Tag: pubmed

Am J Gastroenterol. 2021 Dec 1;116(Suppl 1):S11-S12. doi: 10.14309/01.ajg.0000798780.14901.4e.

ABSTRACT

BACKGROUND: Inflammatory Bowel Disease (IBD) is an inflammatory and chronic disease, as well as non-alcoholic fatty liver disease (NAFLD). Current literature has shown that IBD patients are at high risk for NAFLD. In those patients, the pathogenesis of NAFLD may be more complex and related to multifactor causes, such as gut dysbiosis, unhealthy nutritional behavior, body composition and systemic inflammation. There is an increase in NAFLD’s incidence in the general population, otherwise, there are few studies evaluating NAFLD prevalence in IBD patients. So, this study aimed to evaluate prevalence of NAFLD and identify the clinical factors associated with the presence of NAFLD in patients with IBD.

METHODS: This cross-sectional, descriptive, observational study included 71 IBD patients from an IBD public outpatient in São Paulo State, Brazil. Laboratory evaluation and clinical data were collected. The presence of NAFLD was evaluated by ultrasonography. The exclusion criteria were as follows: pre-existing liver disease, history of alcohol intake >20g/day for women and >30g/day for men, and glucocorticoids treatment >20mg/day. Statistical analysis: descriptive statistics and association tests.

RESULTS: 71 patients were included, of which 34 (47.89%) were Crohn´s disease (CD) and 37 (52.11%) ulcerative colitis (UC). Median age was 45.32±13.59 years, 63.38% were female, 69.1% Caucasian, 7.04% smokers. The time from diagnosis was 12.55 ± 8.01 years. Regarding the characteristics of the diseases, 42.42% of patients with CD have ileocolonic involvement, 50% penetrating disease and 39.4% perianal involvement. In relation to patients with UC, most patients have pancolitis (72.22%). Mostly, the patients were in clinical (63.89%) and endoscopic (52.86%) remission. Regarding medical treatment, the most used drugs were biological therapy (79.41%) and azathioprine (52.94%) in CD, and mesalazine (45.95%), azathioprine (40.54%) and biological therapy (40.54%) in UC. The NAFLD group consists of 32 (45.07%) patients: 40.63% had mild steatosis; 40.63% moderate and 18.65% intense NAFLD. Development of NAFLD vs no NAFLD was associated with body mass index (29.49 ± 3.93 vs 24.32 ± 3.85, p < 0.0001), and laboratory biomarkers, such as C-reactive protein (1.99 ± 4.39 vs 0.87 ± 0.52, p = 0.0061), AST (29.72 ± 16.64 vs 23.46 ± 5.31, p = 0.0226), ALT (24.92 ± 14.22 vs 17.92 ± 6.57, p = 0.0099), albumin (4.1 ± 0.37 vs 4.36 ± 0.32, p = 0.0415), fasting glucose (95.5 ± 14.01 vs 84.36 ± 13.01, p = 0.0251) and blood insulin (18.41 ± 11.88 vs 6.4 ± 4.26, p = 0.0054). Also, the NAFLD group had higher prevalence of systemic arterial hypertension (31.25% vs 10.26%, p = 0.0369). When comparing patients with the presence or absence of NAFLD, there was no difference between the groups regarding time since diagnosis (p = 0.9684), previous surgery (p = 0.5908), Montreal classification, clinical activity assessed by CDAI (p = 0.2258), clinical activity assessed by the Mayo score (p = 0.4935), endoscopic activity (p = 0.0599), histological activity (p = 1.0), or medical treatment.

CONCLUSION: Development of NAFLD is a frequent occurrence in patients with IBD. NAFLD group had higher levels of body mass index, C-reactive protein, AST, ALT, fasting glucose and blood insulin, which are also associated with metabolic syndrome. Early diagnosis and appropriate nutritional orientation are necessary to prevent NAFLD related complications.

PMID:37461963 | DOI:10.14309/01.ajg.0000798780.14901.4e

Am J Gastroenterol. 2021 Dec 1;116(Suppl 1):S9. doi: 10.14309/01.ajg.0000805316.47101.49.

ABSTRACT

BACKGROUND: Crohn’s perianal fistulas (CPF) contribute to lowered quality of life for patients with Crohn’s disease. Previous research has indicated potential racial and/or ethnic disparities in diagnosis and management of patients with CPF. This study aimed to expand on previous investigations in the management of patients with CPF to identify educational needs and explore potential disparities in care.

METHODS: To understand specific educational needs of US patients and caregivers of patients with CPF, a survey instrument was developed and fielded to patients and caregivers in September/October 2020. Subanalysis and inferential statistics were used to segment the patient/caregiver sample by race/ethnicity and determine potential areas of care disparities.

RESULTS: Of 148 patient/caregiver responses analyzed, 28 were non-white (including American/Alaskan Native Indian, Black/African American, Hispanic/Latino, Native Hawaiian/Pacific Islander, and multiethnic); 12/28 were CPF patients and 16/28 were parents or caregivers of CPF patients. The reported mean age of the CPF patient was 32 years for non-whites and 35 for whites. Insurance coverage varied between groups, with non-whites mainly covered by Medicare/Medicaid (68% vs 32% whites), and whites mainly covered by private insurance (64% vs 25% non-whites). Non-white patient/caregivers reported a longer mean time between symptoms and diagnosis (2.08 yr) than white patients/caregivers (less than 1 yr). White patients/caregivers reported more (50%) current use of biologics than non-whites (36%); however, past use of biologics was near equal (51%) for whites and (50%) for non-whites. Of patients who had undergone surgical procedures (86.5%), non-whites had a lower number of different surgery types (1.64) than whites (2.31). The top two reported goals of treatment for both groups were decreasing pain and healing the fistula. Less non-white patients/caregivers agreed or strongly agreed they were satisfied with their current quality of care (39%) and access to care (57%) than white patients/caregivers (72% and 69%, respectively). Non-whites were more likely to disagree or strongly disagree that the main doctor who treats CPF is knowledgeable about their CPF and its treatments (25% vs 3% whites), and that they agree or strongly agree they know more about CPF than their doctor (21% vs 15% whites). Patients/caregivers (non-whites vs whites) perceived somewhat, very or extremely significant barriers to care to be inadequate community social services for CPF care (82% vs 79%), out-of-pocket costs of care (71% vs 84%), limited information to make difficult decisions for their CPF treatment (82% vs 86%), physical/emotional stress of managing their CPF (82% vs 79%), lack of access to specialist care (89% vs 88%) and lack of effective treatments (86% vs 89%). Only 50% of non-white patients/caregivers and 69% of white patients/caregivers agreed or strongly agreed that they know where to go to get CPF information.

CONCLUSION: Disparities in diagnosis and management of CPF exist between non-white and white patients/caregivers, including length of time to diagnosis, perceptions of quality of care and barriers to treatment. Further research into disparities in the management of CPF is needed, as is CPF education for patients/caregivers and HCP education on managing CPF in minority populations.

PMID:37461955 | DOI:10.14309/01.ajg.0000805316.47101.49

Am J Gastroenterol. 2021 Dec 1;116(Suppl 1):S8-S9. doi: 10.14309/01.ajg.0000798736.44273.fa.

ABSTRACT

BACKGROUND: Crohn’s disease (CD) and ulcerative colitis (UC) are inflammatory bowel diseases (IBD) affecting 6.8 million persons globally. Treatment of IBD focuses largely on immune suppression or modulation using corticosteroids, aminosalicylates, thiopurines, or biologic agents. These agents are effective but most of them pose a risk of infections, cancers, and osteoporosis. Many of these complications can be prevented by implementing vaccination, cancer screening, and bone health programs. Despite the progress in IBD care, recent data suggest that many IBD patients do not get preventative services. Previous studies have examined rates of vaccinations and other health maintenance metrics in North America and Europe where IBD patients are mainly of European and African descent. In comparison, Middle Eastern and Asian descent persons comprise the majority of the IBD population in Abu Dhabi, the capital city of United Arab Emirates (UAE), a major country in the Gulf region of the Middle East. Little is known to date about the state of IBD preventative care in this region. We sought to assess the proportion of patients with IBD that underwent recommended vaccinations, cancer screening (surveillance colonoscopy, PAP smear, annual skin examination), and bone health evaluation at Sheikh Shakhbout Medical City (SSMC), the largest tertiary care hospital in Abu Dhabi.

METHODS: This study was a retrospective case series of adult IBD patients (>18 years) seen in the outpatient setting at SSMC from 2019 to 2020. Patients were identified based on ICD-10 codes for IBD [K50.90, K50.00, K51.90, and K50.80] as well as administrative/pharmacy records of the IBD agents (e.g. infliximab). Proportions were assessed using simple summary statistics and one sample proportion 95% confidence intervals were calculated.

RESULTS: A total of 55 IBD patients were identified in our study with the majority being males (76.3%). The mean age was 31.6 years. Sixty-nine percent had Crohn’s. Most of the patients were on infliximab (58.1%), followed by vedolizumab, ustekinumab, and adalimumab. The proportion of patients who received vaccinations was as follows; HAV (67%, 95% CI 28-100%), HBV (50%, 95% CI 28-72%), pneumococcal 23 (20%, 95% CI 9.4-31%), pneumococcal 13 (18.2%, 95% CI 8-28%) and influenza vaccine (16.4%, 95% CI 7-26%). Moreover, the study showed that the proportion of IBD patients who underwent recommended colonoscopy surveillance was 91% (95% CI 79-100%) and the proportion of women IBD patients who had recommended PAP smear was 30%, (95% CI 2-58%). Regarding bone health, the proportion who underwent DXA bone scans was 36%, (95% CI 24-49%) However, the compliance rate of the Tdap, HPV and Zoster vaccinations, and annual skin examination were poor warranting further quality improvement studies.

CONCLUSION: This study revealed that the state of health maintenance among IBD patients seen at our facility before 2021 was largely dismal. Efforts are being taken to improve the proportion of patients who receive recommended vaccinations including annual influenza, pneumococcal 13 and 23, HPV, Zoster, and COVID-19 vaccines. Furthermore, there is a focus on bone health and skin cancer examinations with plans to calculate, report, and publish health maintenance data annually.

PMID:37461953 | DOI:10.14309/01.ajg.0000798736.44273.fa

Am J Gastroenterol. 2021 Dec 1;116(Suppl 1):S7. doi: 10.14309/01.ajg.0000798708.22025.c0.

ABSTRACT

BACKGROUND: Brain fog has been minimally studied in patients with inflammatory bowel disease (IBD). IBD patients frequently consume probiotics, whether sanctioned by a physician or not. However, probiotic consumption in itself has been shown to increase the incidence of brain fog. We aimed to study the association between brain fog in IBD patients with or without probiotic use.

METHODS: We conducted a cross-sectional study among patients visiting a busy IBD clinic. Patients aged >18 with a biopsy-proven diagnosis of inflammatory bowel disease, without pre-existing psychiatric illness or current use of opioid medications were included. They were divided into 2 groups: those using probiotics and those who did not. Patients were given a questionnaire that included details about symptoms of brain fog. Groups were analyzed by chi-square test for differences in baseline demographics, and Mann Whitney U test to compare outcomes between groups. A p-value < 0.05 was considered statistically significant.

RESULTS: Of the 66 patients included (mean age 44±2 years), 35 (53%) were female and 59 (89.4%) were Caucasian. Among these patients, 31.8% (n = 21) took probiotics as dietary supplements with the majority (67%, n = 14) taking probiotics for over a year. Overall, there was a trend for an association between probiotic use and brain fog in all patients (p = 0.080) but no statistical significance was attained. However, brain fog was significantly associated with probiotic use among Caucasian patients (p = 0.044). Furthermore, there was a statistically significant association between brain fog and male patients using probiotics (p = 0.004). Duration of probiotic use was also associated with brain fog (p = 0.038).

CONCLUSION: Consumption of probiotics was independently associated with brain fog in men, as well as Caucasian patients with IBD respectively. Given the high prevalence of probiotic use in IBD patients, prospective studies are warranted to examine the causal relationship between probiotics and IBD-associated brain fog to guide prescription of probiotic supplements for IBD.

PMID:37461946 | DOI:10.14309/01.ajg.0000798708.22025.c0

Am J Gastroenterol. 2021 Dec 1;116(Suppl 1):S4. doi: 10.14309/01.ajg.0000798660.28005.68.

ABSTRACT

BACKGROUND: Persons with inflammatory bowel diseases (IBD) endure the uncomfortable symptomatology of the disease, while trying to carry out daily activities. Given that IBD is not physically distinctive, it may be overlooked and lead to discrimination in the workplace and school. We aim to describe work and study experiences from patients with IBD.

METHODS: A questionnaire containing sociodemographic, psychological, and medical inquiries was administered to patients with IBD in a tertiary care clinic. The survey captured past and present employment and scholarly status. Productivity was established by the number of early leaves or absences patients experienced due to disease symptomatology. Qualitative and quantitative data were analyzed using descriptive statistics. The study is approved by the UPR-MSC IRB.

RESULTS: A total of 120 patients, 59 males and 61 females, with a mean age of 27.00 ± 9.71 were recruited. 91 participants had CD, while 29 had UC. 94% of subjects had some form of income. At the time of interview, 83 patients were working. 19% did not tell the employer of their IBD, while 19% felt discriminated at work due to their condition. 38% said the disease has limited their work goals. Of those working, 74 had to leave early or absent themselves due to disease manifestation. In the last year, 39% of patients had absented themselves for 1-2 days, 27% for 3-4 days, 9% for 5-6 days, 4% for 7-8 days, 3% for 9-10 days and 18% for more than 10 days. The mean of absences from work was 4.4 days. Patients with UC were significantly more prone to work absences than patients with CD (P = 0.0243). 69 patients were studying while having the condition. 67% achieved a college or higher degree, while 33% had high school or less. 34% had to drop a course during their school years. Of the 23 patients who experienced withdrawals, 74% had a total withdrawal from school, while 26% had a partial withdrawal at some point. 14% did not inform of their IBD at school, 12% felt discriminated because of their condition and 32% said the disease has limited their educational goals. 87% of those studying had to miss or leave school early due to disease manifestation. In the last year, 24% of patients had absented themselves for 1-2 days, 29% for 3-4 days, 7% for 5-6 days, 7% for 7-8 days, 3% for 9-10 days and 30% for more than 10 days. The mean of absences was 5.6 days. School absences were not significantly different between subjects with CD and UC (P = 0.384). 22% of participants deemed themselves as a person with a disability given their condition, while 8% did not know whether they should consider themselves as such. Perception of disability was not significantly different between patients with CD and UC (P = 0.870).

CONCLUSION: Absenteeism is a significant factor affecting productivity in patients with IBD. Perception of disability may also impact work and study experiences. Raising awareness is essential for patient support in these settings.

PMID:37461935 | DOI:10.14309/01.ajg.0000798660.28005.68

Am J Gastroenterol. 2021 Dec 1;116(Suppl 1):S3-S4. doi: 10.14309/01.ajg.0000798656.34221.7f.

ABSTRACT

BACKGROUND: Up to 80% of patients with Crohn’s disease (CD) undergo intestinal resection at one point. However, the risk of post-operative recurrence (POR) increases with time, with half of these patients developing recurrence at five years after surgery. Treatment with anti-tumor necrosis factor (anti-TNF) agents has been shown to decrease the risk of clinical and endoscopic recurrence post-operatively. This meta-analysis aims to compare the rate of the two mostly commonly used anti-TNF agents (infliximab (IFX) and adalimumab (ADA)) and their efficacy in maintaining clinical and endoscopic remission in CD patients who were treated with adalimumab versus infliximab after surgery.

METHODS: A comprehensive search of Medline, EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews and Scopus was conducted from each database’s inception to May 29th 2021. Comparative studies assessing the efficacy and safety of infliximab and adalimumab for postoperative CD patients were included. Primary outcomes included postoperative clinical and endoscopic remission. Secondary outcome was the risk of adverse events due to anti-TNF agents. Pooled event rates were calculated per person-year of follow-up.

RESULTS: Four studies with total of 361 CD patients were included in the final analysis. Our meta-analysis showed no statistically significant difference in maintaining clinical and endoscopic remission rates between patients treated with infliximab and those with adalimumab (Pooled incidence rate ratio of 0.75 (95% CI 0.43-1.3), and 0.94 (95% CI 0.71-1.2), respectively) (Figure 1A, 2A). There were low to moderate heterogeneities (I2 = 57.1% for clinical remission and I2 = 0% for endoscopic remission). The funnel plot in each analysis indicated no publication bias, which was supported by Begg’s and Egger’s tests (Figure 1B, 2B). There was also no significant difference in the risk of adverse events between the two groups (RR= 0.56, 95% CI 0.068-4.5) (Figure 3).

CONCLUSION: Our meta-analysis demonstrated comparable efficacy of infliximab and adalimumab in maintaining post-operative clinical and endoscopic remission in Crohn’s disease, with similar rates of adverse events. Our meta-analysis was limited by the small number of total studies and patients included and the lack of randomized controlled trials.

PMID:37461934 | DOI:10.14309/01.ajg.0000798656.34221.7f

Am J Gastroenterol. 2021 Dec 1;116(Suppl 1):S3. doi: 10.14309/01.ajg.0000798648.44410.c4.

ABSTRACT

BACKGROUND: Clinical remission can be achieved with exclusive enteral nutrition (EEN) in patients with Crohn’s Disease with different sites of involvement, varying severity, and complications such as abscess and fistula. In the CHARM study, weekly or every other week administration of adalimumab (ADA) did not provide a significant difference in remission rates. Nevertheless, the subgroup analysis showed that in patients with anti-TNF experience, moderate-to-severely active disease, and high CRP values, rates of remission were significantly higher with weekly doses. Our aim was to determine the efficacy of EEN and weekly adalimumab combination in Crohn’s patients with fibroinflammatory stenosis.

METHODS: Seven consecutive patients with newly diagnosed severe disease and fibro-inflammatory stenosis were included in this retrospective study. The PRO-2 score was used to assess clinical remission, the SES-CD score to determine the severity of endoscopic activity, the Nancy score to determine the severity of inflammation in tissue samples, and the MaRIA score to determine changes in magnetic resonance enterography (MRE). Nestle Modulen® (35kcal/kg) was used for twelve weeks as the EEN solution. In addition to the formulation, patients were only allowed to consume water. At the end of the 12th week, the patients gradually switched to a standard diet. Concomitantly initiated ADA was continued at 40 mg weekly after standard loading doses of 160 mg-80 mg-40 mg. The patients were evaluated with clinical and laboratory findings at the 1st, 4th and 8th weeks of the treatment, and also with colonoscopy and MRE at the 12th week.

RESULTS: The difference between mean PRO-2 score (24.7 ± 1.97, 20.1 ± 1.63, 15.3 ± 1.81,11.4 ± 2.15, 5 ± 1.1, p = 0.031), CRP (14.3 ± 4.54, 11.2 ± 3.31, 6.92 ± 2.88, 2.16 ± 1.14, 0.25 ± 0.13, p = 0.022), albumin (2.9 ± 0.21, 3.05 ± 0.33, 3.4 ± 0.29, 4.1 ± 0.45, 4.6 ± 0.27, p = 0.044), hemoglobin (11.38 ± 0.97, 12.65 ± 0.87, 13.41 ± 0.91, 13.89 ± 0.76, 14.44 ± 0.65, p = 0.063), SES-CD score (17.14 ± 4.87, 7.66 ± 5.98, p = 0.014), MaRIA score (21.13 ± 7.42, 9.91 ± 4.55, p = 0.003) and Nancy score (3.71±0.48, 1.71±0.36, p=0.028) were all statistically significant. The stenotic segment endoscopically passed at week 12 in every patient but one, which had minimally invasive surgery (ileoascendostomy) because of ileus that developed at the eighth week of therapy. Of note, the patient who underwent surgery had perianal involvement.

CONCLUSION: Despite the extremely limited number of patients and short-term follow-up results, 12-week EEN and concurrent weekly ADA therapy may be effective in inducing remission in this group of patients. There is a need for large-scale, prospective studies on this subject.

PMID:37461932 | DOI:10.14309/01.ajg.0000798648.44410.c4

Am J Gastroenterol. 2021 Dec 1;116(Suppl 1):S3. doi: 10.14309/01.ajg.0000798644.60076.bb.

ABSTRACT

BACKGROUND: The prevalence of cannabis use has been increasing in the United States in recent years. We examined the prevalence and predictors of cannabis use disorder among IBD hospitalizations and its effect on length of stay.

METHODS: Using the 2017 National Inpatient Sample, cannabis use disorder was identified using ICD-10-CM code F12.xxx in adult IBD patients. Other variables of interest included age, sex, race, Crohn’s disease (vs. ulcerative colitis), region, metropolitan status, zip code household income, primary insurance, and length of stay. Multivariate logistic and Poisson regressions were used in statistical analysis.

RESULTS: Of the 17,857 IBD hospitalizations, 565 (3.1%) had cannabis use disorder. Patients with cannabis use disorder were younger (mean ± standard deviation [years]: 35.1 ± 11.8 vs. 45.6 ± 18.1), less likely female (32.7% vs. 54.1%), more likely African American (24.8% vs. 13.9%), and more likely Crohn’s disease (72.0% vs. 62.2%) (all p < 0.001). There were also significant differences by region, income, and insurance. Multivariate logistic regression confirmed age (odds ratio [95% confidence interval]: 0.964 [0.957, 0.971]), female (0.444 [0.369, 0.531]), African American (1.405 [1.124, 1.750]), and Crohn’s disease (1.363 [1.126, 1.657]) as predictors of cannabis use disorder. There was no association between cannabis use disorder and length of stay, confirmed in multivariate Poisson regression.

CONCLUSION: Young age, male sex, African American race, and Crohn’s disease were positively associated with cannabis use disorder in IBD hospitalizations. There was no effect of cannabis use disorder on length of stay.

PMID:37461931 | DOI:10.14309/01.ajg.0000798644.60076.bb

Am J Gastroenterol. 2021 Dec 1;116(Suppl 1):S2. doi: 10.14309/01.ajg.0000798628.18430.be.

ABSTRACT

BACKGROUND: Anxiety and depression occur in a significant number of patients with inflammatory bowel diseases (IBD). The prevalence of anxiety and / or depression is 13-44.4% in patients with IBD compared to 4.4% among the world population.

OBJECTIVE: To identify the frequency of anxiety and depression in patients with inflammatory bowel diseases in the Moscow Clinical Scientific Center named after A. S. Loginov.

METHODS: A questionnaire was conducted on the Hospital Anxiety and Depression Scale (HADS) questionnaire for 370 patients with moderate to severe UC during the period of exacerbation of the disease.

RESULTS: Of the 370 patients with UC, 283 (76.48%) had clinical and subclinical signs of anxiety and depression. Subclinical depression was noted in 76 (26.8%), clinically pronounced depression – 11 (3.4%), signs of anxiety had higher indicators-subclinical anxiety was found in 172 (60.8%) of the surveyed patients, pronounced clinical anxiety – in 24 (8.4%) patients with UC. Statistically significant correlations of average strength between the indicators of adherence according to the Morisky – Green questionnaire with scores on the HADS scale, both for anxiety and depression (p < 0.001, r – 0.6299) were revealed Among patients with anxiety and depression, the ratio of patients with high adherence to therapy (HAT) and low adherence to therapy (LAT) was 204 (55,1%) 79 (21,4%), accordingly. When comparing the degree of adherence depending on the presence of anxiety and depression, we found that HAT was associated with anxiety and depression in patients with UC (OR = 0.024; 95% CI 0.003-0.186; p < 0.001).

CONCLUSION: The prevalence of anxiety and/or depression is 77% in patients with IBD during an exacerbation in the Moscow Clinical Scientific Center named after A. S. Loginov.

PMID:37461927 | DOI:10.14309/01.ajg.0000798628.18430.be

Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2023 Jul 15;37(7):788-795. doi: 10.7507/1002-1892.202303008.

ABSTRACT

OBJECTIVE: To assess the effectiveness of supramalleolar osteotomy (SMOT) as a therapeutic intervention for varus-type ankle arthritis, while also examining the associated risk factors that may contribute to treatment failure.

METHODS: The clinical data of 82 patients (89 feet) diagnosed with varus-type ankle arthritis and treated with SMOT between January 2016 and December 2020 were retrospectively analyzed. The patient cohort consisted of 34 males with 38 feet and 48 females with 51 feet, with the mean age of 54.3 years (range, 43-72 years). The average body mass index was 24.43 kg/m ² (range, 20.43-30.15 kg/m ²). The preoperative tibial anterior surface angle (TAS) ranged from 77.6° to 88.4°, with a mean of 84.4°. The modified Takakura stage was used to classify the severity of the condition, with 9 feet in stage Ⅱ, 41 feet in stage Ⅲa, and 39 feet in stage Ⅲb. Clinical functional assessment was conducted using the Maryland sore, visual analogue scale (VAS) score, and psychological and physical scores in Health Survey 12-item Short From (SF-12). Radiology evaluations include TAS, talar tilt (TT), tibiocrural angle (TC), tibial medial malleolars (TMM), tibiocrural distance (TCD), tibial lateral surface angle (TLS), and hindfoot alignment angle (HAA). The results of clinical failure, functional failure, and radiology failure were statistically analyzed, and the related risk factors were analyzed.

RESULTS: The operation time ranged from 45 to 88 minutes, with an average of 62.2 minutes. No complication such as fractures and neurovascular injuries was found during operation. There were 7 feet of poor healing of the medial incision; 9 pin tract infections occurred in 6 feet using external fixator; there were 20 cases of allograft and 3 cases of autograft with radiographic bone resorption. Except for 1 foot of severe infection treated with bone cement, the remaining 88 feet were primary healing, and the healing area was more than 80%. All patients were followed up 24-82 months, with an average of 50.2 months. Maryland score, VAS score, SF-12 psychological and physiological scores, and TAS, TC, TLS, TCD, TT, TMM, HAA, and Takakura stage were significantly improved at last follow-up ( P<0.05). Postoperative clinical failure occurred in 13 feet, functional failure in 15 feet, and radiology failure in 23 feet. Univariate analysis showed that obesity, TT>10°, and Takakura stage Ⅲb were risk factors for clinical failure, HAA≥15° and Takakura stage Ⅲb were risk factors for functional failure, and TT>10° was risk factor for radiographic failure ( P<0.05). Further logistic regression analysis showed that TT>10°, HAA≥15°, and TT>10° were risk factors for clinical failure, functional failure, and radiographic failure, respectively ( P<0.05).

CONCLUSION: SMOT is effective in the mid- and long-term in the treatment of varus-type ankle arthritis, but it should be used with caution in patients with obesity, severe hindfoot varus, severe talus tilt, and preoperative Takakura stage Ⅲb.

PMID:37460173 | DOI:10.7507/1002-1892.202303008