Journal of Orthopaedics and Traumatology最新文献_第4页

Autogenous structural bone graft reconstruction of ≥ 10-mm-deep uncontained medial proximal tibial defects in primary total knee arthroplasty 自体结构骨移植重建初级全膝关节置换术中深度≥ 10 毫米的胫骨内侧近端未闭合缺损

IF 2.8 2区医学 Q1 Medicine

Journal of Orthopaedics and Traumatology

Pub Date : 2024-04-23 DOI: 10.1186/s10195-024-00762-6

Ahmed Abdel-Monem Dewidar, Mohamed Kamal Mesregah, Mustafa Mohamed Mesriga, Ahmed Mohamed El-Behiry

Management of uncontained medial proximal tibial defects during primary total knee arthroplasty (TKA) can be challenging, especially for defects ≥ 10 mm in depth. This study sought to assess the outcomes of autogenous structural bone grafts to address these defects. In this prospective study, patients with uncontained medial proximal tibial defects ≥ 10 mm in depth undergoing TKA were managed by autogenous structural bone grafts fixed by screws and were followed up for at least 36 months. Patients were followed-up clinically with Knee Society Score (KSS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Additionally, radiological follow-up was done to assess bone graft union and implant stability. The study included 48 patients with a mean age of 69.2 ± 4.5 years. The mean body mass index (BMI) was 31.4 ± 3.7 kg/m2. The mean defect depth was 17 ± 3.6 mm. With a mean follow-up period of 52.2 ± 12.3 months, the median KSS improved significantly from 30 preoperatively to 89, P < 0.001. The median WOMAC score reduced significantly from 85 preoperatively to 30.5, P < 0.001. The mean ROM increased significantly from 73 ± 12.4 preoperatively to 124 ± 8.4 degrees, P < 0.001. The mean graft union time was 4.9 ± 1 months. No significant complications were reported. Autogenous bone graft reconstruction is a safe and effective method of addressing uncontained medial proximal tibial defects in primary TKA. Level IV.

在初级全膝关节置换术（TKA）中，处理胫骨内侧近端未愈合的缺损具有挑战性，尤其是深度≥ 10 毫米的缺损。本研究旨在评估自体结构骨移植治疗这些缺损的效果。在这项前瞻性研究中，对胫骨内侧近端深度≥10毫米的非封闭性缺损患者进行了TKA手术，采用自体结构性植骨并用螺钉固定，随访至少36个月。通过膝关节社会评分（KSS）和西安大略和麦克马斯特大学骨关节炎指数（WOMAC）对患者进行临床随访。此外，还进行了放射学随访，以评估植骨结合和植入物的稳定性。研究共纳入48名患者，平均年龄为（69.2 ± 4.5）岁。平均体重指数（BMI）为 31.4 ± 3.7 kg/m2。平均缺损深度为 17 ± 3.6 毫米。平均随访时间为（52.2 ± 12.3）个月，KSS中位数从术前的30分显著提高到89分，P < 0.001。WOMAC评分中位数从术前的85分明显降低到30.5分，P < 0.001。平均活动度从术前的 73 ± 12.4 度明显增加到 124 ± 8.4 度，P < 0.001。平均移植物结合时间为 4.9 ± 1 个月。无重大并发症报告。自体骨移植重建是一种安全有效的方法，可解决初次 TKA 中胫骨近端内侧缺损的问题。四级。

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引用次数: 0

Functional and oncological outcomes of patients with proximal humerus osteosarcoma managed by limb salvage 肱骨近端骨肉瘤患者通过肢体抢救治疗后的功能和肿瘤预后

IF 2.8 2区医学 Q1 Medicine

Journal of Orthopaedics and Traumatology

Pub Date : 2024-04-18 DOI: 10.1186/s10195-024-00756-4

Wael Mohamed Safwat Sadek, Ibrahim Khairy Fayed Elshamly, Moustafa Saladin Mohammed Salem, Wessam Gamal AbouSenna, Emad Ebeid, Walid Atef Ebeid

Osteosarcoma is the most common primary bone malignancy in skeletally immature patients. The proximal humerus is the third most common site of osteosarcoma. The literature shows a paucity of published data concerning the outcome of proximal humerus osteosarcoma managed by limb salvage. The purpose of this study was to answer the following questions: (1) do patients with proximal humerus osteosarcoma managed by limb salvage and neoadjuvant chemotherapy show good functional and oncological outcomes, and (2) are there any prognostic factors that are associated with better oncological and functional outcomes? The study was a retrospective case series study assessing the overall outcome of 34 patients with proximal humerus osteosarcoma. Eighteen patients were males (53%) while 16 were females. Biological reconstruction was done in 15 patients (44%), while nonbiological reconstruction was done in 19 patients. Resections were mainly intraarticular (82%). Functional outcome was assessed using the Musculoskeletal Tumor Society (MSTS) score, while oncological outcome was assessed based on local recurrence and development of chest metastasis. Comparisons between quantitative variables were done using the nonparametric Mann–Whitney test. To compare categorical data, the chi-square (χ2) test was performed. The exact test was used instead when the expected frequency was less than 5. Correlations between quantitative variables were examined using the Spearman correlation coefficient. The mean MSTS score was 25.5 (range 23–29). A younger age was statistically correlated with a poorer MSTS score (P = 0.0016). Six patients out of 34 (17.6%) had local recurrence and four of them (67%) were treated by forequarter amputation. 41% of patients developed chest metastasis, and the majority of them were treated by chemotherapy (71%). In comparison with patients with osteosarcoma at other sites who were also managed in our institution, proximal humerus osteosarcoma patients showed higher incidence rates of local recurrence and chest metastasis along with lower 5-year patient and limb survivorships compared to distal femur, proximal tibia and proximal femur osteosarcoma patients. Treatment of osteosarcoma of the proximal humerus by limb salvage and chemotherapy yields a good functional outcome. The method of reconstruction does not impact the resultant function. The 5-year survivorship of these patients is 65%. Younger patients have a better oncological outcome and an inferior functional outcome. Level IV therapeutic study.

骨肉瘤是骨骼尚未发育成熟的患者最常见的原发性骨恶性肿瘤。肱骨近端是骨肉瘤的第三大常见部位。文献显示，有关肱骨近端骨肉瘤通过肢体抢救治疗的结果的公开数据很少。本研究旨在回答以下问题：(1)肱骨近端骨肉瘤患者通过肢体抢救和新辅助化疗是否能获得良好的功能和肿瘤学疗效；(2)是否存在与更好的肿瘤学和功能疗效相关的预后因素？该研究是一项回顾性病例系列研究，评估了34例肱骨近端骨肉瘤患者的总体预后。18名患者为男性（53%），16名患者为女性。15名患者（44%）进行了生物重建，19名患者进行了非生物重建。切除术主要在关节内进行（82%）。功能预后采用肌肉骨骼肿瘤协会（MSTS）评分进行评估，而肿瘤预后则根据局部复发和胸部转移情况进行评估。定量变量之间的比较采用非参数 Mann-Whitney 检验。比较分类数据时，采用卡方（χ2）检验。当预期频率小于 5 时，则采用精确检验。定量变量之间的相关性采用斯皮尔曼相关系数进行检验。平均 MSTS 得分为 25.5（范围为 23-29）。从统计学角度看，年龄越小，MSTS 评分越低（P = 0.0016）。34 名患者中有 6 名（17.6%）出现局部复发，其中 4 名（67%）接受了前肢截肢治疗。41%的患者出现胸部转移，其中大部分患者（71%）接受了化疗。与同样在本院接受治疗的其他部位骨肉瘤患者相比，肱骨近端骨肉瘤患者的局部复发率和胸部转移率较高，患者和肢体的5年存活率也较股骨远端、胫骨近端和股骨近端骨肉瘤患者低。肱骨近端骨肉瘤通过肢体抢救和化疗可获得良好的功能预后。重建方法并不影响最终的功能。这些患者的 5 年生存率为 65%。年轻患者的肿瘤预后较好，而功能预后较差。四级治疗研究。

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引用次数: 0

Polytherapy versus monotherapy in the treatment of tibial non-unions: a retrospective study 治疗胫骨非整复的综合疗法与单一疗法：一项回顾性研究

IF 2.8 2区医学 Q1 Medicine

Journal of Orthopaedics and Traumatology

Pub Date : 2024-04-18 DOI: 10.1186/s10195-024-00763-5

Fangzhou Lu, Rald V. M. Groven, Martijn van Griensven, Martijn Poeze, Jan A. P. Geurts, Shan Shan Qiu, Taco J. Blokhuis

Treating tibial non-unions efficiently presents a challenge for orthopaedic trauma surgeons. The established gold standard involves implanting autologous bone graft with adequate fixation, but the addition of biologicals according to the so-called diamond concept has become increasingly popular in the treatment of non-unions. Previous studies have indicated that polytherapy, which involves implanting mesenchymal stem cells, bioactive factors and osteoconductive scaffolds, can improve bone healing. This study aims to evaluate the efficacy of polytherapy compared with monotherapy in treating tibial non-unions of varying severity. Data from consecutive tibial non-unions treated between November 2014 and July 2023 were retrospectively analysed. The Non Union Scoring System (NUSS) score before non-union surgery, and the Radiographic Union Score for Tibial fractures (RUST), scored at 1, 3, 6, 9, 12 and 18 months post-surgery, were recorded. Initially, a comparison was made between the polytherapy and monotherapy groups. Subsequently, patients receiving additional surgical non-union treatment were documented, and the frequency of these treatments was tallied for a subsequent per-treatment analysis. A total of 34 patients were included and divided into a polytherapy group (n = 15) and a monotherapy group (n = 19). The polytherapy group demonstrated a higher NUSS score (44 (39, 52) versus 32 (29, 43), P = 0.019, z = −2.347) and a tendency towards a higher success rate (93% versus 68%, P = 0.104) compared with the monotherapy group. For the per-treatment analysis, 44 treatments were divided into the polytherapy per-treatment group (n = 20) and the monotherapy per-treatment group (n = 24). The polytherapy per-treatment group exhibited a higher NUSS score (48 (43, 60) versus 38 (30, 50), P = 0.030, z = −2.173) and a higher success rate (95% versus 58%, P = 0.006) than the monotherapy per-treatment group. Within the monotherapy per-treatment group, the NUSS score displayed excellent predictive performance (AUC = 0.9143). Setting the threshold value at 48, the sensitivity and specificity were 100.0% and 70.0%, respectively. Polytherapy is more effective than monotherapy for severe tibial non-unions, offering a higher success ratio. The NUSS score supports decision-making in treating tibial non-unions. Level III.

如何有效治疗胫骨非塌陷是创伤骨科医生面临的一项挑战。既定的金标准包括植入自体骨移植并进行适当固定，但根据所谓的钻石概念添加生物制剂在治疗非胫骨髁内翻方面越来越受欢迎。以往的研究表明，多疗法（包括植入间充质干细胞、生物活性因子和骨诱导支架）可改善骨愈合。本研究旨在评估多元疗法与单一疗法相比，在治疗不同严重程度的胫骨非塌陷方面的疗效。研究人员回顾性分析了2014年11月至2023年7月期间连续接受治疗的胫骨非联合患者的数据。记录了不愈合手术前的不愈合评分系统（NUSS）评分，以及手术后1、3、6、9、12和18个月的胫骨骨折放射学愈合评分（RUST）。最初，对多疗法组和单一疗法组进行了比较。随后，记录了接受额外手术治疗的患者，并统计了这些治疗的频率，以便进行后续的每次治疗分析。共纳入了 34 名患者，并将其分为多种疗法组（15 人）和单一疗法组（19 人）。与单药治疗组相比，多药治疗组的 NUSS 评分更高（44（39，52）分对 32（29，43）分，P = 0.019，z = -2.347），成功率也更高（93% 对 68%，P = 0.104）。在每次治疗的分析中，44 次治疗被分为每次治疗的多疗法组（n = 20）和每次治疗的单疗法组（n = 24）。与单疗法治疗组相比，多疗法治疗组的 NUSS 评分更高（48 分（43，60）对 38 分（30，50），P = 0.030，z = -2.173），成功率更高（95% 对 58%，P = 0.006）。在单药治疗组中，NUSS 评分显示出极佳的预测性能（AUC = 0.9143）。将临界值设定为 48，灵敏度和特异度分别为 100.0% 和 70.0%。对于严重的胫骨骨不连，联合疗法比单一疗法更有效，成功率更高。NUSS 评分可为治疗胫骨非整复提供决策支持。三级

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引用次数: 0

Lateralising reverse shoulder arthroplasty using bony increased offset (BIO-RSA) or increasing glenoid component diameter: comparison of clinical, radiographic and patient reported outcomes in a matched cohort 使用骨性增大偏移（BIO-RSA）或增大盂状组件直径的侧向化反肩关节置换术：配对队列中临床、放射学和患者报告结果的比较

IF 2.8 2区医学 Q1 Medicine

Journal of Orthopaedics and Traumatology

Pub Date : 2024-04-18 DOI: 10.1186/s10195-024-00764-4

Arno A. Macken, Geert Alexander Buijze, Michael Kimmeyer, Tilman Hees, Denise Eygendaal, Michel van den Bekerom, Laurent Lafosse, Thibault Lafosse

This study aims to compare the range of motion (ROM) of reverse shoulder arthroplasty lateralised by bony increased offset (BIO-RSA) using a standard 38-mm (mm) component to regular reverse shoulder arthroplasty (RSA) lateralised by using a 42-mm glenoid component. The secondary aims are to compare patient-reported and radiographic outcomes between the two groups. All patients with a BIO-RSA and size 38 glenosphere were retrospectively identified and matched to patients with a regular RSA and size 42 glenosphere. Matched patients were invited for a follow-up visit. ROM was assessed as well as radiographic outcomes (lateralisation, distalisation, inferior overhang, scapular notching, heterotopic bone formation, radiolucency, stress shielding, bone graft healing and viability and complications) and patient-reported outcomes (subjective shoulder value, Constant score, American Shoulder and Elbow Surgeons, activities of daily living which require internal rotation, activities of daily living which require external rotation and a visual analogue scale for pain). Outcomes were compared between the two groups. In total, 38 BIO-RSAs with a size 38 glenosphere were matched to 38 regular RSAs with a size 42 glenosphere. Of the 76 matched patients, 74 could be contacted and 70 (95%) were included. At the final follow-up, there were no differences between the two groups in ROM, patient-reported outcomes or radiographic outcomes (p > 0.485). Using a larger glenosphere is a feasible alternative to BIO-RSA for lateralising RSA, providing comparable ROM, patient-reported and radiographic results, while potentially decreasing costs, operative time and complication rates. Level of evidence III.

本研究旨在比较使用标准38毫米（mm）组件的骨性增加偏移侧向反向肩关节置换术（BIO-RSA）与使用42毫米盂组件的常规侧向反向肩关节置换术（RSA）的运动范围（ROM）。次要目的是比较两组患者的患者报告和放射学结果。对所有使用 BIO-RSA 和 38 号盂成形组件的患者进行回顾性鉴定，并与使用普通 RSA 和 42 号盂成形组件的患者进行配对。配对患者被邀请进行随访。对患者的活动度、影像学结果（侧化、远端化、下悬、肩胛骨切迹、异位骨形成、放射性、应力屏蔽、植骨愈合和存活率以及并发症）和患者报告结果（肩部主观价值、Constant评分、美国肩肘外科医生评分、需要内旋的日常生活活动、需要外旋的日常生活活动以及疼痛视觉模拟量表）进行评估。两组结果进行了比较。共有 38 例采用 38 号关节囊的 BIO-RSA 与 38 例采用 42 号关节囊的普通 RSA 进行了配对。在 76 名配对患者中，有 74 人可以联系上，其中 70 人（95%）被纳入配对。在最后的随访中，两组患者在ROM、患者报告结果或放射学结果方面均无差异（P > 0.485）。在侧位RSA中，使用较大的关节囊是BIO-RSA的可行替代方案，可提供相似的ROM、患者报告结果和影像学结果，同时可能降低成本、手术时间和并发症发生率。证据等级 III。

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引用次数: 0

Delaying anterior cruciate ligament reconstruction for more than 3 or 6 months results in lower risk of revision surgery 将前十字韧带重建延迟 3 个月或 6 个月以上会降低翻修手术的风险

IF 2.8 2区医学 Q1 Medicine

Journal of Orthopaedics and Traumatology

Pub Date : 2024-04-18 DOI: 10.1186/s10195-024-00759-1

Helena Amstrup Jensen, Torsten Grønbech Nielsen, Martin Lind

The objective of this study is to investigate the risk of revision surgery when delaying anterior cruciate ligament reconstruction (ACLR) past 3 months or 6 months after injury. A total of 30,280 patients with isolated ACLR were identified in the Danish Knee Ligament Reconstruction Registry and divided into four groups; ACLR < 3 months, > 3 months, < 6 months, or > 6 months after injury. Primary outcome was revision surgery and secondary outcome were objective and subjective clinical outcome. The 2 year relative risk, crude, and adjusted hazard ratio (HR) were calculated. Comparing ACLR < 3 months to ACLR > 3 months of injury the 2 year relative risk of revision surgery was found to be 1.81 (95% CI 1.46–2.23; P < 0.001) with an adjusted hazard ratio (HR) of 1.27 (95% CI 1.12–1.44; P < 0.001). Comparing ACLR < 6 months to ACLR > 6 months of injury the 2 year relative risk of revision surgery was found to be 1.61 (95% CI 1.34–1.92; P < 0.001) with an adjusted HR of 1.27 (95% CI 1.15–1.40; P < 0.001). The risk of revision ACLR surgery was found to be increased when ACLR was performed within 3 months or 6 months of injury compared with later surgery. The 1 year postoperative objective knee laxity and the subjective patient-related outcome was found to be without a clinically significant difference; however, those with early ACLR (< 3 months or < 6 months) were found to have a higher activity level 1 year postoperatively. The information about increased risk of revision when having early surgery should be informed to patients when deciding timing of ACLR treatment. Level of evidence: II.

这项研究的目的是调查前交叉韧带重建术（ACLR）延迟到伤后 3 个月或 6 个月后进行翻修手术的风险。丹麦膝关节韧带重建登记处共登记了30280名孤立前交叉韧带重建患者，并将其分为四组：受伤后3个月或6个月进行前交叉韧带重建。主要结果为翻修手术，次要结果为客观和主观临床结果。计算2年的相对风险、粗略和调整后的危险比（HR）。与受伤后3个月进行的前交叉韧带置换术相比，2年内翻修手术的相对风险为1.81（95% CI 1.46-2.23）；与受伤后6个月进行的前交叉韧带置换术相比，2年内翻修手术的相对风险为1.61（95% CI 1.34-1.92；P < 0.001），调整后的HR为1.27（95% CI 1.15-1.40；P < 0.001）。研究发现，在受伤后3个月或6个月内进行前交叉韧带重建手术的风险要高于之后进行的手术。术后1年的膝关节客观松弛度和患者主观相关结果无显著临床差异；然而，早期进行前交叉韧带重建（小于3个月或小于6个月）的患者术后1年的活动水平更高。在决定前交叉韧带重建治疗时机时，患者应了解早期手术会增加翻修风险的信息。证据等级：II.

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引用次数: 0

Capacitive biophysical stimulation improves the healing of vertebral fragility fractures: a prospective multicentre randomized controlled trial 电容性生物物理刺激改善脊椎脆性骨折的愈合：一项前瞻性多中心随机对照试验

IF 2.8 2区医学 Q1 Medicine

Journal of Orthopaedics and Traumatology

Pub Date : 2024-04-15 DOI: 10.1186/s10195-024-00758-2

Andrea Piazzolla, Davide Bizzoca, Giovanni Barbanti-Brodano, Matteo Formica, Luca Pietrogrande, Umberto Tarantino, Stefania Setti, Biagio Moretti, Giuseppe Solarino

Capacitively coupling electric fields (CCEF) is a method of non-invasive biophysical stimulation that enhances fracture repair and spinal fusion. This multicentre randomized controlled trial aimed to further examine the roles of CCEF in (1) the resolution of vertebral bone marrow oedema (VBME) using a follow-up MRI study and (2) pain relief, analgesic drug consumption and quality of life improvement in stimulated patients who were referred with acute vertebral fragility fractures (VFFs) compared to non-stimulated patients. Between September 2016 and December 2019, patients who were referred to the spine centres that participated in this multicentre randomized clinical study with acute VFFs of type OF1 or OF2 were included in the present study. All the VFFs were conservatively managed according to Good Clinical Practice. Moreover, the patients were randomized into two groups: the CCEF group received, as an adjunct to the clinical study protocol, biophysical stimulation with a CCEF device (Osteospine, IGEA) for 8 h per day for 60 days, whereas the control group was treated according to the clinical study protocol. At baseline (T0), the 30-day follow-up (T1), the 60-day follow-up (T2), and the 6-month follow-up (T3), each patient underwent clinical evaluation using the Visual Analogue Scale (VAS) for Pain and the Oswestry Disability Index (ODI). Analgesic therapy with paracetamol 1000 mg tablets for 7 days—or longer, depending on the pain intensity—was performed; patients were required to report their paracetamol consumption on a specific sheet between study day 8 to 180 days of follow-up. MRI studies of the thoracolumbar spine were performed at 0 (T0), 30 (T1) and 60 days of follow-up (T2) using a 1.5-T MRI system in all of the centres that took part in the study. For each VBME area examined via MRI, the vertebral body geometry (i.e. anterior wall height/posterior wall height and vertebral kyphosis) were assessed. A total of 66 patients (male: 9, 13.63%; mean age: 73.15 years old) with 69 VFFs were included in the present study and randomized as follows: 33 patients were included in the control group and the remaining 33 patients were randomized into the CCEF group. In the CCEF group, good compliance with CCEF therapy was observed (adherence = 94%), and no adverse effects were recorded. In the stimulated patients, faster VBME resolution and significantly less vertebral body collapse during follow-up were observed compared to the control patients. Moreover, in the active group, faster pain reduction and improvement in the ODI mean score were observed. Stimulated patients also reported a significantly lower paracetamol consumption rate from the third follow-up after treatment until the 6-month follow-up. In terms of sex-related differences, in the CCEF group, VBME showed a faster resolution in male patients compared with females. Biophysical stimulation with CCEF, as an adjunct to traditional conservative treatment, is a useful tool to hasten the VBM

电容耦合电场（CCEF）是一种非侵入性生物物理刺激方法，可促进骨折修复和脊柱融合。这项多中心随机对照试验旨在进一步研究电容耦合电场在以下方面的作用：（1）通过磁共振成像随访研究了解椎体骨髓水肿（VBME）的消退情况；（2）与未接受刺激的患者相比，接受刺激的急性椎体脆性骨折（VFF）转诊患者的疼痛缓解情况、镇痛药物消耗量和生活质量改善情况。2016年9月至2019年12月期间，参与这项多中心随机临床研究的脊柱中心将转诊的OF1型或OF2型急性椎体脆性骨折患者纳入本研究。所有 VFF 均按照 "良好临床实践 "进行保守治疗。此外，患者被随机分为两组：CCEF组作为临床研究方案的辅助手段，接受CCEF设备（Osteospine，IGEA）的生物物理刺激，每天8小时，持续60天；而对照组则按照临床研究方案进行治疗。在基线（T0）、30 天随访（T1）、60 天随访（T2）和 6 个月随访（T3）期间，每位患者都接受了疼痛视觉模拟量表（VAS）和 Oswestry 残疾指数（ODI）的临床评估。根据疼痛强度，患者需接受为期 7 天（或更长时间）的扑热息痛 1000 毫克片剂镇痛治疗；患者需在研究第 8 天至随访 180 天期间在特定表格上报告其扑热息痛用量。所有参与研究的中心都使用了 1.5 T 核磁共振成像系统，在随访的 0 天（T0）、30 天（T1）和 60 天（T2）对胸腰椎进行了核磁共振成像检查。通过核磁共振成像检查的每个 VBME 区域，都对椎体几何形状（即前壁高度/后壁高度和椎体后凸）进行了评估。本研究共纳入了 66 名患有 69 个 VFF 的患者（男性：9 名，占 13.63%；平均年龄：73.15 岁），并对其进行了以下随机分组：33 名患者被纳入对照组，其余 33 名患者被随机纳入 CCEF 组。在CCEF组中，患者对CCEF疗法的依从性良好（依从性=94%），且无不良反应记录。与对照组患者相比，受刺激组患者的椎体后凸轮增生（VBME）消退更快，随访期间椎体塌陷明显减少。此外，在积极治疗组中，疼痛减轻的速度更快，ODI 平均得分也有所提高。从治疗后的第三次随访到 6 个月的随访期间，受刺激患者的扑热息痛用量也明显减少。就性别差异而言，在CCEF组，男性患者的VBME缓解速度快于女性。作为传统保守治疗的辅助手段，CCEF生物物理刺激是加速VBME缓解过程和防止椎体变形的有效工具。这些磁共振成像结果也与背痛的快速缓解和生活质量的改善相关。从治疗后的第三次随访到 6 个月的随访，刺激组患者的扑热息痛用量明显低于对照组患者，尽管两组患者的背痛和生活质量没有明显差异。II.试验注册登记：ClinicalTrials.gov，编号：NCT05803681：NCT05803681。

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引用次数: 0

Interlocking intramedullary nail for forearm diaphyseal fractures in adults—A systematic review and meta-analysis of outcomes and complications 治疗成人前臂骺端骨折的交锁髓内钉--对结果和并发症的系统回顾和荟萃分析

IF 2.8 2区医学 Q1 Medicine

Journal of Orthopaedics and Traumatology

Pub Date : 2024-04-13 DOI: 10.1186/s10195-024-00761-7

Ali Lari, Yousef Hassan, Abdulwahab Altammar, Ali Esmaeil, Abdulaziz Altammar, Carlos Prada, Ali Jarragh

The purpose of this systematic review is to examine the outcomes, complications, and potential advantages of using anatomical interlocking intramedullary nails (IMN) in the treatment of radius and ulnar shaft diaphyseal fractures in adults. Medline, Embase, Web of Science, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases were searched between January 2000 and January 2023. Studies meeting criteria were observational or randomized controlled trials evaluating outcomes in IMN for adult diaphyseal forearm fractures. Standardized data extraction was performed and a quality assessment tool was used to evaluate individual study methodology. Descriptive statistics for interventions, functional outcomes, and complications were reported. Meta-analysis was performed for patient-reported outcome measures and operative time. A total of 29 studies involving 1268 patients were included with 764 (60%) undergoing IMN, 21% open reduction and internal fixation (ORIF), and 9% hybrid fixation. There was no significant difference between groups in DASH and Grace–Eversmann scores. Operative time was significantly shorter in IMN compared with ORIF. The DASH scores were: 13.1 ± 6.04 for IMN, 10.17 ± 3.98 for ORIF, and 15.5 ± 0.63 in hybrids. Mean operative time was 65.3 ± 28.7 in ORIF and 50.8 ± 17.7 in IMN. Complication rates were 16.7% in the IMN group, 14.9% in ORIF, and 6.3% in hybrid constructs. There were 11 cases of extensor pollicis rupture in the IMN group. Average IMN pronation and supination were 78.3° ± 7.9° and 73° ± 5.0°, respectively. Average ORIF pronation and supination was 82.15° ± 1.9° and 79.7° ± 4.5°, respectively. Similar functional outcomes and complication rates along with shorter operative times can be achieved with IMN compared with ORIF. The use of IMN is promising, however, higher quality evidence is required to assess appropriate indications, subtle differences in range of motion, implant-related complications, and cost-effectiveness. Trail Registration PROSPERO (International Prospective Register of Systematic Reviews) (ID: CRD42022362353). Level of evidence III.

本系统性综述旨在研究使用解剖交锁髓内钉（IMN）治疗成人桡骨和尺骨骨干骺端骨折的效果、并发症和潜在优势。检索了 2000 年 1 月至 2023 年 1 月期间的 Medline、Embase、Web of Science 和 Cumulative Index to Nursing and Allied Health Literature (CINAHL) 数据库。符合标准的研究均为观察性或随机对照试验，评估了 IMN 治疗成人前臂骨骺骨折的效果。研究人员进行了标准化的数据提取，并使用质量评估工具对各项研究的方法进行了评估。报告了干预措施、功能结果和并发症的描述性统计。对患者报告的结果指标和手术时间进行了 Meta 分析。共纳入了29项研究，涉及1268名患者，其中764人（60%）接受了IMN手术，21%接受了开放复位内固定术（ORIF），9%接受了混合固定术。各组间的 DASH 和 Grace-Eversmann 评分无明显差异。IMN的手术时间明显短于ORIF。DASH评分为IMN为（13.1 ± 6.04）分，ORIF为（10.17 ± 3.98）分，混合型为（15.5 ± 0.63）分。ORIF 的平均手术时间为 65.3 ± 28.7，IMN 为 50.8 ± 17.7。IMN组的并发症发生率为16.7%，ORIF组为14.9%，混合结构组为6.3%。IMN组有11例伸肌断裂。IMN组的平均前伸和上举角度分别为78.3°±7.9°和73°±5.0°。ORIF的平均前伸和后仰角度分别为82.15°±1.9°和79.7°±4.5°。与 ORIF 相比，IMN 可实现相似的功能效果和并发症发生率，且手术时间更短。IMN的应用前景广阔，但还需要更高质量的证据来评估适当的适应症、活动范围的细微差别、植入物相关并发症以及成本效益。追踪注册 PROSPERO（系统性综述国际前瞻性注册）（ID：CRD42022362353）。证据等级 III。

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引用次数: 0

Evaluation of time to reimplantation as a risk factor in two-stage revision with static spacers for periprosthetic knee joint infection. 在使用静态垫片治疗膝关节周围感染的两阶段翻修中，评估重新植入时间作为风险因素的作用。

IF 2.8 2区医学 Q1 Medicine

Journal of Orthopaedics and Traumatology

Pub Date : 2024-03-25 DOI: 10.1186/s10195-024-00745-7

Jan Puetzler, Marc Hofschneider, Georg Gosheger, Christoph Theil, Martin Schulze, Jan Schwarze, Raphael Koch, Burkhard Moellenbeck

Introduction: We investigated the time to reimplantation (TTR) during two-stage revision using static spacers with regard to treatment success and function in patients with chronic periprosthetic joint infection (PJI) of the knee.

Methods: 163 patients (median age 72 years, 72 women) who underwent two-stage exchange for chronic knee PJI between 2012 and 2020 were retrospectively analyzed (based on the 2011 Musculoskeletal Infection Society criteria). A cutoff TTR for increased risk of reinfection was identified using the maximally selected log-rank statistic. Infection control, aseptic revisions and overall survival were analyzed using Kaplan-Meier survival estimates. Adjustment for confounding factors-the Charlson Comorbidity Index (CCI) and C-reactive protein (CRP)-was done with a Cox proportional hazards model.

Results: When TTR exceeded 94 days, the adjusted hazard of reinfection was increased 2.8-fold (95% CI 1.4-5.7; p = 0.0036). The reinfection-free rate was 67% (95% CI 52-79%) after 2 years and 33% (95% CI 11-57%) after 5 years for a longer TTR compared to 89% (95% CI 81-94%) and 80% (95% CI 69-87%) at 2 and 5 years, respectively, for a shorter TTR. Adjusted overall survival and number of aseptic revisions did not differ between the longer TTR and shorter TTR groups. Maximum knee flexion was 90° (IQR 84-100) for a longer TTR and 95° (IQR 90-100) for a shorter TTR (p = 0.0431), with no difference between the groups in Oxford Knee Score. Baseline characteristics were similar (body mass index, age, previous surgeries, microorganisms) for the two groups, except that there was a higher CCI (median 4 vs. 3) and higher CRP (median 3.7 vs 2.6 mg/dl) in the longer TTR group.

Conclusion: A long TTR is sometimes unavoidable in clinical practice, but surgeons should be aware of a potentially higher risk of reinfection.

Level of evidence: III, retrospective comparative study.

简介：方法：回顾性分析了2012年至2020年间因慢性膝关节PJI接受两阶段置换术的163例患者（中位年龄72岁，女性72例）（基于2011年肌肉骨骼感染学会标准）。采用最大选择对数秩统计法确定了再感染风险增加的TTR临界值。采用 Kaplan-Meier 存活率估算法分析了感染控制、无菌翻修和总存活率。使用 Cox 比例危险度模型对混杂因素--Charlson 合并症指数（CCI）和 C 反应蛋白（CRP）进行了调整：当 TTR 超过 94 天时，调整后的再感染风险增加了 2.8 倍（95% CI 1.4-5.7；P = 0.0036）。TTR越长，2年后无再感染率为67%（95% CI 52-79%），5年后为33%（95% CI 11-57%）；TTR越短，2年后无再感染率为89%（95% CI 81-94%），5年后为80%（95% CI 69-87%）。调整后的总生存率和无菌翻修次数在较长的TTR组和较短的TTR组之间没有差异。TTR较长的患者膝关节最大屈曲度为90°（IQR 84-100），TTR较短的患者膝关节最大屈曲度为95°（IQR 90-100）（p = 0.0431），两组患者的牛津膝关节评分无差异。两组患者的基线特征（体重指数、年龄、既往手术、微生物）相似，但TTR较长组的CCI（中位数为4 vs. 3）和CRP（中位数为3.7 vs. 2.6 mg/dl）较高：结论：在临床实践中，长TTR有时是不可避免的，但外科医生应意识到再感染的潜在风险较高：证据等级：III，回顾性比较研究。

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引用次数: 0

TikTok content as a source of health education regarding epicondylitis: a content analysis. 将 TikTok 内容作为上髁炎健康教育的来源：内容分析。

IF 2.8 2区医学 Q1 Medicine

Journal of Orthopaedics and Traumatology

Pub Date : 2024-03-23 DOI: 10.1186/s10195-024-00757-3

Riccardo D'Ambrosi, Enrico Bellato, Gianluca Bullitta, Antonio Benedetto Cecere, Katia Corona, Angelo De Crescenzo, Valentina Fogliata, Gian Mario Micheloni, Maristella Francesca Saccomanno, Fabrizio Vitullo, Andrea Celli

Purpose: This study aimed to assess the validity and informational value of TikTok content about epicondylitis. The hypothesis tested herein was that TikTok video content would not provide adequate and valid information.

Methods: The term "epicondylitis" was used as a keyword to comprehensively search for TikTok videos, and the first 100 videos that were retrieved were subsequently included for analysis. The duration, number of likes, number of shares and number of views were recorded for each video. Furthermore, the videos were categorized on the basis of their source (medical doctor, physiotherapist, or private user), type of information (physical therapy, anatomy, clinical examination, etiopathogenesis, patient experience, treatment, or other), video content (rehabilitation, education, or patient experience/testimony), and the presence of music or voice. Assessments of video content quality and reliability were conducted using the DISCERN tool, the Journal of the American Medical Association (JAMA) benchmark criteria, and the Global Quality Score (GQS).

Results: A total of 100 videos were included in the analysis: 78 (78.0%) were published by physiotherapists, 18 were published by medical doctors (18.0%), and 4 were published by private users (4.0%). Most of the information pertained to physical therapy (75; 75.0%) and most of the content was about rehabilitation (75; 75.0%). The mean length of the videos was 42.51 ± 24.75 seconds; the mean number of views was 193,207.78 ± 1,300,853.86; and the mean number of comments, likes, and shares were 22.43 ± 62.54, 1578.52 ± 8333.11, and 149.87 ± 577.73, respectively. The mean DISCERN score, JAMA score, and GQS were 18.12 ± 5.73, 0.80 ± 0.53, and 1.30 ± 0.52, respectively. Videos posted by medical doctors/private users had higher scores (p < 0.05) than videos posted by physiotherapists. Videos that focused on education or patient experience had higher scores (p < 0.05) than videos based on rehabilitation.

Conclusions: TikTok can be an unreliable source of information regarding epicondylitis treatment. It is common to find nonphysicians who share medical advice on the platform, with medical treatments demonstrating the weakest level of supporting evidence. Elbow surgeons should advise their patients that treatment recommendations from TikTok may not align with established guidelines.

Level of evidence: Level IV-Cross-sectional study.

目的：本研究旨在评估 TikTok 上髁炎内容的有效性和信息价值。本研究测试的假设是：TikTok 视频内容无法提供充分、有效的信息：以 "外上髁炎 "为关键词对 TikTok 视频进行全面搜索，并对搜索到的前 100 个视频进行分析。每个视频的持续时间、点赞数、分享数和观看数都被记录下来。此外，还根据视频来源（医生、物理治疗师或私人用户）、信息类型（物理治疗、解剖、临床检查、病因、患者经历、治疗或其他）、视频内容（康复、教育或患者经历/证词）以及是否有音乐或语音对视频进行了分类。使用 DISCERN 工具、《美国医学会杂志》（JAMA）基准标准和全球质量评分（GQS）对视频内容的质量和可靠性进行了评估：共有 100 个视频被纳入分析：78 个（78.0%）由物理治疗师发布，18 个由医生发布（18.0%），4 个由私人用户发布（4.0%）。大部分信息与物理治疗有关（75；75.0%），大部分内容与康复有关（75；75.0%）。视频的平均长度为 42.51 ± 24.75 秒；平均观看次数为 193,207.78 ± 1,300,853.86 次；评论、点赞和分享的平均次数分别为 22.43 ± 62.54 次、1578.52 ± 8333.11 次和 149.87 ± 577.73 次。DISCERN 评分、JAMA 评分和 GQS 的平均值分别为 18.12 ± 5.73、0.80 ± 0.53 和 1.30 ± 0.52。由医生/私人用户发布的视频得分更高（P 结论：TikTok 并不可靠：TikTok可能是一种不可靠的上髁炎治疗信息来源。在该平台上，非医生分享医疗建议的现象很常见，而医学治疗的支持证据水平最弱。肘部外科医生应告知患者，TikTok上的治疗建议可能与既定指南不一致：证据级别：IV级-横断面研究

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引用次数: 0

Optimizing periprosthetic fracture management and in-hospital outcome: insights from the PIPPAS multicentric study of 1387 cases in Spain. 优化假体周围骨折管理和院内预后：西班牙 1387 例 PIPPAS 多中心研究的启示。

IF 2.8 2区医学 Q1 Medicine

Journal of Orthopaedics and Traumatology

Pub Date : 2024-03-07 DOI: 10.1186/s10195-024-00746-6

Background: The incidence of all periprosthetic fractures (PPF), which require complex surgical treatment associated with high morbidity and mortality, is predicted to increase. The evolving surgical management has created a knowledge gap regarding its impact on immediate outcomes. This study aimed to describe current management strategies for PPF and their repercussions for in-hospital outcomes as well as to evaluate their implications for the community.

Methods: PIPPAS (Peri-Implant PeriProsthetic Survival Analysis) was a prospective multicentre observational study of 1387 PPF performed during 2021. Descriptive statistics summarized the epidemiology, fracture characteristics, management, and immediate outcomes. A mixed-effects logistic regression model was employed to evaluate potential predictors of in-hospital mortality, complications, discharge status, and weight-bearing restrictions.

Results: The study encompassed 32 (2.3%) shoulder, 4 (0.3%) elbow, 751 (54.1%) hip, 590 (42.5%) knee, and 10 (0.7%) ankle PPF. Patients were older (median 84 years, IQR 77-89), frail [median clinical frailty scale (CFS) 5, IQR 3-6], presented at least one comorbidity [median Charlson comorbidity index (CCI) 5, IQR 4-7], were community dwelling (81.8%), and had outdoor ambulation ability (65.6%). Femoral knee PPF were most frequently associated with uncemented femoral components, while femoral hip PPF occurred equally in cemented and uncemented stems. Patients were managed surgically (82%), with co-management (73.9%), through open approaches (85.9%) after almost 4 days (IQR, 51.9-153.6 h), with prosthesis revision performed in 33.8% of femoral hip PPF and 6.5% of femoral knee PPF. For half of the patients, the discharge instructions mandated weight-bearing restrictions. In-hospital mortality rates were 5.2% for all PPF and 6.2% for femoral hip PPF. Frailty, age > 84 years, mild cognitive impairment, CFS > 3, CCI > 3, and non-geriatric involvement were candidate predictors for in-hospital mortality, medical complications, and discharge to a nursing care facility. Management involving revision arthroplasty by experienced surgeons favoured full weight-bearing, while an open surgical approach favoured weight-bearing restrictions.

Conclusions: Current arthroplasty fixation check and revision rates deviate from established guidelines, yet full weight-bearing is favoured. A surgical delay of over 100 h and a lack of geriatric co-management were related to in-hospital mortality and medical complications. This study recommends judicious hypoaggressive approaches. Addressing complications and individualizing the surgical strategy can lead to enhanced functional outcomes, alleviating the economic and social burdens upon hospital discharge. Level of Evidence Level IV case series.

Trial registration: registered at ClinicalTrials.gov (NCT04663893), protocol ID: PI 2

背景：所有假体周围骨折（PPF）都需要复杂的手术治疗，发病率和死亡率都很高，预计这种骨折的发病率还会增加。不断发展的手术治疗方法对近期疗效的影响尚存在知识空白。本研究旨在描述当前 PPF 的管理策略及其对院内治疗效果的影响，并评估其对社区的影响：PIPPAS（Peri-Implant PeriProsthetic Survival Analysis）是一项前瞻性多中心观察研究，研究对象是2021年进行的1387例PPF。描述性统计总结了流行病学、骨折特征、管理和直接结果。研究采用混合效应逻辑回归模型来评估院内死亡率、并发症、出院状态和负重限制的潜在预测因素：研究涵盖了32例（2.3%）肩关节、4例（0.3%）肘关节、751例（54.1%）髋关节、590例（42.5%）膝关节和10例（0.7%）踝关节PPF。患者年龄较大（中位数 84 岁，IQR 77-89），体弱[临床虚弱量表（CFS）中位数 5，IQR 3-6]，至少有一种合并症[查尔森合并症指数（CCI）中位数 5，IQR 4-7]，居住在社区（81.8%），有户外行走能力（65.6%）。股骨膝关节PPF最常见于非骨水泥股骨组件，而股骨髋关节PPF在骨水泥和非骨水泥柄中的发生率相同。患者在近4天（IQR，51.9-153.6小时）后接受了手术治疗（82%）、共同治疗（73.9%）和开放式治疗（85.9%），33.8%的股骨髋关节PPF患者和6.5%的股骨膝关节PPF患者接受了假体翻修。半数患者的出院指导要求限制负重。所有PPF的院内死亡率为5.2%，股骨髋关节PPF的院内死亡率为6.2%。体弱、年龄大于84岁、轻度认知障碍、CFS大于3、CCI大于3以及非老年病患者是预测院内死亡率、医疗并发症和出院后入住护理机构的主要因素。由经验丰富的外科医生进行翻修关节成形术的治疗方法更有利于完全负重，而开放手术方法更有利于限制负重：结论：目前的关节置换术固定检查和翻修率偏离了既定指南，但完全负重仍是首选。手术延迟超过100小时和缺乏老年病科共同管理与院内死亡率和医疗并发症有关。本研究建议采取明智的低侵略性方法。解决并发症和个性化手术策略可提高功能预后，减轻出院后的经济和社会负担。证据级别：IV级病例系列。试验注册：已在ClinicalTrials.gov（NCT04663893）注册，方案ID：PI 20-2041。

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