Annals of Joint最新文献_第6页

Anterior cruciate ligament injury prevention 预防前交叉韧带损伤

IF 0.4 4区医学 Q4 ORTHOPEDICS

Annals of Joint

Pub Date : 2021-01-01 DOI: 10.21037/AOJ-2020-SRI-08

Hannah Bradsell, R. Frank

: Anterior cruciate ligament injuries are a prominent issue in the field of sports medicine, especially for the female athlete. Extensive research has been performed that acknowledges the disparity in anterior cruciate ligament injury rates between male and female athletes and the high prevalence of risk factors specific to females. The underlying causes of anterior cruciate ligament injuries are widespread and are important to consider when approaching injury prevention. For example, prevention techniques aim to correct neuromuscular imbalances and improve biomechanical deficits, which are some of the most significant risk factors leading to these injuries. While there is a lack of opportunity for intervention related to anatomical and hormonal risks, awareness of their influence on injury mechanisms remains an important factor in clinical decision-making. In pursuit of addressing the risks of this injury, several prevention programs have been established that have been shown to successfully reduce anterior cruciate ligament injury rates when properly executed. The most effective programs include early intervention with continuous training and are multicomponent programs including various targeted exercises to modify associated risk factors. Unfortunately, despite the development of these readily available programs, anterior cruciate ligament injury rates remain high due to insufficient implementation of these methods. Recognizing the efficacy and feasibility of utilizing prevention strategies and continuing to develop effective techniques remain of utmost importance to reduce the incidence of this substantial injury among athletes.

前交叉韧带损伤是运动医学领域的一个突出问题，尤其是对女运动员而言。已经进行了广泛的研究，承认男女运动员前交叉韧带损伤率的差异以及女性特有的高风险因素。前交叉韧带损伤的潜在原因是广泛的，是重要的考虑，当接近损伤预防。例如，预防技术旨在纠正神经肌肉失衡和改善生物力学缺陷，这是导致这些损伤的一些最重要的危险因素。虽然缺乏与解剖和激素风险相关的干预机会，但意识到它们对损伤机制的影响仍然是临床决策的重要因素。为了解决这种损伤的风险，已经建立了几个预防方案，如果执行得当，已经证明可以成功地降低前交叉韧带损伤的发生率。最有效的项目包括持续训练的早期干预，以及包括各种有针对性的锻炼在内的多组件项目，以改变相关的风险因素。不幸的是，尽管这些现成的程序的发展，前交叉韧带损伤率仍然很高，由于这些方法的实施不足。认识到利用预防策略的有效性和可行性，并继续开发有效的技术，对于减少运动员中这种重大伤害的发生率仍然是至关重要的。

{"title":"Anterior cruciate ligament injury prevention","authors":"Hannah Bradsell, R. Frank","doi":"10.21037/AOJ-2020-SRI-08","DOIUrl":"https://doi.org/10.21037/AOJ-2020-SRI-08","url":null,"abstract":": Anterior cruciate ligament injuries are a prominent issue in the field of sports medicine, especially for the female athlete. Extensive research has been performed that acknowledges the disparity in anterior cruciate ligament injury rates between male and female athletes and the high prevalence of risk factors specific to females. The underlying causes of anterior cruciate ligament injuries are widespread and are important to consider when approaching injury prevention. For example, prevention techniques aim to correct neuromuscular imbalances and improve biomechanical deficits, which are some of the most significant risk factors leading to these injuries. While there is a lack of opportunity for intervention related to anatomical and hormonal risks, awareness of their influence on injury mechanisms remains an important factor in clinical decision-making. In pursuit of addressing the risks of this injury, several prevention programs have been established that have been shown to successfully reduce anterior cruciate ligament injury rates when properly executed. The most effective programs include early intervention with continuous training and are multicomponent programs including various targeted exercises to modify associated risk factors. Unfortunately, despite the development of these readily available programs, anterior cruciate ligament injury rates remain high due to insufficient implementation of these methods. Recognizing the efficacy and feasibility of utilizing prevention strategies and continuing to develop effective techniques remain of utmost importance to reduce the incidence of this substantial injury among athletes.","PeriodicalId":44459,"journal":{"name":"Annals of Joint","volume":" ","pages":""},"PeriodicalIF":0.4,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48618572","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Charcot’s foot reconstruction with removal of the navicular and cuboid bones plus arthrodesis of the medial and mid columns using two solid intramedullary fusion bolts—a case report 用两个实心髓内融合螺栓去除舟骨和长方体骨加内侧柱和中柱关节融合术重建Charcot足一例

IF 0.4 4区医学 Q4 ORTHOPEDICS

Annals of Joint

Pub Date : 2020-12-31 DOI: 10.21037/AOJ-20-93

J. Mónico, Pedro M. Matos, P. Costa, Maria Pia Monjardino, Jorge Faísca, F. Fonseca, J. Mariano

Charcot neuroarthropathy is a progressive chronic destructive arthropathy which can result in severe foot deformity, recurrent plantar ulceration, osteomyelitis and, ultimately, foot amputation. Treating a Charcot’s foot and preserving or restoring foot’s anatomy can be challenging. Several treatment methods have been previously described but they are associated with high rates of failure or adverse events. We report a clinical case of a 47-year-old patient with Charcot’s foot. Clinical examination and convectional radiography revealed a rocker bottom deformity with plantar ulceration. Plantar ulceration was addressed first with medical treatment, followed by surgical reconstruction and arthrodesis of the foot. In our case, we describe the advantages of complementing surgical treatment with medical treatment using a cast immobilization. Additionally, we describe our surgical reconstruction method with removal of the navicular and cuboid bones plus arthrodesis of the medial and mid columns, using two solid intramedullary fusion bolts, and stabilization of the lateral column with one Kirschner wire. We were able to successfully reconstruct foot’s anatomy and achieve a stable foot arthrodesis. During 12-month follow-up, no adverse medical events or screws breakdown were recorded. The patient is able to wear shoes again and walk in full weight bearing without limitations. Charcot’s foot surgical reconstruction should be done in non-acute inflammatory phase and achieve foot arthrodesis with rotational stability. Extended fixation of the medial and mid foot columns, with intramedullary solid fusion bolts, is mandatory to build a stable construct. Bone graft augmentation and full contact plastered boot in the first 3 postoperative months can provide additional stability.

Charcot神经关节病是一种进行性慢性破坏性关节病，可导致严重的足部畸形、复发性足底溃疡、骨髓炎，并最终导致足部截肢。治疗夏可氏足并保存或恢复足部解剖结构是具有挑战性的。以前已经描述了几种治疗方法，但它们与高失败率或不良事件有关。我们报告一个47岁的夏可氏足患者的临床病例。临床检查和常规x线摄影显示一个摇臂底部畸形与足底溃疡。足底溃疡首先通过药物治疗解决，然后进行手术重建和足关节融合术。在我们的病例中，我们描述了用石膏固定补充外科治疗的优点。此外，我们描述了我们的手术重建方法，包括去除舟状骨和长方体骨，使用两个实心髓内融合螺钉对内侧柱和中柱进行关节融合术，并用一根克氏针稳定外侧柱。我们能够成功地重建足部解剖结构并实现稳定的足部关节融合术。在12个月的随访中，无不良医疗事件或螺钉损坏记录。患者可以再次穿鞋，完全负重行走，没有任何限制。Charcot足部手术重建应在非急性炎症期进行，并实现足关节融合术的旋转稳定性。使用髓内固体融合螺钉对内侧和中足柱进行扩展固定，以建立稳定的构造。术后前3个月骨移植增强术和全接触抹灰靴可提供额外的稳定性。

{"title":"Charcot’s foot reconstruction with removal of the navicular and cuboid bones plus arthrodesis of the medial and mid columns using two solid intramedullary fusion bolts—a case report","authors":"J. Mónico, Pedro M. Matos, P. Costa, Maria Pia Monjardino, Jorge Faísca, F. Fonseca, J. Mariano","doi":"10.21037/AOJ-20-93","DOIUrl":"https://doi.org/10.21037/AOJ-20-93","url":null,"abstract":"Charcot neuroarthropathy is a progressive chronic destructive arthropathy which can result in severe foot deformity, recurrent plantar ulceration, osteomyelitis and, ultimately, foot amputation. Treating a Charcot’s foot and preserving or restoring foot’s anatomy can be challenging. Several treatment methods have been previously described but they are associated with high rates of failure or adverse events. We report a clinical case of a 47-year-old patient with Charcot’s foot. Clinical examination and convectional radiography revealed a rocker bottom deformity with plantar ulceration. Plantar ulceration was addressed first with medical treatment, followed by surgical reconstruction and arthrodesis of the foot. In our case, we describe the advantages of complementing surgical treatment with medical treatment using a cast immobilization. Additionally, we describe our surgical reconstruction method with removal of the navicular and cuboid bones plus arthrodesis of the medial and mid columns, using two solid intramedullary fusion bolts, and stabilization of the lateral column with one Kirschner wire. We were able to successfully reconstruct foot’s anatomy and achieve a stable foot arthrodesis. During 12-month follow-up, no adverse medical events or screws breakdown were recorded. The patient is able to wear shoes again and walk in full weight bearing without limitations. Charcot’s foot surgical reconstruction should be done in non-acute inflammatory phase and achieve foot arthrodesis with rotational stability. Extended fixation of the medial and mid foot columns, with intramedullary solid fusion bolts, is mandatory to build a stable construct. Bone graft augmentation and full contact plastered boot in the first 3 postoperative months can provide additional stability.","PeriodicalId":44459,"journal":{"name":"Annals of Joint","volume":" ","pages":""},"PeriodicalIF":0.4,"publicationDate":"2020-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43098089","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Evaluation and management of patellar instability 髌骨不稳定的评估和治疗

IF 0.4 4区医学 Q4 ORTHOPEDICS

Annals of Joint

Pub Date : 2020-12-04 DOI: 10.21037/AOJ-2020-SRI-09

E. Dennis, S. Gruber, W. Marmor, B. Stein

Patellar instability is a common clinical problem that primarily affects the adolescent and young adult population. The demographic and anatomic risk factors that predispose patients to patellar instability are multifactorial and include young age, female sex, trochlear dysplasia, elevated tibial tubercle to trochlear groove distance (TT-TG), patella alta, femoral and tibial malalignment, ligamentous laxity, and lack of neuromuscular control. There have been substantial efforts to predict which patients who sustain a first-time dislocation will go on to incur additional dislocations. This is particularly important because with each dislocation event, there is a significant risk of injury to the patellofemoral joint including both medial patellofemoral ligament (MPFL) stretch or rupture and damage to the cartilage which can range from simple fissures to full-thickness cartilage defects and osteochondral fractures. Prediction models have demonstrated that amongst first time dislocators, young patients with trochlear dysplasia are at the highest risk for redislocation. The current standard of care for treatment of first-time dislocators without a loose body or osteochondral fracture is nonoperative management. However, recently there has been a focus on implementing a risk-stratified approach to the surgical indications for a first-time dislocator as the highrisk population might be better treated with early surgical stabilization to prevent or reduce their risk of recurrent dislocation and its associated morbidity. Likewise, for patients with recurrent dislocations, it remains to be determined whether an isolated MPFL reconstruction is sufficient for high-risk patients with several poor prognostic risk factors or if bony realignment procedures should be implemented concurrently.

髌骨不稳定是一个常见的临床问题，主要影响青少年和年轻人。使患者易患髌骨不稳定的人口统计学和解剖学风险因素是多因素的，包括年轻、女性、滑车发育不良、胫骨结节至滑车沟距离升高（TT-TG）、高位髌骨、股骨和胫骨对齐不良、韧带松弛和缺乏神经肌肉控制。已经做出了大量的努力来预测哪些首次脱位的患者会继续发生更多的脱位。这一点尤为重要，因为每发生一次脱位事件，髌股关节都有很大的损伤风险，包括髌股内侧韧带（MPFL）拉伸或断裂，以及软骨损伤，从简单的裂隙到全层软骨缺损和骨软骨骨折。预测模型表明，在首次脱位者中，滑车发育不良的年轻患者再次脱位的风险最高。目前治疗首次脱臼且无松动体或骨软骨骨折的患者的护理标准是非手术治疗。然而，最近的重点是对首次脱位的手术适应症实施风险分层方法，因为高危人群可能会得到更好的早期手术稳定治疗，以预防或降低其复发性脱位及其相关发病率的风险。同样，对于复发性脱位的患者，对于具有几种不良预后风险因素的高危患者，单独的MPFL重建是否足够，或者是否应同时进行骨复位手术，仍有待确定。

{"title":"Evaluation and management of patellar instability","authors":"E. Dennis, S. Gruber, W. Marmor, B. Stein","doi":"10.21037/AOJ-2020-SRI-09","DOIUrl":"https://doi.org/10.21037/AOJ-2020-SRI-09","url":null,"abstract":"Patellar instability is a common clinical problem that primarily affects the adolescent and young adult population. The demographic and anatomic risk factors that predispose patients to patellar instability are multifactorial and include young age, female sex, trochlear dysplasia, elevated tibial tubercle to trochlear groove distance (TT-TG), patella alta, femoral and tibial malalignment, ligamentous laxity, and lack of neuromuscular control. There have been substantial efforts to predict which patients who sustain a first-time dislocation will go on to incur additional dislocations. This is particularly important because with each dislocation event, there is a significant risk of injury to the patellofemoral joint including both medial patellofemoral ligament (MPFL) stretch or rupture and damage to the cartilage which can range from simple fissures to full-thickness cartilage defects and osteochondral fractures. Prediction models have demonstrated that amongst first time dislocators, young patients with trochlear dysplasia are at the highest risk for redislocation. The current standard of care for treatment of first-time dislocators without a loose body or osteochondral fracture is nonoperative management. However, recently there has been a focus on implementing a risk-stratified approach to the surgical indications for a first-time dislocator as the highrisk population might be better treated with early surgical stabilization to prevent or reduce their risk of recurrent dislocation and its associated morbidity. Likewise, for patients with recurrent dislocations, it remains to be determined whether an isolated MPFL reconstruction is sufficient for high-risk patients with several poor prognostic risk factors or if bony realignment procedures should be implemented concurrently.","PeriodicalId":44459,"journal":{"name":"Annals of Joint","volume":" ","pages":""},"PeriodicalIF":0.4,"publicationDate":"2020-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49463879","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 1

Osteosarcoma mineralization changes on radiographs have moderate correlation to chemotherapy response using bone subtraction methodology. 骨肉瘤在x线片上的矿化变化与骨减影方法的化疗反应有中度相关性。

IF 0.4 4区医学 Q4 ORTHOPEDICS

Annals of Joint

Pub Date : 2020-10-01 Epub Date: 2020-10-15 DOI: 10.21037/aoj-20-70

Eric R Henderson, Xiaochun Xu, Brian W Pogue, Kimberley S Samkoe, Megan E Anderson

Background: Survival following a diagnosis of osteosarcoma is correlated strongly with response to chemotherapy. Mineralization changes seen on radiographs have been hypothesized to correlate with chemotherapy response, however, this has never been analyzed using modern techniques.

Methods: Retrospective review of radiographs obtained before and after neoadjuvant chemotherapy was performed for 31 patients with high-grade, conventional osteosarcoma. Pre-chemotherapy (PreC) images and post-chemotherapy (PostC) images were co-registered. Tumor luminance measurements were normalized based on the non-tumor bone and then the relative change in tumor mineralization were measured.

Results: Mean luminance values for pre-chemotherapy non-tumor-affected bone and tumor were 0.63±0.12 and 0.65±0.12, respectively. Mean values for PostC non-tumor-affected bone were 0.59±0.14 and 0.64±0.10, respectively. Once normalized, osteosarcoma mineralization change showed a statistically significant moderate correlation-Pearson correlation coefficient (ρ) of 0.36 (P=0.038)-with the tumor necrosis value.

Conclusions: Moderate, positive correlation was found between osteosarcoma mineralization change during chemotherapy and chemotherapy response. Further work is required to determine if these findings are prognostic by identifying best practice for image analysis and repeating this work with prospectively acquired digital radiographs using uniform technique and phantom normalization.

背景:骨肉瘤诊断后的生存与化疗反应密切相关。在x线片上看到的矿化变化被假设与化疗反应有关，然而，这从未使用现代技术进行分析。方法:回顾性分析31例高级别常规骨肉瘤患者新辅助化疗前后的x线片。化疗前(PreC)图像和化疗后(PostC)图像共配准。基于非肿瘤骨对肿瘤亮度测量进行归一化，然后测量肿瘤矿化的相对变化。结果:化疗前未受肿瘤影响的骨和肿瘤的平均亮度值分别为0.63±0.12和0.65±0.12。PostC无肿瘤影响骨的平均值分别为0.59±0.14和0.64±0.10。一旦归一化，骨肉瘤矿化变化与肿瘤坏死值有统计学意义的中度相关- pearson相关系数(P=0.038)为0.36。结论:化疗期间骨肉瘤矿化变化与化疗反应呈正相关。通过确定图像分析的最佳实践，并使用统一技术和幻影归一化对预期获得的数字x线照片重复这项工作，需要进一步的工作来确定这些发现是否具有预后。

{"title":"Osteosarcoma mineralization changes on radiographs have moderate correlation to chemotherapy response using bone subtraction methodology.","authors":"Eric R Henderson, Xiaochun Xu, Brian W Pogue, Kimberley S Samkoe, Megan E Anderson","doi":"10.21037/aoj-20-70","DOIUrl":"https://doi.org/10.21037/aoj-20-70","url":null,"abstract":"Background: Survival following a diagnosis of osteosarcoma is correlated strongly with response to chemotherapy. Mineralization changes seen on radiographs have been hypothesized to correlate with chemotherapy response, however, this has never been analyzed using modern techniques.Methods: Retrospective review of radiographs obtained before and after neoadjuvant chemotherapy was performed for 31 patients with high-grade, conventional osteosarcoma. Pre-chemotherapy (PreC) images and post-chemotherapy (PostC) images were co-registered. Tumor luminance measurements were normalized based on the non-tumor bone and then the relative change in tumor mineralization were measured.Results: Mean luminance values for pre-chemotherapy non-tumor-affected bone and tumor were 0.63±0.12 and 0.65±0.12, respectively. Mean values for PostC non-tumor-affected bone were 0.59±0.14 and 0.64±0.10, respectively. Once normalized, osteosarcoma mineralization change showed a statistically significant moderate correlation-Pearson correlation coefficient (ρ) of 0.36 (P=0.038)-with the tumor necrosis value.Conclusions: Moderate, positive correlation was found between osteosarcoma mineralization change during chemotherapy and chemotherapy response. Further work is required to determine if these findings are prognostic by identifying best practice for image analysis and repeating this work with prospectively acquired digital radiographs using uniform technique and phantom normalization.","PeriodicalId":44459,"journal":{"name":"Annals of Joint","volume":"5 ","pages":""},"PeriodicalIF":0.4,"publicationDate":"2020-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/de/88/nihms-1813817.PMC9430774.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40343698","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 1

The psychology of the female athlete: how mental health and wellness mediate sports performance, injury and recovery 女运动员的心理：心理健康如何调节运动成绩、损伤和恢复

IF 0.4 4区医学 Q4 ORTHOPEDICS

Annals of Joint

Pub Date : 2020-09-06 DOI: 10.21037/AOJ-20-53

C. Herrero, N. Jejurikar, Cordelia Carter

The increase in athletic participation of girls and women over the last half-century has brought into focus the need to better understand the psychology of female athletes. This review explores various non-physical factors that contribute to athletic success, such as resilience, mindfulness and sleep. The role of anxiety and depression in sport-related injury is another key issue that those invested in an athlete’s training must be able to recognize and manage. Additionally, disordered eating and the harmful effects of social media affect females differently and at a higher rate than their male counterparts. Lastly, understanding how the female athlete views injury and recovery may allow us to successfully return injured athletes to sport. The goal of this article is to provide an overview of how a female athlete’s mental and emotional well-being affect her athletic performance, injury risk and recovery following sports-related injury.

在过去的半个世纪里，女孩和妇女参与体育运动的人数增加，使人们更加关注更好地了解女运动员心理的必要性。这篇综述探讨了有助于运动成功的各种非身体因素，如恢复力、正念和睡眠。焦虑和抑郁在运动相关损伤中的作用是另一个关键问题，那些参与运动员训练的人必须能够认识到并处理这个问题。此外，饮食失调和社交媒体的有害影响对女性的影响与男性不同，而且影响率更高。最后，了解女运动员如何看待伤病和恢复，可以让我们成功地让受伤的运动员重返赛场。本文的目的是概述女运动员的心理和情绪健康如何影响她的运动成绩、受伤风险和运动相关损伤后的恢复。

引用次数: 9

Diagnosing prosthetic joint infection: traditional and contemporary techniques 诊断假体关节感染:传统和现代技术

IF 0.4 4区医学 Q4 ORTHOPEDICS

Annals of Joint

Pub Date : 2020-08-17 DOI: 10.21037/AOJ-20-78

M. Sarungi, D. Wallace

: Prosthetic joint infection (PJI) has been recognised as a devastating complication for as long as arthroplasty has been performed. Despite this, there is still no universally agreed standard within either PJI literature or clinical practice for the diagnosis of infection following joint arthroplasty. Recently, however, significant efforts have been made by different specialist musculoskeletal societies to move towards this goal. This paper reviews the history of the diagnosis of PJI, examines the current debate on diagnostic criteria and the limitations of a lack of consensus on infection research, clinical practice, and joint registry data. Based on the current situation, we propose that until there is a consensus on existing algorithms for diagnosis, there is need to implement a “minimum standard set of PJI diagnostics” locally by each national orthopaedic/ trauma association (focusing on those tests which are included in every specialist musculoskeletal society’s recommended list). Since there is still variation not only internationally but at national and sometimes at local level regarding standardisation of PJI testing, a smaller number of universally accepted PJI tests which are implemented and professionally monitored by national musculoskeletal societies will likely to result in significant improvement in PJI management in the short term, whilst the debate regarding the best criteria is still ongoing and is likely to continue for some time. 7

：只要进行了关节成形术，人工关节感染（PJI）就被认为是一种毁灭性的并发症。尽管如此，PJI文献或临床实践中仍然没有公认的标准来诊断关节置换术后感染。然而，最近，不同的专业肌肉骨骼学会为实现这一目标做出了重大努力。本文回顾了PJI的诊断历史，探讨了目前关于诊断标准的争论，以及在感染研究、临床实践和联合登记数据方面缺乏共识的局限性。根据目前的情况，我们建议，在对现有的诊断算法达成共识之前，每个国家骨科/创伤协会都需要在当地实施“PJI诊断的最低标准集”（重点关注每个专业肌肉骨骼协会推荐名单中包含的测试）。由于PJI测试的标准化不仅在国际上，而且在国家层面，有时在地方层面仍然存在差异，因此由国家肌肉骨骼学会实施和专业监测的少数普遍接受的PJI测试可能会在短期内显著改善PJI管理，而关于最佳标准的争论仍在进行中，并且可能会持续一段时间。7.

{"title":"Diagnosing prosthetic joint infection: traditional and contemporary techniques","authors":"M. Sarungi, D. Wallace","doi":"10.21037/AOJ-20-78","DOIUrl":"https://doi.org/10.21037/AOJ-20-78","url":null,"abstract":": Prosthetic joint infection (PJI) has been recognised as a devastating complication for as long as arthroplasty has been performed. Despite this, there is still no universally agreed standard within either PJI literature or clinical practice for the diagnosis of infection following joint arthroplasty. Recently, however, significant efforts have been made by different specialist musculoskeletal societies to move towards this goal. This paper reviews the history of the diagnosis of PJI, examines the current debate on diagnostic criteria and the limitations of a lack of consensus on infection research, clinical practice, and joint registry data. Based on the current situation, we propose that until there is a consensus on existing algorithms for diagnosis, there is need to implement a “minimum standard set of PJI diagnostics” locally by each national orthopaedic/ trauma association (focusing on those tests which are included in every specialist musculoskeletal society’s recommended list). Since there is still variation not only internationally but at national and sometimes at local level regarding standardisation of PJI testing, a smaller number of universally accepted PJI tests which are implemented and professionally monitored by national musculoskeletal societies will likely to result in significant improvement in PJI management in the short term, whilst the debate regarding the best criteria is still ongoing and is likely to continue for some time. 7","PeriodicalId":44459,"journal":{"name":"Annals of Joint","volume":" ","pages":""},"PeriodicalIF":0.4,"publicationDate":"2020-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48235188","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

The burden of prosthetic joint infection (PJI) 人工关节感染的负担

IF 0.4 4区医学 Q4 ORTHOPEDICS

Annals of Joint

Pub Date : 2020-07-09 DOI: 10.21037/AOJ-2020-PJI-11

N. Sandiford, M. Franceschini, D. Kendoff

Total hip and knee arthroplasty are clinically and cost effective procedures. The numbers of patients receiving these procedures are estimated to rise by 150–600% for THA and TKA respectively by 2030 (1) in the USA. The trend is similar in Europe (2,3). Along with this trend in hip and knee arthroplasty patients increasingly also have indwelling prostheses of the shoulder, elbow and ankle. Prosthetic joint infection (PJI) is potentially the most significant complication following total joint arthroplasty. It is challenging for the surgeon to manage, physically and mentally disastrous for the patient and the cost to the health care system and society as a whole is high. PJI has an impact on patients, healthcare delivery institutions and society as a whole. It has significant negative impact on patients’ psychological well being (4). The cost of treating PJI is significant. It is estimated that in the US alone the projected spend on the treatment of PJI is $1.62 billion (5). This is despite little improvement in the success rate in terms of eradication of infection (6). For these reasons there has been an increasing focus on the issue of PJI in the medical literature (6). This paper discusses the incidence of PJI as well as the factors which might account for the current trends and the challenges associated with the contemporary management of PJI. The incidence of PJI varies with the joint involved (7,8). Reported incidences following total knee arthroplasty, total hip arthroplasty and total shoulder arthroplasty have been reported to be 0.25% to 2%, 0.5% to 1% and less than 1% respectively (9,10). Between 23–25% of revision TKA procedures and 12–15% revision THA procedures are performed for PJI (11,12). Risk factors for PJI are presented in Table 1 (13). While the incidence remains low the number of patients are likely to increase over time however as the number of arthroplasty procedures performed annually increases. The incidence of PJI varies throughout the literature. As a result existing data needs to be interpreted with caution. Wang 4

全髋关节和膝关节置换术在临床上和成本上都是有效的。据估计，到2030年，美国接受这些手术的THA和TKA患者人数将分别增加150–600%（1）。欧洲的趋势相似（2，3）。随着髋关节和膝关节置换术的发展，越来越多的患者也有肩部、肘部和脚踝的留置假体。人工关节感染（PJI）可能是全关节置换术后最严重的并发症。外科医生的管理具有挑战性，对患者的身体和精神都是灾难性的，医疗保健系统和整个社会的成本都很高。PJI对患者、医疗保健机构和整个社会都有影响。它对患者的心理健康有显著的负面影响（4）。PJI的治疗成本非常高。据估计，仅在美国，PJI治疗的预计支出就达16.2亿美元（5）。尽管在根除感染方面，成功率几乎没有提高（6）。由于这些原因，医学文献越来越关注PJI问题（6）。本文讨论了PJI的发生率，以及可能导致当前趋势的因素和与PJI当代管理相关的挑战。PJI的发生率随关节的不同而不同（7,8）。据报道，全膝关节置换术、全髋关节置换术和全肩关节置换术后的发病率分别为0.25%至2%、0.5%至1%和小于1%（9，10）。PJI进行了23-25%的TKA翻修手术和12-15%的THA翻修手术（11,12）。PJI的风险因素如表1（13）所示。虽然发病率仍然很低，但随着每年进行的关节成形术数量的增加，患者数量可能会随着时间的推移而增加。PJI的发病率在文献中各不相同。因此，需要谨慎解读现有数据。王4

{"title":"The burden of prosthetic joint infection (PJI)","authors":"N. Sandiford, M. Franceschini, D. Kendoff","doi":"10.21037/AOJ-2020-PJI-11","DOIUrl":"https://doi.org/10.21037/AOJ-2020-PJI-11","url":null,"abstract":"Total hip and knee arthroplasty are clinically and cost effective procedures. The numbers of patients receiving these procedures are estimated to rise by 150–600% for THA and TKA respectively by 2030 (1) in the USA. The trend is similar in Europe (2,3). Along with this trend in hip and knee arthroplasty patients increasingly also have indwelling prostheses of the shoulder, elbow and ankle. Prosthetic joint infection (PJI) is potentially the most significant complication following total joint arthroplasty. It is challenging for the surgeon to manage, physically and mentally disastrous for the patient and the cost to the health care system and society as a whole is high. PJI has an impact on patients, healthcare delivery institutions and society as a whole. It has significant negative impact on patients’ psychological well being (4). The cost of treating PJI is significant. It is estimated that in the US alone the projected spend on the treatment of PJI is $1.62 billion (5). This is despite little improvement in the success rate in terms of eradication of infection (6). For these reasons there has been an increasing focus on the issue of PJI in the medical literature (6). This paper discusses the incidence of PJI as well as the factors which might account for the current trends and the challenges associated with the contemporary management of PJI. The incidence of PJI varies with the joint involved (7,8). Reported incidences following total knee arthroplasty, total hip arthroplasty and total shoulder arthroplasty have been reported to be 0.25% to 2%, 0.5% to 1% and less than 1% respectively (9,10). Between 23–25% of revision TKA procedures and 12–15% revision THA procedures are performed for PJI (11,12). Risk factors for PJI are presented in Table 1 (13). While the incidence remains low the number of patients are likely to increase over time however as the number of arthroplasty procedures performed annually increases. The incidence of PJI varies throughout the literature. As a result existing data needs to be interpreted with caution. Wang 4","PeriodicalId":44459,"journal":{"name":"Annals of Joint","volume":" ","pages":""},"PeriodicalIF":0.4,"publicationDate":"2020-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42200050","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 8

Calcaneal osteotomies 跟骨截骨术

IF 0.4 4区医学 Q4 ORTHOPEDICS

Annals of Joint

Pub Date : 2020-07-01 DOI: 10.21037/aoj.2020.02.02

Dan Prat, Wonyong Lee, Daniel Charles Farber

Alteration of hindfoot alignment is a cornerstone of orthopaedic foot and ankle deformity correction. Hindfoot and forefoot loading are influenced by the alignment of the hindfoot and by the calcaneus configuration. Calcaneal osteotomies allow multi plane modification of the calcaneal axis and deformity correction, which results in improved biomechanics of the foot. Multiple calcaneal osteotomies incorporating numerous techniques, have been described to address the varied pathologies that produce varus and valgus hindfoot deformity. Although no clear evidence supports the superiority of one calcaneal osteotomy over the other, recent studies compare the biomechanical properties of different osteotomies. The aim of this review is to outline the of history and current concepts of calcaneal osteotomies.

后足对齐的改变是矫形足部和踝关节畸形矫正的基石。后脚和前脚负荷受后脚的对齐和跟骨配置的影响。跟骨截骨术可以对跟骨轴进行多平面矫正和畸形矫正，从而改善足部生物力学。多种跟骨截骨术结合了多种技术，已被描述为解决导致后足内翻和外翻畸形的各种病理。尽管没有明确的证据支持一种跟骨截骨优于另一种，但最近的研究比较了不同截骨的生物力学特性。这篇综述的目的是概述跟骨截骨术的历史和目前的概念。

引用次数: 1

Reverse shoulder arthroplasty for proximal humerus fractures 反向肩关节置换术治疗肱骨近端骨折

IF 0.4 4区医学 Q4 ORTHOPEDICS

Annals of Joint

Pub Date : 2020-06-16 DOI: 10.21037/AOJ-20-15

Brian K. Lee, J. Itamura

The optimal treatment of complex proximal humerus fractures continues to be debated. While many fractures can be treated nonoperatively, surgical intervention can be indicated to aid in restoring anatomy, allowing earlier range of motion and an improved final outcome. Historically, when surgical fixation of proximal humerus fractures was not possible due to fracture comminution, bone loss, head involvement or soft tissue/rotator cuff injury, hemiarthroplasty of the shoulder was utilized. Results of hemiarthroplasty, however, were unpredictable and largely dependent on the restoration of tuberosities. Reverse shoulder arthroplasty has emerged as a surgical treatment option in such cases, with results less-dependent on tuberosity healing. The design of reverse shoulder arthroplasty and evolution in surgical techniques have yielded results demonstrating it to be a safe option with consistent results in the treatment of these difficult injuries. Studies have shown rotational strength to be improved in cases where the tuberosities heal, and repair techniques as well as implant designs have evolved to optimize tuberosity healing. Complications of reverse shoulder arthroplasty for fracture are similar to those of other indications, including scapular notching, and neurologic injury. Further studies are still needed to assess the long-term validity of the results seen at the short and mid-term.

复杂肱骨近端骨折的最佳治疗方法仍存在争议。虽然许多骨折可以非手术治疗，但手术干预可以帮助恢复解剖结构，使运动范围更早，最终结果更好。从历史上看，当由于骨折粉碎、骨丢失、头部受累或软组织/肩袖损伤而无法对肱骨近端骨折进行手术固定时，则采用肩部半关节成形术。然而，半关节成形术的结果是不可预测的，并且在很大程度上取决于结节的修复。在这种情况下，反向肩关节置换术已成为一种手术治疗选择，其结果对结节愈合的依赖性较小。反向肩关节置换术的设计和外科技术的发展已经产生了结果，证明它是一种安全的选择，在治疗这些困难的损伤方面具有一致的结果。研究表明，在结节愈合的情况下，旋转强度可以提高，修复技术和植入物设计已经发展到优化结节愈合。反向肩关节置换术治疗骨折的并发症与其他适应症的并发症相似，包括肩胛骨切口和神经损伤。还需要进一步的研究来评估短期和中期结果的长期有效性。

{"title":"Reverse shoulder arthroplasty for proximal humerus fractures","authors":"Brian K. Lee, J. Itamura","doi":"10.21037/AOJ-20-15","DOIUrl":"https://doi.org/10.21037/AOJ-20-15","url":null,"abstract":"The optimal treatment of complex proximal humerus fractures continues to be debated. While many fractures can be treated nonoperatively, surgical intervention can be indicated to aid in restoring anatomy, allowing earlier range of motion and an improved final outcome. Historically, when surgical fixation of proximal humerus fractures was not possible due to fracture comminution, bone loss, head involvement or soft tissue/rotator cuff injury, hemiarthroplasty of the shoulder was utilized. Results of hemiarthroplasty, however, were unpredictable and largely dependent on the restoration of tuberosities. Reverse shoulder arthroplasty has emerged as a surgical treatment option in such cases, with results less-dependent on tuberosity healing. The design of reverse shoulder arthroplasty and evolution in surgical techniques have yielded results demonstrating it to be a safe option with consistent results in the treatment of these difficult injuries. Studies have shown rotational strength to be improved in cases where the tuberosities heal, and repair techniques as well as implant designs have evolved to optimize tuberosity healing. Complications of reverse shoulder arthroplasty for fracture are similar to those of other indications, including scapular notching, and neurologic injury. Further studies are still needed to assess the long-term validity of the results seen at the short and mid-term.","PeriodicalId":44459,"journal":{"name":"Annals of Joint","volume":" ","pages":""},"PeriodicalIF":0.4,"publicationDate":"2020-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49663774","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Patient-derived orthotopic xenograft models for osteosarcoma individualized precision treatment and effective drug discovery 骨肉瘤患者原位异种移植物模型的个体化精确治疗和有效药物发现

IF 0.4 4区医学 Q4 ORTHOPEDICS

Annals of Joint

Pub Date : 2020-05-13 DOI: 10.21037/AOJ.2020.02.08

T. Higuchi, K. Igarashi, H. Oshiro, K. Miyake, Norihiko Sugisawa, N. Yamamoto, Katsuhiro Hayashi, H. Kimura, S. Miwa, Z. Duan, F. Hornicek, H. Tsuchiya, R. Hoffman

Osteosarcoma is the most common malignant primary tumor of bone and mainly occurs in young generations. Due to the heterogeneity, rarity, poor response rate to systemic therapy, and metastatic potential of osteosarcoma, individualized precision medicine and novel drug discovery are greatly needed. Toward this goal, we have established the patient-derived orthotopic xenograft (PDOX) mouse model with surgical orthotopic implantation (SOI) for all major cancers. The PDOX models recapitulate human tumors better than subcutaneous-transplanted xenografts including patient-derived xenograft (PDX). Metastasis is observed to a greater extent in PDOX models due to the intact histology and correct-organ tumor microenvironment of the orthotopically implanted tissue. The present report reviews our research group’s experience with the osteosarcoma-PDOX model, and the power of the PDOX models to identify effective therapeutics. We have obtained many promising and surprising results using the osteosarcoma-PDOX model for discovering active approved drugs as well as combinations of them, and experimental therapeutics for individual patients. The patient does not need to suffer from the potential drug toxicity and morbidity of ineffective chemotherapies. In an era of growing promise of new treatment and precision medicine, PDOX models offer a unique opportunity to provide specific and individualized therapy and novel therapeutic options for osteosarcoma patients.

骨肉瘤是最常见的恶性原发性骨肿瘤，主要发生在年轻一代。由于骨肉瘤的异质性、罕见性、全身治疗的不良反应率和转移潜力，迫切需要个体化的精准药物和新药发现。为了实现这一目标，我们建立了患者来源的原位异种移植物（PDOX）小鼠模型，并对所有主要癌症进行了原位手术植入（SOI）。PDOX模型比包括患者来源的异种移植物（PDX）在内的皮下移植异种移植物更好地概括了人类肿瘤。由于原位植入组织的完整组织学和正确的器官肿瘤微环境，在PDOX模型中观察到更大程度的转移。本报告回顾了我们研究小组在骨肉瘤PDOX模型方面的经验，以及PDOX模型确定有效治疗方法的能力。使用骨肉瘤PDOX模型，我们已经获得了许多有希望和令人惊讶的结果，用于发现活性获批药物及其组合，以及针对个体患者的实验治疗方法。患者不需要承受无效化疗的潜在药物毒性和发病率。在新治疗和精准医学前景日益广阔的时代，PDOX模型为骨肉瘤患者提供了一个独特的机会，为他们提供了特异性和个性化的治疗以及新的治疗选择。

{"title":"Patient-derived orthotopic xenograft models for osteosarcoma individualized precision treatment and effective drug discovery","authors":"T. Higuchi, K. Igarashi, H. Oshiro, K. Miyake, Norihiko Sugisawa, N. Yamamoto, Katsuhiro Hayashi, H. Kimura, S. Miwa, Z. Duan, F. Hornicek, H. Tsuchiya, R. Hoffman","doi":"10.21037/AOJ.2020.02.08","DOIUrl":"https://doi.org/10.21037/AOJ.2020.02.08","url":null,"abstract":"Osteosarcoma is the most common malignant primary tumor of bone and mainly occurs in young generations. Due to the heterogeneity, rarity, poor response rate to systemic therapy, and metastatic potential of osteosarcoma, individualized precision medicine and novel drug discovery are greatly needed. Toward this goal, we have established the patient-derived orthotopic xenograft (PDOX) mouse model with surgical orthotopic implantation (SOI) for all major cancers. The PDOX models recapitulate human tumors better than subcutaneous-transplanted xenografts including patient-derived xenograft (PDX). Metastasis is observed to a greater extent in PDOX models due to the intact histology and correct-organ tumor microenvironment of the orthotopically implanted tissue. The present report reviews our research group’s experience with the osteosarcoma-PDOX model, and the power of the PDOX models to identify effective therapeutics. We have obtained many promising and surprising results using the osteosarcoma-PDOX model for discovering active approved drugs as well as combinations of them, and experimental therapeutics for individual patients. The patient does not need to suffer from the potential drug toxicity and morbidity of ineffective chemotherapies. In an era of growing promise of new treatment and precision medicine, PDOX models offer a unique opportunity to provide specific and individualized therapy and novel therapeutic options for osteosarcoma patients.","PeriodicalId":44459,"journal":{"name":"Annals of Joint","volume":" ","pages":""},"PeriodicalIF":0.4,"publicationDate":"2020-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48467063","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0