Factors influencing postoperative mortality one year after surgery for hip fracture in Chinese elderly population / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Disability and death following hip fracture is becoming more common as the population ages. Previous reports have focused on the selection of internal fixation methods and the analysis of the perioperative therapeutic results in the Chinese population. Few studies have focused on factors influencing medium and long term survival after surgery for hip fracture. We conducted a retrospective study on the factors influencing survival one year after hip fracture surgery in our elderly Chinese population to provide a reference for improved treatment and to enhance efficacy.</p><p><b>METHODS</b>Records from patients undergoing treatment for hip fracture at our hospital from October 2009 through June 2011 were retrospectively reviewed. Through telephone follow-up, the health condition of each patient was surveyed, and the 1-year postoperative mortality was analyzed. The patients' age, gender, fracture type, pre-injury health condition, mobility, complications, surgical timing, surgical types, methods of anesthesia, and postoperative complications were analyzed. Univariate and multivariate regression analysis was performed on relevant influencing factors.</p><p><b>RESULTS</b>A total of 184 patients had complete data and were followed-up for 12-23 months (average, 16.5 months). There were 30 deaths (16.3%) at one-year. Univariate analysis revealed that factors such as age, gender, fracture-type, number of co-existing diseases, complications such as chronic obstructive pulmonary disease or sequelae of stroke, American society of Anesthesiology (ASA) scores, anesthesia methods, pre-injury activity, and post-operative complications were significantly different between survival versus mortality groups (P < 0.05). Multivariate regression analysis revealed that age, ASA score, pre-injury mobility and combined chronic obstructive pulmonary disease were independent risk factors for death.</p><p><b>CONCLUSION</b>Full consideration of medium-/long-term risk factors in the treatment of hip fracture in the elderly, selection of appropriate anesthesia and treatment methods, and improved pre-surgical health conditions would reduce postoperative mortality and enhance surgical efficacy.</p>

Metallic modular radial head prostheses for Mason III and IV unreconstructable radial head fractures / 中国骨伤

<p><b>OBJECTIVE</b>To assess the early efficacy of metallic modular radial head prostheses in patients with Mason III and IV unreconstructable radial head fractures.</p><p><b>METHODS</b>The medical records of 16 patients (9 males, 7 females) with a mean age of 43 years old (31 to 57) with Mason III/IV unreconstructable radial head fractures requiring metallic modular radial head replacement between January 2009 and March 2012, were reviewed retrospectively. The functional results were assessed by range-of-movement, Mayo elbow performance score (MEPS). All patients underwent radiographic evaluation for radial head height and radiolucent lines.</p><p><b>RESULTS</b>Fourteen patients were evaluated with follow-up for 12 to 33 months with an average of 23 months. Range of movement parameters was significantly lower in the affected elbow than in the unaffected side (P < 0.01). MEPS results were excellent in 9 cases, good in 2 cases, fair in 2 cases, and poor in 1 case. According to Grewal grading, there were 4 cases of periprosthetic lucencies of the radius and 1 case had significant clinical signs of loosening.</p><p><b>CONCLUSION</b>Radial head replacement with the metallic modular prostheses yields satisfactory results regarding range of motion and function of the elbow joint in short term. The evolution of this prostheses needs to be evaluated with further studies to assess mid-term and long-term follow-up results.</p>

Treatment of vertical unstable pelvic fracture by percutaneous iliosacral screws fixation / 中国骨伤

<p><b>OBJECTIVE</b>To retrospectively analyze the patients of vertically unstable pelvic fractures treated with percutaneous iliosacral screws fixation and to explore the operative techniques and its therapeutic efficacy.</p><p><b>METHODS</b>From June 2002 to August 2009, 54 patients with vertical unstable pelvic fracture were fixed with percutaneous iliosacral screws. After operation, 46 patients were followed up more than 18 months. Among them, 32 patients were male and 14 patients were female, the average age was 36.4 years old (ranged from 19 to 64 years). The average time from injury to operation was 8.5 days (ranged from 7 to 11 days). All pelvic fractures had vertical dislocation ranging from 8 to 40 mm (averaged 28.5 mm). After admitted, all patients were applied bone traction. After recuction, the fractures were fixed with percutaneous iliosacral 7.3 mm cannulated screws, which crossed the iliac and sacral-iliac joint and sacral promontory to S(1)vertebrae. After operation, all patients took X-ray examination. The reduction and the fracture reduction were judged according to Matta criterion and clinical function was judged according to Majeed functional scoring.</p><p><b>RESULTS</b>Forty-six patients were followed up from 1.5 to 3 years with an average of 29 months. Fracture uninon was achieved in all patients. All patients got clinical recovery at mean time of 5.2 months and returned to normal daily life. According to Matta criterion for fracture reduction, the results were excellent in 40 cases and good in 6 cases. According to Majeed functional scoring, 32 patients were excellent, 12 good and 2 normal. There were no serious complications of vascular damage.</p><p><b>CONCLUSION</b>Percutaneous iliosacral screw fixation is an effective technique with advantages of minimal invasive and faster recovery in the management of vertically unstable pelvic fractures.</p>

Augmentative plate fixation for the treatment of femoral hypertrophic nonunions subsequent to intramedullary nailing fixation / 中国骨伤

<p><b>OBJECTIVE</b>To investigate the effect of augmentative plate fixation to increase stability in the treatment of femoral shaft nonunions subsequent to intramedullary fixation.</p><p><b>METHODS</b>Nine patients with femoral nonunions after intramedullary nail internal fixation were treated with augmentative plate internal fixation from April 1998 to Jane 2008, included 8 males and 1 female, with an average age of 32 years old ranging from 21 to 54 years. One case was upper 1/3 femoral fractures, 5 cases were middle 1/3 femoral fractures, 3 cases were lower 1/3 femoral fractures. The interspace of bone nonunion was more than 5 mm in 6 cases, of them, iliac bone grafting were applied in 4 cases, artificial bone combined with iliac bone grafting were applied in 2 cases; The interspace of bone nonunion was less than 5 mm in other 3 cases,artificial bone grafting was applied in 1 case, fitting bone callus were applied in 2 cases. All patients got protected weight loading preventing the main screw break.</p><p><b>RESULTS</b>All patients achieved radiological solid union at an average of 8 months (ranged 6 to 11 months ). The fixation was removed during 6 to 11 months after operation in 5 cases. Donor site pain of iliac occurrenced on 4 cases,3 cases relieved 1 month later and 1 case relieved 3 months later. No infection, fixation loosening or breaking was observed.</p><p><b>CONCLUSION</b>The augmentative plate fixation can be applied at the fracture site to prevent the rotational instability. The technique is simple and does not require any special instrument, which facilitates an early weight bearing and gives a quick recovery from nonunion.</p>

The value of modified POSSUM scoring system in predicting mortality and morbidity for the intertrochanteric fracture in elder patients / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the value of modified physiological and operative severity score for the enumeration of mortality and morbidity (POSSUM) scoring system in predicting mortality and morbidity for the intertrochanteric fracture in elder patients.</p><p><b>METHODS</b>A retrospective study was conducted over a period of nearly 2 years from January 2007 to December 2008. Complete data from 119 patients were analyzed to compare the mortality and morbidity predicted by the POSSUM and the observed mortality and morbidity. POSSUM risk was calculated using the original POSSUM equation.</p><p><b>RESULTS</b>POSSUM predicted 11(9.2%) deaths, which had no statistical significance with the observed mortality 5 (4.2%) (chi² = 2.412, P = 0.120). The estimated incidence of postoperative complications was 42 (35.3%), which also has no statistical significance with the observed morbidity 39 (32.8%) (chi² = 0.168, P = 0.682).</p><p><b>CONCLUSIONS</b>The modified POSSUM scoring system can predict accurately postoperative mortality and morbidity for the patients underwent intertrochanteric fracture and it predict more accurately in high risk band. The physiological score can be used to evaluate the physiological conditions preoperative and the pulmonary disease is the most important factor lead to death of the elder patients underwent intertrochanteric fracture.</p>

Ex vivo non-viral vector-mediated neurotrophin-3 gene transfer to olfactory ensheathing glia: effects on axonal regeneration and functional recovery after implantation in rats with spinal cord injury / 神经科学通报·英文版

<p><b>OBJECTIVE</b>Combine olfactory ensheathing glia (OEG) implantation with ex vivo non-viral vector-based neurotrophin-3 (NT-3) gene therapy in attempting to enhance regeneration after thoracic spinal cord injury (SCI).</p><p><b>METHODS</b>Primary OEG were transfected with cationic liposome-mediated recombinant plasmid pcDNA3.1(+)-NT3 and subsequently implanted into adult Wistar rats directly after the thoracic spinal cord (T9) contusion by the New York University impactor. The animals in 3 different groups received 4x10(5) OEG transfected with pcDNA3.1(+)-NT3 or pcDNA3.1(+) plasmids, or the OEGs without any plasmid transfection, respectively; the fourth group was untreated group, in which no OEG was implanted.</p><p><b>RESULTS</b>NT-3 production was seen increased both ex vivo and in vivo in pcDNA3.1(+)-NT3 transfected OEGs. Three months after implantation of NT-3-transfected OEGs, behavioral analysis revealed that the hindlimb function of SCI rats was improved. All spinal cords were filled with regenerated neurofilament-positive axons. Retrograde tracing revealed enhanced regenerative axonal sprouting.</p><p><b>CONCLUSION</b>Non-viral vector-mediated genetic engineering of OEG was safe and more effective in producing NT-3 and promoting axonal outgrowth followed by enhancing SCI recovery in rats.</p>

Repair of acute spinal cord injury promoted by transplantation of olfactory ensheathing glia / 中国医学科学院学报

<p><b>OBJECTIVES</b>To observe olfactory ensheathing glia (OEG) survival and repair in vivo for spinal cord injury after OEG transplantation.</p><p><b>METHODS</b>The OEG was cultured with the olfactory bulb of Wistar neonate rats. The spinal cords contusion was made in group A, B, and C with the New York University impactor, then complete transection was performed in the contusion area in group A. OEG labeled by Hoechst was transplanted in group A and B. In group C, DMEM were injected. In group D, laminectomies were done without cord contusion and transection. The functional recovery of the spinal cord injury [Basso, Beattie, Bresnahan (BBB) Locomotor Rating Scale scores] and changes of body weight were observed. The tissue sections were done 24 weeks postoperatively. HE staining, neurofibril (NF) immunohistochemical staining, and silver staining were performed respectively to observe the pathologic changes and axon regeneration. The survival of OEG labeled by Hoechst was observed under the fluorescence microscope.</p><p><b>RESULTS</b>Locomotive behaviour improved 4 weeks postoperatively. The BBB locomotion scores of group A and B were significantly higher than that of group C in all periods (from 4 weeks to 24 weeks) (P < 0.01). Sixteen weeks after operation, the BBB locomotion scores became stable and showed no change. HE staining showed that the area of spinal cord injury was disorder and the number of nerve cell was more in group A and B. In group C, there was the obvious cavum and few wring nerve fiber in the area of spinal cord injury. The nerve fibers innervated to the injuried area in group A and B were more than that of group C, but less than that of group D. A great number of OEG labeled by Hoechst were observed around spinal injuried area under fluorescence microscope. After operation, the body weight reduced in every group. The body weight of group D had recovered after 2 weeks and gradully increased. After 4 weeks, the body weight in group A, B, and C decreased to the minimum and were significantly less than that of group D (P < 0.01). After this, body weight in group A and B increased and was significantly more than that of group C (P < 0.05).</p><p><b>CONCLUSIONS</b>OEG transplantation can promote the axons regeneration and the recovery of locomotion function in experimental spinal cord injuries.</p>