KSSTA: X线片骨关节炎程度可能预示着两期双侧全膝关节置换术中对侧膝关节置换术的疗效不理想

2022-08-24 医路坦克 MedSci原创

高达20%的接受全膝关节置换术的患者对其结果不满意,本研究的目的是确定当患者对第一侧膝关节置换的反应不满意时,是否可以找到预测因素来预测第二侧膝关节置换的结果。

 

高达20%的接受全膝关节置换术的患者对其结果不满意。对于那些对第一次膝关节置换不满意的双侧骨关节炎患者,很难就置换对侧膝关节是否可能有更好的效果给他们提供咨询。

本研究的目的是确定当患者对第一侧膝关节置换的反应不满意时,是否可以找到预测因素来预测第二侧膝关节置换的结果,假设预测因素,如假体因素和骨关节炎的放射水平,可能能够预测对侧膝关节置换的满意反应。

材料与方法:对2012年至2018年在三级关节置换术中心进行的分期双侧膝关节置换术进行分析。这项研究包括275名患者的550例膝关节置换术。测量的主要变量是安大略省西部大学和麦克马斯特大学骨关节炎指数(WOMAC)评分。对手术的满意反应被定义为WOMAC评分提高17分或更多,56分或更多。对首次膝关节置换术疗效不满意的患者进一步分析其对侧膝关节置换术不良反应的预测因素(年龄、性别、术前评分、心理评分、社会经济状况、假体类型、导航使用、膝盖骨表面置换和放射学骨性关节炎)

结果:44例(16%)患者在第一次和对侧膝关节置换术中均未获得满意的反应。最能预测第一次膝关节置换术反应不满意的因素是术前心理健康评分。然而,在第一次膝关节置换没有取得满意反应的患者中,根据Kellgren-Lawrence(KL)评分衡量的放射学骨关节炎对侧膝关节置换反应满意的主要预测因素。只有KL4级骨关节炎患者的对侧膝关节置换术可能有令人满意的反应(KL4和KL3,优势比3.57(CI1.26-10.03)p=0.016*)。KL 3级骨关节炎患者不太可能有满意的反应,在本系列中,没有KL 2级骨关节炎患者有满意的反应。

比较使用WOMAC评分衡量的满意结果与对侧膝关节手术中的放射学关节炎水平(如果患者在第一次膝关节置换后没有达到满意的反应)。

对侧膝关节置换术后满意反应的预测因素--多元回归分析

 

结论:对于第一次膝关节置换疗效不满意的患者,对侧膝关节置换术后疗效满意的最佳预测指标是该膝关节的放射学骨关节炎水平

文献来源: 

Babazadeh S,  Spelman TD,  Dowsey MM, Low grade of radiographic osteoarthritis predicts unsatisfactory response of the contralateral knee replacement in two-stage bilateral total knee arthroplasty.Knee Surg Sports Traumatol Arthrosc 2022 Mar;30(3)

 

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    2023-04-13 lisa438
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    2022-09-14 yxch48
  4. [GetPortalCommentsPageByObjectIdResponse(id=1754249, encodeId=6ebb1e5424952, content=<a href='/topic/show?id=7d3330135ac' target=_blank style='color:#2F92EE;'>#关节置换术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=30135, encryptionId=7d3330135ac, topicName=关节置换术)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=050736663344, createdName=apoenzyme, createdTime=Wed Sep 07 17:13:39 CST 2022, time=2022-09-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2026749, encodeId=7bc72026e496d, content=<a href='/topic/show?id=e0b110159578' target=_blank style='color:#2F92EE;'>#骨关节#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=71, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=101595, encryptionId=e0b110159578, topicName=骨关节)], attachment=null, authenticateStatus=null, createdAvatar=, 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beContent=null, objectType=article, channel=null, level=null, likeNumber=54, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=18892, encryptionId=c42d18892ad, topicName=X线)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=5c64275, createdName=piaojinhua, createdTime=Tue Aug 23 14:13:39 CST 2022, time=2022-08-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1305991, encodeId=0a431305991f5, content=<a href='/topic/show?id=6a96296444d' target=_blank style='color:#2F92EE;'>#全膝关节置换术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=58, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=29644, encryptionId=6a96296444d, topicName=全膝关节置换术)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=2e2c339, createdName=by2009, createdTime=Tue Aug 23 14:13:39 CST 2022, time=2022-08-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1390135, encodeId=215f1390135e0, content=<a href='/topic/show?id=c4d0858e23b' target=_blank style='color:#2F92EE;'>#膝关节置换术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=46, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=85872, encryptionId=c4d0858e23b, topicName=膝关节置换术)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=zhaojie88, createdTime=Tue Aug 23 14:13:39 CST 2022, time=2022-08-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1401892, encodeId=2004140189243, content=<a href='/topic/show?id=a165189092e' target=_blank style='color:#2F92EE;'>#X线片#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=18909, encryptionId=a165189092e, topicName=X线片)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=19412365947, createdName=jiyangfei, createdTime=Tue Aug 23 14:13:39 CST 2022, time=2022-08-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1522494, encodeId=f1af152249412, content=<a href='/topic/show?id=46223e39897' target=_blank style='color:#2F92EE;'>#双侧#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=47, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=37398, encryptionId=46223e39897, topicName=双侧)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=741b11453403, createdName=wangbingxhy, createdTime=Tue Aug 23 14:13:39 CST 2022, time=2022-08-23, status=1, ipAttribution=)]
    2022-08-24 yangchou

    好文章,谢谢分享。

    0

  5. 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encodeId=215f1390135e0, content=<a href='/topic/show?id=c4d0858e23b' target=_blank style='color:#2F92EE;'>#膝关节置换术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=46, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=85872, encryptionId=c4d0858e23b, topicName=膝关节置换术)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=zhaojie88, createdTime=Tue Aug 23 14:13:39 CST 2022, time=2022-08-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1401892, encodeId=2004140189243, content=<a href='/topic/show?id=a165189092e' target=_blank style='color:#2F92EE;'>#X线片#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=18909, encryptionId=a165189092e, topicName=X线片)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=19412365947, createdName=jiyangfei, createdTime=Tue Aug 23 14:13:39 CST 2022, time=2022-08-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1522494, encodeId=f1af152249412, content=<a href='/topic/show?id=46223e39897' target=_blank style='color:#2F92EE;'>#双侧#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=47, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=37398, encryptionId=46223e39897, topicName=双侧)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=741b11453403, createdName=wangbingxhy, createdTime=Tue Aug 23 14:13:39 CST 2022, time=2022-08-23, status=1, ipAttribution=)]
    2022-08-23 lmm397
  6. 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14:13:39 CST 2022, time=2022-08-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1522494, encodeId=f1af152249412, content=<a href='/topic/show?id=46223e39897' target=_blank style='color:#2F92EE;'>#双侧#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=47, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=37398, encryptionId=46223e39897, topicName=双侧)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=741b11453403, createdName=wangbingxhy, createdTime=Tue Aug 23 14:13:39 CST 2022, time=2022-08-23, status=1, ipAttribution=)]
    2022-08-23 piaojinhua
  7. 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  8. 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  9. 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14:13:39 CST 2022, time=2022-08-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1522494, encodeId=f1af152249412, content=<a href='/topic/show?id=46223e39897' target=_blank style='color:#2F92EE;'>#双侧#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=47, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=37398, encryptionId=46223e39897, topicName=双侧)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=741b11453403, createdName=wangbingxhy, createdTime=Tue Aug 23 14:13:39 CST 2022, time=2022-08-23, status=1, ipAttribution=)]
    2022-08-23 jiyangfei
  10. 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ARD:是什么导致SLE临床试验结果测量的不一致?

在所有试验中,大多数患者具有一致的BICLA/SRI(4)结果,双BICLA/SRI(4)反应有利于anifrolumab。在未来的SLE试验中,仔细关注基线疾病活动和监测糖皮质激素锥度变化必不可少。

J Autoimmunity :Rho-GTPase 依赖性白细胞相互作用产生促炎胸腺 Tregs 并引起关节炎

该研究结果证明了巨噬细胞在刺激促炎胸腺Treg发育中的意外作用,并揭示了其致关节炎表型背后的Rho-GTPases激活。

A&R:1990年至2019年特定部位骨关节炎的流行趋势:2019 年全球疾病负担研究的结果

在全球范围内,骨关节炎(OA)的流行病例增加了113.25%,从1990年的2.4751亿增加到2019年的5.2781 亿。OA患病率随着年龄的增长而增加,并揭示出女性主导、地理多样性和解剖部位差异

Euro Radiol:这一新的MR序列,使定量评估关节软骨退变又前进了一步!

三维超短回波时间锥体(3D UTE-Cones)序列可以对膝关节的短T2和长T2组织进行快速容积成像。