Comorbidity and Quality of In-Hospital Care for Hip Fracture Patients

ObjectivesWe examined whether the comorbidity burden of patients with hip fracture was associated with quality of in-hospital care reflected by fulfillment of process performance measures.DesignPopulation-based cohort study using prospectively collected data from the Danish Multidisciplinary Hip Fracture Registry (DMHFR).Setting and ParticipantsPatients aged 65 years or older with an incident hip fracture from 2014 to 2018 registered in the DMHFR (n = 31,443).MethodsComorbidity was measured using the Charlson Comorbidity Index based on hospital diagnoses. Quality of in-hospital care was defined as fulfillment of eligible process performance measures, including preoperative optimization, early surgery, early mobilization, pain assessment, basic mobility, nutritional risk, need for anti-osteoporotic medication, fall prevention, and a post-discharge rehabilitation program, reflecting guideline-recommended in-hospital care. The outcomes were (1) an all-or-none composite measure defined as fulfillment of all relevant process performance measures, and (2) fulfillment of the individual process performance measures. Using binary regression, we calculated relative risk (RR) for the association between comorbidity level and outcomes.ResultsThe overall proportion of patients with hip fracture who fulfilled the all-or-none measure was 31%. Among patients with no comorbidity, 34% fulfilled the all-or-none measure versus 29% among patients with high comorbidity (Charlson ≥ 3). This corresponds to a 15% lower chance (RR = 0.85, 95% confidence interval 0.81–0.89). Increasing comorbidity was also associated with lower fulfillment of the individual process performance measures. The largest difference was seen for preoperative optimization, early surgery, and early mobilization, where patients with high comorbidity had 6% to 11% lower chance of fulfillment of these process performance measures compared with patients without comorbidity.Conclusion and ImplicationsIncreasing level of comorbidity was associated with lower quality of in-hospital care among patients with hip fracture. Our results highlight the need for tailored clinical initiatives to ensure that comorbid patients also benefit from the positive progress in hip fracture care in recent years.     

老年人髋部骨折的骨密度及影响因素的分析

目的调查分析成都地区老年人髋部骨折骨密度变化和影响因素,为预防髋部骨折提供科学依据.方法骨折组答卷式调查有关指标,髋部作X线正斜侧位摄片,骨折组与非骨折组进行配对,均用DEXA测量L2～4,股骨上段骨密度(BMD),骨矿含量(BMC),骨面积(Area)等,并进行统计分析.结果股骨上段及L2～4的BMD、BMC骨折组明显低于非骨折组(P＜0.05),两组各进行男女性比较,女性均明显低于男性(P＜0.05),骨折组L2～4BMD男、女分别为0.872±0.178g/cm2,0.607±0.155g/cm2;非骨折组男女分男为0.921±0.147g/cm2,0.741±0.152g/cm2.同性别的骨面积Area两组比较无差异,骨折组骨质疏松症发生率76%明显高于非骨折组63%(P＜0.05);滑倒和被人撞倒股骨颈骨折发生率较高,自行拌倒者粗隆间骨折发生率较高.结论预防治疗骨质疏松症和避免摔倒,以防骨折的发生.     

心脏瓣膜置换术48例围手术期的处理

目的：总结瓣膜置换术围手术期处理所临床经验。方法：回顾性分析48例瓣膜置换术病人术前、术中、术后处理的临床资料。结果：发生围手术期并发症共14例,其中低心排4例,心律失常4例最多。长期存活47例,死于多器官功能衰竭1例。结论：术前注意纠正心功能不足与合并症的治疗,术中注意心肌保护与三尖瓣关闭不全的矫治,术后强调补足血容量和血清钾后强心利尿。     

全髋关节置换术后异位骨化及其预防

目的：探讨全髋关节置换术后异位骨化发生的原因、机制及其预防方法。方法：将139例接受全髋关节置换的患者入院时随机分为3组,A组53例,B组49例,C组37例,分别于术后次日口服维生素C（100mg,3/d)、消炎痛（25mg/3/d)和布洛芬（200mg,3/d),连续应用4周。术后3个月复查时行X线片检查。结果：异位骨化情况按Brooker分类,A组：0级24例,I级6例,Ⅱ级13例,Ⅲ级7例,Ⅳ级3例,异位骨化发生率54．7％（29／53）。B组：0级42例,Ⅰ级5例,Ⅱ级2例,发生率14．3％（7／49）。C组：0级32例,Ⅰ级3例,Ⅱ级、Ⅲ级各1例,发生率13．5％（5／37）。经统计学分析,异位骨化发生率A组与B组、A组与C组之间有显著差别（P＜0．01）,B组与C组之间无显著差别（P＞0．05）。结论：全髋关节置换术后发生异位骨化的原因很多,发生机制尚不清楚,非甾体类消炎镇痛类药物可有效地预防其发生。     

e-PTFE与Bioglass结合修复重建下颌骨缺损的实验研究

目的通过动物实验,观察膜引导组织再生术(MGTR)与生物活性材料结合修复重建下颌骨骨缺损的效果.方法手术制备下颌骨标准骨缺损不愈合模型,将膨体聚四氟乙烯膜(e-PTFE)与Bioglass结合修复下颌骨缺损.结果实验组(e-PTFE-Bioglass)与对照组(e-PTFE)在术后各时点2、4、8、12w新生骨形成量有显著差异(P＜0.05).结论MGTR与Bioglass结合修复重建下颌骨骨缺损,术后成骨早,术后12w似正常骨质,为进一步临床应用提供实验依据.     

复杂性面骨骨折的处理

（1）目的 探讨复杂性面骨骨折临床治疗方法及效果。（2）方法 对18例面骨多处骨折或多发。陈旧性骨折的病人采用冠状切口加口内切口、面部小切口加口内切口相结合的术式及正颌外科,微小夹板固定技术。进行再骨折复位或截骨复位、固定。（3）结果 全部病人术后张口无受限,咬He关系良好,功能及形态满意,复视消失,2例出现再次脑脊液鼻漏,经7-8d后愈合。无其他严重并发症出现。（4）结论 复杂性面骨骨折应选择合适时机,根据病情采用不同的术式治疗,可达到满意的效果。     

HbA1c over 8.5% is not predictive of increased infection rate following penile prosthesis implant surgery in diabetic patients with erectile dysfunction

Diabetes mellitus is associated with increased risk of erectile dysfunction. Penile prosthesis implantation is an efficient therapeutic option for erectile dysfunction, but not without risk, as infection remains a prominent concern. This study investigates diabetes mellitus as a risk factor for penile prosthesis implantation infection and the relationship between haemoglobinA1c levels and infection rates. All diabetic patients with erectile dysfunction who underwent penile prosthesis implantation surgery between January 2012 and November 2019 at Hamad Medical Corporation, Qatar, were included in this retrospective observational study. A total of 599 diabetic patients with erectile dysfunction had penile prosthesis implantation. Mean age was 59.69 ± 31.19. Penile prosthesis implantation infection rate was 0.83% (5/599), while the mean haemoglobinA1c level was 7.58 ± 1.45 mmol/l (range: 4.1–12.6). A comparison between diabetic patients with penile prosthesis implantation infection and those without infection revealed no significant difference in the level of haemoglobinA1c between the two groups with mean haemoglobinA1c in patients with infected implants 7.14 and 7.59 for noninfected (p = 0.491). Limitations include retrospective single-centre design and low-infection rates reducing sample number. Penile prosthesis implantation infection rate in a large series of diabetic patients was low with no significant association between haemoglobinA1c level and penile prosthesis implantation infection observed.     

Primary versus revision implant for inflatable penile prosthesis: A propensity score-matched comparison

Inflatable penile prosthesis (IPP) provides excellent outcomes after virgin implants. However, few data on IPP after revision surgery are available. This study aimed at comparing the outcomes of IPP in patients undergoing primary or revision implant surgery. Patients who underwent revision implant surgery (Group 1) between 2013 and 2020 were identified. Overall, 20 patients (Group 1) could be matched with a contemporary matched pair cohort of surgery-naive patients (Group 2) in a 1:1 ratio. Patients in Group 2 had a significantly shorter operative time [median (IQR): 84 (65–97) vs. 65 (51–75) min; p = .01] and lower rate of overall complications (25% vs. 10%; p = .01). Of note, mean (SD) scores for the Quality of Life and Sexuality with Penile Prosthesis (QoLSPP) questionnaire demonstrated high satisfaction and IPP efficacy in both Groups 1 and 2: functional domain [3.9 (1.0) vs. 4.0 (1.2); p = .4], personal [3.9 (1.1) vs. 4.0 (1.1); p = .3], relational [3.8 (1.3) vs. 3.9 (1.1); p = .5] and social [3.9 (1.1) vs. 4.0 (1.2); p = .2]. These results suggest that in experienced hands, IPP offers high satisfaction to both patients and partners even in the setting of revision implant. However, it is mandatory to inform those patients about the increased risk of perioperative complications.     

Highly Crosslinked Polyethylene Can Reduce Wear Rate in THA for High-Demand Patients: A Matched-Paired Controlled Study

BackgroundThe average age of patients benefiting from total hip arthroplasty (THA) has been declining. In addition to pain relief, patients seek to return to physical activity. However, the latter may increase polyethylene wear and therefore the potential risk of early aseptic loosening. The introduction of highly crosslinked polyethylene (HXLPE) has reduced wear rates in the general patient population. The objective of this study was to evaluate the influence of impact sports in patients operated with THA using ceramic-on-conventional polyethylene (cPE) versus ceramic-on-HXLPE, in terms of wear and function, with a minimum of five year follow-up.MethodsSixty-eight patients practicing an impact sport (University of California Los Angeles score ≥8) who underwent a primary THA were included: 34 with a ceramic-on-cPE versus 34 with a ceramic-on-HXLPE using the same cementless acetabular and femoral component. Patients were matched-paired by age, sex, BMI, and University of California Los Angeles score. The wear analysis was performed using the IMAGIKA software. The Harris hip score and hip and osteoarthritis outcome score were collected.ResultsThe linear wear rate was statistically higher (P < .0001) in the cPE group (0.13503 ± 0.0630 mm/year) than in the HXLPE group (0.03059 ± 0.0084 mm/year). Postoperatively, the increase in Harris hip score was calculated at 37.64 for the entire cohort and was comparable in both groups (P = .3674). The hip and osteoarthritis outcome score for pain (P = .0009), daily life activities (P = .0016), and quality of life (P = .0179) were significantly higher in the HXLPE group, with, between groups, a difference inferior to the reported minimal clinical important difference. Three patients exhibited signs of periprosthetic osteolysis in the cPE group, one on the femoral side and two on the acetabular side. None were observed in the HXLPE group. No revision for aseptic loosening was reported in both cohorts.ConclusionPatients partaking in impact sports and receiving a ceramic-on-HXLPE THA demonstrated lower wear and osteolysis rates than those having a ceramic-on-cPE THA, with similar functional results.