股骨头直径与手术入路对初次全髋关节置换术后脱位危险率的影响

背景：目前认为应用较大的股骨头可降低全髋关节置换术后脱位的风险，但迄今为止仅有有限的临床数据可证实这种假设。 方法：自1969年至1999年，在同一家医疗机构施行了21047例应用不同型号股骨头的初次全髋关节置换术。对患者进行常规、定期地随访，并特别询问有关脱位的问题。手术入路包括：前外侧入路9155例，后外侧入路3646例，经转子入路8246例。股骨头直径为22mm者8691例，28mm者8797例，32mm者3559例。 结果：在21047髋中有868髋发生一次或多次脱位。术后一年首次脱位的累积危险率为2．2％，术后五年为3．0％，术后10年为3．8％，术后20年为6．0％。前外侧入路的10年累积脱位率为3．1％，经转子入路为3．4％，后外侧入路为6．9％。在前外侧入路，直径22mm股骨头的10年累积脱位率为3．8％，28mm股骨头为3．0％，32mm股骨头为2．4％；经转子入路，直径22mm股骨头的10年累积脱位率为3．5％，28mm股骨头为3．5％，32mm股骨头为2．8％；后外侧入路，直径22mm股骨头的10年累积脱位率为12．1％，28mm股骨头为6．9％，32mm股骨头为3．8％。多因素分析显示：22mm股骨头相对于32mm股骨头脱位的相对危险度为1．7，28mm股骨头相对于32mm股骨头脱位的相对危险度为1.3。 结论：在全髋关节置换术中，较大直径的股骨头可获得较低的远期累积脱位率。无论采取哪种手术入路，股骨头直径对脱位率均有一定影响，而且对行后外侧入路者影响最大。 可信水平：治疗性研究，Ⅲ级，进一步可信度参见作者介绍。     

Biliary events and an increased risk of new onset irritable bowel syndrome: a population-based cohort study

Background  Prospective data are lacking to determine if irritable bowel syndrome (IBS) is a risk factor for cholecystectomy, or if biliary disease and cholecystectomy predisposes to the development of IBS.
Aim  To test the hypothesis that IBS and biliary tract disease are associated.
Methods  Validated symptom surveys sent to cohorts of Olmsted County, MN, (1988–1994) with follow-up in 2003. Medical histories were reviewed to determine any 'biliary events' (defined by gallstones or cholecystectomy). Analyses examined were: (i) time to a biliary event post-initial survey and separately and (ii) risk of IBS (Rome II) in those with vs. without a prior biliary event.
Results  A total of 1908 eligible subjects were mailed a follow-up survey. For analysis (i) of the 726 without IBS at initial survey, 44 (6.1%) had biliary events during follow up, in contrast to 5 of 93 (5.4%) with IBS at initial survey (HR 0.8, 95% CI 0.3–2.1). For analysis (ii) of the 59 subjects with a biliary event at initial survey, 10 (17%) reported new IBS on the follow-up survey, while in 682 without a biliary event up to 1.5 years prior to the second survey, 58 (8.5%) reported IBS on follow-up (OR = 2.2, 95% CI 1.1–4.6, P  = 0.03).
Conclusion  There is an increased risk of new IBS in community subjects who have been diagnosed as having a biliary event.     

Measurement of abdominal symptoms by validated questionnaire: a 3‐month recall timeframe as recommended by Rome III is not superior to a 1‐year recall timeframe

Aliment Pharmacol Ther 31 , 1237–1247

Summary

Background Rome III incorporates changes in the definition of functional gastrointestinal disorder that involve a 3‐month recall time for symptoms, rather than 1‐year. Aim To validate a new version of the Talley‐Bowel Disease Questionnaire (Talley‐BDQ) and assess the impact of recall time period on the prevalence of symptoms. Methods A sample of community residents were randomly mailed a survey using 1‐year (n = 396) or 3‐month recall period (n = 374). We evaluated the reliability and the concurrent validity of the two versions of the questionnaire. The proportions of subjects reporting symptoms in the two versions were compared. Results The median (IQR) kappa on symptom‐related questions was 0.70 (0.57–0.76) from the 1‐year version and 0.66 (0.56–0.77) from the 3‐month version. A median kappa of 0.39 (0.19–0.70) and 0.58 (0.39–0.73) was observed for concurrent validation of the 1‐year and 3‐month versions respectively. Except for gastro‐oesophageal reflux symptoms, no differences were observed on the prevalence of clinically relevant symptoms. Conclusion The revised Talley‐BDQ is reliable, with excellent reproducibility and validity. There were few differences in reported symptom rates between the 3‐month and 1‐year recall time versions of the questionnaire. A 1‐year recall time may more efficiently capture infrequent or subtle symptoms.