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Three-in-one protocol for the management of hemodynamically unstable paediatric pelvic fracture – a level one trauma centre 15 year review 处理血流动力学不稳定的儿科骨盆骨折的三合一方案--一级创伤中心15年回顾
Pub Date : 2024-01-31 DOI: 10.1177/22104917231208210
Adam Yang Zhen Wei, Tim Chui King Him, Lee Kin Bong
A three-in-one protocol comprised of pelvic external fixation, retroperitoneal pelvic packing, and angiography with or without embolization has been developed and used in our centre to improve survival outcomes of hemodynamically unstable pelvic fractures since 2008. Fourteen paediatric patients over a period of 15 years are reviewed in this case series. The mean age is 11.6 and standard deviation is 4.6. The mean injury severity score is 31.6. Sixty four percent underwent three-in-one protocol management. The overall survival rate at index hospital admission and at one year is 85.7% which is higher than the adult group (81%) from a study conducted at our centre and comparable to the rate in paediatric group. One patient had pelvic external fixator pin tract infection and two had lower limb ischemia post embolization. At 6 months follow up, one patient had pelvic pain and one had hip protrusio. We conclude that improvement in survival outcome also applies to the paediatric population. Technical differences in the paediatric group is highlighted to minimize potential complications.
自 2008 年以来,我们中心开发并使用了一种三合一方案,包括骨盆外固定、腹膜后骨盆填塞和带或不带栓塞的血管造影,以改善血流动力学不稳定的骨盆骨折患者的存活率。本病例系列回顾了 15 年来的 14 例儿童患者。平均年龄为 11.6 岁,标准差为 4.6 岁。平均受伤严重程度为 31.6 分。64%的患者接受了三合一方案治疗。入院时和一年后的总存活率为85.7%,高于本中心进行的一项研究中成人组的存活率(81%),与儿科组的存活率相当。一名患者出现骨盆外固定器针道感染,两名患者在栓塞术后出现下肢缺血。在 6 个月的随访中,一名患者出现骨盆疼痛,一名患者出现髋关节突出。我们的结论是,儿科患者的生存率也有所提高。强调儿科组的技术差异是为了最大限度地减少潜在并发症。
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引用次数: 0
Kinesiotaping versus counterforce brace in the management of lateral elbow tendinopathy 在治疗肘外侧肌腱病时,运动塑形疗法与反作用力支撑疗法的比较
Pub Date : 2024-01-27 DOI: 10.1177/22104917231208211
A. Abdelmonem, Mariam A. Ameer, Ammar M. AlAbbad, A. Abdelmohsen
Purpose: The main purpose of the current study was to assess whether counter force brace (CFB) offers any additional value over Kinesiotaping (KT) in the management of tennis elbow. Materials and Methods: Forty-five females with clinically diagnosed tennis elbow participated in the current study. They were equally assigned into three groups of equal numbers. 12 sessions over 4 weeks of treatment interventions; experimental group A received the traditional physiotherapy program in addition to KT. Group B received the physiotherapy program in addition to the CFB. Group C (Control Group) received the physiotherapy program only. The degree of tennis elbow pain and myoelectrical activities of forearm muscles were measured. Results: There was a statistically significant reduction of pain in the experimental group A (KT) in comparison with the control group (p = 0.000), while a statistically significant reduction of pain (p = 0.000) and improvement of the myoelectrical activities of the forearm muscles (p = 0.000) were detected in the experimental group B (CFB) in comparison with the control group. In addition, the statistically significant reduction of pain (p = 0.000) and improvements in wrist flexors and extensors (p = 0.001 and p = 0.000, respectively) were detected in CFB compared with KT. Conclusion: Compared to KT or a physical therapy program alone, the use of CFB in the treatment of lateral elbow tendinopathy may be beneficial, especially in reducing pain and enhancing the muscle activities of the elbow flexors and extensors.
目的:本研究的主要目的是评估反作用力支撑(CFB)在治疗网球肘方面是否比运动塑形(KT)更有价值。材料与方法:45名临床诊断为网球肘的女性患者参加了本次研究。她们被平均分配到人数相等的三组。实验 A 组在接受 KT 治疗的同时,还接受传统的物理治疗。B 组除接受 CFB 治疗外,还接受物理治疗。C组(对照组)只接受物理治疗。对网球肘疼痛程度和前臂肌肉的肌电活动进行了测量。结果显示与对照组相比,实验组 A(KT)的疼痛明显减轻(P = 0.000);与对照组相比,实验组 B(CFB)的疼痛明显减轻(P = 0.000),前臂肌肉的肌电活动明显改善(P = 0.000)。此外,与 KT 组相比,CFB 组的疼痛明显减轻(p = 0.000),腕关节屈肌和伸肌的改善也有统计学意义(p = 0.001 和 p = 0.000)。结论与 KT 或单独的物理治疗方案相比,使用 CFB 治疗肘外侧肌腱病可能是有益的,尤其是在减轻疼痛和增强肘部屈伸肌的肌肉活动方面。
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引用次数: 0
Isolated greater trochanter fractures of the native hip: Is magnetic resonance imaging needed? 原发性髋关节大转子孤立性骨折:是否需要磁共振成像?
Pub Date : 2024-01-23 DOI: 10.1177/22104917231208209
Kevin Heo, Jason A Shah, Nick Cantu, John M. Kopriva, Henry M Gass, Alexander R. Webb, Amoolya Vayalapalli, Thomas J Moore
Background: Isolated greater trochanter fractures represent a subset of hip fractures for which diagnostic work-up and treatment algorithms can vary. Magnetic resonance imaging has been described as the definitive method of evaluating fracture extension into the intertrochanteric region. While prophylactic fixation for those with fracture extension may prevent the propagation of the injury, treatment debates remain. This study aimed to assess adherence to protocols at our institution and evaluate outcomes in those whose care deviated from protocol. Methods: In a retrospective analysis, adult patients (≥18 years old) presenting with a greater trochanter fracture over a 7-year period (2015–2021) were identified. Patients were excluded if the injury was periprosthetic, had a ballistic mechanism, or had any concomitant fractures of the femoral head, neck, or shaft identified on plain radiographs. Patient demographics, comorbidities, treatment, and outcomes were tabulated via chart review. Results: In total, 57 isolated greater trochanter fracture patients were included. Of these, 52 patients (91%) had computed tomographic scans, yet only 41 patients (72%) had magnetic resonance imaging completed. In total, 10 of the 41 (24%) patients with magnetic resonance imaging showed <50% fracture line extension, and all of these patients were treated nonoperatively. In contrast, 24 of 41 magnetic resonance imaging patients (59%) showed >50% fracture line extension in both coronal and axial planes, of which 14 (58%) were treated operatively. However, the 10 nonoperative patients with significant fracture extension showed no increased hospital length-of-stay or fracture extension upon follow-up. Conclusions: Our study showed that institutional protocol for diagnostic workup and treatment evaluation for isolated greater trochanter fractures is not consistently followed. However, patients who deviated from treatment protocol showed no elevated risks of fracture propagation. Our study questions the need for magnetic resonance imaging in all isolated greater trochanter fractures, and suggests that protocols be revisited to ensure that workup is optimal for patients and costeffective for the healthcare system itself.
背景:孤立的大转子骨折是髋部骨折的一个分支,其诊断工作和治疗方法各不相同。磁共振成像被认为是评估骨折延伸至转子间区域的明确方法。虽然对骨折扩展者进行预防性固定可防止损伤扩散,但治疗方面仍存在争议。本研究旨在评估本院对治疗方案的遵守情况,并对偏离治疗方案者的治疗效果进行评估。方法:在一项回顾性分析中,确定了7年间(2015-2021年)出现大转子骨折的成年患者(≥18岁)。如果患者的损伤是假体周围损伤、弹道机制损伤,或在平片上发现股骨头、股骨颈或股骨柄合并骨折,则排除在外。患者的人口统计学特征、并发症、治疗和结果均通过病历审查制成表格。结果:共纳入 57 例孤立性大转子骨骨折患者。其中,52 名患者(91%)进行了计算机断层扫描,但只有 41 名患者(72%)完成了磁共振成像。在 41 例(24%)磁共振成像患者中,共有 10 例(24%)在冠状面和轴面上均显示骨折线延伸 50%,其中 14 例(58%)接受了手术治疗。不过,10 名骨折明显延长的非手术患者在随访时并未显示住院时间延长或骨折延长。结论:我们的研究表明,机构对孤立性大转子骨折的诊断和治疗评估方案并未得到一致遵循。不过,偏离治疗方案的患者骨折扩展的风险并没有增加。我们的研究质疑了对所有孤立性大转子骨折进行磁共振成像检查的必要性,并建议重新审视治疗方案,以确保为患者提供最佳治疗,并为医疗系统本身节约成本。
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引用次数: 0
Cross-cultural adaptation, reliability and validity analysis of the Cantonese-Chinese Manchester Oxford Foot Questionnaire for Foot and Ankle Disorder (Manchester-Oxford Foot Questionnaire HK) 粤语-中文曼彻斯特-牛津足踝疾病问卷(曼彻斯特-牛津足踝问卷 HK)的跨文化适应性、信度和效度分析
Pub Date : 2024-01-22 DOI: 10.1177/22104917231208213
Shu MC Chia, Leung P Ho, V. Ko, He Xin, Long CB Chow, P. S. Yung, Samuel Ka-Kin Ling
The Manchester–Oxford Foot Questionnaire is a validated English 16-item patient-reported outcome measure for evaluating foot and ankle function. This study aimed to translate a Cantonese Chinese version of the questionnaire and evaluate its validity and reliability among patients with foot and ankle disorders. The translation and cross-cultural adaptation were conducted by forward translation, synthesis of translated versions, backward translation, review, and pre-testing by a panel of healthcare professionals. The test-retest reliability was conducted within 2–4 weeks. Internal consistency and construct validity were evaluated using the Visual Analogue Scale and Short-Form 36. 135 participants were recruited to complete the validation process. The overall reliability coefficient constituted 0.86 (intraclass correlation coefficient = 0.72–0.93). A strong, statistically significant correlation was found between the bodily pain subscale of Short-Form 36 and the pain subscale of the Cantonese Chinese-Manchester-Oxford Foot Questionnaire ( r = −0.77, p < 0.001). This was similar to the pain subscale of the Cantonese Chinese-Manchester-Oxford Foot Questionnaire and visual analogue pain score ( r = 0.77, p < 0.001). The overall score for the Cantonese Chinese Manchester-Oxford Foot Questionnaire between the healthy control group and the pathological group was statistically different ( p < 0.001). A good consistency level was found in the questionnaire with a Cronbach's alpha coefficient of 0.78, 0.86, 0.78, 0.85 for pain, walking/standing, social interaction, and the overall domain of the Cantonese Chinese-Manchester-Oxford Foot Questionnaire, respectively. Therefore, this questionnaire can be adapted as a reliable clinical assessment and an outcome measure among the Cantonese Chinese-speaking population.
曼彻斯特-牛津足部问卷(Manchester-Oxford Foot Questionnaire)是一项经过验证的、由 16 个项目组成的患者报告结果测量方法,用于评估足部和踝关节功能。本研究旨在翻译该问卷的粤语中文版,并评估其在足踝疾病患者中的有效性和可靠性。翻译和跨文化调适工作通过正译、翻译版本合成、反译、复核和由医护专业人员组成的小组进行预试来完成。重测可靠性在 2-4 周内进行。使用视觉模拟量表和短表 36 评估了内部一致性和结构效度。共招募了 135 名参与者完成验证过程。总体信度系数为 0.86(类内相关系数 = 0.72-0.93)。短表 36 的身体疼痛分量表与广东汉-曼彻斯特-牛津足部问卷的疼痛分量表之间存在很强的统计学相关性(r = -0.77,p < 0.001)。这与粤语-曼彻斯特-牛津足部问卷的疼痛分量表和视觉模拟疼痛评分(r = 0.77,p < 0.001)相似。健康对照组与病理组的粤语-中文-曼彻斯特-牛津足部问卷总分有统计学差异(P < 0.001)。粤语中文-曼彻斯特-牛津足部问卷的疼痛、行走/站立、社会交往和总领域的 Cronbach's alpha 系数分别为 0.78、0.86、0.78 和 0.85,具有良好的一致性。因此,该问卷可作为可靠的临床评估和结果测量方法,适用于粤语华裔人群。
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引用次数: 0
The relationship between body height and plantar pressure distribution in adult handball players: A cross-sectional study 成年手球运动员的身高与足底压力分布之间的关系:横断面研究
Pub Date : 2024-01-22 DOI: 10.1177/22104917231208214
A. Abdel-aziem, M. Ameer
The relationship between a handball player's upper body posture, body weight distribution in relation to body height is poorly understood. So, this study explored the relationship between body height and sagittal spinal curvatures and plantar pressure distribution in handball players. According to handball player's body height, 63 male handball players were divided into two groups; group A (age, 23.54 ± 1.32 years) consisted of 30 handball players with body height above average, and group B (age, 23.40 ± 1.73 years) consisted of 33 handball players with body height below average. The thoracic and lumbar curvatures and trunk height were measured with the Formetric III 4D spine, and the DIERS Pedoscan device was used to assess the plantar pressure distribution for both groups. The thoracic kyphosis of group A was significantly higher than that of group B ( p = 0.001), without a significant difference in lumbar lordosis ( p = 0.086). Group A showed a significant increase in the forefeet pressure and a significant decrease in the rearfeet pressure compared to group B ( p = 0.001). There was a high positive correlation between the body height and trunk length, and body height and kyphosis angle ( r = 0.932, r = 0.665, respectively). There was a high positive correlation between the body height and forefoot plantar pressure ( r = 0.665, p < 0.01). The taller handball players have an increased thoracic kyphosis angle and forefeet pressure compared to shorter handball players.
人们对手球运动员的上半身姿势、体重分布与身高之间的关系知之甚少。因此,本研究探讨了手球运动员的身高与脊柱矢状曲和足底压力分布之间的关系。根据手球运动员的身高,63 名男性手球运动员被分为两组,A 组(年龄,23.54 ± 1.32 岁)包括 30 名身高高于平均水平的手球运动员,B 组(年龄,23.40 ± 1.73 岁)包括 33 名身高低于平均水平的手球运动员。使用 Formetric III 4D 脊柱测量胸椎和腰椎弯曲度以及躯干高度,并使用 DIERS Pedoscan 设备评估两组球员的足底压力分布。A 组的胸椎后凸明显高于 B 组(P = 0.001),腰椎前凸无明显差异(P = 0.086)。与 B 组相比,A 组的前脚掌压力明显增加,后脚掌压力明显减少 ( p = 0.001)。身高与躯干长度、身高与脊柱后倾角之间存在高度正相关(分别为 r = 0.932 和 r = 0.665)。身高与前脚掌足底压力之间呈高度正相关(r = 0.665,p < 0.01)。与身材矮小的手球运动员相比,身材高大的手球运动员的胸椎后倾角和前脚掌压力更大。
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引用次数: 0
ChatGPT is a promising tool to increase readability of orthopedic research consents ChatGPT 是提高骨科研究同意书可读性的有效工具
Pub Date : 2024-01-22 DOI: 10.1177/22104917231208212
Bissem Gill, John Bonamer, Henry A. Kuechly, Rajul Gupta, Scottie Emmert, Sarah Kurkowski, Kim Hasselfeld, Brian M. Grawe
Background/Purpose: Informed consent is a fundamental ethical requirement in medical research, ensuring that participants have a comprehensive understanding of the risks and benefits associated with their participation. Clinical researchers must ensure effective and efficient communication of the implications of participation, but the complexity and length of traditional research consent forms can impede comprehension and create barriers to effective communication between researchers and participants. For this reason, the American Medical Association recommends a 6th grade reading level for all patient-facing medical information. Can the large language model, ChatGPT-3.5, improve readability while simultaneously preserving information necessary for adequate informed consent?. Methods: Nineteen IRB approved Orthopedic surgery research consent forms were entered into ChatGPT with instructions to make the form “readable at a 6th-grade level.” Post ChatGPT consent forms were assessed using commonly used readability metrics. Additionally, a single Orthopedic surgeon who has practiced independently for 15 years assessed the forms for accuracy and retention of imperative informed consent elements. Results: The median differences between pre-ChatGPT and post-ChatGPT were statistically significant for every readability metric (all p < 0.001) and all favored the post-ChatGPT consent as being more readable. Two language metrics, Automated Readability Index and Raygor Grade Level, indicated the post-ChatGPT consent forms could meet the AMA's recommended 6th-grade reading level. Twelve of 19 post-ChatGPT consents had at least one error. Conclusion: ChatGPT can significantly improve the readability of Orthopedic clinical research consent forms, but these edited consents are not without mistakes and cannot reach the AMA's recommended 6th grade reading level. Therefore, ChatGPT should be used as a tool to supplement the writing and editing process of human researchers.
背景/目的:知情同意是医学研究的一项基本道德要求,可确保参与者全面了解参与研究的相关风险和益处。临床研究人员必须确保切实有效地传达参与研究的意义,但传统研究同意书的复杂性和篇幅可能会妨碍理解,并对研究人员和参与者之间的有效沟通造成障碍。因此,美国医学会建议所有面向患者的医疗信息都应达到六年级的阅读水平。大语言模型 ChatGPT-3.5 能否在提高可读性的同时保留充分知情同意所需的信息?方法:将 19 份经 IRB 批准的骨科手术研究同意书输入 ChatGPT,并说明要使同意书 "具有六年级水平的可读性"。使用常用的可读性指标对 ChatGPT 后的同意书进行评估。此外,一位独立执业 15 年的骨科医生对表格的准确性和必要知情同意要素的保留情况进行了评估。结果:在每项可读性指标上,ChatGPT 前和 ChatGPT 后的中位数差异都具有统计学意义(所有指标的 p 均小于 0.001),而且所有指标都认为 ChatGPT 后的同意书更具可读性。自动可读指数和 Raygor 年级水平这两项语言指标表明,ChatGPT 后的同意书可以达到美国医学会建议的 6 年级阅读水平。19 份 ChatGPT 后同意书中有 12 份至少有一处错误。结论:ChatGPT 可以大大提高骨科临床研究同意书的可读性,但这些经过编辑的同意书并非没有错误,也无法达到美国医学会建议的六年级阅读水平。因此,ChatGPT 应作为人类研究人员写作和编辑过程的补充工具。
{"title":"ChatGPT is a promising tool to increase readability of orthopedic research consents","authors":"Bissem Gill, John Bonamer, Henry A. Kuechly, Rajul Gupta, Scottie Emmert, Sarah Kurkowski, Kim Hasselfeld, Brian M. Grawe","doi":"10.1177/22104917231208212","DOIUrl":"https://doi.org/10.1177/22104917231208212","url":null,"abstract":"Background/Purpose: Informed consent is a fundamental ethical requirement in medical research, ensuring that participants have a comprehensive understanding of the risks and benefits associated with their participation. Clinical researchers must ensure effective and efficient communication of the implications of participation, but the complexity and length of traditional research consent forms can impede comprehension and create barriers to effective communication between researchers and participants. For this reason, the American Medical Association recommends a 6th grade reading level for all patient-facing medical information. Can the large language model, ChatGPT-3.5, improve readability while simultaneously preserving information necessary for adequate informed consent?. Methods: Nineteen IRB approved Orthopedic surgery research consent forms were entered into ChatGPT with instructions to make the form “readable at a 6th-grade level.” Post ChatGPT consent forms were assessed using commonly used readability metrics. Additionally, a single Orthopedic surgeon who has practiced independently for 15 years assessed the forms for accuracy and retention of imperative informed consent elements. Results: The median differences between pre-ChatGPT and post-ChatGPT were statistically significant for every readability metric (all p < 0.001) and all favored the post-ChatGPT consent as being more readable. Two language metrics, Automated Readability Index and Raygor Grade Level, indicated the post-ChatGPT consent forms could meet the AMA's recommended 6th-grade reading level. Twelve of 19 post-ChatGPT consents had at least one error. Conclusion: ChatGPT can significantly improve the readability of Orthopedic clinical research consent forms, but these edited consents are not without mistakes and cannot reach the AMA's recommended 6th grade reading level. Therefore, ChatGPT should be used as a tool to supplement the writing and editing process of human researchers.","PeriodicalId":517288,"journal":{"name":"Journal of Orthopaedics, Trauma and Rehabilitation","volume":"222 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140500332","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Multi-disciplinary Rehabilitation Outcome Checklist: Italian validation of an instrument for risk of discharge in patients with total hip and/or knee replacement 多学科康复结果核对表:意大利对全髋关节和/或膝关节置换术患者出院风险工具的验证
Pub Date : 2020-03-30 DOI: 10.1177/2210491720912551
Silvia Viglianese, A. Servadio, Giuseppe Maggi, R. Mollica, D. Valente, G. Galeoto
Object: This article describes the translation and cultural adaptation of the Multi-disciplinary Rehabilitation Outcome Checklist Scale in Italian and reports the procedures to test their validity and reliability. Methods: The forward and backward translation was conducted by specialized and certified translators, independently from each other. The scale was then reviewed by a group of 20 experts. The process of cultural adaptation and validation took place on a cohort of patients who performed a joint replacement of hip and/or knee surgery in two hospitals of Rome. Results: The culturally adapted scale was administered to 114 patients. It results that the interoperator reliability is equal to intraclass correlation coefficient (ICC) = 0.977 for hip and ICC = 0.97 for knee. The construct validity and the responsiveness are statistically significant. Conclusion: It is a scale capable of assessing the patient in a comprehensive and multidisciplinary manner at the time of hospital discharge, useful for dismissing the patient in the most appropriate timing and with the best clinical and functional conditions.
目的:本文介绍了意大利语多学科康复结果核对表量表的翻译和文化适应性调整,并报告了检验其有效性和可靠性的程序。翻译方法正向和反向翻译由经过认证的专业翻译人员独立完成。然后,由 20 位专家组成的小组对量表进行了审阅。对在罗马两家医院进行髋关节和/或膝关节置换手术的患者进行文化适应和验证。结果:对 114 名患者进行了文化适应性量表测试。结果显示,髋关节的操作者间信度等于类内相关系数(ICC)= 0.977,膝关节的操作者间信度等于类内相关系数(ICC)= 0.97。构建效度和响应度均具有统计学意义。结论该量表能够在患者出院时对其进行多学科综合评估,有助于在最合适的时间、最佳的临床和功能条件下让患者出院。
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引用次数: 1
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Journal of Orthopaedics, Trauma and Rehabilitation
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