Background Hip fractures, prevalent in the elderly, carry significant morbidity and mortality, with perioperative hidden blood loss (HBL) being a critical yet underappreciated factor. The challenge of HBL in intertrochanteric femoral fractures treated with proximal femoral nail antirotation (PFNA) procedures necessitates a predictive tool for improved clinical management. Objectives To identify independent risk factors for perioperative HBL and to develop a predictive nomogram for intertrochanteric femoral fractures managed with PFNA. Methods We conducted a retrospective cohort study of 231 patients who underwent PFNA at Northern Jiangsu People’s Hospital from 2020 to 2022. Data on demographics and surgery were analyzed using SPSS 25.0 and R 4.2.2 to construct a nomogram predicting HBL. Results The study revealed a mean HBL of 1146.91 ± 727.35 ml. Significant predictors included preoperative hemoglobin, platelet count, PT-INR, fracture type by Evans classification, and the interval from admission to surgery. The predictive nomogram demonstrated high accuracy with an AUC of 0.926 for the ROC curve and 0.941 for the PR curve, indicating robust clinical utility. Conclusion The validated nomogram offers a novel, practical approach to forecasting HBL in patients undergoing PFNA for intertrochanteric femoral fractures, with implications for optimizing patient care across the perioperative period.

Osteoporosis is a serious systemic metabolic bone system disease.This study aimed to identify the target genes of isopsoralen and the signaling pathways involved in the differential expression of the genes involved in osteoclast differentiation. We hypothesized that isopsoralen may inhibit osteoclast differentiation by blocking the nuclear factor kappa-B (NF-κB) signaling pathway and verified our hypothesis through basic experiments. The 3-(4, 5-dimethylthiazol-2-yl)-2, 5-diphenyltetrazolium bromide (MTT) assay was used to detect the effect of isopsoralen on the proliferation and viability of primary mouse bone marrow monocytes (BMMCs). The effect of isopsoralen on receptor activator of nuclear factor kappa-B ligand (RANKL)-induced osteoclast differentiation was determined by using tartrate-resistant acid phosphatase (TRAP) staining. Quantitative real-time PCR (qRT-PCR) and Western blot were used to detect the expression of the related genes and proteins. The Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway of isopsoralen target genes were obtained through comprehensive analysis using the STITCH database, Cytoscape 3.8.2, and R-Studio software. Differentially expressed genes (DEGs) were found in osteoclasts induced by RANKL before and after 3 days using R-Studio, following which KEGG analysis was performed. Next, enrichment analysis was performed on the KEGG pathway shared by the target genes of isopsoralen and the differentially expressed genes during osteoclast differentiation to predict the signaling pathway underlying the inhibition of osteoclast differentiation by isopsoralen. Finally, Western blot was used to detect the effect of isopsoralen on the activation of signaling pathways to verify the results of our bioinformatics analysis. Based on the enrichment analysis of isopsoralen target genes and differentially expressed genes during osteoclastogenesis, we believe that isopsoralen can inhibit RANKL-induced osteoclastogenesis by inhibiting the NF-κB signaling pathway.

目的 探讨创伤中心严重多发伤患者谵妄的发生情况及其危险因素.方法 选取2021年6月-2022年1月收治的168例严重多发伤患者,采用意识模糊评估量表(CAM)评估患者谵妄发生情况,并根据是否发生谵妄,分为谵妄组(n=65)和非谵妄组(n=103).收集患者资料并分析其发生谵妄的危险因素.结果 共收集168例创伤中心严重多发伤患者临床资料,其中发生谵妄患者为65例,发生率为38.69％.2组患者在年龄、机械通气、低氧血症(动脉血氧分压＜60 mmHg)、由ICU转出至创伤中心、创伤时发生昏迷、合并高血压病史、合并脑外伤、有创操作、疾病严重程度方面比较,差异均有统计学意义(P＜0.05).多因素Logistic回归分析显示,年龄＞60岁、机械通气、低氧血症(动脉血氧分压＜60 mmHg)、由ICU转出至创伤中心、创伤时发生昏迷、合并高血压病史、合并脑外伤、有创操作、疾病严重程度高[急性生理学与慢性健康状况评分系统Ⅱ(APACHE Ⅱ)评分＞21分]是创伤中心严重多发伤患者并发谵妄的独立危险因素.结论 创伤中心严重多发伤患者的谵妄发生率较高,其并发谵妄的独立危险因素较多且涉及范围广泛,应及时发现并处理.

Background: Posterior internal fixation (PIF) is commonly used in the treatment of thoracolumbar fracture (TLF), but there is still no standard for the number of fixed segments. The objective of this meta-analysis was to evaluate the efficacy and safety of short segment (SS), intermediate segment (IS) and long segment (LS) in the fixation of TLF. Methods: Two authors independently searched through PubMed, Embase, Cochrane Library and Web of Science for studies of thoracolumbar fracture treated by posterior internal fixation, which were published until the end of April 2021. The Aggregate Data Drug Information System (ADDIS) software was used for data evaluation according to the Markov chain Monte Carlo (MCMC) method based on the Bayesian theorem. Results: Nineteen trials evaluating a total of 970 patients were enrolled in these studies, of which 340 in the SS group, 429 in the IS group and 201 in the LS group. For anterior vertebral height ratio (AVHR), IS had the highest AVHR, LS had the second highest AVHR. IS also ranked first in reducing visual analogue scale (VAS), SS ranked second. For sagittal Cobb's angle (SCA), LS had the lowest SCA and IS had the second lowest SCA. In terms of adverse events, IS had the lowest implant failure rate and LS had the second lowest implant failure rate. Conclusions: IS may be the most desirable treatment option for TLF in reducing SCA, implant failure rate, VAS, and improving AVHR. However, more randomized controlled trials are needed to verify these results. (c) 2022 Elsevier Ltd. All rights reserved.

PURPOSE:The anterior cervical approach is commonly used clinically for cervical spondylosis, but it also results in frequent postoperative dysphagia, which can increase the risk of complications and poor treatment satisfaction in severe cases. Intraoperative local application of retropharyngeal steroids has an impact on reducing the occurrence and severity of dysphagia; however, the results of current studies vary. The meta-analysis of this randomized trial was to evaluate the effectiveness and safety of intraoperative topical retropharyngeal steroids for the control of dysphagia after anterior cervical spine surgery.METHODS:Two authors searched electronic databases such as PubMed, MEDLINE, EMBASE, Cochrane Library, and Google Scholar, respectively. The search terms were "Dysphagia," "Steroids," "Anterior Cervical Discectomy and Fusion," etc. A random effects model was used to conduct a meta-analysis based on deviance information criteria.RESULTS:A total of 8 studies were included in this meta-analysis after screening of 792 studies. Bazaz scores were not significantly different in the steroid group at one day postoperatively (P = 0.38), and dysphagia was significantly improved at 14 days postoperatively (95% CI: 0.15 to 0.64; P = 0.002). PSTSI was significantly improved one day (P = 0.03) and 14 days after surgery (P < 0.0001). VAS scores were all lower versus controls (P < 0.001).CONCLUSION:Perioperative local retropharyngeal steroid administration as an adjunct to anterior cervical spine surgery reduces the incidence and severity of dysphagia compared with placebo control. However, future high-quality randomized controlled studies could incorporate nonsubjective dysphagia measures and long-term follow-up on the occurrence of associated complications or other side effects.

INTRODUCTION The vast majority of patients undergoing lumbar surgery experience varying degrees of incision pain, leading to prolonged postoperative recovery and poor satisfaction with treatment. The objective of this meta-analysis was to evaluate the efficacy and safety of dexmedetomidine as an adjunct to local anesthesia for postoperative pain control after lumbar surgery. EVIDENCE ACQUISITION Two authors independently searched eligible random controlled trials in electronic databases, including PubMed, Embase, Cochrane Library, Web of Science, CNKI (China National Knowledge Infrastructure), CBM (The Chinese BioMedical database) using the search terms 'dexmedetomidine', 'infiltration', and 'lumbar'. The random-effect model was used to perform the meta-analysis based on deviance information criteria. EVIDENCE SYNTHESIS Six trials evaluating a total of 330 patients were included in this review. Wound infiltration with dexmedetomidine significantly reduced the postoperative VAS scores (4th hour static VAS scores (MD=-1.03; 95% CI: -1.58 to -0.47; p=0.0003); 24th hour static VAS scores (MD=-0.66; 95% CI: -0.91 to -0.40; p<0.00001); 6th hour dynamic VAS scores (MD=-1.84; 95% CI: -2.23 to -1.45; p<0.00001)) and total supplemental analgesic consumption (SMD=-2.01; 95% CI: -3.04 to -0.98; p<0.00001), prolonged the median time to first rescue analgesia (SMD=3.53; 95% CI:2.31 to 4.76; p<0.00001), and reduced the incidence of nausea or vomiting (RR=0.40; 95% CI: 0.17 to 0.93; P<0.05). CONCLUSIONS Dexmedetomidine infiltration appears to be a promising and safe adjunct for postoperative pain control after lumbar surgery. However, more studies are needed to assess the prevalence of other side effects.

OBJECTIVE:To evaluate the efficacy of suture anchor combined with double-pulley technique for subpatellar comminuted fractures compared with wire vertical suture and Krachow in the treatment of subpatellar fractures.METHODS:Retrospectively selected 48 patients with subpatellar pole comminuted fracture admitted in our hospital from February 2013 to July 2019, 25 patients with double-pulley technique (group A), and 23 patients with vertical wire suture with Krachow suture. Patient age, gender, AT/OTA typing, injury mechanism, follow-up time, surgical time, bleeding volume, mean fracture healing time, and postoperative complications were recorded. The Insall-Salvati index immediately and 6 weeks after surgery. Bostman scores and knee activity were recorded at each follow-up, and month 12 was taken as the final result.RESULTS:Time of surgery in group A (46.52 min) was significantly shorter than in group B (76.30 min). Intraoperative bleeding in group 15.1 ml, B, group 15.9 ml. Both incisions healed in stage I, averaging clinical healing of patella fracture within 10 weeks. There was no significant difference in mean Bostman score and knee activity at month 12 (group A: 28.4, 124.8°; group B: 28.1, 125.7°). There was no significant statistical difference in the Insall-Salvati index immediately or 6 weeks between the two groups. Group B patients had two wire fractures, fracture healing and the wire removed one year after surgery, and the remaining patients had no complications such as internal fixation loosening, fracture, delayed healing, or nonhealing of fracture.CONCLUSION:Compared with the treatment of subpatellar fracture with wire vertical suture and Krachow method, suture anchor with double-pulley technique has short operation time, reliable fixation, and less complications. Patients can have early functional exercise and good knee function recovery without secondary surgery. It can be considered as an alternative therapy for this fracture and deserves clinical adoption and promotion.

目的 分析合并同侧股骨干骨折的Hoffa骨折的临床特点.方法 2014年1月～2019年12月收治的合并同侧股骨干骨折的Hoffa骨折病人14例,均采用髌旁入路逆行髓内钉治疗股骨干骨折,螺钉结合钢板治疗Hoffa骨折.所有病人术后均接受积极的康复治疗.随访12个月,记录膝关节协会评分(KSS),膝关节活动范围(ROM)以及固定稳定性进行影像学和功能结果分析.结果 所有病人均达到骨性愈合标准,股骨髁关节面解剖复位,平均愈合时间为(6.18±0.87)个月,内固定物牢靠,未发生内固定物松动、关节炎、感染等并发症;膝关节功能恢复满意,末次随访时ROM平均0°～122.86°,平均KSS评分88.6±4.9,术后3个月患侧KSS评分低于健侧,但术后6、12个月病人双侧KSS评分比较,差异无统计学意义(P>0.05).结论 采取髌旁入路逆行髓内钉治疗股骨干骨折,螺钉结合钢板治疗Hoffa骨折创伤小、安全,固定可靠,在配合康复的情况下可获得满意的功能恢复效果.

INTRODUCTION: Most patients undergoing lumbar surgery experience varying degrees of incision pain, leading to prolonged postoperative recovery and poor satisfaction with treatment. The objective of this meta-analysis was to evaluate the efficacy and safety of dexmedetomidine as an adjunct to local anesthesia for postoperative pain control after lumbar surgery.EVIDENCE ACQUISITION: Two authors independently searched eligible random controlled trials in electronic databases, including PubMed, Embase, Cochrane Library, Web of Science, CNKI (China National Knowledge Infrastructure), CBM (The Chinese BioMedical database) using the search terms "dexmedetomidine," "infiltration," and "lumbar." The random-effect model was used to perform the meta-analysis based on deviance information criteria.EVIDENCE SYNTHESIS: Six trials evaluating a total of 330 patients were included in this review. Wound infiltration with dexmedetomidine significantly reduced the postoperative VAS scores (4th hour static VAS scores (MD=-1.03; 95% CI: -1.58 to -0.47; P=0.0003); 24th hour static VAS scores (MD=-0.66; 95% CI: -0.91 to -0.40; P<0.00001); 6th hour dynamic VAS scores (MD=-1.84; 95% CI: -2.23 to -1.45; P<0.00001) and total supplemental analgesic consumption (SMD=-2.01; 95% CI: -3.04 to -0.98; P<0.00001), prolonged the median time to first rescue analgesia (SMD=3.53; 95% CI:2.31 to 4.76; P<0.00001), and reduced the incidence of nausea or vomiting (RR=0.40; 95% CI: 0.17 to 0.93; P<0.05).CONCLUSIONS: Dexmedetomidine infiltration appears to be a promising and safe adjunct for postoperative pain control after lumbar surgery. However, more studies are needed to assess the prevalence of other side effects.

OBJECTIVE: The ideal management of thoracolumbar burst fracture (TLBF) remains controversial. We conducted this study to compare the effectiveness and safety of transKambin triangle versus transpedicular bone grafting combined with posterior internal fixation (PIF) for TLBF. METHODS: Fifty-four patients were retrospectively analyzed and divided into 2 groups: the observation group (PIF combined with bone grafting via the Kambin triangle, n = 28) and the control group (PIF combined with bone grafting via transpedicular, n = 26). The anterior vertebral height ratio, sagittal Cobb angle, visual analog scale score, Oswestry Disability Index, bone healing rate, and neurologic complications were measured. RESULTS: All patients were followed up regularly for a mean period of 17.94 months (12 L 24 months). The anterior vertebral height ratio in the observation group was higher than that in the control group (93.93 +/- 2.92 vs. 89.90 +/- 5.54%, P = 0.006), and the loss of correction was lower (1.59 +/- 1.20 vs. 3.00 +/- 1.98%, P = 0.008). The observation group had lower sagittal Cobb angle at final follow-up (8.68 +/- 3.75 vs. 11.33 +/- 4.77 degrees, P = 0.046) and less correction loss (1.96 +/- 1.32 +/- 1.15 vs. 3.90 +/- 2.39 degrees, P = 0.002). The visual analog scale score and Oswestry Disability Index in the observation group were lower (0.61 +/- 0.43 vs. 0.92 +/- 0.38, P = 0.016; 15.86 +/- 4.11 vs. 19.18 +/- 4.04, P = 0.010), while the fracture healing rate showed no significant difference (P > 0.05). No internal fixation failure or neurologic complications occurred in both groups during the follow-up. CONCLUSIONS: Bone grafting via the Kambin triangle combined with PIF is a safe and effective technology for thoracolumbar burst fracture.