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Intraoperative traction has a negligible time-dependent influence on patient-reported outcomes after hip arthroscopy: a cohort study 术中牵引对髋关节镜术后患者报告结果的时间依赖性影响可以忽略不计:一项队列研究
IF 1.5 4区 医学 Q3 ORTHOPEDICS Pub Date : 2023-11-15 DOI: 10.1093/jhps/hnad034
Jacob D Feingold, Thacher Ryan R., Adit Maniar, Stefan Mitrasinovic, Samarth Venkata Menta, Anil Ranawat
The aim of this study is to determine if post-operative patient-reported outcome measures (PROMs) are influenced by hip arthroscopy traction duration. Patients from a local prospective hip arthroscopy database were retrospectively analyzed. Four hip-specific PROMs were utilized: modified Harris Hip Score (mHHS), Hip Outcome Score—Activities of Daily Living (HOS-ADL), Hip Outcome Score—Sports Specific (HOS-SS), and international Hip Outcome Tool (iHOT). PROMs were collected pre-operatively and 6 months, 1 year and 2 years post-operatively. Two cohorts were created based on a cut-off corresponding to the 66th percentile for our patient cohort. Analyses were completed for each PROM at each post-operative interval with univariable statistics. Multivariable statistics were examined to identify the variables that were predictive of achieving post-operative minimal clinically important difference (MCID) at the 2-year follow-up. Overall, 222 patients met the inclusion criteria. The mean age was 32.4 ± 9.4 years, and 116 (52.3%) were female. The average traction time of the study population was 46.1 ± 12.9 min. A total of 145 patients were included in the short traction cohort (65%) with traction times of <50 min (66th percentile). No significant differences were found regarding PROM scores or MCID achievement rates between both cohorts at any post-operative period. In multivariable analyses, achievement of MCID was predicted by a decrease in traction time for all PROMs and pincer-type resection for mHSS, HOS-ADL and iHOT. There was no difference in PROMs and MCID achievement between longer and shorter traction time cohorts. On multivariable analysis, a decrease in traction time is predictive of MCID for all PROM scores and pincer-type resection was predictive of MCID for most PROM scores. Level of evidence: Level III, cohort study
本研究的目的是确定术后患者报告的结果测量(PROMs)是否受到髋关节镜牵引时间的影响。回顾性分析来自局部前瞻性髋关节镜数据库的患者。采用四种髋关节特异性PROMs:改良Harris髋关节评分(mHHS)、髋关节结局评分-日常生活活动(HOS-ADL)、髋关节结局评分-运动特异性(HOS-SS)和国际髋关节结局工具(iHOT)。分别于术前、术后6个月、1年、2年采集prom。根据患者队列的第66百分位的截止值创建了两个队列。采用单变量统计方法对术后各时间间隔的每个胎膜早破进行分析。对多变量统计进行检验,以确定在2年随访中预测实现术后最小临床重要差异(MCID)的变量。总的来说,222例患者符合纳入标准。平均年龄32.4±9.4岁,女性116例(52.3%)。研究人群的平均牵引时间为46.1±12.9 min。145例患者(65%)被纳入短牵引队列,牵引时间为50 min(第66百分位)。在任何术后阶段,两组患者在PROM评分或MCID成功率方面均未发现显著差异。在多变量分析中,通过减少所有PROMs的牵引时间和钳形切除mHSS、HOS-ADL和iHOT来预测MCID的实现。在牵引时间较长和较短的队列中,PROMs和MCID的成就没有差异。在多变量分析中,牵引时间的减少可预测所有PROM评分的MCID,钳型切除术可预测大多数PROM评分的MCID。证据等级:III级,队列研究
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引用次数: 0
The role of iliopsoas fractional lengthening in hip arthroscopy: a systematic review 髂腰肌分段延长在髋关节镜检查中的作用:一项系统综述
IF 1.5 4区 医学 Q3 ORTHOPEDICS Pub Date : 2023-11-15 DOI: 10.1093/jhps/hnad039
Alexander Baur, Wesley Lemons, James Satalich, Alexander Vap, Robert O’Connell
Arthroscopic iliopsoas fractional lengthening (IFL) is a surgical option for the treatment of internal snapping hip syndrome (ISHS) after failing conservative management. Systematic review. A search of PubMed central, National Library of Medicine (MEDLINE) and Scopus databases were performed by two individuals from the date of inception to April 2023. Inclusion criteria were ISHS treated with arthroscopy. Sample size, patient-reported outcomes and complications were recorded for 24 selected papers. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed and registered on PROSPERO database for systematic reviews (CRD42023427466). Thirteen retrospective case series, ten retrospective comparative studies, and one randomized control trial from 2005 to 2022 were reported on 1021 patients who received an iliopsoas fractional lengthening. The extracted data included patient satisfaction, visual analogue scale, the modified Harris hip score and additional outcome measures. All 24 papers reported statistically significant improvements in post-operative patient-reported outcome measures after primary hip arthroscopy and iliopsoas fractional lengthening. However, none of the comparative studies found a statistical benefit in performing IFL. Existing studies lack conclusive evidence on the benefits of Iliopsoas Fractional Lengthening (IFL), especially for competitive athletes, individuals with Femoroacetabular Impingement (FAI), and borderline hip dysplasia. Some research suggests IFL may be a safe addition to hip arthroscopy for Internal Snapping Hip Syndrome, but more comprehensive investigations are needed. Future studies should distinguish between concurrent procedures and develop methods to determine if the psoas muscle is the source of pain, instead of solely attributing it to the joint.
关节镜下髂腰肌分段延长术(IFL)是保守治疗失败后治疗内震髋综合征(ISHS)的一种手术选择。系统的回顾。从建库之日起至2023年4月,两个人对PubMed中央、美国国家医学图书馆(MEDLINE)和Scopus数据库进行了检索。纳入标准为经关节镜治疗的iss。选取24篇论文,记录样本量、患者报告的结果和并发症。遵循系统评价和meta分析指南的首选报告项目,并在PROSPERO数据库中进行系统评价注册(CRD42023427466)。从2005年到2022年,对1021例接受髂腰肌分式延长的患者进行了13个回顾性病例系列、10个回顾性比较研究和1个随机对照试验。提取的数据包括患者满意度、视觉模拟量表、改良Harris髋关节评分和其他结果测量。所有24篇论文都报道了在初次髋关节镜检查和髂腰肌部分延长后,术后患者报告的预后指标有统计学意义的改善。然而,没有一项比较研究发现执行IFL有统计学上的好处。现有研究缺乏关于髂腰肌分式延长(IFL)的益处的确凿证据,特别是对于竞技运动员、股髋臼撞击(FAI)患者和边缘性髋关节发育不良患者。一些研究表明,IFL可能是髋关节镜治疗内震髋关节综合征的安全补充,但需要更全面的研究。未来的研究应该区分并发手术,并开发方法来确定腰肌是否是疼痛的来源,而不是仅仅将其归因于关节。
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引用次数: 0
Development of a simulation system for femoroacetabular impingement detection based on 3D images 基于三维图像的股髋臼撞击检测仿真系统的研制
4区 医学 Q3 ORTHOPEDICS Pub Date : 2023-11-11 DOI: 10.1093/jhps/hnad037
Chun-Ming Chen, Shang-Chih Lin, Chen-Te Wu, Yi-Sheng Chan
ABSTRACT Image-based criteria have been adopted to diagnose femoroacetabular impingement (FAI). However, the overlapping property of the two-dimensional X-ray outlines and static and supine posture of taking computed tomography (CT) and magnetic resonance imaging images potentially affect the accuracy of the criteria. This study developed a CT image–based dynamic criterion to effectively simulate FAI, thereby providing a basis for physicians to perform pre-operative planning for arthroscopic surgery. Post-operative CT images of 20 patients with satisfactory surgical results were collected, and 10 sets of models were used to define the flexion rotation centre (FRC) of the three-dimensional FAI model. First, let these 10 groups of models simulate the FAI detection action and find the best centre offset, and then FRC is the result of averaging these 10 groups of best displacements. The model was validated in 10 additional patients. Finally, through the adjustment basis of FRC, the remaining 10 sets of models can find out the potential position of FAI during the dynamic simulation process. Rotational collisions detected using FRC indicate that the patient’s post-operative flexion angle may reach 120° or greater, which is close to the actual result. The recommended surgical range of the diagnostic system (average length of 6.4 mm, width of 4.1 mm and depth of 3.2 mm) is smaller than the actual surgical results, which prevents the doctor from performing excessive resection operations, which may preserve more bones. The FRC diagnostic system detects the distribution of FAI in a simple manner. It can be used as a pre-operative diagnosis reference for clinicians, hoping to improve the effect and accuracy of debridement surgery.
基于图像的标准已被用于诊断股髋臼撞击(FAI)。然而,二维x线轮廓的重叠特性以及计算机断层扫描(CT)和磁共振成像图像的静态和仰卧姿势可能会影响标准的准确性。本研究建立了一种基于CT图像的动态判据,有效模拟FAI,为医生进行关节镜手术的术前规划提供依据。收集20例手术效果满意的患者的术后CT图像,使用10组模型定义三维FAI模型的屈曲旋转中心(FRC)。首先,让这10组模型模拟FAI检测动作,找到最佳中心偏移量,然后FRC是这10组最佳位移的平均结果。该模型在另外10例患者中得到验证。最后,通过FRC的调整基础,剩余的10组模型可以找出FAI在动态仿真过程中的潜在位置。FRC检测到的旋转碰撞表明患者术后屈曲角度可能达到120°或更大,这与实际结果接近。诊断系统推荐的手术范围(平均长6.4 mm,宽4.1 mm,深3.2 mm)小于实际手术结果,避免医生进行过多的切除手术,可能保留更多的骨骼。FRC诊断系统以简单的方式检测FAI的分布。可作为临床医生的术前诊断参考,以期提高清创手术的效果和准确性。
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引用次数: 0
Analysis of survivorship following periacetabular osteotomy for hip dysplasia based on three-dimensional acetabular coverage 基于三维髋臼覆盖的髋臼周围截骨术治疗髋关节发育不良的生存率分析
4区 医学 Q3 ORTHOPEDICS Pub Date : 2023-11-11 DOI: 10.1093/jhps/hnad044
Tetsuya Tachibana, Hideyuki Koga, Hiroki Katagiri, Takahisa Ogawa, Ryohei Takada, Kazumasa Miyatake, Tetsuya Jinno
ABSTRACT Periacetabular osteotomy (PAO) is an established procedure for correcting acetabular coverage and preventing osteoarthritis progression in hip dysplasia. However, it is unclear how acetabular coverage changes three-dimensionally after PAO and how it affects survival. Therefore, this study aimed to investigate the change in three-dimensional acetabular coverage preoperatively and postoperatively and identify demographic, clinical and radiographic factors associated with conversion to total hip arthroplasty (THA) and radiographic osteoarthritis progression after PAO. We retrospectively reviewed 46 consecutive patients (66 hips) who underwent PAO, using preoperative and postoperative radiographs and pelvic computed tomography (CT). Three-dimensional acetabular coverage based on CT data was investigated. Kaplan–Meier survival analysis was performed, and hazard ratios were calculated using univariate Cox regression models to identify the risk factors associated with conversion to THA and radiographic osteoarthritis progression after PAO as the endpoints. Radiographic osteoarthritis progression was defined as a minimum joint space of <2.0 mm. The mean follow-up was 10.7 years. Post-PAO, acetabular coverage gradually increased from the anterosuperior to the superior to the posterosuperior direction. The survival rate after PAO was 98.0% at 10 years. Less postoperative superior acetabular coverage, with a hazard ratio of 0.93, was significantly associated with conversion to THA and radiographic osteoarthritis progression after PAO (P = 0.03). In this study, poor superior acetabular coverage after PAO was a significant risk factor for conversion to THA and radiographic progression of osteoarthritis. Therefore, surgeons should attempt to prioritize the correction of the superior acetabular coverage when performing PAO.
髋臼周围截骨术(PAO)是一种用于纠正髋臼覆盖和预防髋关节发育不良患者骨关节炎进展的成熟手术。然而,目前尚不清楚PAO术后髋臼覆盖率的三维变化及其对生存率的影响。因此,本研究旨在探讨术前和术后三维髋臼覆盖率的变化,并确定与PAO术后转全髋关节置换术(THA)和影像学骨关节炎进展相关的人口统计学、临床和影像学因素。我们回顾性回顾了连续46例(66髋)接受PAO的患者,使用术前和术后x线片和骨盆计算机断层扫描(CT)。基于CT数据研究三维髋臼覆盖。进行Kaplan-Meier生存分析,并使用单变量Cox回归模型计算风险比,以确定与PAO后转化为THA和影像学骨关节炎进展相关的危险因素为终点。骨性关节炎的影像学进展定义为最小关节间隙为2.0 mm。平均随访时间为10.7年。pao后,髋臼覆盖范围从前上向上至后上方向逐渐增加。PAO术后10年生存率为98.0%。术后髋臼上盖面积较小,风险比为0.93,与PAO术后转THA和影像学骨关节炎进展显著相关(P = 0.03)。在本研究中,PAO术后髋臼覆盖不良是骨关节炎转变为THA和影像学进展的重要危险因素。因此,在进行PAO手术时,外科医生应尝试优先矫正髋臼上盖。
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引用次数: 0
Tibial derotation osteotomies are effective in improving pain and function and avoiding hip arthroscopy in patients with hip pain—a short-term follow-up 胫骨旋转截骨术能有效改善髋关节疼痛患者的疼痛和功能,避免髋关节镜检查-短期随访
4区 医学 Q3 ORTHOPEDICS Pub Date : 2023-11-10 DOI: 10.1093/jhps/hnad041
Vitali Goriainov, Mohamed Farook, Ivor Vanhegan, Tom Pollard, Antonio Andrade
ABSTRACT The primary objective was to determine short-term clinical outcomes following distal tibial derotation osteotomy (DTDO) performed to manage hip pain in the presence of tibial maltorsion and to review how co-existing pathomorphology affected the management. All patients undergoing DTDO for hip pain with tibial rotational deformities recognized as the predominant aetiology were included. Normal tibial torsion range was assumed as 0–40°, measured by trans-malleolar line relative to femoral posterior condyles. All patients had a positive hip impingement test Flexion Adduction Internal Rotation test (FADIR). The patients older than 50 years or presenting with degenerative joint changes and neuromuscular conditions were excluded. Associated ipsilateral MRI-defined intra-articular pathomorphology (cam/pincer), non-cam/pincer-related labral tears and abnormal combined femoral/acetabular version (McKibbin index) were noted. Pre-operative and post-operative functional outcomes were analysed. Thirty-two patients underwent DTDO. Mean tibial torsion was 48.8° (41–63°), average age was 27 years (18–44), and average follow-up was 30 months (16–45). Nine patients (28%) had a co-existing cam/pincer, and eight patients (25%) had an excessive McKibbin index (51–76°). Overall, 63% of all patients (including 54% of patients with co-existing pathology) experienced significant hip functional improvement following DTDO alone. Pre-operative vs 12 months post-operative scores were calculated as follows: International Hip Outcome Tool-12—41 vs 67 (P < 0.01); Hip Outcome Score Activities of Daily Living Scale—47 vs 70 (P < 0.05); and Hip Outcome Score Sport Scale—36 vs 64 (P < 0.05). Patients with hip pain frequently present with a combination of tibial and/or femoral rotational deformity and cam/pincer lesions. It is important to consider tibial maltorsion as an aetiology of hip pain. Tibial derotation with DTDO results in significant clinical and functional recovery within 12 months in symptomatic hip impingement patients even in the presence of co-existing pathomorphology.
主要目的是确定胫骨远端旋转截骨术(DTDO)治疗胫骨畸形髋部疼痛后的短期临床结果,并回顾共存的病理形态如何影响治疗。所有因髋部疼痛伴胫骨旋转畸形而行DTDO的患者被认为是主要病因。假设正常胫骨扭转范围为0-40°,经踝线相对于股骨后髁测量。所有患者髋关节撞击试验屈曲内收内旋试验(FADIR)均为阳性。年龄大于50岁或出现退行性关节改变和神经肌肉疾病的患者被排除在外。观察到相关的同侧mri定义的关节内病理形态学(cam/钳子),非cam/钳子相关的唇裂和异常的股/髋臼联合形态(McKibbin指数)。分析术前、术后功能结局。32例患者行DTDO。平均胫骨扭转度48.8°(41 ~ 63°),平均年龄27岁(18 ~ 44岁),平均随访时间30个月(16 ~ 45个月)。9例患者(28%)夹持钳/夹持钳共存,8例患者(25%)McKibbin指数过高(51 ~ 76°)。总体而言,63%的患者(包括54%的共存病理患者)在单独DTDO后显着改善了髋关节功能。术前与术后12个月的评分计算如下:国际髋关节预后工具-12 - 41 vs 67 (P <0.01);髋部预后评分日常生活活动量表- 47 vs 70 (P <0.05);和髋关节预后评分运动量表- 36比64 (P <0.05)。髋部疼痛患者通常表现为胫骨和/或股骨旋转畸形和cam/钳子病变的组合。重要的是考虑胫骨畸形作为髋关节疼痛的病因。在有症状的髋关节撞击患者中,即使存在共存的病理形态,采用DTDO进行胫骨旋转也能在12个月内取得显著的临床和功能恢复。
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引用次数: 0
A bibliometric analysis and visualization of research trends on periacetabular osteotomy 髋臼周围截骨术研究趋势的文献计量分析与可视化
4区 医学 Q3 ORTHOPEDICS Pub Date : 2023-11-10 DOI: 10.1093/jhps/hnad038
Tengfei Wei, Fangjun Xiao, Xiaoming He, Peng Peng, Wei He, Mincong He, Qiushi Wei
ABSTRACT Bernese periacetabular osteotomy (PAO) is a practical and safe acetabular reorientation technique used to correct structural hip deformities, and much relevant literature has been published over the past decades. This bibliometric study aims to determine the status of PAO research between 1994 and 2022. Information about PAO research publications from 1994 to 2022 was obtained from the Web of Science Core Collection. This bibliometric study is implemented and analyzed through three bibliometric tools with respect to publication counts, countries, institutions, authors, journals, funding agencies, references and keywords. In total, 634 publications concerning PAO were identified. The United States and Washington University in St. Louis have published the most literature in terms of country and institution. Additionally, Switzerland and the University of Bern are the country and the institution with the highest average number of citations in the PAO field. The most published and co-cited journal is Clinical Orthopaedics and Related Research. Burst keyword detection has discovered that ‘patient-reported outcome’, ‘instability’, ‘risk’, ‘survivorship’ and ‘outcome’ are regarded as the current research frontier. In summary, our findings provide insight into the bibliometric overview of research status in the PAO field, which may offer later investigators’ references in exploring further research directions.
摘要:Bernese髋臼周围截骨术(PAO)是一种实用、安全的髋臼复位技术,用于纠正髋关节结构性畸形,在过去的几十年里发表了许多相关的文献。本文献计量学研究旨在确定1994年至2022年间PAO研究的现状。1994 - 2022年PAO研究出版物信息来源于Web of Science Core Collection。本文献计量学研究是通过三种文献计量学工具来实施和分析的,包括出版数量、国家、机构、作者、期刊、资助机构、参考文献和关键词。共鉴定出634篇有关PAO的出版物。在国家和机构方面,美国和圣路易斯华盛顿大学发表的文献最多。此外,瑞士和伯尔尼大学是PAO领域平均被引用次数最高的国家和机构。出版和被共同引用最多的期刊是《临床骨科及相关研究》。突发关键词检测发现,“患者报告的结果”、“不稳定性”、“风险”、“生存”和“结果”被视为当前的研究前沿。综上所述,我们的研究结果为PAO领域的研究现状提供了文献计量学综述,为后续研究者探索进一步的研究方向提供了参考。
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引用次数: 0
Does preoperative gabapentin or intraoperative ketorolac influence postoperative pain following hip arthroscopy? 术前加巴喷丁或术中酮咯酸是否影响髋关节镜术后疼痛?
4区 医学 Q3 ORTHOPEDICS Pub Date : 2023-10-31 DOI: 10.1093/jhps/hnad031
Alex M Meyer, Krit Petrachaianan, Natalie A Glass, Robert W Westermann
ABSTRACT Optimization of perioperative analgesia has important implications for patient satisfaction and short-term outcomes. This study’s purpose is to assess if preoperative gabapentin or intraoperative ketorolac influences postoperative pain or time to discharge following hip arthroscopy. In total, 409 patients who underwent hip arthroscopic femoroplasty and/or acetabuloplasty with a single surgeon for femoroacetabular impingement were retrospectively reviewed (September 2017 to February 2021). The effect of preoperative gabapentin or intraoperative ketorolac on postoperative visual analog scale (VAS) pain scores, perioperative opioids in morphine milligram equivalents (MMEs), time in post-anesthesia care unit (PACU), second-stage recovery and time to discharge was assessed using unadjusted and adjusted t-tests, and generalized linear models controlling for operative time, traction time, preoperative MME, intraoperative MME and postoperative MME were compared between the groups of gabapentin to no gabapentin and ketorolac to no ketorolac. There was no difference in first PACU VAS pain score, final PACU VAS score, VAS pain score prior to discharge, average VAS pain score or pain level on follow-up call in the unadjusted or adjusted analysis for the preoperative gabapentin or intraoperative ketorolac groups. Females had higher first PACU VAS pain score (6.05 versus 5.15 P = 0.0026), final PACU VAS pain score (4.43 versus 3.90, P = 0.0045), final VAS pain score prior to discharge (3.87 versus 3.03, P &lt; 0.001) and average postoperative pain score (4.60 versus 4.03, P &lt; 0.001), but no difference in VAS pain score on follow-up call following surgery. Gabapentin or ketorolac was not associated with decreased VAS pain scores or time to discharge after hip arthroscopy.
围手术期镇痛的优化对患者满意度和短期预后具有重要意义。本研究的目的是评估术前加巴喷丁或术中酮罗拉酸是否影响髋关节镜术后疼痛或出院时间。共有409例患者接受了髋关节镜下股骨成形术和/或髋臼成形术治疗股髋臼撞击(2017年9月至2021年2月)。术前加巴喷丁或术中酮妥拉克对术后视觉模拟量表(VAS)疼痛评分、围手术期吗啡毫克当量阿片类药物(MMEs)、麻醉后护理单元(PACU)时间、第二阶段恢复和出院时间的影响采用未调整和调整t检验,并采用控制手术时间、牵引时间、术前MME、比较加巴喷丁组与不加巴喷丁组、酮罗拉酸组与不加酮罗拉酸组术中MME和术后MME的差异。术前加巴喷丁组和术中酮罗拉酸组的首次PACU VAS疼痛评分、最终PACU VAS评分、出院前VAS疼痛评分、平均VAS疼痛评分或随访时疼痛水平在未调整或调整分析中均无差异。女性患者首次PACU VAS疼痛评分(6.05比5.15 P = 0.0026)、最终PACU VAS疼痛评分(4.43比3.90,P = 0.0045)、出院前最终VAS疼痛评分(3.87比3.03,P <0.001)和术后平均疼痛评分(4.60比4.03,P <0.001),但术后随访时VAS疼痛评分无差异。加巴喷丁或酮罗拉酸与降低VAS疼痛评分或髋关节镜术后出院时间无关。
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引用次数: 0
What the papers say. 报纸怎么说。
IF 1.5 4区 医学 Q3 ORTHOPEDICS Pub Date : 2023-10-18 eCollection Date: 2023-07-01 DOI: 10.1093/jhps/hnad033
Ali Bajwa
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引用次数: 0
Prognosis and risk prediction of bone impaction grafting through femoral head–neck fenestration: a retrospective cohort study 股骨头颈开窗骨嵌塞移植术的预后及风险预测:一项回顾性队列研究
4区 医学 Q3 ORTHOPEDICS Pub Date : 2023-10-16 DOI: 10.1093/jhps/hnad035
Hao Chen, Shuai He, Hongzhong Xi, Peng Xue, Guangquan Sun, Bin Du, Xin Liu
ABSTRACT The bone impaction grafting through femoral head–neck fenestration was a favorable hip preservation procedure but without prognosis estimation. This study retrospectively reviewed 79 patients’ clinical data (114 hips) with osteonecrosis of the femoral head (ONFH) who underwent this procedure from June 2009 to June 2019. By the end of June 2022, the median survival time of the hip was (74.13 ± 44.88) months, and the success rate of hip preservation was 68.42%. Lateral reserved angle (LPA) and combined reserved angle (CPA) had statistically significant differences (P &lt; 0.001) both in univariate analysis and a multivariate logistic regression model. The multivariate logistic regression model of area under curve (AUC) area of the receiver operating characteristic (ROC) curve was 0.931(sensitivity = 95.00%, specificity = 88.40%, log-rank test: P &lt; 0.01), and the calibration curve indicated good prediction accuracy. The ROC analysis and Cox proportional hazards regression model revealed that the cutoff point of LPA was 50.95° (sensitivity = 95.00%, specificity = 72.09%, log-rank test: P &lt; 0.05) and the cutoff point of CPA was 90.51° (sensitivity = 90.00%, specificity = 90.70%, log-rank test: P &lt; 0.05). A nomogram plot to predict the risk of failure (C-index = 0.873, 95% CI: 0.785 to 0.961) and nomograms for predicting the survival probability at 1, 2 or 3 years whose calibration curves showed excellent prediction accuracy were available for the clinician. Preserved angles (PAs) are valuable in the prediction of prognosis in surgical treatment. The bone impaction grafting through femoral head–neck fenestration can achieve better clinical efficacy, especially for patients with LPA &gt;50.95° and CPA &gt;90.51°.
股骨头颈开孔骨嵌塞移植术是一种良好的髋关节保存方法,但缺乏预后评估。本研究回顾性回顾了2009年6月至2019年6月期间接受该手术的79例(114髋)股骨头坏死(ONFH)患者的临床资料。截至2022年6月底,髋关节中位生存时间为(74.13±44.88)个月,髋关节保存成功率为68.42%。侧位保留角(LPA)与联合保留角(CPA)差异有统计学意义(P <0.001),在单因素分析和多因素逻辑回归模型。受试者工作特征(ROC)曲线下面积(AUC)面积的多元logistic回归模型为0.931(灵敏度= 95.00%,特异性= 88.40%,log-rank检验:P <0.01),标定曲线显示较好的预测精度。ROC分析和Cox比例风险回归模型显示,LPA的截断点为50.95°(敏感性= 95.00%,特异性= 72.09%,log-rank检验:P <0.05), CPA截断点为90.51°(敏感性= 90.00%,特异性= 90.70%,log-rank检验:P <0.05)。预测失败风险的nomogram plot (C-index = 0.873, 95% CI: 0.785 ~ 0.961)和预测1年、2年或3年生存率的nomogram graph (nomogram),其校准曲线显示出极好的预测准确性。保留角(PAs)在外科治疗中预测预后有重要价值。股骨头颈开窗骨嵌塞移植术临床疗效较好,尤其对于LPA >50.95°、CPA >90.51°的患者。
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引用次数: 0
Innovation in hip preservation surgery. 髋关节保留手术的创新。
IF 1.4 4区 医学 Q3 ORTHOPEDICS Pub Date : 2023-09-28 eCollection Date: 2023-07-01 DOI: 10.1093/jhps/hnad025
Richard E Field
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引用次数: 0
期刊
Journal of Hip Preservation Surgery
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