Arthroplasty, replacement, knee

关节成形术,更换,膝盖
  • 文章类型: Journal Article
    背景:神经认知恢复延迟(dNCR)可导致老年手术患者的不良结局。身体活动(PA)已被证明可以改善认知功能,可能通过减少全身炎症反应。然而,缺乏支持性数据表明PA是否对dNCR具有保护作用.
    目的:为了研究dNCR与PA之间的相关性,并进一步分析促炎细胞因子是否介导这种关系。
    方法:本研究是对接受膝关节置换手术的老年患者进行的前瞻性巢式病例对照调查。dNCR定义为通过一系列神经心理学测试与基线相比认知功能下降。使用老年人身体活动量表(PASE)评估PA。酶联免疫吸附试验(ELISA)测定血清中IL-6、IL-1β、和TNF-α。采用多变量logistic回归分析评价PA与dNCR的相关性。采用中介分析来评估促炎细胞因子是否介导它们之间的关系。
    结果:纳入了152名患者的队列,dNCR的发生率为23.68%。PA与完全调整后的dNCR相关[OR=0.199,(95%CI,0.061;0.649),P=0.007]。中介分析显示IL-6介导PA与dNCR之间的统计学关联,介导比例(%)为77.68(术后IL-6浓度)或27.58(手术前后IL-6的绝对变化)。
    结论:PA作为dNCR的保护因素,可能通过降低促炎细胞因子浓度。中国临床跟踪注册::www.http://chictr.org。cn,登记号ChiCTR2300070834,注册日期:2023年4月24日。
    BACKGROUND: Delayed neurocognitive recovery (dNCR) can result in unfavorable outcomes in elderly surgical patients. Physical activity (PA) has been shown to improve cognitive function, potentially by reducing systemic inflammatory responses. However, there is a lack of supportive data indicating whether PA has a protective effect against dNCR.
    OBJECTIVE: To examine the correlation between dNCR and PA, and to further analyze if pro-inflammatory cytokines mediate this relationship.
    METHODS: This study is a prospective nested case-control investigation of elderly patients who had knee replacement surgery. dNCR was defined as a decline in cognitive function compared with baseline by using a battery of neuropsychological tests. PA was assessed with the Physical Activity Scale for the Elderly (PASE). Enzyme-linked immunosorbent assay (ELISA) was used to measure the serum concentrations of IL-6, IL-1β, and TNF-α. Multivariable logistic regression analysis was conducted to assess the association between PA and dNCR. Mediation analysis was employed to evaluate whether pro-inflammatory cytokines mediate the relationship between them.
    RESULTS: A cohort of 152 patients was included, resulting in an incidence rate of dNCR of 23.68%. PA was associated with dNCR after full adjustment [OR = 0.199, (95% CI, 0.061; 0.649), P = 0.007]. Mediation analysis showed that the IL-6 mediated the statistical association between PA and dNCR, with mediation proportions (%) of 77.68 (postoperative concentration of IL-6) or 27.58 (the absolute change in IL-6 before and after surgery).
    CONCLUSIONS: PA serves as a protective factor against dNCR, possibly through the reduction of pro-inflammatory cytokine concentrations. THE CHINESE CLINICAL TRAIL REGISTRY: : www.http://chictr.org.cn , Registration No. ChiCTR2300070834, Registration date: April 24, 2023.
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  • 文章类型: Journal Article
    BACKGROUND: Total knee arthroplasty (TKA) is accompanied by severe postoperative pain, which is reported to be an important cause of chronic pain. Ultrasound-guided adductor canal block (ACB) combined with infiltration between the popliteal artery and posterior capsular of the knee (IPACK) has been proven to have a better effect on relieving acute pain after TKA. However, whether it has a significant effect on the incidence of chronic pain after TKA has not been reported. This trial was designed to investigate the effect of ultrasound-guided ACB combined with IPACK on the incidence and intensity of chronic pain after TKA.
    METHODS: In this prospective, randomized, double-blind, placebo-controlled study, 100 subjects scheduled for TKA were randomly (1:1) divided into two groups: the ropivacaine group and the placebo group. Patients in each group received ultrasound-guided ACB + IPACK procedures with 0.25% ropivacaine or equal volume normal saline. All patients received multimodal analgesia. Pain intensity was assessed using the Numerical Rating Scale (NRS). The primary outcome was the incidence of chronic pain at 3 months after TKA by telephone follow-up. In addition, pain intensity in early resting and mobilized states, chronic pain intensity, the time to first rescue analgesia; opioid consumption; CRP and IL-6 after the operation; length of postoperative hospital stay; and cost of hospitalization and postoperative complications; as well as the function of the knee in the early stage after the operation, were recorded.
    RESULTS: Ninety-one participants were included in the final analysis. At 3 months, the incidence of chronic pain was 30.4% in the ropivacaine group, significantly lower than 51.1% in the placebo group. Compared with the placebo group, the ACB + IPACK with ropivacaine group had significantly lower pain scores at 4 hours, 8 hours, 16 hours, and 24 hours after the operation; increased the knee range of motion at 8 hours and 24 hours after the operation; and a significantly decreased incidence of chronic pain at 3 months after the operation. During the follow-up period, there were no nerve block-related complications in either group.
    CONCLUSIONS: In the context of multimodal analgesia protocols, ACB combined with IPACK before surgery decreases the incidence and intensity of chronic pain 3 months after TKA compared with placebo injection. In addition, it reduces the NRS scores, whether at rest or during mobilization, and improves knee function within 24 hours after TKA.
    BACKGROUND: This trial was registered in the China Clinical Trial Center (registration number ChiCTR2200065300) on November 1, 2022.
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  • 文章类型: Journal Article
    目的:这项随机对照双盲研究旨在研究全膝关节置换术后内收肌管阻滞(ACB)联合膝状神经阻滞(GNB)的镇痛效果是否不劣于内收肌管阻滞联合局部浸润镇痛(LIA)。
    方法:共102例全麻下全膝关节置换术患者,随机分为:ACB+GNB和ACB+LIA组;ACB+LIA组接受80mL0.2%罗哌卡因和10µg/mL肾上腺素用于LIA,而ACB+GNB组接受4mL0.2%罗哌卡因阻滞5条膝关节周围神经.主要结果是两组之间在24小时休息时视觉模拟量表评分的中位数差异。次要结局涉及其他时间点疼痛评分的中位数差异。其他结果包括前24小时以吗啡当量计算的阿片类药物的累积剂量以及与膝关节功能恢复相关的指标。
    结果:总计,36例和38例患者被纳入ACB+GNB和ACB+LIA组,分别。我们发现,24小时术后休息疼痛的中位数差异(95%内部置信度)(非劣效性标准,△=1)为-0.5(-1至0,p=0.002)。累积阿片类药物消耗的中位数差异为1mg(-1至3,p=0.019),符合非劣效性标准,△=7.7mg。
    结论:在全膝关节置换术后第1天,ACB联合GNB的镇痛效果与ACB联合LIA的镇痛效果不同,同时显著减少了局部麻醉药的使用。
    背景:注册中心名称:中国临床试验注册中心;试验注册编号:ChiCTR2300074274;注册日期。2023年8月2日。
    OBJECTIVE: This randomized controlled and double-blind study aimed to investigate whether the analgesic effect of the adductor canal block (ACB) combined with the genicular nerve block (GNB) after total knee arthroplasty is noninferior to that of the adductor canal block combined with local infiltration analgesia (LIA).
    METHODS: A total of 102 patients undergoing total knee arthroplasty under general anesthesia were included and randomly divided into: ACB + GNB and ACB + LIA groups; the ACB + LIA group received 80 mL of 0.2% ropivacaine with adrenaline 10 µg/mL for LIA, whereas the ACB + GNB group received 4 mL of 0.2% ropivacaine for the blockade of five peri-knee nerves. The primary outcome was the median difference in the visual analog scale scores at rest at 24 h between the two groups. Secondary outcomes involved the median differences in the pain scores at other time points. Other outcomes included the cumulative dosage of opioids calculated in morphine equivalents in the first 24 h and indicators related to knee joint functional recovery.
    RESULTS: In total, 36 and 38 patients were included in the ACB + GNB and ACB + LIA groups, respectively. We found that the median difference (95% confidence internal) in postoperative rest pain at 24 h (noninferiority criteria, △ = 1) was - 0.5 (- 1 to 0, p = 0.002). The median difference in cumulative opioid consumption was 1 mg (- 1 to 3, p = 0.019), meeting the noninferiority criteria, △ = 7.7 mg.
    CONCLUSIONS: ACB combined with GNB provides noninferior analgesia compared to ACB with LIA on the first day after total knee arthroplasty while significantly reducing local anesthetic use.
    BACKGROUND: Name of the Registry: Chinese Clinical Trial Registry; Trial Registration Number: ChiCTR2300074274; Date of Registration. August 2, 2023.
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  • 文章类型: Journal Article
    背景:探讨术前血清白蛋白低与全关节置换术(TJA)患者围手术期输血的关系。
    方法:我们在2017年1月1日至2022年1月1日期间从我院招募了2,772名TJA患者。从电子病历中提取临床数据,包括病人ID,性别,BMI(身体质量指数),年龄,和诊断。构建受试者工作特征曲线以建立血清白蛋白水平分类的阈值。以术前血清白蛋白为因变量,以围手术期输血相关因素为协变量,进行倾向评分匹配(PSM)。包括BMI等级,年龄等级,性别,诊断,高血压,糖尿病,冠心病,慢性阻塞性肺疾病,慢性支气管炎,脑梗塞,过去12个月内的大型手术,肾功能衰竭,癌症,抑郁症,使用皮质类固醇,吸烟,饮酒,和血型。低血清白蛋白组与正常白蛋白组以1:2的比例匹配,采用0.2的卡尺值。采用二元logistic回归分析结果。
    结果:在0.601的曲线下发现,表明截断值为37.3g/L。在PSM之后,低血清(<37.3g/L)白蛋白组892例配对成功,血清白蛋白正常(≥37.3g/L)组1401例匹配。TJA患者的二元logistic回归分析显示,白蛋白OR为0.911,95CI为0.888~0.935,P<0.001。相对于术前血清白蛋白正常组,低血清白蛋白组TJA患者的围手术期输血率增加了1.83倍(95%CI1.50-2.23,P<0.001)。与正常血清白蛋白组相比,血清白蛋白水平为30-37.3g/L的TJA患者围手术期输血率,25-30g/L,和≤25g/L增加1.63(95%CI1.37-1.99,P<0.001),5.4(95%CI3.08-9.50,P<0.001),和6.43倍(95%CI1.80-22.96,P=0.004),分别。
    结论:在TJA患者中,术前低血清白蛋白水平与围手术期输血风险增加相关.此外,据观察,术前血清白蛋白水平越低,围手术期输血的风险越高。
    背景:2021年12月28日,中国临床试验注册中心,ChiCRT2100054844。
    BACKGROUND: To investigate the relationship between preoperative low serum albumin and perioperative blood transfusion in patients undergoing total joint arthroplasty (TJA).
    METHODS: We enrolled 2,772 TJA patients from our hospital between January 1, 2017, and January 1, 2022. Clinical data were extracted from electronic medical records, including patient ID, sex, BMI (Body Mass Index), age, and diagnoses. Receiver operating characteristic curves were constructed to establish thresholds for serum albumin levels categorization. Propensity score matching (PSM) was developed with preoperative serum albumin as the dependent variable and perioperative blood transfusion-related factors as covariates, including BMI grade, age grade, sex, diagnosis, hypertension, diabetes, coronary heart disease, chronic obstructive pulmonary disease, chronic bronchitis, cerebral infarction, major surgeries within the last 12 months, renal failure, cancer, depression, corticosteroid use, smoking, drinking, and blood type. The low serum albumin group was matched with the normal albumin group at a 1:2 ratio, employing a caliper value of 0.2. Binary logistic regression was employed to analyze the outcomes.
    RESULTS: An under the curve of 0.601 was discovered, indicating a cutoff value of 37.3 g/L. Following PSM, 892 cases were successfully paired in the low serum (< 37.3 g/L) albumin group, and 1,401 cases were matched in the normal serum albumin (≥ 37.3 g/L) group. Binary logistic regression in TJA patients showed that the albumin OR was 0.911 with 95%CI 0.888-0.935, P < 0.001. Relative to the preoperative normal serum albumin group, TJA patients in the low serum albumin group experienced a 1.83-fold increase in perioperative blood transfusion rates (95% CI 1.50-2.23, P < 0.001). Compared to the normal serum albumin group, perioperative blood transfusion rates for TJA patients with serum albumin levels of 30-37.3 g/L, 25-30 g/L, and ≤ 25 g/L increased by 1.63 (95% CI 1.37-1.99, P < 0.001), 5.4 (95% CI 3.08-9.50, P < 0.001), and 6.43 times (95% CI 1.80-22.96, P = 0.004), respectively.
    CONCLUSIONS: In TJA patients, preoperative low serum albumin levels have been found to be associated with an increased risk of perioperative blood transfusion. Furthermore, it has been observed that the lower the preoperative serum albumin level is, the higher the risk of perioperative blood transfusion.
    BACKGROUND: 28/12/2021, Chinese Clinical Trial Registry, ChiCRT2100054844.
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  • 文章类型: Journal Article
    目的:本研究旨在探讨术前外翻畸形的严重程度与中性全膝关节置换术(TKA)的临床结局之间的关系。
    方法:对2006年1月至2014年3月行TKA的376例外翻畸形患者进行回顾性筛查。和287膝盖(242名患者;32名男性,210名女性;平均年龄:64.5±8.8岁;范围,包括手术后35至83年)中性对齐。根据术前髋-膝-踝(HKA)将患者分为四组:轻度(0°15°,n=44)组。运动范围(ROM),膝关节社会评分(KSS),视觉模拟量表(VAS)动态疼痛评分,并对遗忘联合评分(FJS)进行评估。记录机械故障以评估假体存活。使用Kaplan-Meier生存分析进行生存率分析。
    结果:术前外翻畸形程度对术后ROM无明显影响,KSS,VAS动态疼痛评分,或FJS在最后一次跟进。四组之间在10年时,中性排列的TKAs的累积生存率没有显着差异(p=0.513)。
    结论:术前外翻畸形的严重程度在至少5年的随访中不影响中性TKAs的临床结局。此外,它不影响中性对齐TKAs的10年生存率.
    OBJECTIVE: This study aimed to investigate the relationship between the severity of preoperative valgus deformity and clinical outcomes of neutrally aligned total knee arthroplasty (TKA).
    METHODS: A total of 376 knees with valgus deformity who underwent TKA from January 2006 to March 2014 were retrospectively screened, and 287 knees (242 patients; 32 males, 210 females; mean age: 64.5±8.8 years; range, 35 to 83 years) aligned neutrally after the operation were included. Patients were divided into four groups based on the preoperative hip-knee-ankle (HKA): mild (0°< HKA ≤5°, n=94), moderate (5°< HKA ≤10°, n=74), severe (10°< HKA ≤15°, n=75), and very severe (HKA >15°, n=44) groups. Range of motion (ROM), Knee Society Score (KSS), Visual Analog Scale (VAS) dynamic pain scores, and Forgotten Joint Score (FJS) were evaluated. Mechanical failures were recorded to assess prosthesis survival. A survival rate analysis was performed using Kaplan-Meier survival analysis.
    RESULTS: The degree of preoperative valgus deformity did not have a significant impact on the postoperative ROM, KSS, VAS dynamic pain scores, or FJS at the last follow-up. There were no significant differences in cumulative survival rates of neutrally aligned TKAs at 10 years between the four groups (p=0.513).
    CONCLUSIONS: The severity of preoperative valgus deformity did not affect the clinical outcomes of neutrally aligned TKAs in the minimum five-year follow-up. Additionally, it did not impact the survival rates of neutrally aligned TKAs over 10 years.
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  • 文章类型: Journal Article
    背景:假体周围骨折(PPF)是全膝关节置换术(TKA)的罕见并发症。TKA术后最常见的PPF是股骨髁上骨折,这是一种相对罕见的并发症,通常与高能创伤有关,根据AOANJRR,报告的发病率为0.4%至1.7%。然而,在TKA患者中,由于下肢力线的变化,胫骨假体周围的应力性骨折是罕见的,增加承重,和行走步态的变化。
    方法:一名68岁女性因“双膝疼痛加重、畸形8年”就诊我院。“TKA首先在左膝进行,患者在1周内出院。三个月后,患者抱怨胫骨内侧中上1/3部分疼痛2周,逐渐恶化并影响负重。
    方法:体格检查显示左膝关节出现内翻畸形,和右外翻畸形,被诊断为双膝骨关节炎,被称为“吹牛”。该疾病最初在第一次入院时被诊断为双膝骨关节炎,第二次诊断为胫骨PPF。
    方法:对该患者进行了3次手术。第一个是左膝的TKA,第二次是在第一次手术后3个月对胫骨PPF进行切开复位内固定,第三个是右膝盖的TKA。
    结果:直到现在,患者没有复发性PPF,最后的X光片骨折正在愈合.
    结论:临床医生应该意识到TKA后PPF的可能性,尤其是在这样的病人中,最优选的手术治疗方法是使用锁定钢板切开复位内固定骨折,如果带有松动植入物的PPF,修订TKA,或者巨型假体是更好的选择。
    BACKGROUND: Periprosthetic fractures (PPF) are rare complications of total knee arthroplasty (TKA). The most common PPF after TKA is supracondylar femoral fracture, which is a relatively rare complication that is usually associated with high-energy trauma, with a reported incidence ranging from 0.4 to 1.7% according to the AOANJRR. However, in TKA patients, it is rarer that the stress fracture around the tibial prosthesis occurs due to changes in the lower limb force line, increasing weight-bearing, and changes in walking gait.
    METHODS: A 68-year-old woman visited our hospital with \"both knees had aggravated pain and deformity for 8 years.\" TKA was performed first on the left knee and the patient was discharged within 1 week. Three months later, the patient complained of pain in the upper middle 1/3 part of the medial tibia for 2 weeks, which gradually worsened and affected weight-bearing.
    METHODS: Physical examination showed that the left knee joint presented varus deformity, and the right valgus deformity, which diagnosed as osteoarthritis of both knees and was so-called \"blownknee\". The disease was initially diagnosed as osteoarthritis of both knees on first admission and PPF of the tibia in second.
    METHODS: Three operations were performed on this patient. The first was TKA of the left knee, the second was open reduction and internal fixation of the PPF of the tibia 3 months after the first operation, and the third was TKA of the right knee.
    RESULTS: Until now, the patient has had no recurrent PPF, and the fracture is healing from the last X-ray.
    CONCLUSIONS: Clinicians should be aware of the possibility of PPF after TKA, especially in such patients, the most preferred surgical treatment method was open reduction and internal fixation of fractures using locking plates, and if the PPF with loosened implants, Revision TKA, or megaprosthesis was the better choice.
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  • 文章类型: Journal Article
    背景:下肢深静脉血栓(DVT)是全膝关节置换术(TKA)后常见的并发症。本研究的目的是评估TKA后DVT的危险因素,并分析TKA前后miR-199b-5p和一氧化氮(NO)的表达。以及它们对DVT的预测价值。
    方法:对121例TKA患者的基本临床资料进行回顾性分析。RT-qPCR检测TKA治疗前后患者miR-199b-5p的相对表达水平。基于DVT的发生,将患者分为DVT和非DVT组.Logistic回归分析评价DVT的危险因素。受试者工作特征(ROC)曲线评估术后miR-199b-5p水平的预测价值,术前NO水平,以及它们在DVT中的组合。使用生物信息学分析对miR-199b-5p的靶基因及其功能进行了预测和注释。
    结果:TKA后miR-199b-5p水平明显高于TKA前(P<0.001)。TKA术后121例患者中有20例发生DVT,发病率为16.53%。多因素分析显示,年龄,DVT家族史,NO降低和miR-199b-5p升高是TKA后发生DVT的危险因素(P<0.05)。ROC曲线显示miR-199b-5p和NO均对DVT有一定的诊断价值,但miR-199b-5p和NO的组合具有最高的诊断准确性(P<0.001)。
    结论:本研究显示TKA后miR-199b-5p的表达上调,DVT患者的miR-199b-5p水平高于非DVT患者。miR-199b-5p结合NO对TKA术后DVT的诊断具有重要价值。
    BACKGROUND: Deep vein thrombosis (DVT) of lower extremity is a common complications after total knee arthroplasty (TKA). The purpose of this study was to evaluate the risk factors for DVT after TKA and analyze the expression of miR-199b-5p and nitric oxide (NO) before and after TKA, as well as their predictive value for DVT.
    METHODS: Basic clinical information of 121 patients with TKA was analyzed retrospectively. RT-qPCR was used to detect the relative expression level of miR-199b-5p in patients before and after TKA treatment. Based on the occurrence of DVT, patients were divided into DVT and non-DVT groups. Logistic regression analysis evaluated the risk factors of DVT. The receiver operating characteristic (ROC) curve assessed the predictive value of postoperative miR-199b-5p level, preoperative NO level, and their combination in DVT. The target genes of miR-199b-5p and their functions were predicted and annotated using bioinformatics analysis.
    RESULTS: The level of miR-199b-5p after TKA was upregulated compared with that before TKA (P < 0.001). DVT occurred in 20 of 121 patients after TKA, with an incidence of 16.53%. Multivariate analysis showed that age, family history of DVT, decrease of NO and increase of miR-199b-5p were risk factors for DVT after TKA (P < 0.05). The ROC curve showed that both miR-199b-5p and NO had certain diagnostic value for DVT, but the combination of miR-199b-5p and NO had the highest diagnostic accuracy (P < 0.001).
    CONCLUSIONS: This study showed that the expression of miR-199b-5p was up-regulated after TKA, and miR-199b-5p levels were higher in DVT patients than in non-DVT patients. miR-199b-5p combined with NO is of great value in the diagnosis of DVT after TKA.
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  • 文章类型: Journal Article
    UNASSIGNED: To conclude the research progress of unicompartmental knee arthroplasty (UKA) in the treatment of elderly patients with knee osteoarthritis (KOA).
    UNASSIGNED: The literature on UKA at home and abroad in recent years was reviewed to summarize the clinical characteristics of elderly patients with KOA, perioperative management (including evaluating indications preoperatively, intraoperative prosthesis selection, postoperative complication management, etc).
    UNASSIGNED: Through reasonable preoperative evaluation, prosthesis selection, and advanced perioperative management, for elderly patients with KOA who meet the indications, UKA can be considered. Compared with total knee arthroplasty, the incidence of postoperative complications in elderly patients undergoing UKA is lower, joint awareness is reduced, functional improvement and satisfaction are higher. Meanwhile, choosing appropriate prostheses and fixation methods can lead to a good survival rate.
    UNASSIGNED: UKA can provide a safe and effective treatment option for elderly patients with KOA within a certain range of indications.
    UNASSIGNED: 总结膝关节单髁置换术(unicompartmental knee arthroplasty,UKA)治疗高龄膝骨关节炎(knee osteoarthritis,KOA)患者的研究进展。.
    UNASSIGNED: 广泛查阅近年来国内外有关UKA治疗高龄KOA患者的文献,从高龄KOA患者的临床特点、围术期管理(包括术前评估高龄患者适应证、术中假体选择、术后并发症管理)等方面进行归纳与总结。.
    UNASSIGNED: 通过合理的术前评估、假体选择,以及先进的围术期管理,对于符合适应证的高龄KOA患者可考虑行UKA。相较于人工全膝关节置换术,高龄患者行UKA术后并发症发生率更低,关节意识降低,功能改善及满意度更高,选择合适的假体及固定方式可获得良好生存率。.
    UNASSIGNED: 在一定适应证范围内,UKA是高龄KOA患者一种安全且有效的治疗方案。.
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  • 文章类型: English Abstract
    UNASSIGNED: To explore the clinical value of metagenomic next-generation sequencing (mNGS) in diagnosis and treatment of periprosthetic joint infection (PJI) after total knee arthroplasty (TKA).
    UNASSIGNED: Between April 2020 and March 2023, 10 patients with PJI after TKA were admitted. There were 3 males and 7 females with an average age of 69.9 years (range, 44-83 years). Infection occurred after 8-35 months of TKA (mean, 19.5 months). The duration of infection ranged from 16 to 128 days (mean, 37 days). The preoperative erythrocyte sedimentation rate (ESR) was 15-85 mm/1 h (mean, 50.2 mm/1 h). The C reactive protein (CRP) was 4.4-410.0 mg/L (mean, 192.8 mg/L). The white blood cell counting was (3.4-23.8)×10 9/L (mean, 12.3×10 9/L). The absolute value of neutrophils was (1.1-22.5)×10 9/L (mean, 9.2×10 9/L). After admission, the joint fluid was extracted for bacterial culture method and mNGS test, and sensitive antibiotics were chosen according to the results of the test, and the infection was controlled in combination with surgery.
    UNASSIGNED: Seven cases (70%) were detected as positive by bacterial culture method, and 7 types of pathogenic bacteria were detected; the most common pathogenic bacterium was Streptococcus lactis arrestans. Ten cases (100%) were detected as positive by mNGS test, and 11 types of pathogenic bacteria were detected; the most common pathogenic bacterium was Propionibacterium acnes. The difference in the positive rate between the two methods was significant ( P=0.211). Three of the 7 patients who were positive for both the bacterial culture method and the mNGS test had the same results for the type of pathogenic bacteria, with a compliance rate of 42.86% (3/7). The testing time (from sample delivery to results) was (4.95±2.14) days for bacterial culture method and (1.60±0.52) days for mNGS test, and the difference was significant ( t=4.810, P<0.001). The corresponding sensitive antibiotic treatment was chosen according to the results of bacterial culture method and mNGS test. At 3 days after the one-stage operation, the CRP was 6.8-48.2 mg/L (mean, 23.6 mg/L); the ESR was 17-53 mm/1 h (mean, 35.5 mm/1 h); the white blood cell counting was (4.5-8.1)×10 9/L (mean, 6.1×10 9/L); the absolute value of neutrophils was (2.3-5.7)×10 9/L (mean, 4.1×10 9/L). All patients were followed up 12-39 months (mean, 23.5 months). One case had recurrence of infection at 6 months after operation, and the remaining 9 cases showed no signs of infection, with an infection control rate of 90%.
    UNASSIGNED: Compared with bacterial culture method, mNGS test can more rapidly and accurately detect pathogenic bacteria for PJI after TKA, which is important for guiding antibiotics combined with surgical treatment of PJI.
    UNASSIGNED: 探讨宏基因组二代测序(metagenomic next-generation sequencing,mNGS)在人工全膝关节置换术(total knee arthroplasty,TKA)后假体周围感染(periprosthetic joint infection,PJI)诊治中的临床价值。.
    UNASSIGNED: 2020年4月—2023年3月,收治10例TKA术后PJI患者。男3例,女7例;年龄44~83岁,平均69.9岁。置换术后8~35个月发生感染,平均19.5个月;感染病程16~128 d,平均37 d。术前红细胞沉降率(erythrocyte sedimentation rate,ESR)15~85 mm/1 h,平均50.2 mm/1 h;C 反应蛋白(C reactive protein,CRP)4.4~410.0 mg/L,平均192.8 mg/L;白细胞计数(3.4~23.8)×10 9/L,平均12.3×10 9/L;中性粒细胞绝对值(1.1~22.5)×10 9/L,平均9.2×10 9/L。入院后抽取关节液行细菌培养及mNGS检测,根据检测结果调整敏感抗生素,并结合手术控制感染。.
    UNASSIGNED: 细菌培养检测阳性7例(70%),共检出7种病原菌,最常见病原菌为停乳链球菌。mNGS检测阳性10例(100%),共检出11种病原菌,最常见病原菌为痤疮丙酸杆菌。两种方法检测阳性率差异有统计学意义( P=0.211)。7例细菌培养法和mNGS检测均为阳性患者中,3例病原菌类型结果完全一致,符合率42.86%(3/7)。细菌培养检测时间(送样本至出结果)为(4.95±2.14) d,mNGS检测为(1.60±0.52)d,差异有统计学意义( t=4.810, P<0.001)。根据细菌培养及mNGS检测培养结果采取敏感抗生素治疗。一期术后3 d CRP为6.8~48.2 mg/L,平均23.6 mg/L;ESR 17~53 mm/1 h,平均35.5 mm/1 h;白细胞计数(4.5~8.1)×10 9/L,平均6.1×10 9/L;中性粒细胞绝对值(2.3~5.7)×10 9/L,平均4.1×10 9/L。患者均获随访,随访时间12~39个月,平均23.5个月。1例术后6个月感染复发,其余9例均未出现感染征象,感染控制率为90%。.
    UNASSIGNED: 与细菌培养相比,mNGS能更快速准确地检测TKA术后PJI病原菌,对指导抗生素联合手术治疗PJI具有重要意义。.
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  • 文章类型: Journal Article
    背景:单室膝关节置换术(UKA)已被证明是骨关节炎患者的成功治疗方法。然而,人体骨骼和人工植入物之间的机械性能不匹配引起的应力屏蔽仍然是一个具有挑战性的问题。本研究旨在正确设计仿生多孔胫骨植入物,并评估其在UKA手术后重建应力传递途径中的生物力学作用。
    方法:使用Ti6Al4V通过增材制造设计和制造了具有不同支柱尺寸和孔隙率的Voronoi结构,并进行了准静态压缩测试。Gibson-Ashby模型用于将机械性能与设计参数相关联。随后,为多孔UKA开发了有限元模型,常规UKA,和天然膝关节,以评估在站立阶段具有设计结构的胫骨植入物的生物力学效果。
    结果:发现多孔UKA膝关节内侧隔室胫骨平台上的内部应力分布与天然膝关节的内部应力分布非常相似。此外,在大多数负荷条件下,所有受试者的多孔UKA膝关节胫骨平台内侧区域的平均应力值比常规UKA膝关节高至少44.7%。多孔UKA膝盖模型的应变屏蔽降低效果在植入物下和负载接触部位附近是显著的。对于受试者1至3,多孔UKA膝盖模型的骨保存和构建区域(应变值范围为400至3000μm/m)中节点的平均百分比,从68.7%到80.5%,高于传统的UKA膝盖模型,从61.6%到68.6%不等。
    结论:比较结果表明,设计了Voronoi结构的胫骨植入物在UKA术后胫骨平台上提供了更好的生物力学功能。此外,该模型和相关分析为具有Voronoi结构的UKA植入物的设计参数提供了明确的设计过程和可靠的选择标准。
    BACKGROUND: Unicompartmental knee arthroplasty (UKA) has been proved to be a successful treatment for osteoarthritis patients. However, the stress shielding caused by mismatch in mechanical properties between human bones and artificial implants remains as a challenging issue. This study aimed to properly design a bionic porous tibial implant and evaluate its biomechanical effect in reconstructing stress transfer pathway after UKA surgery.
    METHODS: Voronoi structures with different strut sizes and porosities were designed and manufactured with Ti6Al4V through additive manufacturing and subjected to quasi-static compression tests. The Gibson-Ashby model was used to relate mechanical properties with design parameters. Subsequently, finite element models were developed for porous UKA, conventional UKA, and native knee to evaluate the biomechanical effect of tibial implant with designed structures during the stance phase.
    RESULTS: The internal stress distribution on the tibia plateau in the medial compartment of the porous UKA knee was found to closely resemble that of the native knee. Furthermore, the mean stress values in the medial regions of the tibial plateau of the porous UKA knee were at least 44.7% higher than that of the conventional UKA knee for all subjects during the most loading conditions. The strain shielding reduction effect of the porous UKA knee model was significant under the implant and near the load contact sites. For subject 1 to 3, the average percentages of nodes in bone preserving and building region (strain values range from 400 to 3000 μm/m) of the porous UKA knee model, ranging from 68.7 to 80.5%, were higher than that of the conventional UKA knee model, ranging from 61.6 to 68.6%.
    CONCLUSIONS: The comparison results indicated that the tibial implant with designed Voronoi structure offered better biomechanical functionality on the tibial plateau after UKA. Additionally, the model and associated analysis provide a well-defined design process and dependable selection criteria for design parameters of UKA implants with Voronoi structures.
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