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Diathermy and bone sawing are high aerosol yield procedures. 透热和锯骨是高气溶胶产量的程序。
IF 4.6 2区 医学 Q1 Medicine Pub Date : 2023-10-10 DOI: 10.1302/2046-3758.1210.BJR-2023-0028.R1
Victoria Hamilton, Sadiyah Sheikh, Alicja Szczepanska, Nick Maskell, Fergus Hamilton, Jonathan P Reid, Bryan R Bzdek, James R D Murray

Aims: Orthopaedic surgery uses many varied instruments with high-speed, high-impact, thermal energy and sometimes heavy instruments, all of which potentially result in aerosolization of contaminated blood, tissue, and bone, raising concerns for clinicians' health. This study quantifies the aerosol exposure by measuring the number and size distribution of the particles reaching the lead surgeon during key orthopaedic operations.

Methods: The aerosol yield from 17 orthopaedic open surgeries (on the knee, hip, and shoulder) was recorded at the position of the lead surgeon using an Aerodynamic Particle Sizer (APS; 0.5 to 20 μm diameter particles) sampling at 1 s time resolution. Through timestamping, detected aerosol was attributed to specific procedures.

Results: Diathermy (electrocautery) and oscillating bone saw use had a high aerosol yield (> 100 particles detected per s) consistent with high exposure to aerosol in the respirable range (< 5 µm) for the lead surgeon. Pulsed lavage, reaming, osteotome use, and jig application/removal were medium aerosol yield (10 to 100 particles s-1). However, pulsed lavage aerosol was largely attributed to the saline jet, osteotome use was always brief, and jig application/removal had a large variability in the associated aerosol yield. Suctioning (with/without saline irrigation) had a low aerosol yield (< 10 particles s-1). Most surprisingly, other high-speed procedures, such as drilling and screwing, had low aerosol yields.

Conclusion: This work suggests that additional precautions should be recommended for diathermy and bone sawing, such as enhanced personal protective equipment or the use of suction devices to reduce exposure.

目的:骨科手术使用多种高速、高冲击、热能的器械,有时还使用重型器械,所有这些都可能导致受污染的血液、组织和骨骼雾化,引起临床医生的健康问题。这项研究通过测量在关键整形外科手术中到达首席外科医生的颗粒的数量和大小分布来量化气溶胶暴露。方法:在主刀医师的位置,使用空气动力学粒子尺寸计(APS;直径为0.5至20μm的粒子)以1秒的时间分辨率采样,记录17例骨科开放手术(膝关节、髋关节和肩部)的气溶胶产量。通过时间戳,检测到的气溶胶归因于特定的程序。结果:透热(电烙术)和振荡骨锯的使用具有较高的气溶胶产量(每秒检测到>100个颗粒),与首席外科医生在可呼吸范围内(<5µm)的高暴露量一致。脉冲灌洗、扩孔、骨凿的使用和夹具的应用/去除是中等气溶胶产量(10-100个s-1颗粒)。然而,脉冲灌洗气溶胶在很大程度上归因于盐水射流,骨凿的使用时间总是很短,夹具的应用/移除在相关气溶胶产量方面具有很大的可变性。抽吸(有/没有盐水灌溉)的气溶胶产量较低(<10个颗粒s-1)。最令人惊讶的是,其他高速程序,如钻孔和拧螺丝,气溶胶产量很低。结论:这项工作建议对透热疗法和骨锯术采取额外的预防措施,如加强个人防护设备或使用抽吸装置以减少暴露。
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引用次数: 0
Overcoming floor and ceiling effects in knee arthroplasty outcome measurement. 克服膝关节置换术结果测量中的地板和天花板效应。
IF 4.6 2区 医学 Q1 Medicine Pub Date : 2023-10-04 DOI: 10.1302/2046-3758.1210.BJR-2022-0457.R1
Conrad J Harrison, Constantin Y Plessen, Gregor Liegl, Jeremy N Rodrigues, Shiraz A Sabah, David J Beard, Felix Fischer

Aims: To map the Oxford Knee Score (OKS) and High Activity Arthroplasty Score (HAAS) items to a common scale, and to investigate the psychometric properties of this new scale for the measurement of knee health.

Methods: Patient-reported outcome measure (PROM) data measuring knee health were obtained from the NHS PROMs dataset and Total or Partial Knee Arthroplasty Trial (TOPKAT). Assumptions for common scale modelling were tested. A graded response model (fitted to OKS item responses in the NHS PROMs dataset) was used as an anchor to calibrate paired HAAS items from the TOPKAT dataset. Information curves for the combined OKS-HAAS model were plotted. Bland-Altman analysis was used to compare common scale scores derived from OKS and HAAS items. A conversion table was developed to map between HAAS, OKS, and the common scale.

Results: We included 3,329 response sets from 528 patients undergoing knee arthroplasty. These generally met the assumptions of unidimensionality, monotonicity, local independence, and measurement invariance. The HAAS items provided more information than OKS items at high levels of knee health. Combining both instruments resulted in higher test-level information than either instrument alone. The mean error between common scale scores derived from the OKS and HAAS was 0.29 logits.

Conclusion: The common scale allowed more precise measurement of knee health than use of either the OKS or HAAS individually. These techniques for mapping PROM instruments may be useful for the standardization of outcome reporting, and pooling results across studies that use either PROM in individual-patient meta-analysis.

目的:将牛津膝关节评分(OKS)和高活性关节成形术评分(HAAS)项目映射到一个通用量表中,并研究该新量表用于测量膝关节健康的心理测量特性。方法:从NHS PROM数据集和全膝或部分膝关节置换术试验(TOPKAT)中获得测量膝关节健康的患者报告结果测量(PROM)数据。对普通规模建模的假设进行了测试。分级反应模型(适用于NHS PROMs数据集中的OKS项目反应)被用作锚,以校准TOPKAT数据集中的配对HAAS项目。绘制了OKS-HAAS组合模型的信息曲线。Bland-Altman分析用于比较OKS和HAAS项目的常见量表得分。开发了一个转换表来映射HAAS、OKS和通用比例。结果:我们纳入了来自528名接受膝关节置换术的患者的3329个反应集。这些通常满足一维性、单调性、局部独立性和测量不变性的假设。HAAS项目比OKS项目在膝关节健康水平高的情况下提供了更多的信息。将两种仪器组合在一起会产生比单独使用任何一种仪器更高的测试水平信息。OKS和HAAS得出的普通量表评分之间的平均误差为0.29 logits。结论:与单独使用OKS或HAAS相比,通用量表可以更精确地测量膝关节健康状况。这些绘制PROM仪器的技术可能有助于结果报告的标准化,并在个体患者荟萃分析中汇集使用任一PROM的研究结果。
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引用次数: 0
Regeneration of injured articular cartilage using the recombinant human amelogenin protein. 用重组人釉原蛋白修复关节软骨损伤。
IF 4.6 2区 医学 Q1 Medicine Pub Date : 2023-10-03 DOI: 10.1302/2046-3758.1210.BJR-2023-0019.R1
Omer Helwa-Shalom, Faris Saba, Elad Spitzer, Salem Hanhan, Koby Goren, Shany I Markowitz, Dekel Shilo, Nissim Khaimov, Yechiel N Gellman, Dan Deutsch, Anat Blumenfeld, Hani Nevo, Amir Haze

Aims: Cartilage injuries rarely heal spontaneously and often require surgical intervention, leading to the formation of biomechanically inferior fibrous tissue. This study aimed to evaluate the possible effect of amelogenin on the healing process of a large osteochondral injury (OCI) in a rat model.

Methods: A reproducible large OCI was created in the right leg femoral trochlea of 93 rats. The OCIs were treated with 0.1, 0.5, 1.0, 2.5, or 5.0 μg/μl recombinant human amelogenin protein (rHAM+) dissolved in propylene glycol alginate (PGA) carrier, or with PGA carrier alone. The degree of healing was evaluated 12 weeks after treatment by morphometric analysis and histological evaluation. Cell recruitment to the site of injury as well as the origin of the migrating cells were assessed four days after treatment with 0.5 μg/μl rHAM+ using immunohistochemistry and immunofluorescence.

Results: A total of 12 weeks after treatment, 0.5 μg/μl rHAM+ brought about significant repair of the subchondral bone and cartilage. Increased expression of proteoglycan and type II collagen and decreased expression of type I collagen were revealed at the surface of the defect, and an elevated level of type X collagen at the newly developed tide mark region. Conversely, the control group showed osteoarthritic alterations. Recruitment of cells expressing the mesenchymal stem cell (MSC) markers CD105 and STRO-1, from adjacent bone marrow toward the OCI, was noted four days after treatment.

Conclusion: We found that 0.5 μg/μl rHAM+ induced in vivo healing of injured articular cartilage and subchondral bone in a rat model, preventing the destructive post-traumatic osteoarthritic changes seen in control OCIs, through paracrine recruitment of cells a few days after treatment.

目的:软骨损伤很少自发愈合,通常需要手术干预,导致生物力学下纤维组织的形成。本研究旨在评估釉原蛋白对大鼠大鼠骨软骨损伤(OCI)愈合过程的可能影响。方法:在93只大鼠的右腿股骨滑车上建立可重复的大OCI。用0.1、0.5、1.0、2.5或5.0μg/μl溶于丙二醇藻酸盐(PGA)载体的重组人釉原蛋白(rHAM+)或单独用PGA载体处理OCI。治疗12周后,通过形态计量学分析和组织学评估评估愈合程度。在用0.5μg/μl rHAM+处理后4天,使用免疫组织化学和免疫荧光评估损伤部位的细胞募集以及迁移细胞的起源。结果:治疗12周后,0.5μg/μl rHAM+可显著修复软骨下骨和软骨。在缺损表面显示蛋白多糖和II型胶原表达增加,I型胶原表达减少,在新形成的潮痕区域显示X型胶原水平升高。相反,对照组表现出骨关节炎的改变。治疗四天后,观察到表达间充质干细胞(MSC)标志物CD105和STRO-1的细胞从邻近骨髓向OCI募集。结论:我们发现,0.5μg/μl rHAM+在大鼠模型中诱导了损伤的关节软骨和软骨下骨的体内愈合,通过治疗后几天的旁分泌细胞募集,预防了对照OCI中出现的破坏性创伤后骨关节炎变化。
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引用次数: 0
Decision-making in surgical study designs: a proposed decision algorithm to aid in the selection of an appropriate research study design for a given surgical intervention: the PERFECT tool. 外科研究设计中的决策:一种建议的决策算法,有助于为给定的外科干预选择合适的研究设计:完美工具。
IF 4.6 2区 医学 Q1 Medicine Pub Date : 2023-09-21 DOI: 10.1302/2046-3758.129.BJR-2023-0232
A H R W Simpson, Navnit S Makaram, Ewen Harrison, John Norrie
Cite this article: Bone Joint Res 2023;12(9):598–600.
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引用次数: 1
Appraising causal risk and protective factors for rheumatoid arthritis. 评估类风湿性关节炎的因果风险和保护因素。
IF 4.6 2区 医学 Q1 Medicine Pub Date : 2023-09-21 DOI: 10.1302/2046-3758.129.BJR-2023-0118.R1
Peng Gu, Bin Pu, Teng Liu, Dan Yue, Qiao Xin, Hai-Shan Li, Bai-Lin Yang, Dao-Ze Ke, Xiao-Hui Zheng, Zhan-Peng Zeng, Zhi-Qiang Zhang

Aims: Mendelian randomization (MR) is considered to overcome the bias of observational studies, but there is no current meta-analysis of MR studies on rheumatoid arthritis (RA). The purpose of this study was to summarize the relationship between potential pathogenic factors and RA risk based on existing MR studies.

Methods: PubMed, Web of Science, and Embase were searched for MR studies on influencing factors in relation to RA up to October 2022. Meta-analyses of MR studies assessing correlations between various potential pathogenic factors and RA were conducted. Random-effect and fixed-effect models were used to synthesize the odds ratios of various pathogenic factors and RA. The quality of the study was assessed using the Strengthening the Reporting of Observational Studies in Epidemiology using Mendelian Randomization (STROBE-MR) guidelines.

Results: A total of 517 potentially relevant articles were screened, 35 studies were included in the systematic review, and 19 studies were eligible to be included in the meta-analysis. Pooled estimates of 19 included studies (causality between 15 different risk factors and RA) revealed that obesity, smoking, coffee intake, lower education attainment, and Graves' disease (GD) were related to the increased risk of RA. In contrast, the causality contribution from serum mineral levels (calcium, iron, copper, zinc, magnesium, selenium), alcohol intake, and chronic periodontitis to RA is not significant.

Conclusion: Obesity, smoking, education attainment, and GD have real causal effects on the occurrence and development of RA. These results may provide insights into the genetic susceptibility and potential biological pathways of RA.

目的:孟德尔随机化(MR)被认为可以克服观察性研究的偏见,但目前还没有对类风湿性关节炎(RA)的MR研究进行荟萃分析。本研究的目的是在现有MR研究的基础上总结潜在致病因素与RA风险之间的关系。方法:检索PubMed、Web of Science和Embase截至2022年10月关于RA影响因素的MR研究。对评估各种潜在致病因素与RA之间相关性的MR研究进行了荟萃分析。采用随机效应和固定效应模型综合各种致病因素与RA的比值比。该研究的质量是使用孟德尔随机化(STROBE-MR)指南加强流行病学观察研究的报告进行评估的。结果:共筛选出517篇潜在相关文章,35项研究纳入系统综述,19项研究有资格纳入荟萃分析。对19项纳入研究的汇总估计(15种不同风险因素与RA之间的因果关系)表明,肥胖、吸烟、咖啡摄入、低教育程度和Graves病(GD)与RA风险增加有关。相反,血清矿物质水平(钙、铁、铜、锌、镁、硒)、酒精摄入和慢性牙周炎对RA的因果关系贡献并不显著。结论:肥胖、吸烟、文化程度和GD对RA的发生和发展有真正的因果关系。这些结果可能为RA的遗传易感性和潜在的生物学途径提供见解。
{"title":"Appraising causal risk and protective factors for rheumatoid arthritis.","authors":"Peng Gu,&nbsp;Bin Pu,&nbsp;Teng Liu,&nbsp;Dan Yue,&nbsp;Qiao Xin,&nbsp;Hai-Shan Li,&nbsp;Bai-Lin Yang,&nbsp;Dao-Ze Ke,&nbsp;Xiao-Hui Zheng,&nbsp;Zhan-Peng Zeng,&nbsp;Zhi-Qiang Zhang","doi":"10.1302/2046-3758.129.BJR-2023-0118.R1","DOIUrl":"https://doi.org/10.1302/2046-3758.129.BJR-2023-0118.R1","url":null,"abstract":"<p><strong>Aims: </strong>Mendelian randomization (MR) is considered to overcome the bias of observational studies, but there is no current meta-analysis of MR studies on rheumatoid arthritis (RA). The purpose of this study was to summarize the relationship between potential pathogenic factors and RA risk based on existing MR studies.</p><p><strong>Methods: </strong>PubMed, Web of Science, and Embase were searched for MR studies on influencing factors in relation to RA up to October 2022. Meta-analyses of MR studies assessing correlations between various potential pathogenic factors and RA were conducted. Random-effect and fixed-effect models were used to synthesize the odds ratios of various pathogenic factors and RA. The quality of the study was assessed using the Strengthening the Reporting of Observational Studies in Epidemiology using Mendelian Randomization (STROBE-MR) guidelines.</p><p><strong>Results: </strong>A total of 517 potentially relevant articles were screened, 35 studies were included in the systematic review, and 19 studies were eligible to be included in the meta-analysis. Pooled estimates of 19 included studies (causality between 15 different risk factors and RA) revealed that obesity, smoking, coffee intake, lower education attainment, and Graves' disease (GD) were related to the increased risk of RA. In contrast, the causality contribution from serum mineral levels (calcium, iron, copper, zinc, magnesium, selenium), alcohol intake, and chronic periodontitis to RA is not significant.</p><p><strong>Conclusion: </strong>Obesity, smoking, education attainment, and GD have real causal effects on the occurrence and development of RA. These results may provide insights into the genetic susceptibility and potential biological pathways of RA.</p>","PeriodicalId":9074,"journal":{"name":"Bone & Joint Research","volume":null,"pages":null},"PeriodicalIF":4.6,"publicationDate":"2023-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/13/2f/BJR-12-2046-3758.129.BJR-2023-0118.R1.PMC10512867.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41122011","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Development and validation of an open-source tool for opportunistic screening of osteoporosis from hip CT images. 开发和验证一种开源工具,用于髋关节CT图像中骨质疏松症的机会筛查。
IF 4.6 2区 医学 Q1 Medicine Pub Date : 2023-09-20 DOI: 10.1302/2046-3758.129.BJR-2023-0115.R1
Keisuke Uemura, Yoshito Otake, Kazuma Takashima, Hidetoshi Hamada, Takashi Imagama, Masaki Takao, Takashi Sakai, Yoshinobu Sato, Seiji Okada, Nobuhiko Sugano

Aims: This study aimed to develop and validate a fully automated system that quantifies proximal femoral bone mineral density (BMD) from CT images.

Methods: The study analyzed 978 pairs of hip CT and dual-energy X-ray absorptiometry (DXA) measurements of the proximal femur (DXA-BMD) collected from three institutions. From the CT images, the femur and a calibration phantom were automatically segmented using previously trained deep-learning models. The Hounsfield units of each voxel were converted into density (mg/cm3). Then, a deep-learning model trained by manual landmark selection of 315 cases was developed to select the landmarks at the proximal femur to rotate the CT volume to the neutral position. Finally, the CT volume of the femur was projected onto the coronal plane, and the areal BMD of the proximal femur (CT-aBMD) was quantified. CT-aBMD correlated to DXA-BMD, and a receiver operating characteristic (ROC) analysis quantified the accuracy in diagnosing osteoporosis.

Results: CT-aBMD was successfully measured in 976/978 hips (99.8%). A significant correlation was found between CT-aBMD and DXA-BMD (r = 0.941; p < 0.001). In the ROC analysis, the area under the curve to diagnose osteoporosis was 0.976. The diagnostic sensitivity and specificity were 88.9% and 96%, respectively, with the cutoff set at 0.625 g/cm2.

Conclusion: Accurate DXA-BMD measurements and diagnosis of osteoporosis were performed from CT images using the system developed herein. As the models are open-source, clinicians can use the proposed system to screen osteoporosis and determine the surgical strategy for hip surgery.

目的:本研究旨在开发和验证一种从CT图像中量化股骨近端骨密度(BMD)的全自动系统。方法:本研究分析了从三个机构收集的978对髋关节CT和双能X线骨密度仪(DXA)测量的股骨近端(DXA-BMD)。根据CT图像,使用先前训练的深度学习模型自动分割股骨和校准体模。将每个体素的Hounsfield单位转换为密度(mg/cm3)。然后,开发了一个通过315例手动地标选择训练的深度学习模型,以选择股骨近端的地标,将CT体积旋转到中性位置。最后,将股骨的CT体积投影到冠状面上,并量化股骨近端的面积BMD(CT aBMD)。CT aBMD与DXA-BMD相关,受试者操作特征(ROC)分析量化了诊断骨质疏松症的准确性。结果:976/978髋(99.8%)成功测量了CT aBMD,CT aBMD与DXA-BMD之间存在显著相关性(r=0.941;p<0.001),ROC分析中诊断骨质疏松的曲线下面积为0.976。诊断的敏感性和特异性分别为88.9%和96%,临界值为0.625g/cm2。结论:使用本文开发的系统,可以从CT图像中准确地测量和诊断骨质疏松症。由于这些模型是开源的,临床医生可以使用所提出的系统来筛查骨质疏松症,并确定髋关节手术的手术策略。
{"title":"Development and validation of an open-source tool for opportunistic screening of osteoporosis from hip CT images.","authors":"Keisuke Uemura,&nbsp;Yoshito Otake,&nbsp;Kazuma Takashima,&nbsp;Hidetoshi Hamada,&nbsp;Takashi Imagama,&nbsp;Masaki Takao,&nbsp;Takashi Sakai,&nbsp;Yoshinobu Sato,&nbsp;Seiji Okada,&nbsp;Nobuhiko Sugano","doi":"10.1302/2046-3758.129.BJR-2023-0115.R1","DOIUrl":"https://doi.org/10.1302/2046-3758.129.BJR-2023-0115.R1","url":null,"abstract":"<p><strong>Aims: </strong>This study aimed to develop and validate a fully automated system that quantifies proximal femoral bone mineral density (BMD) from CT images.</p><p><strong>Methods: </strong>The study analyzed 978 pairs of hip CT and dual-energy X-ray absorptiometry (DXA) measurements of the proximal femur (DXA-BMD) collected from three institutions. From the CT images, the femur and a calibration phantom were automatically segmented using previously trained deep-learning models. The Hounsfield units of each voxel were converted into density (mg/cm<sup>3</sup>). Then, a deep-learning model trained by manual landmark selection of 315 cases was developed to select the landmarks at the proximal femur to rotate the CT volume to the neutral position. Finally, the CT volume of the femur was projected onto the coronal plane, and the areal BMD of the proximal femur (CT-aBMD) was quantified. CT-aBMD correlated to DXA-BMD, and a receiver operating characteristic (ROC) analysis quantified the accuracy in diagnosing osteoporosis.</p><p><strong>Results: </strong>CT-aBMD was successfully measured in 976/978 hips (99.8%). A significant correlation was found between CT-aBMD and DXA-BMD (r = 0.941; p < 0.001). In the ROC analysis, the area under the curve to diagnose osteoporosis was 0.976. The diagnostic sensitivity and specificity were 88.9% and 96%, respectively, with the cutoff set at 0.625 g/cm<sup>2</sup>.</p><p><strong>Conclusion: </strong>Accurate DXA-BMD measurements and diagnosis of osteoporosis were performed from CT images using the system developed herein. As the models are open-source, clinicians can use the proposed system to screen osteoporosis and determine the surgical strategy for hip surgery.</p>","PeriodicalId":9074,"journal":{"name":"Bone & Joint Research","volume":null,"pages":null},"PeriodicalIF":4.6,"publicationDate":"2023-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10509772/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41103059","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Defining the optimal position of the lipped liner in combination with cup orientation and stem version. 结合杯体方向和阀杆型号确定带唇衬管的最佳位置。
IF 4.6 2区 医学 Q1 Medicine Pub Date : 2023-09-20 DOI: 10.1302/2046-3758.129.BJR-2022-0471.R1
Alessandro Navacchia, Joseph Pagkalos, Edward T Davis

Aims: The aim of this study was to identify the optimal lip position for total hip arthroplasties (THAs) using a lipped liner. There is a lack of consensus on the optimal position, with substantial variability in surgeon practice.

Methods: A model of a THA was developed using a 20° lipped liner. Kinematic analyses included a physiological range of motion (ROM) analysis and a provocative dislocation manoeuvre analysis. ROM prior to impingement was calculated and, in impingement scenarios, the travel distance prior to dislocation was assessed. The combinations analyzed included nine cup positions (inclination 30-40-50°, anteversion 5-15-25°), three stem positions (anteversion 0-15-30°), and five lip orientations (right hip 7 to 11 o'clock).

Results: The position of the lip changes the ROM prior to impingement, with certain combinations leading to impingement within the physiological ROM. Inferior lip positions (7 to 8 o'clock) performed best with cup inclinations of 30° and 40°. Superior lip positions performed best with cup inclination of 50°. When impingement occurs in the plane of the lip, the lip increases the travel distance prior to dislocation. Inferior lip positions led to the largest increase in jump distance in a posterior dislocation provocation manoeuvre.

Conclusion: The lip orientation that provides optimal physiological ROM depends on the orientation of the cup and stem. For a THA with stem anteversion 15°, cup inclination 40°, and cup anteversion 15°, the optimal lip position was posterior-inferior (8 o'clock). Maximizing jump distance prior to dislocation while preventing impingement in the opposite direction is possible with appropriate lip positioning.

目的:本研究的目的是确定使用唇衬进行全髋关节置换术(THAs)的最佳唇位。对于最佳位置缺乏共识,外科医生的实践也存在很大差异。方法:使用20°唇衬建立THA模型。运动学分析包括生理活动范围(ROM)分析和挑衅性脱位动作分析。计算撞击前的ROM,并在撞击场景中评估脱位前的行进距离。所分析的组合包括九个杯状位置(倾斜30-40-50°,前倾5-15-25°)、三个柄部位置(前倾0-15-30°)和五个嘴唇方向(右髋7-11点钟)。结果:嘴唇的位置在撞击前会改变ROM,某些组合会导致生理ROM内的撞击。下唇位置(7到8点钟)表现最好,杯状倾斜30°和40°。上唇位置在杯状物倾斜50°时表现最佳。当撞击发生在唇缘的平面内时,唇缘会增加位错前的行进距离。下唇位置导致后脱位挑衅动作中跳跃距离的最大增加。结论:提供最佳生理ROM的唇部方向取决于杯状物和柄的方向。对于干前倾15°、杯状倾斜度40°和杯状前倾15度的THA,最佳唇部位置为后下(8点钟)。通过适当的唇部定位,可以在脱位前最大限度地增加跳跃距离,同时防止相反方向的撞击。
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引用次数: 0
Global and local fat effects on bone mass and quality in obesity. 肥胖患者全身和局部脂肪对骨量和质量的影响。
IF 4.6 2区 医学 Q1 Medicine Pub Date : 2023-09-20 DOI: 10.1302/2046-3758.129.BJR-2023-0102.R1
Xin Dai, Beizhong Liu, Qingtao Hou, Qijie Dai, Di Wang, Bo Xie, Yue Sun, Bin Wang

Aims: The aim of this study was to investigate the global and local impact of fat on bone in obesity by using the diet-induced obese (DIO) mouse model.

Methods: In this study, we generated a diet-induced mouse model of obesity to conduct lipidomic and 3D imaging assessments of bone marrow fat, and evaluated the correlated bone adaptation indices and bone mechanical properties.

Results: Our results indicated that bone mass was reduced and bone mechanical properties were impaired in DIO mice. Lipidomic sequencing and bioinformatic analysis identified 373 differential lipids, 176 of which were upregulated and 197 downregulated. Functional enrichment analysis revealed a significant downregulation of the pathways: fat digestion and absorption (ko04975) and lipolysis regulation in adipocytes (ko04923) in DIO mice, leading to local fat accumulation. The use of 3D imaging confirmed the increase in fat accumulation within the bone marrow cavity of obese mice.

Conclusion: Our study sheds light on the intricate interplay between fat and bone, and provides a non-toxic and non-invasive method for measuring marrow adipose tissue.

目的:本研究的目的是通过使用饮食诱导肥胖(DIO)小鼠模型来研究脂肪对肥胖小鼠骨骼的全局和局部影响。方法:在本研究中,我们建立了一个饮食诱导的肥胖小鼠模型,对骨髓脂肪进行脂质组学和3D成像评估,并评估相关的骨适应指数和骨力学特性。结果:我们的结果表明,DIO小鼠的骨量减少,骨力学性能受损。脂质组学测序和生物信息学分析鉴定了373种不同的脂质,其中176种上调,197种下调。功能富集分析揭示了以下途径的显著下调:DIO小鼠的脂肪消化和吸收(ko04975)和脂肪细胞中的脂解调节(ko04923),导致局部脂肪积聚。3D成像的使用证实了肥胖小鼠骨髓腔内脂肪积聚的增加。结论:我们的研究揭示了脂肪和骨骼之间复杂的相互作用,并为测量骨髓脂肪组织提供了一种无毒、无创的方法。
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引用次数: 0
Diagnosis of periprosthetic joint infections in patients who have rheumatoid arthritis. 类风湿性关节炎患者假体周围关节感染的诊断。
IF 4.6 2区 医学 Q1 Medicine Pub Date : 2023-09-14 DOI: 10.1302/2046-3758.129.BJR-2022-0432.R1
Yulai Wang, Guoqing Li, Baochao Ji, Boyong Xu, Xiaogang Zhang, Asihaerjiang Maimaitiyiming, Li Cao

Aims: To investigate the optimal thresholds and diagnostic efficacy of commonly used serological and synovial fluid detection indexes for diagnosing periprosthetic joint infection (PJI) in patients who have rheumatoid arthritis (RA).

Methods: The data from 348 patients who had RA or osteoarthritis (OA) and had previously undergone a total knee (TKA) and/or a total hip arthroplasty (THA) (including RA-PJI: 60 cases, RA-non-PJI: 80 cases; OA-PJI: 104 cases, OA-non-PJI: 104 cases) were retrospectively analyzed. A receiver operating characteristic curve was used to determine the optimal thresholds of the CRP, ESR, synovial fluid white blood cell count (WBC), and polymorphonuclear neutrophil percentage (PMN%) for diagnosing RA-PJI and OA-PJI. The diagnostic efficacy was evaluated by comparing the area under the curve (AUC) of each index and applying the results of the combined index diagnostic test.

Results: For PJI prediction, the results of serological and synovial fluid indexes were different between the RA-PJI and OA-PJI groups. The optimal cutoff value of CRP for diagnosing RA-PJI was 12.5 mg/l, ESR was 39 mm/hour, synovial fluid WBC was 3,654/μl, and PMN% was 65.9%; and those of OA-PJI were 8.2 mg/l, 31 mm/hour, 2,673/μl, and 62.0%, respectively. In the RA-PJI group, the specificity (94.4%), positive predictive value (97.1%), and AUC (0.916) of synovial fluid WBC were higher than those of the other indexes. The optimal cutoff values of synovial fluid WBC and PMN% for diagnosing RA-PJI after THA were significantly higher than those of TKA. The specificity and positive predictive value of the combined index were 100%.

Conclusion: Serum inflammatory and synovial fluid indexes can be used for diagnosing RA-PJI, for which synovial fluid WBC is the best detection index. Combining multiple detection indexes can provide a reference basis for the early and accurate diagnosis of RA-PJI.

目的:探讨类风湿关节炎(RA)患者假体周围关节感染(PJI)诊断常用血清学及滑液检测指标的最佳阈值及诊断效果。方法:348例RA或骨关节炎(OA)患者,既往行全膝关节(TKA)和/或全髋关节置换术(THA)(包括RA- pji: 60例,RA-非pji: 80例;回顾性分析OA-PJI: 104例,oa -非pji: 104例)。采用受试者工作特征曲线确定CRP、ESR、滑膜液白细胞计数(WBC)和多形核中性粒细胞百分比(PMN%)诊断RA-PJI和OA-PJI的最佳阈值。比较各指标的曲线下面积(AUC),应用综合指标诊断试验结果评价诊断效果。结果:对于PJI的预测,RA-PJI组和OA-PJI组血清学和滑液指标的结果存在差异。CRP诊断RA-PJI的最佳临界值为12.5 mg/l, ESR为39 mm/h,滑液WBC为3654 /μl, PMN%为65.9%;OA-PJI分别为8.2 mg/l、31 mm/h、2673 /μl和62.0%。RA-PJI组滑液WBC特异性(94.4%)、阳性预测值(97.1%)、AUC(0.916)均高于其他指标。滑液WBC和PMN%诊断THA后RA-PJI的最佳临界值明显高于TKA。综合指标的特异性和阳性预测值均为100%。结论:血清炎症指标和滑液指标可用于RA-PJI的诊断,其中滑液白细胞是最佳的检测指标。结合多种检测指标可为RA-PJI的早期准确诊断提供参考依据。
{"title":"Diagnosis of periprosthetic joint infections in patients who have rheumatoid arthritis.","authors":"Yulai Wang,&nbsp;Guoqing Li,&nbsp;Baochao Ji,&nbsp;Boyong Xu,&nbsp;Xiaogang Zhang,&nbsp;Asihaerjiang Maimaitiyiming,&nbsp;Li Cao","doi":"10.1302/2046-3758.129.BJR-2022-0432.R1","DOIUrl":"https://doi.org/10.1302/2046-3758.129.BJR-2022-0432.R1","url":null,"abstract":"<p><strong>Aims: </strong>To investigate the optimal thresholds and diagnostic efficacy of commonly used serological and synovial fluid detection indexes for diagnosing periprosthetic joint infection (PJI) in patients who have rheumatoid arthritis (RA).</p><p><strong>Methods: </strong>The data from 348 patients who had RA or osteoarthritis (OA) and had previously undergone a total knee (TKA) and/or a total hip arthroplasty (THA) (including RA-PJI: 60 cases, RA-non-PJI: 80 cases; OA-PJI: 104 cases, OA-non-PJI: 104 cases) were retrospectively analyzed. A receiver operating characteristic curve was used to determine the optimal thresholds of the CRP, ESR, synovial fluid white blood cell count (WBC), and polymorphonuclear neutrophil percentage (PMN%) for diagnosing RA-PJI and OA-PJI. The diagnostic efficacy was evaluated by comparing the area under the curve (AUC) of each index and applying the results of the combined index diagnostic test.</p><p><strong>Results: </strong>For PJI prediction, the results of serological and synovial fluid indexes were different between the RA-PJI and OA-PJI groups. The optimal cutoff value of CRP for diagnosing RA-PJI was 12.5 mg/l, ESR was 39 mm/hour, synovial fluid WBC was 3,654/μl, and PMN% was 65.9%; and those of OA-PJI were 8.2 mg/l, 31 mm/hour, 2,673/μl, and 62.0%, respectively. In the RA-PJI group, the specificity (94.4%), positive predictive value (97.1%), and AUC (0.916) of synovial fluid WBC were higher than those of the other indexes. The optimal cutoff values of synovial fluid WBC and PMN% for diagnosing RA-PJI after THA were significantly higher than those of TKA. The specificity and positive predictive value of the combined index were 100%.</p><p><strong>Conclusion: </strong>Serum inflammatory and synovial fluid indexes can be used for diagnosing RA-PJI, for which synovial fluid WBC is the best detection index. Combining multiple detection indexes can provide a reference basis for the early and accurate diagnosis of RA-PJI.</p>","PeriodicalId":9074,"journal":{"name":"Bone & Joint Research","volume":null,"pages":null},"PeriodicalIF":4.6,"publicationDate":"2023-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/1a/b4/BJR-12-2046-3758.129.BJR-2022-0432.R1.PMC10499527.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10259038","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Treatment of infected bone defects with the induced membrane technique. 用诱导膜技术治疗感染性骨缺损。
IF 4.7 2区 医学 Q2 CELL & TISSUE ENGINEERING Pub Date : 2023-09-12 DOI: 10.1302/2046-3758.129.BJR-2022-0439.R2
Jie Shen, Zhiyuan Wei, Shulin Wang, Xiaohua Wang, Wei Lin, Lei Liu, Guanglin Wang

Aims: This study aimed to evaluate the effectiveness of the induced membrane technique for treating infected bone defects, and to explore the factors that might affect patient outcomes.

Methods: A comprehensive search was performed in PubMed, Embase, and the Cochrane Central Register of Controlled Trials databases between 1 January 2000 and 31 October 2021. Studies with a minimum sample size of five patients with infected bone defects treated with the induced membrane technique were included. Factors associated with nonunion, infection recurrence, and additional procedures were identified using logistic regression analysis on individual patient data.

Results: After the screening, 44 studies were included with 1,079 patients and 1,083 segments of infected bone defects treated with the induced membrane technique. The mean defect size was 6.8 cm (0.5 to 30). After the index second stage procedure, 85% (797/942) of segments achieved union, and 92% (999/1,083) of segments achieved final healing. The multivariate analysis with data from 296 patients suggested that older age was associated with higher nonunion risk. Patients with external fixation in the second stage had a significantly higher risk of developing nonunion, increasing the need for additional procedures. The autografts harvested from the femur reamer-irrigator-aspirator increased nonunion, infection recurrence, and additional procedure rates.

Conclusion: The induced membrane technique is an effective technique for treating infected bone defects. Internal fixation during the second stage might effectively promote bone healing and reduce additional procedures without increasing infection recurrence. Future studies should standardize individual patient data prospectively to facilitate research on the affected patient outcomes.

目的:本研究旨在评估诱导膜技术治疗感染性骨缺损的有效性,并探讨可能影响患者预后的因素:方法:在 2000 年 1 月 1 日至 2021 年 10 月 31 日期间,在 PubMed、Embase 和 Cochrane Central Register of Controlled Trials 数据库中进行了全面检索。纳入的研究样本量至少为五名使用诱导膜技术治疗感染性骨缺损的患者。通过对患者个体数据进行逻辑回归分析,确定了与不愈合、感染复发和额外手术相关的因素:经过筛选,共有 44 项研究纳入了采用诱导膜技术治疗的 1,079 名患者和 1,083 个感染性骨缺损片段。平均缺损大小为 6.8 厘米(0.5 至 30 厘米)。在指数第二阶段手术后,85%(797/942)的节段实现了结合,92%(999/1,083)的节段实现了最终愈合。对296名患者的数据进行的多变量分析表明,年龄越大,不愈合的风险越高。在第二阶段进行外固定的患者发生骨不连的风险明显更高,因此需要进行更多手术。从股骨再植器-灌注器-吸引器中获取的自体移植物增加了非骨髁愈合、感染复发和额外手术的发生率:结论:诱导膜技术是治疗感染性骨缺损的有效技术。结论:诱导膜技术是治疗感染性骨缺损的有效技术,在第二阶段进行内固定可有效促进骨愈合,减少额外手术,同时不会增加感染复发率。未来的研究应该对患者的个体数据进行前瞻性标准化,以促进对受影响患者结果的研究。
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引用次数: 0
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Bone & Joint Research
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