Alignment

对齐
  • 文章类型: Journal Article
    本文介绍了一项研究,该研究评估了化学计量学在质量控制背景下对咖啡样品进行分类的应用。高分辨率和准确的质量测量用作基于像素的正交偏最小二乘判别分析(OPLS-DA)模型的输入。使用FT-Orbitrap®质量分析仪,通过组合顶空固相微萃取和气相色谱-高分辨率质谱(GC-HRMS)的全自动工作流程获得组成数据。以准确的质量测量为中心的工作流程已成功用于组型分析,为完全依赖MS相似性搜索的方法提供了替代方案。预测模型经过了彻底的评估,展示了稳健的多变量分类性能。五个关键的咖啡属性,苦涩,酸度,身体,强度,使用GC-HRMS数据成功预测了焙烧水平。结果显示,所有模型的预测准确性都很高,范围从88.9%(苦味)到94.4%(焙烧水平)。这项研究代表了咖啡质量控制自动化方法的重大进展,与现有文献相比,模型的预测能力显著提高。
    This paper presents a study that assesses the application of chemometrics for classifying coffee samples in a quality control context. High-resolution and accurate mass measurements were utilized as input for pixel-based orthogonal partial least squares discriminant analysis (OPLS-DA) models. The compositional data were acquired through a fully automated workflow combining headspace solid-phase microextraction and gas chromatography-high-resolution mass spectrometry (GC-HRMS) using an FT-Orbitrap® mass analyzer. A workflow centered on accurate mass measurements was successfully utilized for group-type analysis, offering an alternative to methods relying solely on MS similarity searches. The predictive models underwent thorough evaluation, demonstrating robust multivariate classification performance. Five key coffee attributes, bitterness, acidity, body, intensity, and roasting level were successfully predicted using GC-HRMS data. The results revealed strong predictive accuracy across all models, ranging from 88.9 % (bitterness) to 94.4 % (roasting level). This study represents a significant advancement in automating methods for coffee quality control, notably increasing the predictive ability of the models compared to existing literature.
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  • 文章类型: Journal Article
    背景:最近已经描述了全膝关节置换术(TKA)中更个性化的对准技术,特别是针对年轻和活跃的患者。使用传统的辅助设备进行理想的胫骨切割可能具有挑战性。因此,这项研究的目的是:(1)描述特定的胫骨标志,以优化TKA中的胫骨切口;(2)与常规技术相比,将胫骨切口与这些标志的准确性进行比较。
    方法:这项回顾性病例对照研究比较了使用常规技术和与特定胫骨标志相关的髓外引导进行的原发性TKAs。对于每种情况,根据体重指数(BMI)匹配一名对照患者,年龄,术前髋关节膝关节踝关节(HKA)角度,和胫骨内侧近端角度(MPTA)。所有对照患者均由相同的外科医生和类似的常规技术进行手术,但没有标志。MPTA目标是以3°的内翻极限重现术前畸形。每组包括34个TKA。两组术前无差异。平均年龄为63岁±8岁。平均BMI为32kg/m2±5。平均HKA为170.6°±2.5。平均MPTA为85.1°±2.3。术前和2个月时进行了影像学评估:HKA,机械股骨远端内侧角(mMDFA),MPTA,胫骨斜坡,关节线高度的恢复。
    结果:胫骨标志对应于深内侧副韧带纤维的插入线,延伸到Gerdy结节上方的囊插入。术后MPTA明显更多的内翻(在标志组中为87.2°±1.6,而在88.3°±2.2;p=0.027),并且在标志组中更接近于术前骨畸形(p=0.002),异常值明显少于常规组。两组术后HKA无显著差异(175.4°±2.3对175.9°±2.5;p=0.42);mMDFA(88.9°±2.3对88.2°±2.1;p=0.18);胫骨斜率(82.6°±1.9对82.4°±2.6;p=0.67),关节线高度的恢复(1.5mm±2对1.8mm±2;p=0.56)。
    结论:在TKA中使用个性化对准技术时,TKA期间的特定胫骨标志可用于提高胫骨切割的准确性。
    方法:IV.
    BACKGROUND: More personalized alignment techniques in total knee arthroplasty (TKA) have recently been described particularly for the young and active patients. Performing the ideal tibial cut might be challenging with a conventional ancillary. Therefore the aims of this study were: (1) to describe specific tibial landmarks to optimize the tibial cut in TKA; (2) to compare the accuracy of the tibial cut with these landmarks compared to a conventional technique.
    METHODS: This retrospective case-control study compared primary TKAs performed using a conventional technique with extramedullary guide associated with specific tibial landmarks. For each case, one control patient was matched based on body mass index (BMI), age, preoperative Hip Knee Ankle (HKA) angle, and Medial Proximal Tibial Angle (MPTA). All control patients were operated by the same surgeon and similar conventional technique but without landmarks. The MPTA target was to reproduce preoperative deformity with a 3° of varus limit. 34 TKA were included in each group. There was no preoperative difference between both groups. Mean age was 63 years old ± 8. Mean BMI was 32 kg/m2 ± 5. Mean HKA was 170.6° ± 2.5. Mean MPTA was 85.1° ± 2.3. The radiographic assessment was performed preoperatively and at 2 months: HKA, mechanical Medial Distal Femoral Angle (mMDFA), MPTA, tibial slope, restoration of the joint line-height.
    RESULTS: The tibial landmarks corresponded to the line of insertion of the deep medial collateral ligament fibers extended to the capsular insertion above the Gerdy tubercle. The postoperative MPTA was significantly more varus (87.2° ± 1.6 in landmark group versus 88.3° ± 2.2; p = 0.027) and closer to preoperative bone deformity in landmark group (p = 0.002) with significantly less outliers than in the conventional group. There was no significant difference between both groups postoperatively for HKA (175.4° ± 2.3 versus 175.9° ± 2.5; p = 0.42); mMDFA (88.9° ± 2.3 versus 88.2° ± 2.1; p = 0.18); tibial slope (82.6° ± 1.9 versus 82.4° ± 2.6; p = 0.67), the restoration of the joint line-height (1.5 mm ± 2 versus 1.8 mm ± 2; p = 0.56).
    CONCLUSIONS: Specific tibial landmarks during TKA can be used to increase the accuracy of the tibial cut when using personalized alignment techniques in TKA.
    METHODS: IV.
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  • 文章类型: Journal Article
    方法:本研究为回顾性多中心比较队列研究。
    方法:采用回顾性的成人脊柱畸形手术患者的机构数据库。包括骶骨/骨盆在内的所有>5个椎体水平的融合均符合纳入条件。修订,3柱截骨术,临床随访<2年的患者被排除在外。根据手术入路将患者分为3组:1)后路无椎间融合术(PSF),2)带椎体间的PSF(PSF-IB),和3)前后路(AP)融合(前路腰椎椎体间融合或后路螺钉固定的外侧腰椎椎体间融合)。术中,射线照相,和临床结果,以及并发症,组间比较采用方差分析和χ2检验。
    结果:纳入了118名患者进行研究(PSF,n=37;PSF-IB,n=44;AP,n=57)。术中,两组间估计的失血量相似(p=0.171).然而,与PSF(385.1)和PSF-IB(370.7)相比,AP组手术时间更长(547.5min)(p<0.001).此外,与AP(13.6)和PSF(12.9)相比,PSF-IB(11.4)的融合长度较短(p=0.004).从术前到术后2年,两组之间的对齐变化没有差异。临床结果无差异。虽然术后并发症在各组之间基本相似,与PSF(5.4%)和PSF-IB(9.1)组相比,AP组(31.6%)的手术并发症较高(p<0.001).
    结论:虽然术中结果(手术时间和融合长度)存在差异,术后临床或影像学结局无差异.AP融合与较高的手术并发症发生率相关。
    METHODS: This study was a retrospective multi-center comparative cohort study.
    METHODS: A retrospective institutional database of operative adult spinal deformity patients was utilized. All fusions > 5 vertebral levels and including the sacrum/pelvis were eligible for inclusion. Revisions, 3 column osteotomies, and patients with < 2-year clinical follow-up were excluded. Patients were separated into 3 groups based on surgical approach: 1) posterior spinal fusion without interbody (PSF), 2) PSF with interbody (PSF-IB), and 3) anteroposterior (AP) fusion (anterior lumbar interbody fusion or lateral lumbar interbody fusion with posterior screw fixation). Intraoperative, radiographic, and clinical outcomes, as well as complications, were compared between groups with ANOVA and χ2 tests.
    RESULTS: One-hundred and thirty-eight patients were included for study (PSF, n = 37; PSF-IB, n = 44; AP, n = 57). Intraoperatively, estimated blood loss was similar between groups (p = 0.171). However, the AP group had longer operative times (547.5 min) compared to PSF (385.1) and PSF-IB (370.7) (p < 0.001). Additionally, fusion length was shorter in PSF-IB (11.4) compared to AP (13.6) and PSF (12.9) (p = 0.004). There were no differences between the groups in terms of change in alignment from preoperative to 2 years postoperative. There were no differences in clinical outcomes. While postoperative complications were largely similar between groups, operative complications were higher in the AP group (31.6%) compared to the PSF (5.4%) and PSF-IB (9.1) groups (p < 0.001).
    CONCLUSIONS: While there were differences in intraoperative outcomes (operative time and fusion length), there were no differences in postoperative clinical or radiographic outcomes. AP fusion was associated with a higher rate of operative complications.
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  • 文章类型: Journal Article
    背景:近年来,全膝关节置换术(TKA)的假体对准技术引起了人们的极大兴趣,特别是在所谓的运动学对准中,其目的是恢复膝盖的自然对齐。然而,实施这项技术需要专门的工具和可能费力的程序步骤。这项研究介绍了滑车沟的平分线作为执行股骨远端切割的可靠标志,同时保持与天然股骨关节线的平行性。方法:三名骨科专家评估了110张全腿X线图像,2021年1月至2022年12月从健康个体获得的负重下肢。在X射线图像上识别出滑车沟的平分线,并测量了该平分线与股骨关节线之间的角度。评估了重复评估和不同检查者之间这些测量的一致性。结果:发现滑车沟的平分线与股骨关节线垂直,平均角度为89.4°。评估者间可靠性在平均值±1.3°内为68%,而评分者内部可靠性在平均值±1.5°范围内为82%。结论:这些结果表明,通过垂直于滑车沟的平分线进行股骨切割,在由于骨关节炎的影响而无法识别天然关节线的患者中,外科医生可以固有地恢复天然膝关节的股骨关节线。该方法可以为目前在TKA中用于运动学对准的标准手术技术提供可行且直接的替代方案。
    Background: In recent years, there has been considerable interest in prosthetic alignment techniques for total knee arthroplasty (TKA), particularly in the so-called kinematic alignment, which aims to restore the knee\'s native alignment. However, implementing this technique requires specialized instruments and procedural steps that can be laborious. This study introduces the bisector of the trochlear groove as a reliable landmark for performing the distal femoral cut while maintaining parallelism with the native femoral joint line. Methods: Three orthopedic specialists assessed 110 X-ray images of full-leg, weight-bearing lower limbs obtained from healthy individuals between January 2021 and December 2022. The bisector of the trochlear groove was identified on the X-ray images, and the angle between this bisector and the femoral joint line was measured. The consistency of these measurements across repeated assessments and different examiners was evaluated. Results: The bisector of the trochlear groove was found to be perpendicular to the femoral joint line, with a mean angle of 89.4°. The inter-rater reliability was 68% within ±1.3° from the mean, while the intra-rater reliability was 82% within ±1.5° from the mean. Conclusions: These results suggest that by performing a femoral cut perpendicular to the bisector of the trochlear groove, surgeons can inherently restore the femoral joint line of the native knee in patients where the native joint line is no longer identifiable due to the effect of osteoarthritis. This method may offer a viable and straightforward alternative to the standard surgical technique currently practiced for kinematic alignment in TKA.
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  • 文章类型: Journal Article
    目的:远端肢体错位可能会导致盆底功能障碍(PFD)。这项研究旨在比较有和没有pesplanus的女性的盆底肌肉力量(PFMS)和功能障碍。
    方法:女性患有(pesplanus组,n=30)和无pesplanus(对照组,包括n=30)。PFD的存在受到质疑。通过Feiss线测试,带有改良牛津量表的PFMS,以及PFD与盆底窘迫清单-20(PFDI-20)的严重程度,包括三个分量表(盆腔器官窘迫量表-6(POPDI-6),用于盆腔器官脱垂,结肠直肠-肛门窘迫量表-8(CRADI-8)用于结肠直肠-肛门症状,和泌尿系统症状的泌尿系统窘迫量表-6(UDI-6),被评估。
    结果:可以看出,在PFMS方面,各组之间没有发现差异(p>0.05)。然而,患有扁平苔藓的女性尿失禁和肛门失禁高于无扁平苔藓的女性(p<0.05)。仅PFDI-20、CRADI-8和UDI-6评分与对照组相比更高(p<0.05)。两组POPDI-6评分无差异(p>0.05)。
    结论:PFMS没有根据扁平苔藓的存在而变化。然而,与对照组相比,患有扁平苔藓的女性PFD的患病率及其严重程度更高.PFD个体的姿势评估,特别是检查脚的姿势,应考虑对体位障碍患者进行盆底评估。
    OBJECTIVE: Distal extremity misalignment may give rise to pelvic floor dysfunctions (PFDs). This study aimed to compare pelvic floor muscle strength (PFMS) and dysfunctions in women with and without pes planus.
    METHODS: Women with (pes planus group, n = 30) and without pes planus (control group, n = 30) were included. The presence of PFDs questioned. Pes planus with the Feiss Line Test, PFMS with the Modified Oxford Scale, and the severity of PFDs with the Pelvic Floor Distress Inventory-20 (PFDI-20), including three subscales (Pelvic Organ Distress Inventory-6 (POPDI-6) for pelvic organ prolapse, Colorectal-Anal Distress Inventory-8 (CRADI-8) for colorecto-anal symptoms, and Urinary Distress Inventory-6 (UDI-6) for urinary symptoms, were assessed.
    RESULTS: It was seen that no difference was found between groups in terms of PFMS (p > 0.05). However, urinary incontinence and anal incontinence were higher in women with pes planus than in women without pes planus (p < 0.05). Only the PFDI-20, CRADI-8, and UDI-6 scores were higher in women with pes planus compared to controls (p < 0.05). There was no difference was found between groups in terms of POPDI-6 scores (p > 0.05).
    CONCLUSIONS: The PFMS did not change according to the presence of pes planus. However, the prevalence of PFDs and their severity were higher in women with pes planus in comparison to controls. Posture assessments of individuals with PFDs, especially examination of foot posture, and pelvic floor assessments of individuals with posture disorders should be considered.
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  • 文章类型: Journal Article
    背景:这项研究旨在研究患有内侧骨关节炎(mOA)的膝盖与没有骨关节炎的膝盖之间股骨远端外侧角(LDFA)的差异,并探讨在运动学对位全膝关节置换术(KA-TKA)中股骨关节面无骨磨损假设的有效性。
    方法:该研究包括69例一侧膝盖有mOA,而另一侧没有OA的患者。LDFA,胫骨近端内侧角(MPTA),机械髋-膝-踝角度(mHKA),测量并比较膝盖之间的算术髋-膝-踝角度(aHKA)。采用Pearson相关系数和配对t检验进行统计学分析。
    结果:mOA膝关节的LDFA和MPTA内翻明显多于非OA膝关节,差异为1.0°±2.3°和0.9°±2.0°,分别。非OA侧的mHKA与mOA侧的aHKA差异不显著,这表明,在没有解剖校正的情况下,在运动学上对齐的全膝关节置换术后,使用aHKA作为术后对齐的估计是合适的。然而,男性和女性患者的mOA和非OA膝盖的MPTA和aHKA差异显著。
    结论:假设股骨关节表面没有骨磨损是可以拒绝的,并且对于软骨磨损2mm的恒定补偿厚度可能是不够的。需要进一步的研究来估计股骨和胫骨侧的骨磨损量,以制定KA-TKA中更个性化的手术计划策略。
    BACKGROUND: This study aimed to investigate the difference in lateral distal femoral angle (LDFA) between knees with medial osteoarthritis (mOA) and knees without osteoarthritis, and to explore the validity of the assumption that there is no bone wear on the femoral articular surface in kinematic alignment total knee arthroplasty (KA-TKA).
    METHODS: The study included 69 patients with mOA on one side of the knee and but no OA on the other side. LDFA, medial proximal tibial angle (MPTA), mechanical hip-knee-ankle angle (mHKA), and arithmetic hip-knee-ankle angle (aHKA) were measured and compared between the knees. Pearson\'s correlation coefficient and paired t-tests were used for statistical analysis.
    RESULTS: The LDFA and MPTA were significantly more varus in mOA knees than in knees non-OA knees, with differences of 1.0° ± 2.3° and 0.9° ± 2.0°, respectively. The difference between mHKA of the non-OA side and aHKA of the mOA side was not significant, indicating that it is appropriate to use aHKA as an estimation of postoperative alignment after kinematically-aligned total knee arthroplasty without anatomical correction. However, there was a significant difference in MPTA and aHKA between male and female patients in both mOA and non-OA knees.
    CONCLUSIONS: The assumption that there is no bone wear on the femoral articular surface is rejectable, and the constant compensation thickness of 2 mm for cartilage wear may not be sufficient. Further research is needed to estimate the amount of bone wear in both femur and tibia side to develop more individualized surgical planning strategies in KA-TKA.
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  • 文章类型: Journal Article
    背景:在经胫骨假体装配的过程中,对准是相对于残肢定位假足的过程。额平面对齐的变化会影响行走过程中的膝盖力矩,这可能会导致或,当正确对齐时,防止受伤。然而,动态膝关节力矩的临床评估具有挑战性,限制假肢医生对动态关节负荷的见解。通常,膝关节载荷在静态姿势中使用膝关节力矩臂作为后续动态对准的代理进行评估。仍然不确定静态对准是否准确地代表行走期间的实际动态。
    目的:经胫骨骨锚接假体使用者步态中的前膝力矩臂和外膝内收力矩是否能预测?
    方法:在本横断面研究中,在M-Gait仪器跑步机上对27名单侧胫骨骨锚假体用户进行了数据采集。进行了静态和动态测量,并计算了膝关节力臂和外部膝关节内收力矩。进行了Pearson相关性和线性回归分析,以检查静态和动态膝关节力矩臂与外部膝关节内收力矩之间的关系。
    结果:静态膝盖力矩臂在地面反作用力峰值处显示出与动态膝盖力矩臂的显着关联(首先:r=0.60,r2=35%,p<0.001;其次:r=0.62,r2=38%,p=0.001)和膝盖内收力矩(首先:r=0.42,r2=17%,p=0.030;第二:r=0.59,r2=35%,p=0.001)。对应的静态膝盖力矩臂的受试者之间的1毫米差异,平均而言,膝盖内收力矩在第一个峰值处差异为0.9%,在地面反作用力的第二个峰值处差异为1.5%。
    结论:虽然静态对准对于优化站立时的内收力矩很重要,但它可能只能部分减轻步态过程中的过度力矩。合理的相关性和有限的解释方差百分比强调了动态对齐在优化步行过程中身体动态负荷方面的重要性。
    BACKGROUND: In the process of transtibial prosthetic fitting, alignment is the process of positioning the prosthetic foot relative to the residual limb. Changes in frontal plane alignment can impact knee moments during walking, which can either cause or, when aligned properly, prevent injuries. However, clinical evaluation of dynamic knee moments is challenging, limiting prosthetists\' insights into dynamic joint loading. Typically, knee joint loading is assessed in static stance using the knee moment arm as a proxy for subsequent dynamic alignment. It remains uncertain if static alignment accurately represents actual dynamics during walking.
    OBJECTIVE: Is the frontal knee moment arm in stance predictive for the knee moment arm and external knee adduction moment during gait in transtibial bone-anchored prosthesis users?
    METHODS: In this cross-sectional study, twenty-seven unilateral transtibial bone-anchored prosthesis users underwent data acquisition on the M-Gait instrumented treadmill. Static and dynamic measurements were conducted, and knee moment arm and external knee adduction moment were calculated. Pearson\'s correlation and linear regression analyses were performed to examine relationships between static and dynamic knee moment arms and external knee adduction moments.
    RESULTS: The static knee moment arm showed significant associations with dynamic knee moment arm at the ground reaction force peaks (First: r=0.60, r2=35%, p<0.001; Second: r=0.62, r2=38%, p=0.001) and knee adduction moment (First: r=0.42, r2=17%, p=0.030; Second: r=0.59, r2=35%, p=0.001). A 1 mm between-subject difference in static knee moment arm corresponded, on average, with a 0.9% difference in knee adduction moment at the first peak and a 1.5% difference at the second peak of the ground reaction force.
    CONCLUSIONS: While static alignment is important to optimize adduction moments during stance it may only partly mitigate excessive moments during gait. The fair correlation and limited percentage of explained variance underscores the importance of dynamic alignment in optimizing the body\'s dynamic load during walking.
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  • 文章类型: Journal Article
    目的:一些研究调查了胸腰椎的力学行为。然而,在胸腰椎交界处(TLJ)找到正常功能局部对准(LA)和节段运动(SM)的准确参考是一项挑战。因此,本研究旨在评估TLJ患者LA和SM的年龄和性别相关变化及差异.
    方法:该研究招募了年龄在20至79岁之间没有背痛症状的健康受试者。具有适当成像结果的健康受试者(60名男性和60名女性)被纳入研究。将受试者分为年龄组(20-29、30-39、40-49、50-59、60-69和70-79岁);每组包括每种性别的10名受试者。
    结果:TLJ处的SM很小,但很明显,运动逐渐向TLJ的较低水平增加,靠近腰部。在TLJ的任何SM测量中,男性和女性受试者之间均未观察到显着差异。随着年龄的增长,TLJ处的SM逐渐降低,而TLJ的局部后凸发展。结果还显示,胸腰椎斜率(TLS)值不随年龄变化,并保持在-12.8±7.2°的平均值(p=0.893)。
    结论:本研究结果为脊柱疾病或创伤患者的适当手术计划和康复提供了有价值的指导。此外,这些结果可以作为准确分类标准的基础,以评估治疗后的残疾程度。
    Several studies have investigated the mechanical behavior of the thoracolumbar spine. However, finding an accurate reference for the normal functional local alignment and segmental motion (SM) at the thoracolumbar junction (TLJ) is challenging. Therefore, this study aimed to assess age- and sex-related changes and differences in local alignment and SM at the TLJ.
    The study recruited healthy subjects aged 20 to 79 without complaints of back pain. Healthy subjects (60 males and 60 females) with appropriate imaging results were enrolled in the study. The subjects were divided into age groups (20-29, 30-39, 40-49, 50-59, 60-69, and 70-79 years); each group included 10 subjects of each sex.
    The SM at the TLJ was small but noticeable, and the motion gradually increased toward the lower level of the TLJ, closer to the lumbar region. No significant differences were observed between male and female subjects in any SM measurements at the TLJ. The SM at the TLJ gradually decreased with age, while local kyphosis of TLJ progressed. The results also showed that the thoracolumbar slope value did not change with age and remained at a mean of -12.8 ± 7.2° (P = 0.893).
    This study\'s results provide valuable guidance for appropriate surgical planning and rehabilitation of patients with spinal diseases or trauma. Furthermore, the results can be the basis for categorizing accurate criteria to evaluate the degree of disability after treatment.
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  • 文章类型: Journal Article
    目的:全膝关节置换术(TKA)后残余内翻可影响功能预后,在肥胖的情况下可能会恶化。然而,没有研究发现可以比较肥胖患者术后残余轻度内翻或中性的结局.这项研究的目的是比较术后并发症和假体存活率,TKA术后中性或轻度内翻的肥胖患者的膝关节功能结局。
    方法:我们回顾性分析了2010年1月至2015年12月在我院接受TKA治疗的188例连续肥胖患者(体重指数≥30kg/m2)。在入院和出院时测量所有患者的机械髋-膝-踝轴角。根据西安大略省和麦克马斯特大学骨关节炎指数(WOMAC)评分对膝关节功能进行回顾性评估,膝关节协会膝关节评分(KS-KS),膝关节社会功能评分(KS-FS),被遗忘的联合得分(FJS),和运动范围(ROM)。使用Studentt检验或方差或Kruskal-Wallis检验的分析,在具有中性或轻度内翻对准的膝盖之间比较连续数据。对于结果的多重比较,我们使用Bonferroni-Dunn方法来调整p值。分类数据使用卡方检验进行比较。
    结果:在137名完成平均8.32±1.47年随访的肥胖患者中,有156个膝盖,97个膝盖从内翻矫正为中性,54个膝盖保持轻度残余内翻。轻度内翻的患者有明显的WOMAC(8.25±8.637vs.14.97±14.193,p=0.009)和更好的FJS(86.03±15.607vs.70.22±30.031,p=0.002)。两种类型的膝盖在KS-KS中没有显着差异,KS-FS,或ROM。尽管一名中性膝盖的患者不得不接受翻修手术,两组间差异无统计学意义。
    结论:对于患有骨关节炎的肥胖患者,TKA后保留残余内翻对齐可改善功能结局,而不影响假体存活.
    OBJECTIVE: Residual varus after total knee arthroplasty (TKA) can affect functional outcomes, which may worsen in the presence of obesity. However, no studies were found to compare the outcomes of obese patients involving postoperative residual mild varus or neutral. The aim of this study was to compare postoperative complications and prosthesis survival, and functional outcomes for knees of obese patients with neutral or mild varus after TKA.
    METHODS: We retrospectively reviewed 188 consecutive obese patients (body mass index ≥30 kg/m2) at our hospital who underwent TKA due to varus knee osteoarthritis from January 2010 to December 2015. The mechanical hip-knee-ankle axis angle was measured in all patients at admission and discharge. Knee functions were retrospectively assessed based on the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, Knee Society Knee Score (KS-KS), Knee Society Function Score (KS-FS), Forgotten Joint Score (FJS), and range of motion (ROM). Continuous data were compared between knees with neutral or mild varus alignment using analysis of Student\'s t test or variance or the Kruskal-Wallis test as appropriate. For multiple comparisons of outcomes, we used Bonferroni-Dunn method to adjust p-values. Categorical data were compared using the chi-squared test.
    RESULTS: Of the 156 knees in 137 obese patients who completed follow-up for a mean of 8.32 ± 1.47 years, 97 knees were corrected from varus to neutral and 54 knees were kept in mild residual varus. Patients with mild varus knees had significantly WOMAC (8.25 ± 8.637 vs. 14.97 ± 14.193, p = 0.009) and better FJS (86.03 ± 15.607 vs. 70.22 ± 30.031, p = 0.002). The two types of knees did not differ significantly in KS-KS, KS-FS, or ROM. Although one patient with a neutral knee had to undergo revision surgery, there was no significant difference between two groups.
    CONCLUSIONS: For obese patients with osteoarthritis, preservation of residual varus alignment after TKA can improve functional outcomes without compromising prosthesis survival.
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  • 文章类型: Journal Article
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