目的·探究在接受防旋股骨近端髓内钉(proximal femoral nail antirotation,PFNA)手术治疗的骨质疏松性股骨转子间骨折高龄患者中,术后早期应用唑来膦酸对骨折愈合的影响,以及其他可能的相关因素。方法·回顾性分析2016年1月至2...目的·探究在接受防旋股骨近端髓内钉(proximal femoral nail antirotation,PFNA)手术治疗的骨质疏松性股骨转子间骨折高龄患者中,术后早期应用唑来膦酸对骨折愈合的影响,以及其他可能的相关因素。方法·回顾性分析2016年1月至2022年2月于上海交通大学医学院附属瑞金医院行PFNA手术的80岁及以上的股骨转子间骨折患者174例,根据术后是否早期接受唑来膦酸治疗将患者分为实验组(n=26)和对照组(n=148),所有患者完成术后6周和12周2次随访。运用倾向性评分匹配(propensity score matching,PSM)法将实验组与对照组患者按照1∶3的比例进行匹配,匹配因素包括年龄、性别、骨折分型以及体质量指数(body mass index,BMI)。比较2组患者匹配后的一般资料,以及2次随访时的骨折愈合和功能恢复情况。采用Logistic回归分析探究患者术后12周骨折愈合的相关因素。结果·PSM法匹配后得到实验组患者25例和对照组患者65例,2组患者一般资料间差异均无统计学意义。实验组患者术后6周和12周的骨折愈合率分别为16.0%和96.0%,均显著高于对照组(分别为1.5%和73.8%,均P<0.05);实验组患者术后12周时Harris髋关节功能评分显著高于对照组(P=0.019)。Logistic回归分析结果显示,良好的手术复位(OR=12.52,95%CI 2.67~58.74,P=0.001)、术后早期使用唑来膦酸(OR=10.14,95%CI 1.01~102.09,P=0.049)和更高的血清白蛋白水平(OR=1.15,95%CI 1.02~1.29,P=0.025)为骨折愈合的促进因素,而不稳定型骨折(OR=0.10,95%CI 0.03~0.31,P=0.000)为不利因素。结论·对于接受PFNA手术的骨质疏松性股骨转子间骨折高龄患者,术后早期使用唑来膦酸可以促进骨折愈合且使患者获得更好的功能恢复;除此之外良好的术中复位、更高的血清白蛋白水平是促进骨折愈合的有利因素,而不稳定型骨折为骨折愈合的阻碍因素。展开更多
Among cancers, lung cancer is the most common cause of death in China. For the prevention and control of lung cancer, it is necessary to investigate the spatial and temporal distribution of lung cancer mortality, as w...Among cancers, lung cancer is the most common cause of death in China. For the prevention and control of lung cancer, it is necessary to investigate the spatial and temporal distribution of lung cancer mortality, as well as the changes in the trend and the affecting mechanism. Based on statistics and auto-correlation analysis, this paper studied the spatial and temporal distribution of lung cancer mortality in Yuhui District, Bengbu, Huaihe River Basin, from 2017 to 2020. In addition, Spearman’s Rank Correlation Assessment Model and Geographic Detector Model were used to examine the relationship between environmental factors and lung cancer mortality to identify impact factors and their mechanisms. The findings indicated that: 1) from the characteristics of temporal distribution, the number of lung cancer deaths exhibited a linear growth tendency, with the highest mortality in winter;2) from the characteristics of spatial distribution, lung cancer mortality showed a strong spatial agglomeration form, concentrating on two clustering areas, located in the old city and the central city of Bengbu, near the Huaihe River;3) from the point of view of the whole research area, there were 15 impact factors with significant correlation in the built and natural environment factors. The significant impacting factors in the built environment included land use, road traffic, spatial form and blue-green space, which could indirectly affect lung cancer mortality, while air pollution and temperature constituted the significant impacting factors in the natural environment;4) the influence of screened environmental factors on lung cancer mortality was different. Spatial stratified heterogeneity assessment, the interaction among environmental factors demonstrated statistical significance, it was found that the interaction between environmental factors in pairs had a significant enhancement effect on lung cancer mortality. To some extent, urban planning and policies could reduce lung cancer mortality.展开更多
基金Under the auspices of Natural Science Foundation of Anhui Province (No. 2008085ME160)Provincial Natural Science Research Projects in Anhui Province-Postgraduate Projects (No. YJS20210500)。
文摘Among cancers, lung cancer is the most common cause of death in China. For the prevention and control of lung cancer, it is necessary to investigate the spatial and temporal distribution of lung cancer mortality, as well as the changes in the trend and the affecting mechanism. Based on statistics and auto-correlation analysis, this paper studied the spatial and temporal distribution of lung cancer mortality in Yuhui District, Bengbu, Huaihe River Basin, from 2017 to 2020. In addition, Spearman’s Rank Correlation Assessment Model and Geographic Detector Model were used to examine the relationship between environmental factors and lung cancer mortality to identify impact factors and their mechanisms. The findings indicated that: 1) from the characteristics of temporal distribution, the number of lung cancer deaths exhibited a linear growth tendency, with the highest mortality in winter;2) from the characteristics of spatial distribution, lung cancer mortality showed a strong spatial agglomeration form, concentrating on two clustering areas, located in the old city and the central city of Bengbu, near the Huaihe River;3) from the point of view of the whole research area, there were 15 impact factors with significant correlation in the built and natural environment factors. The significant impacting factors in the built environment included land use, road traffic, spatial form and blue-green space, which could indirectly affect lung cancer mortality, while air pollution and temperature constituted the significant impacting factors in the natural environment;4) the influence of screened environmental factors on lung cancer mortality was different. Spatial stratified heterogeneity assessment, the interaction among environmental factors demonstrated statistical significance, it was found that the interaction between environmental factors in pairs had a significant enhancement effect on lung cancer mortality. To some extent, urban planning and policies could reduce lung cancer mortality.
