PURPOSE:Spinal cord injury (SCI)-induced diabetes insipidus (DI) presents a unique therapeutic challenge due to concurrent autonomic hypotension unresponsive to conventional desmopressin. This study evaluates the clinical efficacy of Pituitrin, a synthetic vasopressin analog with dual V1a/V2 receptor agonism, designed to simultaneously address antidiuretic hormone deficiency and hemodynamic instability in acute SCI-related DI. METHODS:In this retrospective propensity-matched cohort study, 317 consecutive acute SCI patients (2010 -2021) were screened, with 60 (18.9%) developing DI. Patients were stratified into a Pituitrin-treated group (2014 - 2021, n = 30) and historical controls (2010 - 2013, n = 30). Propensity score matching (1:1 nearest-neighbor, caliper = 0.2 standard deviation) adjusted for age, American Spinal Injury Association (ASIA) grade, injury level (cervical/thoracic), concurrent mild brain injury (Glasgow coma scale 13 - 15), and treatment era covariates, yielding 23 matched pairs. Post-matching groups demonstrated balanced baseline characteristics with cervical injury prevalence 95.7% and ASIA grade A/B injuries 100%. The intervention group received protocolized Pituitrin infusion (initial 1 U/h, titrated 0.5 - 5 U/h based on urine output) with fluid restriction (<2000 mL/day), while controls received standard care including desmopressin and vasopressors as needed. Primary outcomes included DI duration (days to urine output <3000 mL/day concurrent with serum sodium ≥135 mmol/L), in-hospital mortality, and hospitalization length. RESULTS:This study of 317 acute SCI patients (84% male) revealed DI developed in 18.9% (60/317), with striking cervical predominance (57 (31.0%) cervical vs. 3 (4.9%) thoracic SCI; χ2 = 21.4, p < 0.001). In propensity score-matched cohorts (23 pairs balanced for age, ASIA grade, injury level, and era). Early Pituitrin therapy demonstrated transformative efficacy: DI duration reduced by 7.6 days (4.4 ± 1.5 vs. 12.0 ± 2.6 days; 95% confidence interval (CI): 6.4 - 8.8, p < 0.001), 26% absolute mortality reduction (number needed to treat (NNT) = 3.85; p = 0.014), and shortened median hospitalization by 5 days (14 vs. 19 days, p = 0.008). Cervical ASIA A/B patients exhibited maximal benefit with 24% mortality reduction (NNT = 4.17, p = 0.014) and universal hemodynamic stabilization-Pituitrin eliminated vasopressor need in 87% of cases (vs. 23/30 controls requiring norepinephrine; risk difference = 0.63, NNT = 1.59). Notably, 100% of DI cases demonstrated autonomic hypotension preceding hyponatremia, with treatment initiation within 24 h of diagnosis accelerating recovery (r = -0.818, p < 0.001). The intervention proved exceptionally safe, with only 1 (3.3%) experiencing transient headaches. CONCLUSION:This study establishes the first evidence-based protocol for dual V1a/V2 receptor targeting in SCI-induced DI, demonstrating that early Pituitrin administration achieves rapid antidiuresis (median 8-day resolution) while stabilizing hemodynamics (87% vasopressor independence). The 26% absolute mortality reduction (NNT = 3.85) and shortened hospitalization (Δ5 days) suggest promising therapeutic potential, especially for cervical complete injuries, and warrant further validation in larger prospective cohorts. These findings establish a novel treatment paradigm addressing the pathophysiological triad of arginine vasopressin deficiency, autonomic hypotension, and hyponatremia unique to acute SCI.

Preoperative hyponatremia is common in elderly hip fracture patients, but its severity-dependent effects on postoperative complications and short-/long-term mortality, as well as the mediating role of postoperative factors, remain incompletely understood. This retrospective cohort study included 1,901 consecutive patients aged ≥ 60 years who underwent hip fracture surgery between 2015 and 2021. Preoperative hyponatremia was categorized as mild (130–134 mmol/L) or moderate-to-severe (< 130 mmol/L). Multivariable logistic and Cox regression models were used to assess associations with postoperative complications, 30-day and 1-year mortality, with sequential adjustment for confounders. Mediation analyses quantified the contributions of postoperative hyponatremia and postoperative complications. Preoperative hyponatremia was present in 243 patients (12.8

Abstract Background Spinal cord injury (SCI) triggers remote pathological changes in supraspinal regions, including neuroendocrine dysfunction that manifests clinically as hyponatremia and central diabetes insipidus. Clinical observations of lesion-level dependency and sequential transformation between these disorders suggest a temporally ordered hypothalamic cascade in which a compensatory arginine vasopressin (AVP)-driven neuroendocrine surge may precede a later neuroinflammation and endoplasmic reticulum (ER) stress-mediated neuronal exhaustion. Direct transcriptomic evidence for the temporal ordering of these events, however, has been lacking. Methods We performed a dual-cohort transcriptomic analysis. A discovery cohort (NCBI Sequence Read Archive PRJNA953752) comprised hypothalamic tissue from adult male Sprague-Dawley rats subjected to high-thoracic (T3) SCI, low-thoracic (T10) SCI, or sham surgery, sampled at post-injury day 7 and analyzed with edgeR/DESeq2 (|log 2 FC| > 1, P adj < 0.05). An independent chronic-phase validation cohort (Gene Expression Omnibus GSE297887) of hippocampal tissue from SCI and sham mice was interrogated as a sensitive supraspinal proxy for remote neuroinflammatory and ER-stress signatures. Pre-defined gene panels covered neuroendocrine, neuroinflammation, and ER-stress/unfolded-protein-response categories. Results In the discovery cohort, high-thoracic SCI produced a lesion-level-dependent neuroendocrine surge in the hypothalamus: Avp (fold change 7.23; P adj = 0.002), Oxt (fold change 14.25; P adj = 2.3 × 10 −7 ), and Ucn3 (fold change 9.22; P adj = 0.002) were among the most significantly upregulated genes genome-wide, whereas low-thoracic SCI failed to reach significance for any of these targets. Classical neuroinflammation markers and canonical ER-stress effectors remained transcriptionally silent (all P adj > 0.69). The PERK-pathway sentinel genes Trib3 and Ppp1r15a/GADD34 exhibited coordinated sub-threshold trends indicative of early activation, and Avp expression was tightly correlated with Mmp9 (r = 0.833; P = 0.0004). In the chronic-phase validation cohort, microglial P2ry12 and ferroptosis signatures were significantly upregulated ( P2ry12 fold change 1.33; P = 0.008) suggesting a primed microglial state, while ER-stress effectors remained silent. Conclusions These data support a temporally ordered hypothalamic cascade after SCI in which an early compensatory neuroendocrine surge precedes — and may precipitate, through biosynthetic overload and blood–brain-barrier disruption — a subsequent neuroinflammation and ER-stress crisis. The defined molecular window between neuroendocrine activation and inflammatory/ER-stress engagement identifies a candidate therapeutic window for early neuroprotective intervention in acute SCI.

BackgroundDiabetes insipidus (DI) usually coexists with hyponatremia in patients with acute spinal cord injury (SCI). However, the incidence of DI after acute SCI has rarely been reported. In this study, we aimed to determine the incidence rates and risk factors for these conditions and explore early detection and intervention strategies.MethodsPatients with acute SCI who were sequentially admitted to our center between January 2010 and November 2021 were included. Clinical information was extracted from the medical records. Univariate analyses were performed for each potential risk factor. Variables with a P < 0.1 in univariate analysis were included in the multivariate logistic regression analysis, and those with a P < 0.05 were defined as independent risk factors.ResultsThe cohort included 317 patients. One hundred ten (34.7%) of the 317 patients with acute SCI developed hyponatremia, and 60 (18.9%) developed DI. The median time to onset of hyponatremia was 5 days (interquartile range [IQR]: 4-6), and the median time to onset of DI was 7 days (IQR: 6-8). Multivariate logistic regression analysis identified a cervical level of injury and a more severe injury (ASIA A) as strong independent risk factors for hyponatremia (both P < 0.001). Among fracture types, only Type C (compared to Type I) was individually associated with hyponatremia (P = 0.038), although the overall fracture-type variable was not significant (P = 0.156). In contrast, for DI, in addition to cervical level and ASIA A injury (both P < 0.001), the fracture-type variable was a significant predictor overall (P < 0.001), with both Type B (P = 0.027) and Type C (P < 0.001) fractures (vs. Type I) being independent risk factors.ConclusionWe found a high incidence of hyponatremia (34.7%) and DI (18.9%) in patients with acute SCI. Hyponatremia was mainly associated with higher-level and more severe SCI, with an added risk observed in fracture type C, whereas DI was associated with higher-level SCI, more severe injuries, and fracture types B and C. Our study highlights the interconnected nature of hyponatremia and DI as manifestations of acute SCI. Future research should adopt a unified pathophysiological framework that integrates these findings to better understand the underlying mechanisms.

Safe and effective minimally invasive treatments are lacking for very severe osteoporotic vertebral compression fractures (vsOVCF), especially in patients with upper and lower endplate fractures or nonunion of old fractures. This study introduces a minimally invasive approach for the treatment of vsOVCF and introduces a new concept called functional spinal unit height (FSUH) to assess biomechanical stability of the spine after surgery. From January 2020 to January 2022, forty patients with vsOVCF who received percutaneous vertebral-intervertebral plasty (PVIP) were retrospectively reviewed. The clinical and radiological assessments were reviewed. One patients had adjacent vertebral fractures(AVF) due to a trauma after the operation (rate of AVF, 2.9

Postoperative cardiac events (PCEs) are life threatening in older patients undergoing hip fracture surgery. This study aimed to investigate the risk factors for PCEs in these patients and to evaluate the impact of PCEs on all-cause mortality after surgery. A retrospective review was performed of consecutive patients who underwent surgery for hip fractures at the Seventh Medical Center, Chinese PLA General Hospital, from January 2012 to December 2020. The patients were divided into a PCE group and a non-PCE group according to whether they experienced PCEs. Univariate and multivariate logistic regression analyses were employed to investigate the independent risk factors for PCEs. Kaplan‒Meier curves and log-rank tests were used to compare the cumulative mortality between the two groups, and a Cox proportional hazards regression model was used to estimate risk factors for mortality. We recruited 1718 patients, 169 of whom (9.8

BACKGROUND:This study evaluates the outcomes of fibular intramedullary nails (IMNs) compared to traditional plates and screws (PS) in the surgical treatment of unstable ankle injuries in patients aged ≥65 years. METHOD:We conducted a retrospective study involving 32 elderly patients with unstable ankle fractures treated with IMNs from 2010 to 2022. A comparison was made with 125 case-control patients treated with PS during the same period. Outcomes compared included postoperative wound and nonwound complications, surgical reduction, union rates, implant removal rates, and the Olerud Molander Ankle Score (OMAS) at a minimum follow-up of 2 years. RESULTS:The IMN group had a higher incidence of high-energy injuries, open fractures, concomitant surgery, and perioperative transfusion requirements than the PS group. Additionally, the IMN group developed fewer wound-related (3.1% vs 20% in the PS group, P = .043) and non-wound-related complications (18.8% vs 39.2% in the PS group, P = .030). Both groups had similar initial weightbearing restrictions, fracture union times, mean OMAS scores, rates of malunion or nonunion, and delayed implant removal times. Notably, there were significant differences in the quality and adequacy of mortise alignment between the groups (good: 53.1% in IMN group vs 79.2% in PS group, fair: 46.9% in IMN group vs 20.8% in PS group, P = .006). CONCLUSION:Although the IMN group had an inferior outcome in the quality and adequacy of mortise reduction compared with the PS group, elderly patients with ankle fractures treated with IMN showed comparable functional outcomes to those treated with PS but with lower complication rates. Future research in this area will provide vital information for developing optimal treatment strategies, thereby improving the overall care of elderly patients with ankle fractures.

Purpose: Intramedullary nailing is the preferred internal fixation technique for the treatment of subtrochanteric fractures because of its biomechanical advantages. However, no definitive conclusion has been reached regarding whether combined cable cerclage is required during intramedullary nailing treatment. This study is performed to compare the clinical effects of intramedullary nailing with cerclage and non-cerclage wiring in the treatment of irreducible spiral subtrochanteric fractures. Methods: Patients with subtrochanteric fractures admitted to our center from January 2013 to December 2021 were retrospectively analyzed. The patients were enrolled in the case-control study according to the inclusion and exclusion criteria and divided into the non-cerclage group and the cerclage group. The patients' clinical data, including the operative time, intraoperative blood loss, hospital stay, reoperation rate, fracture union time, and Harris hip score, were compared between these 2 groups. Categorical variables were compared using Chi-square or Fisher's exact test. Continuous variables with normal distribution were presented as mean +/- standard deviation and analyzed with Student's t-test. Non- normally distributed variables were expressed as median (Q1, 1 , Q3) 3 ) and assessed using the Mann- Whitney test. A p <0.05 was considered significant. Results: In total, 69 patients were included in the study (35 patients in the non-cerclage group and 34 patients in the cerclage group). The baseline data of the 2 groups were comparable. There were no significant difference in the length of hospital stay (z =-0.391, p = 0.696), operative time (z =-1.289, p = 0.197), or intraoperative blood loss (z =-1.321, p = 0.186). However, compared with non-cerclage group, the fracture union time was shorter (z =-5.587, p < 0.001), the rate of nonunion was lower (c2 c 2 = 6.030, p = 0.03), the anatomical reduction rate was higher (c2 c 2 = 5.449, p = 0.03), and the Harris hip score was higher (z =-2.99, p = 0.003) in the cerclage group, all with statistically significant differences. Conclusions: Intramedullary nailing combined with cable cerclage wiring is a safe and reliable technique for the treatment of irreducible subtrochanteric fractures. This technique can improve the reduction effect, increase the stability of fracture fixation, shorten the fracture union time, reduce the occurrence of nonunion, and contribute to the recovery of hip joint function. (c) 2024 Production and hosting by Elsevier B.V. on behalf of Chinese Medical Association. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

BackgroundPauwels type III femoral neck fractures, as a serious type of femoral neck fractures, have brought about a heavy economic burden on families and society for the high disability rate. Through bibliometric research and visualized analysis, this study aimed at elucidating the global research status of Pauwels type III femoral neck fractures to date, and predicting the future research trends in this field.MethodsPublications and associated information on Pauwels type III femoral neck fractures to date were retrieved from Web of Science Core Collection, and by VoSviewer and R package “bibliometrix”, bibliometric analysis and visual presentation was conducted.ResultsBy retrieval, a total of 98 studies were refinedly extracted, and the volume of publications in this field increased year-over-year. China ranked first in terms of total publication volume and H-Index, with its total citation records second only to the United States. The country with the highest average citation frequency was Switzerland. SHANGHAI JIAO TONG UNIVERSITY was the most productive research institution. Among the authors in this field, Li, Jiantao had published the most researches. INJURY INTERNATIONAL JOURNAL OF THE CARE OF THE INJURED and JOURNAL OF ORTHOPAEDIC TRAUMA were the two magazines with the highest publication volume, total citation records, and H-index. According to keywords co-occurrence analysis, the research content in the past 24 years is mainly divided into four different dimensions. Finite element analysis, femoral neck system, medial buttress plate, cannulated screws, hip screw, open reduction, complications are hot topics for future research.ConclusionsAccording to the global trends analysis of publications production, Pauwels type III femoral neck fractures are receiving increasing attention and input from scholars. China has made the greatest scientific research contribution among countries, but its academic quality should be improved further. The modified therapeutic methods designed for addressing the complications of traditional internal fixation for Pauwels III femoral neck fractures will be the future research hotspot.

目的:分析颈脊髓中央损伤综合征(central cord syndrome,CCS)手术治疗的预后及相关影响因素.方法:回顾性分析2017年1月～2019年12月在我院骨科经手术治疗的CCS病例,收集所有患者的年龄、性别、致伤原因、入院时美国脊髓损伤协会(American Spinal Injury Association,ASIA)运动评分、ASIA感觉(针刺觉)评分、日本骨科协会(Japanese Orthopaedic Association,JOA)评分、手内肌肌力评分及影像学资料信息[包括椎前高信号、后方韧带复合体、椎间盘突出、后纵韧带骨化、髓内高信号范围、椎管最狭窄处矢状径、椎管最狭窄处百分比(maximum canal compromise,MCC)和脊髓最大受压百分比(maximum spinal cord compression,MSCC)等]、受伤至手术时间、手术方式、住院时间、随访时ASIA神经功能评分、随访时JOA评分等资料,评估患者神经功能改善情况;将JOA评分改善率＞50％定义为预后好,≤50％定义为预后差,分析影响手术治疗预后的相关因素.结果:共纳入48例CCS患者,其中男性36例(75％),女性12例(25％),年龄54.76±9.78岁.入院时ASIA运动评分67.23±21.98分,ASIA感觉评分96.58±13.39分;JOA评分9.19±3.08分,手内肌肌力评分7.04±4.50分.19例(39.58％)存在病理征.伤后5.46±2.10d接受手术治疗,其中前路手术21例,后路手术27例.术后随访12～34个月,所有患者均未发生明显手术相关并发症或神经功能恶化,末次随访时ASIA运动评分89.67±13.65分,ASIA感觉评分104.88±7.94分,JOA评分13.73±3.25分,较入院时均有不同程度的提高(P＜0.05).多元回归分析显示ASIA运动评分、ASIA感觉评分和JOA评分的改善率与后纵韧带骨化(β=-0.447、P＜0.001;β=0.524、P=0.001;β=-0.196、P＜0.001)和入院 ASIA 感觉评分(β=0.526、P=0.011;β=0.894、P=0.02;β=-0.784、P＜0.001)有显著相关性.预后好与预后差患者的年龄、椎前高信号、后纵韧带骨化、椎管最狭窄处矢状径、MCC、入院手内肌评分、入院ASIA运动评分和入院JOA评分有统计学差异(P＜0.05),多元回归分析显示良好预后(JOA评分改善率＞50％)与年龄(β=5.889、P=0.015)、椎前高信号(β=15.799、P＜0.001)、MCC(β=6.747、P=0.009)、入院手内肌评分(β=9.012、P=0.003)、入院ASIA运动评分(β=4.837、P=0.028)、入院ASIA感觉评分(β=5.205、P=0.023)和入院JOA评分(β=6.446、P=0.011)存在显著相关性.受试者工作特征(receiver operating characteristic,ROC)曲线分析显示无椎前高信号[曲线下面积(area under curve,AUC)=0.756,95％CI 0.585～0.928,P=0.006]、MCC＜45.41％(AUC=0.731,95％CI 0.566～0.896,P=0.010)、入院手内肌评分＞11 分 AUC=0.77,95％CI 0.628～0.913,P=0.003)、入院 ASIA 运动评分＞75 分(AUC=0.804,95％CI 0.683～0.924,P=0.001)、入院JOA评分＞8.59分(AUC=0.755,95％CI 0.614～0.897,P=0.005)可作为良好预后的预测因子.结论:手术治疗CCS安全有效,无椎前高信号、MCC低(＜45.41％)、入院手内肌评分高(＞11分)、入院ASIA运动评分高(＞75分)和入院JOA评分高(＞8.59分)是CCS患者手术预后良好的预测因子.

Objective:To explore the risk factors of heart failure within 1 year after surgery for hip fracture in the elderly.Methods:A retrospective cohort study was conducted to analyze the clinical data of 476 elderly patients with hip fracture admitted to No.7 Medical Center, Chinese PLA General Hospital from January 2018 to December 2019, including 171 males and 305 females, at age of 60-104 years [(82.5±8.1)years]. There were 271 patients with intertrochanteric fractures and 205 with femoral neck fractures. The patients were divided into heart failure group ( n=111) and non-heart failure group ( n=365) based on the presence of heart failure within 1 year after surgery. The following items were recorded: gender, age, fracture type (intertrochanteric fractures and femoral neck fractures), comorbidities [hypertension, coronary heart disease, arrhythmia, pulmonary infection, chronic obstructive pulmonary disease (COPD), renal insufficiency and diabetes], use of anticoagulants before injury, walking ability and self-care ability before injury, hematological indicators (white blood cell count, hemoglobin, albumin), time from injury to surgery, types of anesthesia (general anesthesia and regional anesthesia), types of surgery (intramedullary nails, dynamic hip screws, cannulated screw and arthroplasty), blood transfusion, length of hospital stay, sorts of perioperative complications (cerebrovascular disease, delirium, pulmonary infection, acute myocardial infarction, malignant arrhythmia, urinary tract infection, venous thromboembolism, acute cholecystitis and intestinal obstruction), and number of perioperative complications. Univariate analysis was used to evaluate the relationship between the above indicators and heart failure within 1 year after surgery in the elderly patients with hip fracture. Multiple Logistic stepwise regression analysis was used to determine the independent risk factors for the heart failure. Results:Univariate analysis showed that age, coronary heart disease, arrhythmia, use of anticoagulants before injury, albumin, blood transfusion, length of hospital stay, and number of perioperative complications≥2 were correlated with heart failure within 1 year after surgery in elderly patients with hip fracture ( P<0.05 or 0.01). Multivariate Logistic stepwise regression analysis showed that coronary heart disease ( OR=1.50, 95% CI 1.10, 2.51, P<0.05), blood transfusion≥2 U ( OR=2.01, 95% CI 1.23, 3.29, P<0.01) and number of perioperative complications≥2 ( OR=2.12, 95% CI 1.27, 3.53, P<0.01) were significantly associated with heart failure within 1 year after surgery in elderly patients with hip fracture. Conclusion:Complications of coronary heart disease, blood transfusion≥2 U and number of perioperative complications≥2 are independent risk factors for heart failure within 1 year after surgery in elderly patients with hip fracture.

OBJECTIVE:To explore incidence, risk factors and the relationship between preoperative heart failure and prognosis in elderly patients with hip fracture.METHODS:A retrospective analysis was performed on 1 569 elderly patients with hip fracture treated from January 2012 to December 2019, including 522 males and 1 047 females, aged 81.00 (75.00, 90.00) years old;896 intertrochanteric fractures and 673 femoral neck fractures. Patients were divided into heart failure and non-heart failure groups according to whether they developed heart failure before surgery, and heart failure was set as the dependent variable, with independent variables including age, gender, fracture type, comorbidities and hematological indicators, etc. Univariate analysis was performed at first, and independent variables with statistical differences were included in multivariate Logistic regression analysis. Independent risk factors for preoperative heart failure were obtained. The length of hospital stay, perioperative complications, mortality at 30 days and 1 year after surgery were compared between heart failure and non-heart failure groups.RESULTS:There were 91 patients in heart failure group, including 40 males and 51 females, aged 82.00 (79.00, 87.00) years old;55 patients with intertrochanteric fracture and 36 patients with femoral neck fracture. There were 1 478 patients in non-heart failure groups, including 482 males and 996 females, aged 81.00(75.00, 86.00) years old;841 patients with intertrochanteric fracture and 637 patients with femoral neck fracture. There were significant differences in age, sex, coronary heart disease, arrhythmia and dementia between two groups(P<0.05). Multivariate Logistic analysis of statistically significant factors showed that males(OR=1.609, P=0.032), age(OR=1.032, P=0.031), arrhythmia(OR=2.045, P=0.006), dementia (OR=2.106, P=0.014) were independent risk factor for preoperative heart failure. The 30-day and 1-year mortality rates were 9.9% and 26.4% in heart failure group and 3.6% and 13.8% in non-heart failure group, respectively;and had statistical significance between two groups (P<0.05). There were significant differences in pulmonary infection, cerebrovascular complications and cardiovascular complications between two groups (P<0.05). The duration of hospitalization in heart failure group was (16.21±10.64) d compared with that in non-heart failure group (13.26±8.00) d, and the difference was statistically significant (t=2.513, P=0.012).CONCLUSION:Male, old age, arrhythmia and dementia are independent risk factors for heart failure after hip fracture in elderly patients. Patients with preoperative heart failure have a higher incidence of postoperative pulmonary infection, cerebrovascular and cardiovascular complications, higher mortality at 30 d and 1 year after surgery, and longer hospital stay.

Objective:To clarify the incidence of serum sodium disorder after hip fracture in elderly patients, and investigate the risk factors of serum sodium disorder as well as the association between the disorder of serum sodium and mortality after hip fracture.Methods:Data from the Hip Fracture Database of the Seventh Medical Center of the General Hospital of PLA of hip fracture in the elderly from January 2012 to December 2016 were retrospectively collected and analysed. Inclusion criteria: age ≥60 years old, able to walk before injury, single hip fracture, and with complete data of serum sodium. Exclusion criteria: pathological fracture, high-energy impact. The serum sodium on admission was recorded, and the patients were divided into hyponatremia group, hypernatremia group and normal group. The serum sodium correlation between disorder of serum sodium and hip fracture was analysed by multivariate logistic regression analysis.Results:A total of 1 001 patients were enrolled, including 327 males and 674 females, and aged 60 to 99 years.The serum sodium in the patients was found 116 to 155 mmol / L. A total of 166 patients (16.6%) were with disorder of serum sodium after admission, of whom 126 were in hyponatremia (12.6%), with 98 in mild hyponatremia (9.8%), 18 in moderate hyponatremia (1.8%) and 10 in severe hyponatremia (1.0%). A total of 40 patients were found in hypernatremia (4.0%). The number of comorbidities over four diseases [odds ratio(OR )=1.578, 95% confidence interval (CI) (1.028, 2.423), P =0.037)] was found as an independent risk factor for the disorder of serum sodium, while serum albumin level (OR=0.950, 95% CI(0.910, 0.991), P =0.018) was negatively correlated with the disorder of serum sodium. The 30-day and one-year mortality in patients with hyponatremia were 9.5% and 26.2%, respectively. The 30-day and one-year mortality in patients with hypernatremia were 5% and 15.0%, respectively. The 30-day and one-year mortality rates in patients with normal serum sodium were 3.5% and 14.1%, respectively. There were statistically significant difference among these groups (30-day: χ2=7.813, P =0.020; one year: χ2=12.053, P =0.002). Multivariate analysis reported that hyponatremia was an independent risk factor for mortality at 30-days (OR=2.557, P=0.014) and at one year(OR=1.755, P=0.022)various confounding factors being adjusted. The 30-day and one-year mortality rates in patients with mild hyponatremia were 6.1% and 24.5%, while those in the patients with moderate or severe hyponatremia were 21.4% and 32.1%, respectively. There was statistically significant difference between patients with mild hyponatremia and patients with moderate or severe hyponatremia at 30-day after operation(χ2=4.278, P=0.039).Conclusions:The incidence of serum sodium disorder is high in elderly patients after hip fracture. Number of coexisting diseases and level of serum albumin are closely related to the disorder of serum sodium. Hyponatremia is an independent risk factor of postoperative mortality in 30-day and one-year after surgery. With an aggravation of low serum sodium, the risk of mortality increases gradually after the surgery of hip fracture.

Clinical Diagnosis, Classification and Individualized Treatment Strategy of Osteoporotic Vertebral Compression Fractures During the Epidemic Prevention and Control of COVID-19

Objective:To investigate the prognosis of hip fracture in elderly patients with dementia.Methods:From January 2012 to December 2017, 91 dementia patients aged (82.7±6.6)y (21 males and 70 females) with hip fracture were enrolled in the study; 91 non-dementia patients matched by age, gender and fracture type were selected as controls. There were 54 cases of intertrochanteric fracture and 37 cases of femoral neck fracture. The length of hospital stay, mortality within 30 days and 1 year, walking ability and risk of reoperation were compared between the two groups. The effect of dementia on the mortality after surgery was analyzed by adjusting confounding factors through multivariate logistic regression analysis.Results:There was no significant difference in the length of hospital stay between dementia group and non-dementia group [(13.95±7.33) vs.(12.63±8.68)d, t=1.12, P=0.266]. The incidence rate of perioperative complications in dementia group was higher than that in non-dementia group [63.7%(58/91) vs. 23.1%(21/91), χ 2 = 44.59, P<0.001]. The incidence of delirium in dementia group was higher than that in non-dementia group [35.3%(42/91) vs.13.2%(12/91), χ 2 = 5.71, P=0.017]. The incidence of pulmonary infection in dementia group was higher than that in non-dementia group [11.0%(10/91) vs. 2.2%(2/91), χ 2= 11.989, P<0.001]. There was no significant difference in 30-day fatality rate [7.7%(7/91) vs. 1.1%(1/91), χ 2= 3.27, P=0.071] between two groups; while the 1-year fatality rate in dementia group was higher than that in non-dementia group [27.5%(25/91) vs. 14.3%(13/91), χ 2= 4.79, P=0.029]. After adjusting for the differences of confounding factors between the two groups, dementia was an independent risk factor for 1-year mortality after hip fracture surgery ( OR = 1.852, 95 %CI:1.048-3.043, P= 0.022). For walking ability of 1 year after operation, 22 (33.3%) patients in dementia group walked independently, 38 (57.6%) patients partially walked independently, 6 (9.1%) patients were in bed; while in non-dementia group, 45 (57.7%) patients walked independently, 27 (34.6%) patients partially walked independently, 6 (7.7%) patients were in bed; there was significant difference between the two groups (χ 2= 8.82, P=0.012). There was no significant difference in reoperation rate between two groups [6.6%(6/91) vs. 5.5%(5/91), χ2=0.10, P=0.756]. Conclusion:Compared to non-dementia patients, dementia patients with hip fracture have poorer prognosis, higher incidence of perioperative complications, pulmonary infection and delirium, higher risk of mortality 1 year after operation, and poorer ability of independent walking.

目的 比较早期手术和晚期手术对伤前使用直接口服抗凝药物(direct oral anticoagulation,DOAC)髋部骨折患者预后的影响.方法 回顾性分析2012年1年至2018年12月解放军总医院第七医学中心收治的64例髋部骨折患者的临床资料,根据是否在入院2 d内进行手术将患者分为早期手术组(30例)和晚期手术组(34例),比较两组患者的术中出血量、手术持续时间、Hb变化率、围术期输血率和输血量、住院时间、围术期并发症、术后30d及1年病死率.结果 与晚期手术组比较,早期手术组术中出血量较多,手术持续时间较长,围术期输血量和输血率较大,静脉血栓栓塞症(venous thromboembolism,VTE)发生率较低,术后30 d及1年病死率较低,但差异均无统计学意义(P＞0.05).与晚期手术组比较,早期手术组Hb变化率较大[(20.56±10.77)％比(15.10±8.90)％],住院时间较短[(11.87±5.07)d比(16.06±6.30)d],围术期并发症发生率较低(13.3％比38.2％),差异均有统计学意义(P＜0.05).结论 对于伤前使用DOAC的髋部骨折患者,在不增加术中出血量、围术期输血量及输血率的基础上,早期手术治疗可以明显缩短患者的住院时间,降低住院期间并发症发生率.

Objective:To explore the predictive values of neutrophil to lymphocyte ratio (NLR), monocyte to lymphocyte ratio (MLR) and platelet to lymphocyte ratio (PLR) for postoperative delirium in the elderly patients with hip fracture.Methods:The data of 1,278 elderly patients with hip fracture were analyzed retrospectively who had been admitted to Department of Orthopedics, The 7th Medical Center, General Hospital of Chinese People's Liberation Army from January 2012 to December 2018. There were 418 males and 860 females, with a median age of 81 (75, 90) years. There were 728 intertrochanteric fractures and 550 femoral neck fractures. The working characteristic curves (ROC) of NLR, MLR, and PLR used to predict postoperative delirium in the elderly patients with hip fracture were worked out to obtain the best cutoff points (sensitivity, specificity, and area under the curve) respectively. According to the best cutoff points, the NLR, MLR, and PLR were respectively divided into an increase group and a normal group. According to whether postoperative delirium occurred or not, the patients were divided into a delirium group and a delirium-free group. After univariable analysis was conducted to screen out the risk factors, binary logistic regression analysis was conducted of the factors with P<0.05 to determine the risk factors. Results:The median values of NLR, MLR and PLR in the 1,278 elderly patients with hip fracture at admission were 5.43 (3.87, 7.88), 0.40 (0.29, 0.54) and 158.40 (118.00, 222.50), respectively. Postoperative delirium occurred in 153 patients (12.0%). In the study of the predictive values of NLR, MLR, and PLR using ROC curves for postoperative delirium in the elderly patients with hip fracture, the best cutoff points (sensitivity, specificity, and area under the curve) for prediction were 7.613 (57.5%, 77.1%, 0.726), 0.512 (52.3%, 74.0%, 0.663), and 201.125 (68.6%, 73.3%, 0.751), respectively. The risk factors for postoperative delirium were increased NLR ( OR=2.046, 95% CI: 1.322 to 3.166, P<0.001), increased MLR ( OR=1.568, 95% CI: 1.039 to 2.367, P=0.032), and increased PLR ( OR=3.489, 95% CI: 2.290 to 5.317, P<0.001). Conclusion:As NLR≥7.613, MLR≥0.512 and PLR≥201.125 may be risk factors for postoperative delirium in elderly patients with hip fracture, NLR, MLR and PLR may have a positive value in prediction of postoperative delirium.

目的 分析Inter-TAN髓内钉治疗股骨转子间骨折的失效原因及影响因素.方法 2018年1月至2020年12月中国人民解放军总医院第7医学中心骨科收治的老年股骨转子间骨折患者资料共238例;其中男166例,女72例;年龄(79.29±5.10)岁,住院时间(11.90±7.37)d;稳定型骨折58例,不稳定型180例;所有患者均使用Inter-TAN固定.记录患者负重时间、骨折愈合情况、术后失效情况等.螺钉切出、切穿、断裂等被认为是失效.分析Inter-TAN髓内钉治疗股骨转子间骨折失效原因及影响因素.结果 术后共有14例患者发生内固定失效,内固定失效率为5.9％.失效原因分别为头颈钉切出11例,切穿2例,断钉1例;10例在术后3个月内失效;3例为术后3～6个月内失效;1例为术后6～12个月内失效.复位质量和骨密度是老年股骨转子间骨折术后失效的独立危险因素.结论 Inter-TAN髓内钉治疗股骨转子间骨折具有一定失效率.这与该系统静态固定的设计理念有关,也与骨质疏松、复位质量有关.

Objective:To determine the factors related to postoperative 1-year and 5-year mortalities in elderly patients with hip fracture plus chronic obstructive pulmonary disease (COPD).Methods:A retrospective study was conducted of the elderly patients with hip fracture who had sought medical attention at Department of Orthopaedics, The 7th Medical Center of PLA General Hospital from January 2012 to December 2016.Of them, 103 were complicated with COPD, and another 103 without COPD were selected as controls who were matched in age, gender and fracture site. The 2 groups were compared in terms of postoperative 30-day, 1-year and 5-year mortalities; the risk factors were explored for postoperative 1-year and 5-year mortalities in patients with hip fracture plus COPD.Results:The postoperative 30-day, 1-year and 5-year mortalities in the COPD group were 7.8%(8/103), 29.1%(30/103) and 48.5%(50/103), significantly higher than those in the control group except for the 30-day value [1.9%(2/103), 13.6%(14/103) and 31.1%(32/103)] ( P<0.05). Advanced age ( P=0.003), cardiovascular disease ( P=0.006), respiratory disease ( P=0.009), acute exacerbation of COPD (AECOPD) ( P<0.01), American Society of anesthesiologists (ASA) grades Ⅲ+Ⅳ ( P=0.001), delayed surgery (>48 h) ( P=0.015), pre-injury activities of daily living (ADL) score ( P=0.002) and mobility ( P=0.010) were related to an increased risk for 1-year mortality after operation. Advanced age ( OR=1.106, 95% CI: 1.016 to 1.210, P=0.021), AECOPD ( OR=5.053, 95% CI: 1.520 to 16.800, P=0.008), and ASA grades Ⅲ+Ⅳ ( OR=1.657, 95% CI: 1.072 to 3.912, P=0.040) were the risk factors for 5-year mortality in patients with COPD; pre-injury ADL ( OR=0.974, 95% CI: 0.987 to 0.967, P=0.043) was negatively correlated with 5-year mortality. Conclusions:COPD can significantly increase the short-term and long-term mortalities in elderly patients with hip fracture.Cardiovascular disease, AECOPD and ASA grades Ⅲ+Ⅳ are factors related to postoperative 1-year mortality in patients with hip fracture plus COPD. Advanced age, AECOPD and ASA grades Ⅲ+Ⅳ and delayed surgery (>48 h) are risk factors for postoperative 5-year mortality in patients with hip fracture plus COPD. ADL score before injury is negatively correlated with postoperative 1-year and 5-year mortalities.

Objective:To evaluate the clinical outcomes of Acumed intramedullary nailing for AO type A3 forearm diaphyseal fracture in adults.Methods:A retrospective study was conducted of the 20 adult patients with AO type A3 forearm diaphyseal fracture who had been treated by Acumed intramedullary nailing from January 2016 to November 2018 at PLA General Hospital. They were 18 males and 2 females, aged from 18 to 56 years (average, 36.5 years). There were 6 radius diaphyseal fractures, 9 ulna diaphyseal fractures and 5 diaphyseal fractures of both forearm bones. The clinical outcomes of Acumed intramedullary nailing for AO type A3 forearm diaphyseal fractures were evaluated by recording the perioperative complications, fracture union time, forearm rotation range at 12-month follow-up, and Disability of the Arm, Shoulder and Hand Questionnaire (DASH) scores for the upper limb function.Results:The 20 patients were followed up for 12 to 18 months (mean, 15.8 months). Bony union was achieved in all the patients after 3 to 4 months (average, 3.3 months). Partial rupture of the extensor pollicis longus tendon happened during operation in one patient and at 3 months post-operation in another due to fixation irritation, and linear ossification of interosseous membranes was observed in one patient with diaphyseal fractures of both forearm bones. 12-month follow-ups showed that, in the 20 patients, forearm pronation ranged from 80° to 90° (average, 89°), supination from 60° to 90° (average, 86.3°) and DASH scores from 0 to 37 (average, 6.5).Conclusions:In the treatment of AO type A3 forearm diaphyseal fracture in adults, Acumed intramedullary nailing can lead to successful fracture union and excellent rotational activity at one year after operation. Therefore, adult AO type A3 forearm diaphyseal fracture can be listed as an indication for Acumed intramedullary nailing.