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Projections of Single-level and Multilevel Spinal Instrumentation Procedure Volume and Associated Costs for Medicare Patients to 2050. 到 2050 年医疗保险患者的单层次和多层次脊柱器械手术量及相关费用预测。
IF 1.5 Q3 Medicine Pub Date : 2024-05-15 eCollection Date: 2024-05-01 DOI: 10.5435/JAAOSGlobal-D-24-00053
Kyle Mani, Emily Kleinbart, Samuel N Goldman, Regina Golding, Yaroslav Gelfand, Saikiran Murthy, Ananth Eleswarapu, Reza Yassari, Mitchell S Fourman, Jonathan Krystal

Background: Instrumented spinal fusions can be used in the treatment of vertebral fractures, spinal instability, and scoliosis or kyphosis. Construct-level selection has notable implications on postoperative recovery, alignment, and mobility. This study sought to project future trends in the implementation rates and associated costs of single-level versus multilevel instrumentation procedures in US Medicare patients aged older than 65 years in the United States.

Methods: Data were acquired from the Centers for Medicare & Medicaid Services from January 1, 2000, to December 31, 2019. Procedure costs and counts were abstracted using Current Procedural Terminology codes to identify spinal level involvement. The Prophet machine learning algorithm was used, using a Bayesian Inference framework, to generate point forecasts for 2020 to 2050 and 95% forecast intervals (FIs). Sensitivity analyses were done by comparing projections from linear, log-linear, Poisson and negative-binomial, and autoregressive integrated moving average models. Costs were adjusted for inflation using the 2019 US Bureau of Labor Statistics' Consumer Price Index.

Results: Between 2000 and 2019, the annual spinal instrumentation volume increased by 776% (from 7,342 to 64,350 cases) for single level, by 329% (from 20,319 to 87,253 cases) for two-four levels, by 1049% (from 1,218 to 14,000 cases) for five-seven levels, and by 739% (from 193 to 1,620 cases) for eight-twelve levels (P < 0.0001). The inflation-adjusted reimbursement for single-level instrumentation procedures decreased 45.6% from $1,148.15 to $788.62 between 2000 and 2019, which is markedly lower than for other prevalent orthopaedic procedures: total shoulder arthroplasty (-23.1%), total hip arthroplasty (-39.2%), and total knee arthroplasty (-42.4%). By 2050, the number of single-level spinal instrumentation procedures performed yearly is projected to be 124,061 (95% FI, 87,027 to 142,907), with associated costs of $93,900,672 (95% FI, $80,281,788 to $108,220,932).

Conclusions: The number of single-level instrumentation procedures is projected to double by 2050, while the number of two-four level procedures will double by 2040. These projections offer a measurable basis for resource allocation and procedural distribution.

背景:器械脊柱融合术可用于治疗椎体骨折、脊柱不稳定、脊柱侧弯或后凸。结构层次的选择对术后恢复、对位和活动度有显著影响。本研究旨在预测美国 65 岁以上医疗保险患者中单层次器械手术与多层次器械手术的实施率和相关费用的未来趋势:数据来自美国医疗保险与医疗补助服务中心(Centers for Medicare & Medicaid Services),时间为 2000 年 1 月 1 日至 2019 年 12 月 31 日。使用 "当前手术术语"(Current Procedural Terminology)代码抽取手术费用和次数,以确定脊柱水平参与情况。使用贝叶斯推理框架的先知机器学习算法生成了 2020 年至 2050 年的点预测和 95% 的预测区间 (FI)。通过比较线性模型、对数线性模型、泊松模型、负二项式模型和自回归综合移动平均模型的预测结果,进行了敏感性分析。成本根据美国劳工统计局 2019 年的消费者价格指数进行了通货膨胀调整:2000年至2019年期间,单层脊柱器械年手术量增加了776%(从7342例增加到64350例),两层至四层增加了329%(从20319例增加到87253例),五层至七层增加了1049%(从1218例增加到14000例),八层至十二层增加了739%(从193例增加到1620例)(P < 0.0001)。2000 年至 2019 年期间,单层器械手术的报销额经通货膨胀调整后从 1148.15 美元降至 788.62 美元,降幅达 45.6%,明显低于其他流行的矫形手术:全肩关节置换术(-23.1%)、全髋关节置换术(-39.2%)和全膝关节置换术(-42.4%)。到2050年,预计每年进行的单层脊柱器械手术数量为124,061例(95% FI,87,027至142,907例),相关费用为93,900,672美元(95% FI,80,281,788至108,220,932美元):预计到 2050 年,单层器械手术的数量将翻一番,而到 2040 年,两层至四层器械手术的数量将翻一番。这些预测为资源分配和程序分布提供了可衡量的依据。
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引用次数: 0
Severity Of Radiographic Osteoarthritis: Association with Improved Patient Reported Outcomes Following Knee Arthroplasty. 放射骨关节炎的严重程度:与改善膝关节置换术后患者报告结果的关系
IF 1.5 Q3 Medicine Pub Date : 2024-05-15 eCollection Date: 2024-05-01 DOI: 10.5435/JAAOSGlobal-D-24-00066
Yoav S Zvi, Shoran Tamura, Jonathan Rubin, Zeynep Seref-Ferlengez, Eli Kamara

Introduction: The Kellgren and Lawrence (KL) classification for knee osteoarthritis estimates disease severity. Its utility in predicting patient-reported outcomes (PROs) after primary total knee arthroplasty (pTKA) has been suggested. We hypothesized that patients who had higher preoperative KL grades would demonstrate greater improvements in PROs after pTKA.

Methods: This was a retrospective review of patients who underwent pTKA between 2016 and 2021. Two observers graded preoperative radiographs (KL1/2, KL3, and KL4). Knee Injury and Osteoarthritis Outcome Score (KOOS) for activities of daily living (KOOS-ADL) and pain (KOOS-Pain) were collected at preoperative and 12-month postoperative visits. Changes in KOOS-ADL (ΔADL) and changes in KOOS-Pain (ΔPain) scores were compared from the preoperative to 12-month postoperative mark across different groups, with the minimal clinically important difference (MCID) for both ΔADL (MCID-ADL) and ΔPain (MCID-Pain) also being calculated. A P-value of < 0.05 was considered statistically significant.

Results: A total of 1651 patients were included in the study. The KL3 and KL4 groups exhibited significantly higher ΔADL scores and ΔPain scores compared with the KL1/2 group (P < 0.01). Patients who had KL3 and KL4 were 1.42 (P = 0.03) and 1.88 (P < 0.01) times, respectively, more likely to achieve MCID-ADL compared with those who had KL1/2. Furthermore, patients who had a KL4 were 1.92 times (P < 0.01) more likely to reach MCID-Pain compared with those who had KL1/2.

Conclusions: This study determined that patients who had higher preoperative KL grades experienced markedly greater improvements in KOOS-ADL and KOOS-Pain scores than those who had lower KL grades. These findings offer surgeons an objective tool when counseling patients on expected outcomes after pTKA.

导言:凯尔格伦和劳伦斯(Kellgren and Lawrence,KL)膝关节骨性关节炎分类估计了疾病的严重程度。有人认为该分级可用于预测初级全膝关节置换术(pTKA)后的患者报告结果(PROs)。我们假设,术前KL分级较高的患者在PTKA术后的PROs会有更大的改善:这是一项对 2016 年至 2021 年期间接受 pTKA 的患者进行的回顾性研究。两名观察员对术前X光片(KL1/2、KL3和KL4)进行分级。在术前和术后 12 个月的访视中收集了日常生活活动(KOOS-ADL)和疼痛(KOOS-Pain)的膝关节损伤和骨关节炎结果评分(KOOS)。比较不同组别从术前到术后 12 个月的 KOOS-ADL (ΔADL) 和 KOOS-Pain (ΔPain) 评分变化,并计算 ΔADL (MCID-ADL) 和 ΔPain (MCID-Pain) 的最小临床重要性差异 (MCID)。P 值小于 0.05 即为具有统计学意义:共有 1651 名患者参与了研究。与 KL1/2 组相比,KL3 和 KL4 组的 ΔADL 评分和 ΔPain 评分明显更高(P < 0.01)。与 KL1/2 组相比,KL3 和 KL4 组患者达到 MCID-ADL 的可能性分别高出 1.42 倍(P = 0.03)和 1.88 倍(P < 0.01)。此外,与患有 KL1/2 的患者相比,患有 KL4 的患者达到 MCID-Pain 的可能性要高出 1.92 倍(P < 0.01):本研究发现,与 KL 等级较低的患者相比,术前 KL 等级较高的患者在 KOOS-ADL 和 KOOS-Pain 评分方面的改善幅度明显更大。这些发现为外科医生提供了一种客观的工具,帮助他们向患者介绍 pTKA 术后的预期效果。
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引用次数: 0
Readability Analysis of Patient Education Material on Rotator Cuff Injuries From the Top 25 Ranking Orthopaedic Institutions. 排名前 25 位骨科机构的肩袖损伤患者教育材料可读性分析。
IF 1.5 Q3 Medicine Pub Date : 2024-05-09 eCollection Date: 2024-05-01 DOI: 10.5435/JAAOSGlobal-D-24-00085
Michael Miskiewicz, Salvatore Capotosto, Kenny Ling, Frederick Hance, Edward Wang

Introduction: Rotator cuff injuries (RCIs) are incredibly common in the US adult population. Forty-three percent of adults have basic or below-basic literacy levels; nonetheless, patient educational materials (PEMs) are frequently composed at levels exceeding these reading capabilities. This study investigates the readability of PEMs on RCIs published by leading US orthopaedic institutions.

Methods: The top 25 orthopaedic institutions on the 2022 U.S. News & World Report Best Hospitals Specialty Ranking were selected. Readability scores of PEMs related to RCI were calculated using the www.readabilityformulas.com website.

Results: Among the 25 analyzed PEM texts, all exceeded the sixth-grade reading level. Only four of 168 scores (2.4%) were below the eighth-grade level.

Discussion: This study indicates that PEMs on rotator cuff injuries from top orthopedic institutions are too complex for many Americans, with readability levels ranging from 8.5 to 16th grade, well above the CDC-recommended eighth-grade level. The research highlights a widespread issue with high reading levels across healthcare information and underscores the need for healthcare providers to adopt patient-centered communication strategies to improve comprehension and accessibility.

Conclusion: PEMs on rotator cuff injuries from leading orthopedic institutions often have a reading level beyond that of many Americans, exceeding guidelines from the NIH and CDC that recommend PEMs be written at an eighth-grade reading level. To increase accessibility, enhance healthcare literacy, and improve patient outcomes, institutions should simplify these materials to meet recommended readability standards.

简介:肩袖损伤(RCIs)在美国成年人群中极为常见。43%的成年人具有基本或低于基本的识字水平;然而,患者教育材料(PEM)的编写水平却经常超出这些阅读能力。本研究调查了美国主要骨科机构出版的 RCI 上的 PEM 的可读性:方法:选取 2022 年《美国新闻与世界报道》最佳医院专科排名前 25 位的骨科机构。使用 www.readabilityformulas.com 网站计算与 RCI 相关的 PEM 的可读性得分:在分析的25篇PEM文章中,所有文章的阅读水平都超过了六年级。在 168 项评分中,只有 4 项(2.4%)低于八年级水平:本研究表明,对于许多美国人来说,顶级骨科机构提供的有关肩袖损伤的 PEM 过于复杂,可读性水平从 8.5 年级到 16 年级不等,远高于疾病预防控制中心建议的八年级水平。这项研究强调了医疗保健信息阅读水平过高这一普遍问题,并强调医疗保健提供者有必要采取以患者为中心的沟通策略,以提高理解能力和可及性:结论:主要骨科机构提供的有关肩袖损伤的 PEM 阅读水平往往超过了许多美国人的阅读水平,超过了美国国立卫生研究院(NIH)和美国疾病预防控制中心(CDC)建议 PEM 以八年级阅读水平编写的指导方针。为了增加可读性、提高医疗保健素养并改善患者的治疗效果,医疗机构应简化这些材料,使其符合推荐的可读性标准。
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引用次数: 0
Increased Risk of 90-Day Complications in Patients With Fibromyalgia Undergoing Total Shoulder Arthroplasty. 接受全肩关节置换术的纤维肌痛患者 90 天并发症风险增加。
IF 1.5 Q3 Medicine Pub Date : 2024-05-09 eCollection Date: 2024-05-01 DOI: 10.5435/JAAOSGlobal-D-24-00102
Joshua G Sanchez, Albert L Rancu, Fortunay H Diatta, Anshu Jonnalagadda, Meera M Dhodapkar, Leonard Knoedler, Martin Kauke-Navarro, Jonathan N Grauer

Introduction: Anatomic and reverse total shoulder arthroplasties (TSAs) are effective treatment options for end-stage glenohumeral osteoarthritis. Those undergoing TSA may also have fibromyalgia, a musculoskeletal condition. However, the association of fibromyalgia with shorter and longer term outcomes after TSA has not been well characterized.

Methods: Patients undergoing TSA for osteoarthritis indications were identified in the PearlDiver M165 database from January 2016 to October 2022. Exclusion criteria included age younger than 18 years, shoulder infection, neoplasm, or trauma within 90 days before surgery, and inactivity in the database within 90 days of surgery. Patients with fibromyalgia were matched in a 1:4 ratio to patients without based on age, sex, and Elixhauser Comorbidity Index. Ninety-day adverse events were compared using univariable and multivariable analyses. Five-year revision-free survival was compared using the log-rank test.

Results: Of 163,565 TSA patients, fibromyalgia was identified for 9,035 (5.52%). After matching, cohorts of 30,770 non-fibromyalgia patients and 7,738 patients with fibromyalgia were identified. Multivariable analyses demonstrated patients with fibromyalgia were at independently increased odds ratios (ORs) for the following 90-day complications (decreasing OR order): urinary tract infection (OR = 4.49), wound dehiscence (OR = 3.63), pneumonia (OR = 3.46), emergency department visit (OR = 3.45), sepsis (OR = 3.15), surgical site infection (OR = 2.82), cardiac events (OR = 2.72), acute kidney injury (OR = 2.65), deep vein thrombosis (OR = 2.48), hematoma (OR = 2.03), and pulmonary embolism (OR = 2.01) (P < 0.05 for each). These individual complications contributed to the increased odds of aggregated minor adverse events (OR = 3.68), all adverse events (OR = 3.48), and severe adverse events (OR = 2.68) (P < 0.05 for each). No statistically significant difference was observed in 5-year revision-free survival between groups.

Discussion: This study found TSA patients with fibromyalgia to be at increased risk of adverse events within 90 days of surgery. Proper surgical planning and patient counseling are crucial to this population. Nonetheless, it was reassuring that those with fibromyalgia had similar 5-year revision-free survival compared with those without.

导言:解剖和反向全肩关节置换术(TSA)是治疗终末期盂肱骨关节炎的有效方法。接受全肩关节置换术的患者也可能患有纤维肌痛这种肌肉骨骼疾病。然而,纤维肌痛与TSA术后短期和长期疗效的关系尚未得到很好的描述:2016年1月至2022年10月期间,在PearlDiver M165数据库中确定了因骨关节炎适应症接受TSA的患者。排除标准包括年龄小于18岁,术前90天内有肩部感染、肿瘤或外伤,以及术后90天内未在数据库中活动。根据年龄、性别和Elixhauser合并症指数,纤维肌痛患者与非纤维肌痛患者按1:4的比例进行配对。通过单变量和多变量分析比较了90天不良事件。使用对数秩检验比较了五年无翻修生存率:在163565名TSA患者中,有9035人(5.52%)患有纤维肌痛。经过配对,确定了 30,770 名非纤维肌痛患者和 7,738 名纤维肌痛患者。多变量分析表明,纤维肌痛患者出现以下 90 天并发症的几率比(ORs)独立增加(ORs 顺序递减):尿路感染(OR = 4.49)、伤口裂开(OR = 3.63)、肺炎(OR = 3.46)、急诊就诊(OR = 3.45)、败血症(OR = 3.15)、手术部位感染(OR = 2.82)、心脏事件(OR = 2.72)、急性肾损伤(OR = 2.65)、深静脉血栓形成(OR = 2.48)、血肿(OR = 2.03)和肺栓塞(OR = 2.01)(P < 0.05)。这些并发症导致轻微不良事件(OR = 3.68)、所有不良事件(OR = 3.48)和严重不良事件(OR = 2.68)的发生几率增加(P < 0.05)。各组间的5年无翻修生存率差异无统计学意义:本研究发现,患有纤维肌痛的TSA患者在术后90天内发生不良事件的风险增加。正确的手术计划和患者咨询对这类人群至关重要。尽管如此,令人欣慰的是,与无纤维肌痛的患者相比,有纤维肌痛的患者有相似的 5 年无翻修生存率。
{"title":"Increased Risk of 90-Day Complications in Patients With Fibromyalgia Undergoing Total Shoulder Arthroplasty.","authors":"Joshua G Sanchez, Albert L Rancu, Fortunay H Diatta, Anshu Jonnalagadda, Meera M Dhodapkar, Leonard Knoedler, Martin Kauke-Navarro, Jonathan N Grauer","doi":"10.5435/JAAOSGlobal-D-24-00102","DOIUrl":"10.5435/JAAOSGlobal-D-24-00102","url":null,"abstract":"<p><strong>Introduction: </strong>Anatomic and reverse total shoulder arthroplasties (TSAs) are effective treatment options for end-stage glenohumeral osteoarthritis. Those undergoing TSA may also have fibromyalgia, a musculoskeletal condition. However, the association of fibromyalgia with shorter and longer term outcomes after TSA has not been well characterized.</p><p><strong>Methods: </strong>Patients undergoing TSA for osteoarthritis indications were identified in the PearlDiver M165 database from January 2016 to October 2022. Exclusion criteria included age younger than 18 years, shoulder infection, neoplasm, or trauma within 90 days before surgery, and inactivity in the database within 90 days of surgery. Patients with fibromyalgia were matched in a 1:4 ratio to patients without based on age, sex, and Elixhauser Comorbidity Index. Ninety-day adverse events were compared using univariable and multivariable analyses. Five-year revision-free survival was compared using the log-rank test.</p><p><strong>Results: </strong>Of 163,565 TSA patients, fibromyalgia was identified for 9,035 (5.52%). After matching, cohorts of 30,770 non-fibromyalgia patients and 7,738 patients with fibromyalgia were identified. Multivariable analyses demonstrated patients with fibromyalgia were at independently increased odds ratios (ORs) for the following 90-day complications (decreasing OR order): urinary tract infection (OR = 4.49), wound dehiscence (OR = 3.63), pneumonia (OR = 3.46), emergency department visit (OR = 3.45), sepsis (OR = 3.15), surgical site infection (OR = 2.82), cardiac events (OR = 2.72), acute kidney injury (OR = 2.65), deep vein thrombosis (OR = 2.48), hematoma (OR = 2.03), and pulmonary embolism (OR = 2.01) (P < 0.05 for each). These individual complications contributed to the increased odds of aggregated minor adverse events (OR = 3.68), all adverse events (OR = 3.48), and severe adverse events (OR = 2.68) (P < 0.05 for each). No statistically significant difference was observed in 5-year revision-free survival between groups.</p><p><strong>Discussion: </strong>This study found TSA patients with fibromyalgia to be at increased risk of adverse events within 90 days of surgery. Proper surgical planning and patient counseling are crucial to this population. Nonetheless, it was reassuring that those with fibromyalgia had similar 5-year revision-free survival compared with those without.</p>","PeriodicalId":45062,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons Global Research and Reviews","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11081627/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140898698","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The Delayed Presentation and Diagnosis of Youth Wrestling Injuries: A 20-Year Analysis of National Injury Data. 青少年摔跤受伤的延迟出现和诊断:20 年全国受伤数据分析》。
IF 1.5 Q3 Medicine Pub Date : 2024-05-09 eCollection Date: 2024-05-01 DOI: 10.5435/JAAOSGlobal-D-23-00150
William H Huffman, Steven R Ayotte, Lori Jia, Kevin Pirruccio, Xinning Li, John D Kelly, Robert L Parisien

Introduction: The nature of wrestling may lead athletes to mask injuries with the delayed presentations of youth wrestling-related injuries not being well characterized.

Methods: This descriptive epidemiological study queried the National Electronic Injury Surveillance System database to characterize delayed presentations of wrestling-related injuries in middle and high-school athletes. Data collection consisted of national estimates, demographics, and injury characteristics of patients with delayed (D) presentations (≥1 day) and same-day (S) presentations to US emergency departments after sustaining a wrestling-related injury during the scholastic wrestling season (December to February, 2000 to 2019).

Results: Of middle and high-school wrestlers presenting to US emergency departments, 5.6% (95% confidence interval [CI] 4.3% to 7.1%) reported delayed presentations for a total of 1,110 patients (CI, 591 to 1,630) annually. Most commonly (P < 0.001), injuries were sustained on Saturdays in both cohorts (D, 28.2%; CI, 22.4% to 34.8%; S, 29.6%; CI, 24.3% to 35.5%). Patients reporting delayed presentations were less likely to sustain fractures (D, 11.5%; CI, 8.3% to 15.6%; S, 18.9%; CI, 15.0% to 23.5%; P = 0.019) and injuries of the head/neck (D, 20.0%; CI, 16.5 to 24.1%; S, 26.2%; CI, 21.4% to 31.7%; P = 0.011).

Discussion: A substantial proportion of adolescent wrestlers report delayed presentations of injuries. This emphasizes the need for vigilance in detecting subtle signs of injury.

简介:摔跤运动的性质可能会导致运动员掩盖损伤,而青少年摔跤相关损伤的延迟表现并不十分明确:摔跤运动的性质可能会导致运动员掩盖损伤,而青少年摔跤相关损伤的延迟表现还没有得到很好的描述:这项描述性流行病学研究查询了国家电子伤害监测系统数据库,以了解初中和高中运动员摔跤相关伤害的延迟表现特征。收集的数据包括在学校摔跤赛季(2000 年 12 月至 2019 年 2 月)期间,摔跤相关损伤后延迟(D)就诊(≥1 天)和当天(S)就诊到美国急诊科的患者的全国估计值、人口统计学和损伤特征:在前往美国急诊科就诊的初中和高中摔跤运动员中,5.6%(95% 置信区间 [CI] 4.3% 至 7.1%)的人报告延迟就诊,每年共有 1,110 名患者(CI,591 至 1,630 人)延迟就诊。在两个队列中,受伤最常见(P < 0.001)的时间都是在周六(D,28.2%;CI,22.4% 至 34.8%;S,29.6%;CI,24.3% 至 35.5%)。报告延迟就诊的患者发生骨折(D,11.5%;CI,8.3%至15.6%;S,18.9%;CI,15.0%至23.5%;P = 0.019)和头颈部受伤(D,20.0%;CI,16.5%至24.1%;S,26.2%;CI,21.4%至31.7%;P = 0.011)的可能性较小:有相当一部分青少年摔跤运动员报告了延迟出现的损伤。讨论:有相当一部分青少年摔跤运动员延迟出现受伤症状,这强调了在发现细微受伤迹象时保持警惕的必要性。
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引用次数: 0
Improving Patient Understanding of Femoroacetabular Impingement Syndrome With Three-Dimensional Models. 利用三维模型增进患者对股骨髋臼撞击综合征的了解。
IF 1.5 Q3 Medicine Pub Date : 2024-05-09 eCollection Date: 2024-05-01 DOI: 10.5435/JAAOSGlobal-D-24-00116
Ermyas A Kahsai, Bailey O'Connor, Kevin J Khoo, Temi D Ogunleye, Scott Telfer, Mia S Hagen

Introduction: Three-dimensional (3D) printed models may help patients understand complex anatomic pathologies such as femoroacetabular impingement syndrome (FAIS). We aimed to assess patient understanding and satisfaction when using 3D printed models compared with standard imaging modalities for discussion of FAIS diagnosis and surgical plan.

Methods: A consecutive series of 76 new patients with FAIS (37 patients in the 3D model cohort and 39 in the control cohort) from a single surgeon's clinic were educated using imaging and representative 3D printed models of FAI or imaging without models (control). Patients received a voluntary post-visit questionnaire that evaluated their understanding of the diagnosis, surgical plan, and visit satisfaction.

Results: Patients in the 3D model cohort reported a significantly higher mean understanding of FAIS (90.0 ± 11.5 versus 79.8 ± 14.9 out of 100; P = 0.001) and surgery (89.5 ± 11.6 versus 81.0 ± 14.5; P = 0.01) compared with the control cohort. Both groups reported high levels of satisfaction with the visit.

Conclusion: In this study, the use of 3D printed models in clinic visits with patients with FAIS improved patients' perceived understanding of diagnosis and surgical treatment.

简介:三维(3D)打印模型可帮助患者了解股骨髋臼撞击综合征(FAIS)等复杂的解剖病理。我们的目的是评估患者对使用三维打印模型与标准成像模式讨论股骨髋臼撞击综合征诊断和手术方案的理解程度和满意度:方法:对来自一家外科医生诊所的 76 名 FAIS 新患者(37 名患者属于 3D 模型队列,39 名患者属于对照队列)进行了连续的系列教育,教育过程中使用了 FAI 的成像和代表性 3D 打印模型,或未使用模型的成像(对照)。患者自愿接受诊后问卷调查,评估他们对诊断的理解、手术计划和就诊满意度:结果:与对照组相比,3D 模型组患者对 FAIS(90.0 ± 11.5 对 79.8 ± 14.9,满分 100 分;P = 0.001)和手术(89.5 ± 11.6 对 81.0 ± 14.5,P = 0.01)的平均理解程度明显更高。两组患者对就诊的满意度都很高:在这项研究中,在 FAIS 患者的门诊中使用 3D 打印模型提高了患者对诊断和手术治疗的理解。
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引用次数: 0
Administration of Low-dose Hyperbaric Bupivacaine for Spinal Anesthesia in the Setting of Outpatient Arthroplasty. 在门诊关节置换术中使用低剂量高压布比卡因进行脊柱麻醉。
IF 1.5 Q3 Medicine Pub Date : 2024-05-09 eCollection Date: 2024-05-01 DOI: 10.5435/JAAOSGlobal-D-23-00240
James T Layson, Matthew C Jackson, Adrienne J Wells, Kathryn Mabee, Jeffrey H DeClaire, Nicholas B Frisch

Introduction: With the rise of ambulatory surgery centers (ASCs), rapid motor and sensory recovery after anesthesia is crucial. The purpose of this study was to evaluate the safety and efficacy of low-dose single-shot hyperbaric bupivacaine for spinal anesthesia (SA) for patients undergoing outpatient arthroplasty.

Methods: Data were reviewed from a single ASC from 2018 to 2020 for two arthroplasty-trained surgeons for all patients with primary arthroplasties that had administration of low-dose hyperbaric bupivacaine. Data collected from the ASC records were then further evaluated for total spinal block time, length of blockade, time to discharge criteria, visual analog scale (VAS) scores, and time to discharge.

Results: Two hundred twenty-seven patients undergoing 244 primary arthroplasties received SA with low-dose hyperbaric bupivacaine. The volume of 0.75% bupivacaine varied: 115 patients received 0.8 mL (6 mg), 111 patients received 1.0 mL (7.5 mg), and 17 patients received 1.2 mL (9 mg). Total SA time averaged 144 minutes with a mean of 30 minutes from post anesthesia care unit arrival to motor recovery. The mean time from post anesthesia care unit arrival to discharge criteria was 89 minutes. The average VAS at discharge was 1.44; the average VAS on POD1 was 3.0. No episodes of urinary retention and no reports of transient neurologic symptoms were noted in the study population.

Conclusion: Low-dose, single-shot hyperbaric bupivacaine SA is an effective option in the ASC for arthroplasty, providing a fast return of motor function, facilitating rapid discharge, and is safe with a relatively low-risk profile.

简介随着门诊手术中心(ASC)的兴起,麻醉后迅速恢复运动和感觉至关重要。本研究旨在评估低剂量单次高压布比卡因用于门诊关节置换术患者脊髓麻醉(SA)的安全性和有效性:研究人员审查了 2018 年至 2020 年期间一家 ASC 的数据,该 ASC 有两名接受过关节置换术培训的外科医生,他们审查了所有使用低剂量高压布比卡因的初级关节置换术患者。然后对从ASC记录中收集到的数据进行进一步评估,包括总脊柱阻滞时间、阻滞时长、出院标准时间、视觉模拟量表(VAS)评分和出院时间:227 名接受 244 例初次关节置换术的患者接受了低剂量高压布比卡因的脊柱阻滞治疗。0.75% 布比卡因的用量各不相同:115 名患者接受了 0.8 mL(6 mg),111 名患者接受了 1.0 mL(7.5 mg),17 名患者接受了 1.2 mL(9 mg)。SA总时间平均为144分钟,从麻醉后护理病房到达到运动恢复的平均时间为30分钟。从到达麻醉后护理病房到达到出院标准的平均时间为 89 分钟。出院时的平均 VAS 为 1.44;POD1 的平均 VAS 为 3.0。研究人群中没有出现尿潴留,也没有一过性神经症状的报告:低剂量、单次高压注射布比卡因SA是关节置换术中ASC的有效选择,可快速恢复运动功能,促进快速出院,而且安全、风险相对较低。
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引用次数: 0
Comparative Studies of Bone Graft and Orthobiologics for Foot Ankle Arthrodesis: A Critical Review. 用于足踝关节置换术的骨移植和骨生物制品的比较研究:批判性评论
IF 1.5 Q3 Medicine Pub Date : 2024-05-02 eCollection Date: 2024-05-01 DOI: 10.5435/JAAOSGlobal-D-23-00216
Ioanna K Bolia, Donal J Covell, Eric W Tan

Graft materials available to supplement hindfoot and ankle arthrodesis procedures include autologous (autograft) or allogeneic bone graft (allograft) but also bone graft substitutes such as demineralized bone matrix, calcium sulfate, calcium phosphate, and tricalcium phosphate/hydroxyapatite. In addition, biologic agents, such as recombinant human bone morphogenetic protein-2 or recombinant human platelet derived growth factor-BB (rhPDGF-BB), and preparations, including platelet-rich plasma or concentrated bone marrow aspirate, have been used to facilitate bone healing in ankle or hindfoot arthrodesis. The purpose of this review was to summarize the available clinical evidence surrounding the utilization and efficacy of the above materials and biological agents in ankle or hindfoot arthrodesis procedures, with emphasis on the quality of the existing evidence to facilitate clinical decision making.

可用于补充后足和踝关节置换术的移植物材料包括自体(自体移植物)或异体骨移植物(异体移植物),以及骨移植物替代物,如脱矿骨基质、硫酸钙、磷酸钙和磷酸三钙/羟基磷灰石。此外,生物制剂,如重组人骨形态发生蛋白-2 或重组人血小板衍生生长因子-BB(rhPDGF-BB),以及制剂,包括富血小板血浆或浓缩骨髓抽吸物,也被用于促进踝关节或后足关节置换术中的骨愈合。本综述旨在总结与上述材料和生物制剂在踝关节或后足关节置换术中的应用和疗效有关的现有临床证据,重点关注现有证据的质量,以便于临床决策。
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引用次数: 0
Management of Pediatric Supination-inversion Ankle Injuries Involving Distal Tibia and Intraepiphyseal Distal Fibula Fractures. 涉及胫骨远端和腓骨远端骨骺内骨折的小儿上翻内翻性踝关节损伤的处理。
IF 2 Q2 ORTHOPEDICS Pub Date : 2024-04-29 eCollection Date: 2024-05-01 DOI: 10.5435/JAAOSGlobal-D-23-00284
Jacob Shermetaro, David Sosnoski, Wendy Ramalingam, Junichi Tamai

Pediatric ankle fractures are prevalent injuries that make up a notable portion of all periphyseal injuries. The Salter-Harris classification is the most popular classification about physeal and periepiphyseal injuries. Ogden expanded on this and described type 7 fractures which are completely intraepiphyseal and include propagation of the fracture from the articular surface through the epiphyseal cartilage and do not involve the physis. These injuries are common about the distal fibula in pediatric patients with supination-inversion type injuries. There are no specific guidelines or recommendations on treatment of these injuries in the literature. We present three cases of this injury pattern and describe our chosen management that leads each patient to full, painless ankle range of motion and return to all prior activities and sports without complication. Supination-inversion type pediatric ankle fractures are common injuries that all orthopaedic surgeons will encounter at some point throughout their practice or training. Recognizing fracture variants and understanding treatment options of pediatric ankle fractures are important for the orthopaedic community as a whole.

小儿踝关节骨折是一种常见的损伤,在所有骺周损伤中占很大比例。Salter-Harris 分类法是关于骺板和骺周损伤最常用的分类法。奥格登(Ogden)在此基础上进行了扩展,描述了完全属于骺内骨折的第7型骨折,包括骨折从关节面通过骺软骨扩展,不涉及骺板。这些损伤常见于腓骨远端上举内翻型损伤的儿科患者。文献中没有关于此类损伤治疗的具体指南或建议。我们介绍了三例这种损伤模式的病例,并描述了我们所选择的治疗方法,这些方法使每位患者的踝关节都能完全、无痛地活动,并能恢复以前的所有活动和运动,且无并发症。上翻内翻型小儿踝关节骨折是常见的损伤,所有骨科医生在执业或培训过程中都会遇到。认识小儿踝关节骨折的骨折变异并了解其治疗方案对整个骨科界都非常重要。
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引用次数: 0
Vastus Lateralis Muscle Flap for High-Risk Patients Undergoing Orthopaedic Hip Surgery. 为接受髋关节矫形手术的高风险患者制作阔筋膜肌肉瓣
IF 1.5 Q3 Medicine Pub Date : 2024-04-25 eCollection Date: 2024-04-01 DOI: 10.5435/JAAOSGlobal-D-23-00151
Sofia E Olsson, Isabella Amado, Arman Fijany, Shirin Soleimani, Thomas Troia, Kimberly L Washington, Hugo B Sanchez, Srikanth Kurapati, Maxim Pekarev

Introduction: Chronic infections and soft-tissue defects are serious complications after total hip arthroplasties (THAs) that may require hip disarticulation (HD). HD is a relatively high-risk procedure with poor long-term outcomes and survival. This is the first study to analyze the effect of an ipsilateral, pedicled vastus lateralis (VL) muscle flap in preventing HD in patients with recurrent complications after THA.

Methods: This retrospective case review analyzed the 6-month postoperative outcomes of 14 patients who underwent soft-tissue hip reconstruction with a VL muscle flap by a single surgeon.

Results: Most (86%) patients fully recovered after 6 months with preserved hip range of motion, no pain, and no weakness on ambulation. Two (14%) patients ultimately required HD despite introducing a VL flap.

Discussion: A VL muscle flap is an effective treatment of nonhealing THA and prophylactic intervention for patients at high risk for HD. The VL muscle is optimal because of its large size allowing reduction of soft-tissue dead space, its local anatomical location to the hip, and its exceptional vascularity. Additional prospective studies are necessary to determine the most appropriate population for this technique.

简介:慢性感染和软组织缺损是全髋关节置换术(THA)后的严重并发症,可能需要进行髋关节离断术(HD)。髋关节离断术是一种风险相对较高的手术,长期疗效和存活率较低。这是第一项分析同侧带蒂阔筋膜(VL)肌皮瓣对预防 THA 术后复发并发症患者髋关节脱位的效果的研究:这项回顾性病例研究分析了14名患者术后6个月的疗效,这些患者均由一名外科医生使用VL肌皮瓣进行了软组织髋关节重建:大多数患者(86%)在术后6个月完全康复,髋关节活动范围保持不变,无疼痛,行走无力。尽管采用了 VL 肌瓣,但仍有两名(14%)患者最终需要进行 HD:讨论:VL 肌瓣是治疗不愈合 THA 的有效方法,也是对 HD 高危患者的预防性干预措施。VL肌是最佳选择,因为其体积大,可减少软组织死腔,与髋关节的局部解剖位置相近,且血管丰富。有必要进行更多的前瞻性研究,以确定这项技术最适合的人群。
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引用次数: 0
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Journal of the American Academy of Orthopaedic Surgeons Global Research and Reviews
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