RESUMEN
BACKGROUND: Diabetes mellitus (DM) is a prevalent chronic condition that influences spine surgery outcomes. The impact of type â and type â ¡ DM on adverse postoperative outcomes, mortality, prolonged length of stay (LOS), and increased in-hospital costs following cervical fusion surgery remains unclear in the past decade. This study aims to determine the specific effect of different classifications of DM on postoperative complications in patients experiencing cervical fusion surgery. METHOD: Data from the Nationwide Inpatient Sample database was acquired between 2010 and 2019. Patients experiencing cervical fusion were included and classified as having type I DM, type II DM, or neither. Patient demographics, hospital characteristics, operative variables, comorbidities, complications, and other postoperative outcomes were assessed. Propensity score matching analysis was used to balance baseline differences. Univariate and multivariate logistic regression were employed to determine the risk of postoperative outcomes in patients with different classifications of DM. RESULT: A total of 267,174 cervical spinal fusions were identified (224,255 were patients without DM, 670 patients had type I DM, and 42,249 patients had type II DM). After propensity score matching, the multivariate analysis of non-DM and type I DM patients shows significant difference in pneumonia (P=0.020). However, type â ¡ DM served as an independent predictor of an increased risk of acute cerebrovascular disease (P=0.001), acute myocardial infarction (P=0.014), pneumonia (P=0.045), continuous trauma ventilation (P=0.016), chest pain (P<0.001), urinary tract infection (P<0.001), transfusion (P=0.005) and dysphagia (P=0.013), prolonged LOS (P<0.001) and increased costs (P=0.008). CONCLUSION: Using non-DM patients as a reference, type II DM group demonstrated a higher risk of postoperative complications than type I DM group among patients receiving cervical fusion surgery. This vital distinction could enhance risk stratification and guidance for patients diagnosed with DM before cervical fusion surgery.
RESUMEN
BACKGROUND: With the modernization of society and transportation in the last decades in China, the incidence of high-energy trauma increased sharply in China, including that of acetabular fractures. AIM: To establish different finite element models for acetabular posterior column fractures involving the quadrilateral area of the acetabulum. METHODS: The three-dimensional models of the normal and fractured pelvis and the five internal fixations were established using the computed tomography data of the pelvis of a living volunteer. After the vertebral body model was inserted in the way of origin matching and all cancellous bones were copied using the duplicated cancellous bone model as the subtractive entity, the Boolean operation was performed on the pelvis model to obtain the model of the complete pelvis cortical and cancellous bones. RESULTS: In the standing position, the maximum stress was 46.21 MPa. In the sitting position, the sacrum bore the simulated gravity load at the upper end. When comparing the five fixations, there were no significant differences in the stress mean values among groups (sitting: P = 0.9794; standing: P = 0.9741). In terms of displacement, the average displacement of the internal iliac plate group was smaller than that of the spring plate group (P = 0.002), and no differences were observed between the other pairs of groups (all P > 0.05). In the standing position, there were no significant differences in the mean value of displacement among the groups (P = 0.2985). It can be seen from the stress nephogram of the internal fixations in different positions that the stress of the internal fixation was mainly concentrated in the fracture segment. CONCLUSION: There were no significant differences among the fixations for acetabular posterior column fractures involving the quadrilateral area of the acetabulum.