BACKGROUND Hip fractures account for 23.8%of all fractures in patients over the age of 75 years.More than half of these patients are older than 80 years.Bipolar hemiarthroplasty(BHA)was established as an effective man...BACKGROUND Hip fractures account for 23.8%of all fractures in patients over the age of 75 years.More than half of these patients are older than 80 years.Bipolar hemiarthroplasty(BHA)was established as an effective management option for these patients.Various approaches can be used for the BHA procedure.However,there is a high risk of postoperative dislocation.The conjoined tendon-preserving posterior(CPP)lateral approach was introduced to reduce postoperative dislocation rates.AIM To evaluate the effectiveness and safety of the CPP lateral approach for BHA in elderly patients.METHODS We retrospectively analyzed medical data from 80 patients with displaced femoral neck fractures who underwent BHA.The patients were followed up for at least 1 year.Among the 80 patients,57(71.3%)were female.The time to operation averaged 2.3 d(range:1-5 d).The mean age was 80.5 years(range:67-90 years),and the mean body mass index was 24.9 kg/m^(2)(range:17-36 kg/m^(2)).According to the Garden classification,42.5%of patients were typeⅢand 57.5%of patients were typeⅣ.Uncemented bipolar hip prostheses were used for all patients.Torn conjoined tendons,dislocations,and adverse complications during and after surgery were recorded.RESULTS The mean postoperative follow-up time was 15.3 months(range:12-18 months).The average surgery time was 52 min(range:40-70 min)with an average blood loss of 120 mL(range:80-320 mL).The transfusion rate was 10%(8 of 80 patients).The gemellus inferior was torn in 4 patients(5%),while it was difficult to identify in 2 patients(2.5%)during surgery.The posterior capsule was punctured by the fractured femoral neck in 3 patients,but the conjoined tendon and the piriformis tendon remained intact.No patients had stem varus greater than 3 degrees or femoral fracture.There were no patients with stem subsidence more than 5 mm at the last follow-up.No postoperative dislocations were observed throughout the follow-up period.No significance was found between preoperative and postoperative mean Health Service System scores(87.30±2.98 vs 86.10±6.10,t=1.89,P=0.063).CONCLUSION The CPP lateral approach can effectively reduce the incidence of postoperative dislocation without increasing perioperative complications.For surgeons familiar with the posterior lateral approach,there is no need for additional surgical instruments,and it does not increase surgical difficulty.展开更多
目的 分析老年股骨颈骨折关节置换术后谵妄的危险因素,并构建Nomogram预测模型。方法 回顾性分析2019年1月至2020年12月于烟台市烟台山医院接受关节置换术的195例65岁以上股骨颈骨折患者的临床资料。记录患者的一般基线资料、血常规检...目的 分析老年股骨颈骨折关节置换术后谵妄的危险因素,并构建Nomogram预测模型。方法 回顾性分析2019年1月至2020年12月于烟台市烟台山医院接受关节置换术的195例65岁以上股骨颈骨折患者的临床资料。记录患者的一般基线资料、血常规检查、炎症相关指标、生化检查指标、凝血与D-二聚体指标及动脉血气分析指标。根据术后是否发生谵妄分为谵妄组与非谵妄组,计算谵妄发病率;利用最小绝对收缩选择算子(Lasso)回归和多因素Logistic回归分析术后谵妄的危险因素并建立Nomogram预测模型。结果 老年股骨颈骨折关节置换术后谵妄率为16.4%。LassoLogistic回归模型显示,性别[OR=0.16,95%CI(0.06,0.44)]、手术方式[OR=3.26,95%CI(1.02,10.37)]、白蛋白[OR=1.19,95%CI(1.03,1.38)]为术后谵妄的独立危险因素。预测模型的曲线下面积(area under the curve,AUC)为0.833,提示Nomogram预测模型有较好的预测能力、精准度。结论 性别、年龄、手术方式、白蛋白是术后谵妄独立风险因素。Nomogram预测模型能够方便地进行术后谵妄风险预测。展开更多
Background:According to the amyloid,tau,neurodegeneration research framework classification,amyloid and tau positive(A+T+)mild cognitive impairment(MCI)individuals are defined as prodromal Alzheimer disease.This study...Background:According to the amyloid,tau,neurodegeneration research framework classification,amyloid and tau positive(A+T+)mild cognitive impairment(MCI)individuals are defined as prodromal Alzheimer disease.This study was designed to compare the clinical and biomarker features between A+T+MCI individuals who progressed to progressive MCI(pMCI)and those who remained stable MCI(sMCI),and to identify relevant baseline clinical biomarker and features that could be used to predict progression to dementia within 2 years.Methods:We stratified 197 A+T+MCI individuals into pMCI(n=64)and sMCI(n=133)over 2 years.Demographics and cognitive assessment scores,cerebrospinal fluid(CSF),and neuroimaging biomarkers(18F-florbetapir positron emission tomography mean standardized uptake value ratios[SUVR]and structural magnetic resonance imaging[MRI])were compared between pMCI and sMCI at baseline,12-and 24-month follow-up.Logistic regression models then were used to evaluate clinical baseline and biomarker features that predicted dementia progression in A+T+MCI.Results:pMCI individuals had higher mean 18F-florbetapir SUVR,CSF total-tau(t-tau),and p-tau181P than those in sMCI individuals.pMCI individuals performed poorer in cognitive assessments,both global and domain specific(memory,executive,language,attention,and visuospatial skills)than sMCI.At baseline,there were significant differences in regions of interest of structural MRI between the two groups,including bilateral amygdala,hippocampus and entorhinal,bilateral inferior lateral ventricle,left superior and middle temporal,left posterior and caudal anterior cingulate(P<0.05).Baseline CSF t-tau levels and cognitive scores of Montreal cognitive assessment,functional assessment questionnaire,and everyday cognition by the patient’s study partner language domain could predict progression to dementia in A+T+MCI within 2 years.Conclusions:In future clinical trials,specific CSF and cognitive measures that predict dementia progression in A+T+MCI might be useful risk factors for assessing the risk of dementia progression.展开更多
文摘BACKGROUND Hip fractures account for 23.8%of all fractures in patients over the age of 75 years.More than half of these patients are older than 80 years.Bipolar hemiarthroplasty(BHA)was established as an effective management option for these patients.Various approaches can be used for the BHA procedure.However,there is a high risk of postoperative dislocation.The conjoined tendon-preserving posterior(CPP)lateral approach was introduced to reduce postoperative dislocation rates.AIM To evaluate the effectiveness and safety of the CPP lateral approach for BHA in elderly patients.METHODS We retrospectively analyzed medical data from 80 patients with displaced femoral neck fractures who underwent BHA.The patients were followed up for at least 1 year.Among the 80 patients,57(71.3%)were female.The time to operation averaged 2.3 d(range:1-5 d).The mean age was 80.5 years(range:67-90 years),and the mean body mass index was 24.9 kg/m^(2)(range:17-36 kg/m^(2)).According to the Garden classification,42.5%of patients were typeⅢand 57.5%of patients were typeⅣ.Uncemented bipolar hip prostheses were used for all patients.Torn conjoined tendons,dislocations,and adverse complications during and after surgery were recorded.RESULTS The mean postoperative follow-up time was 15.3 months(range:12-18 months).The average surgery time was 52 min(range:40-70 min)with an average blood loss of 120 mL(range:80-320 mL).The transfusion rate was 10%(8 of 80 patients).The gemellus inferior was torn in 4 patients(5%),while it was difficult to identify in 2 patients(2.5%)during surgery.The posterior capsule was punctured by the fractured femoral neck in 3 patients,but the conjoined tendon and the piriformis tendon remained intact.No patients had stem varus greater than 3 degrees or femoral fracture.There were no patients with stem subsidence more than 5 mm at the last follow-up.No postoperative dislocations were observed throughout the follow-up period.No significance was found between preoperative and postoperative mean Health Service System scores(87.30±2.98 vs 86.10±6.10,t=1.89,P=0.063).CONCLUSION The CPP lateral approach can effectively reduce the incidence of postoperative dislocation without increasing perioperative complications.For surgeons familiar with the posterior lateral approach,there is no need for additional surgical instruments,and it does not increase surgical difficulty.
文摘目的 分析老年股骨颈骨折关节置换术后谵妄的危险因素,并构建Nomogram预测模型。方法 回顾性分析2019年1月至2020年12月于烟台市烟台山医院接受关节置换术的195例65岁以上股骨颈骨折患者的临床资料。记录患者的一般基线资料、血常规检查、炎症相关指标、生化检查指标、凝血与D-二聚体指标及动脉血气分析指标。根据术后是否发生谵妄分为谵妄组与非谵妄组,计算谵妄发病率;利用最小绝对收缩选择算子(Lasso)回归和多因素Logistic回归分析术后谵妄的危险因素并建立Nomogram预测模型。结果 老年股骨颈骨折关节置换术后谵妄率为16.4%。LassoLogistic回归模型显示,性别[OR=0.16,95%CI(0.06,0.44)]、手术方式[OR=3.26,95%CI(1.02,10.37)]、白蛋白[OR=1.19,95%CI(1.03,1.38)]为术后谵妄的独立危险因素。预测模型的曲线下面积(area under the curve,AUC)为0.833,提示Nomogram预测模型有较好的预测能力、精准度。结论 性别、年龄、手术方式、白蛋白是术后谵妄独立风险因素。Nomogram预测模型能够方便地进行术后谵妄风险预测。
基金the Shandong Provincial key research and development project(No.2018GSF118235)the Shandong Provincial Natural Science Foundation(No.ZR2016HL16).
文摘Background:According to the amyloid,tau,neurodegeneration research framework classification,amyloid and tau positive(A+T+)mild cognitive impairment(MCI)individuals are defined as prodromal Alzheimer disease.This study was designed to compare the clinical and biomarker features between A+T+MCI individuals who progressed to progressive MCI(pMCI)and those who remained stable MCI(sMCI),and to identify relevant baseline clinical biomarker and features that could be used to predict progression to dementia within 2 years.Methods:We stratified 197 A+T+MCI individuals into pMCI(n=64)and sMCI(n=133)over 2 years.Demographics and cognitive assessment scores,cerebrospinal fluid(CSF),and neuroimaging biomarkers(18F-florbetapir positron emission tomography mean standardized uptake value ratios[SUVR]and structural magnetic resonance imaging[MRI])were compared between pMCI and sMCI at baseline,12-and 24-month follow-up.Logistic regression models then were used to evaluate clinical baseline and biomarker features that predicted dementia progression in A+T+MCI.Results:pMCI individuals had higher mean 18F-florbetapir SUVR,CSF total-tau(t-tau),and p-tau181P than those in sMCI individuals.pMCI individuals performed poorer in cognitive assessments,both global and domain specific(memory,executive,language,attention,and visuospatial skills)than sMCI.At baseline,there were significant differences in regions of interest of structural MRI between the two groups,including bilateral amygdala,hippocampus and entorhinal,bilateral inferior lateral ventricle,left superior and middle temporal,left posterior and caudal anterior cingulate(P<0.05).Baseline CSF t-tau levels and cognitive scores of Montreal cognitive assessment,functional assessment questionnaire,and everyday cognition by the patient’s study partner language domain could predict progression to dementia in A+T+MCI within 2 years.Conclusions:In future clinical trials,specific CSF and cognitive measures that predict dementia progression in A+T+MCI might be useful risk factors for assessing the risk of dementia progression.
