一种自动优选标准型股骨柄的方法

髋关节置换手术中采用标准型假体时,术前只能大致选取假体,术中还要预备多个假体,往往手术时间增长。为了解决这一问题,本文提出一种利用计算机优选标准型髋关节假体的方法。从X线片中获取患者股骨解剖数据。利用这些解剖数据和股骨近端截面平均数据库三维重建患者股骨近端,重建出的股骨近端模型使优选标准假体成为可能。理论分析表明,该方法切实可行。     

Ectopia lentis in Loeys‐Dietz syndrome type 4

Loeys‐Dietz syndrome is a heritable disorder of the connective tissue leading to multisystem involvement including craniofacial features, skeletal abnormalities, cutaneous findings and early‐onset and aggressive disease of the aorta and its branches. There are multiple types of Loeys‐Dietz syndrome related to pathogenic variants in TGFBR1, TGFBR2, SMAD3, TGFB2, and TGFB3. Individuals with Loeys‐Dietz syndrome may be misdiagnosed as having Marfan syndrome due to shared phenotypic features and aortic root dilation. However, ectopia lentis has been an important discriminating feature, being unique to Marfan syndrome and not reported to be associated with Loeys‐Dietz syndrome. We report the case of a 46‐year‐old woman with Loeys‐Dietz syndrome type 4 due to a pathogenic variant in TGFB2 who was diagnosed with ectopia lentis at age 44. The patient underwent whole exome sequencing and no other pathogenic variants were found to explain the ectopia lentis. Our findings indicate that ectopia lentis may be an uncommon finding in Loeys‐Dietz syndrome type 4 and emphasize the importance of genetic testing in familial thoracic aortic aneurysm disease.     

老年髋部骨折患者围术期“2P-3R”营养管理模式构建

目的构建老年髋部骨折患者围术期营养管理模式,促进患者早手术、早下地、早康复。方法针对老年髋部骨折患者营养管理现状,采用课题研究型品管圈活动进行改进。经过科学循证、专家指导等,从术前、术后及家庭三个环节,骨科、营养科、家庭三个维度,人员、制度、材料设备、方法、信息五个方面,制定三大对策群组并予以实施,包括组建营养支持团队、构建营养管理策略、搭建多维信息交互平台等。结果老年髋部骨折患者首次下地时间缩短为26.7 h,平均住院日缩短为5.6 d,实现了早手术、早下地、早康复的目标。结论对老年髋部骨折患者实施个性化、全流程的序贯性营养干预具有重要意义。后续还需开展大样本多中心研究以进一步验证成效,数据自动采集与智能反馈也是今后研究重点。     

Comorbidity and Quality of In-Hospital Care for Hip Fracture Patients

ObjectivesWe examined whether the comorbidity burden of patients with hip fracture was associated with quality of in-hospital care reflected by fulfillment of process performance measures.DesignPopulation-based cohort study using prospectively collected data from the Danish Multidisciplinary Hip Fracture Registry (DMHFR).Setting and ParticipantsPatients aged 65 years or older with an incident hip fracture from 2014 to 2018 registered in the DMHFR (n = 31,443).MethodsComorbidity was measured using the Charlson Comorbidity Index based on hospital diagnoses. Quality of in-hospital care was defined as fulfillment of eligible process performance measures, including preoperative optimization, early surgery, early mobilization, pain assessment, basic mobility, nutritional risk, need for anti-osteoporotic medication, fall prevention, and a post-discharge rehabilitation program, reflecting guideline-recommended in-hospital care. The outcomes were (1) an all-or-none composite measure defined as fulfillment of all relevant process performance measures, and (2) fulfillment of the individual process performance measures. Using binary regression, we calculated relative risk (RR) for the association between comorbidity level and outcomes.ResultsThe overall proportion of patients with hip fracture who fulfilled the all-or-none measure was 31%. Among patients with no comorbidity, 34% fulfilled the all-or-none measure versus 29% among patients with high comorbidity (Charlson ≥ 3). This corresponds to a 15% lower chance (RR = 0.85, 95% confidence interval 0.81–0.89). Increasing comorbidity was also associated with lower fulfillment of the individual process performance measures. The largest difference was seen for preoperative optimization, early surgery, and early mobilization, where patients with high comorbidity had 6% to 11% lower chance of fulfillment of these process performance measures compared with patients without comorbidity.Conclusion and ImplicationsIncreasing level of comorbidity was associated with lower quality of in-hospital care among patients with hip fracture. Our results highlight the need for tailored clinical initiatives to ensure that comorbid patients also benefit from the positive progress in hip fracture care in recent years.     

老年人髋部骨折的骨密度及影响因素的分析

目的调查分析成都地区老年人髋部骨折骨密度变化和影响因素,为预防髋部骨折提供科学依据.方法骨折组答卷式调查有关指标,髋部作X线正斜侧位摄片,骨折组与非骨折组进行配对,均用DEXA测量L2～4,股骨上段骨密度(BMD),骨矿含量(BMC),骨面积(Area)等,并进行统计分析.结果股骨上段及L2～4的BMD、BMC骨折组明显低于非骨折组(P＜0.05),两组各进行男女性比较,女性均明显低于男性(P＜0.05),骨折组L2～4BMD男、女分别为0.872±0.178g/cm2,0.607±0.155g/cm2;非骨折组男女分男为0.921±0.147g/cm2,0.741±0.152g/cm2.同性别的骨面积Area两组比较无差异,骨折组骨质疏松症发生率76%明显高于非骨折组63%(P＜0.05);滑倒和被人撞倒股骨颈骨折发生率较高,自行拌倒者粗隆间骨折发生率较高.结论预防治疗骨质疏松症和避免摔倒,以防骨折的发生.     

全髋关节置换术后异位骨化及其预防

目的：探讨全髋关节置换术后异位骨化发生的原因、机制及其预防方法。方法：将139例接受全髋关节置换的患者入院时随机分为3组,A组53例,B组49例,C组37例,分别于术后次日口服维生素C（100mg,3/d)、消炎痛（25mg/3/d)和布洛芬（200mg,3/d),连续应用4周。术后3个月复查时行X线片检查。结果：异位骨化情况按Brooker分类,A组：0级24例,I级6例,Ⅱ级13例,Ⅲ级7例,Ⅳ级3例,异位骨化发生率54．7％（29／53）。B组：0级42例,Ⅰ级5例,Ⅱ级2例,发生率14．3％（7／49）。C组：0级32例,Ⅰ级3例,Ⅱ级、Ⅲ级各1例,发生率13．5％（5／37）。经统计学分析,异位骨化发生率A组与B组、A组与C组之间有显著差别（P＜0．01）,B组与C组之间无显著差别（P＞0．05）。结论：全髋关节置换术后发生异位骨化的原因很多,发生机制尚不清楚,非甾体类消炎镇痛类药物可有效地预防其发生。     

Prevalence of Risk Factors for Adverse Spinopelvic Mobility Among Patients Undergoing Total Hip Arthroplasty

BackgroundPatients with adverse spinopelvic mobility have higher complication rates following total hip arthroplasty (THA). Risk factors include a stiff lumbar spine, standing posterior pelvic tilt ≤ ?10°, and a severe sagittal spinal deformity (pelvic incidence minus lumbar lordosis mismatch ≥20°). The purpose of this study is to define the spinopelvic risk factors and quantify the prevalence of risk factors for pathologic spinopelvic mobility.MethodsA retrospective cohort analysis from January 2014 to February 2020 was performed on a multicenter series of 9414 primary THAs by 168 surgeons, all with preoperative spinopelvic measurements in the supine, standing, and flex-seated positions. All patients were included. The prevalence of adverse spinopelvic mobility and frequency of each spinopelvic risk factor was calculated.ResultsThe cohort was 52% female, 48% male, with an average age of 65 years. Thirteen percent of patients exhibited adverse spinopelvic mobility and 17% had one or more of the 3 risk factors. Adverse mobility was found in 35% of patients with at least 1 risk factor, 47% with at least 2 risk factors, and 57% with all 3 risk factors.ConclusionForty-six percent of patients had spinopelvic pathology driven by one or more of the risk factors. Number of risk factors present and risk of adverse spinopelvic mobility were positively correlated, with 57% of patients with all 3 risk factors exhibiting adverse spinopelvic mobility. Although this study defines the prevalence of these risk factors in this highly selected cohort, it does not report incidence in a general THA population.Level of EvidencePrognostic Level IV.     

Mortality After Revision Total Hip Arthroplasty

BackgroundIn counseling patients about the complications of revision total hip arthroplasty (revTHA), it is imperative that mortality be considered. The actual mortality rate by indication of revision is ill-defined. The purpose of this study is to determine the mortality rate after revTHA.MethodsAn institutional database identified 596 patients who had undergone revTHA between 2012 and 2018. Medical records, national, state, and local death indexes were queried for mortality status and indication for revTHA. For survivors, the last clinical visit date was used for censoring in the mortality analysis. Mortality rates were calculated for all clinical patients and then by specific indication for revision.ResultsThe overall 2-year mortality rate following revTHA was 19.5 deaths per 1000 or 1 in 51 patients. Patients presenting with a periprosthetic fracture had a significantly higher 2-year mortality rate of 74.5 deaths per 1000 or 1 in 13 patients (P < .001), while an indication of dislocation or instability had a slightly higher 2-year mortality rate of 50.3 per 1000 (1 in 20) but this difference was not significant (P = .531). Other indications such as mechanical loosening or infection did not have a significantly different mortality rate.ConclusionThe overall 2-year mortality rate following revTHA was 19.5 deaths per 1000 which was largely attributed to patients with a periprosthetic fracture (74.5 per 1000) with other indications not significantly impacting mortality. Mortality rates and specific rates by indication for revision should be considered when counseling patients prior to revTHA.