Predictive effect of the preoperative ratio of C reactive protein to albumin on perioperative delirium in geriatric patients with femoral intertrochanteric fracture / 中华创伤骨科杂志

Objective:To explore the clinical predictive effect of the preoperative ratio of C reactive protein to albumin (CAR) on perioperative delirium (POD) in geriatric patients with femoral intertrochanteric fracture.Methods:The clinical data were analyzed retrospectively of the 398 patients who had undergone surgery for femoral intertrochanteric fractures at Department of Orthopedics, Xuanwu Hospital from January 2013 to March 2016. According to the presence or absence of POD, all the patients were divided into 2 groups: a delirium group and a normal group. The 2 groups were compared in terms of general clinical data like gender, age, body mass index, blood routine, CAR, biochemical indicators, blood coagulation indicators and concomitant internal diseases. After a single factor logistic regression analysis of the general clinical data of the patients, factors with P<0.10 were introduced into the multivariate logistic binary regression model to screen out the risk factors for POD in geriatric patients with femoral intertrochanteric fracture. The receiver operating characteristic (ROC) curve was drawn to analyze the predictive value and optimal cut-off point of CAR for POD in geriatric patients with femoral intertrochanteric fracture. Results:The incidence of POD in this cohort was 14.32%(57/398). The age, C-reactive protein, CAR, platelet and probability of pulmonary infection in the delirium group were significantly higher than those in the normal group, but the hemoglobin, albumin and prealbumin in the former were significantly lower than those in the latter ( P< 0.05). The multivariate logistic binary regression analysis showed that hemoglobin ( OR=0.975, 95% CI: 0.957 to 0.993, P=0.006) and CAR( OR=53.713, 95% CI: 17.713 to 162.876, P<0.001) were risk factors for POD in geriatric patients with femoral intertrochanteric fracture. The area under ROC of CAR in predicting POD in geriatric patients with femoral intertrochanteric fracture was 0.906 (95% CI: 0.873 to 0.933, P<0.001), and the cut-off point was 2.06. When CAR>2.06, its predicted incidence of POD was 50.50%, with a sensitivity of 89.47% and a specificity of 85.34%. Conclusion:As CAR is a risk factor for POD in geriatric patients with femoral intertrochanteric fracture, it can be used as an effective indicator to predict POD.

Advance of head taper corrosion after metal on polyethylene total hip arthroplasty / 中华骨科杂志

Total hip arthroplasty is currently an important surgical method for the treatment of hip diseases.The modular design of the head and neck taper facilitates the adjustment of limb length and femoral offset during surgery,however,complications such as wear,corrosion and looseness of the modular interface are also inevitable old problems.In recent years,with the changes in the design of prostheses,the trend that patients becomes younger and active,and the development of minimally invasive surgery,taper corrosion has again become a problem that needs to be solved and cannot be ignored,which is causing the attention of joint surgeons.There have been many studies on the complications associated with metal-on-metal prosthesis modular interfaces,such as increased metal ion level,taper corrosion and adverse local tissue reactions,while there are few studies on the complications of metal-on-polyethylene total hip arthroplasty,and metal-on-polyethylene prosthesis has similar problems such as increased local metal ion level and adverse tissue reactions caused by taper corrosion,which may also lead to complications such as prosthesis loosening,dislocation and fracture.Currently there are few reports about head and neck taper corrosion of metal-onpolyethylene prosthesis in China and there are still controversies about its manifestation and mechanism.In this paper,we summarized the above problems through literature reviewto expound the concept,research history,assessment methods,and incidence of metal-on-polyethylene prosthesistaper corrosion and the effect of material composition,diameter of the metal head,neck length,femoral offset,geometry of the taper,surgical factors,in vivo time,and patient factors on taper corrosion are analyzed.In summary,there are still many problems in the researches about the specific forming mechanism that have not been solved,thus it is very important for the prevention of taper corrosion:choosing the same material or ceramic material,avoiding overlarge diameter of the femoral head and femoral offset,avoiding too small taper degree,paying attention to the strength of tapping and cleaning of the taper are the current viable options.

Advance of head taper corrosion after metal on polyethylene total hip arthroplasty / 中华骨科杂志

Total hip arthroplasty is currently an important surgical method for the treatment of hip diseases. The modular design of the head and neck taper facilitates the adjustment of limb length and femoral offset during surgery, however, complications such as wear, corrosion and looseness of the modular interface are also inevitable old problems. In recent years, with the changes in the design of prostheses, the trend that patients becomes younger and active, and the development of minimally invasive surgery, taper corrosion has again become a problem that needs to be solved and cannot be ignored, which is causing the attention of joint surgeons. There have been many studies on the complications associated with metal-on-metal prosthesis modular interfaces, such as increased metal ion level, taper corrosion and adverse local tissue reactions, while there are few studies on the complications of metal-on-polyethylene total hip arthroplasty, and metal-on-polyethylene prosthesis has similar problems such as increased local metal ion level and adverse tissue reactions caused by taper corrosion, which may also lead to complications such as prosthesis loosening, dislocation and fracture. Currently there are few reports about head and neck taper corrosion of metal-on-polyethylene prosthesis in China and there are still controversies about its manifestation and mechanism. In this paper, we summarized the above problems through literature reviewto expound the concept, research history, assessment methods, and incidence of metal-on-polyethylene prosthesistaper corrosion and the effect of material composition, diameter of the metal head, neck length, femoral offset, geometry of the taper, surgical factors, in vivo time, and patient factors on taper corrosion are analyzed. In summary, there are still many problems in the researches about the specific forming mechanism that have not been solved, thus it is very important for the prevention of taper corrosion: choosing the same material or ceramic material, avoiding overlarge diameter of the femoral head and femoral offset, avoiding too small taper degree, paying attention to the strength of tapping and cleaning of the taper are the current viable options.

Analysis of early failure of the PHILOS in proximal humerus fractures / 北京大学学报(医学版)

Objective:To analyze the reasons of early failure of the PHILOS in proximal humerus frac-tures.Methods:From Nov.2010 to Nov.2014,there were 117 patients with humerus fractures treated with PHILOS locking plate in Department of Orthopaedics,Xuanwu Hospital.All of the patients were treated with the plate by open reduction internal fixation,and we analyzed these cases retrospectively. After the operation,we removed the drainage tube within 48 h,and the patients were allowed to do the passive motion 3 days after the surgery if the X-Ray showed the plate and screws were reliable.Eight ca-ses failed within 4 weeks after the operation.We analyzed the reasons of the failure.Results:The rate of the failed cases was 6.83%(8 /117).The average age was 72.4(66 -82)years.In the 8 failed cases, 3 were on the right side,and the other 5 on the left side.As for the reason of the fractures,2 cases were because of car accidents,and the other 6 because of daily life injury.According to the Neer classifica-tion,3 cases were 2-part fractures,and the other 5 3-part fractures.Three cases were total failure,and the other 5 partial failure.All the 8 failed cases failed within 4 weeks after the operation,of which 1 was on the sixth day after surgery,the other 7 2 to 4 weeks after the surgery.The 3 totally failed cases were treated by removing the screws and plates,the other 5 by conservative methods.All of the cases were malunion at the end.Conclusion:The early failure of the PHILOS locking plate in proximal humerus fractures is related to the bad reduction during the operation,the loss of medial cortex support,the limi-tation of screw length,the osteoporosis and the improper rehabilitation after operation.It is very important to do good preoperative plan for a surgeon.During the operation,we should try our best in the fracture reduction,use the appropriate plate and screws,and then pay attention to the rehabilitation after the operation.After all of this,the rate of failure may be decreased.

Low-intensity pulsed ultrasound prompts tissue-engineered bone formation after implantation surgery / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>A practical problem impeding clinical translation is the limited bone formation seen in artificial bone grafts. Low-pressure/vacuum seeding and dynamic culturing in bioreactors have led to a greater penetration into the scaffolds, enhanced production of bone marrow cells, and improved tissue-engineered bone formation. The goal of this study was to promote more extensive bone formation in the composites of porous ceramics and bone marrow stromal cells (BMSCs).</p><p><b>METHODS</b>BMSCs/β-tricalcium phosphate (β-TCP) composites were subcultured for 2 weeks and then subcutaneously implanted into syngeneic rats that were split into a low-intensity pulsed ultrasound (LIPUS) treatment group and a control group. These implants were harvested at 5, 10, 25, and 50 days after implantation. The samples were then biomechanically tested and analyzed for alkaline phosphate (ALP) activity and osteocalcin (OCN) content and were also observed by light microscopy.</p><p><b>RESULTS</b>The levels of ALP activity and OCN content in the composites were significantly higher in the LIPUS group than in the control group. Histomorphometric analysis revealed a greater degree of soft tissue repair, increased blood flow, better angiogenesis, and more extensive bone formation in the LIPUS groups than in the controls. No significant difference in the compressive strength was found between the two groups.</p><p><b>CONCLUSION</b>LIPUS treatment appears to enhance bone formation and angiogenesis in the BMSCs/β-TCP composites.</p>

Predictors of one year mortality in the elderly patients with hip fracture following poststroke hemiplegla / 中华创伤骨科杂志

Objective To investigate predictors of one year mortality in the elderly patients with hip fracture following poststroke hemiplegia.MethodsA retrospective study was conducted to analyze clinical data of the elderly patients who had received surgery in our hospital from January 2000 to May 2007 forhip fractures.Patients in the poststroke hemiplegia group (group A) and the hemiplegia-free group (group B)were compared in terms of general characteristics.Predictors of one year mortality in group A were analyzed statistically.Variables to be analyzed included age,gender,American Society of Anesthesiologists(ASA) rating,preoperative comorbidity,fracture type,prefracture ambulatory status and cognitive ability,hospital stay,interval from injury to surgery,anaesthetic mode and operational mode. Results Altogether 1379 patients with a mean age of 76.4 ± 7.0 years (from 65 to 99 years) were eligible for the present investigation.Of them,101 were assigned into group A.There were significant differences between the 2 groups in ASA rating,number of preoperative comorbidity,prefracture ambulatory status and cognitive ability,hospital stay and one year survival ( P ＜ 0.05).One year follow-up found 25 deaths in group A (mortality rate 24.8％ ).Multiple logistic regression analysis showed that gender ( P =0.017),ASA rating ( P=0.009),prefracture ambulatory status ( P =0.000),chroic respiraory disease ( P =0.022) and number of preoperative comorbidity ( P =0.048) were risk factors associated with the one year mortality in group A.ConclusionsEldarly hip fracture patients with hemiplegia tend to have a longer hospital stay and a higher mortality rate than those without hemiplegia.Male gender,ASA rating ≥ Grade Ⅲ,number of preoperative comorbidity ≥ 3,chronic respiratory disease and weak prefracture ambulatory status are predictors of one year mortality in the elderly patients with hip fracture following poststroke hemiplegia.

Hidden blood loss following total knee arthroplasty: an analysis of influential factors / 中华创伤杂志

Objective To study the characteristic and influential factor of the hidden blood loss after total knee arthroplasty (TKA) so as to provide a reference frame for clinical work. Methods There were 75 patients with osteoarthritis of the knee who were operated with unilateral primary TKA. The patients including 21 males and 54 females at a mean age of 68.7 years were retrospectively analyzed.The perioperative blood loss and the hidden blood loss following TKA were calculated by Gross formula. It was analyzed that if the perioperative blood loss and the hidden blood loss following TKA were affected by gender, haemostasis during operation with deflating tourniquet and reinfusion of the drained blood. Results The preoperative blood loss was (1551.3 ± 369.6) ml and the hidden blood loss was (792.3 ±228.6) ml. The hidden blood loss of male was significantly higher than that of female (P ＜ 0.05). The hidden blood loss was reduced by haemostasis during operation with deflating tourniquet (P ＜ 0.05) but was not affected by postoperative shed blood reinfusion. Conclusions The lowest value of Hct is a representative parameter for calculation of the hidden blood loss. There is no significant difference between male and female about the relative hidden blood loss. Haemostasis during operation with deflating tourniquet can reduce teh hidden blood loss but not affect the total perioperative blood loss. Reinfusion of the drained blood can reduce the transfusion rate but does not affect the total preoperative blood loss and the hidden blood loss.

Clinical multicentre retrospective study of treatment on radial head fractures / 中国综合临床

Objective To evaluate the treatment of radial head fracture of different type. Methods The clinical data of 80 radial head fracture cases from November, 1999 to December,2009 were collected and analyzed retrospectively. Among the 80 cases,12 cases received conservative treatment( all type Mason Ⅰ ) ;48 cases received open reduction internal fixation (ORIF) (4 case type Mason Ⅰ ,15 cases type Mason Ⅱ ,24 cases type Mason Ⅲ,5 cases type Mason Ⅳ ); 12 cases received removing radial head ( 4 cases type Mason Ⅲ and 8 cases type Ⅳ ).8 cases received artificial joint replacement ( 8 cases type Mason Ⅳ ). Results All cases were followed up for 1.0 -4. 1 years. According to the Mayo Elbow Performance Index, the excellent and good rate of treatment in nonoperative,ORIF,excision of the radial head as well as artificial joint replacement was 83.3 % (10/12) ,87.5 %(42/48) ,75.0% (9/12) and 100. 0% (8/8) ,respectively. Conclusions Conservative treatment can be selected for type Mason Ⅰ ;Open reduction and internal fixation can be selected for type Mason Ⅱ , type Mason Ⅲ and part of type Mason Ⅳ. The excision of radial head or mental prosthesis replacement is alternative for type Mason Ⅳ for those can not be treated with open reduction and internal fixation.

β-tricalcium Phosphate Seeded with Bone Marrow Mesenchymal Stem Cells as Bone Graft Substitute for Posterolateral Spinal Fusion / 中国康复理论与实践

@# ObjectiveTo evaluate whether β-tricalcium phosphate (β-TCP) combined with bone marrow mesenchymal stem cells (BMSCs) can be used for lumbar posterolateral spine fusion (PLF) instead of autogenous bone graft. Methods6 crab-eating macaques underwent bilateral PLF at L4-5, and divided into 3 groups that implanted β-TCP/BMSCs composite, autogenous bone, and β-TCP. Monkeys were sacrificed 12 weeks after implantation. Manual palpation, micro computed tomography, peripheral quantitative computed tomography (pQCT), and histology were used to assess bone formation. ResultsManual palpation showed that 75% of β-TCP/BMSCs composite group and autogenous group achieved solid spine fusion, whereas none of β-TCP group fused. Histological analysis showed that all of the β-TCP/BMSCs group achieved massive bone formation. Bone mineral density (BMD) evaluated with pQCT in the β-TCP/BMSCs group increased by additional new bone. Conclusionβ-TCP/BMSCs composite can be used for PLF instead of autogenous bone graft.

Factors affecting the postoperative function of malleolar fracture / 中华创伤骨科杂志

Objective To discuss the factors which affect the postoperative functions of the ankle joint. Methods A retrospective study was done of 102 patients who had been diagnosed as malleolar fracture and operated on in our institute between January 2005 and January 2008. We recorded their age, gender, body mass index(BMI), fracture type (AO type), time from injury to operation and presence or ab-sence of cast immobilization. Their ankle functions were evaluated by X-ray and the Baird-Jackson evaluation system in regular follow-up. Relationship between the above-mentioned factors and the postoperative functions of the ankle joint was statistically analyzed, using univariate logistic regression and multiple stepwise logistic regression. Results A total of 102 patients were followed up for 24.7 (11 to 43) months. A negative correlation between the age, fracture type, reduction and postoperative function was found. The gender, body mass index (BMI), time from injury to operation and presence or absence of east immobilization, however, had no association with the postoperative function. The conservative treatment of the deltoid ligament injury complicated with the lateral malleolar fracture and/or improper treatment of the syndesmotic injury led to poor function. Conclusions The older a patient and the more serious a fracture, as well as the more unsat-isfactory the reduction, the poorer the postoperative ankle functions may be. To some extent, rational treat-ment of the deltoid ligament injury complicated with the lateral malleolar fracture and the syndesmotic injury may also determine the postoperative function of the ankle joint.

Analysis on complications after treatment of unstable femoral intertrochanteric fractures with proximal femoral intramedullary nail in the elderly / 中华创伤杂志

Objective To analyze causes for complications after proximal femoral intramedullary nail treating unstable femoral intertrochanteric fractures in the elderly.Methods A total of 172 cases of unstable intertrochanteric fractures treated with proximal femoral intramedullary nail from December 2001 to May 2007 were reviewed upon postoperative complications to find out the causes for complications and discuss countermeasures.Results Of all, 149 cases were followed up for 6-42 months(mean 18. 5 months), which showed excellence rate of 89. 0% in aspect of functional recovery of the hip. Postoper-ative systemic complications occurred in 26 cases and local complications in 21.Condusions Proxi-real femoral intramedullary nail can be used in most elderly patients with unstable intertrochanteric frac-tures. A thorough evaluation of physiological function, treatment of preoperative comorbidities and aug-mentation of surgical technique are prerequisites for operation safety and decrease of complications.

Diagnosis and treatment of lumbosacral nerve roots anomalies / 中国矫形外科杂志

[Objective]To investigate the diagnosis and treatment of lumbosacral nerve roots anomalies. [Method]Etiological factors,typing,diagnosis and treatment of lumbosacral nerve roots anomalies confirmed by operation were analyzed.Operative treatment included wide laminectomy(n=8),hemilaminectomy(n=8) and enlargement fenestration(n=9).[Result]The presenting symptoms of lumbosacral nerve roots anomalies often resulted from lumbar disc herniation or spinal canal stenosis.The typs of lumbosacral nerve roots anomalies included conjoined nerve roots(n=10),closely adjacent roots(n=8),thickening of nerve roots(n=2),caudal origin roots(n=2),division of nerve roots(n=1),double nerve roots(n=1),and anastomosis of nerve roots(n=1).The levels of nerve roots anomalies were L4 in 1,L5 in 14,and S1 in 10.Only 5 cases were diagnosed preoperatively by myelography,CT or MRI.The others were found at operation.All patients were followed up for more than 2 years.Postoperatively,the results were rated as excellent in 12,good in 8,and fair in 4.One patient had residual radiating pain in the lower lims and weakness in dorsiflexion of the foot. [Conclusion] Radicular symptoms of lumbosacral nerve roots anomalies are changeable.The preoperative diagnosis is difficult to establish by myelography,CT or MRI(axial and sagittal plane).It is necessary to heighten the sensitivity of diagnostic modalities.It may improve the surgical outcomes to expose sufficiently,to explore the nerve roots carefully and to decompress thoroughly.

Application of parvule-impacted bone graft in the posterior lumbar interbody fusion / 中国矫形外科杂志

[Objective] To investigate the feasibility of posterior interbody parvule-impacted bone graft fusion.[Method] A retrospective study was performed in 31 patients admited to our hospital in 2003~2006(M=14,F=17).The ages were 55 to 80,with an average of 66.2 years.There were 9 cases of spondylolisthesis,6 of degenerative unstability and 16 of developmental stenosis.All patients underwent posterior interbody impact bone graft fusion and pedicle screw fixation.The pre-and post-operative JOA score were used to calculate the improvement rate.The postoperative bending-extending plain films were taken to observe whether the fusion was successful.[Result]All patients were followed up for 12~18 months.Three patient had leg symptoms at postoperation and were released 3 months later.Thirteen patients had fusion at 6 month,16 had union at 12 month,and 2 had union at 18 month.The lumbar lordosis angle and intervertebral height got significant restoration.The spinal fusion rate was 100%.No dura tear leakage of cerebrospinal fluid or wound infection was found.No graft absorption,displacement or collapse occurred.There were 16 cases excellent,12 cases good,and 3 cases fair.JOA score was 24~29(average 27.4?1.9)at postoperation.The improvement rate was 89.4%.[Conclusion] Posterior interbody parvule-impacted bone graft is a feasible fusion method.The method is simple and cheap,with advantages of less injury and high fusion rate.

Operative risk factors assessment for 65 years or elder orthopaedic patients / 中国矫形外科杂志

[Objective]To study those risk factors that are associated with adverse postoperative outcomes in old orthopaedic patients.[Method]In Xuanwu Hospital,medical records of 65 years or elder orthopaedic patients in-hospital from January 2002 to October 2004 were reviewed.Take the potential preoperative risk factors associated with adverse postoperative outcomes as variates ,postoperative adverse outcomes as dependent variates.Data were analyzed with SPSS for Windows 11.5.[Result]In the study,the postoperative mortality rate was 3.5%.13.6% of these patients developed one or more complications.American Society of Anesthesiologists (ASA) classification,abnormal cardiac function, abnormal renal function and weak condition of consciousness are the most important risk factors of postoperative mortality,abnormal cardiac function,arrhythmia,ASA classification,poor eating status and operative degree increase the incidence of postoperative complication.[Conclusion]The study demonstrates that there are good postoperative outcomes in most of geriatric orthopaedic patients.But in some degree,there exist the postoperative morbidity (13.6%) and mortality (3.5%).Among operative risk factors,preoperative general status and functional status much influence the postoperative outcomes.

Comparison between anterior and posterior surgical treatments of thoracolumbar burst fractures / 中华创伤骨科杂志

Objective To discuss the results and characteristics of surgical treatments through anterior or posterior approach for thoracolumbar burst fractures. Methods The retrospective review included 43 cases with an average age of 30.4 years from September, 1999 to November, 2004. The surgical approach was chosen according to conditions of the injury. 17 cases received an anterior approach operation. The Frankel scale was used for assessment of nerve function. 3 cases were rated as Grade A, 12 as Grade B, 19 as Grade C, and 9 as Grade D before surgery. Results The mean follow-up period was 36.7 months. There were no severe postoperative complications, such as deterioration of nerve function. All the cases showed notable improvement. Except in 3 cases of complete paraplegia, the improvement was 1.6 and 1.3 Frankel grades respectively for the anterior and posterior approach operations. Conclusions The anterior and posterior approaches are different in advantages and characteristics. The surgery through anterior approach provides more decompression and better maintenance of sagittal plane alignment.

Prosthetic replacement of femoral neck fractures of the hemiplegic extremity in the elderly with previous stroke / 中华骨科杂志

Objective To study the curative effect of prosthetic replacement for femoral neck frac-tures at the hemiplegic extremity in the elderly with previous stroke. Methods From May 1990 to May 2000, 189 elderly patients with femoral neck fractures were treated with prosthetic replacement. 29 cases were of previous stroke with femoral neck fractures (Garden type Ⅲ and type Ⅳ) at hemiplegic extremity. 30 non-hemiplegia cases were adopted randomly as control. Two group patients were subjected to a follow-up study for 2 years and 3 months to 8 years and 2 months(average 4 years and 11 months) to compare the differences of ages, hospitalization days, operation time, blood loss, blood transfusion, complications during perioperative period and short-term complications with each other as well as the results of femoral head re-placement versus total hip replacement in treatment of hemiplegia group. Results Two group patients sur-vived during perioperative period. The ages, hospitalization days, operation time, blood loss and blood trans-fusion were of no significant difference in two groups, while complications during perioperative period were of significant difference. 5 patients died in hemiplegia group and 2 patients died in non-hemiplegia group at 11 months to 5 years follow-up. Mortalities were 17.2% and 6.7% respectively. Short-term complication rate was of no significant difference in 2 groups. In hemiplegia group, short-term complication rate of femoral head replacement were significantly higher than that of total hip replacement. Conclusion Prosthetic re-placement is reliable to treat Garden type Ⅲ and type Ⅳ of femoral neck fractures of the hemiplegic ex-tremity in the elderly with previous stroke. Complications during perioperative period are more in hemiplegia group, but short-term complications are of no significant difference in 2 groups. Mortality of hemiplegia group is higher than in non-hemiplegia group in 5 years after operation. Total hip replacement should be in-dicated in treatment of Garden type Ⅲ and type Ⅳ of femoral neck fractures of the hemiplegic extremity in the elderly with previous stroke on condition that hip muscular strength is beyond Ⅳ degree.

Evaluation of life quality of the elderly undergoing internal fixation and arthroplasty for the displaced femoral neck fractures / 中华创伤杂志

Objective To evaluate the life quality in the elderly who underwent internal fixation with cannulated screws and bipolar hemiarthroplasty for the displaced femoral neck fractures. MethodsA retrospective study was performed on 141 cases older than 60 years treated from 1993 to 2004. All cases were followed up for mean 40.2 months to evaluate the differences in regard of pain and daily living at one and three years. Results The daily living in hemiarthroplasty group possessed better outcome than that in internal fixation group at one year, with statistical difference but without statistical difference at three years. There was no statistical differences in postoperative pain relief between both groups. Conclusions Both internal fixation and hemiarthroplasty can relieve pain and revive the life quality of the elderly.