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。

BACKGROUND & AIMS: :This study tested the hypothesis that patients with mild and severe medial knee osteoarthritis (OA) adopt different compensatory gait patterns to unload the deseased knee, in not only the frontal plane but also the sagittal plane. Fifteen patients with mild and 15 with severe bilateral medial knee OA, and 15 normal controls walked while the kinematic and kinetic data were measured. Compared to the normal group, both OA groups had significantly greater pelvic anterior tilt, swing-pelvis list, smaller standing knee abduction, as well as smaller standing hip flexor and knee extensor moments during stance. The severe group also had greater hip abduction, knee extension and ankle plantarflexion. The mild group successfully reduced the extensor moment and maintained normal abductor moment at the diseased knee mainly through listing and anterior tilting the pelvis. With extra compensatory changes at other joints and increased hip abductor moment, the severe group successfully reduced the knee extensor moment but failed to reduce the abductor moment. These results suggest that, apart from training of the knee muscles, training of the hip muscles and pelvic control are essential in the rehabilitative intervention of patients with knee OA, especially for more severe patients.

背景与目标： ：这项研究检验了以下假设：轻度和重度内侧膝骨关节炎（OA）患者采用不同的补偿性步态模式，不仅可以在额叶平面而且可以在矢状平面上卸下患病的膝盖。在测量运动学和动力学数据的同时，对15例轻度患者和15例严重双侧内侧膝OA以及15例正常对照行走。与正常组相比，两个OA组在站立期间的骨盆前倾，骨盆摆动列表，站立的膝关节外展较小以及站立的髋屈肌和膝伸肌力矩均较小。严重的组还具有更大的髋关节外展，膝盖伸展和踝plant屈。轻度组主要通过倾斜和骨盆前倾成功地减少了患病膝盖的伸肌力矩并保持了正常的外展力矩。随着其他关节的代偿性改变和髋外展肌力矩的增加，严重组成功地减少了膝伸肌力矩，但未能减少外展肌力矩。这些结果表明，除了膝部肌肉训练外，髋部肌肉训练和骨盆控制对于膝骨关节炎患者的康复干预尤其是对于较重的患者而言，也是必不可少的。

BACKGROUND & AIMS: :As the need for hip and knee replacement continues to increase, technical and material changes have allowed a dramatic evolution in the way that degenerative, inflammatory and traumatic arthritis are managed. Advances include new bearing surfaces which should have greater longevity, minimal incision joint replacement, computer guidance and partial joint resurfacing for younger patients. These advances and their implications are discussed.

背景与目标： 随着髋关节和膝关节置换需求的不断增加，技术和材料的变化已使退行性，炎性和创伤性关节炎的管理方式发生了巨大变化。进步包括新的轴承表面，该表面应具有更长的寿命，最小限度的切口关节更换，计算机指导和针对年轻患者的部分关节表面重铺。讨论了这些进展及其含义。

BACKGROUND & AIMS: BACKGROUND:Fabry disease is an X-linked genetic disorder resulting in the accumulation of glycosphingolipids in various organs, leading to exercise intolerance and early mortality. Enzyme replacement therapy (ERT) has recently been approved for use in Fabry patients. GOALS OF STUDY: To assess baseline cardiopulmonary exercise characteristics in both invasive and noninvasive tests and to study the impact of ERT on exercise. METHODS:A total of 15 patients with Fabry disease underwent baseline cardiopulmonary exercise tests. Six patients were randomized 2:1 to receive either ERT or placebo. We performed serial cardiopulmonary exercise tests at baseline and every 3 months over a period of at least 18 months. The baseline test was compared to the last two exercise tests for each patient. RESULTS:Mean age was 32 years. Mean VO2max was 1.680 +/- 0.67 L/min and increased by 0.459 +/- 0.64 L/min in the patients receiving ERT. Mean VO2max was 1.462 +/- 0.25 L/min and decreased by 0.116 +/- 0.44 L/min in patients on placebo. Mean oxygen pulse (VO2/HR) increased by 1.71 with enzyme, but increased only 0.025 in patients taking placebo. Estimated stroke volume (SV) increased by 10 ml in patients on ERT. CONCLUSIONS:In this small cohort, exercise tolerance increased in patients receiving enzyme replacement therapy. Cardiopulmonary exercise testing is a useful test in measuring the response to therapy in Fabry disease patients.

背景与目标： 背景：法布里病是一种X连锁遗传病，导致糖鞘脂在各个器官中积聚，导致运动不耐症和早期死亡。酶替代疗法（ERT）最近已被批准用于法布里（Fabry）患者。研究的目标：在有创和无创测试中评估基线心肺运动特征，并研究ERT对运动的影响。
方法：总共15例法布里病患者接受了基线心肺运动试验。六名患者按2：1的比例随机分配接受ERT或安慰剂。我们在基线以及至少18个月内每3个月进行了一系列心肺运动试验。将基线测试与每位患者的最后两次运动测试进行比较。
结果：平均年龄为32岁。接受ERT的患者的平均VO2max为1.680 /-0.67 L / min，并增加0.459 /-0.64 L / min。服用安慰剂的患者的平均VO2max为1.462 /-0.25 L / min，降低了0.116 /-0.44 L / min。酶的平均氧脉冲（VO2 / HR）增加1.71，但服用安慰剂的患者仅增加0.025。 ERT患者的估计卒中量（SV）增加了10 ml。
结论：在这个小队列中，接受酶替代疗法的患者的运动耐量增加。心肺运动测试是测量法布里病患者对治疗反应的有用测试。

BACKGROUND & AIMS: OBJECTIVE:To present the results of medial unicompartmental knee replacement of patients admitted at a university hospital in Jeddah, Saudi Arabia. METHODS:Of the 99 patients who received medial hemiarthroplasty of the knee since 1989 to 2005, 90 patients (132 operations) with a minimum follow up of one year were evaluated at King Abdul-Aziz University Hospital in Jeddah. Only one patient (2 prostheses) was lost for follow up. Eleven patients (11 prostheses) died after an average time of 108.5 months (36-180 months). Scores were registered according to the Knee Society Clinical Rating System. RESULTS:There was a significant improvement in all functional scores postoperatively throughout the follow up period. One patient developed symptomatic deep vein thrombosis in the calf of the operated leg. There were no other perioperative complications. Twelve patients (14 prostheses) underwent conversion to total knee replacement due to either aseptic loosening of the tibial component (1 prosthesis) or polyethylene wear (3 prostheses) or progression of degenerative disease in the lateral compartment (7 prostheses). Two of these 12 patients (3 prostheses) were operated on at another hospital and no information on the reason for operation is available. CONCLUSION:Unicompartmental knee replacement can be used successfully for the treatment of medial gonarthrosis. Given the proper patient's selection and technical expertise, hemiarthroplasty can give results comparable to or even better than high tibial osteotomy or total knee replacement.

背景与目标： 目的：介绍沙特阿拉伯吉达大学医院收治的患者的单室内侧膝关节置换的结果。
方法：在吉达的阿卜杜勒·阿齐兹国王医院对自1989年至2005年的99例接受了膝关节内侧半成形术的患者进行评估，其中90例（132例手术）至少接受了一年的随访。仅一名患者（2例假肢）丢失以进行随访。 11名患者（11个假体）在平均108.5个月（36-180个月）后死亡。根据膝关节学会临床评分系统记录得分。
结果：在整个随访期间，术后所有功能评分均得到显着改善。一名患者在手术小腿的小腿出现了症状性深静脉血栓形成。没有其他围手术期并发症。 12名患者（14个假体）由于胫骨组件的无菌性松动（1个假体）或聚乙烯磨损（3个假体）或外侧车厢内退行性疾病的进展（7个假体）而进行了全膝关节置换。这12例患者中有2例（3例假肢）在另一家医院接受了手术，目前尚无手术原因的信息。
结论：单室膝关节置换术可成功治疗内侧膝关节病。在适当的患者选择和技术专长的前提下，半髋关节置换术可以提供与甚至高胫骨截骨术或全膝关节置换术相当甚至更好的结果。

BACKGROUND & AIMS: :Acetabular bone loss is a matter for concern in hip resurfacing arthroplasty (HRA), as preservation of the femoral head and neck might demand a larger acetabular cup than in total hip arthroplasty (THA). Using radiographic templating, the cup size required for either THA or HRA was calculated on 100 pelvic films. First, the cup size was determined based on the dimensions of the acetabulum. Then, the cup size for HRA was evaluated taking into account the dimensions of the femoral head/neck. The average cup size required for HRA was larger than for THA (delta + 1.1 mm). The cup size for HRA and THA was similar in 49% of hips; in 51% of the hips the cup required for HRA was larger: one size larger in 31%, two sizes larger in 18% and three sizes larger in 2% of the cases. The greatest difference and highest bone loss were observed for the large sizes (between 52 and 56 mm) and thus predominantly in men (delta + 15 mm male, delta + 0.7 mm female). This study shows that HRA requires a larger acetabular cup in more than 50% of the cases compared to THA. When planning HRA surgeons should remember that cup size is determined by the size of the matching femoral component and that size difference with THA increases with increasing hip sizes.

背景与目标： 髋臼置换术是髋关节置换术（HRA）值得关注的问题，因为与全髋关节置换术（THA）相比，保存股骨头和颈部可能需要更大的髋臼杯。使用射线照相模板，在100份骨盆底片上计算THA或HRA所需的杯子尺寸。首先，根据髋臼的尺寸确定杯的尺寸。然后，考虑股骨头/颈部的尺寸评估HRA的杯大小。 HRA所需的平均杯子尺寸大于THA（δ1.1毫米）。 HRA和THA的罩杯尺寸在49％的髋部中相似；在51％的臀部中，HRA所需的杯子更大：一种大小的人占31％，两个大小的人占18％，三个大小的人占2％。对于大尺寸（52至56毫米之间），观察到最大的差异和最高的骨损失，因此主要出现在男性中（男性为15毫米，女性为0.7毫米）。这项研究表明，与THA相比，HRA在50％以上的病例中需要更大的髋臼杯。在规划HRA时，外科医生应记住，杯的大小由匹配的股骨组件的大小决定，并且THA的大小差异会随着髋关节大小的增加而增加。

BACKGROUND & AIMS: :Ring fencing of joint replacement (JR) units has been reported to reduce infections and is recommended by health authorities in Australia and the UK. It has not been determined whether a demographic risk assessment is adequate to prevent the admission of patients colonized with meticillin-resistant Staphylococcus aureus (MRSA) to ring-fenced units. As such, 250 admissions to the JR unit of a suburban Sydney hospital were screened, and MRSA colonization was identified in 2.8% of patients complying with the demographic risk assessment. Demographic risk assessment is not an adequate substitute for physical MRSA screening, and undermines the effectiveness of ring-fencing procedures.

背景与目标： ：据报道，关节置换术（JR）的环围可以减少感染，澳大利亚和英国的卫生部门建议使用。尚未确定人口统计学风险评估是否足以阻止定性为耐甲氧西林金黄色葡萄球菌（MRSA）的患者入环。因此，筛选了250名进入悉尼郊区医院JR部门的患者，筛查了符合人口统计学风险评估的2.8％患者的MRSA定植。人口统计学风险评估不能完全替代物理MRSA筛查，并且会削弱围栏程序的有效性。

BACKGROUND & AIMS: BACKGROUND:Transcatheter aortic valve replacement (TAVR) is an effective treatment in patients with severe aortic stenosis unsuitable for surgical aortic valve replacement (SAVR). This study evaluated the early experience with the posttrial application of TAVR, with specific focus on non-transfemoral (TF) access. METHODS:All patients who underwent posttrial TAVR at Emory University from November 2011 to April 2012 were reviewed. During this time, 44 posttrial TAVRs were performed: TF in 18, transapical in 11, transaortic in 12, and transcarotid in 3. RESULTS:A total of 40.9% of all patients were candidates for TF implantation. Mean age was 78.2 ± 11.3 years, and 34.1% were women. Mean ejection fraction was 0.463 ± 0.164, and 90.2% had New York Heart Association class III to IV heart failure. Fifty percent were diabetic, 27.3% had moderate to severe chronic obstructive pulmonary disease, and 20.5% had a prior stroke. The mean creatinine was 1.63 ± 1.74 mg/dL, 9.1% required preoperative dialysis, and 61.4% had undergone prior cardiac operations. No patients had postoperative myocardial infarction, stroke, or required new dialysis. Intraoperative vascular complications occurred in 11.4%. No patient had more than mild perivalvular leak by transthoracic echocardiography at discharge. Mean postoperative ventilator time was 17.8 ± 40.1 hours. Intensive care unit length of stay was 58.0 ± 67.0 hours. Postoperative hospital length of stay was 6.1 ± 4.7 days. The 30-day mortality was 6.8% (3 of 44) for all patients, despite a mean The Society of Thoracic Surgeons Predicted Risk of Mortality score of 12.6. CONCLUSIONS:Less than half of patients deemed appropriate for posttrial TAVR were candidates for TF implantation. The use of all available access routes leads to excellent outcomes in patients deemed inoperable.

背景与目标： 背景：经导管主动脉瓣置换术（TAVR）是一种严重的主动脉瓣狭窄不适合手术主动脉瓣置换术（SAVR）的患者的有效治疗方法。这项研究评估了TAVR的事后应用的早期经验，特别侧重于非经股（TF）通路。
方法：回顾性分析2011年11月至2012年4月在埃默里大学接受TAVR治疗的所有患者。在此期间，进行了44次审后TAVR：TF 18例，经心尖的11例，经主动脉的12例，经颈动脉的3例。
结果：所有患者中总共有40.9％是TF植入的候选人。平均年龄为78.2±11.3岁，女性为34.1％。平均射血分数为0.463±0.164，纽约心脏协会III至IV级心力衰竭的发生率为90.2％。 50％患有糖尿病，27.3％患有中度至重度慢性阻塞性肺疾病，20.5％患有中风。平均肌酐为1.63±1.74 mg / dL，需要进行术前透析的比例为9.1％，之前进行过心脏手术的比例为61.4％。术后无心肌梗塞，中风或需要重新透析的患者。术中发生血管并发症的比例为11.4％。出院时经胸超声心动图检查发现没有患者有轻度的周壁渗漏。术后平均呼吸机时间为17.8±40.1小时。重症监护病房的住院时间为58.0±67.0小时。术后住院时间为6.1±4.7天。尽管胸外科医师学会预测的平均死亡风险评分为12.6，但所有患者的30天死亡率均为6.8％（44之3）。
结论：认为适合进行TAVR的患者中，只有不到一半的患者适合进行TF植入。使用所有可用的进入途径可导致无法手术的患者获得出色的治疗效果。

BACKGROUND & AIMS: STUDY DESIGN:Cross-sectional. OBJECTIVE:To investigate predictors of increased frontal plane knee projection angle (FPKPA) in athletes. BACKGROUND:The underlying mechanisms that lead to increased FPKPA are likely multifactorial and depend on how the musculoskeletal system adapts to the possible interactions between its distal and proximal segments. Bivariate and linear analyses traditionally employed to analyze the occurrence of increased FPKPA are not sufficiently robust to capture complex relationships among predictors. The investigation of nonlinear interactions among biomechanical factors is necessary to further our understanding of the interdependence of lower-limb segments and resultant dynamic knee alignment. METHODS:The FPKPA was assessed in 101 athletes during a single-leg squat and in 72 athletes at the moment of landing from a jump. The investigated predictors were sex, hip abductor isometric torque, passive range of motion (ROM) of hip internal rotation (IR), and shank-forefoot alignment. Classification and regression trees were used to investigate nonlinear interactions among predictors and their influence on the occurrence of increased FPKPA. RESULTS:During single-leg squatting, the occurrence of high FPKPA was predicted by the interaction between hip abductor isometric torque and passive hip IR ROM. At the moment of landing, the shank-forefoot alignment, abductor isometric torque, and passive hip IR ROM were predictors of high FPKPA. In addition, the classification and regression trees established cutoff points that could be used in clinical practice to identify athletes who are at potential risk for excessive FPKPA. CONCLUSION:The models captured nonlinear interactions between hip abductor isometric torque, passive hip IR ROM, and shank-forefoot alignment.

背景与目标： 研究设计：横断面。
目的：探讨运动员额叶膝关节前凸角（FPKPA）增加的预测因素。
背景：导致FPKPA增加的潜在机制可能是多因素的，取决于肌肉骨骼系统如何适应其远端和近端节段之间的可能相互作用。传统上用于分析FPKPA增加的发生的双变量和线性分析不够稳健，无法捕获预测变量之间的复杂关系。对生物力学因素之间的非线性相互作用的研究对于进一步了解下肢节段之间的相互依赖性以及由此产生的动态膝关节对准是必要的。
方法：单腿深蹲时对101名运动员进行了FPKPA评估，跳跃着陆时对72名运动员进行了FPKPA评估。研究的预测指标包括性别，髋关节外展肌等距扭矩，髋关节内部旋转（IR）的被动运动范围（ROM）和小腿前掌对准。分类和回归树用于研究预测变量之间的非线性相互作用及其对增加的FPKPA发生的影响。
结果：在单腿下蹲期间，通过髋外展肌等长扭矩与被动髋关节IR ROM的相互作用预测了高FPKPA的发生。在着陆时，小腿前掌的对准，外展肌等距扭矩和被动髋关节IR ROM是高FPKPA的预测指标。此外，分类树和回归树确定了临界点，可在临床实践中使用该临界点来识别可能存在过量FPKPA潜在风险的运动员。
结论：该模型捕获了髋关节外展肌等长扭矩，被动髋关节IR ROM和小腿前掌对准之间的非线性相互作用。

BACKGROUND & AIMS: BACKGROUND:To evaluate the effectiveness and safety of technology-assisted rehabilitation following total hip/knee replacement (THR/TKR). METHODS:Six electronic databases were searched without language or time restrictions for relevant studies: MEDLINE, EMBASE, Cochrane Library, CINAHL, SPORTDiscus, Physiotherapy Evidence Database (PEDro); from inception to November 7th, 2018. Two reviewers independently applied inclusion criteria to select eligible randomised controlled trials (RCTs) that investigated the effectiveness of technology-based interventions, compared with usual care or no intervention for people undergoing THR/TKR. Two reviewers independently extracted trial details (e.g. patients' profile, intervention, outcomes, attrition and adverse events). Study methodological quality was assessed using the PEDro scale. Quality of evidence was critically appraised using the Grading of Recommendations, Assessment, Development and Evaluation approach. RESULTS:We identified 21 eligible studies assessing telerehabilitation, game- or web-based therapy. There were 17 studies (N = 2188) in post-TKR rehabilitation and 4 studies (N = 783) in post-THR rehabilitation. Compared to usual care, technology-based intervention was more effective in reducing pain (mean difference (MD): - 0.25; 95% confidence interval (CI): - 0.48, - 0.02; moderate evidence) and improving function measured with the timed up-and-go test (MD: -7.03; 95% CI: - 11.18, - 2.88) in people undergoing TKR. No between-group differences were observed in rates of hospital readmissions or treatment-related adverse events (AEs) in those studies. CONCLUSION:There is moderate-quality of evidence showed technology-assisted rehabilitation, in particular, telerehabilitation, results in a statistically significant improvement in pain; and low-quality of evidence for the improvement in functional mobility in people undergoing TKR. The effects were however too small to be clinically significant. For THR, there is very limited low-quality evidence shows no significant effects.

背景与目标： 背景：为了评估全髋/膝关节置换术（THR / TKR）后技术辅助康复的有效性和安全性。
方法：搜索六个没有语言或时间限制的电子数据库以进行相关研究：MEDLINE，EMBASE，Cochrane图书馆，CINAHL，SPORTDiscus，物理治疗证据数据库（PEDro）；从开始到2018年11月7日。两名评价者独立地应用纳入标准，选择符合条件的随机对照试验（RCT），以研究基于技术的干预措施与常规护理或不接受THR / TKR干预的患者相比的有效性。两名审稿人独立提取了试验的详细信息（例如，患者档案，干预，结果，磨损和不良事件）。研究方法学质量使用PEDro量表进行评估。使用建议分级，评估，制定和评估方法对证据质量进行严格评估。
结果：我们确定了21项评估远程康复，基于游戏或基于网络的疗法的合格研究。在TKR术后康复中有17项研究（N = 2188），在THR术后康复中有4项研究（N = 783）。与常规护理相比，基于技术的干预在减轻疼痛方面更有效（平均差异（MD）：-0.25； 95％置信区间（CI）：-0.48，-0.02；适度证据）并改善随时间推移而测得的功能-在接受TKR的人群中进行反复测试（MD：-7.03; 95％CI：-11.18，-2.88）。在这些研究中，没有观察到住院再入院率或与治疗相关的不良事件（AE）的组间差异。
结论：有中等质量的证据表明，技术辅助的康复，尤其是远程康复，可使疼痛得到统计学上的显着改善。以及关于TKR患者功能性流动性改善的证据不足。但是，效果太小，不足以具有临床意义。对于THR，仅有非常有限的低质量证据显示没有明显影响。