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1.
BackgroundRestricted kinematically-aligned total knee arthroplasty (KA-TKA) is a reasonable modification to avoid the alignment outlier that may cause implant failure. However, despite a noted high incidence of constitutional varus in Japanese individuals, there has been no investigation into how many knees require the restriction in restricted KA-TKA (RKA-TKA) among Japanese patients. Therefore, we conducted a study using preoperative long-leg radiograms.MethodsWe studied long-leg radiographs of 228 knees in 114 consecutive patients. The numbers of knees within the safety range and their corrective osteotomy angle in the restriction algorithms advocated by Almaawi et al. (2017) and MacDessi et al. (2020) were evaluated.ResultsAccording to the algorithms used by Almaawi et al. and MacDessi et al., out of 228 knees, 46 (20%) and 39 (17%) fell within the safety range, respectively. The mean correction angles of the hip-knee-ankle angle, lateral distal femoral angle and medial proximal tibial angle were 2.8 ± 3.4°, 0.4 ± 1.4° and 2.4 ± 2.8° in the algorithm used by Almaawi et al., while they were −4.9 ± 4.7°, 1.1 ± 2.5° and −6.0 ± 3.4° in the algorithm used by MacDessi et al. Most of the knees needed to be restricted in order to perform RKA-TKA, regardless of the algorithm used.ConclusionsBased on a preoperative analysis of long-leg radiograms in a Japanese population, most knees fall out of the safety range in RKA-TKA. Surgeons must consider whether to allow component outlier or to perform corrective osteotomy that likely requires soft tissue release.  相似文献   
2.
BackgroundHip-to-calcaneus (HC) view is a whole-leg standing view that can visualize the hindfoot in detail. The aim of this study was to investigate the reliability and validity of tibiocalcaneal angle in HC view (H-TCA) by comparing it with that in long axial view (L-TCA). We also verified whether periarticular knee alignment parameters, measured conventionally in whole-leg standing radiography, could be measured in HC view.MethodSixty healthy volunteers and 61 patients with medial knee osteoarthritis were included. H-TCA was measured by two examiners in the healthy group, and intra-class correlation coefficients (ICCs) were evaluated. H-TCA and L-TCA were then measured in the healthy and osteoarthritis groups and correlated. Finally, we measured hip–knee–ankle angle, mechanical axis deviation ratio, mechanical lateral distal femoral angle, medial proximal tibial angle, and joint-line convergence angle in HC view and conventional whole-leg standing radiography to evaluate statistical differences and correlations.ResultsThe intra-observer and inter-observer ICCs were 0.86 and 0.76, respectively. Correlation coefficients (r) between H-TCA and L-TCA were r = 0.87 in healthy group and r = 0.81 in osteoarthritis group, indicating a strong positive correlation in both groups. There was no significant difference in periarticular knee alignment parameters between HC view and conventional whole-leg radiography.ConclusionsHindfoot evaluation in HC view showed high intra-observer and inter-observer reliabilities and strong positive correlation with TCA in long axial view. By using HC view before knee surgery, such as total knee arthroplasty, other necessary alignments can be evaluated simultaneously.  相似文献   
3.
盘状半月板损伤是一种常见的运动损伤,其治疗方法有在关节镜下行盘状半月板成形术、盘状半月板次全切术、盘状半月板全切术等,虽术后短期临床效果佳,但远期临床效果不理想。目前对于盘状半月板损伤手术方式的选择,不同的学者有不同的观点。近年来众多学者研究表明术式的选择及术后下肢力线的改变与盘状半月板损伤的治疗效果相关。本文主要总结了盘状半月板损伤的治疗现状及术后下肢力线的变化情况,阐述了下肢力线的评估在盘状半月板治疗中的作用,为临床个体化治疗盘状半月板损伤提供依据。  相似文献   
4.
目的 :分析高度发育不良性腰椎滑脱(high dysplastic developmental spondylolisthesis,HDDS)的手术复位程度与脊柱-骨盆矢状位参数变化的关系,以了解复位至何种程度能够显著改善术后脊柱-骨盆矢状位序列。方法:回顾性分析2007年3月~2019年4月在我院骨科接受手术治疗的35例HDDS患者,滑脱节段均为L5,年龄14.9±5.9岁(9~35岁)。均行减压、部分复位或完全复位、椎弓根螺钉内固定融合术。随访42.5±33.1个月(3~120个月)。依据术后末次随访时的Dubousset腰骶角(Dubousset lumbosacral angle,Dub-LSA)将患者分为70°(7例)、70°~79.9°(8例)、80°~89.9°(4例)及≥90°(16例)四组,依据末次随访时滑脱的Meyerding分度将患者分为Ⅲ度及以上(5例)、Ⅱ度(6例)、Ⅰ度以内(24例)三组,分别对比各组的术前、末次随访时脊柱-骨盆参数的变化。结果:滑脱率术前为(66.7±22.5)%(35%~100%),末次随访时为(18.9±20.9)%(0%~72%);DubLSA术前为61.9°±14.7°,末次随访时82.1°±17.3°。末次随访时Dub-LSA越大、滑脱程度越低,脊柱-骨盆矢状位参数较术前改善越明显;直至Dub-LSA≥90°和滑移程度在Ⅰ度以内时,骨盆倾斜角(pelvic tilt,PT)和骶骨倾斜角(sacral slope,SS)均有显著性改善,由后倾型骨盆转变为平衡型骨盆的比例显著增加。Dub-LSA≥90°组术前与末次随访时PT分别为36.4°±6.5°与27.2°±4.9°(P0.001)、SS分别为33.5°±9.1°与42.1°±9.3°(P0.001)、平衡型骨盆比例分别为0%(0/16)与43.8%(7/16)(P=0.007),末次随访时与术前比较均有统计学差异。末次随访时滑脱程度在Ⅰ度以内组,术前与末次随访时PT分别为38.9°±8.6°与30.6°±7.4°(P0.001)、SS分别为31.4°±11.5°与41.2°±8.7°(P0.001)、平衡型骨盆比例分别为0%(0/24)与29.2%(7/24)(P=0.009),末次随访时与术前比较均有统计学差异。结论:将HDDS患者的Dub-LSA复位至≥90°和将滑移复位至Ⅰ度以内能够显著改善脊柱-骨盆矢状位参数,并且能够将部分(43.8%)后倾型骨盆改善为平衡型骨盆。  相似文献   
5.
ObjectiveThe aim of study was to analyze the association between Quadriceps Angle (QA) and plantar pressure, navicular height (NH), and calcaneo-tibial angle (CTA).MethodsA total of 64 volunteers (mean age: 22.25 ± 2.54 (range:19–33)) participated in this cross sectional study. EMED-m (Novel GmbH, Germany) electronic pedobarograph was employed for dynamic plantar pressure measurement using two step protocol. The angle between the vertical axis of calcaneus and the long axis of Achilles tendon for CTA. The height of navicular tubercle from the ground was measured while the subject was standing on both feet for NH. QA was measured while the subject was standing in a relaxed posture where both feet bearing equal weight.ResultsThere were significant negative correlations between QA and maximum force (MxF) under the 4th. metatarsal head (MH4). The QA was also significantly correlated with MxF and force-time integral (FTI) under the bigtoe (BT). FTI under the 3rd. metatarsal head (MH3), MH4 and 5th. metatarsal head (MH5) were significantly negatively correlated with QA. Pressure-time integral (PTI) under the MH4 and MH5 were found to be significantly negatively correlated with QA. A significant correlation was also found between QA and NH (p < 0.0001), whilst there was no correlation between QA and CTA. Regression analysis showed that NH was appeared as the major contributor for the QA (β = −0.49, p < 0.001) in the dynamic condition, followed by BT-FTI (β = 0.37, p < 0.001) and MH5-MxF (β = −0.21, p < 0.037).ConclusionThese findings may imply that the NH which can at least be controlled by appropriate shoe inserts may affect QA. This way, loading pattern of both plantar region and whole lower extremity may be altered.Level of evidenceLevel III, Diagnostic Study.  相似文献   
6.
7.

BACKGROUND CONTEXT

It is widely recognized that sagittal spinal alignment changes with age. However, there are presently no clear benchmarks for such values or those for the cervical spine in the general population. Quality epidemiological studies are needed to establish standards for spinal alignment deviation.

OBJECTIVES

In this study of an aged Japanese population, we employed random sampling from the basic resident registry of a rural town for subject selection to determine reference values of sagittal spinal alignment including the cervical spine.

STUDY DESIGN

Japanese resident cohort study based on a municipal registry.

PATIENT SAMPLE

A total of 413 aged people randomly sampled from the resident registry of a rural Japanese town.

OUTCOME MEASURES

All subjects underwent a whole spine lateral radiograph for measurement of sagittal spinal alignment parameters.

METHODS

Registered citizens of 50 to 89 years old were targeted for this survey. We established eight groups based on age (50s, 60s, 70s, and 80s) and gender (male and female) after random sampling from the resident registry of Obuse town in 2014. A total of 413 people (203 males and 210 females) were enrolled. Radiographic parameters of sagittal spinal alignment of the cohort were measured and analyzed. Funding for this study was provided by the Japan Orthopaedics and Traumatology Research Foundation (10,000 USD), the Japanese Orthopaedic Association (5,000 USD), the Japanese Society for Musculoskeletal Medicine (40,000 USD), and the Nakatomi Foundation (15,000 USD).

RESULTS

Global spinal alignments became more misaligned with age for both genders. Sagittal vertical axis (SVA) forward shift was significantly more frequent in 80s males and 70s females, and SVA in 80s females was a mean of 66 mm forward of that of 50s females. Cervical protrusion was markedly greater in 60s males onwards. In women, lumbar lordosis and posterior pelvic inclination were noticeable from a younger age than in men. The amount of pelvic tilt misalignment in female subjects was approximately 10 years earlier than their male counterparts.

CONCLUSIONS

This first resident cohort of Japanese individuals determined average spinal alignment parameters by age and gender. Spinal balance generally shifts forward as age increases. A forward shift in the upper cervical spine occurs first in men, whereas lumbopelvic alignment shift occurs first in women.  相似文献   
8.
目的 :分析Lenke 5型青少年特发性脊柱侧凸(AIS)患者颈椎矢状位曲度(CSA)在后路矫形术后改变的特点。方法:回顾性分析2011年7月~2017年7月解放军总医院脊柱外科收治的43例Lenke 5型AIS患者的临床资料。在术前、术后及末次随访时的X线片上测量颈椎前凸角(CL)、胸椎后凸角(TK)、胸腰段后凸角(TLK)、腰椎前凸角(LL)、融合节段内腰椎前凸角(LIF)、C7矢状位垂直距离(SVA)。同时统计患者的基本资料,包括性别、年龄、Risser征、随访时间、融合节段椎体数目(NVF)及术前胸腰段/腰弯(TL/L Curve,TL/L C)。依据患者术前CSA分为颈椎前凸组(L组,术前CL0°)、颈椎后凸组(K组,术前CL≥0°);依据患者末次随访时CSA较术前的改变分为颈椎前凸增加组(I组)与颈椎前凸减少组(D组)。使用t检验分析L组与K组、I组与D组对应参数的差异性,使用LSD-t检验分析各组内术前、术后、末次随访时参数的差异。使用Pearson相关性检验分析CL与I组和D组各参数的相关性。检验水准为双侧α=0.05。结果:43例患者中男10例,女33例;年龄15.90±4.98岁,随访时间22.84±14.10个月。L组15例,K组17例;I组26例,D组17例。L组与K组、I组与D组的基本资料无显著性差异。所有患者末次随访时TK较术前增加(P=0.000);术后TLK与术前比较有显著性差异(P=0.000);CL在术前、术后及末次随访时无统计学差异。L组与K组术前CL(P=0.000)、LIF(P=0.029)、SVA(P=0.003)差异有统计学意义(P0.05)。K组末次随访时CL较术前改善(P=0.025),TK较术前增加(P=0.000);术后TLK较术前减小(P=0.002)并维持至末次随访(P=0.002)。I组与D组术前LL(P=0.043)、CL(P=0.009)有显著性差异(P0.05)。I组末次随访时CL较术前改善(P=0.008),TK较术前(P=0.000)及术后(P=0.001)增加;术后TLK较术前减小(P=0.005)并维持到末次随访时(P=0.006)。D组术后LL较术前增加(P=0.011)并维持到末次随访(P=0.001)。I组术前CL与TK、SVA有相关性;D组CL术前与LL、SVA,术后与TLK、SVA,末次随访时与TLK有相关性。结论:术前颈椎后凸的患者较颈椎前凸的患者在术后CSA的改善更为明显;随访中TK增加、术后TLK改善可能有助于CSA的改善;术后只有LL增加而无TK、TLK的改变则可能不会引起CSA改善。  相似文献   
9.
目的 :探讨腰椎后路减压复位环形融合治疗腰椎双节段椎体滑脱后临床疗效及腰椎-骨盆矢状位拟合关系的变化。方法:回顾性纳入2014年1月至2018年1月海南医学院第一附属医院关节创伤外科收治的接受腰椎后路减压复位环形融合内固定术且资料完整的67例双节段腰椎滑脱症患者。记录患者术前和末次随访时腰腿疼痛视觉模拟(visual analogue scale,VAS)评分及腰椎功能障碍指数(Oswestry disability index,ODI)评分,计算腰椎前凸角(lumbar lordosis,LL)、骶骨倾斜角(sacral slope,SS)、骨盆倾斜角(pelvic tilt,PT)及骨盆入射角(pelvic incidence,PI)并进行分析比较。结果 :术后12个月,患者腰痛VAS评分由(5.1±0.6)分降至(2.1±0.5)分,ODI评分由(44.5±2.2)分降至(18.6±1.0)分,两者变化差异均具有统计学意义(P<0.001)。腰椎LL由47.3°±5.1°降至32.1°±6.0°,SS由40.3°±3.3°降至26.8°±7.5°,PT由34.5°±3.0°...  相似文献   
10.
The aim of this study was to carry out a retrospective multicentre study comparing the morphological outcome of 8 techniques used for the management of sagittal synostosis versus a large cohort of control patients. Computed tomographic (CT) images were obtained from children CT-scanned for non-craniosynostosis related events (n = 241) and SS patients at preoperative and postoperative follow-up stages (n = 101). No significant difference in morphological outcomes was observed between the techniques considered in this study. However, the majority of techniques showed a tendency for relapse. Further, the more invasive procedures at older ages seem to lead to larger intracranial volume compared to less invasive techniques at younger ages. This study can be a first step towards future multicentre studies, comparing surgical results and offering a possibility for objective benchmarking of outcomes between methods and centres.  相似文献   
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