Journal of Orthopaedic Science最新文献

{"title":"Prognostic nutrition index as a predictive factor for overall survival in trabectedin-treated advanced soft tissue sarcoma","authors":"Hideaki Sabe ,&nbsp;Satoshi Takenaka ,&nbsp;Shigeki Kakunaga ,&nbsp;Hironari Tamiya ,&nbsp;Toru Wakamatsu ,&nbsp;Sho Nakai ,&nbsp;Haruna Takami ,&nbsp;Yoshiki Yamada ,&nbsp;Seiji Okada","doi":"10.1016/j.jos.2024.02.004","DOIUrl":"10.1016/j.jos.2024.02.004","url":null,"abstract":"<div><h3>Background</h3><div>Trabectedin binds covalently to the DNA minor groove and causes DNA to bend toward the main groove, then trabectedin regulates the transcription of the involved genes in cell proliferation or acts on the mononuclear phagocyte system in tumors, which contributes to its antitumor effects. Several clinical trials confirmed the efficacy of trabectedin for patients with advanced soft tissue sarcoma (STS) although clinically useful biomarkers remained unidentified. This study aimed to identify prognostic factors of trabectedin treatment, especially focusing on the systemic inflammatory, immune response, and nutritional status.</div></div><div><h3>Methods</h3><div>This study included 44 patients with advanced STS treated with trabectedin from January 2018 to August 2022. We evaluated the associations of clinical factors that influence the efficacy of trabectedin treatment with progression-free survival (PFS) and overall survival (OS), focusing on systemic inflammatory, immune response, and nutritional status represented by the absolute lymphocyte count (ALC), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), systemic inflammation response index (SIRI), prognostic nutrition index (PNI), and C-reactive protein (CRP) using the Kaplan–Meier method and the log–rank test.</div></div><div><h3>Results</h3><div>ALC, LMR, PNI, NLR, PLR, and SIRI demonstrated no association with PFS. Patients with CRP of ≥0.3 had a significantly shorter PFS than those with CRP of &lt;0.3 (median PFS: 863 vs. 105 days, <em>P</em> = 0.045). PNI of ≥44 (median: 757 days vs. 232 days, <em>P</em> = 0.021) and CRP of &lt;0.3 (median: 877 days vs. 297 days, <em>P</em> = 0.043) were significantly good prognostic factors in terms of OS.</div></div><div><h3>Conclusions</h3><div>The study results indicate pretreatment PNI and CRP levels as prognostic factors for trabectedin treatment in advanced STS.</div></div>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":"30 1","pages":"Pages 171-179"},"PeriodicalIF":1.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140101809","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Estimated number of spine surgeries and related deaths in Japan from 2014 to 2020","authors":"Kosei Nagata ,&nbsp;Chang Chang ,&nbsp;Mitsuhiro Nishizawa ,&nbsp;Koji Yamada","doi":"10.1016/j.jos.2023.12.006","DOIUrl":"10.1016/j.jos.2023.12.006","url":null,"abstract":"<div><h3>Background</h3><div>The total number of spine surgeries per year and their related deaths in Japan has not been adequately estimated in the literature.</div></div><div><h3>Methods</h3><div>We retrospectively reviewed the National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB) between April 2014 to March 2021, which covers 99.9 % of health insurance claim receipts by general practitioners. The annual number of surgeries was counted using K codes, a procedure classification unique to Japan, and classified into the following six categories; percutaneous vertebroplasty, endoscopic surgery, open discectomy, laminoplasty/laminectomy, instrumentation surgery, and others. The data distribution was also summarized by sex and age. Additionally, by reviewing DPC database-related papers for evaluation of the mortality rate after spine surgery in Japan, the number of spine surgery-related deaths was calculated.</div></div><div><h3>Results</h3><div>The NDB showed that the number of spine surgeries analyzed in this study increased from 170,081 in 2014 to 193,903 in 2019, with a slight decrease in 2020. The ratio of instrumentation surgery increased from 33.0 % in 2014 to 37.9 % in 2020. The rate of patients aged 75 or older increased 31.6 % to 39.6 %. Combining these findings with DPC data showing a mortality rate of 0.1 % to 0.4 % revealed that the estimated number of deaths related to spine surgery in Japan ranged from 200 to 800 per year.</div></div><div><h3>Conclusions</h3><div>Approximately 200,000 spine surgeries and 200 to 800 spine surgery-related inpatient deaths were estimated to have occurred in Japan around 2020.</div></div>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":"30 1","pages":"Pages 32-38"},"PeriodicalIF":1.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139072037","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of multi-rod reinforcement on rod fractures in adult spinal deformity: A retrospective case series with a minimum follow up of 5 years","authors":"Yu Yamato ,&nbsp;Tomohiko Hasegawa ,&nbsp;Go Yoshida ,&nbsp;Tomohiro Banno ,&nbsp;Shin Oe ,&nbsp;Hideyuki Arima ,&nbsp;Koichiro Ide ,&nbsp;Tomohiro Yamada ,&nbsp;Kenta Kurosu ,&nbsp;Keiichi Nakai ,&nbsp;Yukihiro Matsuyama","doi":"10.1016/j.jos.2024.01.010","DOIUrl":"10.1016/j.jos.2024.01.010","url":null,"abstract":"<div><h3>Background</h3><div>This study aimed to determine the impact of the multi-rod construct on rod fractures over a minimum follow-up period of five years in comparison to that with the conventional two-rod construct using the same technique, rod composition, and rod reinforcement method.</div></div><div><h3>Methods</h3><div>Data were retrospectively retrieved from a prospectively collected, single-center database. Consecutive patients &gt;50 years of age who underwent thoracopelvic corrective fusion with planned two-stage anterior-posterior surgery and were followed up for at least five years were included in this study. The incidence of rod fracture in the conventional two-rod and multi-rod groups was investigated.</div></div><div><h3>Results</h3><div>A total of 58 patients (mean age, 68.9 years) were included in this study (follow-up rate, 73.4 %). Rod fracture was identified in 25 patients (43.1 %), within an average period of 25.1 months. The incidence of rod fracture in the multi-rod group was significantly lower than that in the two-rod group. However, there was no significant difference in the time to rod fracture between the two groups. Reinforcement of the multi-rod to the distal portion of the connector of the iliac screw had the lowest fracture rate and no cases of reoperation.</div></div><div><h3>Conclusions</h3><div>The incidence of rod fracture was significantly lower using multi-rod reinforcement, but the timing of rod fracture did not differ, compared to that with the two-rod construct using the same surgical technique and rod material. Multi-rod reinforcement covering the distal portion of the iliac screw is recommended to reduce the risk of fracture and reoperation.</div></div>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":"30 1","pages":"Pages 51-57"},"PeriodicalIF":1.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139707017","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does early administration of denosumab delay bone healing after intertrochanteric femoral fractures?","authors":"Masahito Hino ,&nbsp;Manabu Tanaka ,&nbsp;Fumiki Kamoi ,&nbsp;Itsuo Joko ,&nbsp;Kazuo Kasuga ,&nbsp;Yoshinori Tsukahara ,&nbsp;Jun Takahashi ,&nbsp;Shigeharu Uchiyama","doi":"10.1016/j.jos.2024.03.005","DOIUrl":"10.1016/j.jos.2024.03.005","url":null,"abstract":"<div><h3>Introduction</h3><div>Hip fractures are commonly associated with osteoporosis and pose a risk for secondary fractures. Although the administration of anti-osteoporotic drugs is recommended after fractures to mitigate this risk, the potential effect of strong anti-resorptive drugs (e.g., denosumab) on fracture healing processes have not been extensively studied. This prospective study aimed to evaluate the feasibility of early denosumab administration after femoral intertrochanteric fracture surgery and to compare its effect on fracture healing to that of bisphosphonate-treated patients.</div></div><div><h3>Materials and methods</h3><div>Patients who underwent surgery for intertrochanteric femoral fragility fractures between November 2018 and November 2020 were prospectively examined. Patients were randomized into two groups (denosumab [DSM] and ibandronate [IBN] groups) using a simple randomization procedure. Physical findings, plain radiographs, and computed tomography (CT) were used to evaluate fracture healing at 3 months postoperatively.</div></div><div><h3>Results</h3><div>Physical findings showed no significant differences between the two groups in pain on loading, tenderness at fracture site, or walking ability. There were inter-rater differences in radiological fracture healing rate: plain radiographs, 57.5%–81.8% in the DSM group and 51.5%–90.9% in the IBN group; CT, 51.5%–72.7% in the DSM group and 45.4%–81.8% in the IBN group. Although there were variations, there were no significant differences in the fracture healing rate between groups on plain radiographs or CT among all three raters.</div></div><div><h3>Conclusions</h3><div>Early administration of denosumab after intertrochanteric femoral fracture surgery did not delay radiological or clinical fracture healing times when compared with ibandronate administration.</div></div>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":"30 1","pages":"Pages 136-141"},"PeriodicalIF":1.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140189883","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Posterior video-assisted trans pedicular surgery for calcified midline thoracic disc herniation","authors":"Mehdi Sasani ,&nbsp;Hadi Sasani ,&nbsp;Mehmet Yigit Akgun ,&nbsp;Mehdi Hekimoglu ,&nbsp;Ahmet Tulgar Basak ,&nbsp;Tunc Oktenoglu ,&nbsp;Ozkan Ates ,&nbsp;Ali Fahir Ozer","doi":"10.1016/j.jos.2024.01.009","DOIUrl":"10.1016/j.jos.2024.01.009","url":null,"abstract":"<div><h3>Background</h3><div>In the treatment of patients with calcified midline thoracic disc herniation (CMTDH), the posterior video-assisted transpedicular surgery (VATPS) technique is employed. Both anterior and posterior surgical approaches for treating CMTDH carry a significant risk of surgical complications and potential morbidity. This technical note introduces a surgical procedure that avoids the drawbacks associated with these approaches.</div></div><div><h3>Methods</h3><div>The VATPS technique presents a comprehensive approach for treating thoracic disc herniation, combining both microscopic and endoscopic stages. The microscopic phase entails a small thoracoscopic incision, muscle release, hemilaminotomy, facet joint resection, and vertebra removal, culminating in creating a corpectomy cavity for endoscope access. Careful separation of adhesions between the dura and ligaments marks this stage. Transitioning to the endoscopic phase, an endoscope is inserted into the cavity, allowing for precise visualization and separation of residual adhesions, removal of calcified disc fragments using specialized instruments, and ensuring complete discectomy.</div></div><div><h3>Results</h3><div>Fourteen patients underwent VATPS for CMTDH. During the procedure, evoked responses were reduced in one patient. However, no postoperative neurological deficits were observed. We also noted significant improvements in the Oswestry Disability Index (ODI) and the Visual Analog Scale (VAS) scores when comparing the preoperative and postoperative assessments.</div></div><div><h3>Conclusion</h3><div>VATPS, a minimally invasive technique, offers excellent anterior visibility comparable to that of the anterolateral approach, all while avoiding the adverse effects associated with thoracotomies and the complications resulting from spinal cord encroachment often seen in the posterolateral approach. Moreover, it is a safer alternative to conventional endoscopic posterior thoracic surgery. The cavity formed within the vertebral corpus provides ample working space for the use of an endoscope.</div></div>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":"30 1","pages":"Pages 44-50"},"PeriodicalIF":1.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139707018","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anti-osteoporotic drug efficacy for periprosthetic bone loss after total hip arthroplasty: A systematic review and network meta-analysis","authors":"Masaki Hatano ,&nbsp;Yasuhiko Koizumi ,&nbsp;Norio Yamamoto ,&nbsp;Kota Miyoshi ,&nbsp;Kensuke Kawabata ,&nbsp;Takeyuki Tanaka ,&nbsp;Sakae Tanaka ,&nbsp;Akihiro Shiroshita ,&nbsp;Yuki Kataoka","doi":"10.1016/j.jos.2024.01.011","DOIUrl":"10.1016/j.jos.2024.01.011","url":null,"abstract":"<div><h3>Background</h3><div>Periprosthetic bone loss following total hip arthroplasty (THA) threatens prosthesis stability. This systematic review and network meta-analysis aimed to compare the efficacy of anti-osteoporotic drugs for measures of hip function according to functional outcomes, periprosthetic femoral bone mineral density loss in each Gruen zone, and revision surgery after THA.</div></div><div><h3>Methods</h3><div>The systematic search of six literature databases was conducted in December 2021 in accordance with PRISMA guidelines. Adult participants who underwent primary THA were included. A random-effects network meta-analysis was performed within a frequentist framework, and the confidence in the evidence for each outcome was evaluated using the CINeMA tool, which assessed the credibility of results from the network meta-analysis. We included 22 randomized controlled trials (1243 participants) comparing the efficacy and safety of bisphosphonates (including etidronate, clodronate, alendronate, risedronate, pamidronate, and zoledronate), denosumab, selective estrogen receptor modulator, teriparatide, calcium + vitamin D, calcium, and vitamin D. We defined the period for revision surgery as the final follow-up period.</div></div><div><h3>Results</h3><div>Raloxifene, bisphosphonate, calcium + vitamin D, and denosumab for prosthetic hip function might have minimal differences when compared with placebos. The magnitude of the anti-osteoporotic drug effect on periprosthetic femoral bone loss varied across different Gruen zones. Bisphosphonate, denosumab, teriparatide might be more effective than placebo in Gruen zone 1 at 12 months after THA. Additionally, bisphosphonate might be more effective than placebo in Gruen zones 2, 5, 6, and 7 at 12 months after THA. Denosumab was efficacious in preventing bone loss in Gruen zones 6 and 7 at 12 months after THA. Teriparatide was likely to be efficacious in preventing bone loss in Gruen zone 7 at 12 months after THA. Raloxifene was slightly efficacious in preventing bone loss in Gruen zones 2 and 3 at 12 months after THA. Calcium was slightly efficacious in preventing bone loss in Gruen zone 5 at 12 months after THA. None of the studies reported revision surgery.</div></div><div><h3>Conclusions</h3><div>Bisphosphonate and denosumab may be effective anti-osteoporotic drugs for preventing periprosthetic proximal femoral bone loss due to stress shielding after THA, particularly in cementless proximal fixation stems, which are the most commonly used prostheses worldwide.</div></div>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":"30 1","pages":"Pages 126-135"},"PeriodicalIF":1.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139717677","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A quantitative assessment of the anterior tibiofibular gap with and without weight-bearing in healthy adults: An ultrasound-based study","authors":"Tsubasa Tashiro ,&nbsp;Noriaki Maeda ,&nbsp;Shogo Tsutsumi ,&nbsp;Takeru Abekura ,&nbsp;Hinata Esaki ,&nbsp;Koki Tsuchida ,&nbsp;Sakura Oda ,&nbsp;Makoto Komiya ,&nbsp;Yasunari Ikuta ,&nbsp;Yukio Urabe","doi":"10.1016/j.jos.2024.01.008","DOIUrl":"10.1016/j.jos.2024.01.008","url":null,"abstract":"<div><h3>Background</h3><div>Difficulties in the accurate evaluation of tibiofibular clear space in plain radiographs are diagnostic problems in the clinical setting of syndesmosis injury. This study aimed to quantify the anterior tibiofibular gap (ATFG) with weight-bearing using ultrasonography.</div></div><div><h3>Methods</h3><div>In total, 32 healthy adults (16 men and 16 women) with 64 feet participated in this cross-sectional study. The ATFG was measured along the anterior inferior tibiofibular ligament for a US assessment conducted in both sitting and standing postures. The ankle joint was set on the tilt table at four different angles as follows: plantar flexion, 20° (P20); neutral position (N); dorsiflexion, 20° (D20); and dorsiflexion, 20°+ external rotation, 30° (D20ER30). The ankle joint position, sex, and side-to-side values were compared with and without weight-bearing.</div></div><div><h3>Results</h3><div>Under all ankle angle conditions, the ATFG was wider in the standing posture than in the sitting posture (p &lt; 0.001). In both sitting and standing postures, the ATFG widened with increasing dorsiflexion angle, eventually reaching a maximum at D20ER30. The widening ratio (D20ER30/N) in the standing posture was higher in women than in men (p &lt; 0.05). No statistical differences were identified side-to-side differences in the ATFG.</div></div><div><h3>Conclusions</h3><div>Ultrasound measurements for identifying unphysiological increases in ATFG with weight bearing, especially given the side-to-side differences, may provide a means for quantitatively assessing syndesmosis injury in a clinical setting. Further research is warranted to clarify direct attribution as a clinical diagnostic utility of the ATFG measurements for syndesmosis injuries.</div></div>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":"30 1","pages":"Pages 107-112"},"PeriodicalIF":1.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139923277","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patellar tendon shortening surgery restores the knee extensor mechanism in flexed knee gait in children with cerebral palsy","authors":"Henrike Greaves ,&nbsp;David Wright ,&nbsp;Antonio Eleuteri ,&nbsp;Elizabeth Ray ,&nbsp;Ornella Pinzone ,&nbsp;Alfie Bass ,&nbsp;Roger Walton ,&nbsp;Gabor Barton","doi":"10.1016/j.jos.2024.01.004","DOIUrl":"10.1016/j.jos.2024.01.004","url":null,"abstract":"<div><h3>Background</h3><div>This study evaluated a patellar tendon shortening (PTS) surgical procedure that uses an overlapping repair combined with an additional Tycron non-absorbable suture to support the shortening in children with Cerebral Palsy (CP). This study aimed to outline this surgical technique and to evaluate its effectiveness in restoring the knee extensor mechanism.</div></div><div><h3>Methods</h3><div>The sagittal plane lower limb kinematics, peak knee extensor moment, gait deviation index (GDI), localised movement deviation profile (MDP), temporospatial parameters, passive knee extension ROM, quadriceps lag, and knee extensor strength were calculated pre- and postoperatively. To determine significant differences a robust linear regression model with high breakdown point and high efficiency was fitted to the data.</div></div><div><h3>Results</h3><div>In this retrospective cohort study, a total of 41 patients with CP who were treated with unilateral or bilateral PTS in isolation or as part of single event multilevel surgery (SEMLS), with a mean age of 11.1 years were included. The knee extension angle improved at initial contact (p &lt; 0.0001), and during stance phase (p &lt; 0.0001). The peak internal knee extensor moment decreased during early (p = 0.0014) and late stance phase (p &lt; 0.0001). The quadriceps lag decreased (p &lt; 0.0001) and knee extensor strength increased (p &lt; 0.0001). The GDI improved (p &lt; 0.0001), as well as the localised MDP for sagittal angles (p &lt; 0.0001) and moments (p = 0.0001). Walking speed (p = 1.0) remained unchanged, but the cadence decreased (p = 0.024) and step length increased (p = 0.0001).</div></div><div><h3>Conclusions</h3><div>The knee extension angle and moment during stance phase improved significantly. The children with CP in this study showed improvements in knee extensor strength and quadriceps lag. Thereby it can be concluded that the PTS procedure was able to restore the knee extensor mechanism effectively.</div></div>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":"30 1","pages":"Pages 164-170"},"PeriodicalIF":1.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139542718","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Japanese orthopaedic association (JOA) clinical practice guideline on the management of primary malignant bone tumors - Secondary publication","authors":"Kazuaki Tsuchiya ,&nbsp;Toshihiro Akisue ,&nbsp;Shigeru Ehara ,&nbsp;Akira Kawai ,&nbsp;Hirotaka Kawano ,&nbsp;Hiroaki Hiraga ,&nbsp;Ako Hosono ,&nbsp;Hiroyuki Hutani ,&nbsp;Takeshi Morii ,&nbsp;Hideo Morioka ,&nbsp;Yoshihiro Nishida ,&nbsp;Yoshinao Oda ,&nbsp;Akira Ogose ,&nbsp;Shoji Shimose ,&nbsp;Takehiko Yamaguchi ,&nbsp;Tetsuji Yamamoto ,&nbsp;Masahiro Yoshida","doi":"10.1016/j.jos.2023.11.007","DOIUrl":"10.1016/j.jos.2023.11.007","url":null,"abstract":"<div><h3>Background</h3><div>In Japan, there are currently no general guidelines for the treatment of primary malignant bone tumors. Therefore, the Japanese Orthopaedic Association established a committee to develop guidelines for the appropriate diagnosis and treatment of primary malignant bone tumors for medical professionals in clinical practice.</div></div><div><h3>Methods</h3><div>The guidelines were developed in accordance with “Minds Clinical Practice Guideline Development Handbook 2014″ and “Minds Clinical Practice Guideline Development Manual 2017\". The Japanese Orthopaedic Association's Bone and Soft Tissue Tumor Committee established guideline development and systematic review committees, drawing members from orthopedic specialists leading the diagnosis and treatment of bone and soft tissue tumors. Pediatricians, radiologists, and diagnostic pathologists were added to both committees because of the importance of multidisciplinary treatment. Based on the diagnosis and treatment algorithm for primary malignant bone tumors, important decision-making points were selected, and clinical questions (CQ) were determined. The strength of recommendation was rated on two levels and the strength of evidence was rated on four levels. The recommendations published were selected based on agreement by 70% or more of the voters.</div></div><div><h3>Results</h3><div>The guideline development committee examined the important clinical issues in the clinical algorithm and selected 22 CQs. The systematic review committee reviewed the evidence concerning each CQ and a clinical value judgment was added by experts. Eventually, 25 questions were published and the text of each recommendation was determined.</div></div><div><h3>Conclusion</h3><div>Since primary malignant bone tumors are rare, there is a dearth of strong evidence based on randomized controlled trials, and recommendations cannot be applied to all the patients. In clinical practice, appropriate treatment of patients with primary malignant bone tumors should be based on the histopathological diagnosis and degree of progression of each case, using these guidelines as a reference.</div></div>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":"30 1","pages":"Pages 1-17"},"PeriodicalIF":1.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141603723","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acute non-traffic traumatic spinal cord injury in the aging population: Analysis of the National Inpatient Sample 2005–2018","authors":"Zeqin Li ,&nbsp;Hua Ye ,&nbsp;Hongyu Chu ,&nbsp;Liang Chen ,&nbsp;Jun Li ,&nbsp;Jianjun Li ,&nbsp;Degang Yang ,&nbsp;Mingliang Yang ,&nbsp;Liangjie Du ,&nbsp;Maoyuan Wang ,&nbsp;Feng Gao","doi":"10.1016/j.jos.2024.03.002","DOIUrl":"10.1016/j.jos.2024.03.002","url":null,"abstract":"<div><h3>Background</h3><div>This study aimed to determine risk factors for poor in-hospital outcomes in a large cohort of older adult patients with acute non-traffic traumatic spinal cord injury (tSCI).</div></div><div><h3>Methods</h3><div>This is a population-based, retrospective, observational study. Data of older adults ≥65 years with a primary discharge diagnosis of acute non-traffic tSCI were extracted from the US National Inpatient Sample (NIS) database 2005–2018. Traffic-related tSCI admissions or patients lacking complete data on age, sex and outcomes of interest were excluded. Univariate and multivariate logistic regression analysis was used to determine associations between variables and in-hospital outcomes.</div></div><div><h3>Results</h3><div>Data of 49,449 older patients (representing 246,939 persons in the US) were analyzed. The mean age was 79.9 years. Multivariable analyses revealed that severe International Classification of Disease (ICD)-based injury severity score (ICISS) (adjusted odds ratio [aOR] = 3.14, 95% confidence interval [CI]: 2.77–3.57), quadriplegia (aOR = 2.79, 95%CI: 2.34–3.32), paraplegia (aOR = 2.60, 95%CI:1.89–3.58), cervical injury with vertebral fracture (aOR = 2.19, 95%CI: 1.90–2.52), and severe liver disease (aOR = 2.33, 95%CI: 1.34–4.04) were all strong independent predictors of in-hospital mortality. In addition, malnutrition (aOR = 3.19, 95% CI: 2.93–3.48) was the strongest predictors of prolonged length of stay (LOS).</div></div><div><h3>Conclusions</h3><div>Several critical factors for in-hospital mortality, unfavorable discharge, and prolonged LOS among US older adults with acute non-traffic tSCI were identified. In addition to the factors associated with initial severity, the presence of severe liver disease and malnutrition emerged as strong predictors of unfavorable outcomes, highlighting the need for special attention for these patient subgroups.</div></div>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":"30 1","pages":"Pages 66-72"},"PeriodicalIF":1.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140768903","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}