ABSTRACT Objective To investigate the relevant factors of augmented vertebrae recollapse after percutaneous vertebral augmentation (PVA) for the treatment of osteoporotic vertebral compression fractures (OVCFs). Method A prospective study was performed on 116 patients who were diagnosed with osteoporotic compression fractures in which the anterior height loss of the vertebral body was greater than 1/3. All patients underwent percutaneous vertebral augmentation (PKP or PVP). Possible risk factors for augmented vertebral height decrease, such as age, sex, body mass index, surgical approach, fracture location, cement leakage, patterns of vertebral fractures, Vertebral height restoration (VHR), and intervertebral cleft (IVC), were analyzed. Results The radiography follow‐up period was 1 year. Ninety‐five patients completed the trial. Twenty‐four patients suffered postoperative recollapse. Preoperative magnetic resonance imaging showed that the incidence of IVC in the recollapse group was significantly higher than that in the no‐recollapse group (p < 0.050). The OR value (157.891) indicates that the presence of IVC before surgery significantly exacerbates the incidence of postoperative recollapse. The surgical approaches of the recollapse group and the no‐recollapse group were statistically significant (p < 0.050), and the risk of recollapse in the PKP group was lower compared to the PVP group (OR = 0.094). Conclusion Intervertebral cleft (IVC) and those with PVP intervention are at higher risk of recollapse. Patients with osteoporotic compression fractures with anterior vertebral height loss greater than 1/3, especially those with IVC, should be concerned and taken seriously, and PVP should be carefully selected to prevent their clinical course from worsening.

慢性肌肉骨骼疼痛是一种常见的慢性疼痛综合征,在老年人中患病率高,最常见的疼痛部位为腰背部和膝关节.详细的体格检查、心理评估以及准确的疼痛病因诊断有助于选择个体化治疗方法.疼痛受多种因素影响,而老年患者合并疾病较多,慢性肌肉骨骼疼痛的管理要采取多模式综合干预方法.在药物治疗方面,需要考虑药物的安全性、有效性以及费用.外用非甾体抗炎药因其不会引起严重的不良反应而作为治疗轻、中度老年慢性肌肉骨骼疼痛患者的首选药物,口服非甾体抗炎药要以最小的有效剂量和最短的疗程为原则.心理干预可减轻慢性疼痛并减少药物使用,微创介入和外科手术治疗也是重要的治疗手段,但需严格把握手术适应证.定期随访、动态评估要贯穿整个管理过程.本共识根据国内外最新指南、文献和专家经验撰写,旨在规范和推广国内慢性肌肉骨骼疼痛的诊疗工作,提高老年人的生活质量.

To compare high- versus low-viscosity bone cement on the clinical outcomes and complications in patients with Osteoporotic vertebral compression fractures (OVCFs) who underwent percutaneous vertebroplasty (PVP) or percutaneous kyphoplasty (PKP). PubMed, Embase, and the Cochrane Library were searched for papers published from inception up to February 2021 for potentially eligible studies comparing high- versus low-viscosity cement for PVP/PKP. The outcomes were the leakage rate, visual analog scale (VAS), and Oswestry Disability Index (ODI). Eight studies (558 patients; 279 in each group) were included. The meta-analysis showed that the leakage rate was lower with high-viscosity cement than with low-viscosity cement (OR = 0.23, 95%CI 0.14–0.39, P < 0.001; I2 = 43.5%, Pheterogeneity = 0.088); similar results were observed specifically for the disk space, paravertebral space, and peripheral vein, but there were no differences regarding the epidural space and intraspinal space. The VAS was decreased more significantly with high-viscosity cement than with low-viscosity cement (WMD = − 0.21, 95%CI − 0.38, − 0.04, P = 0.015; I2 = 0.0%, Pheterogeneity = 0.565). Regarding the ODI, there was no difference between high- and low-viscosity cement (WMD = − 0.88, 95%CI − 3.06, 1.29, P = 0.426; I2 = 78.3%, Pheterogeneity < 0.001). There were lower cement leakage rates in PVP/PKP with high-viscosity bone cement than low-viscosity bone cement. The two groups have similar results in ODI, but the VAS scores favor high-viscosity bone cement. Therefore, the administration of high-viscosity bone cement in PVP/ PKP could be a potential option for improving the complications of leakage in OVCFs, while the clinical efficacy of relieving pain is not certain.

目的:探讨围手术期口服阿司匹林对早期髓内钉固定治疗老年转子间骨折的影响.方法:回顾性分析2013年1月至2019年11月因转子间骨折行闭合复位股骨近端髓内钉固定的入院前口服阿司匹林抗血小板治疗的84例患者的病例资料.患者年龄70～87岁,平均(76.6±4.2)岁.38例患者(持续组)骨折后继续口服阿司匹林并加用低分子肝素;另外46例患者(暂停组)骨折后停用阿司匹林,使用低分子肝素抗凝.比较两组患者的手术时间、失血量、输血量、心脑血管意外事件、消化道溃疡出血、住院时间.结果:持续组患者的心脑血管意外发生率显著低于暂停组(P=0.030),两组患者在手术时间、失血量、输血量、消化道溃疡出血、住院时间方面的差异无统计学意义(P>0.05).结论:心脑血管意外高风险的老年转子间骨折患者围手术期不停用口服阿司匹林不增加手术的出血量和消化道溃疡出血发生率,不影响早期髓内钉固定手术,且心脑血管意外发生率较低,建议心脑血管意外事件风险高的老年髋部骨折患者围手术期继续口服阿司匹林进行抗血小板治疗.

Objective:To evaluate the effects of percutaneous kyphoplasty(PKP)and percutaneous vertebroplasty(PVP)operation in elderly patients with osteoporotic vertebral compression fracture(OVCF).Methods:From June 2019 to June 2020, a total of 58 patients with OVCF aged over 60 and under 80 years who had a loss of more than one-third of the anterior margin height of vertebral and agreed to participate in the study were randomly divided into PKP group and PVP group.The visual analogue pain scale(VAS)score, SF-36 quality of life score, anterior height of fractured vertebral body, leakage of bone cement, refracture and cost of high-value consumables were observed at the time point before operation, 1 day, 1 month, 3 month, 6 month, 12 month after operation.Results:VAS scores in PKP and PVP groups were decreased after operation as compared with preoperation( F=115.380, 175.010, both P<0.001). VAS score was lower in the PKP group than in the PVP group at 6 months after operation with statistically significant difference( t=2.219, P=0.031), and no statistically significant difference at other time points between the two groups(all P>0.05). In the PKP and PVP groups, the height of the anterior edge of the vertebral body recovered significantly on the first day after operation, and there was a significant difference in the height compared with that before operation( F=43.020, 51.010, both P<0.001). The SF-36 scores at the latter time point in PKP and PVP groups were increased as compared with the previous time point.The increment of the SF-36 scores was statistically significant at 1 month after operation than pre-operation, and also at 3 months after operation than at 1 month after operation.The leakage rate of bone cement was 37.0%(10/27)in PKP group and 25.0%(7/28)in PVP group, with no significant difference between the two groups( χ2=0.930, P=0.391). The refracture rate was 3.7%(1/27)in PKP group and 7.1%(2/28)in PVP group, with no significant difference between the two groups( χ2=0.000, P=1.000). The cost of high-value consumables for single segment fracture was 46 490 yuan in PKP group, and 36 700 yuan in PVP group.The cost of PKP group was higher than that of PVP group. Conclusions:PKP and PVP operation in the treatment of osteoporotic vertebral compression fractures have good effects in aspect of analgesia, restoring vertebral height and improving patients' quality of life.The analgesic effect is slightly better in PKP group than in PVP group.PVP group has more advantages in health economics.

Objective:To analyze the risk factor of postoperative delirium in the elderly hip fracture patients.Methods:A total of 1051 patients with hip fracture aged 60 years and over, admitted to Beijing Hospital from January 2010 to December 2017 were retrospectively analyzed.They were divided into a postoperative delirium group(n=156)with 56 males and 100 females, 81 femoral neck fractures and 75 intertrochanteric fractures, and the control group(n=895)with no delirium, receiving the corresponding treatment in the same period.The complications, laboratory tests, fracture types, operation methods, the time from fracture to operation, operation time, intraoperative blood loss, intraoperative blood transfusion were compared between the two groups.Risk factors of postoperative delirium in the elderly hip fracture patients were screened using the binary multi-factor logistic regression analysis.Results:Of the 1 051 patients, 156 cases(14.8%)delirium occurred.There was no significant difference in fracture type and operation methods( P>0.05)between the 2 groups.The age was significantly older in the observation group(82.9±6.6)years than in the control group(79.9±7.2)years.The serum albumin before operation(37.1±2.9)g/L, creatinine clearance rate(52.4±22.2)ml·min -1·(1.73 m 2) -1in the observation group were significantly lower than in the control group[(37.8±3.8)g/L, (59.0±30.0)ml·min -1·(1.73 m 2) -1]( P<0.05). The past dementia rate was higher in delirium group[19.8%(31 cases)]than in control group[2.2%(20 cases)], with statistically significant difference( χ2=89.503, P<0.01). The proportion of patients with more than two medical diseases was higher in delirium group[51.9%(81 cases)]than in control group[40.3%(361)]( χ2=7.320, P<0.01). There were no significant differences(all P>0.05)between.the two groups in hemoglobin, white blood cell, serum K and Na, American Society of Anesthesiologists(ASA)grade, and the incidences of Parkinson's disease, pulmonary diseases and cardiovascular diseases(all P>0.05). The binary multi-factor Logistic regression analysis showed that the age, past dementia and kidney dysfunction were the risk factors for the postoperative delirium in the elderly hip fracture patients(all P>0.05). Conclusions:The incidence of postoperative delirium in the elderly hip fractures patients is high.Age, past dementia and kidney dysfunction are the risk factors for postoperative delirium in the elderly hip fracture patients, which should be prevented and improved preoperatively.

BackgroundPatellar fracture is a common phenomenon observed in orthopedic clinics. Many methods have been shown to be effective in the fixation of patellar fracture. However, there are few studies on the antirotation effect of these methods. The purpose of this study is to present a new strategy of K-wire tension band therapy for patellar fracture and explore the antirotation effect of the modified tension band method on patellar fracture.MethodsA retrospective clinical observation study was conducted on 75 patients with patellar fracture. Totally, 46 patients were enrolled to the traditional group, who received the traditional K-wire tension band therapy. The modified group included 29 patients on whom our new strategy was implemented. The operation time, intraoperative blood loss, and fracture healing time were collected to compare the two operations and the knee society score (KSS) scores after the operations, and complications were recorded and retrieved to indicate the effectiveness of the two treatments.ResultsThe preoperative baseline data (gender, age, fracture types) of the two groups showed no significant statistical difference. Similarly, there was no significant difference in the operation time, intraoperative blood loss, and fracture healing time between the two groups. The KSS clinical scores 1 year after operation was 90 (84, 95) for the traditional group as compared with 99 (97, 100) for the modified group (p < 0.05). The KSS functional scores 1 year after operation in the two groups were 90 (65, 90) and 100 (90, 100) (p < 0.05). The incidences of complications due to the rotation of K-wires in the traditional group and the modified group were 76.1% (35 of 46) and 6.9% (2 of 29) with a significant statistical difference (p < 0.05).ConclusionThis study shows that our modified tension band therapy is an effective strategy for antirotation in the treatment of patellar fracture and proves that it can achieve better clinical outcomes than the traditional K-wire tension band method. This new strategy may be a safe and effective clinical technique for the treatment of patellar fracture. However, more prospective randomized controlled trials with larger sample sizes are still needed to further prove its efficacy.

Objective:To analyze the epidemiological characteristics of geriatric hip fractures.Methods:This study retrospectively analyzed the clinical characteristics of 2 054 elderly patients with hip fracture aged 60 years and over who were admitted to Beijing Hospital from January 2011 to December 2020.The epidemiological characteristics of geriatric hip fractures were analyzed from the aspects of age, gender, fracture type, length of stay, surgical method and surgical complications.Results:The total number of hip fractures patients admitted from 2011 to 2020 showed a general upward trend in quantity.Among them, there were 1 177 femoral neck fractures(57.3%, 1 177/2 054), and 877 intertrochanteric femoral fractures(42.7%, 877/2 054)with statistical differences in the distribution of fracture types between patients at different ages( χ2=61.727, P<0.001). A total of 1 839 patients chose surgical treatment, accounting for 89.5% of the total number of patients.Artificial femoral head arthroplasty was the most common operation mode for patients with femoral neck fractures(783 cases, 75.4%).534 patients with intertrochanteric femoral fractures(66.8%)were treated with closed reduction and femoral intramedullary nailing.There was a statistically significant difference in operation modes among different fracture types( χ2=1 480.800, P<0.001). The length of hospital stay in patients with femoral neck fracture was(14.2±8.3)days, which was significantly longer than in patients with femoral neck fracture(13.2±10.9)days( t=2.417, P=0.016). There was no significant difference in the time from admission to operation between the two groups[(5.7±3.5)days vs.(5.4±3.3)days]( t=1.954, P=0.051). Among all the comorbidities of hip fracture patients, the top 5 diseases were cardiovascular system diseases(2 001 cases, 97.4%), nervous system diseases(1 105 cases, 53.8%), endocrine system diseases(814 cases, 39.6%), skeletal and muscular system diseases(623 cases, 30.3%), digestive system diseases(472 cases, 23.0%).1 485 patients(72.3%)had 3 or more comorbidities. Conclusions:Hip fractures in the elderly have some epidemiological distribution characteristics in terms of age, gender, length of hospitalization, injury mechanism and comorbidities, which is conducive to further improve the prevention and treatment strategies for hip fractures and promote the rational allocation of medical resources.

Objective:To explore the advantages and disadvantages of anterior versus posterior approach surgery in the treatment of cervical spinal cord injury without radiographic abnormality in elderly patients.Methods:Clinical data of 31 geriatric patients of spinal cord injuries without radiographic abnormality in our department from January 2014 to December 2018 were retrospectively analyzed for the cause of injury and the extent of injury.The patients were divided into two groups: anterior approach operation group and posterior approach operation group.The operation time, blood loss, volume of drainage, Japanese Orthopaedic Association(JOA)score before operation and 3 weeks, 3 months, 6 months, 12 months after operation, were recorded in the two groups.Results:Comparing the anterior versus posterior approach operation groups, the median operation time were 100.0(90.0, 110.0)min versus 132.5(123.7, 140.0)min, the median bleeding volume was 30.0(20.0, 35.0)ml versus 175.0(150.0, 202.5)ml, and the median postoperative drainage volume was 20.0(10.0, 20.0)ml versus 210.0(197.5, 237.5)ml, respectively, with statistically significantly differences between the two groups( U=18.00、0.00、0.00, all P<0.01). When comparing the anterior versus posterior approach operation groups, the median JOA scores at 5 time points were 4.0(3.0, 5.0), 6.0(5.5, 8.5), 9.0(8.5, 11.0), 11.0(10.0, 12.5), 12.0(11.0, 13.0)in the anterior operation group, and 4.0(3.0, 7.3), 6.5(5.7, 10.0), 10.5(8.7, 12.3), 12.5(11.0, 13.0), 13.0(11.0, 13.3)in the posterior operation group, with no significantly difference between the two groups( U=89.01, 90.03, 85.50, 74.02, 89.54, P=0.52, 0.55, 0.42, 0.20, 0.52), but there was significant difference in the median JOA scores at each of five different time points( χ2=82.46, 39.23, all P<0.01). Interestingly, the JOA score was higher at the latter time point than at the previous time point, with statistically significantly differences(all P<0.05). Conclusions:Both anterior and posterior approaches for decompression surgery have good effects on the recovery of spinal cord function in geriatric patients with cervical spinal cord injury without radiographic abnormality.Anterior approaches for decompression surgery are better than posterior approaches for the less operation time, less bleeding, less drainage and quickly recovery.

2021年国家统计局发布的第七次人口普查数据显示，截至2020年底我国60岁以上老年人口占比达18.7%,65岁及以上老年人口占比更是高达13.5%，已接近于深度老龄化社会 [1] 。随着人口老龄化的不断加深，老年骨质疏松症和骨质疏松性骨折的绝对数也逐年增高。国外文献报道，基于高危老年人口的增长，

Objective:To investigate the clinical effectiveness of vertebroplasty for osteoporotic vertebral compression fractures in the elderly aged 90 years and over.Methods:Clinical data of 64 elderly patients aged 90 years and over who had undergone percutaneous vertebroplasty for vertebral compression fractures between January 2015 and January 2021 were retrospectively analyzed.Changes in preoperative and postoperative pain, intraoperative bone cement leakage, postoperative pneumonia, bedsores, urinary tract infections, lower extremity venous thrombosis and changes in preoperative and postoperative physical mobility were evaluated.Pain scores, physical mobility scores, bone cement extravasation and complications such as re-fractures of the vertebral body, postoperative pneumonia, bedsores, urinary tract infections and thrombosis were recorded before surgery, 3 and 30 days after surgery.Results:The visual analogue scale(VAS)scores of 64 patients before surgery, 3 and 30 days after the procedure were 8.34±1.12, 2.17±1.45 and 1.83±1.15, retrospectively( F=540.876, P<0.01). The physical mobility scores before surgery, 3 and 30 days after the procedure were 2.83±0.94, 1.59±0.70 and 1.39±0.60, retrospectively( F=65.492, P<0.01). There were 18 cases(28.13%)of bone cement leakage during surgery, 4 cases(6.25%)of pneumonia within 30 days after surgery, 9 cases(14.06%)of urinary tract infections, 3 cases(4.69%)of lower extremity venous thrombosis, 1 case(1.56%)of bedsores, and 2 cases(3.13%)of vertebral re-fractures after surgery.No patient died during the 30-day follow-up. Conclusions:Percutaneous vertebroplasty can reduce pain and improve physical mobility and is an effective and safe minimally invasive treatment for elderly patients with spinal compression fractures aged 90 years and over.

Objective:To evaluate our self-designed stick supporting reposition which was used to treat irreducible intertrochanteric fractures.Methods:A retrospective study was conducted of the 138 patients with irreducible intertrochanteric fracture (an observational group) who had been treated by stick supporting reposition followed by intramedullary nailing at Department of Orthopaedics, Beijing Hospital between April 2015 and December 2019. They were 45 males and 93 females with an age of (79.9±8.2) years; by AO classification, there were 25 cases of type 31-A1, 98 cases of type 31-A2 and 15 cases of type 31-A3. The other 142 patients with irreducible intertrochanteric fracture were included as a control group who had been treated by open or limited open reduction and intramedullary nailing between January 2010 and March 2015. The 2 groups were compared in terms of reduction time, operation time, intraoperative blood loss, reduction quality, fracture union time and complications.Results:The 2 groups were comparable because there was no significant difference between them in preoperative general data or follow-up time ( P>0.05). The reduction time [(12.0±3.4) min], operation time [(64.1±6.5) min], and intraoperative blood loss [(228.0±40.0) mL] in the observational group were significantly less than those in the control group [(18.3±8.9) min, (72.3±11.2) min and (319.1±95.0) mL] ( P<0.05). The reduction quality in the observational group (82 excellent and 56 acceptable cases) was significantly better than that in the control group (63 excellent, 65 acceptable and 14 poor cases) ( P<0.05). The fracture union time for the observational group [(3.8±0.9) months] was significantly shorter than that for the control group [(4.0±0.9) months] ( P>0.05). There were 6 cases of internal fixation failure and 8 cases of hip varus deformity in the control group, but no such complications occurred in the observational group. Conclusion:In the treatment of irreducible intertrochanteric fractures, compared with open or limited open reduction, our stick supporting reposition may shorten operation time, reduce intraoperative blood loss and improve quality of fracture reduction.

老年患者慢性肌肉骨骼疼痛患病率高，最常见的疼痛部位是腰背部和膝关节。疼痛受多因素影响，老年患者合并疾病较多，慢性肌肉骨骼疼痛的管理要采取多模式综合干预方法。药物治疗要考虑安全、有效及费用，外用非甾体抗炎药可作为治疗轻、中度老年患者慢性肌肉骨骼疼痛的首选药物；口服非甾体抗炎药要用最低的有效剂量和最短的疗程。心理干预可减轻慢性疼痛并减少药物使用。定期随访动态评估要贯穿整个管理过程。

Objective To investigate the risk factors for postoperative cardiorespiratory complications within one month after operative treatment of hip fracture in the elderly. Methods Data of clinical examination ,samples test ,CT or MRI images were collected in 665 hip fracture patients aged 60 years and over who were admitted to our hospital from January 2010 to December 2014. Risk factors for postoperative cardiorespiratory complications within one month after operation were analyzed by correlation analysis and multiple regression analysis. Results The incidence of postoperative complications in cardiovascular system was 4.5% (30/665)in all patients.The risk factors for postoperative circulatory complications included gender ,high white blood cell(WBC)counts before operation ,hypoalbuminemia ,a low hemoglobin level (＜ 35 g/L ) ,renal insufficiency , hyponatremia ,pulmonary arterial hypertension ,segmental ventricular wall abnormal motion ,abnormal ST segment changes. The incidence of postoperative complications in respiratory system was 6.9% (46/665)in all patients. The risk factors for postoperative respiratory complications included high WBC counts before operation ,hypoalbuminemia ,chronic obstructive pulmonary disease (COPD ) , bronchiectasis and emphysema ,history of respiratory failure and abnormal lung markings (P＜0.05 or P＜ 0.01 ). Conclusions The elderly hip fracture patients have high incidence of postoperative respiratory and circulatory complications , and risk factors for these complications include accompanying diseases ,hypoalbuminemia ,abnormal echocardiography and electrocardiogram and hyponatremia.

Objective To observe the efficacy of long-term treatment with Teriparatide on osteoporotic intertrochanteric fracture in the elderly.Methods T he elderly patients w ith osteoporotic intertrochanteric fracture meeting inclusion and exclusion criteria were recruited. They received proximal femoral nail anti-rotation(PFNA)surgery with the combined intakes of calcium of 600 mg/day and 1-alpha ,25-(OH)2-vitamin D3 analogs of 0.5 μg/day as a basic standard treatment protocol(BSTP).The study subjects included control group(n= 10)who underwent PFNA surgery plus oral calcium and vitamin D supplements without teriparatide (20 μg/d) ,and the observation group who received PFNA surgery plus oral calcium and vitamin D supplements with teriparatide (20 μg/d) , for more than twelve months or over at our department from October 2012 to February 2016. Gender ,age ,socio-demographics and clinical values of the American Society of Anesthesiologists (ASA )score ,fracture types ,preoperative serum albumin level ,preoperative BM I ,bone mineral density 1 week postoperatively ,serum N-terminal propeptide of type I collagen (PINP) and C-terminal telopeptides of type 1 collagen(β-CTX)1 week postoperatively were matched between the two groups , no statistically significant difference was found(all P＞0.05).Levels of PINP and β-CTX 3 ,6 and 12 months postoperatively ,BMD 1 year postoperatively ,fracture healing time and complications were compared between the two groups. The prognosis of 1 case of patient undergoing conservative treatment was observed. Results There was no significant difference between the two groups in serum levels of PINP and β-CTX 1 week postoperatively(P=0.362 and 0.517 ,respectively).Serum level of PINP was significantly increased in observation group at 3 ,6 and 12 months postoperatively versus at 1 week postoperatively(P= 0.008 ,0.001 and 0.004 ,respectively) ,while serum level of PINP had no significant difference in control group at 3 ,6 and 12 months postoperatively versus at 1week postoperatively(P＞ 0.05).Serum levels of PINP 3 ,6 and 12 months postoperatively were higher in the observation group than in control ( P= 0. 002 ,0. 002 and 0. 000 ,respectively ). In the observation group ,serum β-CTX level reached the peak at 6 months after surgery ,which was higher than that at 1 week after surgery(P=0.041) ,and slowly decreased at 12 months after surgery.In the control group ,β-CTX slowly increased at 3 ,6 and 12 months postoperatively versus at 1 week postoperatively ( P ＞ 0.05 ). There was no significant difference in BMD of lumbar spine and contralateralhipbetweenthetwogroupsat1weekpostoperatively(P=0.440and0.325).At1year postoperatively versus at 1 week postoperatively ,the BMD of lumbar spine and contralateral hip was increased(P=0.039 and 0.009)in the observation group ,while was decreased(P＞ 0.05)in control group. The fracture healing time was shorter in observation group than in control group (13.6 ± 2.2 weeks vs.17.6 ± 3.4 weeks ,P=0.033).No one had a delayed fracture healing in observation group and 1 patient showed a delayed fracture healing in the control group. There were no complications such as lag screw sliding ,refracture ,pressure ulcer and deep vein thrombosis in both groups. The fracture nonunion was found in the patient undergoing conservative treatment after 20 months of teriparatide treatment. Conclusions The medium-and long-term of teriparatide treatment can significantly promote bone formation ,improve BMD of the lumbar spine and hip ,and shorten fracture healing time in patients with osteoporotic intertrochanteric fracture ,but it is not a substitute for surgical treatment.

Objective To investigate the causes and prognosis of conservative treatment for hip fracture in the elderly. Methods The 47 elderly patients undergoing conservative treatment for hip fracture were recruited and retrospectively analyzed in our hospital from July 2014 to June 2017. The causes of conservative treatment and corresponding therapeutic methods were analyzed ,and hip joint function ,complications ,survival situation at 12-36 months after fracture were followed up. Results A total of 47 hip fracture patients aged(80.0 ± 7.2)years(range ,63-92 years)with 25 females and 22 males included 30 cases with femoral neck fractures and 17 cases with intertrochanteric fractures.Details of prognosis of treatments in all (100% )patients followed for 12-36 months after fracture were as follows :(1 ) In treatment methods ,43 patients were treated with bed-rest immobilization after discharge from hospital and 4 patients were rehospitalized for surgery due to pain and intolerance of long-term bedridden. (2)There were 40 patients with three comorbidities or more , accounting for 85.1% of the total.11 cases had surgical contraindications.27 cases choose conservative treatment due to the high risk of surgery.9 cases gave up surgery due to psychological or economic reasons. (3)In complications and death ,complications were found in 43(91.5% ,43/47)patients with conservative treatment ,including pneumonia(37.2% ,16/43 cases ,)and bedsore(51.2% ,22/43 cases). (4)In fracture healing and hip joint function ,among the 43 patients receiving conservative treatment , hip fractures were not healed in 31 patients ,and fractures were malunited in 12 patients. Hip Harris score was poor in 31 cases and fair in 12 cases. The mortality rate within 1 year after fracture is high in the elderly hip fracture patients with conservative treatment and complication incidence rates are also high.Most of them have poor function recovery of hip joint ,and clinical results are not good. Conclusions The elderly hip fracture patients with conservative treatment have a high rate of complications and mortality within 1 year after fracture.Most of them have poor hip joint function recovery.

Objective To clarify the characteristics of bone metabolism in elderly patients with osteoporotic hip fracture, and to analyze the fluctuant features of bone metabolism biochemical markers in the early stage to guide the early anti-osteoporosis treatment. Methods A total of 180 cases were enrolled in this study. The patients were divided into the elderly hip fracture group ( 60 cases of femoral neck fractures and 60 cases of femoral intertrochanteric fractures ) and non-fracture group ( 60 cases ). The average age of the hip fracture group was ( 80.1 ± 7.1 ) years, including 34 males and 86 females. The average age of the non-fracture group was ( 78.5 ± 4.6 ) years, including 25 males and 35 females. For the elderly hip fracture group, bone metabolism biochemical markers ( P1NP, β-CTX, OC, 25 ( OH ) D, ALP, calcium, phosphorus ) were measured respectively on the day after the admission and the day after the operation. Bone mineral density was measured after the operation. For the non-fracture group, bone metabolism biochemical markers ( P1NP, β-CTX, OC, 25 ( OH ) D, ALP, calcium, phosphorus ) and bone mineral density were measured on the day after the admission. T test and chi-square test were used to compare the differences of bone metabolism biochemical markers between groups ( the elderly hip fracture group versus non-fracture group, femoral neck fractures versus intertrochanteric fractures, woman versus man ). Matched t-test was used to analyze the fluctuant features of bone metabolism biochemical markers in the early stage of the fracture. Results The elderly hip fracture group ( compared with the non-fractured group ): the hip bone mineral density was lower with statistically significant differences ( P < 0.01 ); 25 ( OH ) D level was lower with statistically significant differences ( P < 0.05 ); calcium and phosphorus levels were lower with statistically significant differences ( P < 0.01, P < 0.05 ); no significant differences in P1NP, β-CTX, OC and ALP, ( P > 0.05 ). Femoral intertrochanteric fracture ( Compared with femoral neck fractures ):lower level of serum calcium with statistically significant differences ( P < 0.05 ); no significant differences in P1NP, β-CTX, OC, 25 ( OH ) D, ALP and phosphorus between the two groups ( P > 0.05 ). The elderly female patients with hip fracture had higher level of serum OC, ALP and phosphorus when compared with the elderly male patients, with statistically significant differences ( P < 0.01, P < 0.01, P < 0.05 ); no significant differences in serum levels of P1NP, β-CTX, 25 ( OH ) D and calcium ( P > 0.05 ). The level of P1NP, OC, 25 ( OH ) D and calcium decreased with statistically significant differences ( P < 0.05, P < 0.01, P < 0.01, P < 0.01, P < 0.05 ), while the level of β-CTX and phosphorus increased in the early stage of the fracture with statistically significant differences ( P < 0.01, P < 0.01 ). Conclusions 25 ( OH ) D, calcium and phosphorus levels are significantly lower in the elderly hip fracture group so that 25 ( OH ) D and calcium supplementation should be paid more attention in the treatment of the hip fracture. The level of bone metabolism biochemical markers changes significantly on the early stage of the fracture. Bone formation markers decease and bone resorption markers increase, so that anti-osteoporosis treatment should be taken immediately.

目的 观察在关节镜辅助下对胫骨平台骨折行微创复位和内固定的治疗效果.方法 2008-2012年北京医院(北京大学第五临床医学院)使用关节镜辅助微创治疗SchatzkerⅡ～Ⅵ型胫骨平台骨折15例,17个平台,其中男性10例12个平台,女性5例5个平台.年龄22～85(45.00±5.23)岁.致伤原因包括车祸、砸伤、滑雪扭伤及普通摔伤.骨折类型按Schatzker分型,Ⅱ型3例、Ⅲ型5例、Ⅳ型4例、Ⅴ型3例及Ⅵ型2例.手术时先镜下观察骨折复位情况,克氏针临时固定并复位其他骨折块,于平台外侧或内侧小切口置入解剖钢板并固定.术后早期康复锻炼,定期随访其功能和骨折愈合情况.结果 17个平台骨折手术均顺利完成,手术时间为60～ 90 min,其中关节镜检查时间10 ～ 15 min.骨折愈合时间为3～5个月,术后平均随访(26.8±4.1)个月,无下肢血栓、组织感染、骨筋膜室综合征等并发症.按照Lysholm膝关节评分标准,优1 3膝(76.5％),良3膝(17.6％),可1膝(5.9％),优良率达94.1％.结论 关节镜辅助下微创治疗胫骨平台骨折创伤小、并发症少、疗效肯定,具有很好的临床应用价值,适用于SchatzkerⅡ～Ⅵ型胫骨平台骨折,但对手术技术要求较高.

Objective: To investigate the clinical characteristics and to analyze the clinical risk factors of lower extremity deep vein thrombosis (DVT) after hip fracture among elderly patients. Methods: From October 2000 to April 2010, 95 patients who suffered from hip fracture were recruited, including 30 males (mean age 75.3 +/- 12.47 years, range 60-90 years) and 65 females (mean age 77.9 +/- 11.45 years, range 61-96 years). There were 55 cases with femoral neck fracture and 40 cases with intertrochanteric fracture. Color Doppler flow imaging (CDFI) was used to screen DVT of bilateral lower extremities in all patients before orthopedic surgery and within 14 days postoperatively. All patients were treated with operation and given low-molecular-weight heparin (LMWH) for 10-14 days postoperatively to prevent DVT. Results: There were 16 patients who developed DVT preoperatively and 20 patients postoperatively. The perioperative and postoperative incidences were 16.8% (16/95) and 21.1% (20/95) respectively. 87.2% DVT were found in fractured extremities. Logistic regression analysis demonstrated a definite association of intertrochanteric fracture with postoperative DVT with odds ratio of 5.977 (P<0.05). Conclusions: There was higher perioperative DVT incidence in fractured extremities than that in the uninjured side. Intertrochanteric fracture was a risk factor for postoperative DVT. Patients with hip fracture are at a high risk of lower extremity DVT and should be screened using color Doppler ultrasound blood flow imaging (CDFI) before orthopedics surgery. Routine usage of LMWH is an effective way to prevent DVT during perioperative period. Anticoagulant and inferior vena cava filter had been proved to be effective to prevent perioperative DVT.