ABSTRACT
Objective:To determine the factors related to postoperative 1-year and 5-year mortalities in elderly patients with hip fracture plus chronic obstructive pulmonary disease (COPD).Methods:A retrospective study was conducted of the elderly patients with hip fracture who had sought medical attention at Department of Orthopaedics, The 7th Medical Center of PLA General Hospital from January 2012 to December 2016.Of them, 103 were complicated with COPD, and another 103 without COPD were selected as controls who were matched in age, gender and fracture site. The 2 groups were compared in terms of postoperative 30-day, 1-year and 5-year mortalities; the risk factors were explored for postoperative 1-year and 5-year mortalities in patients with hip fracture plus COPD.Results:The postoperative 30-day, 1-year and 5-year mortalities in the COPD group were 7.8%(8/103), 29.1%(30/103) and 48.5%(50/103), significantly higher than those in the control group except for the 30-day value [1.9%(2/103), 13.6%(14/103) and 31.1%(32/103)] ( P<0.05). Advanced age ( P=0.003), cardiovascular disease ( P=0.006), respiratory disease ( P=0.009), acute exacerbation of COPD (AECOPD) ( P<0.01), American Society of anesthesiologists (ASA) grades Ⅲ+Ⅳ ( P=0.001), delayed surgery (>48 h) ( P=0.015), pre-injury activities of daily living (ADL) score ( P=0.002) and mobility ( P=0.010) were related to an increased risk for 1-year mortality after operation. Advanced age ( OR=1.106, 95% CI: 1.016 to 1.210, P=0.021), AECOPD ( OR=5.053, 95% CI: 1.520 to 16.800, P=0.008), and ASA grades Ⅲ+Ⅳ ( OR=1.657, 95% CI: 1.072 to 3.912, P=0.040) were the risk factors for 5-year mortality in patients with COPD; pre-injury ADL ( OR=0.974, 95% CI: 0.987 to 0.967, P=0.043) was negatively correlated with 5-year mortality. Conclusions:COPD can significantly increase the short-term and long-term mortalities in elderly patients with hip fracture.Cardiovascular disease, AECOPD and ASA grades Ⅲ+Ⅳ are factors related to postoperative 1-year mortality in patients with hip fracture plus COPD. Advanced age, AECOPD and ASA grades Ⅲ+Ⅳ and delayed surgery (>48 h) are risk factors for postoperative 5-year mortality in patients with hip fracture plus COPD. ADL score before injury is negatively correlated with postoperative 1-year and 5-year mortalities.
ABSTRACT
Objective:To evaluate the clinical outcomes of Acumed intramedullary nailing for AO type A3 forearm diaphyseal fracture in adults.Methods:A retrospective study was conducted of the 20 adult patients with AO type A3 forearm diaphyseal fracture who had been treated by Acumed intramedullary nailing from January 2016 to November 2018 at PLA General Hospital. They were 18 males and 2 females, aged from 18 to 56 years (average, 36.5 years). There were 6 radius diaphyseal fractures, 9 ulna diaphyseal fractures and 5 diaphyseal fractures of both forearm bones. The clinical outcomes of Acumed intramedullary nailing for AO type A3 forearm diaphyseal fractures were evaluated by recording the perioperative complications, fracture union time, forearm rotation range at 12-month follow-up, and Disability of the Arm, Shoulder and Hand Questionnaire (DASH) scores for the upper limb function.Results:The 20 patients were followed up for 12 to 18 months (mean, 15.8 months). Bony union was achieved in all the patients after 3 to 4 months (average, 3.3 months). Partial rupture of the extensor pollicis longus tendon happened during operation in one patient and at 3 months post-operation in another due to fixation irritation, and linear ossification of interosseous membranes was observed in one patient with diaphyseal fractures of both forearm bones. 12-month follow-ups showed that, in the 20 patients, forearm pronation ranged from 80° to 90° (average, 89°), supination from 60° to 90° (average, 86.3°) and DASH scores from 0 to 37 (average, 6.5).Conclusions:In the treatment of AO type A3 forearm diaphyseal fracture in adults, Acumed intramedullary nailing can lead to successful fracture union and excellent rotational activity at one year after operation. Therefore, adult AO type A3 forearm diaphyseal fracture can be listed as an indication for Acumed intramedullary nailing.
ABSTRACT
Objective:To investigate the clinical effect of minimally invasive plate osteosynthesis (MIPO) through anterolateral approach in treatment of middle-distal humeral shaft fracture.Methods:A retrospective case series study was conducted to analyze the clinical data of 21 patients with middle-distal humeral shaft fracture admitted to 7th Medical Center of Chinese PLA General Hospital from August 2015 to March 2018, including 12 males and 9 females, aged 18-68 years [(31.3±3.6)years]. All were closed fracture. According to AO classification, the fracture were classified as type A in 6 patients, type B in 10 and type C in 5. All patients were treated with anterolateral minimally invasive plate fixation. The operation time, intraoperative blood loss and hospital stay were recorded. The fracture healing was observed after operation. The visual analogue scale (VAS), University of California at Los Angeles (UCLA) shoulder rating scale, and Mayo elbow performance score (MEPS) were used to evaluate the effectiveness before operation and at 2 weeks, 3 months and 12 months after operation.Results:All patients were followed up for 12-26 months [(18.2±2.4)months]. The operation time was 50-82 minutes [(68.2±19.4)minutes], with intraoperative blood loss of 40-95 ml [(60.2±21.3)ml]. The hospital stay was 6-16 days [(6.8±1.2)days]. There was no iatrogenic vascular or nerve injury during operation. The patients with radial nerve injury before operation were all adventitia contusion. The nerve function returned to normal within 3 months after operation. All fractures were healed within 5-10 months [(5.3±1.2)months]. At 2 weeks, 3 months and 12 months after operation, the VAS [(3.6±0.8)points, (2.1±0.4)points, (1.8±0.3)points] was lower than that before operation [(8.3±1.6)points] ( P<0.05); UCLA shoulder rating scale [(31.2±1.5)points, (33.6±0.8)points, (34.6±0.5)points] was higher than that before operation [(28.4±2.3)points] ( P<0.05); and MEPS [(80.2±3.4)points, (93.4±2.2)points, (96.4±3.5)points] was higher than that before operation [(60.5±4.5)points] ( P<0.05). At the last follow-up, the UCLA shoulder rating scale and MEPS showed excellent results. Conclusion:For middle and lower humeral shaft fracture especially for the fracture line relatively distal to the shaft, MIPO technique through anterolateral approach can attain satisfactory results in terms of pain, range of motion of shoulder and elbow joint, and joint function.
ABSTRACT
Objective To compare the efficacy of operation and non-operation treatment for nonagenarians with hip fracture.Methods A retrospective case control study was conducted to analyze the data of 183 patients over 90 years old with hip fracture admitted to the seventh medical center of Chinese PLA General Hospital from January 2012 to December 2016.There were 87 males and 96 females,aged 90-104 years [(93.0 ± 2.9) years].Among the patients,101 were treated surgically (operation group) and 82 were treated nonoperatively (non-operation group).The hospitalization time,incidence of complications,mortality and survival curve at 30 days and 1 year after injury were compared between the two groups.Multivariate logistic regression analysis was used to calculate the risk of death in patients who did not undergo operation at 30 days and i year after injury.Functional recovery was assessed by comparing the walking ability and activities of daily living (ADL) before injury and 1 year after injury.Results The hospitalization time was (16.6 ± 13.7)days for operation group and (21.7 ± 16.0) days for the non-operation group (P ＜ 0.05).The operation group had a complication incidence of 40.6％ (41/101),and the non-operation group 58.5％ (48/82).Nine patients (8.9％) in the operation group and nine patients (11.0％) in the non-operation group died 30 days after injury (P ＜0.05).A total of 27 deaths (26.7％) in operation group and 38 deaths (46.3％) in the non-operation group were recorded within 1 year after injury (P ＜ 0.05).The non-operation group had a much higher death risk than the operation group (P ＜ 0.05).Multivariate Logistic regression analysis showed that nonoperation treatment was significantly associated with death risk 1-year after injury (OR =2.672,95％ CI 1.262-5.655,P ＜ 0.05),but not with the death risk 30-day mortality (OR =1.144,95％ CI 0.678-3.461,P ＞ 0.05).In the operation group,45 patients (44.6％) could walk independently before injury and 56 patients (55.4％) could walk partially independently before injury;in the non-operation group,31 patients (37.8％) could walk independently before injury and 51 patients (62.2％) could walk partially independently before injury,with no significant difference between the two groups (P ＞ 0.05).The average ADL score before injury in operation group was (61.4 ± 8.2)points,while that in nonoperation group was (60.3 ± 9.2) points (P ＞ 0.05).At 1 year after operation,20 patients (19.8％) in the operation group could walk independently,43 patients (42.6％) could walk partially independently,and 11 patients (10.9％) needed to stay in bed;only one patient (1.2％) in the non-operation group could walk independently,32 patients (39.0％) could walk partially independently,and 11 patients (13.4％) needed to stay in bed,with significant difference between the two groups (P ＜ 0.05).The average ADL score was (51.4 ± 10.9) points in the operation group and (43.2 ± 7.2) points in the nonoperation group 1 year after operation (P ＜ 0.05).Conclusions For the nonagenarians patients with hip fracture,operation treatment is superior to non-operation treatment in terms of hospitalization time,complication incidence,1-year mortality and functional recovery.Non-operation treatment is the independent risk factor for death risk 1 year after injury.
ABSTRACT
Objective@#To compare the efficacy of operation and non-operation treatment for nonagenarians with hip fracture.@*Methods@#A retrospective case control study was conducted to analyze the data of 183 patients over 90 years old with hip fracture admitted to the seventh medical center of Chinese PLA General Hospital from January 2012 to December 2016. There were 87 males and 96 females, aged 90-104 years [(93.0±2.9) years]. Among the patients, 101 were treated surgically (operation group) and 82 were treated nonoperatively (non-operation group). The hospitalization time, incidence of complications, mortality and survival curve at 30 days and 1 year after injury were compared between the two groups. Multivariate logistic regression analysis was used to calculate the risk of death in patients who did not undergo operation at 30 days and 1 year after injury. Functional recovery was assessed by comparing the walking ability and activities of daily living (ADL) before injury and 1 year after injury.@*Results@#The hospitalization time was (16.6±13.7)days for operation group and (21.7±16.0)days for the non-operation group (P<0.05). The operation group had a complication incidence of 40.6% (41/101), and the non-operation group 58.5% (48/82). Nine patients (8.9%) in the operation group and nine patients (11.0%) in the non-operation group died 30 days after injury (P<0.05). A total of 27 deaths (26.7%) in operation group and 38 deaths (46.3%) in the non-operation group were recorded within 1 year after injury (P<0.05). The non-operation group had a much higher death risk than the operation group (P<0.05). Multivariate Logistic regression analysis showed that non-operation treatment was significantly associated with death risk 1-year after injury (OR=2.672, 95%CI 1.262-5.655, P<0.05), but not with the death risk 30-day mortality (OR=1.144, 95% CI 0.678-3.461, P>0.05). In the operation group, 45 patients (44.6%) could walk independently before injury and 56 patients (55.4%) could walk partially independently before injury; in the non-operation group, 31 patients (37.8%) could walk independently before injury and 51 patients (62.2%) could walk partially independently before injury, with no significant difference between the two groups (P>0.05). The average ADL score before injury in operation group was (61.4±8.2)points, while that in non-operation group was (60.3±9.2)points (P>0.05). At 1 year after operation, 20 patients (19.8%) in the operation group could walk independently , 43 patients (42.6%) could walk partially independently, and 11 patients (10.9%) needed to stay in bed; only one patient (1.2%) in the non-operation group could walk independently, 32 patients (39.0%) could walk partially independently, and 11 patients (13.4%) needed to stay in bed, with significant difference between the two groups (P<0.05). The average ADL score was (51.4±10.9)points in the operation group and (43.2±7.2)points in the non-operation group 1 year after operation (P<0.05).@*Conclusions@#For the nonagenarians patients with hip fracture, operation treatment is superior to non-operation treatment in terms of hospitalization time, complication incidence, 1-year mortality and functional recovery. Non-operation treatment is the independent risk factor for death risk 1 year after injury.
ABSTRACT
CONTEXT: Both tacrolimus (FK506) and nerve growth factor (NGF) enhance peripheral nerve regeneration, and in vitro experimental results demonstrate that the combination of FK506 and NGF increased neurite outgrowth compared with either treatment alone. AIM: To determine if the combination of FK506 and NGF benefits peripheral nerve regeneration compared with either treatment alone in vivo. SETTINGS AND DESIGN: Rat sciatic nerves were cut off to form a 10 mm defect and repaired with the nerve conduits. All of the 32 Wistar rats were randomly divided into 4 groups: Group A: RGD peptide modification of poly{(lactic acid)-co-[(glycolic acid)-alt-(L-lysine)]} (PRGD)/FK506/NGF; Group B: PRGD/FK506; Group C: PRGD/NGF; and Group D: autologous nerves. MATERIALS AND METHODS: At 3 months after surgery, the regenerated rat sciatic nerve was evaluated by electrophysiology, calf triceps wet weight recovery rate, and histologic assessment. STATISTICAL ANALYSIS USED: The SPSS 10.0 software (Bizinsight, Beijing China) was used for statistical analysis. RESULTS: The compound muscle action potentials (CMAPs) of groups A and D were significantly stronger than those of groups B and C. The calf triceps wet weight recovery rate of groups A and D were higher than those of groups B and C. The regenerated nerves of groups A and D were more mature than those of groups B and C. There was no significant difference between groups A and D. CONCLUSIONS: PRGD/FK506/NGF sustained-release nerve conduits are more effective in regenerating nerves than both PRGD/FK506 sustained-release nerve conduits and PRGD/NGF sustained-release nerve conduits. The effect is as good as that of an autograft.