面未观察到统计学差异，但在盂肱关节前侧不稳定的患者中，使用钢板更容易恢复运动活动（P=0.039）。

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引用次数: 0

Clinical and radiological outcomes of the SL-Plus stem with a minimum 10-year follow-up: A retrospective study. 至少随访 10 年的 SL-Plus 支架的临床和放射学效果：一项回顾性研究。

Q3 Medicine

Revista Espanola de Cirugia Ortopedica y Traumatologia

Pub Date : 2024-11-08 DOI: 10.1016/j.recot.2024.10.014

L Palacios-Díaz, R Fernández-Fernández, A Losa Sánchez, A Cruz-Pardos

Purpose: The SL-Plus cementless stem was introduced in 1993 as an evolution of the Alloclassic® stem with some modifications. The aim of this study was to analyse if these modifications have any influence in clinical and radiological outcomes at minimum 10-year follow-up.

Methods: Sixty-eight consecutive implants (64 patients) were retrospective evaluated. The mean duration of clinical and radiographic follow-up was 12.2 years. There were 41 female and 23 male patients with a median age of 73.5 years. All complications and reinterventions were collected. Functional outcomes were assessed using the modified Harris Hip Score (mHHS). Radiographs were evaluated immediately after the operation, after a minimum 2-year follow-up and by the end of follow-up (time A, B and C, respectively).

Results: Two stems were revised, one due to periprosthetic fracture and one due to aseptic loosening with a cumulative probability of not having a stem revision for any reason of 97.2% at 12.2 years. Mean mHHS was 76.7 points at the latest follow-up. Significant differences were found in distal migration (time A: 5.9mm±6.7; B: 6.9mm±7.1 and C: 8.2mm±6.3; P=.000) and varus angulation (time A: 0.0°±2: B: 0.0°±2 and C: 1.0°±3; P<.001), although these stems showed radiographic signs of osseointegration. Thirty-three hips (48.5%) showed any radiolucent line around the stem, most of them located the proximal femur (Gruen 1 and 7). Multivariate regression analysis showed lower mHHS scores in older patients (P=.004) and female (P=.00).

Conclusions: The modifications of the SL-Plus stem influence the long-term outcome of the implant regarding radiological results, particularly in progressive varus angulation and distal migration. However, our study has not been able to demonstrate any clinical repercussions: functional scores and survival free of all cause revision were favorable and comparable to previous reports.

目的：SL-Plus无骨水泥柄于1993年推出，是Alloclassic柄的改进版，并进行了一些修改。本研究的目的是分析这些改良是否会影响至少10年随访的临床和放射学结果：方法：对68例连续种植体（64名患者）进行了回顾性评估。临床和放射学随访的平均时间为 12.2 年。其中女性患者 41 人，男性患者 23 人，中位年龄为 73.5 岁。所有并发症和再干预情况均已收集。使用改良哈里斯髋关节评分（mHHS）评估功能结果。术后立即、至少两年随访后和随访结束时（分别为时间A、B和C）对X光片进行评估：12.2年后，未因任何原因进行骨干翻修的累计概率为97.2%。最近一次随访时，mHHS的平均值为76.7分。远端移位（A时间：5.9mm±6.7，B时间：6.9mm±7.1，C时间：8.2mm±6.3；p=0.000）和屈曲角度（A时间：0.0°±2，B时间：0.0°±2，C时间：1.0°±3；p结论：SL-Plus骨干的改良影响了植入物的长期放射学结果，尤其是在渐进性屈曲成角和远端移位方面。然而，我们的研究并未显示出任何临床影响：功能评分和无各种原因翻修的存活率均良好，与之前的报告相当：证据等级：治疗四级（病例系列）。

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引用次数: 0

[Translated article] Evaluation, differential diagnosis and treatment of vertebral osteoporosis: How to avoid the occurrence of new fractures [椎体骨质疏松症的评估、鉴别诊断和治疗：如何避免出现新的骨折。

Q3 Medicine

Revista Espanola de Cirugia Ortopedica y Traumatologia

Pub Date : 2024-11-01 DOI: 10.1016/j.recot.2024.08.008

M. Nikitsina , P. Quiroga-Colina , S. Castañeda

Osteoporosis is a highly prevalent and multifactorial disease whose main manifestation is the appearance of fragility or low-impact fractures. The most frequent locations of osteoporotic fractures occur at the vertebrae, femoral, distal end of the radius and humerus. Osteoporotic vertebral fracture deserves special mention among them due to its prevalence, importance as it often goes unnoticed and medium-long term consequences are: pain, deformity, disability and deterioration in quality of life. In this review we will focus on the classification and initial evaluation of the patient with osteoporosis, estimation of risk factors, laboratory and imaging studies for an adequate assessment using simple radiography, dual densitometry and magnetic resonance imaging. We will also address the main aspects of the differential diagnosis, treatment and prevention of vertebral fragility fracture, briefly reviewing the main therapeutic agents currently used for its prevention and treatment.

骨质疏松症是一种多因素导致的高发疾病，主要表现为脆性或低冲击性骨折。骨质疏松性骨折最常见的部位是脊椎、股骨、桡骨远端和肱骨。其中值得特别一提的是椎体骨质疏松性骨折，因为其发病率高、重要性大，而且常常不被人注意，中长期后果是：疼痛、畸形、残疾和生活质量下降。在这篇综述中，我们将重点讨论骨质疏松症患者的分类和初步评估、风险因素评估、实验室和影像学研究，以便使用简单的射线照相术、双密度测量法和磁共振成像进行充分评估。我们还将讨论椎体脆性骨折的鉴别诊断、治疗和预防的主要方面，并简要回顾目前用于预防和治疗椎体脆性骨折的主要治疗药物。

引用次数: 0

[Translated article] Osteoporotic vertebral fractures: Natural history and impact 骨质疏松性脊椎骨折：自然史和影响。

Q3 Medicine

Revista Espanola de Cirugia Ortopedica y Traumatologia

Pub Date : 2024-11-01 DOI: 10.1016/j.recot.2024.08.003

P. Checa-Betegón, R. Luque-Pérez, D. Oñate-Martínez-Olascoaga, J.L. Pérez-González, I. Domínguez-Esteban

Osteoporosis, and the consequences derived from it, such as fragility fractures, constitute a growing public health problem. Suffering from a fracture of this nature is the main risk factor for suffering a new fracture.

It is documented that vertebral compression fractures lead to significant morbidity and mortality, in the short and long term, as well as other complications, such as sagittal imbalance and hyperkyphosis of the segment. However, we have not found documentation that analyzes the medium and long-term consequences of these injuries, assessing the type of treatment used, and the economic impact they represent.

The purpose of this review is to analyse the main recent literature on the subject and make a breakdown of the consequences of these fractures in various spheres, such as economic, quality of life, sagittal balance and radiographic parameters, pain or mortality; as well as a brief analysis of epidemiology and natural history.

Conclusion

Osteoporotic fractures constitute an emerging problem, both in the medical and economic fields. The consequences and sequelae on the patient are multiple and although surgical options offer good long-term results, it is necessary to properly select the patient, through multidisciplinary teams, to try to minimise potential complications.

骨质疏松症及其引发的后果，如脆性骨折，是一个日益严重的公共健康问题。这种性质的骨折是再次发生骨折的主要风险因素。有资料显示，椎体压缩性骨折会导致严重的短期和长期发病率和死亡率，以及其他并发症，如椎节矢状不平衡和椎体后凸。然而，我们尚未发现有文献对这些损伤的中长期后果进行分析，评估所采用的治疗方式及其对经济的影响。本综述旨在分析近期有关该主题的主要文献，并对这些骨折在经济、生活质量、矢状平衡和放射学参数、疼痛或死亡率等不同领域造成的后果进行细分；同时对流行病学和自然病史进行简要分析。结论骨质疏松性骨折在医疗和经济领域都是一个新出现的问题。对患者造成的后果和后遗症是多方面的，虽然手术治疗可提供良好的长期效果，但有必要通过多学科团队对患者进行适当的选择，以尽量减少潜在的并发症。

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引用次数: 0

Diagnóstico radiográfico de pacientes con fracturas por compresión vertebral 脊椎压缩性骨折患者的诊断成像。

Q3 Medicine

Revista Espanola de Cirugia Ortopedica y Traumatologia

Pub Date : 2024-11-01 DOI: 10.1016/j.recot.2024.06.007

E. Arana

Vertebral compression fractures by osteoporosis (OVF) is usually a diagnostic problem and coincides on the age group of metastatic vertebral compression fractures (MVF). Although radiography is the first diagnostic technique, generally is not accurate for depicting demineralization and soft tissue lesions. Magnetic resonance (MRI) is the diagnostic choice. The most relevant signs are Intravertebral fluid collection or fluid signal, other vertebral deformities without edema and older age. Among the most relevant findings for diagnosis MVF are soft tissue mass and pedicle intensity signal asymmetries. However, reproducibility of these findings in clinical practice is moderate.

骨质疏松症导致的椎体压缩性骨折（OVF）通常是一个诊断问题，与转移性椎体压缩性骨折（MVF）的年龄组相吻合。虽然放射摄影是第一诊断技术，但一般不能准确描述脱矿化和软组织病变。磁共振成像（MRI）可诊断无水肿和年龄较大的椎体畸形。诊断椎体后凸畸形最重要的发现是软组织肿块和椎弓根强度信号不对称。然而，这些发现在临床实践中的再现性一般。

引用次数: 0

Estatus socioeconómico, osteoporosis y fracturas por fragilidad "社会经济地位、骨质疏松症和脆性骨折"。

Q3 Medicine

Revista Espanola de Cirugia Ortopedica y Traumatologia

Pub Date : 2024-11-01 DOI: 10.1016/j.recot.2024.06.010

G. Martínez-Díaz-Guerra, F. Hawkins Carranza, S. Librizzi

Low socioeconomic status (SES) is associated with a higher risk of fragility fractures, as well as higher mortality in the first year post-fracture. The SES variables that have the greatest impact are educational level, income level, and cohabitation status. Significant disparities exist among racial and ethnic minorities in access to osteoporosis screening and treatment.

In Spain, a higher risk of fractures has been described in people with a low income level, residence in rural areas during childhood and low educational level. The Civil War cohort effect is a significant risk factor for hip fracture. There is significant geographic variability in hip fracture care, although the possible impact of socioeconomic factors has not been analyzed. It would be desirable to act on socioeconomic inequalities to improve the prevention and treatment of osteoporotic fractures.

低社会经济地位（SES）与脆性骨折的高风险以及骨折后第一年的高死亡率有关。影响最大的社会经济地位变量是教育水平、收入水平和同居状况。在西班牙，收入水平低、童年时期居住在农村地区以及教育水平低的人群发生骨折的风险较高。内战队列效应是髋部骨折的一个重要风险因素。髋部骨折护理存在很大的地域差异，但尚未分析社会经济因素可能产生的影响。最好能针对社会经济不平等采取行动，以改善骨质疏松性骨折的预防和治疗。

引用次数: 0

Tips and tricks for using cement augmentation of pedicle screws and vertebral body replacements—A literature review supported by two case reports 使用骨水泥增强椎弓根螺钉和椎体置换术的技巧和窍门--文献综述，辅以两份病例报告。

Q3 Medicine

Revista Espanola de Cirugia Ortopedica y Traumatologia

Pub Date : 2024-11-01 DOI: 10.1016/j.recot.2024.07.011

V.J. Heck , M. Rauschmann , T. Prasse , J.M. Vinas-Rios , A. Slavici

Background

The prevalence of osteoporosis is escalating alongside an aging global population, increasing the demand for spinal surgeries, including those necessitating cement augmentation for enhanced construct stability.

Objective

This article delves into the nuanced application of cement augmentation techniques for pedicle screws and vertebral body replacements (VBR), aimed at optimizing surgical outcomes in osteoporotic spines.

Method

Drawing from a comprehensive literature review according to important clinical and biomechanical studies and the authors’ clinical experiences, we elucidate strategies to mitigate complications and improve surgical efficacy.

Results

Cement augmentation has shown promise in managing vertebral fractures and in securing pedicle screws within osteoporotic vertebrae, with the advent of polymethylmethacrylate (PMMA) bone cement marking a pivotal advancement in spinal surgery. We highlight intraoperative measures like the choice between pre-injecting cement and utilizing cannulated or fenestrated screws, emphasizing the importance of controlling cement viscosity to prevent leakage and embolism. Through two case reports, we demonstrate the practical application of endplate cementation following VBR.

Conclusion

While the use of cement augmentation poses certain risks, its judicious application—supported by evidence-based guidelines and surgical expertise—can substantially enhance the stability of spinal constructs in osteoporotic patients. This allows a reduction in instrumentation length by enhancing biomechanical stability concerning pullout, bending, and rotational forces. Furthermore, the incidence of endplate sintering following VBF can be significantly reduced. Future research, particularly on antibiotic-loaded PMMA, may further expand its utility and optimize its safety profile.

背景：随着全球人口老龄化的加剧，骨质疏松症的发病率也在不断上升：随着全球人口老龄化的加剧，骨质疏松症的发病率也在不断攀升，这增加了脊柱手术的需求，包括那些需要用骨水泥增强以提高结构稳定性的手术：本文深入探讨了椎弓根螺钉和椎体置换术（VBR）中骨水泥增强技术的细微应用，旨在优化骨质疏松脊柱的手术效果：方法：根据重要的临床和生物力学研究以及作者的临床经验，通过全面的文献综述，我们阐明了减少并发症和提高手术疗效的策略：结果：骨水泥增量在处理椎体骨折和固定骨质疏松椎体内的椎弓根螺钉方面显示出了良好的前景，聚甲基丙烯酸甲酯（PMMA）骨水泥的出现标志着脊柱外科手术取得了举足轻重的进步。我们重点介绍了术中措施，如选择预先注入骨水泥、使用插管螺钉还是栅栏螺钉，并强调了控制骨水泥粘度以防止渗漏和栓塞的重要性。通过两个病例报告，我们展示了VBR术后终板骨水泥的实际应用：尽管使用骨水泥增强会带来一定的风险，但在循证指南和外科专业知识的支持下，明智地应用骨水泥增强可大大提高骨质疏松患者脊柱结构的稳定性。通过增强牵拉、弯曲和旋转力方面的生物力学稳定性，可以减少器械长度。此外，VBF 还能显著降低终板烧结的发生率。未来的研究，尤其是关于抗生素负载的 PMMA 的研究，可能会进一步扩大其用途并优化其安全性。

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引用次数: 0

Manejo de la deformidad espinal en el contexto de fracturas por compresión vertebral osteoporóticas 骨质疏松性椎体压缩骨折的脊柱畸形管理。

Q3 Medicine

Revista Espanola de Cirugia Ortopedica y Traumatologia

Pub Date : 2024-11-01 DOI: 10.1016/j.recot.2024.08.009

C. Mengis , N. Plais , F. Moreno , G. Cózar , F. Tomé-Bermejo , L. Álvarez-Galovich

Osteoporosis and fragility play a significant role in the treatment and planning of patients with deformity secondary to osteoporotic vertebral fracture (OVF). The resulting deformity can present significant challenges for its management, both from a medical and surgical perspective. The need for a specific classification for these deformities, including the potential for the development of artificial intelligence and machine learning in predictive analysis, is emerging as a key point in the coming years. Relevant aspects in preoperative optimization and management of these patients are addressed. A classification with therapeutic guidance for the management of spinal deformity secondary to OVF is developed, emphasizing the importance of personalized treatment. Flexibility and sagittal balance are considered key aspects. On the other hand, we recommend, especially with these fragile patients, management with minimally invasive techniques to promote rapid recovery and reduce the number of complications.

骨质疏松和脆性在骨质疏松性脊椎骨折（OVF）继发畸形患者的治疗和规划中起着重要作用。由此导致的畸形无论从内科还是外科角度来看，都会给治疗带来巨大挑战。对这些畸形进行特定分类的需求，包括人工智能和机器学习在预测分析方面的发展潜力，正在成为未来几年的一个关键点。本文探讨了这些患者术前优化和管理的相关方面。对继发于 OVF 的脊柱畸形进行了分类和治疗指导，强调了个性化治疗的重要性。灵活性和矢状平衡被认为是关键因素。另一方面，我们建议，尤其是对这些脆弱的患者，采用微创技术进行治疗，以促进快速康复并减少并发症的发生。

引用次数: 0

[Artículo traducido] Consejos y trucos para el uso de cemento óseo en tornillos pediculares y en reemplazos de cuerpos vertebrales: una revisión de la literatura respaldada por dos informes de casos 使用骨水泥增强椎弓根螺钉和椎体置换术的技巧和窍门--文献综述，辅以两份病例报告。

Q3 Medicine

Revista Espanola de Cirugia Ortopedica y Traumatologia

Pub Date : 2024-11-01 DOI: 10.1016/j.recot.2024.09.009

V.J. Heck , M. Rauschmann , T. Prasse , J.M. Vinas-Rios , A. Slavici

Background

The prevalence of osteoporosis is escalating alongside an aging global population, increasing the demand for spinal surgeries, including those necessitating cement augmentation for enhanced construct stability.

Objective

This article delves into the nuanced application of cement augmentation techniques for pedicle screws and vertebral body replacements (VBR), aimed at optimizing surgical outcomes in osteoporotic spines.

Method

Drawing from a comprehensive literature review according to important clinical and biomechanical studies and the authors’ clinical experiences, we elucidate strategies to mitigate complications and improve surgical efficacy.

Results

Cement augmentation has shown promise in managing vertebral fractures and in securing pedicle screws within osteoporotic vertebrae, with the advent of polymethylmethacrylate (PMMA) bone cement marking a pivotal advancement in spinal surgery. We highlight intraoperative measures like the choice between pre-injecting cement and utilizing cannulated or fenestrated screws, emphasizing the importance of controlling cement viscosity to prevent leakage and embolism. Through two case reports, we demonstrate the practical application of endplate cementation following VBR.

Conclusion

While the use of cement augmentation poses certain risks, its judicious application—supported by evidence-based guidelines and surgical expertise—can substantially enhance the stability of spinal constructs in osteoporotic patients. This allows a reduction in instrumentation length by enhancing biomechanical stability concerning pullout, bending, and rotational forces. Furthermore, the incidence of endplate sintering following VBF can be significantly reduced. Future research, particularly on antibiotic-loaded PMMA, may further expand its utility and optimize its safety profile.

背景：随着全球人口老龄化的加剧，骨质疏松症的发病率也在不断上升：随着全球人口老龄化的加剧，骨质疏松症的发病率也在不断攀升，这增加了脊柱手术的需求，包括那些需要用骨水泥增强以提高结构稳定性的手术：本文深入探讨了椎弓根螺钉和椎体置换术（VBR）中骨水泥增强技术的细微应用，旨在优化骨质疏松脊柱的手术效果：方法：根据重要的临床和生物力学研究以及作者的临床经验，通过全面的文献综述，我们阐明了减少并发症和提高手术疗效的策略：结果：骨水泥增量在处理椎体骨折和固定骨质疏松椎体内的椎弓根螺钉方面显示出了良好的前景，聚甲基丙烯酸甲酯（PMMA）骨水泥的出现标志着脊柱外科手术取得了举足轻重的进步。我们重点介绍了术中措施，如选择预先注入骨水泥、使用插管螺钉还是栅栏螺钉，并强调了控制骨水泥粘度以防止渗漏和栓塞的重要性。通过两个病例报告，我们展示了VBR术后终板骨水泥的实际应用：尽管使用骨水泥增强会带来一定的风险，但在循证指南和外科专业知识的支持下，明智地应用骨水泥增强可大大提高骨质疏松患者脊柱结构的稳定性。通过增强牵拉、弯曲和旋转力方面的生物力学稳定性，可以减少器械长度。此外，VBF 还能显著降低终板烧结的发生率。未来的研究，尤其是关于抗生素负载的 PMMA 的研究，可能会进一步扩大其用途并优化其安全性。

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引用次数: 0

Manejo rehabilitador y ortopédico de las fracturas por compresión vertebral osteoporótica 骨质疏松性脊椎压缩骨折的康复和矫形治疗。

Q3 Medicine

Revista Espanola de Cirugia Ortopedica y Traumatologia

Pub Date : 2024-11-01 DOI: 10.1016/j.recot.2024.10.003

A. Teixeira Taborda , C. De Miguel Benadiva , P. Sánchez Tarifa

Osteoporosis represents a public health problem that can be prevented and treated early through health education. Over time, screening techniques, diagnosis and treatments even conservative and surgical, have improved.

Through this publication we want to highlight the importance of the medical and orthopedic management of these fractures, describing the benefit of diet and physical exercise as the protagonists of conservative treatment but above all its indications and contraindications, emphasizing the limitations of exercise in a vertebral osteoporotic fracture. The different orthoses prescriptions are also highlighted.

骨质疏松症是一个公共卫生问题，可以通过健康教育及早预防和治疗。随着时间的推移，筛查技术、诊断和治疗（包括保守治疗和手术治疗）都在不断改进。通过本出版物，我们希望强调这些骨折的医疗和矫形管理的重要性，介绍作为保守治疗主角的饮食和体育锻炼的益处，但最重要的是其适应症和禁忌症，强调在椎体骨质疏松性骨折中锻炼的局限性。此外，还重点介绍了不同的矫形器处方。

引用次数: 0