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Objective:To compare the efficacy of 2 fixation modes [dynamic hip screw (DHS) plus anti-rotation screw versus 3 cannulated compression screws (CCS)] in the treatment of femoral neck fractures complicated with comminuted posterior wall.Methods:The data were analyzed retrospectively of the 109 patients who had been treated for femoral neck fractures complicated with comminuted posterior wall at Department of Orthopaedics, Shenzhen Hospital, University of Chinese Academy of Sciences from February 2017 to December 2019. They were divided into 2 groups according to 2 fixation modes. There were 42 males and 16 females with an age of 48.5 (40.0, 55.3) years in CCS group of 58 cases subjected to fixation with 3 CCSs; there were 31 males and 20 females with an age of 47.0 (38.0, 53.0) years in DHS group of 51 cases subjected to fixation with DHS plus anti-rotation screw. The length of incision, operation time, intraoperative bleeding, weight-bearing time for the affected limb, visual analog scale (VAS), hip Harris score, and incidence of postoperative complications were compared between the 2 groups.Results:The comparison of preoperative general data between the 2 groups was not statistically significant, showing comparability between groups ( P>0.05). In the CCS group, the incision length [3.0 (2.9, 4.5) cm] and operation time [90.0 (73.8, 125.0) min] were significantly shorter than those in the DHS group [10.0 (9.0, 12.0) cm and 135.0 (110.0, 165.0) min], the intraoperative bleeding [40.0 (10.0, 100.0) mL] was significantly less than that in the DHS group [200.0 (150.0, 300.0) mL], the partial and complete weight-bearing durations of the affected limb [12.0 (12.0, 13.0) weeks and 24.0 (21.0, 25.0) weeks] were significantly longer than those in the DHS group [11.0 (10.0, 12.0) weeks and 19.0 (18.0, 20.0) weeks], and the perioperative VAS pain score [2.0 (2.0, 3.0) points] was significantly lower than that in the DHS group [5.0 (4.0, 6.0) points], but the incidence of follow-up complications [56.9% (33/58)] was significantly higher than that in the DHS group [33.3% (17/51)] (all P<0.05). There was no significant difference between the DHS group and the CCS group in the excellent and good rate of Harris hip score at one year after operation [94.1% (48/51) versus 91.4% (53/58)] ( P>0.05). Conclusions:In the treatment of femoral neck fractures complicated with comminuted posterior wall, DHS plus anti-rotation screw and 3 CCSs can both result in fine therapeutic outcomes but a relatively high incidence of complications at late follow-up. However, the former fixation mode can shorten the weight-bearing time for the affected limb and reduce complications but is more invasive than the latter fixation mode.
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Objective:To investigate the predictive value of triglyceride-glucose (TyG) index for the overall burden of cerebral small vessel disease (CSVD).Methods:Consecutive patients with CSVD admitted to Jiaxing First Hospital from July 2019 to January 2021 were enrolled. MRI was used to conduct the overall burden score of CSVD. The difference of TyG index and other risk factors between high burden group (3-4 points) and low burden group (0-2 points) was analyzed. The independent predictors of the high burden of CSVD were determined by the multivariate logistic regression analysis, and the predictive value of TyG index for the high burden of CSVD was evaluated by the receiver operating characteristic (ROC) curve. Results:A total of 165 patients with CSVD were enrolled, including 103 patients (62.4%) in the low burden group and 62 (37.6%) in the high burden group. The proportion of patients with previous stroke or transient ischemic attack, as well as age, fasting blood glucose, glycosylated hemoglobin and TyG index in the high burden group were significantly higher than those in the low burden group ( P<0.05). Multivariate logistic regression analysis showed that TyG index (odds ratio [ OR] 4.584, 95% confidence interval [ CI] 2.180-8.887; P=0.001) and age ( OR 1.075, 95% CI 1.025-1.128; P=0.003) were the independent predictors of high burden of CSVD. The ROC curve showed that the area under the curve of TyG index for predicting the high burden of CSVD was 0.69 (95% CI 0.60-0.77). The optimal cutoff value was 8.5, and its sensitivity and specificity for predicting the high burden of CSVD were 72.6% and 64.1%, respectively. Conclusion:TyG index is associated with the overall burden of CSVD and has certain predictive value for the high burden of CSVD.
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@#Objective The study aims to explore the value of insulin resistance（IR）in predicting the occurrence of cerebral small vessel disease（CSVD）.Methods A total of 172 patients were enrolled in the Affiliated Hospital of Jiaxing University from August 2019 to December 2020.HOMA-IR index was calculated according to the formula and the 3.0 value was the cut-off point of IR.All patients were divided into CSVD group and non-CSVD group or IR group and non-IR group.The total CSVD score was calculated according to the presence of each CSVD feature on MR from 0 to 4 using a recent described score rule.The relationship between CSVD and HOMA-IR was analyzed via the dichotomy logistic method.And the receiver operating characteristic curve (ROC curve) was used to evaluate the accuracy and specificity of HOMA-IR for predicting CSVD.Results The results showed the IR ratio rises with the increase of CSVD score.We compared the difference in the proportion of IR between mild CSVD and moderate-to-severe CSVD with the result of 44.1% vs 66.1% (P<0.05).HOMA-IR in non-CSVD group was significantly lower than those in CSVD group 1.9 (IQR:1.0~4.2) compared with 3.7 (IQR:1.5~5.1)(P<0.05).The result of OR value for multiple logistic regression analysis was 1.18 (95%CI 1.01~1.38)(P<0.05).ROC curve shows the sensitivity and specificity of the optimal cut-off value,marked as 2.54,were 65.25% and 62.96% (P=0.004).Conclusion IR has a certain predictive value in the diagnosis of CSVD.It is involved in the pathogenesis and progression of CSVD.
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Insulin resistance is a important risk factor for ischemic stroke.It plays an important role in the occurrence and development of ischemic stroke.Therefore,the detection of insulin resistance as early as possible and appropriate treatment are important for the outcomes and prevention of ischemic stroke.This article briefly summarizes the diagnoses and pathological mechanisms of insulin resistance,and focuses on the main mechanisms of insulin resistance-induced ischemic stroke and the clinical relevance of the two.