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1.
Chinese Journal of Trauma ; (12): 825-832, 2021.
Article in Chinese | WPRIM | ID: wpr-909945

ABSTRACT

Objectives:To investigate the nursing effect of perioperative enhanced recovery after surgery(ERAS)management model in elderly patients with hip fracture.Methods:A retrospective case-control study was conducted to analyze the clinical data of 94 elderly patients with hip fracture admitted to Second Affiliated Hospital of Soochow University from July 2017 to June 2018,including 24 males and 70 females aged 76-98 years[(83.7±5.4)years]. There were 54 patients with intertrochanteric fracture and 40 patients with femoral neck fracture. Surgical method was proximal femoral nail antirotation(PFNA)fixation or artificial hip arthroplasty. A total of 44 patients were managed by ERAS(enhanced recovery group)and 50 patients by traditional nursing(traditional rehabilitation group). The off-bed time was compared between the two groups from aspects of different fracture sites,bone mineral density and causes of injury. The visual analogue scale(VAS)was tested preoperatively and at postoperative days 1,3 and 7. The complications were recorded at postoperative 1 month. The activity of daily living(ADL)score was assessed preoperatively and at postoperative 1 week,1 month and 3 months. The Harris hip score was assessed at postoperative 1 week,1 month,3 months and at the last follow-up. The length of hospital stay and death at postoperative 3 months and at the last follow-up were recorded.Results:All patients were followed up for 12-24 months[(17.7±6.2)months]. In enhanced recovery group,the off-bed time of patients with different fracture sites(femoral neck,femoral intertrochanter),bone mineral density(>-2.5 SD,≤-2.5 SD)and causes of injury(falls,traffic accidents and others)were markedly shortened as compared with traditional rehabilitation group( P<0.01). There was no significant difference in VAS between the two groups before operation( P>0.05). However,the VAS in enhanced recovery group was(3.4±0.9)points,(2.7±0.5)points,(1.7±0.6)points at postoperative days 1,3 and 7,significantly lower than that in traditional rehabilitation group[(4.3±1.1)points,(3.5±0.5)points,(2.7±0.9)points]( P<0.01). One month after operation,the incidence of pulmonary infection was 0% in enhanced recovery group and 28%(14/50)in traditional rehabilitation group( P<0.01). While there showed no significant differences in incidences of cardiovascular system,nervous system,urinary tract infection,lower limb deep vein thrombosis,impaired liver and kidney function,anemia,electrolyte disorder or hypoalbuminemia between the two groups( P>0.05). There was no significant difference in preoperative ADL score between the two groups( P>0.05). The ADL score in enhanced recovery group was(37.0±6.6)points,(70.1±8.4)points,(86.2±9.3)points at postoperative 1 week,1 month and 3 months,significantly higher than that in traditional rehabilitation group[(26.5±10.4)points,(50.1±11.4)points,(70.7±9.0)points]( P<0.01). The Harris hip score in enhanced recovery group was(80.9±8.6)points at postoperative 1 month,significantly higher than that in traditional rehabilitation group[(71.1±9.2)points]( P<0.01). There were no significant differences in Harris hip score between the two groups at postoperative 1 week,3 months and at the last follow-up( P>0.05). The length of hospital stay was(4.7±2.4)days in enhanced recovery group,significantly shorter than(7.8±3.9)days in traditional rehabilitation group( P<0.01). The enhanced recovery group showed no death within 3 months after operation and 2 deaths[5%(2/44)]at the last follow-up,while the traditional rehabilitation group revealed 4 deaths[8%(4/50)]within 3 months after operation. There was no significant difference in the mortality between the two groups until the last follow-up( P>0.05). Conclusion:For elderly patients with hip fracture,perioperative ERAS management model can effectively shorten periods in bed,relieve postoperative pain,reduce incidence of postoperative pulmonary infection,accelerate recovery of hip function,improve quality of life,shorten length of hospitalization and promote early recovery.

2.
Article in Chinese | WPRIM | ID: wpr-885133

ABSTRACT

Objective:Iron accumulation is related to the occurrence of postmenopausal osteoporosis. Meanwhile, autophagy abnormality of bone marrow hematopoietic cells is observed in hip osteoporotic fracture. This study is performed to investigate correlation between iron accumulation induced bone loss and hematopoietic autophagy dysfunction to explore the new risk factor of osteoporosis.Methods:Male iron accumulation mice model was established by intraperitoneally injecting ferric ammonium citrate. Serum ferritin and osteogenic indicator P1NP were tested by ELISA. Bone mineral density was measured by micro-CT. Femur and tibia bone marrows were collected for hematopoietic stem and progenitor cells proportion and cell apoptosis analysis. Autolysosome formation was measured by image flow cytometry. We used conditional mouse model Atg7 flox/flox; Vav-Cre(Atg7 -/-) in which Atg7 had been genetically deleted in the hematopoietic system. Bone marrow hematopoietic stem and progenitor cells were collected for RNA sequence. micro-CT scan was conducted for Atg7 -/- femur. Results:Ferritin level of iron accumulation mice was significantly higher than control group( P<0.05). Iron accumulation inhibited P1NP and induced decreased bone mineral density( P<0.05). Iron accumulation bone marrow displayed enhanced hematopoietic stem and progenitor cells proportion( P<0.05), with more cell apoptosis( P<0.05). Hematopoietic autophagy was deteriorated in iron accumulation bone marrow. Transcriptomic profiling showed up-regulation of iron activity in Atg7 -/- mice, with increased iron homeostasis and iron membrane transporter genes, including Lcn2, Tfr2, Slc40a1(Fpn1), Steap3, and Cpox. micro-CT revealed severe bone loss and decreased bone mineral density in Atg7 -/- mice( P<0.05). Conclusion:Iron accumulation induced bone loss is related to inhibition of hematopoietic cells. Hematopoietic autophagy dysfunction is associated with bone loss.

3.
Article in Chinese | WPRIM | ID: wpr-870071

ABSTRACT

Ferroptosis is a new concept of cell death. With the deepening of ferroptosis research, there have been many new understandings of the correlation of ferroptosis with clinical outcomes, diagnosis, and treatment of diseases. Ferroptosis is different from programmed cell death such as apoptosis and autophagy. Ferroptosis is an iron-dependent adjustable cell death that is regulated by glutathione peroxidase 4(GPX4), which requires iron to participate. Moreover, ferroptosis is involved in in many disease processes such as tumors and neurodegeneration. In 2019, journals such as Nature and Cell successively published studies on the mechanism of ferroptosis and clinical diseases, and " ferroptosis" has been increasingly recognized by clinical researchers. Therefore, understanding the main characteristics and regulation mechanism of ferroptosis as well as the influence pathway and mode of iron metabolism process on the occurrence of ferroptosis in vivo is very beneficial to understand the correlation between clinical diseases and ferroptosis, and to enlighten and expand the thinking of clinical diagnosis and treatment. This article reviewed the literature on ferroptosis as well as the relationship between ferroptosis and clinical diseases, in order to gain a deeper understanding of the new concept of ferroptosis.

4.
Chinese Journal of Orthopaedics ; (12): 873-879, 2020.
Article in Chinese | WPRIM | ID: wpr-869034

ABSTRACT

Objective:To explore the changes of bone mineral density (BMD) and type H vessel, which was recently identified as strongly positive for CD31 and Endomucin (CD31 hiEmcn hi) in long bone from ovariectomized (OVX) mice compared withSham group. Methods:C57BL/6Jwild-type mice were used for experiments and bone tissuewas collected. Eight-week-old female mice were randomly divided into bilateral ovariectomy (OVX) and a sham operation (Sham). The bilateral ovaries were exposed and removed in the OVX group. In the sham group, the ovaries were only exposed but left intact. After 4weeks, these mice were killed for experiment and the femurs were collected for Micro CT scanning in order to observe the changes of bone mineral density (BMD) and trabecular indexes, including bone volume (BV), total volume of interest (TV), bone volume fraction (BV/TV), trabecular thickness (Tb.Th), trabecular separation (Tb.Sp), trabecular number (Tb.N). The fresh tibia of each mouse was fixed, decalcified, dehydrated and embedded for immunostaining. All experimental data were analyzed with t-test. Results:Mouse femora from two groups were dissected at 4 week time points, and the attached soft tissue was completely removed for Micro CT scanning. BMD in OVX is 0.11±0.01 g/cm 3 and 0.21±0.01 g/cm 3 in Sham, which indicated the BMD in OVX significantly decreased. The results showed significant difference between the groups ( P=0.001). The microarchitecture in trabecular bone changed. BV/TV in OVX is 11.52%±1.77% and 25.87%±1.31% in Sham, which indicated the BV/TV in OVX significantly decreased. The results showed significant difference between the groups ( P<0.05). Tb.N in OVX is 1.67±0.33/mm and 2.95±0.82/mm in Sham, which indicated the Tb.N in OVX slightly decreased. The results showed no significant difference between the groups ( P=0.066). Tb.Th in OVX is 0.06±0.01 mm and 0.07±0.01 mm in Sham, which indicated the Tb.Th in OVX significantly thinned. The results showed significant difference between the groups ( P=0.021). Tb.Sp in OVX is 0.29±0.15 mm and 0.19±0.01 mm in Sham, which indicated the Tb.Sp in OVX significantly increased. The results showed significant difference between the groups ( P<0.05). In the groups BMD decreased and trabecular microstructure was broken. Both BMD and trabecular indexes (BV/TV, Tb. Th, Tb. Sp) showed significant changes in OVX group compared with Sham ( P<0.05) except Tb.N. We next examined the expression of CD31 and EMCN via immunostaining in order to observe the changes of type H vessel.By immunostaining, the percentage of HV/TV in OVX group was 9.14%±0.99% and 29.33%±1.22% in the sham-operated mice. Dramatically decreased type H vessels in the metaphysis of OVX mice were observed compared with that of Sham control mice. The results showed significant difference between the groups ( P<0.05). Conclusion:In this study, ovariectomized mice, a widely used model for postmenopausal osteoporosis, exhibited significantly reduced type H vessels accompanied by reduced BMD, which indicatedtype H vessel involved in the occurrence of postmenopausal osteoporosis.

5.
Chinese Journal of Trauma ; (12): 804-809, 2020.
Article in Chinese | WPRIM | ID: wpr-867789

ABSTRACT

Objective:To evaluate the effect of zoledronic acid administration for osteoporotic vertebral compression fracture (OVCF) after treatment with percutaneous kyphoplasty (PKP).Methods:A retrospective case-control study was performed on 430 elderly patients with OVCF admitted to the Second Affiliated Hospital of Soochow University from January 2012 to December 2016. There were 31 males and 399 females, with age of 52-92 years[(72.8±8.3)years]. Fracture segments were at T 5-T 10 (82 vertebrae), T 11-L 2 (389 vertebrae) and L 3-L 5 (173 vertebrae). In zoledronic acid group ( n=178), patients were given zoledronic acid 3 days after PKP surgery. In basic treatment group ( n=252), patients were only given basic treatment after PKP surgery. Bone mineral density was measured before operation and one year after operation. Visual analogue scale (VAS) and Oswestry disability index (ODI) were assessed before operation, 3 days and one year after operation. Incidence rate of refracture, mortality and complication rate were recorded after operation. Results:All patients were followed up for 12-60 months (mean, 27 months). Before operation and at postoperative 1 year, the vertebral bone mineral density in zoledronic acid group was (-2.3±1.5)SD and (-1.2±2.3)SD ( P<0.05), and that in basic treatment group was (-2.2±1.2)SD and (-2.1±1.1)SD ( P>0.05). At postoperative 1 year, the bone mineral density in zoledronic acid group was significantly better than that in basic treatment group ( P<0.05). At preoperative 3 days, postoperative 3 days and postoperative 1 year, the VAS was (8.6±0.8)points, (2.8±0.8)points, (2.1±0.8)points in zoledronic acid group, and was (8.5±1.1)points, (2.9±0.9)points, (3.0±2.3)points in basal treatment group; ODI was 48.7±5.3, 24.0±2.9, 22.3±3.3 in zoledronic acid group, and was 48.3±6.1, 24.5±3.8, 27.6±4.0 respectively in basal treatment group. The VAS and ODI were significantly reduced in two groups at postoperative 3 days and 1 year compared to those before operation ( P<0.05). Moreover, the VAS and ODI in zoledronic acid group were significantly lower than those in basal treatment group at postoperative 1 year ( P<0.05). At postoperative 2 years, the incidence rate of refracture in zoledronic acid group was 10.1%(18/178), significantly lower than 16.7%(43/252) in basic treatment group ( P<0.05). Mortality rate in zoledronic acid group was 5.1%(9/178), and that in basic treatment group was 6.3%(16/252) ( P>0.05). No serious complications were observed in both groups such as nerve injury or pulmonary embolism. Conclusion:For OVCF patients, zoledronic acid given after PKP can improve the bone mineral density, reduce pain, fasten function recovery, and effectively decrease the refracture rate.

6.
Chinese Journal of Trauma ; (12): 45-50, 2020.
Article in Chinese | WPRIM | ID: wpr-867669

ABSTRACT

Objective To investigate the guiding significance of Daping orthopedics operative risk scoring system for senile patient (DORSSSP) for stratified treatment of elderly patients with severe hip fractures.Methods A retrospectively case-control study was performed for data of 440 elderly patients with hip fracture admitted to Second Affiliated Hospital of Soochow University from January 2014 to January 2018,including 130 male and 310 female patients aged 60-98 years [(79.3 ± 6.3) years].According to the DORSSSP scoring system,the patients were divided into low risk group (Group A,n =208),medium risk group (Group B,n =157) and high risk group without SICU transfer after operation (Group C,n =23) and high risk group with SICU transfer after operation (Group D,n =52).The risk prediction results of each group were recorded and compared with the actual complications and mortality.Results (1)According to the prediction of DORSSSP,the number of postoperative complications in Groups A,B,C and D were 52,60,14 and 31,respectively,while the number of actual complications after operation was 45,55,13 and 16.There was significant difference between the predicted value and the actual value of postoperative complications in Group D (P < 0.01),which was not found in other three groups (P > 0.05).The incidence of postoperative complications in Group D was lower than that in Group C (P <0.05).(2) According to the prediction of DORSSSP,the number of postoperative death in Groups A,B,C and D were 0,three,two and four,respectively,while the number of actual death after operation was 0,one,two and one,respectively.The predicted value and the actual value of death were significantly different in Group D (P < 0.05),but were not in other three groups (P > 0.05).The incidence of postoperative death in Group D was lower than that in Group C (P > 0.05).Conclusions There is a good correlation between DORSSSP score and postoperative complications and mortality.Based on DORSSSP score for stratified treatment,the interventional treatment of elderly patients with severe hip fracture after operation into SICU can better reduce the incidence of complications.

7.
Chinese Journal of Trauma ; (12): 45-50, 2020.
Article in Chinese | WPRIM | ID: wpr-798620

ABSTRACT

Objective@#To investigate the guiding significance of Daping orthopedics operative risk scoring system for senile patient (DORSSSP) for stratified treatment of elderly patients with severe hip fractures.@*Methods@#A retrospectively case-control study was performed for data of 440 elderly patients with hip fracture admitted to Second Affiliated Hospital of Soochow University from January 2014 to January 2018, including 130 male and 310 female patients aged 60-98 years [(79.3±6.3)years]. According to the DORSSSP scoring system, the patients were divided into low risk group (Group A, n=208), medium risk group (Group B, n=157) and high risk group without SICU transfer after operation (Group C, n=23) and high risk group with SICU transfer after operation (Group D, n=52). The risk prediction results of each group were recorded and compared with the actual complications and mortality.@*Results@#(1)According to the prediction of DORSSSP, the number of postoperative complications in Groups A, B, C and D were 52, 60, 14 and 31, respectively, while the number of actual complications after operation was 45, 55, 13 and 16. There was significant difference between the predicted value and the actual value of postoperative complications in Group D (P<0.01), which was not found in other three groups (P>0.05). The incidence of postoperative complications in Group D was lower than that in Group C (P<0.05). (2) According to the prediction of DORSSSP, the number of postoperative death in Groups A, B, C and D were 0, three, two and four, respectively, while the number of actual death after operation was 0, one, two and one, respectively. The predicted value and the actual value of death were significantly different in Group D (P<0.05), but were not in other three groups (P>0.05). The incidence of postoperative death in Group D was lower than that in Group C (P>0.05).@*Conclusions@#There is a good correlation between DORSSSP score and postoperative complications and mortality. Based on DORSSSP score for stratified treatment, the interventional treatment of elderly patients with severe hip fracture after operation into SICU can better reduce the incidence of complications.

8.
Chinese Journal of Orthopaedics ; (12): 1096-1100, 2019.
Article in Chinese | WPRIM | ID: wpr-802883

ABSTRACT

Most osteoporotic hip fracture occurs in the elderly, with the aging of society, the incidence of such fracture is increasing. The majority of patients are now treated with surgery due to high mortality rate by non-surgical treatment. In the choice of time interval about "fracture-operation", several studies found that elderly with osteoporotic hip fracture had various co-morbidities and their physiological reserve function of the body were obviously reduced, which should be corrected before surgery. However, others believed that the co-morbidities are not aggravated within 2-3 days, using the "window period" to perform surgery could help patients to stand as early as possible after operation, which was beneficial not only to the control of co-morbidities, but also to the prevention of complications such as pneumonia, bedsore and muscular atrophy caused by lying on bed after fracture. Therefore, there are some different opinions on the operation time after fracture in the guidelines and consensus of various countries, including 36 hours, 48 hours, 120 hours and early operation. Among these time points, the idea of "surgery within 48 hours after fracture" has been incorporated into the National Medical Insurance Payment Conditions by the Israeli Ministry of Health, and has been included in the guidelines by the American Association of Orthopaedics, and has been reported in most clinical studies. This article reviewed the studies on different operation time after hip osteoporotic fracture, especially for the reasons, advantages and clinical management process of hip fracture surgery within 48 hours. In addition, these views were analyzed in order to provide reference and inspiration for clinical treatment and hospital management of hip osteoporotic fracture.

9.
Chinese Journal of Orthopaedics ; (12): 1075-1082, 2019.
Article in Chinese | WPRIM | ID: wpr-802880

ABSTRACT

Objective@#To investigate the effect of endogenous iron accumulation onbone mass, intraosseous vessels and the effect of exogenous iron on endothelial cell activity.@*Methods@#The mice were divided into control group (C57/BL6 mice without hepcidin knockout) and hepcidin-knockout group (10 mice in each group, 8 weeks old and weighing about 22 g). The mice in both groups were killed at the age of 16 weeks. Serum ferritin levels were measured by Enzyme-linked immunosorbent assay (ELISA), and iron accumulation in liver tissue was measured by Prussian blue staining, while femoral micro-structure was measured by micro-CT, and H-type vessel immunofluorescence staining was used to detect the number of H-vessels in bone. Cell experiments were divided into normal culture group (normal cell group) and intervention group (Fe group) with 200 μmol/L ammonium ferric citrate. Scratch test was used to detect the migration ability of vascular endothelial cells, and tube formation test was used to detect the function of vascular endothelial cells. The endothelial activity of vascular endothelial cells was detected by immunofluorescence.@*Results@#The level of serum ferritin (318.30±12.53 ng/ml) in the hepcidin-knockout group was significantly higher than that in control group (109.60±4.66 ng/ml). The percentage of blue area of Prussian liver iron staining in the hepcidin-knockout group (80.80%±3.156%) was significantly higher than that in control group (20.94%±2.813%). Bone mineral density in the hepcidin-knockout group (0.044±0.002 mg/m3) was significantly higher than that in control group (0.131±0.008 mg/m3). The number of intraosseous blood vessels in the hepcidin-depleted mice (17.06%±1.060%) was significantly lower than that in control group (38.76%±4.576%). There were significant differences between the two groups in each index (t=-49.367,-13.788, 35.293, 6.165; all P < 0.05). The scratches of vascular endothelial cells in Fe group were reduced by 24.300%±1.849% after 24 hours of culture, which was significantly lower than that in normal group (39.060%±3.211%). The area of vascular endothelial cells in Fe group (0.035±0.003 mm2) was significantly lower than that in normal group (0.330±0.018 mm2). The EMCN positive cells of vascular endothelial cells in Fe group were significantly lower than those in normal group. The percentage of cell number (12.000%±3.462%) was significantly lower than that of normal cell group (0.035%±0.003%). There were significant differences in cell indices between the two groups (t=9.790, 18.929, 13.922; all P< 0.05).@*Conclusion@#Endogenous iron accumulation aggravated bone loss in mice, and the number of intraosseous blood vessels decreased significantly. Vascular endothelial cells were inhibited by iron intervention in migration, tube-formation and endothelial ability.

10.
Chinese Journal of Orthopaedics ; (12): 1037-1043, 2019.
Article in Chinese | WPRIM | ID: wpr-802875

ABSTRACT

Objective@#To compare the clinical effects of surgery within and over 48 hours for hip fractures in elderly patients.@*Methods@#From May 2017 to April 2018, 47 patients over 75 years old with hip fracture were operated in our hospital and met with inclusion criteria. The patients were divided into two groups: within 48-hour group and over 48-hour group according to study design. In the within 48-hour group, there were 22 patients including 5 males and 17 females, aged from 76 to 97 years, with an average age of 83.6±5.0 years, and there were 10 femoral neck fractures (3 total hip arthroplasty, 7 hemiarthroplasty) and 12 femoral intertrochanteric fractures (proximal femoral intramedullary nail fixation). There were 25 patients (7 males and 18 females) in the over 48-hour group, aged from 76 to 98 years, with an average age of 83.8±5.8 years, and there were 10 femoral neck fractures (2 total hip arthroplasty, 8 hemiarthroplasty) and 15 femoral intertrochanteric fractures (proximal femoral intramedullary nail fixation). At the end of the follow-up period, the clinical data of the two groups were compared. The differences in the length of stay, cost of stay (excluding implants), postoperative complications within 1 month, hip function score (Harris score) within 1 month and 3 months, and mortality within 3 months and at the end of follow-up were analyzed.@*Results@#Both groups were followed up for 12 to 24 months, with an average of 17.7 months. The hospitalization time (7.9±3.0 d), hospitalization expenses (16 627.5±6 428.8 yuan), the incidence of early complications after operation (59.1%) and Harris score (80.9±8.6) in the within 48-hour group were significantly better than those in the over 48-hour group (12.3±4.1 d, 23 799.0±9 785.3 yuan, 88.0%, 71.1±9.2, respectively). At 3 months after operation, there was no significant difference in Harris score between the two groups (83.9±7.3 in within 48-hour group and 82.3±8.9 in over 48-hour group; t=0.668, P=0.507). Within 3 months, there was no death inwithin 48-hour group, but 2 in over 48-hour group; and 1 in within 48-hour group at the last follow-up.@*Conclusion@#Elderly patients with hip fracture benefit significantly from surgery within 48 hours after admission.

11.
Article in Chinese | WPRIM | ID: wpr-745688

ABSTRACT

Objective To observe the effect of a hypoxia mimicking agent deferoxamine (DFO) on the mineral density,volume,architecture,strength,and metabolism of the bones in type 1 diabetic mice withosteoporosis.Methods Type 1 diabetic mice model was established by intraperitoneal injections of streptozotocin.The mice were divided into control (normal mice),diabetes mellitus,and DFO groups.Micro-CT was used to analyze the bone mineral density,volume,architecture,and strength of the trabecule in the distal part of femurs.Three point bending test was carried out to evaluate the bone strength.Hematoxylin and eosin (HE) staining was performed to observe the alteration in the number of osteoblasts.Real-time PCR was used to detect the mRNA expressions of Runt-related gene 2 (Runx-2),osteoclacin,and tartrate resistant acid phosphatase (TRAP) in tibias.Western blot was used to detect the protein expressions of Hypoxia-inducible factor-1α(HIF-1α) and vascular endothelial growth factor (VEGF) in tibias.Results There was a decrease in mineral density,volume,strength of bones as well as deteriorated trabecular microarchitecture in diabetic mice as compared to control mice,which were partially improved by DFO treatment.Moreover,DFO treatment increased the number of osteoblasts and mRNA expression levels of Runx-2,osteoclacin,TRAP,as well as protein expression levels of HIF-1 α and VEGF(P<0.05).Conclusion Bone loss could be partially prevented by DFO treatment in type 1 diabetic osteoporosis mice,which might be ascribed to increased bone formation via stimulating hypoxia inducible factor singnaling pathway.

12.
Article in Chinese | WPRIM | ID: wpr-755712

ABSTRACT

Objective To study the impact on bone mineral density, serum bone metabolism markers, and the expression of osteoprotegerin ( OPG) and receptor activator of NF-κB ligand ( RANKL) in the adult offspring exposed to maternal high sucrose diet during gestation. Methods The pregnant Sprague-Dawley ( SD) rats were randomly divided into two groups: high sucrose diet group ( HS group ) rats were given 20% sucrose solution and standard rat food, normal diet group ( ND group) rats were provided with fresh tap water and standard rat food. The serum concentrations of alkaline phosphatase ( ALP ) , osteocalcin, tartrate resistant acid phosphatase-5b ( TRACP-5b) , OPG, and RANKL were measured by the enzyme linked immunosorbent assay ( ELISA) . The lumbar vertebrae were attained and prepared for micro-computed tomography ( Micro-CT) scanning. Compared the expression of OPG and RANKL mRNA in the adult lumbar vertebrae were determined by realtime quantitative PCR. Results The maternal blood glucose levels and insulin levels were higher in the HS group( P<0.05) . The body weight gain during pregnancy and fetal body weight were heavier in the HS group(P<0.05). In HS group that compared to ND group, the serum concentrations of ALP and OPG were decreased,while TRACP-5b and RANKL were increased,and the ratio of OPG/RANKL were significantly increased(P<0.05). Compared to ND group, the bone mineral density, the bone volume per tissue volume, trabecular thickness, the trabecular number were decreased in HS group( P<0.05) . The trabecular separation was increased in HS group compared to ND group( P<0.05) . The expression of OPG mRNA in the offspring lumbar vertebrae was significantly down-regulated. Conversely, the expression of RANKL mRNA was significantly up-regulated. Conclusion Maternal high sucrose diet during gestational periods may affect the bone mineral density, serum bone metabolism markers, and the expression of OPG and RANKL in adult offspring.

13.
Chinese Journal of Orthopaedics ; (12): 1096-1100, 2019.
Article in Chinese | WPRIM | ID: wpr-755258

ABSTRACT

Most osteoporotic hip fracture occurs in the elderly, with the aging of society, the incidence of such fracture is increasing. The majority of patients are now treated with surgery due to high mortality rate by non?surgical treatment. In the choice of time interval about "fracture?operation", several studies found that elderly with osteoporotic hip fracture had various co?morbidi?ties and their physiological reserve function of the body were obviously reduced, which should be corrected before surgery. Howev?er, others believed that the co?morbidities are not aggravated within 2-3 days, using the "window period" to perform surgery could help patients to stand as early as possible after operation, which was beneficial not only to the control of co?morbidities, but also to the prevention of complications such as pneumonia, bedsore and muscular atrophy caused by lying on bed after fracture. There?fore, there are some different opinions on the operation time after fracture in the guidelines and consensus of various countries, in?cluding 36 hours, 48 hours, 120 hours and early operation. Among these time points, the idea of "surgery within 48 hours after frac?ture" has been incorporated into the National Medical Insurance Payment Conditions by the Israeli Ministry of Health, and has been included in the guidelines by the American Association of Orthopaedics, and has been reported in most clinical studies. This article reviewed the studies on different operation time after hip osteoporotic fracture, especially for the reasons, advantages and clinical management process of hip fracture surgery within 48 hours. In addition, these views were analyzed in order to provide ref?erence and inspiration for clinical treatment and hospital management of hip osteoporotic fracture.

14.
Chinese Journal of Orthopaedics ; (12): 1075-1082, 2019.
Article in Chinese | WPRIM | ID: wpr-755255

ABSTRACT

Objective To investigate the effect of endogenous iron accumulation onbone mass, intraosseous vessels and the effect of exogenous iron on endothelial cell activity. Methods The mice were divided into control group (C57/BL6 mice with?out hepcidin knockout) and hepcidin?knockout group (10 mice in each group, 8 weeks old and weighing about 22 g). The mice in both groups were killed at the age of 16 weeks. Serum ferritin levels were measured by Enzyme?linked immunosorbent assay (ELI?SA), and iron accumulation in liver tissue was measured by Prussian blue staining, while femoral micro?structure was measured by micro?CT, and H?type vessel immunofluorescence staining was used to detect the number of H?vessels in bone. Cell experiments were divided into normal culture group (normal cell group) and intervention group (Fe group) with 200 μmol/L ammonium ferric ci?trate. Scratch test was used to detect the migration ability of vascular endothelial cells, and tube formation test was used to detect the function of vascular endothelial cells. The endothelial activity of vascular endothelial cells was detected by immunofluores?cence. Results The level of serum ferritin (318.30±12.53 ng/ml) in the hepcidin?knockout group was significantly higher than that in control group (109.60±4.66 ng/ml). The percentage of blue area of Prussian liver iron staining in the hepcidin?knockout group (80.80%±3.156%) was significantly higher than that in control group (20.94%±2.813%). Bone mineral density in the hepci? din?knockout group (0.044±0.002 mg/m3) was significantly higher than that in control group (0.131±0.008 mg/m3). The number of intraosseous blood vessels in the hepcidin?depleted mice (17.06% ± 1.060% ) was significantly lower than that in control group (38.76%±4.576%). There were significant differences between the two groups in each index (t=-49.367,-13.788, 35.293, 6.165;all P<0.05). The scratches of vascular endothelial cells in Fe group were reduced by 24.300%±1.849% after 24 hours of culture, which was significantly lower than that in normal group (39.060%±3.211%). The area of vascular endothelial cells in Fe group (0.035±0.003 mm2) was significantly lower than that in normal group (0.330±0.018 mm2). The EMCN positive cells of vascular en?dothelial cells in Fe group were significantly lower than those in normal group. The percentage of cell number (12.000%±3.462%) was significantly lower than that of normal cell group (0.035%±0.003%). There were significant differences in cell indices between the two groups (t=9.790, 18.929, 13.922; all P<0.05). Conclusion Endogenous iron accumulation aggravated bone loss in mice, and the number of intraosseous blood vessels decreased significantly. Vascular endothelial cells were inhibited by iron interven?tion in migration, tube?formation and endothelial ability.

15.
Chinese Journal of Orthopaedics ; (12): 1037-1043, 2019.
Article in Chinese | WPRIM | ID: wpr-755250

ABSTRACT

Objective To compare the clinical effects of surgery within and over 48 hours for hip fractures in elderly pa?tients. Methods From May 2017 to April 2018, 47 patients over 75 years old with hip fracture were operated in our hospital and met with inclusion criteria. The patients were divided into two groups: within 48?hour group and over 48?hour group according to study design. In the within 48?hour group, there were 22 patients including 5 males and 17 females, aged from 76 to 97 years, with an average age of 83.6±5.0 years, and there were 10 femoral neck fractures (3 total hip arthroplasty, 7 hemiarthroplasty) and 12 femoral intertrochanteric fractures (proximal femoral intramedullary nail fixation). There were 25 patients (7 males and 18 females) in the over 48?hour group, aged from 76 to 98 years, with an average age of 83.8±5.8 years, and there were 10 femoral neck frac?tures (2 total hip arthroplasty, 8 hemiarthroplasty) and 15 femoral intertrochanteric fractures (proximal femoral intramedullary nail fixation). At the end of the follow?up period, the clinical data of the two groups were compared. The differences in the length of stay, cost of stay (excluding implants), postoperative complications within 1 month, hip function score (Harris score) within 1 month and 3 months, and mortality within 3 months and at the end of follow?up were analyzed. Results Both groups were fol?lowed up for 12 to 24 months, with an average of 17.7 months. The hospitalization time (7.9±3.0 d), hospitalization expenses (16 627.5± 6 428.8 yuan), the incidence of early complications after operation (59.1% ) and Harris score (80.9 ± 8.6) in the within 48?hour group were significantly better than those in the over 48?hour group (12.3±4.1 d, 23 799.0±9 785.3 yuan, 88.0%, 71.1±9.2, respec?tively). At 3 months after operation, there was no significant difference in Harris score between the two groups (83.9±7.3 in within 48?hour group and 82.3±8.9 in over 48?hour group; t=0.668, P=0.507). Within 3 months, there was no death inwithin 48?hour group, but 2 in over 48?hour group; and 1 in within 48?hour group at the last follow?up. Conclusion Elderly patients with hip fracture benefit significantly from surgery within 48 hours after admission.

16.
Article in Chinese | WPRIM | ID: wpr-799865

ABSTRACT

The specimens of femur from wild-type mice(WT) of 6 months and Hepcidin-knockout(KO) mice of 6 months(iron accumulation model) were obtained for Micro-CT examination. Western blot and co-immunoprecipitation were used to detect the changes of related parameters in Wnt signaling pathway. Compared with wild-type mice, the bone mass in Hepcidin-KO mice was significantly decreased, the binding of β-catenin to FOXO3a increased, and binding of β-catenin to TCF4/TCF7L2 decreased in bone tissue, without significant changes in the expression of β-catenin, TCF4/TCF7L2, and FOXO3a. These results suggest that iron accumulation may affect bone formation through interfering with canonical Wnt/β-catenin signaling pathway, finally leading to osteoporosis.

17.
Article in Chinese | WPRIM | ID: wpr-797385

ABSTRACT

Objective@#To study the impact on bone mineral density, serum bone metabolism markers, and the expression of osteoprotegerin (OPG) and receptor activator of NF-κB ligand (RANKL) in the adult offspring exposed to maternal high sucrose diet during gestation.@*Methods@#The pregnant Sprague-Dawley (SD) rats were randomly divided into two groups: high sucrose diet group (HS group) rats were given 20% sucrose solution and standard rat food, normal diet group (ND group) rats were provided with fresh tap water and standard rat food. The serum concentrations of alkaline phosphatase (ALP), osteocalcin, tartrate resistant acid phosphatase-5b (TRACP-5b), OPG, and RANKL were measured by the enzyme linked immunosorbent assay (ELISA). The lumbar vertebrae were attained and prepared for micro-computed tomography (Micro-CT) scanning. Compared the expression of OPG and RANKL mRNA in the adult lumbar vertebrae were determined by realtime quantitative PCR.@*Results@#The maternal blood glucose levels and insulin levels were higher in the HS group(P<0.05). The body weight gain during pregnancy and fetal body weight were heavier in the HS group(P<0.05). In HS group that compared to ND group, the serum concentrations of ALP and OPG were decreased, while TRACP-5b and RANKL were increased, and the ratio of OPG/RANKL were significantly increased(P<0.05). Compared to ND group, the bone mineral density, the bone volume per tissue volume, trabecular thickness, the trabecular number were decreased in HS group(P<0.05). The trabecular separation was increased in HS group compared to ND group(P<0.05). The expression of OPG mRNA in the offspring lumbar vertebrae was significantly down-regulated. Conversely, the expression of RANKL mRNA was significantly up-regulated.@*Conclusion@#Maternal high sucrose diet during gestational periods may affect the bone mineral density, serum bone metabolism markers, and the expression of OPG and RANKL in adult offspring.

18.
Article in Chinese | WPRIM | ID: wpr-824714

ABSTRACT

The specimens of femur from wild-type mice(WT) of 6 months and Hepcidin-knockout(KO) mice of 6 months ( iron accumulation model ) were obtained for Micro-CT examination. Western blot and co-immunoprecipitation were used to detect the changes of related parameters in Wnt signaling pathway. Compared with wild-type mice, the bone mass in Hepcidin-KO mice was significantly decreased, the binding ofβ-catenin to FOXO3a increased, and binding of β-catenin to TCF4/TCF7L2 decreased in bone tissue, without significant changes in the expression ofβ-catenin, TCF4/TCF7L2, and FOXO3a. These results suggest that iron accumulation may affect bone formation through interfering with canonical Wnt/β-catenin signaling pathway, finally leading to osteoporosis.[Summary] The specimens of femur from wild-type mice(WT) of 6 months and Hepcidin-knockout(KO) mice of 6 months ( iron accumulation model ) were obtained for Micro-CT examination. Western blot and co-immunoprecipitation were used to detect the changes of related parameters in Wnt signaling pathway. Compared with wild-type mice, the bone mass in Hepcidin-KO mice was significantly decreased, the binding ofβ-catenin to FOXO3a increased, and binding of β-catenin to TCF4/TCF7L2 decreased in bone tissue, without significant changes in the expression ofβ-catenin, TCF4/TCF7L2, and FOXO3a. These results suggest that iron accumulation may affect bone formation through interfering with canonical Wnt/β-catenin signaling pathway, finally leading to osteoporosis.

19.
Article in Chinese | WPRIM | ID: wpr-707462

ABSTRACT

Objective To systematically evaluate the postoperative complications following open reduction and internal fixation combined with vascularized bone flap graft versus only reduction and internal fixation for femoral neck fractures.Methods CNKI,Wan Fang Chinese database,Pubmed,EMBASE and Google Scholar English database were searched for the randomized controlled trials from January 1,2000 through October 31,2017 which compared open reduction and internal fixation combined with vascularized bone flap graft (combined surgery group) with only reduction and internal fixation (simple surgery group) for femoral neck fractures.The data concerning postoperative nonunion and avascular necrosis of the femoral head were extracted.The 2 surgical treatments of the patients with femoral neck fracture were compared in terms of the 2 complications.Statistical analyses were conducted using software Stata 12 by relative risk (RR) and corresponding 95% confidence intervals (95% CI).Results According to our inclusion and exclusion criteria,a total of 23 studies were included,involving 2,162 cases (1,048 cases receiving combined surgery and 1,114 cases simple surgery).The Meta analyses showed that the fracture nonunion rate for the combined surgery group was significantly lower than that for the simple surgery group [RR =0.27,95% CI(0.19,0.38),P < 0.001] and the rate of avascular necrosis was also significantly lower for the former than for the latter [RR =0.31,95 % CI(0.24,0.42),P < 0.001].Conclusion In the treatment of femoral neck fractures,open reduction and internal fixation combined with vascularied bone graft may lead to lower rates of nonunion and avascular necrosis of the femoral head than simple open reduction and internal fixation.

20.
Chinese Journal of Trauma ; (12): 206-213, 2018.
Article in Chinese | WPRIM | ID: wpr-707292

ABSTRACT

Objective To investigate the efficacy of calf self weight traction reduction combined with locking plate fixation for the treatment of intertrochanteric fractures in the elderly.Methods A retrospective case series study was conducted on the clinical records of 174 elderly patients with the modified Evans Ⅰ-Ⅲ types of fresh intertrochanteric fractures treated with locking plate from January 2012 to December 2015.According to treatment method,the patients were assigned to traction bed reduction with locking plate fixation (Group A,62 patients) and calf self weight traction reduction with locking plate fixation (Group B,112 patients).Group A comprised 32 males and 30 females,with age range of 65-91 years [(72.47 ± 6.35) years].Group B comprised 68 males and 44 females,with age range of 65-95 years [(73.23 ± 6.05) years].The time of reduction,operation time,incision length,intraoperative blood loss,frequency of fluoroscopy,postoperative drainage volume,hospital stay,postoperative weightbearing standing time or walking time (ambulation time),surgical complications,and fracture healing were recorded.Harris and modified Barthel index score in Chinese (MBI-C) were used to evaluate the functional recovery of hip joint.Results All patients were followed up for 5-61 months (mean,15 months),and noted with fracture healing.The time of reduction in Group A was (13.27 ± 3.03) minutes,longer than that in Group B (0 minute) (P <0.05).The operation time in Group A was (63.63 ± 13.90)minutes,longer than that in Group B [(59.62 ± 8.38) minutes] (P < 0.05).Fluoroscopy in Group A was (5.35 ± 2.36) times,more than (4.28 ± 3.11) times in Group B (P < 0.05).There were no significant differences in the incision length,intraoperative blood loss,postoperative drainage volume,ambulation time,fracture healing time,Harris score,and MBI-C index between the two groups (P >0.05).There were no significant differences in the postoperative complications such as deep venous thrombosis,pulmonary infection,incisional infection,urinary tract infection,delirium,bed sores,cardiac insufficiency,electrolyte disturbance,and postoperative plate rupture between the two groups (P>0.05).The incidence of deep vein thrombosis was 9.7% (6/62) in Group A,and 4.5% (5/112) in Group B (P >0.05).No screw fracture,nail and plate combination failure,bone nonunion,or screw cut out of the femoral head were observed in both groups.Conclusions For the modified Evans Ⅰ-Ⅲ types of intertrochanteric fractures,both traction bed reduction and calf weight reduction with locking plate have equivalent efficacy.However,the latter method has advantages of shorter reduction and operation time and less intraoperative X-ray exposure,and hence is worthy of clinical application.

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