Objective:This research aims to evaluate the efficacy of multidisciplinary care model in the management of geriatric hip fractures before and after COVID-19 pandemic and explore the breakthrough of the clinical pathway optimization in the situation of routine epidemic prevention and control.Methods:The elderly patients with hip fracture treated with a multidisciplinary approach in the Department of Geriatric Orthopaedics and Traumatology of Beijing Jishuitan Hospital from January 2019 to December 2020 were included. The clinical data including age, gender, fracture type, ASA score, surgical treatment rate, time from injury to emergency, time from emergency to admission, time from admission to operation, operation rate within 48 hours of admission, length of stay, incidence of perioperative complications and in-hospital mortality were collected retrospectively and analyzed.Results:A total of 2275 elderly patients with hip fracture were enrolled, in which 663 males (29.1%) and 1612 females (70.9%). The average age was 79.7 y (65-105 y). There were 1219 cases of femoral neck fracture (53.6%), 1016 cases of trochanteric fracture (44.7%), and 40 cases of subtrochanteric fracture (1.8%). High ASA score accounted for 49.6%. The surgical treatment rate was 97.7%. The in-hospital mortality rate was 0.2% (4 cases). Compared with 2019, in 2020, the average time from injury to emergency was significantly longer (1.7 d VS. 3.4 d, P=0.000); the average time from emergency to admission was unchanged (23.4 h VS. 24.0 h, P=0.109); the average time from admission to operation increased slightly (30.7 h VS. 38.3 h, P=0.000); the operation rate within 48 hours of admission decreased (82.1% VS. 72.4%, P=0.000); the average length of stay was slightly longer (4.1 d VS. 4.3 d, P=0.005); the incidence of perioperative complications increased significantly (16.9% VS. 22.5%, P=0.001), mainly reflected in the increased incidence of bedsore, pneumonia and urinary tract infection.Conclusions:"Green Pathway" with a multidisciplinary approach is efficient in the management of geriatric hip fractures with an extremely low in-hospital mortality. Effective shortening the waiting time before operation might reduce the incidence of perioperative complications.

目的 旨在比较肌肉密度(肌肉质量)和肌肉大小(肌量)与起立-行走测试及握力的相关性.方法 招募北京积水潭医院附近新街口社区的301名老年志愿者.所有研究对象均行髋部CT检查及大腿中段1 cm层厚的CT扫描.用Osirix软件体质分析模块分别测量髋部臀大肌和大腿中段的肌肉面积和密度.完成握力和起立-行走测试(TUG).运用Logistic回归分析比较肌肉密度和大小与TUG和握力的相关性.结果 校正年龄和BMI后,女性臀大肌密度与TUG呈负相关(Ptrend=0.0366),而女性臀大肌大小及大腿中段肌肉大小均与TUG无关;对于男性,各个肌肉密度和大小均与TUG无关.校正年龄和BMI后,男性臀大肌密度与握力呈正相关(Ptrend=0.0334),而大腿中段肌肉大小与握力也呈正相关(Ptrend=0.0155);对于女性,各个肌肉密度和大小均与握力无关.结论 肌肉大小和密度与握力及起立行走测试的关系存在性别差异,臀大肌的肌肉密度与肌力和躯体功能相关,而大腿中段肌肉大小与肌力相关.

目的 探讨老年原发性骨质疏松症患者衰弱状态与再入院、死亡的关系.方法 采取前瞻性队列研究,纳入2017年1月至2019年12月首都医科大学附属复兴医院综合科住院的骨质疏松症患者227例(≥65岁).入院后根据临床衰弱量表(CFS-09)确定是否衰弱,将老年性骨质疏松症患者分为2组:衰弱组121例(CFS≥5)和非衰弱组106例(CFS<5).收集患者性别、年龄、病史及口服药种类等一般资料,进行认知功能、营养风险等老年综合评估.出院后随访1～3(1.8±0.7)年,记录患者再入院及死亡信息.采用SPSS 23.0软件进行数据分析.根据数据类型,组间比较分别采用t检验、Wilcoxon检验及χ2检验.采用Cox回归分析衰弱状态与再入院、死亡的关系.结果 患者年龄为67～100(85.1±5.0)岁,衰弱患者121例(53.3％).衰弱组中年龄(P<0.001)、查尔森共病指数(P<0.001)、口服药种类(P=0.004)、服用潜在不适当用药(PIM)的人数(P=0.004)和种类(P=0.001)、存在营养风险人数(P<0.001)、认知功能障碍(P<0.001)、日常生活能力受损(P<0.001)均高于非衰弱组.Cox回归分析结果显示,在校正年龄、共病及潜在不适当用药(PIM)因素后,衰弱状态(CFS≥5)对死亡、再入院无明显影响.将衰弱分组进一步限制为中度以上,其中衰弱组64例(CFS≥6)和轻度衰弱及非衰弱组163例(CFS<6),校正年龄、共病及PIM因素后,中度以上衰弱(CFS≥6)明显增加全因死亡(HR=3.260,95％CI 1.626～6.538,P=0.001)和再入院(HR=1.727,95％CI 1.213～2.458,P=0.002)的风险.结论 以CFS-09确定的中度以上衰弱(CFS≥6)增加老年原发性骨质疏松患者死亡、再入院风险.临床医师应重视骨质疏松患者衰弱评估,尽早采取干预措施,减少患者死亡和再入院的风险.

Objectives Although geriatric hip fracture is a serious public health problem in China, the result of orthogeriatric co‐management (OGC) is rarely reported. This study aimed to evaluate the effect of OGC in Chinese patients aged ≥65 years. Methods In this single‐centre, pre‐post intervention, retrospective study, traditional orthopaedic care (TOC) was used until OGC was implemented in May 2015, a multidisciplinary team was organized, and clinical protocol was designed. Consecutive hip fracture patients who were ≥65 years and injured within 3 weeks were included in this study. Demographic characteristics, comorbidities, fracture patterns, surgical procedure, time to surgery, length of hospital stay, inpatient complications, and in‐hospital mortality were extracted and examined. At 1‐year after surgery, data on patients' mobility and mortality were collected. The time to surgery, incidence of inpatient complications, mortality and functional outcomes were compared between the groups. Results There were no significant differences in sex, fracture type, and surgical pattern between OGC (n = 434) and TOC (n = 452) groups. Patients in OGC group were significantly older (P < 0.001) and had a higher age‐adjusted Charlson comorbidity index (P < 0.001). However, waiting time between admission and operation was significantly lower in OGC group (P < 0.001). There was no significant difference in the mortality rate at the time of the patient being in‐hospital and at 1, 3, and 6 months after surgery. Although 1‐year mortality was higher in OGC group (P = 0.036), Cox regression analysis showed no significant correlation of OGC with 1‐year mortality. There was no significant difference in pre‐injury mobility and 1‐year follow‐up mobility assessed by Parker score. Only approximately half of the patients in both groups completely returned to their pre‐injury mobility level. Conclusion OGC significantly shortens time to surgery for geriatric hip fractures compared with TOC. However, there is no significant effect on mortality rate within 1 year and functional status at 1 year of follow‐up.

目的 探讨老年男性人群血浆同型半胱氨酸(Hcy)水平与髋关节骨密度(BMD)的关系.方法 选取2015年1月—2017年12月于北京积水潭医院老年科住院男性患者共246例,按血清同型半胱氨酸水平分为高(H)Hcy组86例(≥15μmol/L),正常组160例(<15μmol/L),研究两组患者髋关节骨密度与Hcy水平的相关性.结果 HHcy组甲状旁腺激素(PTH)水平高于正常组,差异有统计学意义(P<0.05).HHcy组股骨颈、股骨大粗隆及股骨全部的骨密度低于正常组,差异有统计学意义(P<0.05).Hcy水平与股骨颈、股骨大粗隆及股骨全部骨密度呈负相关(r=-0.267、-0.165、-0.209,P<0.05).PTH水平与股骨颈、股骨大粗隆及股骨全部骨密度呈负相关(r=-0.160、-0.123、-0.133,P<0.05).结论 老年男性患者髋关节骨密度与Hcy水平呈负相关,应重视高Hcy导致的骨密度减低,积极治疗高同型半胱氨酸血症对于延缓髋关节骨密度减低具有重要意义.

目的 探讨阿仑膦酸钠和唑来膦酸治疗原发性骨质疏松症的疗效,以及骨转换标志物(BTMs)作为骨质疏松症药物疗效观察指标的优势.方法 收集2017年1月至2019年3月在北京积水潭医院骨质疏松症门诊就诊的原发性骨质疏松患者,64例患者纳入本研究,并按照随机数字表法分为阿仑膦酸盐组(ALN组,34例)和唑来膦酸盐组(ZOL组,30例)接受治疗.所有患者在就诊期间都完成了数据采集,包括一般临床情况、BTMs和骨密度(BMD)水平等.在使用抗骨质疏松药物3～6个月时,均重新检查BTMs,1年时检查BTMs和BMD水平.结果 ALN组和ZOL组的组间年龄和性别与治疗前肝肾功能、BTMs、BMD比较,均差异无统计学意义;治疗3～6个月,两组BTMs均下降,ALN组BTMs治疗有效率高于ZOL组[Ⅰ型胶原交联C-末端肽(CTX):(0.18±0.13)μg/L比(0.20±0.16)μg/L,P=0.56;Ⅰ型原胶原N-端前肽(P1NP):(23.46±11.33)μg/L比(22.98±10.10)μg/L,P=0.86;骨钙素(OC):(12.82±4.20)μg/L比(12.65±4.90)μg/L,P=0.88].治疗1年,ALN组BTMs治疗有效率继续升高,ZOL组则下降[CTX:(0.15±0.08)μg/L比(0.21±0.17)μg/L,P=0.04;P1NP:(20.05±10.26)μg/L比(26.14±11.61)μg/L,P=0.03;OC:(10.53±3.06)μg/L比(12.62±5.40)μg/L,P=0.07].两组BMD较原始值均增加(P≤0.05),BMD治疗有效率ALD组低于ZOL组.结论 ZOL对骨密度的改善作用优于ALN.BTMs水平显示,ZOL的作用相对更快,而ALN的作用更平缓、持续时间更长.对于接受唑来膦酸治疗的患者,建议下次治疗前应及时复查BTMs,必要时适当缩短治疗间隔.

Objective:To investigate the safety of early hip fracture surgery for elderly patients on clopidogrel.Methods:This retrospective study included 242 consecutive elderly patients (≥65 years) with acute hip fracture who had undergone surgery at Department of Orthopaedic Trauma, Beijing Jishuitan Hospital between November 2016 and April 2017. Of them, 20 were assigned into the study group who had taken clopidogrel before injury but discontinued its use within 4 days before surgery. They were 6 males and 14 females, with a median age of 80 years (77, 81). Their operation procedures for hip fracture included internal fixation with cannulated screws for femoral neck fracture in 2 cases, hemiarthroplasty for displaced femoral neck fracture in 11 cases, and internal fixation for intertrochanteric fracture in 7 cases. The control group included 222 patients who had undergone the same operative procedures but not taken any antiplatelet or anticoagulant drugs. The 2 groups were compared in terms of time between admission and operation, operation duration, intraoperative blood loss, perioperative transfusion and complications related to bleeding to analyze the safety of early surgery.Results:There was no significant difference in the preoperative general data between the 2 groups, showing comparability ( P>0.05). There was no significant difference between the 2 groups in the time between admission and operation [42.5 (36.3, 48.0) h for the study group versus 43.0 (28.0, 61.0) h for the control group] ( P=0.870). The median time between the last use of clopidogrel and operation was 55.0 (30.5, 71.0) h. There were no significant differences between the 2 groups in preoperative hemoglobin, operation duration, intraoperative blood loss, rate or amount of perioperative blood transfusion, or rate or amount of wound drainage ( P>0.05). The rate of general anesthesia was significantly higher for the study group (45.0%, 9/20) than for the control group (18.5%,41/222) ( P=0.012). No complications related to spinal hematoma occurred in the patients receiving spinal anesthesia from the study group. Wound hematoma and subsequent infection occurred in 2 patients from the control group. Conclusion:Early hip fracture surgery is safe for elderly patients on clopidogrel.

目的 分析2型糖尿病患者血清尿酸水平,并探讨血清尿酸水平与代谢综合征和慢性肾病的相关性.方法 选取2019年10月至2020年10月北京积水潭医院收治的120例2型糖尿病患者,根据血清尿酸水平将患者分为高尿酸组与正常尿酸组,检测两组代谢综合征和慢性肾病相关指标,血清尿酸水平与代谢综合征和慢性肾病的相关性采用logistic回归分析.结果 120例患者的血清尿酸检测值为(363.79±88.13)μmol/L,其中高尿酸组44例(36.7％),正常尿酸组76例(63.3％);两组TG[(2.73±0.23) mmol/L比(2.05±0.17) mmol/L]、HDL-C [(1.17±0.12)mmol/L比(1.04±0.09) mmol/L]、SCr[(79.27±12.79) μmol/L比(63.06±10.15) μmol/L]、肾小球滤过率[(63.34±15.82)ml/(min· 1.73 m2)比(74.10±18.34)ml/(min· 1.73 m2)]和蛋白尿发生率(20.5％比7.9％)比较,差异均有统计学意义(P＜0.05).Logistic回归分析显示,血清尿酸水平与TG、HDL-C、SCr和蛋白尿发生率均呈正相关性,与肾小球滤过率呈负相关性.结论 2型糖尿病患者血清尿酸水平呈高表达状态,且其水平与代谢综合征和慢性肾病存在一定相关性.

Abstract Background: Geriatric hip fracture patients receiving clopidogrel are a surgical challenge. In China, most of these patients undergo delayed surgical treatment after clopidogrel withdrawal for at least 5 to 7 days. However, delayed surgery is associated with increased complications and mortality in the older adults. This retrospective paralleled comparison study investigated the safety of early surgery for geriatric hip fracture patients within 5 days of clopidogrel withdrawal. Methods: Acute hip fracture patients (≥65 years) who were hospitalized in the orthogeriatric co-management ward of Beijing Jishuitan Hospital between November 2016 and April 2018 were retrospectively reviewed. Sixty patients taking clopidogrel before injury and discontinued <5 days before surgery constituted the clopidogrel group. The control group constituted 60 patients not taking antiplatelet or anticoagulant drugs and matched 1:1 with the clopidogrel group for sex, fracture type, operative procedure, and time from injury to operation (±10 h). The primary outcome was perioperative blood loss and the secondary outcomes were transfusion requirement, complications, and mortality. The Student's t test or Wilcoxon signed rank sum test was used for continuous variables and the Chi-square test was used for categorical variables. Results: Age, body mass index, American Society of Anesthesiologists score, and percentage undergoing general anesthesia were comparable between the groups (P > 0.050). The percentages of patients with coronary heart disease (61.7% vs. 18.3%; P < 0.001) and cerebrovascular disease (45.0% vs. 15.0%; P < 0.010) were significantly higher in the clopidogrel vs. control groups, respectively. The median clopidogrel discontinuation time before operation was 73.0 (range: 3.0–120.0) h. There was no significant difference in the estimated perioperative blood loss between the clopidogrel group (median: 745 mL) and control group (median: 772 mL) (P = 0.866). The intra-operative transfusion rate was higher in the clopidogrel group (22/60, 36.7%) than that in the control group (12/60, 20.0%) (P < 0.050). However, there was no significant difference in the blood transfusion rate during the entire perioperative period (26/60, 43.3% vs. 20/60, 33.3%; clopidogrel group vs. control group, respectively; P > 0.050). There was no significant difference in perioperative complications, and 30-day and 1-year mortality rates between the groups. Conclusions: Early hip fracture surgery is safe for elderly patients within 5 days of clopidogrel withdrawal, without increased perioperative blood loss, transfusion requirement, complications, and mortality compared with patients not taking antiplatelet drugs.

目的 评估老年髋部骨折患者围手术期异体红细胞输血(allogeneic red blood cell transfusions,ABT)的需求及不同因素对ABT的影响.方法 对2019年1月至2019年12月期间因髋部骨折入住北京积水潭医院老年创伤骨科病房行手术治疗的1112例老年(≥65岁)患者进行了研究.收集患者围手术期的资料,用单因素和多因素逐步Logistic回归分析,确定老年髋部骨折患者围手术期ABT的危险因素.结果 1112例患者中50.6％(563例)的患者围手术期有ABT记录.单因素分析显示:老年髋部骨折患者围手术期ABT组的患者年龄更大、术中出血量(intraoperative blood loss,IBL)更多,体质量指数(body mass index,BMI)、入院血红蛋白(hemoglobin,Hb)及血清白蛋白(albumin,ALB)更低,凝血酶原时间(prothrombin time,PT)、活化部分凝血活酶时间(activated partial thromboplastin time,APTT)更长,手术持续时间更短,女性、股骨粗隆间骨折、美国麻醉医师协会(American Association of Anesthesiologists,ASA)分级≥Ⅲ级、全身麻醉和不合并糖尿病的患者所占比例更高.多因素逐步Logistic回归分析提示:入院Hb低、股骨粗隆间骨折、IBL多、高龄、BMI低、ASA分级≥Ⅲ级和全身麻醉是老年髋部骨折患者围手术期ABT的独立危险因素.结论 老年髋部骨折患者围手术期ABT很常见,ABT与入院Hb低、股骨粗隆间骨折、IBL多、高龄、BMI低、ASA分级≥Ⅲ级和全身麻醉相关,可以从这几个方面来考虑降低围手术期ABT,针对不可变的危险因素则需早期充分备血.

目的 研究高龄老年髋部骨折患者术前下肢深静脉血栓(deep vein thrombosis,DVT)形成的危险因素.方法 回顾性研究2018年3月至2019年2月北京积水潭医院老年创伤骨科病房收治的687例80岁以上的高龄老年髋部骨折患者.通过多普勒超声对下肢DVT进行初筛,可疑或阳性的患者行静脉造影确诊DVT.通过单因素和多因素逐步Logistic 回归分析,探讨术前下肢DVT的独立危险因素.结果 高龄老年髋部骨折术前下肢DVT发生率为12.4％(85/687).经过多因素逐步Logistic回归分析得出受伤至入院时间、活化部分凝血活酶时间(activated partial thromboplastin time,APTT)、股骨粗隆间骨折是高龄老年髋部骨折术前下肢DVT的独立预测因子(P<0.05).结论 高龄老年髋部骨折患者术前下肢DVT的发生率高,股骨粗隆间骨折、骨折后延迟入院以及APTT缩短的患者术前下肢DVT的发生率增加,对有这些危险因素的患者应采取预防措施,以降低术前DVT的发生率.

目的 通过对老年髋部骨折病例分析,了解老年髋部骨折患者致伤因素,为预防髋部骨折提供依据.方法 收集北京积水潭医院2015年9月1日至2016年8月31日老年髋部骨折住院病例570例,按照年龄、性别等对致伤因素进行分析.结果 老年髋部骨折病例中男性167例(29. 3%),女性403例(70. 7%),平均年龄79. 5岁(60～100岁).老年髋部骨折患者中94. 9%为低应力骨折,且随着年龄增长脆性骨折比例逐步升高;骨折地点随着年龄增高逐步由户外为主转为室内为主;患者在户外及室内客厅发生髋部骨折的时间段均以白天为主(8:00～20:00),卧室及卫生间发生髋部骨折的时间段均以晚上为主(20:00～6:00);髋部骨折地域不同,摔倒的主要原因亦有不同;570例患者中95. 1%合并基础疾病,随着年龄的增长合并多种基础疾病的比例也逐步升高;多元回归分析进一步得出,存在呼吸系统基础疾病、中重度营养不良以及患者基础疾病数量是髋部骨折后新发急性疾病严重程度的独立危险因素.结论 老年髋部骨折致伤原因包括自身因素、药物因素以及环境因素等多方面,医疗工作人员应做好预防摔倒宣教、积极控制基础疾病、纠正骨质疏松,以期降低髋部骨折风险.

目的 探讨高龄男性慢性阻塞性肺疾病(COPD)患者的骨密度情况及相关影响因素.方法 选择北京积水潭医院老年科2019年1月～2019年6月门诊或病房诊治的47例高龄男性COPD稳定期患者为研宄对象.采集患者基本信息、血常规、生化、C反应蛋白(CRP)、血气分析、糖化血红蛋白、VitD水平,腰椎、髋部骨密度测定及肺功能检查.结果 47例COPD患者平均年龄(84.89±5.21)岁,BMI(24.06±2.04)kg/m2,有吸烟史者63.83％,吸烟指数平均417.02±60.06,戒烟比例87.2％,正在使用吸入激素的比例为17.02％;25(OH)D3(11.723±5.60)ng/ml、CRP(6.15±3.330)mg/L;腰椎总体骨密度值为(1.393±0.256)g/cm2,T值为0.862±0.192;髋部总体骨密度值为(0.950±0.198)g/cm2,T值为-0.321±0.522;FEV1％(63.383±7.061)％,FEV1/FVC(57.021±7.078)％,DLCO％(71.511±5.247)％,FVC％(82.96±10.61)％,RV/TLC(58.787±7.014)％;血气分析PaCO2(39.264±3.792)mmHg,PaO2(76.017±9.446)mmHg;logistic回归分析以腰椎总体骨密度值为因变量分析得出BMI减低、CRP升高、VitD缺乏、FVC％减低及DLCO％减低均为高龄COPD患者骨密度下降的独立危险因素;以髋部总体骨密度值为因变量分析得出增龄、吸入激素、白蛋白减低、VitD缺乏、RV/TLC升高及DLCO％减低均为高龄COPD患者骨密度下降的独立危险因素.结论 高龄男性COPD患者存在增龄、VitD缺乏、营养状况不佳及激素使用等致骨密度减低的独立危险因素,临床上应做好早期筛查及诊治工作.与此同时稳定期C RP水平、阻塞性通气功能障碍及肺气肿严重程度、肺弥散功能均与其骨密度减低独立相关,提示COPD与骨代谢之间可能存在多途径的相互作用机制,有待进一步研究.

Bone turnover markers (BTMs) can be used to monitor bone metabolism, while the actual clinical changing in hip fracture had not been certified to evaluate the changes of BTMs during the healing process after surgery of elderly hip fractures; and to get the effects of operation type, gender, serum 25(OH)D level, and age on bone turnover markers. A total of 100 elderly cases with hip fracture were selected, including 74 females and 26 males, and the patients were followed to 180–230 days after surgery. Serum levels of N-propeptide of type 1 collagen (P1NP), C-terminal crosslinking telopeptides of type 1 collagen (CTX), Osteocalcin (OC), and 25 hydroxy vitamin D (25OHD) were investigated. Bone mineral density (BMD) was measured with dual-energy X-ray absorptiometry (DXA). (1) P1NP and CTX showed peak time at 30–60 days after operation, while OC keep going even at 180–230 days; P1NP showed less than 4 times elevation during healing, CTX and OC only had less than 2 times rise. (2) Female had higher serum CTX and OC than male, intramedullary nailing for intertrochanteric fracture patients had higher P1NP than hip replacement for femoral neck fracture patients, and both the degrees of increase were less than 50%. (3) Serum average 25(OH)D level had no effect on BTMs during the fracture healing; different from the young old (65–84 years), serum OC level of eldest older patients(≥ 85 years) decreased early in the process of fracture healing. BTMs reached the peak level in 30–60 days after surgery, P1NP showed less than 4 times elevation, and CTX and OC had less than 2 times rise. It was not necessary to take gender into account when observing P1NP, and it was not necessary to take fracture and operation type into account when observing CTX and OC.

目的 探讨跌倒所致髋部骨折患者的流行病学情况.方法 收集2015年5月至2017年12月住院的年龄≥65岁脆性髋部骨折患者(A组),其中男性179例,女性456例;并以同期老年科住院的年龄≥65岁无髋部骨折病史患者作为对照(B组),其中男性29例,女性52例;应用SPSS 19统计学软件,采用二元Logistic回归分析危险因素.结果 ①635例髋部骨折老年患者,平均年龄(79.69±7.64)岁;有45.2％的跌倒是发生在家中,在家中的高发地点是卧室、起居室(占家中跌倒的72.1％),跌倒高发时间为人睡时间段,22:00～7:00占33.6％;有54.8％的跌倒是发生在户外,老人因使用非机动车产生的相关非暴力伤占到户外跌倒的28.2％.②发生跌倒后髋部骨折与老人行走时是否使用助行器(P=0.000)、步态(P=0.000)、优势手握力(P=0.000)、内科合并症CCI(P=0.006)有关;其中,行走时需要双手支撑辅助的老年患者比独立行走的老年患者发生髋部骨折的风险高4.7倍(95％ CI:2.7,8.0).③反复发生跌倒,即跌倒超高危老人与行走时是否使用助行器(P=0.000)、优势手握力(P=0.027)、内科合并症指数(P=0.027)相关.结论 老年人需尽可能的改善肌力及掌控平衡,居家出门少的老人需要注意卧室和起居室的布置,使用非机动车来助行的老人在上下车时及行驶时需要尽可能的缓慢来预防跌倒.随着人口老龄化程度的加剧,需要更多的社会力量来开展跌倒预防及跌倒损伤发生后的复健工作.

Objective: To investigate the relations between dietary intake during pregnancy and the incidence of their babies with small for gestational age (SGA). Methods: Data on demographics, dietary intake of protein, fat, and carbohydrates of the pregnant mothers during the first, second and third trimester, were collected. Information related to birth weight and gestational age of the infants were also gathered. A total of 8 102 women, who delivered their babies at the First Affiliated Hospital of Shanxi Medical University from March 2012 to September 2016, were enrolled in this project. Among them, 961 mothers had infants with SGA but the other 7 141 of them having normal infants. Unconditional logistic regression model was used to analyze the effect of dietary nutrient intake on SGA the first, second and third trimester. Results: We found that low dietary intake of protein during the first trimester and following trimesters during pregnancy were positively associated with higher risk of SGA (OR=1.534, 95%CI: 1.217-1.934; OR=1.268, 95%CI: 1.005-1.599; OR=1.310, 95%CI: 1.036-1.655). When adjusting for maternal pre-pregnancy BMI, we found that when mothers were with a pre-pregnancy BMI less than 18.5 or with low maternal intake of protein during the first trimester, positive association with higher risk of SGA (OR=1.872, 95%CI: 1.033-3.395; OR=1.754, 95%CI: 1.125-2.734), was noticed. However, for mothers with a pre-pregnancy BMI between 18.5 and 24.0 or with low protein intake during the first trimester, significant association with higher risk of SGA (OR=1.465, 95%CI: 1.089-1.972) was found. Conclusions: Through our observation, maternal dietary intake during pregnancy seemed to be associated with the risk of SGA but the effects of dietary intake were different, according to the BMI of pre-pregnancy population. Early pregnancy appeares as the key period for dietary intake which may influence the SGA.

Objective To observe the influence of perioperative delirium (PED) on prognosis in elderly patients with hip fracture.Methods From April to October 2017,219 elderly patients with hip fracture who underwent surgical treatment in Beijing Jishuitan Hospital were included;31 patients had PED (PED group),among which 11 cases were preoperative delirium(2 cases were relieved after surgery) and 20 cases were postoperative delirium;188 patients without PED were control group.Length of hospital stay,intensive care unit(ICU) transfer rate and mortality were recorded.Cognitive function was evaluated by Mini-Mental State Examination(MMSE) 1 d before and the same day after surgery.Living capacity before fracture was evaluated by Activities of Daily Living (ADL) according to patients or their relatives' description on admission.ADL score and exercise recovery were assessed 1 week and 1 month after surgery.Results Length of hospital stay in the control group was shorter than that in the PED group [(1.8 ± 0.8) d vs (2.4 ± 1.0) d] (P ＜ 0.05).Postoperative MMSE score decreasing rate in postoperative delirium patients was higher than that in the control group [90.0％ (18/20) vs 35.1％ (66/188)] (P ＜0.001).One week after surgery,ADL score decreased in both groups and the score in the PED group was lower than that in the control group[(23 ± 13) vs (40 ± 16)] (P ＜ 0.001).One month after surgery,ADL score was higher than that 1 week after surgery but still lower than that before fracture;the score in the PED group was lower than that in the control group[(44 ± 20) vs (69 ± 20)] (P ＜0.001).Ratios of patients being able to stand or walk 1 week after surgery and walking ratio 1 month after surgery in the PED group were lower than those in the control group(P ＜0.05).Conclusion PED is an important prognostic risk factor in elderly patients with hip fracture.

说到慢性阻塞性肺病(简称慢阻肺、COPD)可能一些老年人并不十分了解,可"老慢支""气管炎""肺气肿"等呼吸道疾病表述其实都是慢阻肺的常见表现.慢阻肺是以持续气流受限与高气道炎症反应为特征的、可预防和可治疗的疾病,多为慢性支气管炎、肺气肿进展致肺功能明显损减的特定阶段.

Objective: The objective of this study was to investigate the diagnostic discordance of osteoporosis by quantitative computed tomography (QCT) and dual-energy X-ray absorptiometry (DXA) in Chinese elderly men. Methods: A total of 313 males older than 60 years, who underwent both spinal QCT and lumbar spine and hip DXA in our department, were included. The diagnostic criteria established by the World Health Organisation in 1994 were used for DXA to diagnose osteoporosis, and the criteria recommended by the International Society of Clinical Densitometry were used for QCT. The osteoporosis detection rate by the two techniques was calculated, and the difference was compared. The minor discordance was considered present when the different diagnostic classes between the two techniques were adjacent. Major discordance was present when the diagnosis by one technique was osteoporosis and the other was normal. The computed tomography images were reviewed by radiologists to assess whether vertebral fracture, aorta calcification or degeneration was present. Results: In the 313 participants (mean age, 79.6 +/- 7.2 years), the osteoporosis detection rate was 10.9% for DXA (lumbar spine and hip) and 45.1% for QCT, a significant difference (p < 0.001). The major discordance, minor discordance and concordance of diagnosis between the two techniques were seen in 8.3%, 50.8% and 40.9%, respectively. QCT detected osteoporosis better than DXA. The causes of this discordance were degeneration of spine, abdominal aorta calcification and vertebral fractures. Conclusion: Our study demonstrated that discordance was common when using QCT and DXA to diagnose osteoporosis and that spinal degeneration, aorta calcification and fracture obscure the bone mineral density measurement of spine by DXA. QCT is a more sensitive method of choice to identify osteoporosis in elderly Chinese men. The translational potential of this article: This study investigated the diagnostic discordance of osteoporosis by quantitative computed tomography (QCT) and dual-energy X-ray absorptiometry (DXA) in Chinese elderly men. The results demonstrated that QCT is a more sensitive method of choice to identify osteoporosis in elderly Chinese men. This work may help clinicians make an appropriate choice of technique for the accurate diagnosis of osteoporosis and identify the patients at high risk of osteoporosis who should be treated early to prevent fractures. This may influence the therapeutic plan and the overall prognosis of patients. (C) 2018 The Authors. Published by Elsevier (Singapore) Pte Ltd on behalf of Chinese Speaking Orthopaedic Society.

目的:研究全皮下置入式心律转复除颤器(S-ICD)术前心电图QRS-T形态模板匹配筛查(TMS)对于双室起搏患者反应性的预测价值.方法:2016年1月至2017年3月,中国医学科学院阜外医院心脏再同步化治疗CRT(CRT-P/CRTD)置入的患者共55例,利用TMS对患者在心脏再同步化治疗(CRT)置入术前和术后进行S-ICD两种体位三个向量下的心电图描记和筛查,统计TMS通过率.在CRT置入后第6个月对患者进行随访,对比TMS通过与未通过患者的CRT的反应率.结果:所有患者在CRT置入术前,自身心律时均未通过TMS筛查,39例患者(70.9％)在双室起搏状态下通过TMS筛查.TMS通过组中高血压患者的比例低于TMS未通过组(7.7％ vs.43.8％,P=0.004).6个月随访时,TMS通过组有反应和超反应的患者比例明显高于未通过组(有反应:31/36 (86.1％)vs.5/16(31.3％),P ＜0.001;超反应:9/39(23.1％)vs.1/16(6.3％),P=0.026).三个向量均通过的患者超反应比率高于另外两组(3向量vs.2向量,P=0.018;3向量vs.1向量,P=0.003).基线时较小的LVEDD、LAD以及双室起搏通过TMS筛查是CRT有反应的预测因素.结论:双室起搏模式下通过TMS的患者CRT置入后更易有反应及超反应.