BACKGROUND & AIMS: OBJECTIVE:A forearm fracture (Colles' fracture) is often the first sign of osteoporosis and should alert the patient and physician to the possibility of underlying skeletal fragility. Therefore, the establishment of a more accurate and reliable method for the measurement of bone mineral density (BMD) at the distal radius would be beneficial for the patients who suffer from osteoporosis. The objective of the present study was to evaluate the usefulness of peripheral quantitative computed tomography (pQCT) to assess the change of BMD at the distal radius in early postmenopausal women who receive hormone replacement therapy (HRT). METHODS:Twenty healthy early postmenopausal women who were diagnosed as osteoporosis or osteopenia were randomized to either HRT or placebo treatment. We analyzed BMD of the distal radius by pQCT, lumbar spine by dual-energy X-ray absorptiometry (DXA) and the biochemical markers of bone turn over (osteocalcin, deoxypyridinoline) every 6 months. RESULTS:The placebo group showed a significant decrease from the baseline in the trabecular BMD of the radius at 12 months (7.4+/-2.5%) (p<0.05), whereas the HRT group showed a slight increase (0.7+/-2.2%). The changes in the trabecular BMD of the radius between the HRT and placebo groups were statistically different at 12 months (p<0.05). On the other hand, in the cortical BMD of the radius, no significant differences were seen between the changes of bone densities in the HRT and control groups after 1 year of treatment. pQCT could detect a significant loss of BMD of the radius in early postmenopausal women after 1 year and HRT prevented its loss. CONCLUSION:Our preliminary clinical trial showed that pQCT might be useful for the early detection of bone loss in early postmenopausal women and for the monitoring BMD of the patients who receive HRT.

背景与目标： 目的：前臂骨折（Colles骨折）通常是骨质疏松的最初征兆，应提醒患者和医生潜在的骨骼脆弱性。因此，建立一种更准确和可靠的方法来测量远端radius骨的骨矿物质密度（BMD）对于患有骨质疏松症的患者将是有益的。本研究的目的是评估外围定量计算机体层摄影术（pQCT）的有效性，以评估接受激素替代疗法（HRT）的绝经后早期女性远端radius骨BMD的变化。
方法：将20名被诊断为骨质疏松或骨质减少的健康早期绝经后妇女随机分为HRT或安慰剂治疗组。我们每6个月通过pQCT分析远端radius骨的BMD，通过双能X线吸收法（DXA）分析腰椎，并分析骨翻倒的生化标志物（骨钙蛋白，脱氧吡啶并啉）。
结果：安慰剂组在12个月时the骨小梁BMD较基线显着降低（7.4 /-2.5%）（p <0.05），而HRT组则略有增加（0.7 /-2.2%） 。 HRT组与安慰剂组之间的radius骨小梁骨密度变化在12个月时有统计学差异（p <0.05）。另一方面，在治疗1年后，HRT和对照组的骨密度变化在the骨的BMD中没有发现显着差异。 pQCT可以检测到绝经后早期女性在1年后B骨BMD的显着减少，而HRT可以防止这种情况的发生。
结论：我们的初步临床试验表明，pQCT可能对早期绝经后妇女的骨丢失早期检测以及监测接受HRT的患者的BMD有用。

BACKGROUND & AIMS: Androgen therapy may improve libido and psychologic symptoms in hypogonadal women. Such replacement may also cause undesirable lipoprotein changes and virilizing side effects. By detailing the benefits and risks, this article may help the clinician determine the role of androgen therapy as a supplement to conventional estrogen/progestin replacement in menopausal women.

背景与目标： 雄激素治疗可以改善性腺功能减退妇女的性欲和心理症状。这种替换也可能导致不希望的脂蛋白变化和毒副作用。通过详细介绍其益处和风险，本文可以帮助临床医生确定雄激素疗法在更年期女性中作为常规雌激素/孕激素替代品的补充的作用。

BACKGROUND & AIMS: In the study presented, knee joint proprioception of 17 patients with primary degenerative joint disease of the knee joint was evaluated. As a control group, the proprioception of 30 healthy volunteers with clinical and anamnestically inconspicuous knee joints was examined. We tested the proprioceptive capability of the subjects with an angle reproduction test. Additionally, all knee joints were measured with and without an elastic knee bandage. The study showed significantly more deterioration in knee joint proprioception in patients with gonarthrosis than in the control group. Even the proprioception of the contralateral, healthy knee joint was worse than the results of the control group. However, after using an elastic knee bandage, significant improvement in the proprioceptive abilities of the injured knee joint was documented.

背景与目标： 在提出的研究中，对17例膝关节原发性退行性关节疾病患者的膝关节本体感受进行了评估。作为对照组，检查了30名健康的志愿者的本体感受，这些志愿者的膝关节临床且无明显症状。我们通过角度再现测试测试了受试者的本体感受能力。另外，在有或没有弹性膝盖绷带的情况下测量所有膝关节。该研究表明，狼疮患者的膝关节本体感受的恶化比对照组明显更多。甚至对侧健康膝关节的本体感觉也比对照组的结果差。但是，在使用弹性膝盖绷带后，有记录表明受伤的膝关节的本体感受能力有了显着改善。

BACKGROUND & AIMS: :The alkenyldiarylmethanes (ADAMs) are a unique class of non-nucleoside reverse transcriptase inhibitors that have potential value in the treatment of HIV/AIDS. However, the potential usefulness of the ADAMs is limited by the presence of metabolically labile methyl ester moieties. A series of novel ADAMs were therefore designed and synthesized in order to replace the metabolically labile methyl ester moieties of the existing ADAM lead compounds with hydrolytically stable, fused isoxazolone, isoxazole, oxazolone, or cyano substituents on the aromatic rings. The methyl ester and methoxy substituents on both of the aromatic rings in the parent compound 1 were successfully replaced with metabolically stable moieties with retention of anti-HIV activity and a general decrease in cytotoxicity.

背景与目标： ：烯基二芳基甲烷（ADAM）是一类独特的非核苷类逆转录酶抑制剂，在治疗HIV / AIDS中具有潜在价值。然而，ADAM的潜在用途受到代谢不稳定的甲基酯部分的存在的限制。因此，设计并合成了一系列新颖的ADAM，以在芳香环上用水解稳定的稠合异恶唑酮，异恶唑，恶唑酮或氰基取代基取代现有ADAM铅化合物的代谢不稳定的甲基部分。母体化合物1的两个芳香环上的甲酯和甲氧基取代基均成功地被代谢稳定的部分所取代，并保留了抗HIV活性并普遍降低了细胞毒性。

BACKGROUND & AIMS: :Wound infections are an infrequent but serious complication of total knee arthroplasty. Between January 1984 and November 1987, 20 of 243 (8.2%) patients at two affiliated hospitals developed surgical wound infections following 259 total knee arthroplasty procedures performed in clean-air operating rooms. Eighteen (90%) of the patients had deep infections; nine required removal of the prosthesis. A single surgeon (surgeon X) was associated with 18 of the procedures that had subsequent infection (risk ratio (RR) = 9.4, 95% confidence interval (CI) 2.2-39), and an investigation was carried out in an effort to explain the difference in infection rates between surgeon X and other surgeons. In a cohort study, stratified analyses identified a preoperative American Society of Anesthesiologists (ASA) physical status class greater than or equal to 3, surgeon X, and early postoperative use of a continuous passive motion device as risk factors associated with surgical wound infection following total knee arthroplasty procedures. Logistic regression analyses identified being a patient operated on by surgeon X with an ASA class greater than or equal to 3 as the only significant independent risk factor for total knee arthroplasty-associated surgical wound infections (RR = 9.3, 95% CI 2.8-31). The effect due to surgeon X could not be explained by receipt or timeliness of administration of antimicrobial prophylaxis, type of prosthesis inserted, duration of operation, postoperative use of continuous passive motion, or underlying etiology of joint disease. The authors conclude that surgical technique and patient's severity of illness were the primary determinants of surgical wound infection after total knee arthroplasty. This study demonstrates the complexity of epidemiologic investigation of surgical wound infections and the importance of considering patient severity of illness when interpreting surgeon-specific infection rates.

背景与目标： ：伤口感染是全膝关节置换术的一种罕见但严重的并发症。在1984年1月至1987年11月之间，两家附属医院的243名患者中有20名（8.2％）在清洁空气手术室中进行了259次全膝关节置换手术后出现了手术伤口感染。 18名（90％）患者患有深部感染；九个需要去除假体。一名外科医生（外科医生X）与18例随后感染的手术相关联（风险比（RR）= 9.4，95％置信区间（CI）2.2-39），并进行了调查以解释X外科医师和其他外科医师之间的感染率差异。在一项队列研究中，分层分析确定术前美国麻醉医师协会（ASA）身体状况等级大于或等于3，X医师和术后早期使用连续被动运动装置是与总手术后伤口感染相关的危险因素。膝关节置换术。 Logistic回归分析确定是由ASA级大于或等于3的X外科医师手术的患者，是全膝关节置换相关手术伤口感染的唯一重要独立危险因素（RR = 9.3，95％CI 2.8-31） 。不能通过接受抗生素预防措施的及时性，插入的假体的类型，手术的持续时间，术后持续使用被动运动或关节病的病因来解释外科医生X的影响。作者得出结论，手术技术和患者疾病的严重程度是全膝关节置换术后手术伤口感染的主要决定因素。这项研究证明了外科伤口感染的流行病学调查的复杂性，以及在解释外科医生特定感染率时考虑患者疾病严重性的重要性。

BACKGROUND & AIMS: :Patients undergoing total knee replacement for end stage knee osteoarthritis (OA) become increasingly younger and more demanding. Consequently, outcome assessment tools need to evolve toward objective performance-based measures. We applied a novel approach toward ambulatory biomechanical assessment of physical function using a single inertial sensor located at the pelvis to derive various motion parameters during activities of daily living. We investigated the potential of a clinically feasible battery of tests to define relevant parameters of physical function. We compared preoperative measures of end stage knee OA patients to healthy subjects. Our results show that measures of time yield the highest discriminative capacity to differentiate between groups. Additionally we found disease-dependent and task-specific alterations of movement for inertial sensor-derived motion parameters with good discriminative capacity. The inertial sensor's output quantities seem to capture another clinically relevant dimension of physical function that is supplementary to time. This study demonstrates the potential of inertial sensor-based motion analysis and provides a standardized test feasible for a routine clinical application in the longitudinal follow-up.

背景与目标： ：正在接受全膝关节置换以治疗终末期膝骨关节炎（OA）的患者变得越来越年轻，要求也越来越高。因此，结果评估工具需要朝着基于绩效的客观指标发展。我们使用位于骨盆的单个惯性传感器对运动功能进行动态生物力学评估的新方法，以在日常生活活动中得出各种运动参数。我们研究了临床上可行的一系列测试的潜力，以定义相关的身体机能参数。我们比较了晚期膝骨关节炎患者与健康受试者的术前措施。我们的结果表明，时间量度具有最高的区分人群的区分能力。此外，我们发现了惯性传感器衍生的运动参数具有良好的判别能力的疾病相关和任务特定的运动变化。惯性传感器的输出量似乎捕获了另一项与临床相关的物理功能，是对时间的补充。这项研究证明了基于惯性传感器的运动分析的潜力，并为纵向随访中的常规临床应用提供了可行的标准化测试方法。

BACKGROUND & AIMS: OBJECTIVE:Although there is evidence for a beneficial effect of increased quadriceps strength on knee symptoms, the effect on knee structure is unclear. We undertook this study to examine the relationship between change in vastus medialis cross-sectional area (CSA) and knee pain, tibial cartilage volume, and risk of knee replacement in subjects with symptomatic knee osteoarthritis (OA). METHODS:One hundred seventeen subjects with symptomatic knee OA underwent magnetic resonance imaging of the knee at baseline and at 2 and 4.5 years. Vastus medialis CSA was measured at baseline and at 2 years. Tibial cartilage volume was measured at baseline and at 2 and 4.5 years. Knee pain was assessed by the Western Ontario and McMaster Universities Osteoarthritis Index at baseline and at 2 years. The frequency of knee joint replacement over 4 years was determined. Regression coefficients (B) and odds ratios were determined along with 95% confidence intervals (95% CIs). RESULTS:After adjusting for confounders, baseline vastus medialis CSA was inversely associated with current knee pain (r = -0.16, P = 0.04) and with medial tibial cartilage volume loss from baseline to 2 years (B coefficient -10.9 [95% CI -19.5, -2.3]), but not with baseline tibial cartilage volume. In addition, an increase in vastus medialis CSA from baseline to 2 years was associated with reduced knee pain over the same time period (r = 0.24, P = 0.007), reduced medial tibial cartilage loss from 2 to 4.5 years (B coefficient -16.8 [95% CI -28.9, -4.6]), and reduced risk of knee replacement over 4 years (odds ratio 0.61 [95% CI 0.40, 0.94]). CONCLUSION:In a population of patients with symptomatic knee OA, increased vastus medialis size was associated with reduced knee pain and beneficial structural changes at the knee, suggesting that management of knee pain and optimizing vastus medialis size are important in reducing OA progression and subsequent knee replacement.

背景与目标： 目的：尽管有证据表明增加股四头肌力量对膝关节症状有有益作用，但对膝关节结构的影响尚不清楚。我们进行了这项研究，以检查有症状膝骨关节炎（OA）患者的股内侧截面积（CSA）变化与膝关节疼痛，胫骨软骨体积和膝关节置换风险之间的关系。
方法：117名有症状膝骨关节炎的受试者在基线，2岁和4.5岁接受了膝部磁共振成像。在基线和第2年测量中侧股静脉CSA。在基线以及第2和4.5年测量胫骨软骨体积。在基线和第2年，通过西安大略和麦克马斯特大学的骨关节炎指数评估膝关节疼痛。确定了4年内膝关节置换的频率。确定回归系数（B）和比值比以及95％的置信区间（95％CI）。
结果：校正混杂因素后，基线膝关节内侧内侧CSA与当前膝关节疼痛呈负相关（r = -0.16，P = 0.04），并且与基线至2年时胫骨内侧软骨体积减少呈负相关（B系数-10.9 [95％CI- 19.5，-2.3]），但不包括胫骨基线软骨体积。此外，从基线期到2年内，腓肠肌CSA的增加与同期膝关节疼痛的减轻有关（r = 0.24，P = 0.007），胫骨内侧软骨损失从2年减少到4.5年（B系数-16.8） [95％CI -28.9，-4.6]），并在4年内降低了膝关节置换的风险（赔率0.61 [95％CI 0.40，0.94]）。
结论：在有症状的膝骨关节炎患者中，股骨内侧vast增大与膝关节疼痛减轻和膝部有益的结构变化有关，这表明管理膝部疼痛和优化股骨内侧media肌对于减少OA进展和随后的膝关节起重要作用。替代品。

BACKGROUND & AIMS: INTRODUCTION:Prosthetic and operative modifications in total knee arthroplasty (TKA) have been proposed to maximise post-operative knee flexion as it is essential in routine functional activities. METHODS:We performed a double blind randomised controlled trial to compare clinical outcomes of primary cruciate-retaining TKA for osteoarthritis with the femoral component implanted in either 4° flexion in the sagittal plane (F) or in a neutral position (C). The primary outcome of knee flexion and secondary outcomes knee extension, quadriceps strength, WOMAC, SF-12v2, timed stand test, stair climb test and satisfaction were assessed at 1 year. Knee flexion and extension were also assessed intra-operatively. Implant flexion was measured from true lateral radiographs. RESULTS:Thirty-nine participants (40 knees) were recruited, 20 knees per group. Three subjects from the control group and two from the flexed group were lost to 1 year follow-up but numbers were sufficient to satisfy the sample size calculation. Significant differences were found between the groups in knee flexion (F: 113.6±8.8° pre-operative, 122.4±6.0° intra-operative, 110.2±7.5° 1 year, C: 117.4±11.7°, 117.4±7.6°, 103.5±10.7°. p=0.031) and mental component score of the SF12-v2 (F 53.3±13.2, C 61.1±7.3, p=0.009) but there were no significant differences in other outcomes and patients were equally satisfied. CONCLUSION:Flexing the femoral implant in this cruciate retaining TKA system provided a significant difference in knee flexion compared to a neutral position. The improvement appears to occur predominantly at surgery and was not associated with a clinical or functional benefit at 1 year. (ACTRN12606000325505). LEVEL OF EVIDENCE:Level 1; randomised controlled trial.

背景与目标： 简介：已经提出对全膝关节置换术（TKA）进行假体和手术修改，以最大程度地提高术后膝关节屈曲度，因为它是常规功能活动中必不可少的。
方法：我们进行了一项双盲随机对照试验，比较了在骨矢状面（F）或中性位（C）中以4°屈曲度植入股骨组件的原发性保留骨关节炎的TKA的临床结局。在1年时评估膝关节屈曲的主要结果和膝关节伸展，次股四头肌力量，WOMAC，SF-12v2，定时站立测试，爬楼梯测试和满意度的主要结果。术中还评估了膝盖的屈伸性。从真实的侧位X线照片测量植入物的弯曲度。
结果：招募了39名参与者（40膝），每组20膝。对照组的三名受试者和屈肌训练的三名受试者失去了1年的随访，但数量足以满足样本量的计算。两组之间的膝关节屈曲有显着差异（F：术前113.6±8.8°，术中122.4±6.0°，10.2±7.5°1年，C：117.4±11.7°，117.4±7.6°，103.5± SF12-v2的10.7°。p = 0.031）和精神成分评分（F 53.3±13.2，C 61.1±7.3，p = 0.009），但其他结局无显着差异，患者也同样满意。
结论：在这种十字形保持的TKA系统中弯曲股骨植入物与中立位置相比，在膝关节屈曲方面有显着差异。改善似乎主要发生在手术上，并且在1年时与临床或功能获益无关。 （ACTRN12606000325505）。
证据级别：1级；随机对照试验。

BACKGROUND & AIMS: BACKGROUND CONTEXT:Although autogenous bone is still considered to be the gold standard graft material for promoting spinal fusion, other bone graft substitutes have been developed in an attempt to improve arthrodesis rates and avoid the complications associated with the procurement of autograft. The bone morphogenetic proteins (BMPs) represent a family of osteoinductive growth factors that are known to stimulate the osteoblastic differentiation of stem cells. Osteogenic protein-1 (OP-1) Putty is a commercially available BMP preparation that is already approved for use in humans. Previous clinical studies involving patients with degenerative spondylolisthesis have reported that the efficacy and safety of OP-1 Putty is comparable to that of autograft at both 1- and 2-year follow-up. PURPOSE:The purpose of this study was to evaluate the intermediate-term efficacy and safety of OP-1 Putty as an alternative to autogenous bone by comparing the 4-year radiographic, clinical, and safety data of these same patients who underwent decompression and uninstrumented fusion with either OP-1 Putty or iliac crest autograft. STUDY DESIGN/SETTING:A prospective, randomized, controlled, multicenter clinical pilot study. PATIENT SAMPLE:Thirty-six patients undergoing decompressive laminectomy and single-level uninstrumented fusion for degenerative spondylolisthesis and symptomatic spinal stenosis were randomized in a 2:1 fashion to receive either OP-1 Putty (24 patients) or autogenous iliac crest bone graft (12 patients). OUTCOME MEASURES:Patient-reported outcome measures consisting of Oswestry Disability Index and Medical Outcomes Study 36-Item Short Form Health Survey (SF-36) scores were used to evaluate clinical efficacy. Perioperative data including operative time, estimated blood loss, and duration of hospital stay were also recorded for each surgery. Postoperatively, a neurological examination and an assessment of donor-site pain (if applicable) were performed at every follow-up visit. Radiographic fusion success was defined as the presence of continuous bridging bone formation between the transverse processes at the level of the spondylolisthesis with minimal motion evident on dynamic lateral x-ray films. The primary efficacy endpoint was the overall success rate, a composite measure derived from both radiographic and clinical parameters. The safety of OP-1 Putty was confirmed by comparing the nature and frequency of all adverse events and complications that were prospectively observed in either of the groups. METHODS:Thirty-six patients with degenerative spondylolisthesis and symptoms of neurogenic claudication underwent decompressive laminectomy and single-level uninstrumented fusion with either OP-1 Putty or autograft. All patients were evaluated at 6 weeks and 3, 6, 9, 12, and 24 months, after which time they were instructed to return on a yearly basis. Multiple neuroradiologists blinded to the assigned treatment reviewed static and dynamic X-ray films with digital calipers to assess fusion status according to the presence of continuous bridging bone across the transverse processes as well as the amount of residual motion evident at the level of interest. Oswestry Disability Index surveys and SF-36 questionnaires were used to assess clinical outcomes. RESULTS:At the 48-month time point, complete radiographic and clinical data were available for 22 of 36 patients (16 OP-1 Putty and 6 autograft) and 25 of 36 patients (18 OP-1 Putty and 7 autograft), respectively. Radiographic evidence of a solid arthrodesis was present in 11 of 16 OP-1 Putty patients (68.8%) and 3 of 6 autograft patients (50%). Clinically successful outcomes defined as at least a 20% improvement in preoperative Oswestry scores were experienced by 14 of 19 OP-1 Putty patients (73.7%) and 4 of 7 autograft patients (57.1%); these clinical findings were corroborated by similar increases in SF-36 scores. The respective overall success rates of the OP-1 Putty and autograft group were 62.5% and 33.3%. In this study, there were no incidents of local or systemic toxicity, ectopic bone production, or other adverse events directly related to the use of OP-1 Putty. CONCLUSION:Despite the challenges associated with obtaining a solid uninstrumented fusion in patients with degenerative spondylolisthesis, the rates of radiographic fusion, clinical improvement, and overall success associated with the use of OP-1 Putty were at least comparable to that of the autograft controls for at least 48 months after surgery. These results appear to validate the short-term results previously reported for OP-1 Putty and suggest that this material may potentially represent a viable bone graft substitute for certain fusion applications.

背景与目标： 背景技术：尽管自体骨仍被认为是促进脊柱融合的金标准移植材料，但已开发出其他骨移植替代品以试图提高关节固定率并避免与自体移植相关的并发症。骨形态发生蛋白（BMP）代表一类骨诱导生长因子，已知这些因子可刺激干细胞的成骨细胞分化。成骨蛋白1（OP-1）腻子是一种可商购的BMP制剂，已被批准用于人类。先前涉及退行性脊椎滑脱患者的临床研究报告，在1年和2年的随访中，OP-1腻子的功效和安全性与自体移植相当。
目的：本研究的目的是通过比较这些接受减压和非器械治疗的患者的4年放射学，临床和安全性数据，评估OP-1油灰替代自体骨的中期疗效和安全性与OP-1油灰或骨自体融合。
研究设计/设置：一项前瞻性，随机，对照，多中心临床试验研究。
患者样本：36例行减压椎板切除术和单级非器械融合治疗退行性腰椎滑脱和症状性椎管狭窄的患者以2：1方式随机接受OP-1腻子（24例）或自体骨植骨（12例）耐心）。
结局指标：采用Oswestry残疾指数和医学结局研究36项简表健康调查（SF-36）评分组成的患者报告结局指标，用于评估临床疗效。每次手术还记录了围手术期数据，包括手术时间，估计的失血量和住院时间。术后，每次随访均进行神经系统检查和对供体部位疼痛的评估（如果适用）。影像学上的融合成功定义为在横向滑突之间在脊椎滑脱水平处连续桥接骨形成，而在动态侧向X射线胶片上可见的运动极小。主要功效终点是总体成功率，这是一项从放射学和临床参数中得出的综合指标。 OP-1腻子的安全性通过比较两组中预期观察到的所有不良事件和并发症的性质和频率来确定。
方法：36例退行性腰椎滑脱和神经源性lau行症状的患者接受减压椎板切除术和单层非器械融合OP-1腻子或自体移植。在第6周和第3、6、9、12和24个月对所有患者进行评估，然后指示他们每年返回一次。多位神经放射科医生对指定的治疗方法视而不见，并用数字卡尺检查了静态和动态X射线胶片，以根据横断过程中连续桥接骨的存在以及感兴趣水平上明显的残余运动量来评估融合状态。 Oswestry残疾指数调查和SF-36问卷用于评估临床结局。
结果：在48个月的时间点，分别可获得36例患者中的22例（16例OP-1腻子和6例自体移植）和36例患者中的25例（18例OP-1腻子和7例自体移植）的完整影像学和临床资料。 16例OP-1腻子患者中有11例（68.8％）和6例自体移植患者中有3例（50％）出现了牢固的关节固定的影像学证据。 19例OP-1腻子患者中的14例（73.7％）和7例自体移植患者中的4例（57.1％）经历了临床上成功的结果，定义为术前Oswestry评分至少提高了20％。这些临床发现被SF-36分数的类似提高所证实。 OP-1腻子和自体移植组的总体总体成功率分别为62.5％和33.3％。在这项研究中，没有发生局部或全身毒性，异位骨生成或与使用OP-1腻子直接相关的其他不良事件的事件。
结论：尽管在退行性脊椎滑脱患者中获得牢固的非器械融合具有挑战性，但与使用OP-1腻子相关的放射成像融合率，临床改善率和总体成功率至少可与自体植骨对照用于手术后至少48个月。这些结果似乎证实了先前报道的OP-1油灰的短期结果，并表明该材料可能是某些融合应用中可行的骨移植替代品。

BACKGROUND & AIMS: :A prospective evaluation of 333 consecutive patients undergoing isolated mitral valve replacement between 1982 and 1985 was performed to identify the predictors of survival and valve failure. Follow-up between 2 and 6 years postoperatively (mean, 32 +/- 17 months) was 98% complete. Four prostheses were inserted to permit a prospective evaluation of alternative valves: Björk-Shiley mechanical (n = 118), Ionescu-Shiley pericardial (n = 146), Carpentier-Edwards porcine (n = 38), and Hancock pericardial (n = 31). Hospital mortality was 6%, and actuarial survival at 5 years was 74% +/- 5%. Multivariate Cox regression analysis identified advancing age (less than 40 years, 88% +/- 7%; greater than 70 years, 50% +/- 14%) and poor left ventricular function (ejection fraction less than 0.20, 62% +/- 17%; ejection fraction greater than 0.60, 80% +/- 7%) as independent predictors of postoperative survival. Freedom from structural valve dysfunction, prosthetic valve endocarditis, reoperation, and valve-related mortality and morbidity were 86% +/- 4%, 91% +/- 4%, 81% +/- 4%, and 72% +/- 5%, respectively, at 5 years. The actuarial incidence of valve failure was inordinately high with the Hancock pericardial valve (p less than 0.05). Freedom from thromboembolic events (78% +/- 8% at 5 years) was significantly lower in patients with poor ventricular function (ejection fraction (less than 0.20, 54% +/- 20%; ejection fraction greater than 0.60, 73% +/- 11%; p less than 0.05). Survival after mitral valve replacement was determined by age and left ventricular function. Premature failure of the Hancock pericardial valve resulted in an unacceptable rate of valve-related complications.

背景与目标： ：对1982年至1985年间连续333例接受二尖瓣置换的患者进行了前瞻性评估，以明确其生存率和瓣膜衰竭的预测因素。术后2至6年（平均32 /-17个月）的随访完成了98％。插入了四个假体，以对其他瓣膜进行前瞻性评估：Björk-Shiley机械式（n = 118），Ionescu-Shiley心包式（n = 146），Carpentier-Edwards猪（n = 38）和Hancock心包式（n = 31 ）。医院死亡率为6％，5年的精算生存率为74％/-5％。多元Cox回归分析确定年龄提前（小于40岁，88％/-7％;大于70岁，50％/-14％）和左心室功能差（射血分数小于0.20，62％/-17％） ;射血分数大于0.60，80％/-7％）作为术后生存的独立预测指标。摆脱结构性瓣膜功能障碍，人工瓣膜心内膜炎，再次手术以及与瓣膜相关的死亡率和发病率分别为86％/-4％，91％/-4％，81％/-4％和72％/-5％ ，在5年后。汉考克心包瓣膜的瓣膜衰竭的精算发生率异常高（p小于0.05）。心室功能较差的患者（射血分数（小于0.20，54％/-20％；射血分数大于0.60，73％/-11）时，无血栓栓塞事件（5年时为78％/-8％）显着降低％； p小于0.05）。二尖瓣置换术后的存活率由年龄和左心室功能决定，汉考克心包瓣膜过早衰竭导致瓣膜相关并发症的发生率不可接受。

BACKGROUND & AIMS: BACKGROUND:Various techniques have been proposed for cerebral protection during the surgical treatment of complex aortic disease. The authors propose a revisited strategy of normothermic replacement of the aortic arch to avoid limitations and complications of profound hypothermic circulatory arrest. MATERIALS AND METHODS:From April 2000 to May 2006, 19 patients with an aneurysm of the aortic arch and 10 patients with an acute (7) or a chronic (3) aortic dissection underwent a totally normothermic, complete replacement of the aortic arch using three pumps: One pump ensured antegrade cerebral perfusion, at a flow rate adapted to obtain a pressure of 70 mmHg in the right radial artery, and required a selective cannulation of the supra-aortic vessels. A second pump ensured body perfusion at a flow rate adapted to obtain a pressure of 55 mmHg in the left femoral artery and was situated between the right femoral artery and the right atrium. A special balloon aortic occlusion catheter was placed in the descending thoracic aorta. A third pump ensured intermittent normothermic myocardial perfusion via the coronary venous sinus. The arch reconstruction was performed with no time limit. RESULTS:There were two operative, in-hospital (6.8%) mortalities. All others patients were rapidly extubated, except one, with no neurological sequelae, and postoperative course was uneventful, without coagulopathy or hepato-renal impairment. CONCLUSIONS:In the light of these results, a normothermic procedure is possible for arch surgery and may ensure a more physiological autoregulation of cerebral blood flow while maintaining body perfusion without high vascular resistances.

背景与目标： 背景：已经提出了多种技术用于复杂主动脉疾病的外科手术治疗中的脑保护。作者提出了一种重新常规的主动脉弓置换策略，以避免局限性和严重的低温循环性停搏的并发症。
材料与方法：从2000年4月至2006年5月，对19例主动脉弓瘤和10例急性（7）或慢性（3）主动脉夹层患者进行了完全正常的，完全的置换，其中三个泵：一台泵确保顺行性脑灌注，其流量适于在右radial动脉中获得70 mmHg的压力，并且需要选择性地插管主动脉上血管。第二个泵确保以适合于在左股动脉中获得55 mmHg压力的流速进行身体灌注，并位于右股动脉和右心房之间。将特殊的球囊主动脉阻塞导管置于降主动脉中。第三个泵确保通过冠状静脉窦进行间歇性常温心肌灌注。足弓重建没有时间限制。
结果：有两次手术中院内死亡（6.8％）。除一名患者外，其他所有患者均迅速拔管，无神经系统后遗症，术后病程平稳，无凝血病或肝肾损害。
结论：根据这些结果，弓形手术可能需要进行常温手术，并可以确保脑血流的更多生理自动调节，同时保持体内灌注而无高血管阻力。

BACKGROUND & AIMS: BACKGROUND:In Asia, obesity has reached epidemic proportions and physicians are likely to face a burden of obesity-related disorders, of which osteoarthritis of the knee is one. However, it is unclear whether obesity affects improvement of conventional TKAs in Asian patients. PURPOSE:We therefore asked whether obese patients with a BMI of 30 kg/m(2) or greater would have worse ROM and function after TKA compared with their nonobese counterparts and whether they would have less improvement preoperatively to postoperatively. METHODS:We retrospectively reviewed 369 patients who underwent TKAs from 2006 to 2010. We stratified patients into four groups: (1) 98 patients with BMIs less than 25 kg/m(2); (2) 158 patients with BMIs between 25 kg/m(2) and 29.9 kg/m(2); (3) 87 patients with BMIs between 30 kg/m(2) and 34.9 kg/m(2); and (4) 26 patients with BMIs greater than 35 kg/m(2). We then compared ROM, function score, Knee Society score, Oxford Knee Questionnaire, and SF-36 questionnaire(®) across the four groups at 6- and 12-month follow-ups. RESULTS:At the 6-month followup, we found a difference only in the ROM. At the 2-year followup, there were no differences in any functional scores across the four groups. Severely obese patients had greater improvement in postoperative ROM than the other groups but did not have any greater improvement in function. CONCLUSION:BMI had little clinical impact on short-term outcomes of conventional TKAs in Asian patients. The data suggest that BMI should not be used as a major determinant to exclude obese patients from surgery with the presumption of poorer outcomes.

背景与目标： 背景：在亚洲，肥胖症已达到流行病的程度，医生可能会面临与肥胖症有关的疾病负担，其中膝部骨关节炎就是其中之一。然而，目前尚不清楚肥胖是否会影响亚洲患者传统TKA的改善。
目的：因此，我们询问BMI为30 kg / m（2）或更大的肥胖患者，与非肥胖患者相比，TKA后ROM和功能是否较差，并且他们在术前和术后的改善是否会较小。
方法：我们回顾性分析了2006年至2010年接受TKA的369例患者。我们将患者分为四组：（1）98例BMI低于25 kg / m的患者（2）； （2）158名BMI在25 kg / m（2）至29.9 kg / m（2）之间的患者; （3）87名BMI在30 kg / m（2）至34.9 kg / m（2）之间的患者; （4）26例BMI大于35 kg / m的患者（2）。然后，我们在6个月和12个月的随访中比较了四组的ROM，功能评分，膝关节评分，牛津膝盖问卷和SF-36问卷。
结果：在6个月的随访中，我们仅在ROM中发现了差异。在为期2年的随访中，四组的任何功能评分均无差异。严重肥胖的患者术后ROM较其他组有更大的改善，但功能没有任何改善。
结论：BMI对亚洲患者传统TKA的短期预后影响不大。数据表明，不应将BMI作为排除肥胖患者的主要决定因素，因为他们认为结果较差。

BACKGROUND & AIMS: :For 17 years, the Blauth total knee prosthesis has been implanted with its basic constructional features remaining unchanged. While it is true that the prosthetic components are constrained by a mechanical hinge, load transmission is actually effected in accordance with the low-friction principle through the cup-shaped condylar surfaces. Packing of the prosthesis in the bone is ensured by large load-bearing surfaces and by specific elements intended for rotational stability. In a comprehensive follow-up review, 497 implants were studied over a period of one to 15 years (average, 45 months). Aseptic loosening occurred in only 1.2% of the prostheses, and deep infection was found in 3% of the patients in the follow-up review. According to survival statistics, the probability of finding prostheses without deep infection or loosening after more than ten years is 89%. The efficiency of total knee arthroplasty (TKA) by hinged prostheses should therefore not be judged by the results obtained with the pioneer implants, which date back to the beginnings of TKA. The clinical results obtained clearly demonstrate that there is 90 degrees knee flexion in more than 88% of the implants. A subjective appraisal demonstrated substantially less pain compared with the preoperative findings. Problems originating from the patella were recorded in less than 10%. However, in 1985, an improved prosthetic design was introduced that also provided for the replacement of the posterior surface of the patella and for a proximally extended patellar bearing. The position of the hinge and implant packing remained unchanged. The results obtained so far with the modified prosthetic design are very good.

背景与目标： ：17年来，Blauth全膝关节假体已被植入，其基本结构特征保持不变。虽然假肢部件确实受机械铰链约束，但实际上是根据低摩擦原理通过杯状con表面实现了载荷传递。假体在骨头中的堆积可通过较大的承重表面和用于旋转稳定性的特定元件来确保。在全面的随访评估中，在1至15年（平均45个月）的时间内对497个植入物进行了研究。在随访检查中，仅1.2％的假体发生了无菌性松动，而3％的患者中发现了深部感染。根据生存统计，超过十年后发现没有深层感染或松动的假体的可能性为89％。因此，不应通过先驱植入物获得的结果来判断铰接式假体进行的全膝关节置换术（TKA）的效率，这可以追溯到TKA的开始。获得的临床结果清楚地表明，超过88％的植入物有90度的膝盖弯曲。与术前相比，主观评估显示疼痛明显减轻。 recorded骨引起的问题少于10％。然而，在1985年，引入了改进的假体设计，该假体设计还提供了the骨后表面的替换和向近侧延伸的tell骨轴承。铰链和植入物填充物的位置保持不变。到目前为止，使用改良的假体设计所获得的结果非常好。

BACKGROUND & AIMS: :The objective indicators which reflect the past results of end-stage knee osteoarthritis (OA) patients who have already received total knee arthroplasty (TKA) could be helpful for physicians to discuss with patients who are considering TKA. The aim of this prospective cohort study was to examine whether we could predict the knee OA patients who would receive TKA in advance based on baseline data, and to set cut-off points for receiving TKA. The two-hundred and forty end-stage medial-type knee OA patients were enrolled and followed up for 6 months while performing therapeutic exercises. Radiographic findings, visual analog scale for pain and a patient-oriented outcome measure, the Japanese Knee Osteoarthritis Measure (JKOM), were recorded at baseline. Relative risks (RRs) using the area under the curve (AUC) for a receiver operating characteristic (ROC) curve were calculated to evaluate several scores for receiving TKA. While 119 patients (55.3 %) did not undergo TKA, the remaining 96 patients (44.7 %) underwent TKA during this period. The AUCs of the ROC curve for the JKOM total score [0.71 (95 % CI 0.64-0.79)] were higher than those for radiographic parameters. Among the JKOM subcategories, JKOM category III, which indicates the condition in daily life, showed the highest AUC of 0.72 (0.65-0.80). The JKOM total score (65/100) and JKOM category III score (17/40) showed RRs of 2.20 (1.33-3.63) and 1.95 (1.18-3.22) for receiving TKA, respectively. The presence of disability in daily living was found to be an important factor determining whether the patient should undergo TKA.

背景与目标： ：客观的指标反映了已经接受全膝关节置换术（TKA）的晚期膝关节骨关节炎（OA）患者的过去结果，可能有助于医生与正在考虑进行TKA的患者进行讨论。这项前瞻性队列研究的目的是检查我们是否可以根据基线数据预测可以提前接受TKA的膝骨OA患者，并设定接受TKA的临界点。入选了240例中晚期膝关节OA患者，并进行了6个月的随访，同时进行了治疗性锻炼。在基线记录影像学发现，疼痛的视觉模拟量表和以患者为导向的结果指标，即日本膝骨关节炎指标（JKOM）。使用接收者操作特征（ROC）曲线的曲线下面积（AUC）计算相对风险（RRs），以评估接收TKA的几个分数。虽然有119名患者（55.3％）没有接受过TKA，但其余96名患者（44.7％）在此期间接受了TKA。 JKOM总分[0.71（95％CI 0.64-0.79）]的ROC曲线的AUC高于射线照相参数的AUC。在JKOM子类别中，指示日常生活状况的JKOM第三类显示最高的AUC为0.72（0.65-0.80）。 JKOM总评分（65/100）和JKOM III类评分（17/40）分别显示，接受TKA的RR为2.20（1.33-3.63）和1.95（1.18-3.22）。发现日常生活中是否存在残疾是决定患者是否应该接受TKA的重要因素。

BACKGROUND & AIMS: BACKGROUND:To improve the anatomy-based alignment of prosthetic components in total knee replacement, surgical navigation systems have recently been developed, based on anatomical reference frame definitions through landmark digitations and functional calibration. In this study, femoral and tibial resection plane alignments, obtained by conventional tecnique, were measured intraoperatively during total knee replacements by a navigation system to quantify potential errors in conventional bone preparation techniques. METHODS:Femoral and tibial resection plane alignments, obtained by conventional femoral intramedullary and tibial extramedullary cutting guides, were measured intraoperatively in 25 primary total knee replacements by a navigation system. This system enabled the surgeon to calculate, before definitive bone sawing, the final position and orientation of all resection planes. RESULTS:The measurements revealed unsatisfactory alignments in nearly all anatomical planes. Except for tibial varus/valgus, final plane orientations were considerably different from those targeted by the surgeon via the navigation system, respectively 7 degrees, 8 degrees and 10 degrees apart in varus-valgus and flexion-extension at the femur, and in flexion-extension at the tibia. CONCLUSION:Modern computer-aided surgery in total knee replacement, once relevant precision has been established in all femur and tibia anatomical planes, can in the future limit the current critical component misalignments.

背景与目标： 背景：为改善全膝关节置换术中假体成分的基于解剖结构的对齐方式，最近通过基于界标数字化和功能校准的解剖学参考框架定义，开发了手术导航系统。在这项研究中，通过导航系统在术中测量了通过常规技术获得的股骨和胫骨切除平面的对齐方式，该过程是通过导航系统在术中进行测量的，以量化传统骨骼制备技术中的潜在误差。
方法：通过常规的股骨髓内和胫骨髓外切割导轨获得的股骨和胫骨切除平面对准，在术中通过导航系统对25例初次全膝关节置换术进行了测量。该系统使外科医生能够在确定的骨锯之前计算所有切除平面的最终位置和方向。
结果：测量结果显示，几乎所有解剖平面的排列均不令人满意。除胫骨内翻/外翻外，最终平面方向与外科医生通过导航系统确定的目标方向有很大不同，内翻外翻和股骨屈伸分别为7度，8度和10度，屈曲-在胫骨上延伸。
结论：一旦在所有股骨和胫骨解剖平面中建立了相关的精度，现代的全膝关节置换计算机辅助手术就可以在将来限制当前的关键部件错位。