显微技术下前路多节段颈椎人工椎间盘置换术短期疗效观察

目的探讨显微镜下多节段颈椎人工椎间盘置换术的短期疗效,观察术后颈椎活动度及临床功能的变化,为多节段颈椎间盘突出症的外科治疗提供临床依据。方法因颈椎病(cervical spondylosis,CS)行显微镜下多节段颈椎人工椎间盘置换术患者,其中使用颈椎动态稳定器DCI 2例,使用Prestige-LP人工椎间盘3例。患者术前与术后6月均行颈椎正侧位、过伸过屈位X射线片、颈椎MRI检查,测量脊髓功能评分(JOA)和置换节段活动度(range of motion,ROM)。结果显微镜下微创手术未出现手术并发症,神经功能明显改善;术后6月颈椎运动范围与术前比较差异无统计学意义(P>0.05);所有患者的JOA评分较术前均有明显改善(P<0.05)。结论显微镜下手术创伤小,并发症少,多节段颈椎人工椎间盘置换术基本保留了颈椎的稳定性,具有良好的活动度,短期临床效果良好。     

A three-dimensional parameterized and visually kinematic simulation module for the theoretical range of motion of total hip arthroplasty

Background

Proper option and optimal alignment of implants are major factors in obtaining the desired range of motion of total hip arthroplasty. It would be very useful if a tool is available to assist clinicians to preoperatively determine proper implants and their optimal intraoperative alignment for individual patient.

Methods

Based on the secondary development function of ADAMS/VIEW, a three-dimensional parameterized module was developed to simulate six motions of implants for total hip arthroplasty. Total eight parameters (stem abduction, acetabular size, head size, general head–neck ratio, stem–neck angle, acetabular anteversion, acetabular inclination and femoral antetorsion) were included and three definitions of acetabular orientations (operative, radiographic and anatomical) were available. Any initial position of implants and simulation precision could be defined on the demand.

Findings

After entering these eight parameters, a special model of total hip arthroplasty would be constructed. Single or combined motion until the prosthetic impingement could be simulated visually and the corresponding maximal rotation angle would be quantified.

Interpretation

Clinical factors, such as patients with severe deformity of hip joint or a large range of motion demand, should be considered during total hip arthroplasty. This module can provide references for clinicians on proper option and intraoperative implantation of components, and be suitable for postoperative evaluation. Furthermore, it is a tool to investigate the “safe-zones” of total hip arthroplasty and also can be employed for the design of new implant system.     

C5/6 Prestige LP人工颈椎间盘置换术后不同屈伸运动特性的临床疗效观察

目的探讨人工颈椎间盘置换术后手术节段屈曲、后伸活动差异对临床疗效的影响。方法四川大学华西医院脊柱外科行C5/6单节段Prestige LP人工颈椎间盘置换的110例患者,依据术后手术节段矢状面屈曲、后伸活动度大小的不同,分为屈>伸、屈=伸、屈<伸三组。采用日本骨科协会(JOA)评分、颈椎功能障碍指数(NDI)、疼痛视觉模拟评分(VAS)评估患者的临床疗效;影像学评价指标包括矢状面屈伸活动特性分组评价、颈椎整体曲度、颈椎整体活动度、置换节段活动度及异位骨化率。结果随访时间24~109月(31.2±17.9)月。末次随访三组VAS、JOA、NDI评分及颈椎整体曲度和活动度、置换节段活动度比较差异均无统计学意义(P>0.05),HO发生率屈>伸组为10.21%,屈=伸组为7.41%,屈<伸组为35.29%,屈<伸组HO发生率显著高于另外两组(P<0.05)。结论C5/6单节段Prestige-LP间盘置换术后,不同矢状面屈伸运动特性不影响患者术后临床疗效、置换节段活动度、颈椎整体曲度及活动度,术后手术节段后伸活动度大于屈曲活动度可能是异位骨化率增高的影响因素。     

Effects of posterior pelvic tilt on anterior instability in total hip arthroplasty: A parametric experimental modeling evaluation

Background

Anterior dislocation is one of the concerns of patients with posterior pelvic tilt undergoing total hip arthroplasty. This study aimed to evaluate the magnitude of posterior pelvic tilt constituting a risk for anterior dislocation by measuring the range of motion until impingement and dislocation under various pelvic tilt.

Methods

Using a jig mounted prosthetic hip model, the ranges of external rotation at extension and internal rotation at flexion until reaching dislocation were tested. The site of impingement prior to dislocation was also recorded. Posterior pelvic tilt and the cup version were changed with 10° increments from 0° to 40° and from 10° retroversion to 30° anteversion, respectively. Effects of increasing femoral offset were also tested. We defined a required range of motion as having 30° external rotation at extension and 40° internal rotation at 90° flexion.

Findings

External rotation decreased in a posterior pelvic tilt-dependent manner. In the case with more than 20° posterior pelvic tilt, available external rotation extended beyond required range with the cup anteversion of 20°. Decreasing cup anteversion improved external rotation, however, internal rotation decreased simultaneously. In the case with posterior pelvic tilt more than 20°, only cup anteversion with 0° or 10° satisfied the required range of motion. A + 4 mm horizontal offset improved external rotation by 10° with delaying bony impingement.

Interpretation

More than 20° of posterior pelvic tilt may cause anterior instability and diminish the optimal range of cup version. Increasing the femoral offset improved external rotation without reducing internal rotation.     

Acute neck pain: cervical spine range of motion and position sense prior to and after joint mobilization

Despite the relatively high prevalence of cervical spine pain, the efficacy of treatment procedures is limited. In the current study, range of motion and proprioception was assessed prior to and after specific cervical spine mobilisation techniques. A 44-year-old male office worker presented with a history of cervical pain of 1 day duration. He had woken with pain, stiffness and a loss of range of motion. Examination findings indicated pain to be at C5–6 on the left side. Measurement of maximal three-dimensional cervical motion was undertaken using a Zebris system. A position matching task tested the individual's ability to actively reposition their head and neck. The treatment undertaken involved grade III down-slope mobilisations on the left side at C5–6 and C6–7 in supine lying. This technique was then progressed by placing the subject in an upright sitting position, and sustained natural apophyseal glides were performed at C6.Immediately following the treatment, the patient reported a considerable decrease in pain, less difficulty in movement and reduced stiffness. Motion analyses showed the most marked percentage improvements in range of motion after treatment were in flexion (55%), extension (35%), left rotation (56%), and left lateral flexion (22%). Ipsilateral lateral flexion with axial rotation was also notably improved following treatment. No change in proprioceptive ability was found following the treatment. The findings showed that the application of standardised specific mobilisation techniques led to substantial improvements in the range of motion and the restitution of normal coupled motion.     

Clinical and radiographic features of spinal osteoarthritis predict long-term persistence and severity of back pain in older adults

BackgroundPatients with back pain can show one or more features of spinal osteoarthritis (OA), such as morning stiffness, limited or painful range of motion (ROM), and lumbar disc degeneration (LDD). However, it has not been investigated whether these features are prognostic of long-term back pain.ObjectivesThis study assessed whether spinal morning stiffness, ROM and LDD are prognostic factors for back pain after 1 year in older adults with back pain.MethodsThis prospective observational study (BACE cohort) included patients aged > 55 years visiting a general practitioner for a back-pain episode. Baseline patient-reported morning stiffness, physical examined ROM and radiographic LDD features (i.e., multilevel osteophytes and disc space narrowing) were analysed as potential prognostic factors in unadjusted and adjusted regression models with the outcomes of persistent back pain (yes/no) and back pain severity after 1-year follow-up.ResultsThis study included 543 patients with mean (SD) age 67 (8) years, 59% female, and 62% reporting back pain at 1-year follow-up. When studied in separate adjusted models, persistent back pain was associated with morning stiffness > 30 min (OR 3.0, 95%CI 1.3; 5.5), restricted lateroflexion (OR 1.8, 95%CI 1.0; 3.2), pain during rotation (OR = 1.7, 95%CI 1.0; 2.9), multilevel osteophytes (OR 2.4, 95%CI 1.4; 4.1), and multilevel disc space narrowing (OR 1.5, 95%CI 0.9; 2.4). When investigated in the same adjusted model, persistent back pain remained associated with only morning stiffness > 30 min (OR 2.4, 95%CI 1.0; 3.9), pain during rotation (OR 1.6, 95%CI 0.9; 2.8), and multilevel osteophytes (OR 2.1, 95%CI 1.2; 3.7). The same spinal OA-related features were associated with back pain severity.ConclusionsSpinal morning stiffness, painful rotation, and multilevel osteophytes are prognostic factors for persistent back pain and back pain severity after 1 year. Evaluating these clinical and radiographic features of spinal OA could help clinicians identify older patients who will experience long-term back pain.     

T1倾斜角-颈椎前凸角（T1S-CL）在三节段颈椎前路椎间盘切除融合术中的意义

目的本研究目的在于探究连续性3节段颈椎前路椎间盘切除融合术（ACDF）手术前后颈椎序列和平衡状态的变化情况,并进一步探究该术式下T1倾斜角减去C2-C7颈椎前凸角（T1S-CL）的合理阈值。 方法本研究为单中心回顾性研究。收集2011年1月至2015年12月北京大学人民医院脊柱外科73例脊髓型颈椎病（CSM）患者接受连续性3节段ACDF,其中45例患者使用零切迹独立自锁系统,28例使用椎间融合器-前方钛板内固定系统,平均随访周期为73.8±8.6（m）。颈椎矢状位参数包括CL、C2-C7矢状位垂直距离（C2-C7 SVA）、T1S和T1S-CL,T1S-CL用于评估颈椎平衡状态,所有参数在术前和末次于颈椎X线上测得。生活质量由颈椎功能障碍指数（NDI）和日本矫形外科协会（JOA）评分评估,NDI=20分定义为生活质量评分阈值。T1S-CL阈值的确定基于影像学参数和临床指标,通过线性回归和Logistic回归模型进行双重判定。 结果CL和T1S在末次较术前相比均有提高（P＜0.05）而T1SCL平均减低4.5±9.7°（P=0.008）,C2-C7 SVA对比基线差异无统计学意义（P=0.253）。临床疗效方面,NDI和JOA在末次较术前相比显著改善（P＜0.001）。相关性分析显示,末次随访C2-C7 SVA与T1S-CL存在相关性,T1S与T1S-CL存在相关性（P＜0.05）,末次随访NDI与矢状位参数之间存在相关性。C2-C7 SVA为NDI的独立危险因素（χ²=34.02,P=0.001,比值比=1.51,ROC-AUC=0.955）,而T1S-CL为C2-C7 SVA的独立影响因素（χ²=12.26,P=0.001,比值比=1.24,ROC-AUC=0.878）。当NDI=20分时,线性回归和Logistic回归分析预测C2-C7 SVA的临界值为29.2 mm,此时对应T1S-CL的阈值为20.7°。 结论3节段ACDF能够重建CSM患者颈椎矢状位序列并改善颈椎平衡状态。对于该人群,C2-C7 SVA的临界值为29.2 mm,此时对应颈椎平衡参数T1S-CL的阈值为20.7°。     

Clinical and radiological assessment of the cervical extensor muscles in people with neck pain. A narrative review

Background: Clinical and radiological investigations of the function and structure of the cervical extensor muscles are increasingly being used in physiotherapy practice.

Objectives: The aim of this review is to investigate the reliability and clinical utility of these tests, to report on normative data and to evaluate the association between the results of these investigations and neck pain.

Major Findings: A range of clinical and radiological tests have been described to assess the function and structure of the cervical extensor muscles. Clinical tests that evaluate cervical muscle strength and endurance can be performed reliably and there is some evidence that performance of these tests is impaired in people with neck pain. There is however, a need for better understanding of what constitutes normal strength and endurance in these muscles and whether abnormal function is a cause or effect of neck pain. Clinical tests of extensor motor control have not been extensively studied. Of the radiological investigations commonly used for evaluation of cervical extensor muscle structure, ultrasound cross-sectional measures have demonstrated acceptable reliability and correlate reasonably well with higher resolution MRI images.

Conclusions: The clinical and radiological tests commonly used to assess cervical extensor muscles generally have acceptable reliability and are mostly well suited within the physiotherapy clinic. Both clinical and radiological tests need further investigation through case-controlled longitudinal studies that explore the relationship between these tests and neck pain.     

人工椎间盘置换对颈椎临近节段活动度及椎间盘内压力的影响

目的观察人工椎间盘置换对颈椎临近节段活动度及椎间盘内压力的影响。方法应用人工椎间盘置换术治疗颈椎病患者20例,于术中椎间盘置换前后分别测量临近节段椎间盘内压力,并于术前及术后3个月、半年分别摄颈椎动力位x线片,观察上下临近节段的活动度。结果人工椎间盘置换术后颈椎临近节段椎间盘内压力较术前无明显变化（P〉0．05）,上下临近关节活动度未显著增加（P〉0．05）。结论人工椎间盘置换在治疗颈椎病的同时保留正常的椎间运动而不影响邻近节段,从而防止邻近节段继发性退变。     

A systematic review of empirical studies between 1966 and 2005 of patient outcomes of total hip arthroplasty and related factors

Aim. To determine patient outcomes of total hip arthroplasty and the research methods used to produce knowledge of use to clinical nursing and for purposes of health education. The review consists of three parts. Firstly, it describes the patient outcomes of total hip arthroplasty. Secondly, it addresses the factors related to the patient outcomes and thirdly the research methods used are explored. Background. Previous research has identified that total hip arthroplasty is a very common procedure to reduce pain and improve physical function in patients with osteoarthritis. The greatest improvements have been found in reduction in pain. Methods. Two databases, Medline and CINAHL were searched from 1966–2005. Studies were eligible for review and included if they met the following criteria: (1) publication in English, (2) empirical research and (3) the indication for total hip arthroplasty was osteoarthritis; 17 studies met the criteria. Results. Total hip arthroplasty resulted in pain relief, improved physical function and enhanced health‐related quality of life regardless of patients’ characteristics, type of operation or type of prosthesis. The only factor affecting patient outcomes was patients’ poor pre‐operative function. These patients were more likely to have postoperative pain and low postoperative physical function. Long‐waiting time for surgery may reduce quality‐adjusted life years. Different kinds of questionnaires were used in the studies reviewed leaving out patients’ perceptions concerning the outcomes of total hip arthroplasty. Conclusions. Patients’ perceptions should be assessed more closely in further research to gain subjective knowledge about the outcomes of total hip arthroplasty. This could be achieved by using qualitative methods also. Relevance to clinical practice. The findings can be seen as a challenge for nurses to plan patients’ education. It is also important that the outcomes of total hip arthroplasty correspond to patients’ expectations. Patients’ preoperative function should be taken into consideration when planning the timing of surgery so that the best possible outcomes were attainable.     

The effect of prehabilitation on the range of motion and functional outcomes in patients following the total knee or hip arthroplasty: A pilot randomized trial

Objective: The study investigated the effect of prehabilitation on the quality of life and function in patients having total knee replacement (TKR)/total hip replacement (THR). Methods: A pilot randomized controlled trial with concealed allocation, assessor blinding, and intention-to-treat analysis was conducted. Sixty-four people undergoing elective lower-limb arthroplasty were included. Prehabilitation included one-hour twice-weekly sessions for at least three and a maximum of four weeks prior to surgery. Control participants did not complete any pre-surgical programs. Health utility and quality of life as measured by the EQ-5D-3L and the patient-specific functional scale were the primary outcomes measured before allocation and eight weeks post-operatively. Results: No between-group differences were evident in health utility (main effect of the group ?0.04 (95% Confidence Interval [CI] ?0.16 to 0.08, p = 0.50) or patient-specific functional scale (main effect of the group ?0.59 (95% CI ?1.8 to 0.6, p = 0.73), but the group-by-joint interaction effects for the timed up and go (TUG) (7.6 (95% CI ?0.9 to 16.1, p = 0.08)) and the EQ-5D VAS (?18.3 (95% CI ?41.1 to 4.5), p = 0.11) were larger. Prehabilitation participants’ knee flexion improved by 12.6 degrees (95% CI 5.2–20, p = 0.001). Conclusions: Prehabilitation improved knee flexion, but this did not translate into improved functional mobility or quality of life.     

Economic outcomes from patients' perspective and health-related quality of life after total hip arthroplasty

The aim of this study was to determine the economic outcomes (service use, health care and nonhealth care out-of-pocket costs) related to total hip arthroplasty from the perspective of patients. Also, examined was the relationship between economic outcomes and health-related quality of life (HRQOL). One hundred patients, 54 female and 46 male, mean age 63.9 (SD 11.6) years, with osteoarthritis in the hip and undergoing primary or revision arthroplasty, participated in this follow-up study. The drop-out race was 13%. Patients' service use, and out-of-pocket costs were recorded, and HRQOL was measured up to 6 months. The Friedman and Wilcoxon nonparametric tests showed that use of home nursing and transportation was most frequent at 1 month, whereas physiotherapy was used most often after 1 month. The Spearman coefficient of correlation, Fisher's, Mann–Whitney U and Kruskal–Wallis tests were used to compare background factors with economic outcomes and HRQOL. Age, pain, gender, civil status, type of surgery and discharge destination showed associations with service use. Healthcare costs composed over 90% of total out-of-pocket costs, and nonhealthcare costs <10%. Age and discharge destination were related to total out-of-pocket costs. Patients' HRQOL improved after surgery. The worse it was before, or after surgery, the more services were used, but no significant correlations between costs and HRQOL were observed. When deciding the timing of surgery, patients' characteristics, especially level of pain and HRQOL should carefully evaluated, as they may predict patients' service use and ability to manage at home after surgery.     

Isometric osteopathic manipulation influences on cervical ranges of motion and correlation with osteopathic palpatory diagnosis: A randomized trial

IntroductionIsometric manipulation is a current practice in osteopathy and treatment benefits have been reported in the literature. Such benefits could be assessed using experimental non-invasive cervical mobility measurements. The main objective was to quantitatively measure the effects of isometric manipulation on principal and compensatory cervical motions.Methods101 healthy volunteers were included in this study. 51 healthy volunteers selected randomly underwent the experimental protocol before and after isometric treatment and were compared to 50 healthy volunteers who underwent a placebo treatment. Osteopathic diagnosis was performed on each healthy volunteer before and after the treatment. The experimental protocol included measurements by a motion capture system focusing on principal range of motion and compensatory motions.ResultsIn both the isometric and the placebo sample, respectively including 51 (age: 29.2 ± 8.1, BMI: 22.2 ± 3.5) and 50 healthy volunteers (age: 27.4 ± 6.8, BMI: 22.9 ± 2.8), a pre-treatment diagnosis revealed a light cervical dysfunction in all subjects, mainly in levels C3 and C4. Altered ranges of motion thresholds (C3/C4 alterations) were identified: 113.2° for flexion, 130.0° for rotation and 90.2° for lateral flexion.After manipulations, the volunteers who underwent the isometric treatment presented a slight increase in amplitude for lateral flexion (p < 0.04), which was not found in the volunteers who underwent the placebo treatment. Compensatory motions showed differences pre and post isometric treatment without reaching significant values.ConclusionPrincipal ranges of motion were found significantly higher after osteopathic treatment when compared to the placebo treatment. Osteopathic palpatory diagnosis showed significant correlation with range of motions before treatment.     

创伤性颈椎损伤内固定置入相关临床试验注册项目分析

背景：创伤性颈椎损伤不容忽视,如果不及时有效救治,伤及脊髓会产生瘫痪的风险。目的：通过中国临床试验注册中心,北美临床试验注册中心以及汤森路透WebofScience数据库进行相关检索,对创伤性颈椎相关临床试验注册项目及发表文献进行文献计量学分析。方法：①使用关键词“颈椎”在中国临床试验注册中心进行临床试验项目检索,得到颈椎创伤相关临床试验项目。②使用关键词“Cervicalvertebra”,“Trauma”或“cervicalspine”,“Trauma”在北美临床试验注册中心进行临床试验项目检索,得到的注册项目有22项。③使用关键词“Neckvertebra”,“cervicalvertebra”,“vertebraecervicales”,“cervicalspine”,“C．spine”,“Trauma”在汤森路透WebofScience数据库对创伤性颈椎损伤相关文献进行检索,时间范围2003至2012年。结果与结论：①中国临床试验注册中心关于颈椎创伤的临床试验注册项目仅有5项,北美临床试验注册中心关于颈椎创伤的临床试验注册项目有22项。中国临床试验注册中心明显少于北美临床试验注册项目。北美临床试验注册中心相关颈椎创伤的临床试验注册项目分布于3个州,17个国家。主要分布在美国。②创伤性颈椎临床试验注册项目多为干预性研究,干预措施多涉及内固定物。暂时没有诊断性试验研究进行临床试验注册。2003至2012年在汤森路透WebofScience数据库中关于创伤性颈椎损伤已发表文献多达1597篇。美国发文量占总数比重最大,为46．84％。中国发文量占所有文章的1．94％。高被引文章主要分布于JournalofTrauma-InjuryInfectionandCriticalCare（《创伤一损伤感染和危重护理学杂志》）杂志上。④中国临床试验注册中心关于颈椎创伤相关临床试验注册单位2003至2012年在汤森路透WebofScience数据库中未发表文章。北美临床试验注册中心关于颈椎创伤相关临床试验注册最多的单位是OttawaHospitalResearchInstitute（渥太华医院研究所）发表文章4篇;发文量最多的单位是UniversityofBritishColumbia（英国哥伦比亚大学）发表文章30篇,多集中在2009年和2012年。同时这两个单位合作的关于颈椎创伤的文章也进行了临床试验注册,注册号为NCT00290875。     

宫颈癌扩散加权成像表观扩散系数与磁共振动态增强定量参数的临床价值

目的探讨磁共振扩散加权成像表观扩散系数(apparent diffusion coefficient,ADC)值和MR动态增强定量参数联合应用在宫颈癌诊断中的临床价值。材料与方法对100例宫颈癌患者和20例健康志愿者行常规MRI、扩散加权成像(diffusion weighted imaging,DWI)和MR动态增强扫描。(1)测量ADC值:在DWI b=800 s/mm~2上获取ADC图,对病灶低信号内取3个感兴趣区点位ADC值平均值,即ADC_(mean)。(2)将采集到的动态增强图像输入后处理工作站,通过血液双室模型(Tofts模型)软件,得出血流动力学参数:K~(trans)、K_(ep)和V_e。独立样本比较t检验,比较采用直线回归分析,绘制ROC曲线分析K~(trans)、K_(ep)和ADC_(mean)联合应用对宫颈癌的诊断效能。P0.05为差异有统计学意义。结果宫颈癌组ADC_(mean)、K~(trans)、K_(ep)、Ve均值分别为:(0.8600±0.1608)×10-3 mm2/s、(2.6650±1.4750)/min、(4.0369±2.1073)/min、0.4875±0.2336;健康组ADC_(mean)、K~(trans)、K_(ep)、V_e均值分别为:(1.3495±0.1543)×10-3 m m2/s、(0.9086±0.4922)/min、(1.3689±0.5214)/min、0.4204±0.2771。直线回归分析:ADC_(mean)与K~(trans)、ADC_(mean)与Kep、K~(trans)与Kep间的P值均0.05,有统计学意义;V_e各P值0.05,无统计学意义。ROC曲线进一步分析ADC_(mean)和K~(trans)、Kep联合应用诊断宫颈癌效能,当阈值为-0.6时,ADC_(mean)、K~(trans)和Kep敏感度和特异度分别为:98%和100%,98%和75%,100%和90%。结论宫颈癌的ADC_(mean)和动态增强定量参数K~(trans)、K_(ep)能作为癌肿影像学诊断可靠标记物,联合应用可以提高正确诊断率。     

Cervical flexion: a study of dynamic surface electromyography and range of motion

BACKGROUND: In the comprehensive assessment of painful conditions, dynamic surface electromyography (sEMG) and range of motion (ROM) recordings can provide information regarding muscle spasm, antalgic postures, fear of pain (protective guarding), muscle injury, and disordered movement caused by pain. This study examines ROM and sEMG patterns observed during cervical flexion. OBJECTIVE: To demonstrate 2 distinctive sEMG recruitment and dynamic ROM patterns observed during cervical flexion and return to mid-line. DESIGN: Single-subject design with independent measurement of dynamic ROM and sEMG. SETTING: Applied clinical setting. PARTICIPANTS: Two subjects with normal ROM and cervical muscles were studied. MAIN OUTCOME MEASURE: One subject was studied with sEMG. looking at the cervical paraspinals and sternocleidomastoid muscles; the other subject was studied with an active ROM device. Three cervical movements were studied: lower cervical flexion, atlantoaxial (upper) cervical flexion, and a combination upper/lower cervical flexion. RESULTS: The active ROM device indicates larger movements (higher degrees of flexion) for the lower cervical flexion compared with upper flexion. The combined movement indicates a differential movement from 2 spinal segments. The sEMG recordings indicated differential recruitment patterns. The sternocleidomastoid recruits briskly during the flexion phase of the upper cervical flexion movement, whereas the cervical paraspinals recruit briskly during return to mid-line when the lower cervical flexion is used. The combined upper then lower cervical flexion movement recruits both sets of muscles. CONCLUSIONS: The results of the study indicate 2 distinct movement patterns associated with upper versus lower cervical flexion and 2 distinct sEMG recruitment patterns. The study suggests that these 2 distinct movements involve 2 distinct cervical segments and are associated with recruitment of different muscle groups. Applied clinical research on the cervical spine should use sEMG recordings to assess both the upper and lower flexion movements as the standard for the study of cervical flexion.     

Impact of being underweight on peri-operative and post-operative outcomes of total knee or hip arthroplasty: A meta-analysis

BACKGROUNDMany systematic reviews have focused on assessing the effect of body mass index (BMI) on the outcomes and complications associated with total hip arthroplasty (THA) and total knee arthroplasty (TKA), but primarily dealt with obesity compared to normal weight (NW). None of these reviews attempted to assess the effect of low BMI or underweight (UW) compared to NW in patients undergoing THA or TKA.AIMThis review aims to compare specific operative outcomes such as operation duration, length of hospital stay, and post-operative complications including mortality, infections, deep vein thrombosis, etc. along with re-hospitalization and reoperation rates between UW and NW patients undergoing THA, TKA or both.METHODSAn electronic search was performed in PubMed, Scopus, Excerpta Medica database (EMBASE), Web of Science (WoS), and Cochrane Central Register of Controlled Trials (CENTRAL) along with a manual search. The quality of the studies was assessed using the Newcastle-Ottawa scale for cohort studies. The data were subjected to both qualitative and quantitative analysis.RESULTSThirteen retrospective and five prospective cohort studies were included. The quality of included studies was assessed to be good to fair. The length of hospital stay after TKA or THA was found to be significantly higher for UW patients when compared to NW patients, with a mean difference: 0.39 95%CI: [0.06, 0.72], P = 0.02 (in days). Studies presenting both THA and TKA together as total joint arthroplasty showed an increased incidence of mortality in patients treated with THA or TKA alone, Odds ratio: 4.18 95%CI: [2.88, 6.07]. A higher incidence of post-operative complications was also observed in UW patients undergoing THA. CONCLUSIONUW patients undergoing THA or TKA had a higher incidence of post-operative complications and were associated with a higher readmission rate. Moreover, UW patients were associated with an increased incidence of mortality in the studies that reported THA and TKA together.     

Clinical outcomes and 5-year follow-up results of keratosis pilaris treated by a high concentration of glycolic acid

BACKGROUNDKeratosis pilaris is a hereditary abnormal keratosis of the hair follicle orifice. Gray-brown keratotic plugs in the pores and dark red keratotic papules at the openings of hair follicles can be seen, which contain coiled hair and are often accompanied by perifollicular erythema and pigmentation. Glycolic acid can correct the abnormalities of hair follicular duct keratosis and eliminate excessive accumulation of keratinocytes. It also promotes skin metabolism and accelerates the melanin metabolism. The therapeutic effect is related to the glycolic acid concentration.AIMTo evaluate the efficacy and safety of a high concentration of glycolic acid in the treatment of keratosis pilaris, and to observe the outcomes at 5-year of follow-up.METHODSTwenty-five participants were recruited and areas with typical keratosis pilaris were selected as testing sites. High concentrations of glycolic acid (50% or 70%) were applied to a circular area (d = 8 cm, S = 50 cm²) and repeated four times, on days 0, 20, 40 and 60. Before each treatment and 20 d after the last treatment, on days 0, 20, 40, 60, and 80 and at a 5-year follow-up, The number of follicular keratotic papules were counted and the extent of perifollicular erythema and pigmentation was determined. At the same time, the participants provided subjective evaluations of treatment efficacy and safety.RESULTSTreatment effectiveness was indicated by the percentage of keratotic papules in the test site, on days 20, 40, 60 and 80, which were 8%, 12%, 36%, and 60%, respectively. Compared with day 0, each difference was significant (P < 0.05). Compared with day 0, differences in melanin content (M) in the skin and skin lightness (L) on days 40, 60 and 80, the were statistically significant (P < 0.05); skin hemoglobin content (E) on days 60 and 80 was statistically different as compared with before treatment (P < 0.05). There were no significant differences in the number of keratotic papules, M, L, and E in 9 participants at the 5-year follow-up compared with before treatment (P > 0.05%).CONCLUSIONA high concentration of glycolic acid significantly improved skin roughness as well as follicular hyperpigmentation of patients with keratosis pilaris. The treatment was relatively safe, but there was no significant difference at the 5-year follow-up compared to before treatment.