Summary
This study investigated the long-term survival and incidence of secondary fractures after fragility hip fractures. The 5-year survival rate was 62%, and the mortality risk was seen in ...patients with GNRI < 92. The 5-year incidence of secondary fracture was 22%, which was significantly higher in patients with a BMI < 20.
Background
Malnutrition negatively influences the postoperative survival of patients with fragility hip fractures (FHFs); however, little is known about their association over the long term.
Objective
This study evaluated the ability of the geriatric nutritional risk index (GNRI) as a risk factor for long-term mortality after FHFs.
Methods
This study included 623 Japanese patients with FHFs over the age of 60 years. We prospectively collected data on admission and during hospitalization and assessed the patients’ conditions after discharge through a questionnaire. We examined the long-term mortality and the incidence of secondary FHFs and assessed the prognostic factors.
Results
The mean observation period was 4.0 years (range 0–7 years). The average age at the time of admission was 82 years (range 60–101 years). The overall survival after FHFs (1 year, 91%; 5 years, 62%) and the incidence of secondary FHFs were high (1 year, 4%; 5 years, 22%). The multivariate Cox proportional hazard analysis revealed the risk factors for mortality as older age (hazard ratio HR 1.04), male sex (HR 1.96), lower GNRI score (HR 0.96), comorbidities (malignancy, HR 2.51; ischemic heart disease, HR 2.24; revised Hasegawa dementia scale ≤ 20, HR 1.64), no use of active vitamin D3 on admission (HR 0.46), and a lower Barthel index (BI) (on admission, HR 1.00; at discharge, HR 0.99). The GNRI scores were divided into four risk categories: major risk (GNRI, < 82), moderate risk (82–91), low risk (92–98), and no risk (> 98). Patients at major and moderate risks of GNRI had a significantly lower overall survival rate (
p
< 0.001). Lower body mass index (BMI) was also identified as a prognostic factor for secondary FHFs (HR 0.88
p
= 0.004).
Conclusions
We showed that older age, male sex, a lower GNRI score, comorbidities, and a lower BI are risk factors for mortality following FHFs. GNRI is a novel and simple predictor of long-term survival after FHFs.
For Ag alloy film used for the storage media, it is required to have heat-resistance, anti-constant temperature and anti-constant humidity characteristics, corrosion resistance, while high ...reflectivity over Al is maintained. An Ag alloy thin film （additive element Pd, Cu, P） was created on glass substrates, and various heat treatment was conducted. Then, fine structure was observed on this thin film using AFM, and fine structure evaluation of the inside was carried out by the in-plane diffractometry and X-ray diffraetometry, and in addition, residual stress analysis was carried out. These results were compared and were examined, and fine structure and physical property in a metallic thin film were evaluated, and usefulness of evaluation method was verified.
Twenty patients with vertebral osteomyelitis and 18 with tuberculous spondylitis were investigated by magnetic resonance imaging to identify the distinguishing features. The number of vertebral ...bodies involved was less in vertebral osteomyelitis than in tuberculous spondylitis, and the paravertebral abscesses were smaller. The magnetic resonance intensity of the involved vertebral bodies was more homogeneous in vertebral osteomyelitis than in tuberculous spondylitis. Rim enhancement with Gadolinium-DTPA was less frequent in vertebral osteomyelitis. The differentiation of the two conditions by MRI was helpful in establishing the correct diagnosis of the infection.
It has been reported that flexibility of the neck decreases after cervical laminoplasty. It also is known that kyphosis can be an unfavorable result after posterior decompression surgery of the ...cervical spine. To examine whether a decrease in cervical mobility resulting from contracture of the cervical spine helps prevent postoperative kyphotic alignment, changes in radiographic findings after cervical expansive laminoplasty were evaluated. There was a strong correlation postoperatively between range of motion of the cervical spine and cervical lordotic alignment, namely, the more that cervical mobility was maintained, the more that cervical lordosis was preserved. This relationship was not found preoperatively. A postoperative increase in the number of unstable vertebrae was found only in a few patients and was not associated with any deterioration in clinical outcome. The current results suggest that postoperative cervical lordosis is preserved not through intervertebral soft tissue contracture or bony fusion, but through more dynamic factors such as muscles or ligaments, therefore implicating the importance of early removal of cervical orthosis and early postoperative rehabilitation.
A technical note.
To describe and discuss a novel technique for surgical resection of spinal meningioma.
With conventional methods for surgical resection of isolated intradural spinal meningioma, ...there are two ways of dealing with the dural attachment of the tumor. One is complete resection of the involved dura together with the tumor, and the other is coagulation only of the tumor base of the dura. In the case of the novel technique herein described, the dura mater is preserved in a new manner.
In the surgical procedure a small incision is made in the surface of the dura mater after the conventional laminectomy. The spinal dura can be easily divided into two layers, comprising inner and outer layers. The outer layer is stripped away from the inner layer surrounding the tumor base. The tumor is then resected together with the inner layer alone outside the arachnoid membrane, and finally the outer layer is simply closed.
This method has been applied to three cases. The preserved outer layer of the dura mater did not demonstrate the existence of tumor cells histologically. Neither complications nor tumor recurrence have been experienced.
The authors introduced a novel technique for surgical resection of isolated intradural spinal meningioma. Using this simple procedure the outer part of the dura mater, which is not involved by the tumor, can be preserved and complicated dural reconstruction is not necessary. Furthermore, there is less risk of postoperative cerebrospinal fluid fistulas than when the dura is completely resected together with the tumor. However, long-term observation as a result of the possibility of local recurrence is strongly recommended.
The risk of persistence and recurrence of infection in posterior spinal instrumentation surgery for spinal tuberculosis was studied clinically and microbiologically. Eleven patients with thoracic, ...thoracolumbar, and lumbar spinal tuberculosis treated by debridement, anterior fusion, and combined posterior instrumentation surgery were analyzed. Seven patients had tuberculosis in both anterior and posterior spinal elements. There were no cases of persistence or recurrence of infection after surgery, and instrumentation provided immediate stability and protected against development of kyphotic deformity. The adherence properties of Mycobacterium tuberculosis to stainless steel (SUS 316) was evaluated experimentally. The results showed that posterior instrumentation surgery was not a hazard to spinal tuberculosis infection when combined with radical debridement and intensive anti-tuberculosis chemotherapy.
In our previous study, we developed a walking support shoe with an elastomer-embedded flexible joint (EEFJ) to assist the function of tibialis anterior (TA) in initial stances (IC) and swing phases ...(SW). However, its usability and supporting effect have not been sufficiently evaluated. Therefore, in this study, we developed a dorsiflexion support unit (DSU) using the EEFJs with consideration on the usability for frail persons. Their needs were investigated in hearings at community centers. With reference to their comments, we proposed a three-phased scenario in which pre- / post-activities were considered as important factors of its product design of the DSU. We designed the DSU for better usability in the pre- / post-activities. Its basic function and mechanical properties were also investigated in experiments. According to the mechanical tests, the supporting torque was around 10% of the activation of TA in IC. In addition, the results of gait tests show reductions of ankle rotations by 17% and 11% in IC and SW, respectively, without significant increases of TA activations.
Purpose The aim of this study was to analyze the crutch position in the horizontal plane to confirm the stability of the axillary pad during double-crutch walking. Subjects Twelve healthy young ...subjects (6 males and 6 females). Methods The subjects were asked to walk in a straight line, using double crutches, for a distance of 5 m, 5 times. Crutch position data were obtained using four infrared reflective markers attached to both crutches (two markers each on both crutches). The crutch angles of each subject were compared across three time points during the crutch stance phase (crutch contact, mid stance, and crutch off). Results Crutch angles of each of the two crutches were significantly different across the crutch stance phase of 11 of the 12 subjects. Phasic differences were shown by 4 of the 12 subjects, and a strong correlation was observed between the left and right crutch angles of all subjects. Conclusion External rotation of the crutch throughout the stance phase was very important for keeping the axillary pad in the axilla, not only for single-crutch walking, but also for double-crutch walking. In addition, symmetry of the crutch positioning is one of the most important factors for safe double-crutch walking.
Walking is one of the most important activities in daily living, and difficulty walking presents a severe limitation. In this study, we develop shoes with elastomer-embedded flexible joints (EEFJ) ...that assist the tibialis anterior in its function during the initial stance and swing phase of the gait cycle. The EEFJ designed is suitable for shoes, with an adjustment mechanism incorporated for easy adjustment. To assess the ease of wearing, we measured the time it took four elderly subjects to wear the shoes for the first time. The donning time was less than one minute for all four participants. Furthermore, no one indicated discomfort when they walked naturally with the shoes. The supporting effect of the EEFJ shoes was assessed for ten healthy male subjects walking with their ankles relaxed. Statistical analysis reveals significant differences in the ankle at initial contact (
p
=0.02) and maximum plantar flexion (
p
=0.03). The average angle at initial contact while wearing the EEFJ shoes is 5.3° less than without it, and the average maximum plantar flexion is 5.1° less than without the shoes.
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