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Age-related eye diseases are a series of ophthalmic diseases caused by degenerative disease of ocular tissues, and age-related macular degeneration(ARMD), age-related cataract(ARC), diabetic retinopathy(DR)and glaucoma are the four most common age-related eye diseases. With the increasing aging of the global social population, the incidence of these eye diseases is also increasing year by year. Metformin is currently one of the most commonly used hypoglycemic agents in clinical practice. It has become the drug of choice for treating type 2 diabetes after more than 60 years of clinical practice. In recent years, metformin has shown great potential in the prevention and treatment of tumors, systemic diseases and age-related diseases, and the mechanisms of action involved in anti-oxidative stress, anti-inflammation, and induction of autophagy are also closely related to the pathological changes of age-related eye diseases. The paper aims to review the current research status and potential application value of metformin in age-related eye diseases.
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Objective To investigate the efficacy and safety of hypofractionated thoracic radiotherapy combined with EP chemotherapy in the treatment of limited-stage small-cell lung cancer (LS-SCLC). Methods A total of 117 patients with LS-SCLC were enrolled and randomly divided into test group (n=59) and control group (n=58). Patients in the experiment group were given hypofractionated thoracic radiotherapy combined with EP chemotherapy, while patients in the control group were given hyperfractionation radiotherapy combined with EP chemotherapy. Objective response rate (ORR), 2-year overall survival (OS), 2-year progression free survival (PFS), and immune cell level were used to evaluate clinical efficacy. We compared the incidence of side effects between the two groups. Results After the treatment, the ORR of patients in the test group was higher than that in the control group (P > 0.05). The mean OS and PFS of patients in the test group were significantly longer than those in the control group (P < 0.05). The levels of CD3+, CD4+, CD4+/CD8+, and NK cells in the test group were significantly higher, whereas the levels of CD8+ were significantly lower than those in the control group (P < 0.05). The incidence of radiation pneumonitis, radiation esophagitis, and severe dermatitis in the test group was significantly lower than that in the control group (P < 0.05). Conclusion Hypofractionated radiotherapy combined with EP chemotherapy for treatment of LS-SCLC can effectively improve the anticancer efficacy and patient survival, reduce the damage to the body's immune function, and alleviate adverse reaction of radiotherapy.
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OBJECTIVE@#To investigate the mutational spectrum in young patients with diffuse large B-cell lymphoma (DLBCL) based on next generation sequencing (NGS), and to provide a basis for in-depth understanding of the molecular biological characteristics and accurate prognosis of young DLBCL.@*METHODS@#From March 2009 to March 2021, 68 young DLBCL patients with complete initial diagnosis data from the Department of Hematology, The People's Hospital Xinjiang Uygur Autonomous Region were retrospectively analyzed, and their paraffin-embedded tissues were subjected to targeted sequencing analysis by NGS technology (including 475 Target genes), and the differences in gene mutation profiles and signaling pathways between high-risk patients with aaIPI ≥2 and low-intermediate risk patients with aaIPI <2 were compared.@*RESULTS@#A total of 44 high-frequency mutation genes were detected in 68 young DLBCL patients. By comparing the high-frequency mutation genes in aaIPI high-risk group and low-intermediate risk group, it was found that CARD11 mutation in aaIPI high-risk group was significantly higher than that in low-intermediate risk group (P =0.002), while MGA mutation (P =0.037) only appeared in the aaIPI high-risk group, and SPEN mutation (P =0.004) only appeared in the aaIPI low-intermediate risk group. The high-frequency mutation genes and clinical indicators of the aaIPI high-risk group were included in the survival analysis, and the results showed that TP53 (P =0.009, P =0.027), POU2AF1 (P =0.003, P =0.006) and CCND3 (P =0.040, P =0.014) genes mutations were associated with worse PFS and OS, while B2M was associated with better PFS (P =0.014) and OS (P =0.013). Multivariate COX regression analysis showed that the TP53, POU2AF1 and CCND3 were independent risk factors for PFS（P ＝0.021，P =0.005，P =0.020） and OS（P ＝0.042，P =0.010，P =0.013）.@*CONCLUSION@#The aaIPI staging combination with molecular biology markers is more conducive to accurately judging the prognosis of young DLBCL patients. TP53, POU2AF1 and CCND3 mutations predict worse survival in the patients with the aaIPI high-risk group.
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Humans , Retrospective Studies , Prognosis , Lymphoma, Large B-Cell, Diffuse/genetics , Biomarkers , Mutation , High-Throughput Nucleotide SequencingABSTRACT
Femtosecond laser small incision lenticule extraction(SMILE)is one of the most advanced corneal refractive operations at present. Different from other traditional corneal refractive operations, SMILE achieves minimally invasive and valveless operation. Therefore, the evaluation of postoperative visual quality of SMILE also has its own characteristics, at present, the latest research at home and abroad has confirmed that the naked eye vision can be significantly improved and the refractive status is stable after SMILE. However, there are different understandings of the objective visual quality indexes and their influencing factors, such as higher-order aberration, modulation transfer function cut off(MTF cut off)and objective scatter index(OSI)after SMILE. This paper reviews the postoperative visual quality and its influencing factors after SMILE to provide clinical help.
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Objective:To observe the postoperative complications and revision rates of robot arm-assisted unicompartment arthroplasty by means of a meta-analysis.Methods:Relevant databases including Cochrane Library, PubMed, EMBASE, Wanfang, VIP, CNKI, and Web of Science were searched by computer for high-quality studies on complications and revision rates after robot arm-assisted unicompartment arthroplasty in both English and Chinese from the database establishment date to March 2021. The quality of the studies retrieved was evaluated. Relevant data including postoperative complications, infection, pain, prosthesis loosening, and revision were extracted for a meta-analysis using STATA 15.0 software.Results:A total of 16 studies were included, including one randomized controlled study, 6 case-control studies and 9 cohort studies. By the methodological index for non-randomized studies (MINORS), 7 studies scored 14 points, 3 studies 13 points, one study 12 points, 4 studies 11 points, and one study 10 points. Meta analysis showed that the total rate of complications was 2% (95% CI: 1%to 4%) . Three studies used NAVIO robot, 7 studies MAKO robot, one study NAVIO and MAKO robots, and one study Acrobot robot. Since just one study used Acrobot robot, only MAKO and NAVIO robots were included for the subgroup analysis which showed that the postoperative complication rates for NAVIO and MAKO robots were 4.0% (95% CI: -2% to 10%) and 3% (95% CI: 1% to 5%) , respectively. The incidence of postoperative pain was 0.2% (95% CI: 0.1% to 0.3%), the incidence of postoperative infection 0.5% (95% CI: 0.3% to 0.8%), the incidence of postoperative prosthesis loosening 0.5% (95% CI: 0.3% to 0.8%), and the revision rate 2% (95% CI: 1% to 2%). According to the subgroup analysis of NAVIO and MAKO robots, their revision rates were 4% (95% CI: 2% to 7%) and 2% (95% CI: 1% to 2%), respectively. Conclusion:The clinical efficacy of robot arm-assisted unicompartment arthroplasty is good, for the complications in the patients are limited and the long-term survival rate of the prosthesis is excellent.
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Objective:To compare percutaneous cannulated screw (PCS) fixation and plating via a minimally invasive longitudinal approach (MILA) after closed reduction for the treatment of intra-articular tongue-type calcaneal fractures.Methods:A retrospective analysis was conducted of the 67 patients with intra-articular tongue-type calcaneal fracture who had been treated at Department of Orthopedics, The Third Hospital of Peking University from May 2017 to May 2020. They were 56 males and 11 females, 19 to 58 years of age (average, 34.5 years). Of them, 32 were treated by the PCS fixation after closed reduction (PCS group) and 35 by the MILA plating after closed reduction (MILA group). The operation time, preoperative time, post-operative hospital stay, blood loss and postoperative complications were recorded and compared between the 2 groups. The calcaneal length, width and height, Gissane angle, B?hler angle, varus angle, valgus angle and visual analog scale (VAS) were compared between the 2 groups at preoperation, immediate postoperation, 3 months postoperation, and the last follow-up. The American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot score was used at 3 months postoperation and the last follow-up to evaluate the function of the injured hindfoot.Results:There was no significant difference in the preoperative general data between the PCS group and the MILA group, showing they were comparable ( P>0.05). All patients were followed up for an average of 18.5 months (from 15 to 25 months). For the PCS group and the MILA group, respectively, the operation time was 60.5 (51.5, 68.0) min and 86.0 (78.0, 96.0) min, the blood loss 10 (5.0, 20.0) mL and 20 (15, 25) mL, the postoperative hospital stay 1 (1.0, 1.8) d and 2 (2, 3) d, the calcaneal width at immediate postoperation (43.8±4.4) mm and (40.6±2.8) mm, the calcaneal width at 3 months postoperation 43.8 (39.6, 48.3) mm and 41.5 (38.8, 44.5) mm, the calcaneal width at the last follow-up 44.2 (40.2, 48.0) mm and 41.3 (39.0, 44.3) mm, the VAS at the last follow-up 5.0 (5.0, 5.0) and 6.0 (5.0, 6.0). The comparisons of the above items showed significant differences between the 2 groups (all P<0.05). No significant differences were observed between the 2 groups in the calcaneal length or height, Gissane or B?hler angle, AOFAS hindfoot score, or complication rate (all P>0.05). Conclusions:In the treatment of tongue-type calcaneal fractures, after closed reduction, the PCS fixation can shorten operation time and postoperative hospital stay, and reduce intraoperative blood loss and postoperative pain, but the MILA plating is more advantageous in restoring the calcaneal width.
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Zanubrutinib is a highly selective second-generation BTK inhibitor developed in China and first approved by the U.S. Food and Drug Administration (FDA) as a novel antineoplastic drug. In recent years, with the birth of molecularly targeted drugs, the treatment of B-cell lymphoma have entered the era of targeted therapy, and immunotherapy has been widely accepted. Especially in some relapsed and refractory lymphomas, zanubrutinib has shown deep and sustained remissions and a favorable safety, which lays a foundation for precision therapy. In this review the clinical application and new progress for zanubrutinib in B-cell lymphoma was summarized briefly.
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Humans , Lymphoma, B-Cell/drug therapy , Piperidines/therapeutic use , Protein Kinase Inhibitors/therapeutic use , Pyrazoles/therapeutic use , Pyrimidines/therapeutic useABSTRACT
Objective:To evaluate the curative effects of Masquelet technique and 3D printing in repair of Cierny-Mader type Ⅳ long bone osteomyelitis.Methods:A retrospective study was conducted of the 8 patients who had been treated at Department of Orthopaedics, The Third Affiliated Hospital to Peking University for Cierny-Mader type Ⅳ osteomyelitis of the lower extremity from June 2017 to December 2019. They were 6 males and 2 females, aged from 27 to 79 years (average, 54.6 years). The defects involved femoral shaft in 5 cases, femoral metaphysis in one, tibia shaft in one, and tibial metaphysis in one. The defect lengths ranged from 7.7 to 15.5 cm, averaging 10.2 cm. Stage one was local infection control and temporary stability reconstruction using Masquelet technique, stage two design and 3D printing of the prosthesis and stable pattern design, and stage three prosthesis implantation and rehabilitation. The ranges of motion of the knee and ankle were recoded postoperatively and the functions evaluated using the Johner-Wruhs scores.Results:The average follow-up time for the 8 patients was 12.6 months (from 6 to 18 months). The total treatment time from the first admission to the last discharge ranged from 62 to 125 days (average, 91.0 days), the time for stage one from 13 to 57 days (average, 28.7 days), that for stage two from 30 to 87 days(average, 48.3 d), and that for stage three from 28 to 84 days (average, 63.0 days). The infection was controlled and there was no recurrence, implant loosening or breakage. Seven patients were capable of full weight-bearing at 14.7 days (from 4 to 42 days) after surgery. One patient recovered full weight-bearing 6 months after surgery due to severe osteoporosis. Fine functional recovery was achieved in the 8 patients, with a range of motion from 0° to 100° for the knee and a range from 35° dorsal flexion to 40° toe flexion for the ankle. The Johner-Wruhs scores at the last follow-up showed 2 excellent, 5 good and one moderate cases.Conclusion:In repair of Cierny-Mader type Ⅳ long bone osteomyelitis, Masquelet technique and 3D printing can shorten the treatment process and allow for early recovery.
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Acute ischemic stroke has become one of the important causes of death and disability in human beings, especially in elderly patients. Intravenous thrombolysis with alteplase is an important treatment. However, there are many underlying diseases and poor overall conditions in elderly patients, which increase the risk of intracranial hemorrhage. Intracranial hemorrhage transformation makes the patient′s condition worse, which is the most serious complication of alteplase intravenous thrombolysis, and also one of the important reasons for the low treatment rate of alteplase intravenous thrombolysis in elderly patients. Therefore, we need to pay close attention to the occurrence mechanism and risk factors of intracranial hemorrhage transformation after alteplase intravenous thrombolysis in elderly patients, so as to reduce the risk of intracranial hemorrhage transformation, improve the prognosis and reduce the risk of morbidity and mortality.
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Objective:To assess the nutritional status of elderly patients with dementia in a memory clinic and to identify patients with malnutrition and patients at risk for malnutrition.Methods:A total of 510 elderly dementia patients were recruited from a memory clinic of the First Affiliated Hospital of Chongqing Medical University.All subjects were assessed with the mini-nutritional assessment short-form(MNA-SF), mini-mental state examination(MMSE), activities of daily living scale(ADL)and neuropsychiatric inventory(NPI). Logistic regression was used to explore potential risk factors and to establish a prediction model.Results:13.33%(68/510)of participants were classified as being malnourished, 52.94%(270/510)as being at risk for malnutrition and 33.73%(172/510)as well nourished.A Logistic regression model for predicting malnutrition identified dysphagia, irritability, physical self-maintenance scale(PSMS), appetite and eating disorders as important influencing factors( OR=4.334, 1.096, 1.121, 1.213, all P<0.05), and MMSE score, family history of dementia and age were important influencing factors for predicting malnutrition/at risk for malnutrition( OR=0.923, 0.517, 1.045, all P<0.05). Conclusions:The incidence of malnutrition and the risk of malnutrition in elderly patients with dementia in the memory clinic are high, and there are many related influencing factors.Early detection and intervention can delay or avoid malnutrition.
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With population aging, the prevalence of Alzheimer's disease(AD)is rapidly growing year by year.In recent years, nutritional treatment, as a non-pharmaceutical intervention for AD, has made great progress and shown great potential for the development of treatment strategies.Nutritional intervention mainly includes micronutrient intervention, medical food intervention and dietary pattern intervention, which together play an important role in the prevention and treatment of AD.This review primarily focuses on the mechanisms and methods of nutritional treatment and summarizes the progress in theoretical research and practice about nutrition intervention in China and other countries.
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Objective:To investigate the effectiveness and safety of early combined with tirofiban in the treatment of elderly patients with acute ischemic stroke after intravenous thrombolysis with alteplase.Methods:Elderly (60-75 years old) patients with acute ischemic stroke received intravenous alteplase thrombolysis in the Department of Neurology, Traditional Chinese Medicine Hospital of Huangdao District, Qingdao from January 2018 to May 2020 were enrolled prospectively. According to whether tirofiban is combined or not, they were divided into tirofiban group and non-tirofiban group. Tirofiban was pumped intravenously 2 h after intravenous thrombolysis, first 0.4 μg/(kg·min) for 30 min, then 0.1 μg/(kg·min) for 24 h. The efficacy endpoints included National Institutes of Health Stroke Scale (NIHSS) score at 7 d after treatment and modified Rankin Scale (mRS) score at 90 d after onset. 0-2 was defined as good outcome, and >2 was defined as poor outcome. The safety endpoints included the incidence of hemorrhagic transformation, symptomatic intracranial hemorrhage (sICH) and mortality within 90 days after onset.Results:A total of 124 patients with acute ischemic stroke were enrolled. The median age was 68 years (range, 60-75 years). There were 73 males (58.9%) and 51 females (41.1%). There were 62 patients (50%) in the tirofiban group and 62 (50%) in the non-tirofiban group. The median baseline NIHSS score was 14. Hemorrhagic transformation occurred in 7 patients (5.6%), of which 2 were sICH (1.6%). The follow-up at 90 d after onset showed that 68 patients (54.8%) had a good outcome, 56 (45.2%) had a poor outcome, of which 4 (3.2%) died. The NIHSS score at 7 d after treatment (5.52±4.79 vs. 7.35±3.80; t=2.357, P=0.020) and the rate of good outcome at 90 d after onset (64.5% vs. 45.2%; χ2=4.689, P=0.030) in the tirofiban group were significantly better than those of the non-tirofiban group, and there were no significant differences among the incidence of hemorrhagic transformation (4.8% vs. 6.5%; P=1.000), sICH (1.6% vs. 1.6%; P=1.000), and 90 d mortality (3.2% vs. 3.2%; P=1.000). Conclusion:After intravenous thrombolysis with alteplase, the early combined treatment with tirofiban in elderly patients with acute ischemic stroke can significantly improve the efficacy and outcome, and will not increase the risk of hemorrhagic transformation, sICH and death.
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@#AIM: To investigate the clinical effect of canaliculotomy joint novel R-S lacrimal tube implantation under lacrimal endoscope for canaliculitis.<p>METHODS: Thirty-one patients(thirty-two eyes)diagnosed as canaliculitis were investigated from July 2016 to September 2019 in our department. All patients have treated with canaliculotomy joint lacrimal tube implantation under lacrimal endoscope. The patients were randomly divided into two groups. Group A was treated with novel R-S lacrimal tube for 15 cases 15 eyes, and group B was treated with annular silicone tube. They were removed the lacrimal tube after 2-3mo, and followed postoperatively for at least 1a. The treatment results were comparatively analyzed.<p>RESULTS: The effective rate was 93% in group A and 94% in group B(<i>P</i>>0.05). The mean time of lacrimal tube implantation of group A was 2.27±1.335min, and group B was 5.29±1.404min. The total rate of complications was 7% in group A and 47% in group B. The rate of foreign body sensation in nasal cavity was 7% in group A and 41% in group B. The rate of increased nasal secretions was 0 in group A and 29% in group B. The difference of the mean time of lacrimal tube implantation, the rate of complications, the rate of foreign body sensation in nasal cavity and the rate of increased nasal secretions between two groups was statistically significant(<i>P</i><0.05).<p>CONCLUSION: Canaliculotomy joint novel R-S lacrimal tube implantation under lacrimal endoscope is an effective way. The novel R-S lacrimal tube has the advantages of simple operation, less postoperative complications and high patient comfort.
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Objective:To compare the short-term outcomes of femoral neck system (FNS) and dynamic hip screw (DHS) in the treatment of femoral neck fractures.Methods:A retrospective analysis was performed of the 105 patients with fresh femoral neck fracture who had been treated by FNS fixation from September 2019 to October 2020 or by DHS fixation from January 2018 to October 2020 at Department of Orthopaedics, The Third Hospital Affiliated to Peking University. In the FNS group of 54 cases, there were 18 males and 36 females with a mean age of (60.7±15.2) years; in the DHS group of 51 cases, there were 14 males and 37 females with a mean age of (63.3±13.2) years. The 2 groups were compared in terms of hospital stay, operation time, intraoperative blood loss, incision length, intraoperative fluoroscopy frequency, qualify of reduction, and femoral neck shortening length, Harris hip score and complications at the last follow-up.Results:The 2 groups were comparable due to insignificant differences in their preoperative general data or follow-up time ( P>0.05). In the FNS group, the median operation time [45.0 (40.0, 59.0) min], intraoperative blood loss [30.0 (20.0, 50.0) mL], incision length [4.0 (4.0, 5.0) cm], intraoperative fluoroscopy frequency [10.5 (9.0, 12.0) times] and hospital stay [2.0 (2.0, 4.0) d] were significantly superior to those in the DHS group [72.0 (55.0, 89.0) min, 50.0 (30.0, 50.0) mL, 7.0 (6.0, 8.0) cm, 18.0 (15.0, 19.0) times, and 3.0 (3.0, 6.0) d] (all P<0.05). There were no statistical differences between the 2 groups in quality of reduction, length of femoral neck shortening, failure rate of internal fixation or Harris hip score at the last follow-up ( P>0.05). There were no such surgical complications as deep infection or femoral head necrosis in either of the 2 groups. Conclusions:In the fixation of femoral neck fractures, both FNS and DHS may lead to fine short-term outcomes. However, compared with DHS, FNS exhibits advantages of simplicity, minimal invasion, less surgical trauma and intraoperative fluoroscopy frequency, and reduced operation time and hospital stay.
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Objective:To find the natural environmental boundary of the origin of the authentic Ligusticum chuanxiong by analyzing the distribution characteristics of soil elements in the traditional geo-authentic area and the southern continuous expanding areas along the same longitude. Method:The contents of 24 elements both in soil and plant L. chuanxiong samples were determined by using X-ray fluorescence spectrometry （XRF） and ICP-MS，etc. Spearman correlation test was used to evaluate the correlations of rhizosphere soil and each portion of L. chuanxiong，to screen out “characteristic elements”. Bray-Curtis similarity indexes based on all elements and "characteristic elements" were used for hierarchical cluster analysis of soil samples, to identify the sample range with similar soil element charateristics to the traditional geo-authentic area of L. chuanxiong. Result:K，Mg，Mn and Rb elements were significantly correlated in rhizosphere soil and plant L. chuanxiong. Geographical differentiation of all elements and four characteristic elements showed that there was a highest similarity between geo-authentic area and its neighbor plots S1-S6 (except plot S4) in soil elements distribution, followed by plots S14-S16. The middle section plots S7-S13 in the expansion areas were quite different from the traditional geo-authentic production areas. Conclusion:The soil element characteristics in the study areas were not completely controlled by geographical distance，but demonstrated the "fault" variation in the areas along longitude. This study provides a theoretical basis for the detrrmination of suitable cultivation area for Ligusticum Chuanxiong, and the natural boundary of its geo-authentic area may be extended an additional 60 km southward along longitude beyond the traditional origin. Additionally， K，Mg，Mn and Rb characteristic elements may be the potential markers to evaluate the suitable soil environment for cultivating L. chuanxiong.
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BACKGROUND@#The purpose of this study was to analyze cases of AO31-A2 intertrochanteric fractures (ITFs) and to identify the relationship between the loss of the posteromedial support and implant failure.@*METHODS@#Three hundred ninety-four patients who underwent operative treatment for ITF from January 2003 to December 2017 were enrolled. Focusing on posteromedial support, the A2 ITFs were divided into two groups, namely, those with (Group A, n = 153) or without (Group B, n = 241) posteromedial support post-operatively, and the failure rates were compared. Based on the final outcomes (failed or not), we allocated all of the patients into two groups: failed (Group C, n = 66) and normal (Group D, n = 328). We separately analyzed each dataset to identify the factors that exhibited statistically significant differences between the groups. In addition, a logistic regression was conducted to identify whether the loss of posteromedial support of A2 ITFs was an independent risk factor for fixation failure. The basic factors were age, sex, American Society of Anesthesiologists (ASA) score, side of affected limb, fixation method (intramedullary or extramedullary), time from injury to operation, blood loss, operative time and length of stay.@*RESULTS@#The failure rate of group B (58, 24.07%) was significantly higher than that of group A (8, 5.23%) (χ = 23.814, P < 0.001). Regarding Groups C and D, the comparisons of the fixation method (P = 0.005), operative time (P = 0.001), blood loss (P = 0.002) and length of stay (P = 0.033) showed that the differences were significant. The logistic regression revealed that the loss of posteromedial support was an independent risk factor for implant failure (OR = 5.986, 95% CI: 2.667-13.432) (P < 0.001).@*CONCLUSIONS@#For AO31-A2 ITFs, the loss of posteromedial support was an independent risk factor for fixation failure. Therefore, posteromedial wall reconstruction might be necessary for the effective treatment of A2 fractures that lose posteromedial support.
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BACKGROUND@#Reverse intertrochanteric fractures are usually initially treated with closed reduction. However, sometimes these fractures are not amenable to closed reduction and require open reduction. To date, few studies have been conducted on predictors of and reduction techniques for irreducible reverse intertrochanteric fractures. Therefore, this study aimed to summarize the displacement patterns of irreducible reverse intertrochanteric fractures and corresponding reduction techniques, and explore predictors of irreducibility.@*METHODS@#We reviewed 1174 cases of trochanteric fractures treated in our hospital from January 2006 to October 2018, 113 of which were reverse intertrochanteric fractures. An irreducible fracture was determined according to intra-operative fluoroscopy imaging after closed manipulation. Fractures were assessed for displacement patterns, radiographic features of irreducibility, and reduction techniques. Logistic regression analysis was performed on potential predictors for irreducibility, including gender, age, body mass index, AO Foundation/Orthopaedic Trauma Association (AO/OTA) classification, and radiographic features.@*RESULTS@#Seventy-six irreducible fractures were identified, accounting for 67% of reverse intertrochanteric fractures. Six patterns of fracture displacement after closed manipulation were identified; the most common pattern was medial displacement and posterior sagging of the femoral shaft relative to the head-neck fragment. Multivariate logistic regression analysis identified three predictors of irreducibility: a medially displaced femoral shaft relative to the head-neck fragment on the anteroposterior (AP) view (odds ratio [OR], 8.00; 95% confidence interval [CI], 3.04-21.04; P < 0.001), a displaced lesser trochanter (OR, 3.61; 95% CI, 1.35-9.61; P = 0.010), and a displaced lateral femoral wall (OR, 2.92; 95% CI, 1.02-8.34; P = 0.046).@*CONCLUSIONS@#A high proportion of reverse intertrochanteric fractures are not amenable to closed reduction. Six patterns of fracture displacement after closed manipulation were identified. Different reduction techniques are required for different displacement patterns. Predictors of irreducibility include a medially displaced femoral shaft relative to the head-neck fragment on the AP view, a displaced lesser trochanter, and a displaced lateral femoral wall. These patients warrant special consideration in terms of recognition and management.
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Background@#Reverse intertrochanteric fractures are usually initially treated with closed reduction. However, sometimes these fractures are not amenable to closed reduction and require open reduction. To date, few studies have been conducted on predictors of and reduction techniques for irreducible reverse intertrochanteric fractures. Therefore, this study aimed to summarize the displacement patterns of irreducible reverse intertrochanteric fractures and corresponding reduction techniques, and explore predictors of irreducibility.@*Methods@#We reviewed 1174 cases of trochanteric fractures treated in our hospital from January 2006 to October 2018, 113 of which were reverse intertrochanteric fractures. An irreducible fracture was determined according to intra-operative fluoroscopy imaging after closed manipulation. Fractures were assessed for displacement patterns, radiographic features of irreducibility, and reduction techniques. Logistic regression analysis was performed on potential predictors for irreducibility, including gender, age, body mass index, AO Foundation/Orthopaedic Trauma Association (AO/OTA) classification, and radiographic features.@*Results@#Seventy-six irreducible fractures were identified, accounting for 67% of reverse intertrochanteric fractures. Six patterns of fracture displacement after closed manipulation were identified; the most common pattern was medial displacement and posterior sagging of the femoral shaft relative to the head-neck fragment. Multivariate logistic regression analysis identified three predictors of irreducibility: a medially displaced femoral shaft relative to the head-neck fragment on the anteroposterior (AP) view (odds ratio [OR], 8.00; 95% confidence interval [CI], 3.04-21.04; P < 0.001), a displaced lesser trochanter (OR, 3.61; 95% CI, 1.35-9.61; P = 0.010), and a displaced lateral femoral wall (OR, 2.92; 95% CI, 1.02-8.34; P = 0.046).@*Conclusions@#A high proportion of reverse intertrochanteric fractures are not amenable to closed reduction. Six patterns of fracture displacement after closed manipulation were identified. Different reduction techniques are required for different displacement patterns. Predictors of irreducibility include a medially displaced femoral shaft relative to the head-neck fragment on the AP view, a displaced lesser trochanter, and a displaced lateral femoral wall. These patients warrant special consideration in terms of recognition and management.
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Objective@#To identify the risk factors for failure of internal fixation with proximal femoral nail antirotation (PFNA) for reverse intertrochanteric hip fractures.@*Methods@#A retrospective study was conducted of the 45 patients with reverse intertrochanteric hip fracture who had been treated with PFNA fixation from January 2006 through January 2018 at the Department of Traumatic Orthopaedics, The Third Affiliated Hospital to Peking University. They were 19 males and 26 females, aged from 19 to 97 years (average, 71.9 years). According to the AO/OTA classification, there were 7 cases of type 31-A3.1, 4 cases of type 31-A3.2 and 34 cases of type 31-A3.3. Fracture healing was judged according to the X-ray at the time of last follow-up. The patients were assigned into a healed group and a failed group. The 2 groups were compared in terms of gender, age, body mass index (BMI), mechanism of injury, AO classification, type of main fracture line, reduction method, reduction quality, status of lateral femoral wall and tip-apex distance. A multivariate logistic regression model was designed to analyse the dependent variable 'implant failure’ with a set of independent variables as risk factors.@*Results@#The 45 patients were followed up for 12 to 62 months (average, 28.4 months). Implant failure was observed in a total of 6 patients (13.3%), 3 of whom had helical blade perforation, 2 main screw breakage, and one cut-out of helical blade. The single factor analysis revealed significant differences in reduction quality and type of main fracture line between the patients with successful fixation and those with failed fixation (P<0.05). The multiple logistic regression analysis identified poor reduction quality (OR=30.809, 95%CI: 1.052~902.298, P=0.047) and a transverse fracture line (OR=25.639, 95%CI: 1.636~401.917, P=0.021) as risk factors for implant failure.@*Conclusion@#Poor reduction quality and a transverse fracture line may be predictors of implant failure in reverse intertrochanteric hip fractures treated with PFNA fixation.
ABSTRACT
Objective To identify the risk factors for failure of internal fixation with proximal femoral nail antirotation (PFNA) for reverse intertrochanteric hip fractures.Methods A retrospective study was conducted of the 45 patients with reverse intertrochanteric hip fracture who had been treated with PFNA fixation from January 2006 through January 2018 at the Department of Traumatic Orthopaedics,The Third Affiliated Hospital to Peking University.They were 19 males and 26 females,aged from 19 to 97 years (average,71.9 years).According to the AO/OTA classification,there were 7 cases of type 31-A3.1,4 cases of type 3 1-A3.2 and 34 cases of type 3 1-A3.3.Fracture healing was judged according to the X-ray at the time of last follow-up.The patients were assigned into a healed group and a failed group.The 2 groups were compared in terms of gender,age,body mass index (BMI),mechanism of injury,AO classification,type of main fracture line,reduction method,reduction quality,status of lateral femoral wall and tip-apex distance.A multivariate logistic regression model was designed to analyse the dependent variable'implant failure'with a set of independent variables as risk factors.Results The 45 patients were followed up for 12 to 62 months (average,28.4 months).Implant failure was observed in a total of 6 patients (13.3％),3 of whom had helical blade perforation,2 main screw breakage,and one cut-out of helical blade.The single factor analysis revealed significant differences in reduction quality and type of main fracture line between the patients with successful fixation and those with failed fixation (P ＜ 0.05).The multiple logistic regression analysis identified poor reduction quality (OR=30.809,95％ CI:1.052～902.298,P=0.047) and a transverse fracture line (OR =25.639,95％ CI:1.636 ～ 401.917,P =0.021) as risk factors for implant failure.Conclusion Poor reduction quality and a transverse fracture line may be predictors of implant failure in reverse intertrochanteric hip fractures treated with PFNA fixation.