OBJECTIVE:Fractures due to falls are a significant global public health concern, yet comprehensive analyses of their burden remain limited. This study aimed to assess the global, regional and national incidence and years lived with disability (YLDs) of fractures attributable to falls from 1990 to 2021. METHODS:Data on fall-related fractures were extracted from the global burden of disease study for the years 1990-2021. Analyses included trends in incidence, YLDs, age-standardised incidence rates (ASIR) and age-standardised YLDs rates (ASYR) for both sexes globally and across 204 countries. Fracture-specific data were analysed by anatomical site, age group and regions. RESULTS:From 1990 to 2021, the global incidence and YLDs of fall-related fractures rose significantly. While ASIR and ASYR declined overall, they began to rise again over the past 4 years. In 2021, there were approximately 100.5 million new fracture cases, a 49.5% increase since 1990, with a 35.6% increase in females and a 64.6% increase in males. ASIR decreased by 7% overall, with declines of 9.8% in females and 2.8% in males. The most common fracture sites were the hand, femur and vertebral column. Regionally, the highest ASIR was observed in males in Saudi Arabia and in females in Andorra. CONCLUSION:The global burden of fractures attributable to falls has increased markedly, particularly among females. Although ASIR and ASYR have declined overall, recent years have seen a resurgence. Targeted prevention strategies in high-risk populations and regions are crucial to mitigate the future burden of fall-related fractures.

BACKGROUND:Malignant neoplasm of bone and articular cartilage (MNBAC) is one of the causes of cancer-related deaths worldwide. To date, there is a lack of detailed studies on the disease burden of MNBAC. METHODS:Data on the incidence, mortality, and disability-adjusted life years (DALYs) of MNBAC from 1990 to 2021 were obtained from the Global Burden of Disease study. We estimated the trends in the burden of MNBAC by calculating the estimated annual percentage change (EAPC) in age-standardized rates by region, country, and social development index. RESULTS:Globally, the cases of incidence and deaths of MNBAC showed a significant upward trend. In 2021, the global incidence cases of MNBAC were 91,375.1 (73,780.4-102,469.7), and the number of deaths was 66,114.3 (53,305.4-74,466.9). The age-standardized incidence, mortality, and DALYs rates were all on the rise, with EAPCs of 0.59 (0.51 to 0.68), 0.11 (0.02 to 0.21), and 0.08 (0 to 0.17), respectively. In 2021, China had the highest number of incidence cases and deaths. Two peaks in incidence cases and deaths were observed in the 15-19 and 65-69 age groups, with incidence rates and death rates generally increasing with age, and higher in males than females. The region with the highest incidence cases, deaths, and age-standardized incidence rate was East Asia, while Eastern Sub-Saharan Africa had the highest age-standardized mortality, and DALYs rates. CONCLUSION:From 1990 to 2021, the global burden of MNBAC has continued to increase, particularly in East Asia, which faces the highest number of incidence cases and deaths, while Eastern Sub-Saharan Africa faces the highest ASMR and ASDR. To mitigate this burden, different regions should develop cancer control actions based on their respective epidemiological characteristics, with a focus on the elderly and adolescents, and control of risk factors.

Objectives Occupational injuries pose a significant challenge to global health and development. This study aimed to quantify the international and regional burdens of occupational injuries from 1990 to 2019, stratified by specific causes.Methods We analysed global trends in deaths, disability-adjusted life years (DALYs), age-standardised mortality rates (ASMR) and age-standardised DALY rates (ASDR) related to occupational injuries. Specific injuries, including animal contact, drowning, mechanical forces, falls, fire, heat, hot substances, foreign bodies, poisoning and road injuries, were evaluated. Age-stratified and regional analyses were also performed.Results Globally, the number of deaths, DALYs, ASMR and ASDR related to occupational injuries declined from 1990 to 2019. The middle Socio-demographic Index (SDI) region exhibited the highest burden, whereas the high SDI region showed the least burden. China and India had the highest occupational injury-related death rates in 2019. Males, particularly those aged 25-44 years, were found to be more vulnerable. Road injuries were the leading cause of death in all age groups. Compared with 1990, mortality numbers and rates decreased significantly by 2019, with the highest burdens experienced in East Asia, South Asia and Southeast Asia.Conclusion The global decline in occupational injuries is promising; however, certain regions and demographics remain disproportionately affected. Targeted interventions in high-burden areas are crucial to further reduce the impact of occupational injuries.

Accurately measuring the spatial extension distance of nerve bundles in completing a split/merge is impossible because no clear mathematical definition exists for the starting and ending positions in nerve-bundle splitting/merging. We manually count the number of nerve-bundle splits/merges in long nerve segments, which is labor-intensive, inefficient, and prone to counting errors. Currently, the mathematics are unclear for the nerve-bundle diameter before and after splitting/merging. This paper explores these problems and proposes nerve-bundle splitting/merging rules. Based on the method of defining the beginning and ending positions of nerve-bundle splitting/merging, we explored the mathematical law of equivalent diameter of nerve bundles before and after splitting/merging. The experimental results revealed that the moving average of circularity of nerve bundle accurately defines the beginning and ending positions of nerve-bundle splitting/merging. The diameter of the nerve bundles before and after split/merge approximately conforms to the principles of the Da Vinci formula. The proposed automatic counting algorithm based on centroid offset matching obtains the number of split/merged nerve bundles in the sequence scan images with 100 % accuracy. The mathematical definition of the starting and ending positions of nerve-bundle splitting/merging proposed in this paper is accurate and strict and is the foundation of subsequent research. The proposed automatic counting algorithm based on centroid offset matching (ACA-COM) can accurately and efficiently count the number of times the nerve bundles split and merge in sequential images. The mathematical law satisfied by the diameter of the nerve bundles before and after splitting/merging reflects that the nerve bundles tend to have better capability to resist breaking.

Background Sternum and rib fractures represent a significant global health concern, contributing to morbidity and disability on a worldwide scale. However, there is a notable lack of recent epidemiological data detailing the global and regional burden of these fractures. Methods We undertook a systematic analysis of the prevalence of sternum and rib fractures at the global, regional, and national levels in 2019, while also examining time trends spanning from 1990 to 2019. To achieve this, we extracted data from the Global Burden of Disease Study 2019, enabling us to determine incidence, prevalence, years lived with disability (YLDs), and their corresponding age-standardized rates. Results In 2019, there were 4.1 million incident cases and 2 million prevalent cases of sternum and rib fractures worldwide. These figures represent increases of 43.7 % and 64.1 %, respectively, since 1990. YLDs also exhibited a notable increase, rising by 62.4 % to reach 190,834 cases. However, since 1990, their equivalent age-standardized rates, which ranged from 5.5 % to 7.1 %, have decreased. Notably, China had the greatest incidence (1.2 million cases), prevalence (573,000 cases), and number of YLDs (55,400 cases), all in 2019. The greatest age-standardized incidence rate (143/100,000) and age-standardized prevalence rate (65/100,000) were both recorded in Greenland in the same year. It's critical to emphasize that men experience these fractures at considerably higher rates than women. Around 70 % of incident instances included unintentional injuries worldwide and across all regions. High-socioeconomic regions had the highest rates of incidence, prevalence, and YLDs, albeit these rates have declined by 6.4 % to 7.1 % since 1990, whereas low-middle and low-income areas have had rises. Conclusions This study, which spans the years 1990 to 2019, provides a thorough and current assessment of the global burden attributed to sternum and rib fractures. In terms of nations, regions, sociodemographic index (SDI) levels, age groups, genders, and reasons, it reveals significant variances and trends. The knowledge obtained from this study can be extremely useful in formulating health policy, allocating resources, and developing methods to prevent these injuries.

BackgroundThe body roundness index (BRI) is a quantitative measure used to evaluate the presence of obesity and the distribution of body fat. However, the relationship between the BRI and osteoarthritis (OA) is still unclear. This study aimed to examine the relationship between the BRI and the occurrence of OA.MethodsThis study was a cross-sectional analysis used to analyze data from the National Health and Nutrition Examination Survey (NHANES) from 2011 to 2018. A variety of variables were included in this investigation, which employed logistic regression analysis to assess the correlation between the BRI and OA. The robustness of the results and the impact of stratification variables were evaluated using subgroup and sensitivity analyses. To evaluate the ability of the BRI to predict OA, receiver operating characteristic (ROC) analysis was performed.ResultsThe analysis included 19,717 participants. Participants with OA had a significantly greater BRI than those without OA. Logistic regression analysis revealed a statistically significant positive correlation between the BRI and OA (OR = 1.18, 95% CI = 1.15–1.21, p-value <0.001). Despite the complete adjustment for covariates, this association remained stable (OR = 1.10, 95% CI = 1.04–1.17, p-value = 0.002). The results were corroborated by subgroup and sensitivity analyses, which demonstrated their robustness. Moreover, the BRI exhibited greater predictive accuracy for OA than did BMI.ConclusionThe BRI and OA are significantly associated in adults in the United States. The risk of developing OA may be increased by elevated levels of the BRI. Monitoring levels of the BRI is essential to prevent or reduce the prevalence and advancement of OA.

Objective:To evaluate the short term efficacy of 160 biological revision handle in femoral revision.Methods:The patients who underwent the femoral revision of Chunli 160? handle in Guangdong Hospital of Traditional Chinese Medicine from August 2017 to September 2019 were retrospectively analyzed. The clinical and imaging manifestations before and at the last follow-up were evaluated and compared with the patients who underwent the revision of Johnson’s Solution? handle at the same time. The efficacy score of artificial hip joint (Harris score) and the hip score of Oxford University were evaluated before and at the last follow-up (OHS score). The paired sample t test was used, and independent sample t test was used for inter-group comparison.Results:A total of 35 patients who met the criteria were enrolled with completed follow-up, including 18 patients in the Chunli 160? handle group (the observation group) and 17 patients in the Solution? handle group (the control group). The Harris score of the observation group increased from preoperative (34±8) to postoperative (72±7) (t =-13.91, P<0.001), the control group increased from preoperative (30±6) to postoperative (68±11) (t =-10.98, P<0.001). The OHS score of the observation group decreased from preoperative (30±8) to postoperative (16±9) (t =9.40, P <0.001). The OHS score of the control group decreased from preoperative (34±2) to postoperative (16±2) (t =16.05, P<0.001) There was no statistically significant difference in the postoperative Harris score and OHS score between the two groups (t =-1.41, 0.19, both P>0.05). Imaging showed that the prosthesis was firmly fixed, and there was no significant difference in prosthesis sinking distance and prosthesis loosening rating between the two groups (Z =-0.857, -0.474, both P>0.05) .Conclusions:The 160? biological revision handle performs well in the short-term follow-up of hip revision patients. The short-term curative effect is equivalent to that of solution handle, and the long-term curative effect needs to be further observed.

探讨单髁置换术(UKA)应用于膝骨性关节炎治疗的临床效果. 方法:将2014 年12 月 -2020年12月本院收治的149例膝骨性关节炎患者按手术方式的差异分为对照组( n=145 )和观察组( n=4 ).对照组采用全膝关节置换术( TKA)治疗,观察组采用UKA 治疗,比较2组手术相关指标、膝关节疼痛评分、膝关节功能恢复情况.结果:观察组术中出血量较对照组更少,手术时间较对照组更短,住院费用较对照组更低(P<0. 05);观察组术后膝关节生理性外翻角较对照组更小,而胫骨角、膝关节活动度均较对照组更大(P<0. 05);2组术后膝关节视觉模拟疼痛评分( VAS评分)、膝关节功能评分( HSS评分)比较差异无统计学意义(P>0. 05);2组术后下地时间、膝关节屈曲达90°所需时间、住院时间等术后恢复指标比较差异无统计学意义(P>0. 05);观察组术后生理及心理质量量表评分均较对照组明显更高(P<0. 05);2组术后假体松动、半月板衬套脱位、深静脉血栓、关节感染等并发症发生率比较差异无统计学意义( P>0 . 05 ).结论:临床应用UKA治疗膝骨性关节炎的效果理想,且创伤小、费用少、并发症少,有助于患者早期更快恢复及生活质量提升,值得临床推广.

Abstract Background Enhanced recovery after total knee arthroplasty (TKA) has been suggested to enhance postoperative recovery. The use of multimodal cocktail periarticular injection (MCPI) to control the pain of TKA has gained wide acceptance. MCPI containing corticosteroids is believed to be an effective solution because of its local anti-inflammatory effects and ability to reduce the local stress response postoperatively. However, there is conflicting evidence about its benefits. This trial aims to compare MCPI containing a high dose of corticosteroid, MCPI containing anormal dose of corticosteroid, and MCPI without a corticosteroid during TKA to assess the effectiveness of MCPI containing corticosteroid in postoperative pain relief, functional improvement, rescue analgesia and side effects. This will provide evidence regarding the effectiveness of high-dose corticosteroids on prolonged pain control and better recovery after total knee arthroplasty. Methods/design This trial is a double-blinded randomized, placebo-controlled study. A total of 234 patients will be randomized into 3 groups to receive a high dose of betamethasone MCPI (group H), a normal dose of betamethasone MCPI (group N), and a nonbetamethasone MCPI (group C). the following indexes will be recorded and analyzed: knee pain at rest and bending at 90° at 6 h, 24 h, 48 h, 72 h, 5 days, 14 days, and 30 days after surgery; 1-minute walking ability and circumference around patella at 2, 4, 7, 14, and 30 days after surgery; HSS score at 14 and 30 days after surgery; C-reactive protein and blood sedimentation as well as blood sugar at 2, 4, 7, 14, 30 days after surgery; additional morphine analgesics consumption; and side effects. Discussion The results from this study will provide clinical evidence on the effectiveness of MCPI-containing corticosteroids in postoperative pain relief, functional improvement, rescue analgesia, and side effects as well as evidence on the efficacy of high-dose corticosteroids for leading to prolonged pain control and better recovery after TKA. Trial registration Chinese Clinical Trial Registry ChiCTR2000038671. Registered on 27 September 2020

Enhanced recovery following total knee arthroplasty (TKA) has been advocated to enhance postoperative recovery. Multimodal cocktail periarticular injection (MCPI) use for pain control in TKA has gained wide acceptance. MCPI-containing corticosteroids are believed to be an effective solution owing to their local anti-inflammatory effects and ability to reduce the local stress response postoperatively. However, there is conflicting evidence regarding its benefits. This trial aims to compare MCPI with a high dose of corticosteroid, normal dose of corticosteroid, and non-corticosteroid during TKA, to assess the effectiveness of MCPI containing corticosteroids in postoperative pain relief, functional improvement, rescue analgesia, and side effects and provide evidence that high-dose corticosteroids result in prolonged pain control and better recovery following TKA. This is a double-blinded, randomized, placebo-controlled study. A total of 234 patients scheduled for TKA will be recruited. During surgery, before wound closure, 80 ml of the cocktail analgesic will be injected into the muscle and joint capsule for local infiltration analgesia; the participants will be randomly assigned to three groups to receive a high dose of betamethasone MCPI (group H), normal dose of betamethasone MCPI (group N), and non-betamethasone MCPI (group C). The following indices will be recorded and analyzed: the strongest knee pain experienced during 90° flexion at 6 h, 24 h, 48 h, 72 h, 5 days, 14 days, and 30 days after surgery; 1 min walking ability; and circumference around the patella at 2, 5, 14, and 30 days after surgery; Knee Society knee score at 14 days and 30 days after surgery; C-reactive protein and blood sedimentation; blood sugar 2, 5, 14, and 30 days following surgery; rescue analgesic consumption; and adverse events. If any participant withdraws from the trial, an intention-to-treat analysis will be performed. The results of this study will provide clinical evidence on the effectiveness of MCPI-containing corticosteroids in postoperative pain relief, functional improvement, rescue analgesia, and adverse events, as well as provide evidence on the efficacy of high-dose corticosteroids in prolonged pain control and better recovery following TKA. Chinese Clinical Trial Registry, ChiCTR2000038671 . Registered on September 27, 2020.

目的 探讨显微镜下通道技术治疗腰椎间盘突出症的临床疗效.方法 采用微创通道下靶点穿刺、显微镜下开窗摘除脱出髓核治疗20例单节段腰椎间盘脱出症患者.手术前后采用疼痛VAS评分评估疼痛程度,采用ODI评分进行功能评估.末次随访时采用MacNab标准评估临床疗效.结果 患者均获得随访,时间6～18个月.无手术并发症,切口均一期愈合.VAS评分术后3 d、2周、3个月及末次随访均较术前改善(P<0.05),术后各时间点比较差异均无统计学意义(P>0.05);ODI评分术后2周、3个月及末次随访均较术前改善(P<0.05),术后各时间点比较差异均无统计学意义(P>0.05).末次随访时,采用MacNab标准评定临床疗效:优16例,良2例,可2例,优良率为18/20.结论 显微镜下通道技术高速磨钻骨面开窗摘除脱出髓核治疗腰椎间盘突出症,手术简便,患者恢复快,临床效果满意.

目的 探讨椎间孔镜技术辅助抗生素治疗腰椎间隙感染的疗效.方法 回顾性分析我科2010年11月 ～2017年4月28例腰椎间隙感染,观察组采用经皮椎间孔镜技术辅助抗生素治疗腰椎间隙感染15例,对照组采用抗生素及卧床保守治疗13例腰椎间隙感染,比较2组治疗前和治疗后2周、1个月、3个月、末次随访疼痛视觉模拟评分(Visual Analogue Scale,VAS),日本骨科协会(Japanese Orthopaedic Association,JOA)评分及Oswestry功能障碍指数(Oswestry Disability Index,ODI),末次随访采用改良MacNab标准评价疗效.结果 观察组患者疼痛消失时间(3.6±1.3)周,明显短于对照组(7.1±0.7)周(t=-8.645,P=0.000);红细胞沉降率正常时间(4.4±1.7)周,显著短于对照组(9.8±1.1)周(t=-10.134,P=0.000);观察组C-反应蛋白转阴时间(3.6±1.3)周,显著短于对照组(8.2±0.9)周(t=-10.851,P=0.000).观察组治疗后2周、1个月、3个月疼痛VAS评分明显低于对照组(P<0.05),2组末次随访疼痛VAS评分无统计学差异(P>0.05);ODI和JOA评分组间、时间和组间与时间的交互作用差异均有显著性(P<0.05).28例随访12～24个月,平均13.7月,观察组和治疗组末次随访改良MacNab疗效优良率分别为93.3％(14/15)、76.9％(10/13),差异无显著性(Z=-1.270,P=0.204).

目的:探讨髋部骨折老年患者的入院水合状态对围术期急性并发症的影响.方法:2013年1月至2018年6月期间前瞻性调查了332例因髋部骨折住院的老年患者.根据急诊、住院期间首2次血浆渗透压的均值,将患者分为正常水合组(275～295 mmol·L-1)、脱水倾向组(295～300 mmol·L-1)、脱水组(＞ 300 mmol·L-1),比较各组患者住院期间压疮、下肢深静脉血栓、术后认知功能障碍、便秘等急性并发症的发生情况.结果:332例患者平均住院(15.88±5.71)d,其中脱水倾向患者占44.87％,脱水患者占22.28％,且随年龄增大脱水及脱水倾向患者增多(P＜0.05).年龄在75岁以下的脱水组患者中,53.84％发生压疮,57.69％发生术后认知功能障碍,79.92％发生便秘;年龄在75～90岁的脱水组患者中,48.71％发生压疮,71.79％发生术后认知功能障碍,82.05％发生便秘.同年龄段不同水合状态组间比较压疮、术后认知功能障碍、便秘发生率差异具有统计学意义(P＜0.05),但下肢深静脉血栓发生率差异无统计学意义(P＞0.05).结论:脱水、脱水倾向是老年人群髋部骨折后常见的病理水合状态,可增加住院期间发生压疮、术后认知功能障碍、便秘等急性并发症的风险.

目的:观察全膝关节置换术(total knee arthroplasty,TKA)后关节腔内追加注射混合镇痛液能否延长术后镇痛时间.方法:采用回顾性配对研究方法,以30例仅在TKA术中接受关节周围浸润注射混合镇痛液患者为对照组、30例在术后第2天还接受了关节腔内追加注射混合镇痛液的患者为观察组.术后第2、3、4、5、7天,记录患者的静息和屈膝90°时的视觉模拟量表(Visual Analogue Scale,VAS)评分、1 min步行距离;记录术后7 d患者追加镇痛药物盐酸曲马多的使用情况;记录患者的不良反应.结果:观察组患者在术后静息VAS评分、追加镇痛药物使用方面与对照组患者无显著差异,但在术后屈膝90°VAS评分和1 min步行能力方面较对照组患者有显著改善.结论:关节腔内追加注射混合镇痛液能显著改善TKA术后患者膝关节屈伸运动时的疼痛程度和步行能力.

目的 探讨经皮椎间孔镜技术联合射频消融术治疗腰椎椎间隙感染疾病的疗效及安全性.方法 回顾性分析自2016-11-2017-10诊治的15例腰椎椎间隙感染疾病,经皮椎间孔镜下病灶彻底清除、射频消融、置管引流,并辅助抗菌药物治疗.结果 15例手术均顺利完成,术中未出现手术并发症,术后腰腿疼痛症状得到明显缓解,睡眠质量得到明显改善.术后感染均得到控制,血红蛋白、血沉、C反应蛋白恢复正常.15例均获得随访,随访时间平均13.7(12～24)个月.术后3个月时JOA评分、ODI指数、疼痛VAS评分较术前明显改善,差异有统计学意义(P＜0.05).采用改良MacNab评分标准评定疗效:优10例,良4例,可1例.结论 经皮椎间孔镜技术联合射频消融术及抗菌药物治疗腰椎椎间隙感染疾病创伤小,病灶清除彻底,患者术后康复快,是一种安全有效的方法.

目的:探讨采用全髋置换术(THA)治疗成人髋关节发育不良(DDH)的临床疗效.方法:收集我院2015年1月-2017年6月的髋关节发育不良患者共40例,术前Harris评分为21-59分,平均为(45.41±5.43)分.患者均采用THA治疗,观察临床疗效及安全性.结果:本次研究40例患者中术后Harris评分为71-97分,平均为(85.45±4.67)分,较术前(45.41±5.43)分得到了提高(t=35.361,P<0.001).40例患者中未出现感染、脱位等并发症,术后伤口获得1期愈合.对患者进行随访,随访截止时间为2017年12月,患肢延长2.1-3.8cm,平均延长(3.12±0.84)cm,随访截止时间后无患者出现临近骨溶解及髋臼翻修的情况.结论:成人DDH患者采用THA治疗后,可有效地改善Harris评分,临床疗效及安全性较高,值得在临床中推广实施.

目的:分析评价锁定钢板内固定治疗复杂胫骨平台骨折的临床效果.方法:采取随机盲选法将高州市人民医院在2015年1月至2016年12月收治的60例复杂胫骨平台骨折患者分成两组,每组30例.其中,对照组患者采取传统钢板固定方法治疗,观察组患者采取锁定钢板内固定方法治疗,对两组患者的临床治疗效果进行评价.结果:在术后开始负重训练时间、骨折愈合时间以及住院时间上,观察组均明显短于对照组,差异具有统计学意义(P＜0.05).在膝关节功能康复优良率上,观察组为96.67％,与对照组的66.67％比较明显更高,差异具有统计学意义(P＜0.05).此外,观察组术后并发症发生率为10.00％,与对照组的26.67％比较明显更低,差异具有统计学意义(P＜0.05).结论:在临床中,针对复杂胫骨平台骨折患者,采取锁定钢板内固定治疗具备显著的疗效,可以改善患者的膝关节功能,降低术后并发症发生率,并加快骨折愈合时间及缩短住院时间.

目的 分析全髋关节置换术治疗股骨头坏死(ONFH)和髋关节发育不良(DDH)的疗效.方法 选取2015年9月至2018年1月我院收治的40例ONFH患者作为ONFH组,同期选取40例CroweⅠ型、 Ⅱ型DDH患者作为DDH组.两组患者均采用生物型全髋置换术治疗,分析比较两组患者的围术期相关指标、 手术前后Harris评分以及并发症发生率.结果 与DDH组比较,ONFH组的术中出血量较少,住院时间和首次下床行走时间较短,双下肢长度差异较小(P均<0.05).术后1个月、2个月、3个月,两组患者的Harris评分均显著高于术前,且ONFH组的Harris评分高于DDH组(P均<0.05).ONFH组的并发症发生率低于DDH组(P<0.05).结论 全髋关节置换术治疗ONFH和DDH均可明显改善患者的髋关节功能,促进其疾病转归,及早恢复正常生活.相对于ONFH,全髋关节置换术治疗DDH的并发症较多,恢复时间较长.

目的:分析唑来膦酸改善粗隆间骨折PFNA内固定术后患者的骨质和缓解骨折性疼痛的临床效果.方法:选取于2015年6月～2017年6月本院收治的40例粗隆间骨折(均行PFNA内固定)的患者作为研究对象.通过计算机随机抽选的方式进行分组,主要分为对照组和观察组2组.对照组(n=20)术后予以钙剂、骨化三醇治疗;观察组(n=20)在以上药物治疗的基础上增加唑来膦酸治疗.对比分析2组患者的骨密度改变、VAS评分及不良反应情况.结果:经治疗后,观察组患者的VAS评分、骨密度均显著优于对照组(P<0.05);其不良反应总发生率(15.00％)显著低于对照组(35.00％)(P<0.05).结论:对粗隆间骨折内固定术后的患者在予以钙剂和骨化三醇治疗的基础上增加唑来膦酸进行治疗,可有效提高药物疗效,降低老年粗隆间骨折内固定术后再次骨折的发生率,不仅可以有效缓解疼痛,还能提高患者的生活质量,具有很高的推广价值.

BACKGROUND:Cell therapy for the treatment of intervertebral disc degeneration (IDD) faces serious barriers since tissue-specific adult cells such as nucleus pulposus cells (NPCs) have limited proliferative ability and poor regenerative potential; in addition, it is difficult for exogenous adult stem cells to survive the harsh environment of the degenerated intervertebral disc. Endogenous repair by nucleus pulposus mesenchymal stem cells (NPMSCs) has recently shown promising regenerative potential for the treatment of IDD. Notochordal cells (NCs) and NC-conditioned medium (NCCM) have been proven to possess regenerative ability for the treatment of IDD, but this approach is limited by the isolation and passaging of NCs. Our previous study demonstrated that modified notochordal cell-rich nucleus pulposus (NC-rich NP) has potential for the repair of IDD. However, whether this can protect NPMSCs during IDD has not been evaluated.METHODS:In the current study, tumor necrosis factor (TNF)-α was used to mimic the inflammatory environment of IDD. Human NPMSCs were cocultured with NC-rich NP explants from healthy rabbit lumbar spine with or without TNF-α. Cell proliferation and senescence were analyzed to investigate the effect of NC-rich NP explants on TNF-α-treated NPMSCs. The expression of mRNA encoding proteins related to matrix macromolecules (such as aggrecan, Sox-9, collagen Iα, and collagen IIα), markers related to the nucleus pulposus cell phenotype (including CA12, FOXF1, PAX1, and HIF-1α), and senescence markers (such as p16, p21, and p53), senescence-associated proinflammatory cytokines (IL-6), and extracellular proteases (MMP-13, ADAMTS-5) was assessed. The protein expression of CA12 and collagen II was also evaluated.RESULTS:After a 7-day treatment, the NC-rich NP explant was found to enhance cell proliferation, decrease cellular senescence, promote glycosaminoglycan (GAG), collagen II, and CA12 production, upregulate the expression of extracellular matrix (ECM)-related genes (collagen I, collagen II, SOX9, and ACAN), and enhance the expression of nucleus pulposus cell (NPC) markers (HIF-1α, FOXF1, PAX1, and CA12).CONCLUSION:Modified NC-rich NP explants can attenuate TNF-α-induced degeneration and senescence of NPMSCs in vitro. Our findings provide new insights into the therapeutic potential of NC-rich NP for the treatment of IDD.