Objective To evaluate effectiveness of proximal femur bionic nail (PFBN) in treatment of intertrochanteric fractures in the elderly compared to the proximal femoral nail antirotation (PFNA). Methods A retrospective analysis was made on 48 geriatric patients with intertrochanteric fractures, who met the selection criteria and were admitted between January 2020 and December 2022. Among them, 24 cases were treated with PFBN fixation after fracture reduction (PFBN group), and 24 cases were treated with PFNA fixation (PFNA group). There was no significant difference in baseline data such as age, gender, cause of injury, side and type of fracture, time from injury to operation, and preoperative mobility score, American Society of Anesthesiologists (ASA) score, Alzheimer’s disease degree scoring, self-care ability score, osteoporosis degree (T value), and combined medical diseases between the two groups (P>0.05). The operation time, intraoperative blood loss, number of blood transfusions, transfusion volume, length of hospital stay, occurrence of complications, weight-bearing time after operation, and postoperative visual analogue scale (VAS) score, walking ability score, mobility score, self-care ability score were recorded and compared between the two groups. And the radiographic assessment of fracture reduction quality and postoperative stability, and fracture healing time were recorded. ResultsThe operations in both groups were successfully completed. All patients were followed up 6-15 months with an average time of 9.8 months in PFBN group and 9.6 months in PFNA group. The operation time was significantly longer in PFBN group than in PFNA group (P<0.05), but there was no significant difference in intraoperative blood loss, number of blood transfusions, transfusion volume, length of hospital stay, change in activity ability score, and change in self-care ability score between the two groups (P>0.05). The weight-bearing time after operation was significantly shorter in PFBN group than in PFNA group (P<0.05), and the postoperative VAS score and walking ability score were significantly better in PFBN group than in PFNA group (P<0.05). Radiographic assessment showed no significant difference in fracture reduction scores and postoperative stability scores between the two groups (P>0.05). All fractures healed and there was no significant difference in fracture healing time between the two groups (P>0.05). The incidence of complications was significantly lower in PFBN group (16.7%, 4/24) than in PFNA group (45.8%, 11/24) (P<0.05). ConclusionCompared with PFNA, PFBN in the treatment of elderly intertrochanteric fractures can effectively relieve postoperative pain, shorten bed time, reduce the risk of complications, and facilitate the recovery of patients’ hip joint function and walking ability.
Objective To investigate the safety of nano-hydroxyapatite/polyamide 66 (n-HA/PA66) bioactive support in bone grafting and fusion for elderly patients with lumbar tuberculosis, and to analyze its effectiveness and advantages by comparing with autologous iliac bone grafting. Methods A retrospective analysis was performed on 48 elderly patients with lumbar tuberculosis who met the selection criteria between January 2017 and January 2020. The patients all underwent one-stage posterior pedicle screw internal fixation combined with anterior lesion removal and bone grafting and fusion, of which 23 cases applied n-HA/PA66 bioactive support+allogeneic bone graft (n-HA/PA66 group) and 25 cases applied autologous iliac bone graft (autologous iliac bone group). There was no significant difference between the two groups in gender, age, bone density, disease duration, lesion segment, and preoperative pain visual analogue scale (VAS) score, Japanese Orthopaedic Association (JOA) score, and Cobb angle (P>0.05). The operation time, intraoperative blood loss, and postoperative complications, as well as the VAS score, JOA score, American Spinal Injury Association (ASIA) spinal cord injury grading, Cobb angle, and bone fusion were recorded and compared between the two groups. Results The operations were completed successfully in both groups. n-HA/PA66 group had significantly less operation time and intraoperative blood loss than the autologous iliac bone group (P<0.05). All patients were followed up 12-24 months, with an average of 15.7 months. And the difference in follow-up time between the two groups was not significant (P>0.05). Postoperative complications occurred in 3 cases (13%) in the n-HA/PA66 group and 10 cases (40%) in the autologous iliac group, and the difference in the incidence of complications between the two groups was significant (χ2=4.408, P=0.036). The postoperative VAS scores and JOA scores significantly improved when compared with the preoperative scores in both groups (P<0.05), and the difference was significant (P<0.05) between 2 weeks after operation and the last follow-up. The difference in VAS score at 2 weeks after operation was significant between the two groups (P<0.05), and there was no significant difference (P>0.05) at the other time points. At last follow-up, according to the ASIA grading, the effective improvement rate was 86% (18/21) in the n-HA/PA66 group and 90% (18/20) in the autologous iliac group, with no significant difference (χ2=0.176, P=0.675). Imaging review showed that grade Ⅰ bony fusion was obtained in both groups, and the fusion time of bone graft in the n-HA/PA66 group was significantly longer than that in the autologous iliac bone group (P<0.05). There was no significant difference in the Cobb angle at each time point between the two groups (P>0.05). No recurrence of tuberculosis, loosening or fracture of the internal fixator, or displacement of the bone graft was observed during follow-up. Conclusion In elderly patients with lumbar spine tuberculosis, the n-HA/PA66 bioactive support combined with allogeneic bone graft can effectively restore and maintain the fusion segment height and physiological curvature of the lumbar spine, and the fusion rate of bone graft is similar to that of autologous iliac bone, which can achieve better effectiveness.
Objective To compare the effectiveness of locking plate and intramedullary nail in treatment of Neer two- and three-part fractures of the proximal humerus in the elderly. Methods A retrospective analysis was conducted on 86 elderly patients with Neer two- and three-part fractures of the proximal humerus met the selection criteria between January 2015 and December 2018. Forty-six patients were treated with locking plate fixation (locking plate group), and 40 patients with intramedullary nail fixation (intramedullary nail group). There was no significant difference in gender, age, cause of injury, fracture side and type, time from injury to operation, and comorbidities between the two groups (P>0.05). Visual analogue scale (VAS) score, American Shoulder and Elbow Surgery (ASES) score, Constant-Murley score, and shoulder range of motion (forward flexion, abduction, and external rotation) were compared between the two groups. X-ray films were taken to assess the fracture healing, and the neck-shaft angle was measured at 2 days after operation and at last follow-up, and the difference between the two time points was calculated. Results Patients in both groups were followed up 18-40 months, with an average of 30.4 months. There was no significant difference in follow-up time between the two groups (t=?0.986, P=0.327). X-ray films reexamination showed that the fractures of two groups healed, and the healing time was (11.3±2.1) weeks in locking plate group and (10.3±2.0) weeks in intramedullary nail group, which had significant difference between the two groups (t=2.250, P=0.027). The difference of neck-shaft angle was (7.63±7.01)° in locking plate group and (2.85±2.82)° in intramedullary nail group, which had significant difference between the two groups (t=4.032, P<0.001). There was no significant difference in Constant-Murley score, ASES score, VAS score, and shoulder range of motion between the two groups at last follow-up (P>0.05). Complications occurred in 13 cases (28.3%) of locking plate group and in 4 cases (10.0%) of intramedullary nail group, and the difference between the two groups was significant (χ2=4.498, P=0.034). Conclusion Both locking plates and intramedullary nails can be used for the treatment of Neer two- and three-part fractures of the proximal humerus in the elderly. The intramedullary nail fixation surgery is more minimally invasive, which has fewer postoperative complications and faster fracture healing.
To observe the effects of ultrasound-guided stellate ganglion block (SGB) on cerebral oxygen metabolism and postoperative cognitive dysfunction (POCD) of elderly patients, we collected 80 elderly patients undergoing selective coronary artery bypass graft under cardiopulmonary bypass. The Mini Mental State Examination (MMSE) was applied to test the cognitive function. The SjvO2, Da-jvO2 and CEO2 were used for the analysis of the cerebral oxygen metabolism. We found that POCD was related to disequilibrium of cerebral oxygen metabolism. Ultrasound-guided SGB before surgery reduced the incidence of POCD because of the improvement of cerebral oxygen metabolism.
Objective To investigate the relationship between the Clinical Frailty Scale (CFS) and prognosis in elderly patients with pelvic fractures who are treated conservatively. Methods Patients aged ≥65 years admitted to Chengdu Pidu District People’s Hospital between January 2015 and January 2023 with low-energy pelvic-ring fractures (Tile type A/B) who received non-operative management were retrospectively collected. The patients were stratified by CFS score on admission into robust (CFS 1-3), vulnerable (CFS 4), and frail (CFS 5-9) groups. Baseline characteristics (age, sex, smoking history, alcohol use, and so on) and outcomes (complications, discharge destination, and in-hospital mortality) were compared among groups. Binary logistic regression was used to assess the association between CFS and outcomes. Results A total of 197 patients were enrolled: 78 robust, 59 vulnerable, and 60 frail. Significant differences were observed among the robust, vulnerable, and frail groups in age [(68.72±2.53), (71.47±3.53), and (73.25±2.33) years, respectively; P<0.05], incidence of complications (28.2%, 33.9%, and 56.7%, respectively; P<0.05), and incidence of adverse discharge destinations (15.4%, 25.4%, and 38.3%, respectively; P<0.05). Logistic regression analysis revealed that frailty (CFS 5-9 vs. 1-3) was an independent predictor of any complications [odds ratio (OR)=3.342, 95% confidence interval (CI) (1.390, 8.037), P=0.007] and adverse discharge destination [OR=4.871, 95%CI (1.762, 13.469), P=0.002]. Conclusion CFS-assessed frailty correlates with the adverse discharge destination and any complication in elderly patients undergoing conservative treatment for pelvic fractures.
ObjectiveTo investigate the effect of the screw blade position on the effectiveness of proximal femoral nail anti-rotation (PFNA) internal fixation for unstable intertrochanteric fractures in the elderly.MethodsA clinical data of 131 elderly patients with unstable intertrochanteric fractures who were treated with PFNA internal fixation between January 2010 and January 2017 was retrospectively analyzed. According to the anteroposterior X-ray films, the screw blades were placed in the middle of the femoral neck in 72 patients (group A) and at one-third of the femoral neck in 59 patients (group B). There was no significant difference between the two groups (P>0.05) in the gender, age, bone density, classification of fractures, other medical diseases, and the time between injury and operation. Multiple treatment indexes were analyzed, including complications, hip Harris score, the healing status of fracture, tip-apex distance (TAD), and the height of the tail nail.ResultsAll patients were followed up 11-14 months, with an average of 12.1 months. All incisions healed by first intention with no complications. All fractures healed and no significant difference in bone healing time between the two groups (Z=?0.190, P=0.849). At 6 months after operation, TAD was (2.23±0.07) cm in group A and (2.85±0.12) cm in group B, showing significant difference (t=?47.643, P=0.000); and the height of the tail nail was (1.72±0.14) cm in group A and (0.53±0.26) cm in group B, showing significant difference (t=31.031, P=0.000). According to the Harris score, the hip functions were rated as excellent in 48 cases, good in 15 cases, and poor in 9 cases in group A, while as excellent in 38 cases, good in 16 cases, and poor in 5 cases in group B, with no significant difference between the two groups (Z=?0.075, P=0.941).ConclusionFor the unstable intertrochanteric fracture in the elderly, the PFNA internal fixation with appropriated TAD and the screw blades placed in the middle or at one-third of the femoral neck can obtain good effectiveness.
ObjectiveTo investigate the early effectiveness of the Ti-Robot assisted femoral neck system (FNS) in the treatment of elderly Garden type Ⅱ and Ⅲ femoral neck fractures. Methods A retrospective analysis was conducted on the clinical data of 41 elderly patients with Garden type Ⅱ and Ⅲ femoral neck fractures who were admitted between December 2019 and August 2022 and met the selection criteria. Among them, 21 cases were treated with Ti-Robot assisted FNS internal fixation (study group), and 20 cases were treated solely with FNS internal fixation (control group). There was no significant difference in baseline data, including gender, age, side, cause of injury, time from injury to surgery, fracture Garden classification, and fracture line classification, between the two groups (P>0.05). Surgical effectiveness was evaluated based on parameters such as operation time (including incision time and total operation time), reduction level, number of dominant pin insertions, intraoperative fluoroscopy frequency, incision length, whether to extend the incision, need for assisted reduction, postoperative hospital stay, fracture healing time, incidence of osteonecrosis of the femoral head, postoperative visual analogue scale (VAS) score at 1 day, and Harris hip score at last follow-up. Results The study group showed significantly shorter incision time, fewer dominant pin insertions, fewer instances of extended incisions, fewer intraoperative fluoroscopy frequency, and smaller incisions than the control group (P<0.05). There was no significant difference in total operation time, reduction level, and assisted reduction frequency between the two groups (P>0.05). Both groups achieved primary wound healing postoperatively, with no complications such as incision leakage or skin infection. All patients were followed up 12-24 months with an average of 14.6 months. Fractures healed in both groups, with no significant difference in healing time (P>0.05). There was no significant difference in postoperative hospital stay between the two groups (P>0.05). The study group showed significantly better VAS score at 1 day after operation and Harris hip score at last follow-up when compared to the control group (P<0.05). No complication such as internal fixation failure, fracture displacement, or hip joint varus occurred in both groups during the follow-up. Osteonecrosis of the femoral head occurred in 1 patient of the control group, while no was observed in the study group, and the difference in the incidence of osteonecrosis of the femoral head between the two groups was not significant (P=0.488).Conclusion Compared to sole FNS internal fixation treatment, Ti-Robot assisted FNS internal fixation for elderly Garden typeⅡ and Ⅲ femoral neck fractures can reduce incision time, achieve minimally invasive and accurate nail implantation, and decrease intraoperative fluoroscopy frequency, leading to improved postoperative hip joint function recovery.
ObjectiveTo analyze the risk factors for postoperative mortality of the elderly patients with femoral neck fracture undergoing hemiarthroplasty.MethodsPatients who underwent hemiarthroplasty for femoral neck fractures between January 2011 and December 2015 were enrolled as object. One hundred and nine patients who met the selection criteria were included in the study, and the clinical data were collected, including gender, age, time from admission to surgery, comorbidities, and preoperative hemoglobin level and nutritional status. Univariate analysis and Cox proportional hazard regression model were used to screen the risk factors for postoperative mortality.ResultsThe 1-year and 2-year mortalities were 6.4% (7/109) and 17.4% (19/109), respectively. Univariate analysis showed that the age, preoperative hemoglobin level and nutritional status were the influencing factors of postoperative mortality in the elderly patients with femoral neck fractures treated with hemiarthroplasty (P<0.05). Multivariate analysis showed that the age≥80 years and malnutrition were the independent risk factors for postoperative mortality (P<0.05).ConclusionTo improve the clinical outcomes, perioperative risk should be comprehensively evaluated by multidisciplinary and perioperative management should be strengthened in the elderly patients with femoral neck fracture, especially those with advanced age and malnutrition, for the high postoperative mortality.
摘要:目的:探討老年人股骨粗隆間骨折不同手術方式的選擇。方法:我院2004年1月至2007年12月間應用不同術式治療老年股骨粗隆間骨折110例,其中動力髖螺釘(DHS)25例, 股骨近端髓內釘(PFN)41例,人工股骨頭置換44例。術后所有患者均獲隨訪,平均12.6個月。對術后并發癥和按照Kuderna 改良 Merli D’Aubigne標準得到的髖關節功能恢復優良數(率)進行評價。結果:術后出現并發癥3例,其中PFN術式2例;人工股骨頭置換術式1例。圍手術期內無傷口感染,無死亡病例。三種術式總體優良數(率)為:107(97.3%)。結論:三種手術方式各有其優缺點,沒有一種術式能普遍適用于各種類型粗隆間骨折,臨床上,為了最大限度降低手術風險,我們沒有必要專注或偏好于某一種手術方式,要根據患者的個體差異及每種術式的優缺點,靈活地為每例股骨粗隆間骨折患者制定出其最適宜的手術方式,大都能取得滿意的療效。Abstract: Objective: To investigate the chosen of 3 different surgical methods in the treatment of intertrochanteric femoral fractures in the elderly. Methods:From January, 2004 to December, 2007, 110 cases with the femoral intertrochanteric fractures in the elderly were treated with the followed 3 kinds of operations respectively:dynamic hip screw (25 cases), proximal femoral nail (41 cases), hip hemiarthroplasty (44 cases). After surgery all patients were followed up; Followedup period range from 6 months to 18 months(average 12.6 months). The good and excellent number (rate) of 3 surgical methods with Merli D’Aubigne evaluation criteria were evaluated, and compared in the postoperative complications. Results: 3 complications occurred postoperatively ( 2 with PFN,1 with hip hemiarthroplasty), none wound infection or died in Perioperatie. The total good successful number (rate) was 107(97.3%). Conclusion:Each has its advantages and its disadvantages. None of three kinds of surgical methods can be used generally all kinds of the femoral intertrochanter fracture. In clinical work, we don not need to focus on or prefer to the only one of them in order to minimize the risk. The good response to treatment will be get if we can choose the appropriate method according to the individual differences of the advantages and disadvantages of each method.
Objective To investigate the perioperative changes in serum interleukin 6 (IL-6) levels in elderly male patients with intertrochanteric fractures, and provide evidence for inflammatory control in this patient population. Methods The clinical data of 40 male patients aged more than 60 years with intertrochanteric fractures who met the selection criteria between January 2021 and December 2022 were retrospectively analyzed, including 25 non-osteoporosis patients (T value>?2.5, group A) and 15 osteoporosis patients (T value≤?2.5, group B). In addition, 40 healthy men aged more than 60 years old were included as controls (group C) according to the age matching rule. There was no significant difference in age, smoking history, drinking history, body mass index, complications (hypertension and diabetes), alanine aminotransferase, aspartate aminotransferase, blood urea nitrogen, creatinine, and total protein among the 3 groups (P>0.05). Serum samples were collected from group C subjects and from groups A and B patients preoperatively and on postoperative days 1, 3, 5, and 7. IL-6 levels were measured using ELISA assay. Pearson correlation analysis was used to assess the relationship between IL-6 levels and T values at various time points in groups A and B. Postoperative complications during hospitalization and 1-year mortality rates were recorded for groups A and B. Results Preoperative IL-6 levels were significantly higher in groups A and B than in group C (P<0.05), with group B being significantly higher than group A (P<0.05). In groups A and B, IL-6 levels increased significantly on postoperative day 1 compared to preoperative levels and then gradually decreased, approaching preoperative levels by postoperative day 7. IL-6 levels in group B were significantly higher than those in group A at all postoperative time points (P<0.05). Correlation analysis showed that IL-6 levels were negatively correlated with T values at all perioperative time points in all patients from groups A and B (P<0.05). Complications occurred in 4 patients (16.0%) in group A, including 2 cases of pulmonary infection, 1 case of urinary tract infection, and 1 case of heart failure, and in 3 patients (20.0%) in group B, including 2 cases of pulmonary infection and 1 case of gastrointestinal bleeding. There was no significant difference in the incidence of complications between the two groups (χ2=0.104, P=0.747). There were 2 cases (8.0%) and 4 cases (26.7%) died within 1 year after operation in groups A and B, respectively, and there was no significant difference in 1-year mortality rates between the two groups (χ2=2.562, P=0.109). Conclusion Serum IL-6 levels significantly increase in the early postoperative period in elderly male patients with intertrochanteric fractures, especially in those with osteoporosis. Monitoring the inflammatory state and promptly controlling the inflammatory response during the perioperative period, may reduce complications and improve postoperative survival in this patient population.
