[Risk factors and prognosis of preoperative herat failure after hip fracture].

OBJECTIVE: To explore incidence, risk factors and the relationship between preoperative heart failure and prognosis in elderly patients with hip fracture. METHODS: A retrospective analysis was performed on 1 569 elderly patients with hip fracture treated from January 2012 to December 2019, including 522 males and 1 047 females, aged 81.00 (75.00, 90.00) years old;896 intertrochanteric fractures and 673 femoral neck fractures. Patients were divided into heart failure and non-heart failure groups according to whether they developed heart failure before surgery, and heart failure was set as the dependent variable, with independent variables including age, gender, fracture type, comorbidities and hematological indicators, etc. Univariate analysis was performed at first, and independent variables with statistical differences were included in multivariate Logistic regression analysis. Independent risk factors for preoperative heart failure were obtained. The length of hospital stay, perioperative complications, mortality at 30 days and 1 year after surgery were compared between heart failure and non-heart failure groups. RESULTS: There were 91 patients in heart failure group, including 40 males and 51 females, aged 82.00 (79.00, 87.00) years old;55 patients with intertrochanteric fracture and 36 patients with femoral neck fracture. There were 1 478 patients in non-heart failure groups, including 482 males and 996 females, aged 81.00(75.00, 86.00) years old;841 patients with intertrochanteric fracture and 637 patients with femoral neck fracture. There were significant differences in age, sex, coronary heart disease, arrhythmia and dementia between two groups(P<0.05). Multivariate Logistic analysis of statistically significant factors showed that males(OR=1.609, P=0.032), age(OR=1.032, P=0.031), arrhythmia(OR=2.045, P=0.006), dementia (OR=2.106, P=0.014) were independent risk factor for preoperative heart failure. The 30-day and 1-year mortality rates were 9.9% and 26.4% in heart failure group and 3.6% and 13.8% in non-heart failure group, respectively;and had statistical significance between two groups (P<0.05). There were significant differences in pulmonary infection, cerebrovascular complications and cardiovascular complications between two groups (P<0.05). The duration of hospitalization in heart failure group was (16.21±10.64) d compared with that in non-heart failure group (13.26±8.00) d, and the difference was statistically significant (t=2.513, P=0.012). CONCLUSION: Male, old age, arrhythmia and dementia are independent risk factors for heart failure after hip fracture in elderly patients. Patients with preoperative heart failure have a higher incidence of postoperative pulmonary infection, cerebrovascular and cardiovascular complications, higher mortality at 30 d and 1 year after surgery, and longer hospital stay.

[Clinical manifestation and treatment strategy of intervertebral space infection after radiofrequency ablation of lumbar nucleus pulposus].

OBJECTIVE: To study the clinical manifestations and treatment of intervertebral space infection after percutaneous lumbar radiofrequency ablation of nucleus pulposus. METHODS: A retrospective analysis was performed of 496 patients who underwent percutaneous lumbar disc decompression using low-temperature plasma radiofrequency ablation nucleus pulposus from June 2009 to June 2019. Six patients had lumbar infection, and the infection rate was 1.21%. All patients were male, ranging in age from 20 to 61 years old. Three patients underwent single segment radiofrequency ablation, two patients underwent dual segments ablation;and one patient underwent three segment ablation, totaling 10 intervertebral discs. One patient was complicated with type 2 diabetes before operation. The interval between infection occurrence ranged from 21 to 65 days. RESULTS: All 6 patients were followed up, and the duration ranged from 18 to 40 months, with an average of 24 months. Among them, 2 patients presented with symptoms of low back pain accompanied by fever, and imaging examination showed intervertebral space infection accompanied by abscess. In addition, 4 patients experienced low back pain but no fever, and MRI showed abnormal signals of the infected intervertebral endplate or vertebral body. One patient showed staphylococcus aureus in blood culture, while the remaining 5 patients showed negative bacterial culture. All the patients were treated with antibiotics after diagnosis. Four patients were treated with conservative management to control infection;1 patient was treated with debridement of posterior lumbar infection focus, and 1 patient was treated with debridement of posterior lumbar infection focus combined with interbody fusion and internal fixation. CONCLUSION: The occurrence of intervertebral space infection during lumbar radiofrequency ablation nucleoplasty should be given sufficient attention. Strict aseptic technique, avoiding repeated multi segment puncture, realizing early detection and treatment, and selecting appropriate treatment methods according to the severity of infection is the guarantee of achieving curative effect.

[Retracted] Mitochondrial DNA induces inflammation and increases TLR9/NF­κB expression in lung tissue.

Following the publication of this paper, it was drawn to the Editor's attention by a concerned reader that several of the western blotting images shown in Fig. 4 on p. 822 were strikingly similar to data which had appeared in Fig. 5A of the following paper: Fan J, Frey RS and Malik AB: TLR4 signaling induces TLR2 expression in endothelial cells via neutrophil NADPH oxidase. J Clin Invest 112: 1235­1243, 2003. Owing to the fact that the contentious data in the above article had already been published elsewhere prior to its submission to International Journal of Molecular Medicine, the Editor has decided that this paper should be retracted from the Journal. The authors were asked for an explanation to account for these concerns, but the Editorial Office did not receive a reply. The Editor apologizes to the readership for any inconvenience caused. [International Journal of Molecular Medicine 33: 817­824, 2014; DOI: 10.3892/ijmm.2014.1650].

Guidelines for management of pediatric acute hyperextension spinal cord injury.

Pediatric acute hyperextension spinal cord injury (SCI) named as PAHSCI by us, is a special type of thoracolumbar SCI without radiographic abnormality and highly related to back-bend in dance training, which has been increasingly reported. At present, it has become the leading cause of SCI in children, and brings a heavy social and economic burden. Both domestic and foreign academic institutions and dance education organizations lack a correct understanding of PAHSCI and relevant standards, specifications or guidelines. In order to provide standardized guidance, the expert team formulated this guideline based on the principles of science and practicability, starting from the diagnosis, differential diagnosis, etiology, admission evaluation, treatment, complications and prevention. This guideline puts forward 23 recommendations for 14 related issues.

Risk factor analysis of disc and facet joint degeneration after intersegmental pedicle screw fixation for lumbar spondylolysis.

BACKGROUND: Patients who do not respond to conservative treatment of the isthmus are often treated with surgery. We used direct repair plus intersegment pedicle screw fixation for the treatment of lumbar spondylolysis. The aim of this observational study was to assess the effects of this technique and evaluate various risk factors potentially predicting the probability of disc and facet joint degeneration after instrumentation. METHODS: The study included 54 male L5 spondylolysis patients who underwent pars repair and intersegment fixation using pedicle screws. Bony union was evaluated using reconstruction images of computed tomography. Radiographic changes, including disc height, vertebral slip, facet joint and disc degeneration in the grade of adjacent and fixed segments, were determined from before to final follow-up. Logistic regression analysis was performed to identify factors associated with the incidence of disc and facet joint degeneration. RESULTS: Bony union was achieved in all cases. Logistic regression analysis revealed that instrumentation durations of greater than 15.5 months and 21.0 months were significant risk factors for the incidence of L4/5 and L5S1 facet degeneration, respectively. CONCLUSIONS: Intersegmental pedicle screw fixation provides good surgical outcomes and good isthmic bony union rates in patients with lumbar spondylolysis. The duration of fixation was confirmed as a risk factor for facet joint degeneration. Once bony union is achieved, instrument removal should be recommended.

[Single-segment lumbar microdiscectomy:drainage or not].

OBJECTIVE: To evaluate the safety and feasibility of single-segment lumbar microdiscectomy without drainage. METHODS: The clinical data of 135 patients with single-segment lumbar disc herniation treated by microdiscectomy surgery from January 2018 to August 2019 were retrospectively analyzed. There were 95 males and 40 females, aged from 18 to 40 years old, with a mean of (28.3±5.4) years. They were divided into drainage group (78 cases) and non-drainage group (57 cases) according to whether the drainage tube was placed during operation. The general conditions of patients were recorded such as age, gender, operation segment, body mass index(BMI), symptom duration, follow-up time, operation time, intraoperative blood loss, out-of-bed time, hospital stay, postoperative drainage removal time and drainage volume of drainage group, postoperative body temperature. VAS of incisional pain in supine resting state on the 1 and 3 days after operation, the VAS of low back pain and lower extremity radiating pain during ground exercise before operation, 3 days, 1 month and 3 months after operation were compared. Oswestry Disability Index (ODI) was collected before operation, 1 month and 3 months after operation. The ratio of complications was calculated such as symptomatic incision hematoma, poor incision healing, incision infection, exacerbation and progressive aggravation of neurological dysfunction, and unplanned secondary surgery. RESULTS: There were no significant differences in age, gender, operation segment, BMI, symptom duration, follow-up time, operation time, intraoperative blood loss, and postoperative body temperature between two groups. The average hospital stay and out-of-bed time in non-drainage group were shorter than in drainage group(P=0.0000). VAS of incision pain in non-drainage group was lower than that in control group at 1 and 3 days after surgery (P<0.05). Postoperative low back pain VAS and ODI of all patients were significantly reduced compared with those before surgery. No symptomatic hematoma occurred in two groups. Postoperative neurological dysfunction immediately aggravated each one patient in two groups, and no progressive aggravation of neurological function was found in two groups. Incision infection occurred in one case in each of the two groups, and both were cured by drug treatment; poor incision healing occurred in one case in each of the two groups, and both were healed after repeated dressing changes. There was one case of unplanned second operation in drainage group, the patient received a second operation due to disc protrusion recurrence within 1 month. CONCLUSION: Single-segment lumbar microdiscectomy without drainage can shorten the average hospital stay and promote early exercise out of bed, and reduce the trauma and stress reaction of drainage. No drainage may be an option for patients with enhanced recovery after lumbar microdiscectomy.

Repair of symptomatic bilateral L5 spondylolysis with autogenous iliac crest graft and temporary intersegmental pedicle screw fixation in youth.

BACKGROUND: When symptomatic spondylolysis fail to respond to nonoperative treatment, surgical management may be required. A number of techniques have been described for repair by intrasegmental fixation with good results; however, there are still some problems. We reported a repair technique with temporary intersegmental pedicle screw fixation and autogenous iliac crest graft. The aim of present study is to assess the clinical outcomes of L5 symptomatic spondylolysis with this technique. METHODS: A retrospective analysis of 128 patients with L5 spondylolysis treated with this method was performed. According to CT scan, the spondylolysis were classified into 3 categories: line, intermediate, and sclerosis type. The diagnostic block test of L5 bilateral pars defect was done in all patients preoperatively. The sagittal and axial CT images were used to determine the bone union. The healing time, complications, number of spina bifida occulta, Japanese Orthopedic Association (JOA) score, and VAS for back pain were recorded. After fixation removal, the rate of ROM preservation at L5S1 was calculated. RESULTS: There were 97 patients (194 pars) followed with mean follow-up of 23 months (range, 12-36 months). The union rate of pars was 82.0% at 12 months and 94.3% at 24 months postoperatively. Low back pain VAS significantly (P < 0.05) improved from preoperative mean value of 7.2 to 1.3 at the final follow-up postoperatively (P < 0.05). JOA score increased significantly postoperatively (P < 0.05) with average improvement rate of 79.3%. The rates of L5S1 ROM preservation were 79.8% and 64.0% after fixation removal at 1 and 2 years postoperatively. There were 3 patients of delayed incision healing without other complications. CONCLUSIONS: Although sacrificing L5S1 segment motion temporarily, more stability was obtained with intersegmental fixation. This technique is reliable for spondylolysis repair which has satisfactory symptom relief, high healing rate, low incidence of complications, and preserve a large part of ROM for fixed segment.

[Curative effect of anterolateral spinal canal decompression combined with short segment screw fixation with posterior approach for severe thoracolumbar burst fractures with spinal cord injury].

OBJECTIVE: To explore the effect of anterolateral spinal canal decompression combined with short segment screw fixation with posterior approach for severe thoracolumbar burst fractures with spinal cord injury. METHODS: From January 2016 to June 2018, 16 patients with severe thoracolumbar burst fractures (more than 50% of ratio of spinal canal encroachment, reverse fragment at the posterior edge of the vertebral body) with spinal cord injury were retrospectively analyzed, including 10 males and 6 females, ranging in age from 19 to 57 years old. Causes of injury:8 cases of fall injury, 6 cases of traffic accident injury and 2 cases of other injuries. Fracture site:T11 in 4 cases, T12 in 5 cases, L1 in 5 cases, L2 in 2 cases. All the patients underwent anterolateral spinal canal decompression combined with short segment screw fixation with posterior approach. The curative imaging effects were evaluated by measuring the loss height of the anterior edge of the injured vertebra, Cobb angle of the adjacent segment of the injured vertebra, and ratio of spinal canal encroachment. The clinical effects were evaluated by Frankel spinal cord injury rating and visual analogue scale (VAS). RESULTS: All 16 patients were followed up, and the average follow up time was (15.9±5.4) months. The average operation time was (234±41) minutes and the average amount of bleeding was (431±93) ml. The loss of anterior height of injured vertebrae was (52.25±10.10)% before operation, (8.93± 3.61)% at 3 days after operation, and (9.25±2.88)% at the latest follow up. The results of 3 days after operation and the latest follow up were better than that before operation, and there was no significant differencesbetween results at the latest follow up and 3 days after operation (P<0.01). Cobb angle of adjacent segment of injured vertebrae was (28.19±10.89)°before operation, (5.31±5.14)° 3 days after operation, and (6.81±4.59)°at the latest follow-up. The ratio of spinal canal encroachment was (67.68±12.45)% before operation, (7.69±4.46)% at 3 days after operation, and (4.75±1.63)% at the latest follow-up. At 3 days and the latest follow-up, the rate recovered to a certain extent (P<0.05). At the latest follow up, spinal nerve function was improved in 12 patients, no improvement in 4 patients and no deterioration in nerve function. VSA score was improved from preoperative 7.8±0.9 to final follow-up 1.8±0.7. CONCLUSION: For severe thoracolumbar burst fracture and spinal cord injury, with more than 50% of ratio of spinal canal encroachment and reverse fragment at the posterior edge of the vertebral body, the anterolateral spinal canal decompression combined with short segment screw fixation with posterior approach has the characteristics of accurate reduction, complete decompression and firm fixation, and the clinical effect is satisfactory.

Guideline for diagnosis and treatment of spine trauma in the epidemic of COVID-19.

Outbreak of COVID-19 is ongoing all over the world. Spine trauma is one of the most common types of trauma and will probably be encountered during the fight against COVID-19 and resumption of work and production. Patients with unstable spine fractures or continuous deterioration of neurological function require emergency surgery. The COVID-19 epidemic has brought tremendous challenges to the diagnosis and treatment of such patients. To coordinate the diagnosis and treatment of infectious disease prevention and spine trauma so as to formulate a rigorous diagnosis and treatment plan and to reduce the disability and mortality of the disease, multidisciplinary collaboration is needed. This expert consensus is formulated in order to (1) prevent and control the epidemic, (2) diagnose and treat patients with spine trauma reasonably, and (3) reduce the risk of cross-infection between patients and medical personnel during the treatment.

Long-Term Outcome of Dynesys Dynamic Stabilization for Lumbar Spinal Stenosis.

BACKGROUND: Many clinical studies over the past decade have indicated positive outcomes for patients treated with Dynesys dynamic stabilization for lumbar degenerative disease. However, long-term outcomes of Dynesys for lumbar spinal stenosis are rarely reported. The aim of this study was to analyze the long-term clinical and radiologic outcomes for patients with lumbar spinal stenosis treated with Dynesys stabilization. METHODS: Thirty-eight patients with lumbar spinal stenosis were treated with Dynesys stabilization from July 2008 to March 2010. The minimal duration of follow-up was 72 months. The patients were divided into stenosis and spondylolisthesis groups according to degenerative spondylolisthesis. Clinical outcomes were evaluated using the Oswestry Disability Index (ODI) and visual analog scale (VAS). Radiographic evaluations included range of motion (ROM) and the disc heights of stabilized segments and the upper adjacent segments. We also evaluated the occurrence of radiographic and symptomatic adjacent segment degeneration (ASD). RESULTS: There were 23 patients in stenosis group and 15 patients in spondylolisthesis group. The ODI scores were significantly improved at the final follow-up evaluation, as compared to the baseline values (16.1 ± 5.7 vs. 57. 2 ± 14.2, t = 61.41, P < 0.01). The VAS scores for back and leg pain were significantly improved from 4.82 ± 0.89 and 4.04 ± 0.82 preoperatively to 0.93 ± 0.61 and 0.54 ± 0.51 postoperatively (t = 6.59, P < 0.01, and t = 5.91, P < 0.01, respectively). There were no differences between the two groups with respect to VAS and ODI scores. The ROM of stabilized segments decreased significantly from 7.8° ± 2.4° to 4.5° ± 1.5° (t = 7.18, P < 0.05), while the upper adjacent segments increased significantly from 8.3° ± 2.4° to 10.4° ± 2.4° (t = 2.87, P = 0.01). The change in disc height of stabilized segments was not significant (11.9 ± 2.1 preoperatively vs. 12.5 ± 1.5 postoperatively, t = 1.43, P = 0.15), whereas the decrease in disc height of the upper adjacent segments was significant (12.5 ± 2.0 preoperatively vs. 11.0 ± 1.7 postoperatively, t = 2.94, P = 0.01). The occurrence of radiographic and symptomatic ASD was 16% (6/38) and 3% (1/38), respectively. CONCLUSIONS: Decompression and Dynesys stabilization for lumbar stenosis with or without spondylolisthesis showed good long-term clinical and radiographic results. Lumbar stenosis with or without Grade I spondylolisthesis, particularly in patients <60 years of age with mild-to-moderate lumbar disc degeneration, would be one of the main indications for the Dynesys system.

[Dynesys and posterior decompression and fusion internal fixation for the treatment of lumbar degenerative diseases: a systematic review].

OBJECTIVE: Meta analysis was used to evaluate the efficacy and safety of Dynesys and posterior decompression and fusion internal fixation for lumbar degenerative diseases. METHODS: The computer was used to retrieve the Cochrane library, Medline, Embase, CNKI, Wanfang database and Chinese biomedical literature database; and the references and main Chinese and English Department of orthopedics journals were manually searched. All the prospective or retrospective comparative studies on the clinical efficacy and safety of Dynesys and posterior decompression and fusion internal fixation were collected, so as to evaluate the methodological quality of the study and to extract the data. The RevMan 5.2 software provided by Cochrane collaboration was used for systematic evaluation. RESULTS: A total of 9 clinical studies were included, including 3 prospective randomized controlled trials(RCT) and 6 retrospective controlled observational studies, which included 692 patients, with 336 cases in Dynesys group, and 356 cases in posterior decompression and fusion internal fixation (PLIF) group. The results showed that compared with PLIF, Dynesys system significantly decreased operation time(P<0.01), intraoperative blood loss (P<0.01). Both Dynesys and PLIF groups experienced improved ODI and back/leg pain VAS scores at final follow-up, and no statistically significant difference was noted according to the two surgical procedures(P>0.05). Dynesys could remain the range of motion (ROM) of surgical segments with less increased ROM of adjacent segments compared with that of PLIF group(P<0.01). Regarding the disc height of surgical segments, no statistically significant difference was noted according to the two groups(P>0.05), but postoperative complications incidence rate in PLIF group was higher than that in Dynesys group (P<0.05). CONCLUSIONS: Both Dynesys system and PLIF can improve clinical outcomes of lumbar degenerative diseases effectively. Compared with PLIF, Dynesys could remain the range of motion(ROM) of surgical segments with less increased ROM of adjacent segments and lower complication incidence rate. But the ability to prevent adjacent segments degeneration needs more RCTs with long-term follow-up to confirm.

[Comparison of clinical effects of total artificial hip replacement and cannulated screw fixation for the treatment of displaced femoral neck fractures in elderly patients].

OBJECTIVE: To compare of clinical effects of different surgical methods in the treatment of elderly femoral neck fractures. METHODS: From January 2013 to June 2016, 144 elderly patients with femoral neck were treated and divided into artificial hip replacement group and cannulated screw fixation group according to the surgical methods. In the total hip arthroplasty group, there were 89 cases, 28 males and 61 females, with an average age of(84.10±3.10) years old;Hollow nail fixation group 55 cases, 20 males and 35 females, with an average age of (86.80±2.88) years. Preoperative patients data, postoperative complications, mortality and postoperative Harris hip score were compared between the two groups. RESULTS: A total of 144 cases were followed up for 12 to 36 months with an average of 18 months. There was no significant difference between two groups in gender, fracture side, preoperative complications, osteoporosis, ASA score, injury to surgery interval, the number of patients admitted to ICU and perioperative death. However, the patients in hollow screw fixation group was older than the joint replacement group(t=5.311, P<0.05);The degree of preoperative fracture displacement in the joint replacement group was higher than that in the hollow nail fixation group(χ²=6.894, P=0.009<0.05);Hollow nail fixation group in operation time, hospital stay, intraoperative blood loss, perioperative blood transfusion was significantly better than the number of joint replacement group(P<0.05);The Harris score of the joint replacement group was higher than that of the hollow screw fixation group(P<0.05). CONCLUSIONS: For elderly femoral neck patients, if there is a significant shift in the fracture (Garden III, IV), the preferred treatment is hip replacement. Postoperative complications are relatively small, satisfactory joint function recovery. If the fracture displacement is not obvious (Garden type I, II) or patients with more medical diseases, poor physical condition, poor surgical tolerance, postoperative life expectancy is not high, the first choice is closed reduction and cannulated screw fixation.

In vivo evaluation of microglia activation by intracranial iron overload in central pain after spinal cord injury.

BACKGROUND: Central pain (CP) is a common clinical problem in patients with spinal cord injury (SCI). Recent studies found the pathogenesis of CP was related to the remodeling of the brain. We investigate the roles of iron overload and subsequent microglia activate in the remodeling of the brain after SCI. METHODS: An SCI-induced CP model was established in Sprague-Dawley rats that were randomly assigned to SCI, sham operation, deferoxamine (DFX), minocycline, and nitric oxide synthase inhibitor treatment groups. At 12 weeks, pain behavior and thermal pain threshold were evaluated in each group, and iron transferrin receptor (TfR)1 and ferritin (Fn) mRNA, as well as iron-regulatory protein (IRP)1, FN, lactoferrin, and nuclear factor (NF)-κB protein levels in the rat brains were measured. Microglia proliferation and differentiation and IRP1 expression were evaluated by immunohistochemistry. RESULTS: Autophagy was observed in rats after SCI, accompanied by reduced latency of thermal pain, increased iron content and IRP1 and NF-κB levels in the hindlimb sensory area, hippocampus, and thalamus, and decreased Fn levels in the hindlimb sensory area. TfR1 mRNA expression was upregulated in activated microglia. Treatment with an iron-chelating agent, or inhibitors of nitric oxide synthase or microglia suppressed microglia proliferation. CONCLUSIONS: SCI may induce intracranial iron overload, which activates microglia via NF-κB signaling. Microglia secrete inflammatory factors that induce neuronal damage and lead to CP. Treatment with an iron-chelating agent or NF-κB or microglia inhibitors can relieve CP resulting from SCI.

Effect of oxidative stress induced by intracranial iron overload on central pain after spinal cord injury.

BACKGROUND: Central pain (CP) is a common clinical problem in patients with spinal cord injury (SCI). Recent studies found the pathogenesis of CP was related to the remodeling of the brain. We investigate the roles of iron overload and subsequent oxidative stress in the remodeling of the brain after SCI. METHODS: We established a rat model of central pain after SCI. Rats were divided randomly into four groups: SCI, sham operation, SCI plus deferoxamine (DFX) intervention, and SCI plus nitric oxide synthase (NOS) inhibitor treatment. Pain behavior was observed and thermal pain threshold was measured regularly, and brain levels of iron, transferrin receptor 1 (TfR1), ferritin (Fn), and lactoferrin (Lf), were detected in the different groups 12 weeks after establishment of the model. RESULTS: Rats demonstrated self-biting behavior after SCI. Furthermore, the latent period of thermal pain was reduced and iron levels in the hind limb sensory area, hippocampus, and thalamus increased after SCI. Iron-regulatory protein (IRP) 1 levels increased in the hind limb sensory area, while Fn levels decreased. TfR1 mRNA levels were also increased and oxidative stress was activated. Oxidative stress could be inhibited by ferric iron chelators and NOS inhibitors. CONCLUSIONS: SCI may cause intracranial iron overload through the NOS-iron-responsive element/IRP pathway, resulting in central pain mediated by the oxidative stress response. Iron chelators and oxidative stress inhibitors can effectively relieve SCI-associated central pain.

Plasma mitochondrial DNA levels were independently associated with lung injury in elderly hip fracture patients.

INTRODUCTION: Hip fracture in the elderly can induce systemic inflammatory response (SIRS) and lung injury which increases the risk of lung infection and death. Mitochondrial DNA (mtDNA) plays a role in SIRS and lung injury in patients with multi-trauma, and also in patients with hip fractures. This study evaluated the potential value of plasma mtDNA in the early prognosis of lung injury in elderly fracture patients. METHODS: This study enrolled 156 elderly patients with intertrochanteric fracture. Plasma mtDNA, IL-6, IL-10, prostaglandin E2 (PGE2) levels were measured at admission. Sixty-one and 31 patients were diagnosed with systemic inflammatory response syndrome (SIRS) and lung injury, respectively. RESULTS: Plasma mtDNA levels were higher in hip fracture patients compared to healthy controls (P<0.001) and significantly higher in the lung injury subgroup compared to the lung injury absent subgroup (P<0.001). MtDNA levels were correlated with the SIRS score (r=0.446, P<0.001), IL-6 (r=0.506, P<0.001), IL-10 (r=0.523, P<0.001), and PGE2 (r=0.360, P<0.001). Logistic regression analysis revealed that plasma mtDNA, IL-6, PGE2 and SIRS score were independent predictors of the risk of lung injury. CONCLUSION: Plasma mtDNA release induced by hip fracture in elderly patients, might be an early predictor of lung injury in these patients.

[Effect of hip fracture at different sites in elderly patients on prognosis].

OBJECTIVE: To determine the effect of site of fracture on the prognosis for patients of elderly hip fracture. METHODS: From January 2012 to December 2014, 667 patients with hip fractures were divided into femoral neck fracture group and intertrochanteric fracture group according to the site of fracture. There were 304 cases of intertrochanteric fracture, including 96 males and 208 females, with an average age of (80.33±7.94) years old. There were 217 cases of femoral neck fracture, including 74 males and 143 females, with an average age of (79.82±9.33) years old. Patients' data, mortality and activities of daily living were compared between two groups. RESULTS: There were no significant differences in age, gender, comorbidity, ASA classification, and anesthesia between two groups, but the time of admission to surgery, duration of operation, blood loss of intra-operative, volume of drainage, and the average of transfusion were shown to have significant differences. The levels of White blood cell count (WBC) for intertrochanteric fracture group were shown to be higher than that of femoral neck fracture patients at admission, 1, 3 and 5 days after operation. The levels of hemoglobin, and albumin for intertrochanteric fracture were lower than that of femoral neck fracture patients at all period of time. The mortality of intertrochanteric fracture group during hospitalization, 1, 3, 6, and 12 months were higher than that of femoral neck fracture, but did not reach significant difference. In patients who survived, the scores of ADL for femoral neck fracture were higher than that of intertrochanteric fracture at discharge, 1, 3 months after operation, but there was no significant difference for ADL at 6 and 12 months between two groups. CONCLUSIONS: The response of stress for intertrochanteric fracture were more than femoral neck fracture, but the mortality was similar than that of femoral neck fracture after excluding the influence of age, sex, comorbidity, and other factors. Compared to intertrochanteric fracture, the femoral neck fracture patients had a better functional recovery during early stage, and the two groups reached a similar functional recovery at 1 year after operation.