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Evaluation of the Three-Dimensional Translational and Angular Deformity in Slipped Capital Femoral Epiphysis.

股骨头骨骺滑脱的三维平移和角化畸形的评价。

  • 影响因子:3.07
  • DOI:10.1002/jor.24548
  • 作者列表:"Bland DC","Valdovino AG","Jeffords ME","Bomar JD","Newton PO","Upasani VV
  • 发表时间:2020-05-01
Abstract

:The purpose of this study was to quantify three-dimensional translational and angular deformity (defined as theta) present at the proximal femoral physis in slipped capital femoral epiphysis (SCFE), and to use theta to differentiate between SCFE hips, contralateral unaffected hips, and normal hips by comparing to the current gold standard measure of the Southwick slip angle (SSA). 3DCT reconstructions of the pelvis and femur in SCFE patients and normal adolescents were obtained and pelvic position was standardized. The center point and direction vector of the femoral epiphysis was determined. The femoral neck axis was defined. The angle between the femoral neck axis and epiphysis vector defined the 3D angle of deformity (theta). The 3D translation of the femoral epiphysis, measured as a percentage of femoral neck diameter, was measured in three planes. The average theta angle was significantly greater in SCFE hips (46.5 ± 24.3°) compared with control (13.7 ± 6.4°) or normal (11.7 ± 3.7°) hips (p < 0.001). There was no significant difference in theta angle between control and normal hips (p = 0.468). Theta angle correlated strongly with SSA (rs  = 0.737, p < 0.001). Statement of clinical significance: The proximal femoral deformity in patients with slipped capital femoral epiphysis can be defined by measuring displacement of the epiphysis in all three dimensions in relation to the femoral neck axis. This information can be used in epiphyseal reorientation surgery to ensure anatomic reduction. The similarity between control and normal hips may argue against the thought that there is pre-existing deformity in a pre-slip condition of unaffected contralateral hips in SCFE patients. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 38:1081-1088, 2020.

摘要

: 本研究的目的是量化存在于股骨近端骨骺 (SCFE) 的三维平移和角畸形 (定义为 θ),并使用 θ 来区分SCFE髋关节和对侧未受影响的髋关节,和正常的臀部通过比较目前的金标准测量的Southwick滑移角 (SSA)。获得SCFE患者和正常青少年骨盆和股骨的3DCT重建,并标准化骨盆位置。确定股骨骨骺的中心点和方向向量。定义股骨颈轴。股骨颈轴和骨骺向量之间的角度定义了畸形的3D角度 (θ)。在三个平面中测量股骨骨骺的3D平移,测量为股骨颈直径的百分比。与对照 (46.5 ± 24.3 °) 或正常 (13.7 ± 6.4 °) 髋关节 (p <11.7) 相比,SCFE髋关节的平均 θ 角 (3.7 ± 0.001 °) 显著更大。对照组和正常髋关节的 θ 角无显著性差异 (p = 0.468)。Θ 角与SSA密切相关 (rs   =   0.737,p  <  0.001)。临床意义的陈述: 股骨头骨骺滑脱患者的股骨近端畸形可以通过测量骨骺在所有三个维度上相对于股骨颈轴的位移来定义。该信息可用于骺复位手术以确保解剖复位。对照和正常髋关节之间的相似性可能会反对SCFE患者在未受影响的对侧髋关节的预滑动条件下存在预先存在的畸形的想法。©2019骨科研究学会。发表于Wiley journals,Inc. J Orthop Res 38:1081-1088,2020。

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影响因子:2.98
发表时间:2020-01-01
DOI:10.1136/neurintsurg-2019-014962
作者列表:["Guo W","Liu H","Tan Z","Zhang X","Gao J","Zhang L","Guo H","Bai H","Cui W","Liu X","Wu X","Luo J","Qu Y"]

METHODS:BACKGROUND:The main surgical techniques for spontaneous basal ganglia hemorrhage include stereotactic aspiration, endoscopic aspiration, and craniotomy. However, credible evidence is still needed to validate the effect of these techniques. OBJECTIVE:To explore the long-term outcomes of the three surgical techniques in the treatment of spontaneous basal ganglia hemorrhage. METHODS:Five hundred and sixteen patients with spontaneous basal ganglia hemorrhage who received stereotactic aspiration, endoscopic aspiration, or craniotomy were reviewed retrospectively. Six-month mortality and the modified Rankin Scale score were the primary and secondary outcomes, respectively. A multivariate logistic regression model was used to assess the effects of different surgical techniques on patient outcomes. RESULTS:For the entire cohort, the 6-month mortality in the endoscopic aspiration group was significantly lower than that in the stereotactic aspiration group (odds ratio (OR) 4.280, 95% CI 2.186 to 8.380); the 6-month mortality in the endoscopic aspiration group was lower than that in the craniotomy group, but the difference was not significant (OR=1.930, 95% CI 0.835 to 4.465). A further subgroup analysis was stratified by hematoma volume. The mortality in the endoscopic aspiration group was significantly lower than in the stereotactic aspiration group in the medium (≥40-<80 mL) (OR=2.438, 95% CI 1.101 to 5.402) and large hematoma subgroup (≥80 mL) (OR=66.532, 95% CI 6.345 to 697.675). Compared with the endoscopic aspiration group, a trend towards increased mortality was observed in the large hematoma subgroup of the craniotomy group (OR=8.721, 95% CI 0.933 to 81.551). CONCLUSION:Endoscopic aspiration can decrease the 6-month mortality of spontaneous basal ganglia hemorrhage, especially in patients with a hematoma volume ≥40 mL.

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