What Is the Impact of Body Mass Index Cutoffs on Total Hip Arthroplasty Complications?

BackgroundBody mass index (BMI) cutoffs are commonly utilized to decide whether to offer obese patients elective total hip arthroplasty (THA). However, weight loss goals may be unachievable for many, and some patients are thereby denied complication-free surgery. The purpose of this study was to assess the impact of varying BMI cutoffs on the rates of complication-free surgery after THA.MethodsPatients undergoing THA between 2015 and 2018 were identified in the American College of Surgeons National Surgical Quality Improvement Program database using Common Procedural Terminology code 27130. BMI and rates of 30-day complications were collected. BMI cutoffs of 30, 35, 40, 45, and 50 kg/m² were applied to model the incidence of complications if THA would have been allowed to proceed based on BMI.ResultsA total of 192,394 patients underwent THA, and 13,970 (7%) of them had a BMI ≥40 kg/m². With a BMI cutoff of 40 kg/m², 178,424 (92.7%) patients would have proceeded with THA. From this set, 170,296 (95.4%) would experience complication-free surgery, and 11.8% of complications would be prevented. THA would proceed for 191,217 (99.3%) patients at a BMI cutoff of 50 kg/m², of which 182,123 (95.2%) would not experience a complication, and 1.3% of complications would be prevented. Using 35 kg/m² as the BMI cutoff would prevent 28.6% of complications and permit 75.9% of complication-free surgeries to proceed.ConclusionLower BMI cutoffs for THA can result in fewer complications although they will consequentially limit access to complication-free THA. Consideration of risks of obesity in THA may be best considered as part of a holistic assessment and shared decision-making when deciding on goals for weight reduction.     

小儿呼吸道异物影像表现的探讨

目的评价各种影像检查在小儿呼吸道异物中的价值,提高小儿呼吸道异物的诊断水平。方法本院近5年收治小儿呼吸道异物56例。回顾性评价影像检查方法,分析不同类型不同部分的影像表现。结果声门附近异物7例,5例可见异物的直接征象。气管异物14例,均可见两肺不同程度的肺气肿,透视下11例可见心脏反常大小,5例可见异物在气管内的上下移动。右支气管异物22例,左支气管异物13例。30例患者可见明确的肺气肿伴纵隔摆动。全部病例最后作了喉镜或支气管镜检查。取出不同种类的异物包括金属类2例,动物骨骼6例,花生23例,各种瓜子17例,水果、蔬菜5例,其他3例。影像诊断正确51例(91.1%),误漏诊5例(8.9%)。结论照片加透视检查,必要时辅以CT冠状位扫描,全面认识不透X线异物的各种间接征象,可以显著提高诊断符合率。     

周亚滨运用“三辨”法治疗稳定型心绞痛

周亚滨教授根据多年临床经验,认为稳定型心绞痛病因病机为心气血阴阳不足,心脉闭阻;病性为本虚标实、虚实夹杂,病程可分早、中、后三期;病位在心,涉及肝、脾、肾等脏。临证运用辨病、辨证、辨体结合的"三辨"法进行诊治,认为辨病为首要环节,辨证需辨明邪气所属,急则从标、缓则从本,分期论治,同时应考虑患者个体差异,因人而异,辨体选方。     

肌内注射舒适体位的应用研究

目的探讨肌内注射的最舒适体位。方法对410例(共1045例次)肌内注射病人采取自身对照法,每例病人至少注射2次,交替取传统的侧卧位肌内注射体位即侧卧,上腿伸直,下腿弯曲(传统体位)和改进后的体位即侧卧,上腿弯曲,下腿伸直(改良体位),采用简化Mcgil疼痛评分表和自制的卧位舒适评定表进行评定,对比两种不同注射体位注射时病人的疼痛和舒适程度。结果两种体位的疼痛评分无显著性差异(P=0.314),但两种体位的舒适度评分有显著性差异(P<0.0001),病人感觉采取改良体位注射较为舒适。结论上腿弯曲、下腿伸直的侧卧注射体位较传统的上腿伸直、下腿弯曲的体位更加舒适,较易为病人接受。     

减重步行训练对脑卒中后偏瘫步态康复的影响

目的:观察减重步行训练(BWSTT)对脑卒中患者偏瘫步态的恢复作用。方法:51例脑卒中患者分入实验组(21例)和对照组(30例)。两组均进行常规运动疗法(PT),实验组加BWSTT。共6周,5次／周,1单元／天,30min／单元。训练前后各行1次评价。结果:训练后实验组FAC评分、FMA下肢评分、步速、步长均明显提高(P<0.05),患侧单肢支撑期明显延长,双侧支撑期明显缩短(P<0.01),而对照组仅FMA下肢评分明显提高(P<0.001)。两组间对比,仅FMA下肢评分差异无显著性意义(P>0.05),其余各指标均为实验组改善更明显(P<0.05)。结论:BWSTT可提高偏瘫患者的步行能力、步速、步长,增加患侧单肢支撑期,减少双侧支撑期,改善步态对称性。     

The Influence of Obesity on Hip Pain,Function, and Satisfaction 10 Years Following Total Hip Arthroplasty

BackgroundThe prevalence of obesity is rising, and increasing numbers of joint arthroplasty surgeries are being performed on obese patients. Concern exists that obesity increases surgical risk; however, its impact on function following total hip arthroplasty (THA) is inconsistently affirmed and less understood. A paucity exists in the literature pertaining long-term objective functional measures. Therefore, we investigated the impact of obesity on hip pain, function, and satisfaction 10 years following THA.MethodsThis single-center, prospective, observational study categorized consecutive THA patients according to their body mass index to nonobese (<30 kg/m²) and obese (≥30 kg/m²) groups. Preoperative assessment included a numerical pain rating and the Oxford Hip Score. These were repeated along with a 6-minute walk test and a Likert satisfaction scale at 3 months, 1, 5, and 10 years postoperatively.ResultsThe series included 191 primary THA patients. No significant differences were found in hip pain or function between the obese and nonobese groups. Obese patients however had poorer walking capacity (P = .008), were more likely to use walking aids (P = .04), and were less satisfied (P = .04) at 10 years.ConclusionTHA confers significant long-term symptom resolution irrespective of obesity; however, despite undergoing surgery, obese patients can be counseled they may not be as satisfied as or achieve the same walking capacity as nonobese individuals.