Background The prevalence of hip fractures is increasing due to increased number of aging people and availability of modern transportation. Elderly patients with hip fracture tend to have many basic diseases and poor prognosis, with 1-year postoperative mortality as high as 15%-25%. Timely screening of those at high risk of hip fractures with predictive tools and providing them with interventions can improve the prognosis. But there are rare studies and no appropriate objective indicators regarding predicted 1-year postoperative mortality in older hip fracture patients. Objective To assess the predictive association of Controlling Nutritional Status (CONUT) score and other possible associated factors for 1-year postoperative mortality in elderly patients with hip fracture. Methods A total of 399 patients with unilateral hip fracture (including femoral neck and intertrochanteric fractures) hospitalized in Xuanwu Hospital Capital Medical University from January 2013 to March 2016 were selected. General data, routine blood test results, biochemical and coagulation indices, and calculated CONUT score, geriatric nutritional risk index (GNRI) and neutrophil-to-lymphocyte ratio (NLR) were collected. All the patients received internal fixation or femoral head replacement procedure, and 1-year postoperative clinic- and telephone-based follow-up with death as an endpoint. Multivariate Logistic regression was used to identify influencing factors of 1-year postoperative mortality. Receiver operating characteristic (ROC) curve analysis was used to analyze the predictive value of CONUT score for 1-year postoperative mortality. Results Among the 399 patients, 47 died and 352 survived at the end of follow-up. Multivariate Logistic regression analysis found that age〔OR=1.093, 95%CI (1.040, 1.148) 〕, old cerebral infarction〔OR=0.353, 95%CI (0.169, 0.737) 〕, serum creatinine〔OR=1.006, 95%CI (1.002, 1.010) 〕, CONUT score〔OR=1.261, 95%CI (1.005, 1.583) 〕 and NLR〔OR=1.049, 95%CI (1.003, 1.098) 〕 were associated with 1-year postoperative mortality (P<0.05). In predicting 1-year postoperative mortality, the area under the curve of CONUT score was 0.681〔95%CI (0.590, 0.771) 〕 with 4.5 as the optimal cutoff point, 48.9% sensitivity and 83.5% specificity. The area under the curve of NLR was 0.611〔95%CI (0.523, 0.699) 〕, with 7.055 μg/L as the optimal cutoff point, and 47.8% sensitivity and 75.9% specificity. Conclusion Age, old cerebral infarction, serum creatinine, CONUT score and NLR were associated with 1-year postoperative mortality in elderly patients with hip fracture. Preoperative CONUT score greater than 5 may be associated with worse postoperative nutritional status and higher risk of death. The CONUT score could be used for postoperative risk assessment in these patients.

目的 探讨外固定结合康复治疗高龄转子间骨折的临床疗效.方法 2010年5月至2020年6月首都医科大学附属北京康复医院骨科治疗的高龄转子间骨折患者40例.根据治疗方式的不同将所有患者分为2组,研究组患者采用闭合复位外固定结合康复治疗;对照组采用保守治疗.通过2组患者的髋关节Harris评分、骨折愈合时间、负重行走时间、治疗期间ICU入住率、1年生存率及并发症发生情况等指标评价治疗效果.结果 末次随访时,研究组Harris评分(78.9±17.8)分,优于对照组(65.2±13.1)分,差异有统计学意义(P<0.05).研究组负重时间为(38.6±10.8)d;对照组为(58.4±13.3)d;2组之间负重时间差异有统计学意义(P<0.05).研究组骨折愈合时间为(116.3±17.6)d;对照组为(123.9±14.9)d;2组之间骨折愈合时间差异无统计学意义(P>0.05).研究组治疗期间ICU入住率为14.3％;对照组为50.0％;2组患者之间ICU入住率差异有统计学意义(P<0.05).研究组患者1年生存率为92.9％;对照组为66.7％;对照组患者1年生存率显著低于研究组(P<0.05).研究组并发症总体发生率为32.1％;对照组为75.0％;2组之间差异有统计学意义(P=0.013).结论 外固定结合康复治疗高龄转子间骨折可以达到满意的治疗效果,并且围手术期的安全性高,为高龄转子间骨折患者的治疗提供了新的的选择.

目的 探讨80岁及以上髋部骨折患者术后1年病死率及病死危险因素.方法 对2016年1月至2019年12月首都医科大学宣武医院骨科收治的80岁及以上髋部骨折患者290例的临床资料进行回顾性分析.其中男86例,女204例;年龄(85.1±4.05)(80～100)岁.收集患者一般临床资料(年龄和性别),住院资料[骨折部位、手术方式、住院时间、受伤至手术时间、手术进行时段、手术时长、术中出血量、实验室检查指标、心脏左室射血分数(LVEF)、术前控制营养状况(CONUT)评分、术前合并症、术后是否发生肺部感染、是否吸烟、是否进行康复训练]和术后资料(是否存活和是否进行康复训练).根据术后1年是否生存将全部患者分为生存组(220例)和病死组(70例).对两组数据进行单因素分析,对其中P<0.1的单因素进一步进行多因素logistic二元回归分析,筛选出患者术后1年发生病死的危险因素.结果 290例患者术后1年病死率为24.1％(70/290).单因素分析结果显示,年龄、白蛋白水平、CONUT评分、LVEF、康复训练、吸烟、焦虑和抑郁以及肺部感染是80岁及以上髋部骨折患者术后1年内病死的相关因素(均P<0.05).多因素logistic二元回归分析结果显示,焦虑和抑郁、吸烟、CONUT评分高以及肺部感染是80岁及以上髋部骨折患者术后1年高病死率的独立危险因素(均P<0.05).结论 80岁及以上髋部骨折患者术后1年病死率为24.1％.年龄、白蛋白水平、CONUT评分、心脏LVEF、康复训练、吸烟、焦虑和抑郁、肺部感染是80岁及以上髋部骨折患者术后1年内病死的相关因素,其中焦虑和抑郁、吸烟、CONUT评分高以及肺部感染是独立危险因素.

(1)一般情况：患者女性，年龄86岁，身高155 cm，体重60 kg，主因摔倒致右侧髋部疼痛伴活动障碍1 d余入院。患者1 d前因不慎摔倒致右侧髋部疼痛，呈持续性，活动时加重，程度剧烈，伴活动受限及肿胀，X线显示右侧股骨粗隆间骨折。

背景:踝关节骨折中的内踝形态十分复杂,不同程度的内踝损伤影响踝关节骨折的稳定性和最终的治疗方法.目的:利用三维CT研究踝关节骨折中内踝形态的特点,探讨内踝形态的分型方法和对治疗策略的影响.方法:选取2015年1月至2018年1月在我院行踝关节三维CT检查并接受手术治疗的143例踝关节骨折患者,年龄19～85岁,平均(53.1±15.9)岁.收集全部患者的一般资料,阅读术前三维CT片后根据内踝形态的特点进行分型.对于部分内踝骨折的病例,能够在CT片上测量骨折线的冠状面角度(α)和矢状面角度(β).结果:本研究中的内踝形态大致可分为4型:1型,内踝无骨折或有撕脱骨折;2型,前丘骨折累及不同范围后丘;3型,后丘骨折伴或不伴前丘骨折;4型,内踝粉碎骨折.其中2型可进一步分为两个亚型:2a型(丘下骨折)和2b型(丘上骨折).对2型中内踝骨折线的测量结果显示,α为28.8°±17.4°,β为26.4°±8.0°.两个亚型之间的α和β值差异有统计学意义(P＜0.001).结论:三维CT有助于认识不同的内踝形态并指导分型.2型内踝形态中两个亚型内踝骨折线角度差异有统计学意义.这些发现凸显了踝关节骨折中内踝形态的多样性,有助于临床医师根据不同的内踝形态制定治疗方案.

目的 探讨老年难复型股骨粗隆间骨折复位及内固定的有效方法.方法 回顾性分析201 1年4月至2012年7月我科收治的老年难复型股骨粗隆间骨折手术治疗患者的临床资料,记录患者性别、年龄、骨折原因、就诊时间以及治疗效果等指标.结果 本组29例,男13例,平均年龄(72.6±11.7)岁,女16例,平均年龄(78.4±12.5)岁;均为闭合性骨折,随访时间6～18个月,平均(10.4±5.2)个月.难复型骨折占同期所有股骨粗隆间骨折(125例)的发生率23.2％.18例采用改良的手法复位获得成功,占难复型骨折的62.1％;11例采用微创切开复位的方法获得手术成功,占37.9％.所有病例骨折愈合良好,无术后内固定物失效和螺钉切出等不良事件发生.结论 对于老年难复型股骨粗隆间骨折,早期明确骨折的复杂性,并采取行之有效的手术方法,能够获得良好的预后.

Background & Objective: Hip fracture is common osteoporotic fracture associated sometimes with failed internal fixation. Joint replacement is commonly used to salvage failed internal fixation of hip fractures (FIFHF). Our objective was to present the outcome of Arthroplasty after FIFHF in our patients.Methods: A prospective analysis was made on consecutive patients who underwent prosthetic replacements for FIFHF in Orthopaedics Department of Xuanwu Hospital between June 2012 and January 2015. Fifty six patients were included. There were 32 cases of failed internal fixation of femoral neck fracture (FIFFNF) and 24 cases of failed internal fixation of intertrochanteric fracture (FIFIF). The reoperations included 36 cases of total hip replacements, and 20 cases of bipolar femoral head replacements. Cemented prostheses were used in 19 patients (long-stems in 7 patients), and uncemented prostheses in 37 patients (long-stems in 12 patients). The patients were followed up for a minimum of 12 months or until their death.Results: Two patients died of pulmonary infection in the perioperative period, two died of myocardial infarction in two months after the operation, and the rest survived 12 month follow-up at the least. The mean Harris hip scores of the patients were 47 and 85 before and after the operation, respectively. The rate of Excellent and Good results is 82.7%. T tests showed that difference between pre and post-operation Harris hip scores is statistically significant (p < 0.001).Conclusions: Arthroplasty may serve as a suitable salvage technique for FIFHF, and long-stem prosthesis replacement is proved to obtain reliable curative effect, especially in FIFIF.

Remote ischemic post‑conditioning (RIPC) is an established method to activate the hypoxia‑inducible factor‑1α (HIF‑1α) pathway, which is involved in the impairment of fracture healing. However, the role of RIPC in fracture healing remains to be fully elucidated. In the present study, rats received fractures and were divided into two groups: Control and RIPC, in which hind limb occlusion was performed. Rats were sacrificed at 7, 14, 28 and 42 days subsequent to tibial fracture. Micro‑computed tomography was performed to measure healing of the bone tissue and biomechanical testing was used to test mechanical strength. In addition, the effects of hind limb occlusion on the expression of two primary angiogenic mediators, HIF‑1α and vascular endothelial growth factor (VEGF), as well as the osteoblast markers runt‑related transcription factor 2 (Runx2), alkaline phosphatase (ALP) and osteocalcin (OCN), were determined at the mRNA and protein levels by reverse transcription‑quantitative polymerase chain reaction, western blot analysis and immunohistochemistry. Systemic administration of hind limb occlusion (3 cycles/day, with each occlusion or release phase lasting 10 min) significantly promoted fracture healing and mechanical strength. The present study demonstrated that in rats treated with hind limb occlusion, the expression of HIF‑1α, VEGF, Runx2, ALP and OCN was significantly increased at the mRNA and protein levels, and that RIPC enhances fracture repair in vivo.

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

Background/Aims: Hypoxia has been reported to regulate osteoblastic differentiation of bone cells and cartilage development. However, information concerning the molecular mechanisms remains largely unknown. Methods: The expression of miR-429 was evaluated by quantitative real-time PCR analysis. To test whether miR-429 directly regulate the expression level of ZFPM2 at transcription level, dual-luciferase reporter gene assay was performed. Western blotting was performed to detect osteogenesis related protein expression. The cell proliferation, apoptosis, alkaline phosphatase activity and matrix mineralization were performed to assess the functions of miR-429 in vitro and in vivo the effects of miR-429 on fracture healing. Results: Expression of miR-429 was increased in MC3T3-E1 cells treated with 200 μM CoCl2 by qRT-PCR, and overexpression of miR-429 promoted cell differentiation, and enhanced alkaline phosphatase activity and matrix mineralization. Luciferase reporter assays suggested that miR-429 directly targets the 3'UTR of ZFPM2. In addition, knockdown of ZFPM2 could phenocopy the effects of miR-429 expression. Furthermore, overexpression of ZFPM2 in miR-429-expressing MC3T3-E1 cells suppressed cell differentiation. Conclusions: Our results provide valuable insight into the potential role of hypoxia in regulation of osteoblastic cell differentiation.

目的：探讨带锁髓内钉结合Ilizarov外固定器行股骨延长术治疗股骨短缩畸形的效果。方法回顾性分析61例股骨短缩畸形患者的临床资料，其中采用带锁髓内钉结合Ilizarov外固定器行股骨延长术治疗36例（观察组），采用单纯Ilizarov外固定器行股骨延长术治疗25例（对照组）。比较手术后两组患者的骨延长相关参数（速度、长度）、外固定佩戴时间、术后半年膝关节活动度及并发症情况。结果所有患者均获1.5～4.5（2.5±2.0）年的随访。两组骨延长长度和延长速度的比较差异无统计学意义（ P＞0.05）；观察组外固定佩戴时间显著短于对照组（P＜0.05），膝关节活动度明显高于对照组（P＜0.05）；观察组无再骨折、畸形、针道感染等并发症发生，对照组出现严重针道感染7例9针，观察组并发症发生率明显低于对照组（ P＜0.05）。结论带锁髓内钉结合Ilizarov外固定器行股骨延长术治疗股骨短缩畸形，能减少股骨穿针，缩短外固定器佩戴时间，增加舒适度，有利于患者尽早行关节功能锻炼，且能减少关节僵硬并发症的发生。

目的 观察低强度超声波照射后组织工程骨的骨形成情况和生物力学变化.方法 将骨髓间充质细胞/β-磷酸三钙(BMSCs/β-TCP)共同增殖分化培养2周后,手术植入同基因鼠背部两侧皮下,一侧行超声波照射20 min/d,另一侧作为对照.术后5、10、25和50 d,分别取出组织工程骨,行HE染色和CD31免疫组化染色,观察组织学变化.结果 组织学观察发现,超声波组组织工程骨较对照骨软组织修复、血运和血管形成更佳,骨形成更广泛.结论 低强度超声波能够促进组织工程骨内的血运和骨形成.

不同疾病可出现不同性质、不同程度的疼痛，来源于骨质疏松症的骨痛是骨质疏松症患者的主要临床症状之一。骨质疏松症（osteoporosis, OP）是一种以骨量减少，骨微结构破坏，骨脆性增加，易发生骨折为特征的全身骨骼之疾病[1]，是骨骼的退化，是老年退行性疾患的一种。我国界定60周岁以上的公民为老年人，截止2012年底，60岁以上老年人口达到1．94亿。随着老年人群的不断增加，伴随着年龄增长而患骨质疏松症的风险亦增加[2]。其实，老年OP的程度反应的是骨骼老化的程度，临床上主要体现在：①骨折。骨质疏松性骨折对健康危害最大，后果也最严重。它不仅增加了医疗成本、社会和家庭负担，而且完全可能由于一次轻微外伤所致的骨折而使患者死亡。鉴于其后果的严重性，骨质疏松性骨折已经引起了人们的高度重视；②身材变矮，骨骼弯曲、变形，驼背。其直观感觉是影响患者体形和外观，但是、由于老年人骨骼的高脆性[3]，轻微外力甚至无明显外力即可能导致疏松变形、弯曲的骨骼出现骨折；③骨质疏松性骨痛。疼痛本来就是疾病的一种基本表现形式，如果骨质疏松骨痛得不到有效治疗，不仅增加了患者的痛苦，而且降低了行走和反应能力，从而使步履瞒珊老人跌倒的机率显著增加，即大大增加骨质疏松性骨折的风险。所以，在防范骨质疏松性骨折的同时，也应该关注骨质疏松骨痛的治疗。

Objective To explore the feasibility of external fixation of osteoporotic fractures in distal radius for el-der patients. Methods One hundred and seventy-seven cases of distal radial fractures with osteoporosis from May, 2009 to Jun, 2012 were treated. Among them, 26 cases (14.7%, with 4 cases of type B and 22 cases of type C in AO classifica-tion) were treated with external fixation after either open (15 cases) or close (11 cases) reductions. Results Twenty-five out of the 26 cases (96.2%) were followed up for 3~20 months and evaluated with Gartland and Werley evaluation systems. Eight patients were fulfilled the criteria of excellence, 11 were good (the total satisfaction rate was 76%), 4 were fair and 2 were poor (8%). Of the 14 cases with open reduction who were followed up, 5 were excellent, 6 were good (78.6%), 3 were fair and there was no case of poor. Of the 11 cases with close reduction cases, 3 were excellent ,5 were good (72.7%),1 was fair and 2 were poor (18.2%). Conclusion External fixation is suitable for surgical procedures in elderly patients be-cause of its minimally invasive in nature and limited open reduction can facilitate the rehabilitation of the anatomical rela-tions such as the radial length and articular surface of the distal radius, and good bone stability without displacement of the distal radius. Therefore, it is an effective approach in the treatment of osteoporotic fractures in the distal radius in elder pa-tients.

Objective To analyze the clinical data of intertrochanteric fractures,and to explore the potential factors influencing the perioperative blood loss volume and possible measures for improving the condition. Methods 343 patients treated intertrochanteric fractures with proximal femoral intramedullary snail were analyzed retrospectively from Jan 2008 to Dec 2011. Complete perioperative data were collected. The perioperative blood loss was calculated according to Equation of Gross. The potential factors influencing perioperative blood loss were analyzed. Results 343 cases of intertrochanteric fractures were treated successfully,without serious complications. 140 patients were male, and 203 patients were female. The average age was( 78. 76 ± 6. 97) years. The blood loss amount was 305-692 ml,and( 482. 8 ± 43. 6) ml averagely. The statistical analysis indicated that ages,hypertension,diabetes mellitus, cerebrovascular diseases and history,the type of fracture as well as operation time were the potential risk influencing factors of blood loss volume. In addition,the hidden blood losses were obviously more than the dominant blood loss. The hidden blood losses in patients older than 75 years old were more than those in patients less than 75 years old. The dominant blood losses in emergency operation were more than those inselective operation. Conclusion During the treatment of intertrochanteric fractures,older adults with diabetes or cerebrovascular diseases should be noted. Hematocrit must be tested at regular intervals. The comorbidities should be controlled properly,and careful manipulations are also benefit for reducing blood loss,such as blood pressure control during operation,incision closures in the operation and so on.

Objective To review the outcomes of geriatric distal humeral fracture fixed with locking compression plate(LCP). Methods Twenty-four elder patients with distal humeral fracture underwent open reduction and internal fix- ation with LCP. Fracture was caused by injury from fall in 23 cases, by traffic accident in 1 case. There were 9 cases of type A2, 2 cases of type A3, 2 cases of type B1, 2 cases of type C1, 5 cases of type C2, 4 cases of type C3 fractures ac- cording to AO/ASIF classification. Open reduction with olecranon osteotomy technique was applied to all patients except for those with type A fracture, and triceps sparing was considered only in comminuted type A fracture. Results The aver- age length of follow-up was 14 months(6-24 months). All fractures were healed within 6 months with an average of about 5 months. Five patients showed excellent healing, 12 were good, 3 were fair and 1 had poor healing according to the im- provement Cassebaum score system. Conclusion Open reduction and internal fixation with LCP for geriatric distal humer- al fracture can achieve relatively good functional results and bone healing.

Objective To explore the possibility and necessity of a new first aid model for trauma which integrates pre-hospital medial care with in-hospital treatment.Methods A comparison was made at the times of pre-operation preparation and hospitalization between two different trauma rescue models.From October in 2010 to October in 2011,116 patients were managed with the new integrated first aid model(pre-hospital care,emergency and multi-department consultations in the hospital) and 86 patients with traditional model(triage in emergency room,preliminary diagnosis by orthopedic doctors,multi-department consultations and medical care).Results There was no significant difference between the two groups in pre-hospital index score(PHI).The total times needed for the preparation before emergency operation and for hospitalization of the new model group were(58±29)min and(28±15)d respectively while those for the traditional model group were(125±60)min and(40±19)d.The differences between the two groups were statistical significant(P 0.01).Conclusion Both the time of pre-emergency operation and that of hospitalization for trauma patients are shortened through the application of the new trauma rescue model.Patients get better medical care and the efficiency of treatments is improved.

目的比较尺骨茎突基底型骨折采用两种不同方法治疗的效果。方法对采用手术治疗的29例和非手术治疗的30例尺骨茎突基底型骨折的资料进行回顾分析。结果本组获随访14～58个月,术后1、3个月及末次随访时DAHS评分差异有统计学意义,进一步两两比较,术后1个月与3个月评分差异有统计学意义,而术后3个月与末次随访时评分比较,差异无统计学意义。手握持力及腕关节活动度方面无明显差异。结论尺骨茎突基底型骨折采用非手术治疗亦可取得较好的疗效。