颈椎畸形诊疗的评估与治疗现状

颈椎拥有脊柱最大的活动度,其相关疾病带来的生活质量下降在脊柱疾患中最为严重。其中,颈椎畸形较之于其他脊柱疾患,症状更为严重且预后较差。文章简述了该病的分类及病因,影像学参数的测量与评估,临床治疗选择和预后,对评估系统和手术治疗进行重点阐述。目前对于颈椎畸形而言,尚缺乏普遍接受的分类和评估系统,手术指征暂不明确,有望进一步探索。     

Correlation of first metatarsal sagittal alignment with clinical and functional outcomes following the Lapidus procedure

BackgroundThe purpose of this study was to evaluate the effect of the variation of the first metatarsal (M1) sagittal alignment after the Lapidus procedure (LP) on clinical and functional outcomes, and transfer metatarsalgia.MethodsTwenty-nine patients who underwent a LP, with a mean follow-up of 20 months, were reviewed. Radiographic, clinical and functional measurements were compared. Clinical and functional questionnaires applied were the visual analogue scale (VAS), American Orthopaedic Foot and Ankle Society (AOFAS) scale, lower extremity functional scale (LEFS) and SF-12, which is divided in physical (PCS-12) and mental-health (MCS-12) scales. Radiographic analysis of M1 sagittal alignment was based on the first metatarsal declination angle (FMDA) and Meary Angle (MA). Intermetatarsal angle (IMA) and hallux valgus angle (HVA) were also measured.ResultsFMDA, IMA and HVA showed significant variation, but MA did not. Clinical and functional improvements were observed, except in MCS-12. No patient developed transfer metatarsalgia. A direct correlation was found between Δ-FMDA with Δ-PCS-12 and Δ-LEFS, meaning that excessive M1 dorsiflexion as measured by FMDA led to a decrease in PCS-12 and LEFS. Patients with Δ-FMDA of up to 3.2° of dorsiflexion were those who had significant improvements.ConclusionDorsiflexion of M1 can lead to decreased outcomes as measured by PCS-12 and LEFS. However, satisfactory outcomes can be obtained even with some dorsal deviation of the M1.Level of EvidenceIV, retrospective case series.     

A preliminary modeling investigation into the safe correction zone for high tibial osteotomy

Background

High tibial osteotomy (HTO) re-aligns the weight-bearing axis (WBA) of the lower limb. The surgery reduces medial load (reducing pain and slowing progression of cartilage damage) while avoiding overloading the lateral compartment. The optimal correction has not been established. This study investigated how different WBA re-alignments affected load distribution in the knee, to consider the optimal post-surgery re-alignment.

Total Hip Arthroplasty in Patients With Previous Lumbar Fusion Surgery: Are There More Dislocations and Revisions?

Background

The purpose of this study was to determine whether the risk of dislocation and/or revision following THA is increased in patients with a history of prior lumbar fusion given the alterations in dynamic pelvic motion following LSF.

Genomic characteristics of Streptococcus agalactiae based on the pan-genome orthologous group analysis according to invasiveness and capsular genotype

ObjectiveFollowing the construction of a bacterial pan-genome from the whole genome sequences on a web-based pipeline, all coding DNA sequences (CDSs) can be clustered into pan-genome orthologous groups (POGs), which is a similar approach to comparative genome hybridization on glass microscope slides. We aimed to clarify the genomic characteristics of Streptococcus agalactiae based on the POG analysis.MethodsSixty-six S. agalactiae isolates obtained from invasive specimens (blood and cerebrospinal fluid) and non-invasive specimens (urine and vaginal discharge) between 2010 and 2017 in Korea were subjected to whole genome sequencing (WGS). Based on the WGS data, we conducted the POG analysis and constructed a phylogenetic tree along with capsular polysaccharide (CPS) genotyping. We compared the genomics of invasive vs. non-invasive isolates, as well as CPS III vs. non-CPS III genotypes.ResultsPredicted pan- and core-genome sizes were 3416 and 1658 genes, respectively. We found four clusters consisting of CPS genotypes (III, VIII, Ib/VI, and Ia) in the phylogenetic tree. There were significant differences in two metabolic pathways specific to invasiveness, and in six metabolic pathways specific to CPS III type produced by CDSs.ConclusionOur observations reveal the pan- and core-genome sizes, four clusters of genomes distributed by CPS genotypes, and unique CDS features of S. agalactiae by comparative genomics in terms of invasiveness and CPS genotype.     

Accelerometer-Based and Computer-Assisted Navigation in Total Knee Arthroplasty: A Reduction in Mechanical Axis Outliers Does Not Lead to Improvement in Functional Outcomes or Quality of Life When Compared to Conventional Total Knee Arthroplasty

Background

Accelerometer-based navigation (ABN) is a novel navigation system that attempts to combine the accuracy of computer-assisted surgery (CAS) with the familiarity of conventional instrumentation (CON). No studies have compared the clinical outcomes of this new technology with existing techniques to date.