摘要
Objective:To investigate the relationship between preoperative left ventricular ejection fraction (LVEF) and the risk for postoperative major adverse cardiovascular events (MACE) in elderly patients with hip fracture.Methods:A retrospective study was conducted to analyze the data of 403 elderly patients with hip fracture who had undergone surgical treatment at Department of Orthopedics, Beijing Anzhen Hospital from January 2015 to January 2021. Gender: 118 males and 285 females; age: 80 (74, 85) years; fracture type: 228 femoral neck fractures and 175 intertrochanteric (including subtrochanteric) fractures. Cardiovascular disease was complicated in 161 patients before surgery. The incidence of MACE within 30 days after surgery was statistically analyzed. The patients were divided into 2 groups according to whether MACE occurred 30 days after surgery: an MACE group and a non-MACE group. The baseline data, LVEF, preoperative cardiovascular complications, American Society of Anesthesiologists(ASA) grading and other indicators were compared between the 2 groups. Based on patient sample analysis, the receiver operating characteristic curve (ROC) was plotted to determine the optimal cutoff value of preoperative LVEF, according to which the relationship was analyzed between preoperative LVEF and the risk for postoperative MACE.Results:The overall incidence of postoperative MACE was 12.4% (50/403). There were statistically significant differences between the MACE group and the non-MACE group in preoperative LVEF[60.0% (56.0%, 63.0%) versus 62.0% (60.0%, 65.0%)], preoperative cardiovascular complications[74.0% (37/50) versus 35.1% (124/353)] and ASA grade ≥3[90.0% (45/50) versus 74.8% (264/353)]. ROC analysis showed that LVEF=60% was the optimal threshold for prediction of postoperative MACE (area under curve=0.680, sensitivity 48.0%, and specificity 83.0%). Multivariate logistic regression analysis showed that LVEF<60% and preoperative cardiovascular disease were risk factors for postoperative MACE. Subgroup analysis showed that the incidence of MACE in patients with LVEF<60% was significantly higher than that in patients with LVEF≥60% regardless of preoperative cardiovascular disease ( P<0.05). Conclusion:Preoperative LVEF<60% is a risk factor for postoperative MACE in elderly patients with hip fracture.
摘要
Objective:To explore the epidemiological characteristics of geriatric hip fractures in Beijing so as to provide evidence for effective prevention and control measures.Methods:This multicenter study was conducted in 3 urban (Beijing Jishuitan Hospital, Beijing Hospital and Beijing Anzhen Hospital) and 3 suburban hospitals (Beijing Shunyi District Hospital, Beijing Changping District Hospital and Beijing Liangxiang Hospital) in Beijing from November 2018 to November 2019. Eligible patients were those aged ≥ 65 years with hip fracture confirmed by X-ray and being admitted to hospital within 21 days of injury. To explore the epidemiological characteristics of geriatric hip fractures in Beijing, such data were collected as patients' age, gender, comorbidities, as well as type, site, time and cause of the fracture.Results:① A total of 2,071 patients were included in this suevey. They were 653 males and 1,418 females (M∶F=1∶2.17). Their age ranged from 65 to 102 years (average, 79.8 years). The patients aged from 75 to 84 years were the most common, accounting for 44.81% (928/2,071). ② Femoral neck fractures accounted for 43.41% (899/2,071), and intertrochanteric fractures accounted for 56.59% (1,172/2,071). The age of the patients with femoral neck fracture was (78.6±7.7) years, which was significantly younger than that of those with intertrochanteric fracture [(80.7±7.4) years] ( P<0.05). ③ 94.69% of the hip fractures (1,961/2,071) were caused by falling, and 71.27% fractures (1,476/2,071) happened at home. ④ Approximately 83.00% of the patients (1,719/2,071) had one or more comorbid conditions. Hypertension was the most prevalent disease (57.89%, 1,199/2,071), followed by diabetes (27.09%, 561/2,071), and coronary atherosclerotic heart disease (22.02%, 456/2,071). Conclusions:In Beijing, significantly more geriatric females sustain a hip fracture than males, and the proportion of those aged from 75 to 84 year is the largest. The proportion of intertrochanteric fractures increases with age. Falls are the leading cause for geriatric hip fractures. Most of the patients have one or more chronic comorbid conditions. Corresponding prevention and intervention measures should be formulated according to the distribution characteristics of elderly hip fractures in Beijing.
摘要
Objective To investigate the mid-term efficacy and complications of bone cement or biotype hemiarthroplasty for the femoral neck fracture in the elderly patients.Methods From January 2011 to January 2014,sixty-seven elderly patients (67 hips) with femoral neck fracture were treated with hemiarthroplasty.All patients were treated with bipolar femoral head prosthesis,and the prosthesis included into bone cement and biologic type,according to the fixation of the femoral stem.The 3 year postoperative Harris score and surgeryrelated complications (joint dislocation,prosthesis loosening,acetabular subsidence,and mortality) were evaluated.Results All patients were followed up for 3 years.The excellent and good rate of Harris score was 87.1％ (27/31) in the bone cement group and 80.6％ (25/31) in the cementless group (X2 =0.47,P＞0.05).There was no significant difference in the complications between the two groups (P＞0.05).Conclusion The hemiarthroplasty is an effective and safe methodfor the treatment of femoral neck fracture in the elderly.The key to achieve excellent results is to choose the femoral prosthesis based on the preoperative planning and operation.
摘要
OBJECTIVE:To observe therapeutic efficacy and safety of low molecular heparin calcium (fraxiparine) combined with vapour-pressure type blood circulation driver for the prevention and treatment of postoperative lower limb deep vein thrombo-sis(DVT)in elderly fracture patients. METHODS:80 elderly patients receiving fracture surgery were randomly divided into con-trol group and observation group,with 40 cases in each group. Control group only received preventive measures for lower limb DVT under the action of vapour-pressure type blood circulation driver,while observation group was additionally given Low molecu-lar heparin calcium injection on the basis of control group,Preoperative 2 h,postoperative 12 h and 24 h,0.4 ml was administrat-ed;Postoperative d2-d3,0.4 ml was subcutaneously injected;postoperative d4,0.6 ml was administrated and lasted for 10 d. The incidence of lower limb venous thrombosis,therapeutic efficacy,the changes of blood rheology indexes and the cross-section diam-eter difference of uninjured side limb were observed in 2 groups;the incidence of ADR was compared between 2 groups. RE-SULTS:The observation group;total effective rate (95.00%) was higher than control group (72.50%),with statistical signifi-cance (P<0.05). After treatment,the cross-section diameter difference of side and uninjured side limb in observation group de-creased to(1.10±0.87)cm,which was significantly lower than control group(2.59±1.55)cm,with statistical significance(P<0.05). The blood viscosity at both high and low shear rates,plasma viscosity and fibrinogen of observation group were all better than those of control group,with statistical significance(P<0.05). No obvious ADR was found in 2 groups. CONCLUSIONS:In the prevention of lower limb DVT in elderly fracture patients,Low molecular heparin calcium injection combined with vapour-pres-sure type blood circulation driver show high effective rate,significantly improve blood rheological index and lower the incidence of lower limb DVT with good safety.