Recurrent Proximal Junctional Kyphosis: Incidence, Risk Factors, Revision Rates, and Outcomes at 2-Year Minimum Follow-up.
复发性近端交界性后凸: 发生率、危险因素、翻修率和 2 年最低随访结果。
- 作者列表："Kim HJ","Wang SJ","Lafage R","Iyer S","Shaffrey C","Mundis G","Hostin R","Burton D","Ames C","Klineberg E","Gupta M","Smith J","Schwab F","Lafage V","International Spine Study Group.
STUDY DESIGN:Retrospective comparative cohort study. OBJECTIVE:Assess the incidence, risk factors, and outcomes of recurrent proximal junctional kyphosis (r-PJK) in PJK revision patients. SUMMARY OF BACKGROUND DATA:Several studies have identified the incidence and risk factors for PJK after primary surgery. However, few studies have reported on PJK recurrence after revision for PJK. METHODS:A multicenter database of patients who underwent PJK revision surgery with minimum 2-year follow-up was analyzed. Demographic, operative, and radiographic outcomes were compared in patients with r-PJK and patients without recurrence no-Proximal Junctional Kyphosis (n-PJK). Postoperative Scoliosis Research Society-22r, Short Form-36, and Oswestry Disability Index were compared. Preoperative and most recent spinopelvic, cervical, and cervicothoracic radiographic parameters were compared. Univariate and multivariate analyses were used to determine r-PJK risk factors. A predictive model was formulated based on our logistic regression analysis. RESULTS:A total of 70 patients met the inclusion criteria with an average follow-up of 21.8 months. The mean age was 66.3 ± 9.4 and 80% of patients were women. Before revision, patients had a proximal junctional angle angle of -31.7° ± 15.9°. The rate of recurrent PJK was 44.3%. Logistic regression showed that pre-revision thoracic pelvic angle (odds ratio [OR]: 1.060 95% confidence interval [CI] 1.002; 1.121; P = 0.042) and prerevision C2-T3 sagittal vertical axis (SVA; OR: 1.040 95% CI [1.007; 1.073] P = 0.016) were independent predictors of r-PJK. Classification with these parameters yielded an accuracy of 72.7%, precision of 80.6%, and recall of 73.5%. When examining correction, or change in alignment with revision surgery, we found that change in SVA (OR: 0.981 95% CI [0.968; 0.994] P = 0.005) was the only predictor of r-PJK with accuracy of 66.7%, precision of 74.2%, and recall of 69.7%. CONCLUSION:Patients after PJK revision surgery had a recurrence rate of 44%. Logistic regression based on the prerevision variables showed that prerevision thoracic pelvic angle and prerevision C2-T3 SVA were independent predictors of r-PJK. LEVEL OF EVIDENCE:4.
研究设计: 回顾性比较队列研究。 目的: 评估PJK翻修患者近端交界性后凸 (r-PJK) 复发的发生率、危险因素和结局。 背景资料摘要: 多项研究确定了初次手术后PJK的发生率和危险因素。然而，很少有研究报道PJK翻修后复发。 方法: 对接受PJK翻修手术且至少随访 2 年的患者的多中心数据库进行分析。比较r-PJK患者和无复发无近端交界性后凸畸形 (n-PJK) 患者的人口统计学、手术和影像学结局。比较术后脊柱侧凸研究Society-22r、Short Form-36 和Oswestry残疾指数。比较术前和最近的脊髓骨盆、颈椎和颈胸影像学参数。采用单因素和多因素分析确定r-PJK危险因素。根据我们的logistic回归分析制定了预测模型。 结果: 共有 70 例患者符合纳入标准，平均随访 21.8 个月。平均年龄为 66.3 ± 9.4，80% 的患者为女性。翻修前，患者的近端交界角为-31.7 ° ± 15.9 °。PJK复发率为 44.3%。Logistic回归显示翻修前胸骨盆角 (比值比 [OR]: 1.060 95% 可信区间 [CI] 1.002; 1.121; P = 0.042) c2-T3 矢状面纵轴 (SVA; OR: 1.040 95% CI [1.007; 1.073] p = 0.016) 是r-PJK的独立预测因子。使用这些参数进行分类的准确率为 72.7%，精密度为 80.6%，召回率为 73.5%。当检查矫正或与翻修手术对齐的变化时，我们发现SVA的变化 (or: 0.981 95% CI [0.968; 0.994] p = 0.005) 是r-PJK的唯一预测因子，准确度为 66.7%，精密度为 74.2%，召回率为 69.7%。 结论: PJK翻修术后患者复发率为 44%。基于prerevision变量的Logistic回归显示，prerevision胸骨盆角和prerevision C2-T3 SVA是r-PJK的独立预测因子。 证据级别: 4.
METHODS:BACKGROUND:Postoperative cognitive dysfunction (POCD) is a common complication after orthopedic surgery, which is not conducive to the prognosis of the elderly. AIMS:We performed this study to investigate the effects of oxycodone applied for patient-controlled intravenous analgesia (PCIA) on postoperative cognitive function in elderly patients after total hip arthroplasty (THA). METHODS:Ninety-nine participants were enrolled and allocated into two groups: oxycodone group (group O) and sufentanil group (group S). The primary outcome was the incidence of POCD, diagnosed according to the changes in the Mini-mental status examination (MMSE) and Montreal Cognitive Assessment (MoCA) scores. The secondary outcomes included the plasma levels of S-100B protein and neuron-specific enolase (NSE), the amount of postoperative analgesic consumption and the incidence of adverse reactions. RESULTS:The incidence of POCD was significantly lower in patients receiving oxycodone up to the 3rd postoperative day (POD, 1st POD 27.3% vs. 51.1%, P = 0.021; 3rd POD 20.5% vs. 40.0%, P = 0.045), as compared to patients receiving sufentanil. The MMSE and MoCA scores of both groups decreased to varying degrees. However, compared with group S, the MMSE scores at 1st POD, 3rd POD, 5th POD and 7st POD in group O were higher than that in group S, while MoCA scores at 1st POD, 3rd POD and 5th POD in group O were higher. Compared with group S, the plasma levels of S-100B protein in group O at 4 h, 8 h, 12 h post-surgery were lower. While the plasma levels of NSE in group O at 4 h, 8 h, 12 h, 24 h post-surgery were lower. Number of PCIA boluses and consumption of analgesic drug during the first two POD were similar between two groups. However, postoperative incidence of nausea, vomiting and pruritus was significantly lower in patients receiving oxycodone. CONCLUSION:Oxycodone applied for PCIA in elderly patients after THA could reduce the incidence of POCD, improve postoperative cognitive function and decrease the adverse reactions.
METHODS:BACKGROUND:Primary treatment for Blount disease has changed in the last decade from osteotomies or staples to tension band plate (TBP)-guided hemiepiphysiodesis. However, implant-related issues have been frequently reported with Blount cases. The purpose of our study is to evaluate the surgical failure rates of TBP in Blount disease and characterize predictors for failure. METHODS:We performed an Institutional Review Board-approved retrospective chart-review of pediatric patients with Blount disease to evaluate the results of TBP from 2008 to 2017 and a systematic literature review. Blount cases defined as pathologic tibia-vara with HKA (hip-knee-ankle) axis and MDA (metaphyseal-diaphyseal angle) deviations ≥11 degrees were included in the analysis. Surgical failure was categorized as mechanical and functional failure. We studied both patient and implant-related characteristics and compared our results with a systematic review. RESULTS:In 61 limbs of 40 patients with mean follow-up of 38 months, we found 41% (25/61) overall surgical failure rate and 11% (7/61) mechanical failure rate corresponding to 11% to 100% (range) and 0% to 50% (range) in 8 other studies. Statistical comparison between our surgical failure and nonfailure groups showed significant differences in deformity (P=0.001), plate material (P=0.042), and obesity (P=0.044) in univariate analysis. The odds of surgical failure increased by 1.2 times with severe deformity and 5.9 times with titanium TBP in the multivariate analysis after individual risk-factor adjustment. All 7 mechanical failures involved breakage of cannulated screws on the metaphyseal side. CONCLUSIONS:Most of the studies have reported high failure rates of TBP in Blount cases. Besides patient-related risk factors like obesity and deformity, titanium TBP seems to be an independent risk factor for failure. Solid screws were protective for mechanical failure, but not for functional failure. In conclusion, efficacy of TBP still needs to be proven in Blount disease and implant design may warrant reassessment. LEVEL OF EVIDENCE:Level III-retrospective comparative study with a systematic review.
METHODS:INTRODUCTION:As cancer treatments continue to improve the overall survival rates, more patients with a history of cancer will present for anatomic total shoulder arthroplasty (TSA). Therefore, it is essential for orthopaedic surgeons to understand the differences in care required by this growing subpopulation. Although the current research suggests that good outcomes can be predicted when appropriately optimized patients with cancer undergo lower extremity total joint arthroplasty, similar studies for TSA are lacking. The primary study question was to examine whether a history of cancer was associated with an increased rate of venous thromboembolism (VTE) after TSA. Secondarily, we sought to examine any association between a history of prostate and breast cancer and surgical or medical complications after TSA. METHODS:Using a national insurance database, male patients with a history of prostate cancer and female patients with a history of breast cancer undergoing anatomic TSA for primary osteoarthritis were identified and compared with control subjects matched 3:1 based on age, sex, diabetes mellitus, and tobacco use. Patients with a history of VTE and patients who underwent reverse TSA or hemiarthroplasty were excluded. RESULTS:Female patients with a history of breast cancer and male patients with a history of prostate cancer undergoing TSA had significantly higher incidences of acute VTE (including deep venous thrombosis and pulmonary embolism) compared with matched control subjects (female patients: odds ratio, 1.41; 95% confidence interval, 1.10 to 1.81; P = 0.024 and male patients: odds ratio, 1.37; 95% confidence interval, 1.05 to 1.79; P = 0.023). No significant differences were noted in the incidences of any other complications assessed. CONCLUSION:Although a personal history of these malignancies does represent a statistically significant risk factor for acute VTE after anatomic TSA, the overall VTE rate remains modest and acceptable. The rates of other surgical and medical complications are not significantly increased in patients with a history of these cancers after TSA compared with control subjects.