Risk factors and prognosis of acute cerebrovascular events at 1 year after hip fracture in elderly patients / 中国骨伤

OBJECTIVE@#To investigate risk factors of acute cerebrovascular events and effects on the prognosis within 1 year after hip fracture surgery.@*METHODS@#A retrospective analysis was performed on 320 elderly patients with hip fracture treated from July 2017 to December 2020, including 111 males and 209 females, aged from 60 to 101 years old with an average of (79.05±8.48) years old. According to whether acute cerebrovascular events occurred within 1 year after surgery, patients were divided into cerebrovascular events and non-cerebrovascular events group. Clinical data of patients were collected, including age, sex, comorbidities, fracture type, white blood cell count, hemoglobin, albumin, activities of daily living (ADL) score, walking ability, type of anesthesia, type of surgery, and length of hospital stay, Univariate analysis and multivariate Logistic regression were used to analyze the independent risk factors of acute cerebrovascular events within 1 year after hip fracture in elderly patients. ADL, walking ability and mortality were compared between the two groups 1 year after surgery.@*RESULTS@#Acute cerebrovascular events occurred in 38 patients (11.9%) within 1 year after surgery. In the cerebrovascular events group, there were 20 males and 18 females, aged (82.53±7.91) years. In the non-cerebrovascular event group, there were 91 males and 191 females, aged with an average of (78.59±8.46) years old . Univariate analysis showed that acute cerebrovascular events were associated with age (t=2.712, P=0.007), male (χ2=6.129, P=0.013), hypertension (χ2=8.449, P=0.004), arrhythmia (χ2=6.360, P=0.012), stroke history (χ2=34.887, P=0.000), diabetes mellitus (χ2=4.574, P=0.032) and length of hospital stay (t=2.249, P=0.025) were closely related. Multivariate Logistic regression analysis showed age (OR=1.068, P=0.018), male (OR=2.875, P=0.008), arrhythmia (OR=2.722, P=0.017) and stroke history (OR=7.382, P=0.000) was an independent risk factor for acute cerebrovascular events 1 year after surgery. The patients with cerebrovascular events died at 1 year after surgery (11 cases) compared with those without cerebrovascular events (41 cases), and the difference was statistically significant(χ2=5.108, P=0.024). ADL scores of patients with cerebrovascular events at 1 year after operation were (58.70±14.45) points compared with those without cerebrovascular events (67.83±10.45) points, and the difference was statistically significant(t=4.122, P=0.000). Independent walking, assisted walking and bed rest were 3, 17 and 7 cases in cerebrovascular event group, and 54, 174 and 13 cases in non-cerebrovascular event group, respectively;and the difference was statistically significant(χ2=11.030, P=0.003).@*CONCLUSION@#Acute cerebrovascular events were common in elderly patients 1 year after hip fracture. Age, male, arrhythmia and stroke history were independent risk factors for acute stroke. The patients in the cerebrovascular event group had higher mortality and worse self-care ability and walking ability one year after operation.

Clinical observation of percutaneous coblation nucleoplasty for the treatment of cervical spondylotic radiculopathy / 中国骨伤

<p><b>OBJECTIVE</b>To evaluate the clinical effects of percutaneous coblation nucleoplasty in treating cervical spondylotic radiculopathy and investigate its mechanism of action.</p><p><b>METHODS</b>Form January 2015 to January 2017, 21 patients with cervical spondylotic radiculopathy were treated by percutaneous coblation nucleoplasty, including 8 males and 13 females with an average age of 49.6 years old ranging from 43 to 61 years old. The course of disease was for 1 to 6 months with a median age of 4 months. Three cases were single segment, 9 cases were double segments, 7 cases were three-segment, 2 cases were four-segment. Intervertebral disc pressure, VAS were compared before and after operation. Angular displacement(AD) and horizontal displacement(HD) were measured by image data and in order to evaluate the cervical stability. Modified MacNab criteria was used to assess clinical effects.</p><p><b>RESULTS</b>All the patients were followed up from 1 to 12 months with an average of 8.6 months. Preoperative intervertebral disc pressure was (32.0±5.26) cmH2O and immediately after operation was (21.0±7.18) cmH2O, there was statistical significance between before and after operation(=0.003). Preoperative angular displacement and horizontal displacement was (3.85±1.26) ° and (1.23±0.58) mm, six months after operation was (4.18±1.31) ° and (1.69±0.46) mm, respectively. There was no statistical significance before and after operation(>0.05). Preoperative VAS scores were 7.49±0.53, postoperative at 3 days, 3, 6 months were 3.51±0.49, 2.63±0.61, 2.56±0.71, respectively, and postoperative obtained obvious improvement(<0.05). According to modified MacNab criteria, 6 cases obtained excellent results, 7 good, 4 fair 3 poor at 3 days;10 cases obtained excellent results, 5 good, 3 fair, 2 poor at 3 months; 12 cases obtained excellent results, 6 good, 1 fair, 1 poor at 6 months after operation. Postoperative clinical effect at 6 months was better than 3 d, and 3 months(<0.05), and postoperative at 3 months was better than 3 d(<0.05).</p><p><b>CONCLUSIONS</b>Percutaneous coblation nucleoplasty in treating cervical spondylotic radiculopathy can effectively relieve the pain of neck, shoulder and upper limb and can also relieve some associated symptoms such as headache and dizziness.</p>