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Objective:To investigate the early clinical effectiveness of using customized 3D printed acetabular augment to repair large acetabular bone defects in delayed total hip arthroplasty after failed treatment of acetabular fractures.Methods:A retrospective study was conducted to analyze the 6 patients who had undergone 3D printed acetabular augment to reconstruct acetabular bone defects in delayed total hip replacement from July 2021 to January 2023 after failed treatment of acetabular fractures. They were all males, with an age of (51.3±15.0) years. Paprosky classification: 2 cases of type ⅡB, 1 case of type ⅡC, and 3 cases of type ⅢA. Recorded were surgical time, intraoperative bleeding, hospitalization time, and visual analogue scale (VAS), and modified Merle d'Aubigné & Postel score, Harris hip score, and leg length discrepancy at the last follow-up.Results:For the 6 patients, the mean surgical time was (222.5±46.9) min, the mean intraoperative bleeding 1,100 (1,000, 2,625) mL, the mean hospitalization time (9.0±4.5) d, and the mean follow-up time (11.8±7.9) months. At the last follow-up, the VAS [(2.5±1.0) points] significantly decreased compared with the preoperative value [(6.2±0.8) points], the modified Merle d'Aubigné & Postel score [(13.2±2.1) points] and Harris hip score [(67.8±15.3) points] significantly increased compared with the preoperative values [(6.7±0.8) and (34.2±8.4) points], the vertical position of center of rotation [(22.5±5.2) mm] and the horizontal position of center of rotation [(40.7±2.6) mm] were significantly reduced compared with the preoperative values [(38.1±14.2) and (53.1±10.0) mm] ( P<0.05). At the last follow-up, the leg length discrepancy was (6.2±3.6) mm, showing no statistically significant difference from the preoperative value [(18.7±1.7) mm] ( P>0.05). At the last follow-up, no clear line at the cup-bone or augment-bone interface, or no possible prosthetic loosening or displacement was observed on the X-ray films. Conclusion:In delayed total hip arthroplasty after failed treatment of acetabular fractures, the customized 3D printed augment for repair of large bone defects in the acetabulum can reconstruct the normal rotation center of the hip joint, provide reliable stability for the cup prosthesis, and enable patients to obtain significant improvements in hip function.
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Objective:To explore the short-term efficacy of fixation with a 3D printed individualized custom-made plate in the treatment of elderly patients with periprosthetic femoral fracture.Methods:Retrospectively analyzed were the 5 elderly patients with periprosthetic femoral fracture who had been treated by fixation with a 3D printed individualized custom-made plate from January 2022 to July 2022 at Department of Orthopaedics and Traumatology, Beijing Jishuitan Hospital. There were 3 males and 2 females, aged 81, 86, 77, 91 and 87 years, respectively. One left and 4 right limbs were affected. Vancouver classification: type B1 ( n=3), type B2 ( n=1), and type C ( n=1). The time from operation to injury was 5, 6, 10, 5 and 7 days, respectively. Preoperatively, the femur affected, prosthesis and individualized plate with a greater trochanteric hook, loop cable channel and bone-like trabecular microporous structure were custom-made by 3D printing according to 1:1 models. Virtual operations were simulated to formulate surgical protocols. The operation time, length of surgical incision, intraoperative blood loss and transfusion, hospital stay, hip function and complications at the last follow-up were recorded. Results:The 5 patients were followed up for 12, 7, 10, 3 and 6 months, respectively. There were no events of superficial incision or deep prosthesis infection. Respectively, the operation time was 1.8, 1.7, 2.3, 2.0 and 3.3 h; the length of surgical incision 31, 30, 38, 27 and 30 cm; the intraoperative bleeding volume 400, 300, 300, 500 and 600 mL; the length of hospital stay 8, 9, 15, 14 and 11 d. Four patients received intraoperative blood transfusion of 300, 900, 150 and 1, 050 mL, respectively. One patient died of a heart attack 3 months after discharge; another patient developed dyskinesia at the contralateral limb 3 months after discharge due to cerebral infarction and died of recurrent cerebral infarction 7 months after discharge. At the last follow-up, the Harris hip scores of 3 patients were 86, 77 and 69 points, respectively. None of the patients had complications like breakage or loosening of implants.Conclusion:In the treatment of elderly patients with periprosthetic femoral fracture, fixation with a 3D printed individualized custom-made plate may lead to fine limb function and good short-term curative efficacy.
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Objective:To analyze the causes and risks of in-hospital death in geriatric patients with hip fracture.Methods:Retrospectively analyzed were the data of 1,878 elderly patients with hip fracture who had been admitted to Department of Orthopaedics and Traumatology, Beijing Jishuitan Hospital from May 2015 to December 2017. There were 543 males and 1,335 females, with a male-to-female ratio of 1∶2.5 and a mean age of 79.6 years (from 65 to 105 years). There were 988 (52.6%) femoral neck fractures, 850 (45.3%) intertrochanteric fractures, and 40 (2.1%) femoral subtrochanteric fractures. 94.8% of the patients (1,781/1,878) received surgery. Cases of in-hospital death were recorded and their causes analyzed. The Estimation of Physiologic Ability and Surgical Stress (E-PASS) and the Nottingham Hip Fracture Score (NHFS) were used to assess the in-hospital deaths. The accuracy of these 2 assessment tools was validated on a small scale.Results:Thirteen in-hospital deaths were recorded, giving an in-hospital mortality of 0.69% (13/1,878). The direct causes of death were pulmonary infection in 7 cases, acute myocardial infarction in 2 cases, acute erosive hemorrhagic gastritis in 2 cases, acute respiratory distress syndrome in one, and suspected acute pulmonary embolism in one. Thirteen patients died, yielding a rate of in-hospital death of 5.3%±2.8% by E-PASS and that of 9.3%±4.0% by NHFS which were statistically different ( t=2.596, P=0.023). Conclusions:As geriatric patients with hip fracture are at a high risk of perioperative pulmonary infection, vigilance and early prevention are required during treatment. Care should be taken to monitor cardiovascular events and blood glucose, and stress ulcers should be prevented. The NHFS is recommended to assess the risks of in-hospital death in geriatric patients with hip fracture.
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Objective:To explore the epidemiological characteristics of geriatric hip fractures in Beijing so as to provide evidence for effective prevention and control measures.Methods:This multicenter study was conducted in 3 urban (Beijing Jishuitan Hospital, Beijing Hospital and Beijing Anzhen Hospital) and 3 suburban hospitals (Beijing Shunyi District Hospital, Beijing Changping District Hospital and Beijing Liangxiang Hospital) in Beijing from November 2018 to November 2019. Eligible patients were those aged ≥ 65 years with hip fracture confirmed by X-ray and being admitted to hospital within 21 days of injury. To explore the epidemiological characteristics of geriatric hip fractures in Beijing, such data were collected as patients' age, gender, comorbidities, as well as type, site, time and cause of the fracture.Results:① A total of 2,071 patients were included in this suevey. They were 653 males and 1,418 females (M∶F=1∶2.17). Their age ranged from 65 to 102 years (average, 79.8 years). The patients aged from 75 to 84 years were the most common, accounting for 44.81% (928/2,071). ② Femoral neck fractures accounted for 43.41% (899/2,071), and intertrochanteric fractures accounted for 56.59% (1,172/2,071). The age of the patients with femoral neck fracture was (78.6±7.7) years, which was significantly younger than that of those with intertrochanteric fracture [(80.7±7.4) years] ( P<0.05). ③ 94.69% of the hip fractures (1,961/2,071) were caused by falling, and 71.27% fractures (1,476/2,071) happened at home. ④ Approximately 83.00% of the patients (1,719/2,071) had one or more comorbid conditions. Hypertension was the most prevalent disease (57.89%, 1,199/2,071), followed by diabetes (27.09%, 561/2,071), and coronary atherosclerotic heart disease (22.02%, 456/2,071). Conclusions:In Beijing, significantly more geriatric females sustain a hip fracture than males, and the proportion of those aged from 75 to 84 year is the largest. The proportion of intertrochanteric fractures increases with age. Falls are the leading cause for geriatric hip fractures. Most of the patients have one or more chronic comorbid conditions. Corresponding prevention and intervention measures should be formulated according to the distribution characteristics of elderly hip fractures in Beijing.
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Objective:To evaluate the efficacy and safety of perioperative rehabilitation approaches based on the concept of Enhanced Recovery After Surgery (ERAS) for pelvic fractures.Methods:A prospective randomized control trial was conducted to include 114 emergency patients who had been admitted to Department of Orthopaedic Trauma, Beijing Jishuitan Hospital for surgical treatment of pelvic fractures from June 2019 to December 2020. Of them, 57 were assigned into an intervention group according to a random digits table. They were 42 males and 15 females, aged from 18 to 77 years and subjected to management of pelvic fractures with tentative perioperative ERAS approaches which were adjusted at different stages. The other random 57 patients were assigned into a control group. They were 40 males and 17 females, aged from 17 to 70 years and subjected to management of pelvic fractures with conventional rehabilitation approaches which included postoperative in-hospital consultation and guidance by rehabilitation physicians. The 2 groups were compared in terms of Majeed pelvis scores and Barthel indexes at postoperative 2, 6, 12 and 24 weeks, and visual analogue scale (VAS) pain scores and SF36 scores at postoperative 12 and 24 weeks.Results:A total of 105 patients (55 in the intervention group and 50 in the control group) were completely followed up for 151 to 254 d (mean, 177 d). The 2 groups were comparable due to no significant difference between them in the preoperative general data ( P>0.05). The Majeed scores (44±13, 67±16, 86±14 and 98±7) and Barthel indexes (57±13, 79±16, 95±8 and 100±2) at postoperative 2, 6, 12 and 24 weeks in the intervention group were significantly higher than those in the control group [(35±16, 51±16, 73±14 and 91±12) and (45±19, 67±18, 86±12 and 98±4)] (all P<0.05). At postoperative 12 and 24 weeks, the SF-36 scores (129±15 and 141±6) in the intervention group were significantly higher than those in the control group (114±15 and 131±12) ( P<0.05). There was no significant difference in the pain degree between the 2 groups ( P>0.05). Conclusion:In management of pelvic fractures, compared with conventional perioperative rehabilitation approaches, the perioperative ERAS rehabilitation approaches may improve early functional outcomes and thus help the patients restore their activities of daily living earlier.
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Although internal fixation is still a standard treatment for geriatric Garden Ⅰ/Ⅱ femoral neck fractures, it is reported to lead to a high rate of reoperation. Therefore, identification of risk factors for internal fixation failure can help a sensible decision-making in initial treatment. In recent years, many studies have suggested that posterior tilt of the femoral head before surgery may affect the rates of internal fixation failure and reoperation. Some studies have even recommended hip arthroplasty for geriatric Garden Ⅰ/Ⅱ femoral neck fractures. However, different studies adopted different measurement methods and thus obtained inconsistent results. By literature review, this article expounds on various measurement methods for femoral head tilt and correlation between posterior tilt of femoral head and prognosis after internal fixation, and compares therapeutic efficacy between internal fixation and hip arthroplasty, hoping to provide useful information and data for clinical treatment of geriatric Garden Ⅰ/Ⅱ femoral neck fractures.
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Objective:To investigate the safety of early hip fracture surgery for elderly patients on clopidogrel.Methods:This retrospective study included 242 consecutive elderly patients (≥65 years) with acute hip fracture who had undergone surgery at Department of Orthopaedic Trauma, Beijing Jishuitan Hospital between November 2016 and April 2017. Of them, 20 were assigned into the study group who had taken clopidogrel before injury but discontinued its use within 4 days before surgery. They were 6 males and 14 females, with a median age of 80 years (77, 81). Their operation procedures for hip fracture included internal fixation with cannulated screws for femoral neck fracture in 2 cases, hemiarthroplasty for displaced femoral neck fracture in 11 cases, and internal fixation for intertrochanteric fracture in 7 cases. The control group included 222 patients who had undergone the same operative procedures but not taken any antiplatelet or anticoagulant drugs. The 2 groups were compared in terms of time between admission and operation, operation duration, intraoperative blood loss, perioperative transfusion and complications related to bleeding to analyze the safety of early surgery.Results:There was no significant difference in the preoperative general data between the 2 groups, showing comparability ( P>0.05). There was no significant difference between the 2 groups in the time between admission and operation [42.5 (36.3, 48.0) h for the study group versus 43.0 (28.0, 61.0) h for the control group] ( P=0.870). The median time between the last use of clopidogrel and operation was 55.0 (30.5, 71.0) h. There were no significant differences between the 2 groups in preoperative hemoglobin, operation duration, intraoperative blood loss, rate or amount of perioperative blood transfusion, or rate or amount of wound drainage ( P>0.05). The rate of general anesthesia was significantly higher for the study group (45.0%, 9/20) than for the control group (18.5%,41/222) ( P=0.012). No complications related to spinal hematoma occurred in the patients receiving spinal anesthesia from the study group. Wound hematoma and subsequent infection occurred in 2 patients from the control group. Conclusion:Early hip fracture surgery is safe for elderly patients on clopidogrel.
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Objective:To summarize our experience in prevention of COVID-19 infection in emergency and confined operations during the first 3 weeks after Spring Festival in 2020.Methods:From February 3rd to 23rd, 2020, 151 patients were admitted to Department of Orthopaedic Trauma, Beijing Jishuitan Hospital for emergency and confined operations. In this cohort, 125 patients were admitted to ordinary wards. They were 70 males and 55 females with an age of 51.1 years ± 14.9 years. Of them, 2 were subjected to emergency operation and 123 to confined operation. The mean time from injury to operation was 9.9 days ± 6.1 days. There were 26 cases in the senile wards, 7 males and 19 females with an age of 80.8 years ± 7.0 years all of whom underwent confined operations. The mean time from injury to operation was 8.4 days ± 6.3 days. The protocols for emergency diagnosis, admission, emergency and confined operations, postoperative rehabilitation and management of suspects with COVID-19 during the epidemic of COVID-19 were optimized according to Diagnosis and Treatment Protocols for Novel Coronavirus Pneumonia (Trial version 5), emergency responding pre-plans of our hospital, and our experience in Enhanced Recovery After Surgery (ERAS) as well.Results:The patients in the ordinary wards had a hospital stay of 6.8 days ± 4.6 days while those in the senile wards 5.1 days ± 2.0 days. Abnormal temperature (≥37.3 ℃) was observed perioperatively in 17 cases in the ordinary wards. It was absorption fever in all and appeared in 4 cases upon admission. Fever appeared in 11 patients in the senile wards and upon admission in 3 of them. One senile patient who had been diagnosed of normal pneumonia returned to normal temperature and remained stable conditions after antibiotic therapy. The other patients were free of complications related to COVID-19 during their hospital stay.Conclusion:The first-line medical staff working at emergency department, wards and surgical theaters must heighten their vigilance against COVID-19 infection and rigorously follow protocols for prevention of COVID-19 infection in their daily clinical practice.
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Radiotherapy is the main treatment of nasopharyngeal carcinoma (NPC). With the continuous improvement of radiotherapy technology, the survival time of NPC patients is significantly improved, but the complications after radiotherapy have been paid more and more attention, in which the incidence of radiation-induced temporal lobe injury is higher, which seriously affects the quality of life of patients, and even reduces the survival rate. Therefore, it is particularly important to find a method for the examination of early radiation-induced temporal lobe injury. Three-dimensional arterial spin labeling (3D-ASL) analysis of cerebral blood flow (CBF) changes before and after radiotherapy, magnetic resonance spectroscopy (MRS) analysis to determine the changes of NAA/Cr, Cho/NAA, Cho/Cr ratio in the anterior and posterior temporal lobe before and after radiotherapy, and diffusion tensor imaging (DTI) to determine the changes of temporal lobe average diffusion coefficient (ADC) and anisotropy fraction (FA) before and after radiotherapy can help in the early diagnosis of radiation brain injury, especially through the combined use of the above three tests. It is expected to provide a feasible basis for the early diagnosis of radiation encephalopathy, and early nutritional neurotherapy is of great significance to improve the quality of life and survival rate of patients.
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Objective@#To understand the current situation of maternal health care in this area, and to provide basis for further improving the quality of maternal and child health care service in this area and in the western region of China.@*Methods@#The clinical data of 8 539 pregnant women from 10 hospitals in Yunnan Province was collected, including the general situation, the situation of medication and intervention during delivery, the mode of delivery and the outcome of delivery.@*Results@#Age (χ2=149.878, P<0.01), number of pregnancies (χ2=12.251, P<0.01), times of delivery (χ2=49.141, P<0.01), number of fetuses (χ2=18.580, P<0.01) and history of pregnancy (χ2=146.688, P<0.01)all affected the incidence of complications during parturition. And whether there are maternal complications will affect the situation of medication (χ2=131.959, P<0.01), induced labor (χ2=13.129, P<0.01) and the length of midwifery service in the delivery room (Z=-14.328, P<0.01).@*Conclusion@#Paying attention to the pregnant women with pregnancy complications/complications could help to reduce the maternal mortality rate, and provide the high-level health care for mothers and children in Yunnan Province and even in the western region of China.
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Objective To evaluate the demand for midwives in Yunnan province utilizing Birthrate Plus for planning and development of such workforce. Methods A convenient sample method was used to investigate 8435 maternal cases at 9 hospitals in Yunnan province in four months from 9 - 12 in 2017, and Birthrate Plus was used to calculate the demand for midwifery at each hospital. We also analyzed the two core elements of Birthrate Plus- maternal category allocation and midwife hours of each hospital. Results Maternal cases fall into five categories and maternal category allocation in hospitals is roughly the same;Maternal in higher category tended to need longer midwife hours; the average birthrate of 9 hospitals was (194. 22 ± 44. 84) case/ ( year·midwife). The number of midwives in two tertiary hospitals is obviously insufficient. Midwives at 7 secondary hospitals are more than predicted. Conclusions Midwives in Yunnan are generally faced with a large workload, especially at secondary hospitals, and midwives need to bear numerous non-midwifery workload beyond Birthrate Plus. Therefore, the Birthrate Plus can reflect the midwifery workload scientifically and reasonably in the current situation of midwifery work. But the predication for midwifery workforce requires a study of the ratio of midwifery work in the entire clinical work of the hospital.
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Objective In order to explore the role of autophagy in the development of systemic lupus erythematosus (SLE),we measured the expression of autophagy related gene microtubule-associated protein 1 light chain 3 (LC3),Atg5,Beclinl,Atg7 and the incidence of autophagy in T cells from patients with SLE.Methods The mRNA levels of LC3,Atg5,Beclinl,Atg7 in T cells from 67 SLE patients and 31 healthy individuals were detected by real-time quantitative polymerase chain reacton (qPCR) technique.Autophagy in T cells from 17 SLE patients and 11 healthy controls was also determined by flow cytometry (FACs).The correlation of Atg7 mRNA expression with clincal features was then analyzed.The differences between the two groups were tested by t-test and x2 tcst,all data were analyzed by statistical and service solutions (SPSS) 17.0 software.Results The mRNA levels of LC3 and Atg7 (ΔCT value) in SLE patients were obviously down-regulated as compared to healthy populations (P=0.010,P=0.002),paralleled with the decreased autophagy rate detected by flow cytometry in T cells of SLE patients [(3.7±1.9)％ vs (6.6±1.4)％,t=4.132,P=0.000].Also,the protein expression levels of LC3-Ⅱ in T cells of SLE patients (LC3-Ⅱ/GAPDH) was significantly lower than those in healthy controls (0.21±0.08 vs 0.34±0.11,t=1.846,P=0.047).Moreover,Atg7 mRNA expression levels were found to be negatively correlated to autophagy rate (r=-0.492,P=0.008).However,when comparing the clinical features of 24 SLE patients with decreased Atg7 mRNA expression (ΔCT value＞9.86) to 43 SLE patients with normal or high Atg7 mRNA expression (ΔCT value ＜9.86),increasing trend of incidence of arthritis,blood involvement and CNS was noted in patients with decreased Atg7 mRNA expression.However,there was a significant difference between the two groups in the incidence of renal involvement and anti-dsDNA antibody and SLEDAI (P=0.008,P=0.018,P=0.035).Conclusion The impaired autophagy resulted from down-regulated LC3 and Atg7 mRNA levels in T cells from SLE patients indicates that autophagy plays a role in mediating the occurrence and development of SLE,which might be through unable to clean harmful molecules effectively.
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Objective In order to explore the effect of 25-(OH)D3 on monocyte chemoattratant protein (MCP)-1 expression from patients with system lupus erythematosus (SLE),we detected the level of active vitamin D and the expression of MCP-1 mRNA in patients with SLE,and analyzed the correlation between them.Methods The level of serum 25-(OH)D3 and mRNA expression of MCP-1 in 154 SLE patients and 31 healthy individuals were detected by enzyme-linked immuno sorbent assay (ELISA) and real time quanti-tative pol ymerase chain reaction (PCR) respectively.We also analyzed the correlation between serum 25-(OH)D3 level and the expression of MCP-1 mRNA,then analyzed the function of 25(OH)D3 on the regula-tion of MCP-1 mRNA expression in vitro.The differences between the two groups were tested by t-test and x2 test,multiple data were tested by one-way ANOVA and the correlation was analyzed by Pearson's correlation,all data were analyzed by statistical product and service solutions (SPSS) 17.0 software.Results The serum 25(OH)D3 levels in SLE group (20±11) ng/ml was significantly lower than normal control group (29±11) ng/ml (t=4.198,P＜0.01),and the ratio of the serum levels of vitamin D deficiency in SLE group were significantly higher than that of normal control group [55.8％(86/154) vs 22.6％(7/31),x2=11.421,P=0.001].The expression level of MCP-1 mRNA in PBMCs from the normal control group was significantly lower than the SLE group (1.14±0.27 vs 1.44± 0.31,t=3.277,P=0.001),serum 25(OH)D3 level and MCP-1 mRNA expression in patients with SLE PBMCs were significantly negatively correlated (r=-0.289,P＜0.01).Further study found that 25-(OH)D3 inhibited MCP-1 mRNA expression in PBMCs from SLE patients depending on the concentration.Conclusion The decreased 25-(OH)D3 level and up-regulated MCP-1 mRNA expression suggestthat MCP-1 may play an important role in SLE pathological process.
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Hip fractures,with an increasing morbidity in the elderly patients,pose a serious threat to the health of the aged.At the moment,surgery is the preferred treatment for the vast majority of these patients.Early surgical intervention is strongly recommended by most guidelines and articles.It is still controversial,however,whether surgery should be postponed or performed and whether medication therapy should be withdrawn or continued in some of the elderly patients with hip fracture who are taking anticoagulant or antithrombotic drugs before they are injured.Clopidogrel is one of the anti-platelet drugs commonly used clinically.This article reviews the literature regarding the impact of clopidogrel on surgical timing for hip fractures in the aged,hoping to provide useful clues to the clinical study and practice.
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Objective To investigate the current perioperative management of geriatric hip fractures in China.Methods The survey was performed between 15th to 21st of November,2017.An electric questionnaire was delivered to the orthopedic surgeons attending the 12th International Congress of Chinese Orthopedic Association (COA) and the orthopedic fellows attending grand round at Department of Orthopaedic Trauma,Beijing Jishuitan Hospital.The questionnaire addressed the current perioperative management of geriatric hip fractures (≥ 65 years) at the departments where the participants worked,covering preoperative examination and preparation,postoperative rehabilitation and multidisciplinary collaboration.Results 171 valid questionnaires were collected for this study.Of the 171 orthopedic surgeons from 28 provinces in China,106 (62.0％) came from a tertiary hospital and 65 (38.0％) from a secondary hospital.In 74.3％ (127/171) of the hospitals,more than 100 geriatric hip fractures were treated annually.63.2％ (108/171) of the hospitals treated 100 to 500 cases annually,5.9％ (10/171) 500 to 1,000 cases and 5.3％ (9/171) more than 1,000 cases.Multidisciplinary collaboration was not established in most hospitals (71.9％,123/171) for geriatric hip fractures.Pulmonary function test (61.4％,105/171),Holter (38.0％,65/171) and ambulatory blood pressure monitoring (53.8％,92/171) were indicated as routine preoperative investigations.In 56.3 ％ (96 / 171) of the hospitals,traction was performed before operation.In 80.1％ (137 / 171) of the hospitals,the interval between admission to surgery was more than 48h for the patients.In 36.3％ (62/171)of the hospitals,patients were allowed to ambulate within one week after surgery.In 4.1％ (7/171) of the hospitals,patients were allowed full weight-bearing within one week after surgery.Conclusion Significant gaps exist in perioperative management of geriatric hip fractures between current practice in China and worldwide guidelines and consensus.
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Objective To investigate the therapeutic effect of multidisciplinary orthogeriatric management for geriatric hip fractures. Methods The 492 consecutive patients aged 65~99 years (mean ,79.6 years)with woman 69.9% (344/492)were recruited between May 2015 and April 2016 in the retrospective study. Clinical data ,time from admission to initiation of surgery ,in-hospital mortality and mobility status of patients receiving orthogeriatric co-management were analyzed. Results The operation was performed in 434 patients(88.2% ). The 49.8% (216/434)of patients underwent surgery within 48 hours after admission. The average time between admission and operation was 66.5 hours(6~246 hours).In-hospital mortality was 0.7% (3/434).The 382 patients(88.0% )were followed up , with mean follow-up of 21.2 months(range ,16~27 months). The total mortality was 9.9% (38/382) and one-year mortality was 6.5% (25/382). The average Parker mobility score of 344 survived patients was significantly reduced from 8.4 before injury to 6.6 at final follow up(P＜0.01).The 42.4% (162/382)of patients returned to their pre-injury mobility status. Re-operation was performed in 8 patients(2.1% )during follow up. Conclusions Multidisciplinary orthogeriatric management for geriatric hip fractures is effective with a low in hospital and one-year mortality ,while the mobility status is deteriorated significantly and more than half of the patients cannot return to their pre-injury mobility status.
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Objective To explore the management of postoperative infection following open reduction and internal fixation for acetabular fractures.Methods Ten patients were treated and completely followed up in Beijing Jishuitan Hospital from February 2012 to December 2016 for postoperative infection after open reduction and internal fixation for acetabular fracture.They were 9 males and one female,aged from 14 to 64 years(mean,40.6 years).According to Letournel classification,there were 2 double-column fractures,2 anterior descending transverse fractures,2 anterior column fractures,one posterior wall fracture,and one posterior wall fracture.Eight cases developed surgical regional infection within 2 weeks after internal fixation,and 2 presented with symptoms of infection more than 3 months after fracture fixation.Vacuum sealing drainage (VSD) was used to treat one case of acute superficial infection;open debridement surgery,carrier with sensitive antibiotics and intravenous antibiotics were used to treat 7 cases of acute deep infection and 2 cases of chronic deep infection.Results The infection symptoms disappeared 9 days after removal of VSD device in the one case of acute superficial infection.Normal fracture union was achieved in 6 cases after their infection was controlled;4 cases had to undergo total hip arthroplasty because their articular structure was damaged after control of infection.The 10 patients were followed up for 6 to 54 months (mean,25.7 months).Their Harris scores at the last follow-up averaged 74.8 (from 32 to 92).Conclusions Negative-pressure wound therapy is an effective management for acute superficial infection after acetabular fracture.Deep acute infection needs early repeated debridement combined with sensitive antibiotic carrier to protect joint function.For infection which is difficult to control or chronic infection associated with structural damage,repeated debridement combined with sensitive antibiotic spacer is effective for infection control at the first stage and artificial total hip arthroplasty can be carried out at the second stage when the infection is controlled.
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Objecttve To explore the roles of p53,Bax and Bcl-2 in rat lens epithelial cells apoptosis induced by ultraviolet radiation.Methods Healthy SpragueDawley rats (40,6-weeks old,150 g) were selected and divided into 5 groups randomly.After SD rats were injected 100 g · L-1 chloral hydrate (0.35 mL/100 g) intraperitoneally and pupil dilation,the eyes of SD rats were radiated 15 minutes by using UV-B (300-320 nm).The exposed animals were sacrificed at 1 day,3 days,5 days and 7 days after exposure.Both lenses from all animals were extracted.The apoptosis of rats lens epithelial cells was performed by Hoechst 33258 staining.The expression of p53,Bax and Bcl-2 in rat lens epithelial cells at mRNA level was detected by real-time PCR.The distribution and expression of p53,Bax and Bcl-2 were observed by immunohlstochemistry.Results The apoptosis of lens epithelial cells was aggravated after exposure.The expression of p53 and Bax at mRNA and protein level was increased after UV exposure (P ＜ 0.01).But for Bcl-2 the expression both at mRNA and protein level was decreased after a 1 day-exposure(P ＜0.01) and was increased after UV exposure of 5 days and 7 days(P ＜ 0.01).The mRNA expression level of p53 was positively correlated with the Bax (r =0.952,P ＜ 0.01).The expression of p53 and Bax protein were increased after UV exposure,and transferred from cytoplasm to nucleus;While the expression of Bc1-2 protein was decreased at 1 day after UV exposure,and increased gradually at 3 days,5 days and 7 days.Conclusion The apoptotic process of rat lens epithelial cells induced by ultraviolet may be related with p53 regulating the expression of Bax/Bcl-2.
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Objective To evaluate the clinical effect of early total care (ETC) for treatment of unstable pelvic fractures.Methods This retrospective case series study included eighteen patients with unstable pelvic fractures treated surgically from May 2013 to May 2015.There were 11 male and 7 female patients,aged (45.1 ± 13.1)years.Eleven patients were injured due to road traffic accidents and 7 due to fall from height.Tile B type pelvic fractures were seen in 8 patients and Tile C type in 10 patients.All patients were treated with ETC method and received open reduction and internal fixation within 24 to 48 hours after the primary treatment.Data were collected,such as operation time,intraoperative blood loss,hospital length of stay and perioperative complications.Majeed score and EuroQol 5 dimension (EQ-5D) were used for evaluation of clinical outcome and quality of life respectively.Excellent and good rate of operation was assessed using the Matta clinical evaluation standard.Results Three patients died and fifteen patients survived.Operation time was (120.1 ± 22.2)minutes,amount of intraoperative blood loss was (355.9 ± 56.4) ml,and hospitalization was (8.5 ± 1.6) days.Incidence of perioperative complications was 56％,including 3 patients with acute respiratory distress syndrome,1 pneumonia,2 acute lung injury,1 incisional wound infection,2 multiple organ failure and 1 diffuse intravascular coagulation.All patients were followed up for (15.1 ±2.4)months (range,12-21 months).Majeed score was decreased from preoperative (93.7 ± 6.1) points to final follow-up of (74.1 ± 9.2) points,and the EQ-5D index was decreased from preoperative 0.96 ± 0.04 to final follow-up of 0.74 ± 0.19 (both P ＜ 0.05).Excellent and good rate of operation was 80％.Conclusions ECT provides satisfactory short-term outcome for treatment of unstable pelvic fractures,but the incidence of complications is high.Doctors should choose reasonable treatment plan according to the surgical indications.
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Objective To explore the perinatal outcome of vaginal birth after cesarean (VBAC) in women with advanced age.Methods Totally 2 587 women delivered after one or two prior cesarean sections (gestational age≥28 weeks) in the First Affiliated Hospital of Kunming Medical University from July 2013 to February 2017.909 trial of labor after cesarean(TOLAC) cases of singleton pregnancy with one prior cesarean section were studied retrospectively.According to the age,of the 909 TOLAC cases,237 were the advanced age group,and 672 cases were the low age group.The maternal and neonatal outcomes between the two groups were compared.Results The percentage of TOLAC in women with advanced age was 32.4％ (237/731),and VBAC rate was 88.2％ (209/237).The percentage of TOLAC in younger women was 36.2％ (672/1 856),and VBAC rate was 82.4％ (554/672).The difference of the TOLAC rate between the two groups was not significant (P＞0.05),and the VBAC rate of the advanced age group was higher than the low age group (P＜0.05).In the comparison of the two groups,the proportion of bachelor degree or above(55.7％,132/ 237),the prepregnancy BMI (22.4±3.0) kg/m2,pregnant interval time (68.5±38.3) months,the proportion of gestational hypertension (8.4％,20/237),the proportion of gestational diabetes(34.6％,82/237) and the rate of the neonatal ICU admission (18.1％,43/237) in the advanced age group were higher than those of the low age group (P＜0.05),respectively.And there were no significant differences in the rate of postpartum hemorrhage,the rate of postpartum hemorrhage≥1 500 ml,the rate of postpartum transfusion,puerperal morbidity,neonatal birth weight,neonatal 5 min Apgar score＜7 score,umbilical artery blood pH＜7.0,neonatal tracheal intubation and respiratory distress syndrome (all P＞0.05).In all TOLAC cases,the rate of uterine rupture was 0.11％(1/909) and there was no maternal and neonatal death.Conclusion VBAC is a safe and feasible way of delivery for singleton pregnancy after one prior cesarean section in women with advanced age.