Abstract:The epidemiological survey of osteoporosis in Chinese residents released by the National Health Commission in 2018 showed that osteoporosis in the middle-aged and elderly people in China is serious with a prevalence of 19.2% among those over 50 years old and 32.0% among those over 65 years old, and more than 90.0% of the patients being unaware of their own diseases. For every 10% decrease in BMD, the risk of fracture increases by 2－3 times. The recovery of osteoporotic fracture is slow, the failure rate of internal fixation is high, and the social burden is large. This paper reviews systematically the prevention and treatment of osteoporotic fracture.

Abstract:Objective To analyze the clinical characteristics, failure causes and revision methods of the patients undergoing revision surgery after failure of internal fixation for intertrochanteric fractures. Methods Clinical data of 8 patients who underwent revision surgery after internal fixation of intertrochanteric fractures in the orthopedic department of our medical center from September 2012 to September 2014 were collected and retrospectively analyzed. Their medical and surgical records, results of postoperative follow-up examinations, X-ray film and other detailed clinical data were employed to analyze the failure causes for internal fixation. Revision surgical strategies were analyzed and proposed. Results Among the 2 patients treated with plate, 1 experienced broken plate and the other fracture nonunion. In the 6 patients treated with proximal femoral nail/proximal femoral nail anti-rotation (PFN/PFNA), there were 3 cases of nail cut-out, 1 of cut-through, 1 of back screw, and 1 of broken screw. The reasons for failure of internal fixation included inappropriate position of screw (5/6), loss of support from the medial/lateral wall of the femur (6/8), non-anatomical reduction (6/8), excess dissection of soft tissue (1/8), and infection (2/8). For reasons of failure, revision procedures included total hip arthroplasty (5/8), plate fixation (1/8), PFNA fixation (1/8), and PFN fixation (1/8). Among them, 2 patients were treated with antibiotic-loaded cement in the first stage due to bone infection, and 1 patient was treated with autologous cancellous bone graft because of poor bone quality. Conclusion Failure of intertrochanteric fracture internal fixation attributes to multiple risk factors, mainly including inappropriate position of screw, poor reduction and loss of support of the medial/lateral wall of the femur. Therefore, anatomical reduction, proper selection and good placement of implants are important measures to prevent the failure of intertrochanteric fracture internal fixation. According to the reason of failure and condition of the patients, we need to choose an appropriate revision surgery procedure.

Abstract:Objective To compare the short-term clinical effects of total hip arthroplasty with dual-mobility cup and hemiarthroplasty for the elderly femoral neck fracture. Methods Forty-seven elderly patients with femoral neck fracture admitted in our department from June 2016 to June 2019 were enrolled in this study. According to the surgical treatments, they were divided into observation group (total hip arthroplasty with dual-mobility cup, n=19) and control group (hemiarthroplasty, n=28). The operation time, blood loss volume, and length of hospital stay, Harris hip score (HHS), incidence of complications, and postoperative mortality within 1 year were recorded and evaluated, and compared between the two groups. Results All patients were followed up for 9 to 40 months (mean 23 months). The operation time and blood loss were better in the control group than the observation group, but no significant difference was seen in length of hospital stay between the two groups (P<0.05). The postoperative HHS scores were improved in both groups after operation. The observation group had better HHS scores than the control group at the subsequent follow-up time points, and obtained predominantly better excellent rates of hip function recovery till the last follow-up. The incidence of postoperative complications was 5.3%(1/19) in the observation group and 17.9%(5/28) in the control group, and the mortality within 1 year was 5.3%(1/19) in the former and 7.1%(2/28) in the latter group, with significant difference between them (P>0.05). Conclusion Hemi-arthroplasty has the advantages of short operation time, less blood loss and simple operation, but the rates of postoperative hip pain, dislocation and reoperation are higher than those of dual-mobility total hip arthroplasty, which can also provide better joint function and prosthesis stability. So we recommend the latter operation to be the first choice for femoral neck fracture in the elderly.

Abstract:Objective To evaluate the clinical efficacy of percutaneous kyphoplasty (PKP) with “trailing sign” anchoring bone cement in the treatment of senile patients with Kummell′s disease. Methods A retrospective study was carried out on 33 aged patients with Kummell′s disease in our department from August 2014 to August 2017. According to the surgical procedure, they were divided into observation group (treated by PKP with “trailing sign”, n=16) and control group (routine PKP, n=16). The incidence rates of intra- and post-operative complications were compared between the 2 groups. All patients were followed up for 24 months. Oswestry disability index (ODI), visual analogue scale (VAS) score and Cobb′s angle before and at 1d and 24 months after surgery were compared between the 2 groups. SPSS statistics 18.0 was used to perform the statistical analysis. Student′s t test or Chi-square test was employed for comparison between the two groups. Results The operations were successfully completed on all 33 patients. There were no statistical differences in operation time [(55.46±7.63) vs (53.56±8.54)min] and amount of cement used [(5.8±0.6) vs (5.6±0.8)ml] between the two groups (P>0.05). In 24 months after surgery, the Cobb angle [(14.23°±1.85°) vs (17.54°±2.02°)] was statistically decreased, while the anterior height [(1.75±0.42) vs (1.39±0.61)cm] and midline height [(1.69±0.61) vs (1.35±0.34)cm] of injured vertebrae were increased significantly in the observation group than the control group (all P<0.05). The former group had obviously lower incidence rate of post-operative complications than the latter group [6.3%(1/16) vs 41.2%(7/17), P<0.01]. Conclusion Both PKP with “trailing sign” and routine PKP can achieve good short-term outcome in the treatment of Kummell′s disease in the elderly, but the former procedure effectively reduces the risk of bone cement displacement in long-term follow-up.

Abstract:Objective To compare the effectiveness of locking plate combined with minimally invasive plate osteosynthesis (MIPO) and intramedullary nailing in the treatment of proximal humeral fractures in the elderly. Methods The clinical data of 51 elderly patients with displaced proximal humeral fracture treated in our department from January 2018 to January 2019 were collected and analyzed retrospectively. According to the treatment, they were divided into MIPO group (n=29) and intramedullary nailing group (n=22). The perioperative indexes, visual analogue scale (VAS) score at 12 h postoperatively and incidence of complications were compared between the two groups. Constant-Murley scale was performed at 3,6 and 12 months after operation to evaluate the function of shoulder joint. SPSS statistics 13.0 was used for statistical analysis. Student′s t test or Chi-square test was employed for data com-parison between the two groups. Results The two groups both had smaller incision length [(7.3±2.7) vs (7.3±2.6)cm], less amount of intraoperative bleeding [(79.7±25.7) vs (78.3±21.4)ml], shorter operation time [(64.1±17.2) vs (62.5±14.6)min], and lower VAS score at 12h post-operatively [(2.47±0.81) vs (2.44±0.69)], and there was no significant differences between the two groups (P>0.05). No statistical difference was seen in Constant-Murley score between the two groups at 3,6 and 12 months after operation (P>0.05). However, the incidence of postoperative complications was significantly higher in the MIPO group than the intramedullary nailing group [17.24%(5/29) vs 9.09%(2/22), P<0.05]. Conclusion Both locking plate combined with MIPO technology and intramedullary nail fixation can achieve better effectiveness in the treatment of proximal humeral fractures in the elderly. The latter procedure is superior to the former one in the control of complications.

Abstract:Objective To compare the clinical efficacy of minimally invasive surgery with preservation of palmar side of pronator quadratus versus traditional Henry approach in the treatment of distal radius fractures in the elderly. Methods A retrospective study was carried out on 46 elderly patients with distal radius fracture treated in our department from January 2016 to January 2019. The patients were divided into minimally invasive group and control group, with 23 cases in each group. The minimally invasive group was treated by internal fixation with locking plate and screw and preservation of pronator quadratus, while the control group was treated with traditional open Henry volar approach of pronator quadratus muscle combined with internal fixation of plate and screw. The length of incision, intraoperative bleeding volume, complications, length of hospital stay, reduction of fracture and wrist joint function in 3 months after operation were compared between the two groups. SPSS statistics 20.0 was used to perform the statistical analysis. Student′st test or Chi-square test was employed in intergroup comparison for different data types. Results Compared with the control group, the incision length [(2.4±0.3) vs (7.2±1.4)cm] and the intraoperative bleeding volume [(13.2±2.1) vs (31.2±4.1)ml] were significantly less, and postoperative length of hospital stay [(4.6±0.9) vs (7.5±1.2)d] was obviously shorter in the minimally invasive group (P<0.05). No postoperative complications occurred in both groups. The visual analogue scale (VAS) scores of the patients were notably lower in the minimally invasive group than the control group [(0.5±0.2) vs (2.2±0.4), P<0.05], while the rates of the patients with better Gartland-Werley scores (95.65% vs 73.91%) and the wrist pronation angles [(83.8°±10.8°)vs (74.6°±9.5°)] were significantly larger in the former group than the latter group (P<0.05). Conclusion Minimally invasive surgery with preservation of palmar side of pronator quadratus and internal fixation with locking plate and screw exerts good efficacy in the treatment of distal radius fractures in the elderly, with small incision, less intraoperative bleeding, and sound overall wrist function in 3 months after operation.

Abstract:With the increasing morbidity of fragility fractures of the pelvis due to aging, the disease becomes a rising concern in medical professionals. Low bone density, impairments in activities of daily living, and propensity to fall are the main risk factors of pelvic fractures among the elderly. Considering the characteristics of fragility fractures and its significances in the options of treatments, Rommens and his colleagues developed a comprehensive classification system for fragility fractures of the pelvis. Based on this new classification system, we thereby introduce the progresses in radiological examination and minimally invasive surgical treatment for fragility fractures of the pelvis.

Abstract:Objective To study the risk factors for new cardiac adverse events during post-operative hospitalization in the elderly patients with hip fracture. Methods A retrospective analysis was conducted on the elderly patients over aged 65 years with hip fracture undergoing surgical treatment in Beijing Geriatric Hospital from July 2014 to June 2018. Their baseline data, preoperative complications and anesthetic modes were collected and analyzed for the clinical features and risk factors of new cardiac adverse events during hospitalization. The data were processed with SPSS statistics 22.0. Multivariate logistic regression analysis was used to analyze the statistically significant indices found by univariate logistic regress analysis. Results A total of 418 patients were enrolled in this study, and they are at a mean age of (76.7±9.2) years and had an average length of hospital stay of (13.2±6.8) d. There were 56 cases reporting new adverse cardiac events during hospitalization (13.4%, cardiac events group). Three patients died due to cardiac events, accounting for 0.72% (3/418). And the left 362 cases were assigned into the non-cardiac events group. Significant differences were seen in the ratios of patients with abnormal electrocardiogram, left ventricular ejection fraction ≥50%, hemoglobin ≥90g/L, albumin ≥33g/L, pro-B-type natriuretic peptide ≥450 pg/ml, general anesthesia and electrolyte disturbance after operation between the cardiac and non-cardiac events groups (P<0.05). Multivariate logistic analysis showed that the history of cardiovascular diseases (OR=13.58, 95%CI 10.12-21.39; P<0.01), combination of basic diseases of internal medicine (except cardiovascular system) >4 (OR=5.28,95%CI 1.21-15.25; P<0.01), ASA grade Ⅲ/Ⅳ(OR=4.01,95%CI 3.24-10.34; P<0.01), age >70 years(OR=2.86, 95%CI 1.05-7.55; P<0.05), serum albumin <33g/L (OR=2.61,95％CI 1.23-5.51; P<0.01), hemoglobin <90g/L (OR=1.81,95%CI 1.03-6.21; P<0.01), electrolyte disturbance (OR=1.11,95%CI:1.02-2.34; P<0.01) were independent risk factors for new cardiac adverse events in elderly patients after operation for hip fracture. Conclusion Cardiac adverse events after hip fracture surgery in the elderly are the result of multiple factors. Special attention should be paid to those with history of cardiovascular diseases.

Abstract:Objective To analyze affecting factors of multidrug-resistant (MDR) bacterial infection in elderly patients with acute attack of chronic bronchitis with a view of providing reference for clinical prevention and control. Methods The clinical data were retrospectively reviewed of 313 elderly patients with acute attack of chronic bronchitis from September 2015 to May 2019. Infection rate and distribution of infectious strains were analyzed. SPSS statistics 19.0 was used for statistical analysis. Univariate and multivariate regression analysis were performed to identify independent affecting factors of MDR bacterial infections in elderly inpatients with acute attack of chronic bronchitis. Results Of 313 elderly inpatients with acute attack of chronic bronchitis, MDR bacterial infection was detected in 107(34.19%). A total of 301 pathogenic bacteria were isolated from clinical specimens, 118(39.20%) being multidrug resistant. Univariate analysis showed that age ≥70 years, history of diabetes mellitus, combined use of antibiotics ≥ 3 kinds in the past 6 months before admission, length of hospital stay ≥ 14d, pulmonary heart disease, admission to Intensive Care Unit (ICU), glycosylated blood protein >7%, types of antibiotics ≥ 3 kinds after admission, combined use of antibiotics after admission ≥ 3 kinds,fasting blood glucose ≥ 11.1mmol/L, the time of using antibiotics after admission > 7d were the risk factors of MDROs infectionin elderly patients with chronic bronchitis at acute stage (P<0.05), while oral care and aerosol inhalation were the protective factors of MDROs infection in elderly patients with chronic bronchitis at acute stage (P<0.05). Multivariate logistic regression analysis showed that the independent risk factors of MDROs infection were age>70 years, combined use of antibiotics>3 kinds within 6 months before admission, admission to ICU, glycosylated menstrual protein>7%, and combining used antibiotics>3 kinds after admission (P<0.05). Conclusion MDR bacterial infection in elderly inpatients with acute attack of chronic bronchitis is associated with many factors, and infection rate can be reduced by controlling blood sugar, reducing complications of pulmonary heart disease, paying attention to the recent use of antibiotics before admission, reducing unnecessary admission to ICU, and rational use of antibiotics.

Abstract:Objective To investigate the effect of stress-induced hyperglycemia on the prognosis of the patients after operation for severe craniocerebral injury. Methods A retrospective study was conducted on the patients with severe craniocerebral injury confirmed by radiological imaging and Glasgow Coma score (GCS score, 3 to 8 points), who were admitted to our hospital from January 2016 to December 2018. After surgical treatment, all the patients were transferred to the intensive care unit (ICU) for further treatment, and were divided into normoglycemia group, stressinduced hyperglycemia group and diabetes mellitus group. The 28-day mortality, length of ICU stay, and complications were compared among the three groups. SPSS statistics 16.0 was used to perform the statistical analysis. Data were expressed as mean±standard deviation (±s), median and interquartile range [M(Q₁, Q₃)], or number of cases (percentage). According to the data type, one-way analysis of variance, SNK-q test, Kruskal-Waills rank sum test, Chi-square test or Fisher exact probability test were employed for comparison. Survival data were analyzed using Kaplan-Meier method to draw survival curves, and intergroup comparison of survival rates was performed using Log-rank test. Cox regression model was applied to analyze the risk factors affecting prognosis. Results A total of 165 patients were enrolled, with 55 in each group. Kaplan-Meier survival analysis showed that the 28-day cumulative survival rate was significantly lower in the stress-induced hyperglycemia group than thenormoglycemia group and the diabetes mellitus group. The 28-day mortality rate was obviously higher in the stress-induced hyperglycemia group [43.27%, (26/55)] followed by the diabetes mellitus group [23.64%, (13/55)] and the normoglycemia group [18.18%, (10/55)] sequentially. The mortality of the stress-induced hyperglycemia group was significantly higher than those of the other 2 groups (both P<0.05). But no such difference was seen between the normoglycemia group and the diabetes mellitus group (P>0.05). The incidence of pulmonary infection within 4 weeks were notably higher in the stress-induced hyperglycemia group than the normoglycemia group [58.18%(32/55) vs 34.55%(19/55), P<0.05], and was higher than the diabetes mellitus group [49.10%(27/55)], but the difference was not statistically significant (P>0.05). There were no remarkable differences in the incidences of complications, such as intracranial infection, secondary cerebral infarction, deep venous thrombosis of the lower extremity, acute renal failure and ICU stay length among the 3 groups (P>0.05). Multivariate Cox proportional hazard regression analysis showed that stress-induced hyperglycemia was one of the risk factors affecting prognosis (HR=1.16,95%CI:1.07-1.26). Conclusion The 28-day mortality rate is significantly higher in the patients with severe craniocerebral injury complicated with stress-induced hyperglycemia than those with normoglycemia and diabetes history, suggesting that stress-induced hyperglycemia is a risk factor for prognosis.

Abstract:Objective To investigate the expression levels of N-terminal pro-B-type natriuretic peptide (NT-proBNP), high-sensitivity C-reactive protein (hs-CRP) and cluster of differentiation 137 (CD137) in patients with acute myocardial infarction and their relationship with left ventricular remodeling (LVR). Methods A total of 124 hospitalized patients diagnosed with acute myocardial infarction were recruited from the Department of Cardiology of Yixing People′s Hospital from January 2017 to May 2018. Blood routine indicators, biochemical indicators, myocardial enzymes, serum troponin T (cTNT), NT-proBNP, hs-CRP and serum CD137 were routinely detected at admission, and echocardiography was performed during hospitalization and in 12 months after discharge. According to the results of echocardiography in 12 months′ follow-up, the patients were divided into LVR group (n=38) and non-LVR group (n=86). SPSS statistics 16.0 was used for data analysis. Pearson correlation analysis was applied for correlation analysis. Multivariate binary logistic regression analysis was used to analyze the independent risk factors of LVR, and receiver operating characteristic (ROC) curve was employed to evaluate the predictive value of NT-proBNP, hs-CRP and serum CD137 for LVR. Results NT-proBNP, hs-CRP and serum CD137 in the LVR group were significantly higher than those in non-LVR group at admission (P<0.05). Pearson correlation analysis showed that NT-proBNP (r=0.419), hs-CRP (r=0.209) and serum CD137 (r=0.604) were positively correlated with the increase of left ventricular end-diastolic diameter (all P<0.05). Binary logistic regressionanalysis showed that NT-proBNP, hs-CRP and serum CD137 levels were independent risk factors for LVR after acute myocardial infarction (P<0.05). The area under the ROC curve (AUC) of NT-proBNP, hs-CRP and serum CD137 levels in prediction of LVR occurrence was 0.753,0.722 and 0.690, respectively, and the AUC of the combined prediction of the 3 indicators was 0.805 (all P<0.05). Conclusion NT-proBNP, hs-CRP and serum CD137 levels are closely associated with LVR after acute myocardial infarction. The combined detection of them may be of certain predictive value for LVR.

Abstract:Objective To investigate the efficacy of His bundle pacing in patients with heart failure via a meta-analysis. MethodsDatabases (Cochrane Library, PubMed, Embase, Wanfang Database, VIP Database, CNKI Database, Sinomed) were searched to select the studies that meet the inclusion criteria and evaluate the efficacy of His bundle pacing in patients with heart failure. Data were collected and analyzed of QRS duration, left ventricular ejection fraction, pacing threshold at baseline and follow-up. Analysis was performed using Stata 12.0. Results A total of 14 studies were included, enrolling 539 patients with heart failure (mean age:70.9 years). Meta-analysis showed that His bundle pacing significantly shortened the QRS duration (WMD=-51.51ms, 95%CI =-59.50 to -43.52, P<0.01) and improved left ventricular ejection fraction (WMD=10.91%, 95%CI=7.55 to 14.27, P<0.01). However, compared with baseline, His bundle capture threshold tended to be higher (WMD=0.26V, 95%CI=0.15 to 0.36, P<0.01). Conclusion His bundle pacing can significantly improve cardiac function in patients with heart failure. More large-scale clinical randomized controlled trials are needed in the future to confirm the efficacy of His bundle pacing in such patients.

Abstract:Objective To investigate the clinical efficacy of reteplase in the treatment of elderly patients with cerebral infarction. Methods A total of 64 elderly patients with cerebral infarction from September 2018 to March 2019 were randomly divided into study group and control group. The study group were treated with reteplase, and the control group with alteplase. After the treatment, the two groups were evaluated using National Institute of Health Stroke Scale (NIHSS), and adverse reactions were recorded. The recovery of the patients′ neurological function was measured by the modified Rankin scale (MRS), and survival rate was analyzed during three months of follow-up. Serum superoxide dismutase (SOD) and malondialdehyde (MDA) were assessed by ELISA before and after thrombolytic therapy. The data were statistically analyzed by SPSS statistics 20.0. The comparison between the two groups was performed by t/χ² test. Survival analysis was estimated by Kaplan-Meier method and tested by Log-rank test. Results NIHSS score was lower in study group than in the control group (P<0.05) at 3d, 7d, 30 d of thrombolysis, and the overall effective rate was higher in the former than in the latter [(93.55%(29/31) vs 77.78%(21/27);χ²=10.631, P=0.001]. After 3 months of treatment, no obvious disability was observed in 62.5%(20/32) of the study group, which was significantly higher than 43.75%(14/32) of the control group (χ²=6.816, P=0.009). The 3-month survival rate of the study group was higher than that of the control group (P<0.05). Adverse reactions such as bleeding occurred in both groups, but with no significant difference between the two groups (P>0.05). Compared with before treatment, SOD significantly increased and MDA significantly decreased (P<0.05) in both groups after treatment. SOD increased more significantly and MDA decreased more significantly in the study group than in the control group (P<0.05). Conclusion Reteplase treatment can improve the prognosis of patients with cerebral infarction without increasing the incidence of adverse reactions, and its mechanism may be related to inhibition of oxidative stress reaction.

Abstract:Objective To investigate the effect of total saponins of Dioscorea pathaica (TSDP) on cardiac senescence induced by advanced glycation end-products (AGEs) and its mechanism. Methods Neonatal rat cardiomyocytes were incubated with different concentrations of TSDP, and cell viability was measured by Cell Counting Kit-8 (CCK-8). AGEs were added 2h after the cells were pre-treated with TSDP. Western blotting was used to detect levels of silent mating type information regulation 2 homolog-3 (SIRT3), superoxide dismutase-2 (SOD2), and aging-related p53 and p15. 2,7-Dichlorodi-hydrofluorescein diacetate (DCFH-DA) was used to detect intracellular reactive oxygen species (ROS). Results Compared with the control group, the activity of SA-β-Gal and the level of p53 and p16 increased, the production of ROS increased, and the expression of SOD2 and SIRT3 decreased in the AGEs group, the differences being statistically significant (P<0.05). Compared with the AGEs group, the activity of SA-β-Gal decreased, ROS increased, SIRT3 and SOD2 protein levels increased, and p53 and p16 decreased in the TSDP pre-treatment group, differences being statistically significant (P<0.05). Conclusion TSDP has protective effects on AGEs-induced cardiomyocyte aging, and its mechanism may be related to the increase of SIRT3 and regulation of oxidative stress.

Abstract:Extracorporeal circulation (ECC) is a mature life support technology used for cardiac surgery, and its invention made it possible to cut open the heart and large blood vessels for direct vision surgery. Besides effects of the surgery, however, ECC-induced injuries on such important organs as the heart is the critical influencing factors of the patient′s prognosis. In case of serious injury, postoperative prognosis can be significantly affected. Over the decades, enhanced proactive measures have attenuated the extent of the myocardial injury, but decline in cardiac function exists because of the technical characteristics of ECC itself. This article reviews the pathological mechanism of ECC-induced myocardial injury and feasible measures to attenuate its extent.