RESUMO
Objective To investigate the risk factors of delirium in elderly patients with intertrochanteric fracture after internal fixation.Methods The data of 160 patients with intertrochanteric fractures who received internal fixation in our hospital from January 2012 to July 2014 were analyzed retrospectively.The risk factors such as age,sex,preoperative complications,preoperative cognitive function,fracture location,operation mode,operation time,anesthesia method,hospital-to-operation time and intraoperative blood loss were summarized.Results The incidence of postoperative delirium was 28.15％ in postoperative elderly patients with intertrochanteric fractures.Univariate analysis showed that delirium had correlated with preoperative cognitive impairment,preoperative preparation time,serum sodium,fentanyl,atrial fibrillation,anesthesia method,operation time and perioperative blood loss (P ＜ 0.05).The multivariate Logistic regression analysis showed that the independent risk factors of postoperative delirium were preoperative cognitive dysfunction,operative time more than 2 hours and preoperative preparation time more than 4 days.Conclusion The occurrence of postoperative delirium was associated with anesthesia method,cognitive deficits,preoperative preparation time and perioperative blood loss.The anesthesia method which had less effect on the whole body condition and less time of operation preparation can decrease the occurrence of postoperative delirium in a certain extent,which is conducive to improving the prognosis.
RESUMO
Objective To observe the clinical effects and safety of vertebroplasty combined with zoledronic acid for osteoporotic thoracolumbar vertebral compression fractures .Methods 56 osteoporotic thoracolumbar vertebral compression fractures patients were radomly divided into the two groups ,each group had 28 cases.All patients had re-set treatment including lying on the hard bed and Padded waist .The treatment group had the surgery of vertebroplasty , 3 days after surgery these patients treated with 100mL Zoledronic acid by means of intravenous drip .The control group had the conservative treatment ,these patients received the closed reduction ,after operations the patients had the treat-ment of traction suspension ,lying on the hard bed ,padded the fractures .The two groups were compared at the time be-fore treatment,24h after treatment and 6 months after treatment .The anterior height of vertebral body ,kyphosis Cobb's angle,low back pain visual analog scale ,Oswsetry dysfunction index score and complications were included into the study.Results (1) The anterior height of vertebral body: The difference of the anterior height of vertebral body at different time before or after the treatment was statistically significant , that showed the time effect [ the treatment group:(13.81 ±2.09)mm,(20.14 ±2.26)mm,(21.89 ±2.60mm;the control group:(15.24 ±2.21)mm,(17.39 ± 2.57)mm,(17.40 ±1.81) mm].The difference of the overall anterior height of vertebral body between the two groups was statistically significant ,which showed the grouping effect .(2) Kyphosis Cobb's angle: The difference of Kyphosis Cobb's angle at different time was statistically significant ,which showed the time effect [ the treatment group:(26.18 ±2.03)°,(9.56 ±1.11)°,(9.57 ±1.08)°;the control group:(27.36 ±2.71)°,(14.59 ±1.28)°, (14.52 ±1.48)°],the difference of the overall Kyphosis Cobb's angle between the two groups was statistically signifi-cant,which showed the grouping effect .(3) Low back pain visual analog scale:The difference of low back pain visual analog scale at different time was statistically significant ,which showed the time effect[the treatment group:(8.31 ± 0.94)points,(1.86 ±0.74) points,(1.87 ±0.77) points;the control group:(8.12 ±0.95) points,(3.85 ± 1.07)points,(3.82 ±1.08)points].The difference of the overall low back pain visual analog scale between the two groups was statistically significant , which showed the grouping effect .( 4 ) Oswsetry dysfunction index score: The difference of Oswsetry dysfunction index score at different time was statistically significant , which showed the time effect[the treatment group:(73.27 ±4.55)points,(32.11 ±2.57)points,(29.14 ±3.60)points;the control group:(75.49 ±4.20)points,(43.83 ±2.98)points,(38.67 ±5.28)points].The difference of the overall Oswsetry dys-function index score between the two groups was statistically significant ,which showed the grouping effect .Conclusion The treatment of vertebroplasty combined with zoledronic acid for osteoporotic thoracolumbar vertebral compression fractures was effective .It is able to relieve low back pain ,improve bone density and quality ,improve life quality ,and prevent Osteoporosis from further development .