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Yao R, Yin P, Zhang Y, Li D, Zhang XN, Tao L, Zhou J, Su Q. Is there a risk of further displacement of the fractured fragment into the spinal canal in osteoporotic vertebral burst fractures after unilateral PKP? A prospective study. Spine J 2024; 24:1077-1086. [PMID: 38110090 DOI: 10.1016/j.spinee.2023.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 11/14/2023] [Accepted: 12/14/2023] [Indexed: 12/20/2023]
Abstract
BACKGROUND CONTEXT The optimal treatment for osteoporotic vertebral burst fracture (OVBF) without neurological symptoms is still a matter of debate. PURPOSE To evaluate the safety and efficacy of percutaneous kyphoplasty (PKP) for OVBF. STUDY DESIGN The study is a prospective study and is registered in the China Clinical Trials Registry with the registration number ChiCTR-OOC-17013227. PATIENT SAMPLE The study involved 119 patients with 137 fractured vertebrae who underwent unilateral PKP for OVBF. OUTCOME MEASURES The measurements were carried out independently by two physicians and measured with picture archiving and communication system (PACS) and ImageJ software (National Institutes of Health, Bethesda, MD, USA). METHODS The change in the spinal canal area and posterior wall protrusions (PWP) were measured before and after surgery via three-dimensional computed tomographic imaging (CT). Preoperative, postoperative, and final follow-up standing X-rays were used to measure the height of the anterior wall (HAW), height of the posterior wall (HPW), and local kyphotic angle (LKA). Additionally, visual analogue scale (VAS) and the Oswestry Disability Index (ODI) were also determined. RESULTS Among the 137 vertebrae assessed, 79 exhibited an increased postoperative canal area, while 57 showed a decrease, with mean values of 8.28±6.871 mm² and -9.04±5.991 mm², respectively. Notably, no significant change in postoperative canal area was identified on the entire dataset (p>.01). There was a significant decrease between median preoperative (3.9 [IQ1-IQ3=3.3-4.8] mm) and postoperative (3.7 [IQ1-IQ3=3.0-4.4] mm) PWP (p<.01). Preoperative and postoperative HAW measurements were 19.4±6.1 mm and 23.2±5.2 mm, respectively (p<.01). However, at the final follow-up, the HAW was lower than the postoperative value. The HPW was also significantly improved after surgery (p<.01), but at the final follow-up, it was significantly decreased compared with the postoperative measurement. Following surgery, KA was significantly corrected (p<.01); however, at the final follow-up, relapse was detected (average KA: 18.4±10.3°). At the final follow-up, both VAS and ODI were significantly improved compared with the preoperative period (p<.01). As for complications, 50 patients experienced cement leakage, and 16 patients experienced vertebral refracture. All patients did not develop neurological symptoms during the follow-up. CONCLUSIONS OVBF without neurological deficits showed significant improvement in symptoms during the postoperative period after PKP. There was no notable alteration in the spinal canal area, but a significant decrease in PWP was observed. Consequently, we posit that PKP stands as a secure and efficacious surgical intervention for treating OVBF cases devoid of neurological symptoms.
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Affiliation(s)
- Ruizhang Yao
- Beijing Chao-Yang Hospital, 8 Gongti South Road, Chaoyang District, Beijing, 100020, China
| | - Peng Yin
- Beijing Chao-Yang Hospital, 8 Gongti South Road, Chaoyang District, Beijing, 100020, China
| | - Yaoshen Zhang
- Beijing Chao-Yang Hospital, 8 Gongti South Road, Chaoyang District, Beijing, 100020, China
| | - Dongyue Li
- Beijing Chao-Yang Hospital, 8 Gongti South Road, Chaoyang District, Beijing, 100020, China
| | - Xi-Nuo Zhang
- Beijing Chao-Yang Hospital, 8 Gongti South Road, Chaoyang District, Beijing, 100020, China
| | - Luming Tao
- Beijing Chao-Yang Hospital, 8 Gongti South Road, Chaoyang District, Beijing, 100020, China
| | - Junlin Zhou
- Beijing Chao-Yang Hospital, 8 Gongti South Road, Chaoyang District, Beijing, 100020, China
| | - Qingjun Su
- Beijing Chao-Yang Hospital, 8 Gongti South Road, Chaoyang District, Beijing, 100020, China.
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Yu Q, Fu M, Wang Z, Hou Z. Predictive characteristics and model development for acute heart failure preceding hip fracture surgery in elderly hypertensive patients: a retrospective machine learning approach. BMC Geriatr 2024; 24:296. [PMID: 38549043 PMCID: PMC10976760 DOI: 10.1186/s12877-024-04892-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 03/13/2024] [Indexed: 04/01/2024] Open
Abstract
BACKGROUND Hip fractures are a serious health concern among the elderly, particularly in patients with hypertension, where the incidence of acute heart failure preoperatively is high, significantly affecting surgical outcomes and prognosis. This study aims to assess the risk of preoperative acute heart failure in elderly patients with hypertension and hip fractures by constructing a predictive model using machine learning on potential risk factors. METHODS A retrospective study design was employed, collecting preoperative data from January 2018 to December 2019 of elderly hypertensive patients with hip fractures at the Third Hospital of Hebei Medical University. Using SPSS 24.0 and R software, predictive models were established through LASSO regression and multivariable logistic regression analysis. The models' predictive performance was evaluated using metrics such as the concordance index (C-index), receiver operating characteristic curve (ROC curve), and decision curve analysis (DCA), providing insights into the nomogram's predictive accuracy and clinical utility. RESULTS Out of 1038 patients screened, factors such as gender, age, history of stroke, arrhythmias, anemia, and complications were identified as independent risk factors for preoperative acute heart failure in the study population. Notable predictors included Sex (OR 0.463, 95% CI 0.299-0.7184, P = 0.001), Age (OR 1.737, 95% CI 1.213-2.488, P = 0.003), Stroke (OR 1.627, 95% CI 1.137-2.327, P = 0.008), Arrhythmia (OR 2.727, 95% CI 1.490-4.990, P = 0.001), Complications (OR 2.733, 95% CI 1.850-4.036, P < 0.001), and Anemia (OR 3.258, 95% CI 2.180-4.867, P < 0.001). The prediction model of acute heart failure was Logit(P) = -2.091-0.770 × Sex + 0.552 × Age + 0.487 × Stroke + 1.003 × Arrhythmia + 1.005 × Complications + 1.181 × Anemia, and the prediction model nomogram was established. The model's AUC was 0.785 (95% CI, 0.754-0.815), Decision curve analysis (DCA) further validated the nomogram's excellent performance, identifying an optimal cutoff value probability range of 3% to 58% for predicting preoperative acute heart failure in elderly patients with hypertension and hip fractures. CONCLUSION The predictive model developed in this study is highly accurate and serves as a powerful tool for the clinical assessment of the risk of preoperative acute heart failure in elderly hypertensive patients with hip fractures, aiding in the optimization of preoperative risk assessment and patient management.
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Affiliation(s)
- Qili Yu
- Department of Geriatric Orthopedics, Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, China
| | - Mingming Fu
- Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, China
| | - Zhiqian Wang
- Department of Geriatric Orthopedics, Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, China.
| | - Zhiyong Hou
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, 050051, 050051, Hebei, China.
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Zheng F, Yang J, Zhang J, Li J, Fang W, Chen M. Efficacy and complications of single-port thoracoscopic minimally invasive esophagectomy in esophageal squamous cell carcinoma: a single-center experience. Sci Rep 2023; 13:16325. [PMID: 37770495 PMCID: PMC10539285 DOI: 10.1038/s41598-023-41772-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 08/31/2023] [Indexed: 09/30/2023] Open
Abstract
The traditional surgical technique for esophageal cancer is mainly open esophagectomy. With the innovation of surgical instruments, it is necessary to re-optimize the minimally invasive surgery. Therefore, single-port thoracoscopic minimally invasive esophagectomy (SPTE) is an important direction of development. This study retrospectively analyzed 202 patients with esophageal squamous cell carcinoma undergoing SPTE. Surgical variables and postoperative complications were further evaluated. All procedures were performed using SPTE. The number of patients who received R0 resection was 201 (99.5%). The total number of resected lymph nodes during the whole operation was on average 32.01 ± 12.15, and the mean number of positive lymph nodes was 1.56 ± 2.51. In 170 cases (84.2%), intraoperative blood loss did not exceed 100 ml (ml), while 1 case had postoperative bleeding. Only 1 patient (0.5%) required reoperation after surgery. Postoperative complications included 42 cases of pneumonia (20.8%), 9 cases of anastomotic leak (4.5%), 7 cases of pleural effusion (3.8%), and 1 case (0.5%) of both pleural hemorrhage and acute gastrointestinal hemorrhagic ulcer. Besides, we also recorded the time to remove the drain tube, which averaged 9.13 ± 5.31 days. In our study, we confirmed that the application of SPTE in clinical practice is feasible, and that the postoperative complications are at a low level.
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Affiliation(s)
- Fei Zheng
- Department of Radiation Oncology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, No. 420 Fuma Rd. Jin'an District, Fuzhou, 350014, Fujian Province, People's Republic of China
| | - Jun Yang
- Department of Radiation Oncology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, No. 420 Fuma Rd. Jin'an District, Fuzhou, 350014, Fujian Province, People's Republic of China
| | - Jiulong Zhang
- Department of Thoracic Surgery, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, No. 420 Fuma Rd. Jin'an District, Fuzhou, 350014, Fujian Province, People's Republic of China
| | - Jiancheng Li
- Department of Radiation Oncology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, No. 420 Fuma Rd. Jin'an District, Fuzhou, 350014, Fujian Province, People's Republic of China
| | - Weimin Fang
- Department of Thoracic Surgery, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, No. 420 Fuma Rd. Jin'an District, Fuzhou, 350014, Fujian Province, People's Republic of China.
| | - Mingqiu Chen
- Department of Radiation Oncology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, No. 420 Fuma Rd. Jin'an District, Fuzhou, 350014, Fujian Province, People's Republic of China.
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Qian H, Zhou J, Huang T, Cao X, Zhou C, Yang M, Chen Y. Comfort nursing can alleviate pain and negative emotion of patients after surgery for LVCFs and improve their living ability. Am J Transl Res 2021; 13:2939-2946. [PMID: 34017459 PMCID: PMC8129384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 12/24/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To determine the effect of comfort nursing in elderly patients with lumbar vertebral compression fractures (LVCFs). METHODS A total of 194 elderly patients with LVCFs were enrolled, and assigned to two groups based on different nursing intervention methods. Among them, 93 patients were given routine nursing intervention as a control group (CON group), while the rest 101 patients were given comfort nursing as an intervention group (INT group). The visual analog scale (VAS) was adopted to evaluate patients' pain and Japanese Orthopaedic Association score (JOA) to evaluate their dysfunction. In addition, Barthel score was used to evaluate patients' self-care ability, and the self-rating anxiety scale (SAS) and self-rating depression scale (SDS) were adopted to score their anxiety and depression. Moreover, the compliance and nursing satisfaction of the two groups were investigated. RESULTS After nursing, t VAS, SAS, and SDS scores of both groups declined significantly, and these scores of the INT group declined more notably. After nursing, the JOA and Barthel scores of the two groups increased greatly, and both scores of the INT group were significantly higher than those of the CON group. Additionally, the INT group consumed significantly less analgesic drugs and experienced significantly shorter hospital stay than the CON group. Moreover, according to the survey on nursing compliance and nursing satisfaction, the INT group showed significantly higher nursing compliance and nursing satisfaction than the CON group. CONCLUSION For elderly patients with LVCFs, comfort nursing can effectively relieve their postoperative pain and negative emotion and improve their daily living ability.
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Affiliation(s)
- Hong Qian
- Department of Orthopaedics, Affiliated Hospital of Jiangnan UniversityWuxi 214125, Jiangsu Province, China
| | - Jingfen Zhou
- Department of Hematology, Affiliated Hospital of Jiangnan UniversityWuxi 214125, Jiangsu Province, China
| | - Tingmin Huang
- Department of Orthopaedics, Affiliated Hospital of Jiangnan UniversityWuxi 214125, Jiangsu Province, China
| | - Xingye Cao
- Department of Orthopaedics, Affiliated Hospital of Jiangnan UniversityWuxi 214125, Jiangsu Province, China
| | - Chao Zhou
- Department of Orthopaedics, Affiliated Hospital of Jiangnan UniversityWuxi 214125, Jiangsu Province, China
| | - Minjuan Yang
- Department of Orthopaedics, Affiliated Hospital of Jiangnan UniversityWuxi 214125, Jiangsu Province, China
| | - Yan Chen
- Department of Nephrology, Affiliated Hospital of Jiangnan UniversityWuxi 214125, Jiangsu Province, China
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Yolcu YU, Helal A, Alexander AY, Bhatti AU, Alvi MA, Abode-Iyamah K, Bydon M. Minimally Invasive Versus Open Surgery for Degenerative Spine Disorders for Elderly Patients: Experiences from a Single Institution. World Neurosurg 2020; 146:e1262-e1269. [PMID: 33276177 DOI: 10.1016/j.wneu.2020.11.145] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 11/24/2020] [Accepted: 11/25/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Minimally invasive surgery (MIS) of the spine has been associated with lower complication rates and improved patient-reported outcomes in recent studies. In this study, we aimed to investigate operative and postoperative outcomes associated with both surgical techniques in elderly patients. METHODS Patients who are 65 years old or older underwent either minimally invasive or open surgery for lumbar degenerative conditions. Patients with a nondegenerative cause such as infection or trauma were excluded from the analysis. Patient characteristics such as demographics and associated comorbidities as well as perioperative and postoperative complications were collected. Outcomes of interest were operative time, estimated blood loss (EBL), length of stay (LOS), readmissions, reoperations, and any complications. RESULTS A total of 107 elderly patients were identified for this study, with a median age of 73.0 years. Demographics and comorbidities in both groups were similar in both groups. Univariate analysis yielded an MIS group with significantly lower EBL (P < 0.001), operative time (P < 0.001), and LOS (P < 0.001). In multivariable analysis, EBL and LOS were found to be significantly lower in the MIS group (P = 0.02 and 0.001, respectively). Rates of complications, readmissions (no readmissions in MIS group), reoperations, and pain improvement also favored the MIS group and although they were not found to be significantly different between the 2 groups on univariate and multivariable analysis, the results trended toward significance. CONCLUSIONS These findings suggest that minimally invasive spine surgery in the elderly is safe and may pose a lower risk of associated perioperative and postoperative complications with faster recovery time.
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Affiliation(s)
- Yagiz U Yolcu
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA; Mayo Clinic Neuro-informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA
| | - Ahmed Helal
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA; Mayo Clinic Neuro-informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA
| | - Alex Y Alexander
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA; Mayo Clinic Neuro-informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA; University of Minnesota, Minneapolis, Minnesota, USA
| | - Atiq U Bhatti
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA; Mayo Clinic Neuro-informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA
| | - Mohammed A Alvi
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA; Mayo Clinic Neuro-informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Mohamad Bydon
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA; Mayo Clinic Neuro-informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA.
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