Haichuan Guo’s research while affiliated with Hebei Medical University and other places

Background Systemic inflammation biomarkers have been widely shown to be associated with infection. This study aimed to construct a nomogram based on systemic inflammation biomarkers and traditional prognostic factors to assess the risk of surgical site infection (SSI) after hip fracture in the elderly. Methods Data were retrospectively collected from patients over 60 with acute hip fractures who underwent surgery and were followed for more than 12 months between June 2017 and June 2022 at a tertiary referral hospital. Biomarkers were calculated from peripheral venous blood collected on admission. The Centers for Disease Control and Prevention (CDC) definition of SSI was applied, with SSI identified through medical and pathogen culture records during hospitalization and routine postoperative telephone follow-ups. Multivariable logistic regression identified independent risk factors for SSI and developed predictive nomograms. Model stability was validated using an external set of patients treated from July 2022 to June 2023. Results A total of 1430 patients were included in model development, with 41 cases (2.87%) of superficial SSI and 6 cases (0.42%) of deep SSI. Multivariable analysis identified traditional prognostic factors older age (OR = 1.08, 95% CI 1.04–1.12), ASA class III-IV (OR = 2.46, 95% CI 1.32–4.56), surgical delay ≥ 6 days (OR = 3.59, 95% CI 1.36–9.47), surgical duration > 180 min (OR = 2.72, 95% CI 1.17–6.35), and systemic inflammation biomarkers Platelet-to-lymphocyte ratio (PAR) ≥ 6.6 (OR = 2.25, 95% CI 1.17–4.33) and Systemic Immune-Inflammation Index (SII) ≥ 541.1 (OR = 2.24, 95% CI 1.14–4.40) as independent predictors of SSI. Model’s stability was proved by internal validation, and external validation with 307 patients, and an online dynamic nomogram (https://brooklyn99.shinyapps.io/DynNomapp/) was generated. Conclusions This study combined systemic inflammatory biomarkers and developed an online dynamic nomogram to predict SSI in elderly hip fracture patients, which could be used to guide early screening of patients with high risk of SSI and provide a reference tool for perioperative management.

Background Assessment of postoperative ambulation in osteonecrosis of the femoral head (ONFH) patients treated with total hip arthroplasty (THA) is limited. This study aimed to define the incidence and risk factors for losing walking independence (LWI) at one-year postoperatively in patients with ONFH undergoing primary THA, and to establish and validate a predictive nomogram. Methods This was a retrospective analysis of prospective collected data from patients admitted to a tertiary referral hospital with ONFH who underwent primary unilateral THA from October 2014 to March 2018. The Functional Independence Measure-Locomotion scale was used to quantify walking independence and was documented at a one-year continuous postoperative follow-up, which classified patients with a final score below 6 as LWI. Multivariate logistic regression identified independent risk factors for LWI, and a predictive nomogram was constructed based on the analysis results. The stability of the model was assessed using patients from April 2018 to April 2019 as an external validation set. Results 1152 patients were enrolled in the study, of which 810 were used in the training cohort and the other 342 for the validation cohort. The incidence of LWI was 5.93%. Multivariate analysis revealed that age 62 years or older (odd ratio (OR) = 2.37, 95% confidence interval (CI) 1.07–5.24), Charlson’s comorbidity index 3 or higher (OR = 3.64, 95% CI 1.09–12.14), Association Research Circulation Osseous stage IV (OR = 2.16, 95% CI 1.03–4.54), reduced femoral offset (OR = 2.41, 95% CI 1.16–5.03), and a higher controlling nutritional status score (OR = 1.14, 95% CI 1.01–1.30) were independent risk factors of LWI. The nomogram had a concordance index of 0.773 and a Brier score of 0.049 in the training set, with corrected values of 0.747 and 0.051 after internal validation. The receiver-operating characteristic curve, calibration curve, Hosmer-Lemeshow test, and decision curve analysis all performed well in both the training and validation cohorts. Conclusions This study reported a 5.93% incidence of LWI and established a risk prediction model in patients undergoing THA for ONFH, supporting targeted screening and intervention to assist surgeons in assessing ambulation capacity and managing rehabilitation.

Background Systemic inflammation biomarkers have been widely shown to be associated with infection. This study aimed to construct a nomogram based on systemic inflammation biomarkers and traditional prognostic factors to assess the risk of surgical site infection (SSI) after hip fracture in the elderly. Methods Data were retrospectively collected from patients over 60 with acute hip fractures who underwent surgery and were followed for more than 12 months between June 2017 and June 2022 at a tertiary referral hospital. Biomarkers were calculated from peripheral venous blood collected on admission. The CDC definition of SSI was applied, with SSI identified through medical and pathogen culture records during hospitalization and routine postoperative telephone follow-ups. Multivariable logistic regression identified independent risk factors for SSI and developed predictive nomograms. Model stability was validated using an external set of patients treated from July 2022 to June 2023. Results A total of 1430 patients were included in model development, with 41 cases (2.87%) of superficial SSI and 6 cases (0.42%) of deep SSI. Multivariable analysis identified traditional prognostic factors older age (OR = 1.08, 95% CI 1.04–1.12), ASA class III-IV (OR = 2.46, 95% CI 1.32–4.56), surgical delay ≥ 6 days (OR = 3.59, 95% CI 1.36–9.47), surgical duration > 180 minutes (OR = 2.72, 95% CI 1.17–6.35), and systemic inflammation biomarkers PAR ≥ 6.6 (OR = 2.25, 95% CI 1.17–4.33) and SII ≥ 541.1 (OR = 2.24, 95% CI 1.14–4.40) as independent predictors of SSI. Model’s stability was proved by internal validation, and external validation with 307 patients, and an online dynamic nomogram (https://brooklyn99.shinyapps.io/DynNomapp/) was generated. Conclusions This study combined systemic inflammatory biomarkers and developed an online dynamic nomogram to predict SSI in elderly hip fracture patients, which could be used to guide early screening of patients with high risk of SSI and provide a reference tool for perioperative management.

Purpose Excessive sliding of intramedullary nails following surgical treatment of intertrochanteric fracture has been strongly associated with the development of mechanical complications and unfavorable results. This study aims to investigate the factors that influence the postoperative sliding distance in elderly patients treated with PFNA-II device for intertrochanteric fracture fixation. Methods A retrospective analysis of patients over 65 years old with intertrochanteric fractures using PFNA-II device in a university teaching hospital was performed between January 2020 and December 2021. Data on sociodemographics, comorbidities, operative procedure and postoperative radiographic sliding distance were collected. The Youden index was used to determine the threshold for excessive sliding, and the risk of mechanical complication in relation with excessive sliding was calculated using multivariate regression analysis. Also, potential factors influencing the slinding distance as a continuous outcome variable were investigated using univariate and multivariate linear regression analysis. Result Among the 507 eligible patients, the mean postoperative sliding distance was 4.45 mm (SD, 5.39 mm; range, 0-31.67 mm). The threshold for excessive sliding was determined as 6.75 mm, and 103 patients (20.3%) had excessive sliding, among whom 18 (17.5%) developed mechanical complications. The risk of postoperative mechanical complications was significantly higher in the excessive sliding group (adjusted OR = 14.714, 95% CI: 4.270–50.710, P < 0.001) than in non-excessive sliding group. Multiple linear regression analysis revealed that older age (B = 0.061, 95% CI: 0.007–0.114, P = 0.026), poor reduction quality (B = 4.736, 95% CI: 1.236–8.235, P = 0.008), and subtype P in lateral view (B = 11.193, 95% CI: 6.836–15.549, P < 0.001) were positively correlated with postoperative sliding distance. Conclusions Age, reduction quality and LAT reduction mode are important predictors of helical blade sliding distance after intertrochanteric fracture surgery. Surgeons should pay close attention to these factors during preoperative planning and postoperative rehabilitation protocols.

Background The objective of this study was to compare the clinical outcomes of two internal fixation methods for high tibial osteotomy (HTO): double-triangle locking compression plate (DT-LCP) and T-shaped locking compression plate (T-LCP). Methods 202 adult patients in our hospital between January 2018 and December 2021 were included and followed up for at least one year: group 1(DT-LCP, 98 patients) and group 2 (T-LCP, 104 patients). Detailed information on demographics, preoperative and postoperative follow-up, surgical procedures, and complications were collected. The information of the International Knee Documentation Committee Knee Evaluation Form (IKDC), Knee Injury and Osteoarthritis Outcome Score (KOOS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) were collected before surgery and at the last follow-up. Results A total of 202 patients were included in the per-protocol analysis. No significant difference was found in terms of demographic data between groups, except for age and BMI. Clinically relevant improvements in knee pain were reached up to last follow-up after the operation in both groups. The mean pain scores (KOOS, WOMAC) at the final follow-up were significantly higher among group 1 compared to group 2 (P = 0.040 and P = 0.023). Furthermore, the DT-LCP internal fixation exerted more excellent effects on other symptoms, function and quality of life than T-LCP internal fixation. Conclusions Our study demonstrated that DT-LCP provided better clinical performance due to its implant irritant pain, compared with T-LCP. Thus, DT-LCP is a feasible alternative for the fixation of OW-HTO.

Purpose We developed a novel guider-assisted osteotomy (GAO) procedure to improve the safety of open wedge high tibial osteotomy (OWHTO) and aimed to compare its efficacy and complications with the conventional pendulum-saw osteotomy (PSO). Methods This is a retrospective cohort study of patients undergoing either GAO or PSO procedure in the OWHTO to treat varus knee osteoarthritis, who had a minimum of 2 years of follow-up. Patients were propensity score matched (PSM) in a 1:1 ratio based on demographic and clinical data with a caliper width of 0.02. The outcomes assessed involved the hospital for special surgery (HSS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, and the Intraoperative and postoperative complications. Results 199 patients were included in each group after PSM. The mean duration of follow-up was 38.3 ± 8.9 months. The GAO group had a shorter operation duration (104.5 ± 35.7 vs. 112.1 ± 36.0 min, p = 0.027) and fewer times of intraoperative fluoroscopy (4.2 ± 1.4 vs. 6.0 ± 1.4, p < 0.001). At the last follow-up, clinical scores for knee achieved significant improvements in both GAO and PSO groups: HSS (67.5 ± 10.5 vs. 90.2 ± 7.0, p < 0.001; 69.4 ± 8.2 vs. 91.7 ± 6.8, p < 0.001) and WOMAC (65.7 ± 11.6 vs. 25.2 ± 10.4, p < 0.001; 63.3 ± 12.2 vs. 23.8 ± 9.5, p < 0.001). However, no significant difference was observed between groups for any measures (p > 0.05). In addition, the intraoperative complications (0.5% vs. 3.5%, p = 0.068) and the postoperative bone delayed union and nonunion (1.0% vs. 4.5%, p = 0.032) were marginally or significantly reduced in the GAO versus PSO group. Conclusion GAO demonstrates improvements in intraoperative radiation exposure and complications, with comparable short-term efficacy to PSO, and could be considered a viable alternative in clinical practice.

Background The association of low-density lipoprotein cholesterol (LDL-C) and lymphocyte counts with the development of deep vein thrombosis (DVT) has been demonstrated in many fields but remains lacking in open wedge high tibial osteotomy (OWHTO). This study aimed to assess the predictive value of LDL-C to lymphocyte count ratio (LLR) in screening for postoperative new-onset DVT. Methods Clinical data were retrospectively collected from patients who underwent OWHTO between June 2018 and May 2023. The limited restricted cubic spline (RCS) was conducted to evaluate the nonlinear relationship between LLR and the risk of postoperative new-onset DVT. The receiver operating characteristic (ROC) curves were plotted and the predictive value of biomarkers was assessed. After adjusting for intergroup confounders by propensity score matching, the univariate logistic regression was applied to assess the association between LLR and DVT. Results 1293 eligible patients were included. RCS analysis showed a linear positive correlation between LLR and the risk of DVT (P for overall = 0.008). We identified LLR had an area under the curve of 0.607, accuracy of 74.3%, sensitivity of 38.5%, and specificity of 80.7%, and LLR > 1.75 was independently associated with a 1.45-fold risk of DVT (95% CI: 1.01–2.08, P = 0.045). Furthermore, significant heterogeneities were observed in the subgroups of age, BMI, diabetes mellitus, hypertension, Kellgren-Lawrence grade, the American Society of Anesthesiologists (ASA) score, and intraoperative osteotomy correction size. Conclusion LLR is a valuable biomarker for predicting postoperative new-onset DVT in patients with OWHTO, and routine screening is expected to yield positive benefits.

The optimal choice of distal locking modes remains a subject due to limited available data, and therefore, this study aims to investigate the relationship between distal locking mode and postoperative mechanical complications in an intertrochanteric fracture (ITF) population who underwent closed reduction and intramedullary fixation with a PFNA-II. Patients aged 65 years or older who underwent surgery with PFNA-II fixation in a university teaching hospital between January 2020 and December 2021 were potentially eligible. Based on the distal locking mode, patients were classified into static, dynamic, and limited dynamic groups, among which the differences were tested using univariate analysis. Multivariate logistic regression was used to examine whether the distal locking mode was independently associated with the risk of postoperative one year mechanical complications, adjusting for covariates and potential confounders. Subgroup analyses were performed to evaluate the robustness of the findings. Among 507 eligible patients, 33 (6.5%) developed postoperative mechanical complications. In the univariate analysis, sex (P = 0.007), fracture type (P = 0.020), LAT Parker ratio (P = 0.023), and lateral femoral (P = 0.003) wall showed that the differences were significant. Compared to the static group, the limited dynamic group and the dynamic group showed higher odds of postoperative mechanical complications (OR = 3.314, 95% CI: 1.215–9.041; and OR = 3.652, 95% CI: 1.451–9.191, respectively). These associations were robust across a series of analyses, including adjusting for confounders and subgroup analyses. Using a distal non-static locking mode significantly increases the risk of postoperative mechanical complications, and static locking could be a preferable option when treating an intertrochanteric fracture.