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Ankylosing spondylitis (AS) combined with lower cervical fracture is often categorized into unstable fracture, with a high incidence of neurological injury and a high rate of disability and morbidity. As factors such as shoulder occlusion may affect the accuracy of X-ray imaging diagnosis, it is often easily misdiagnosed at the primary diagnosis. Non-operative treatment has complications such as bone nonunion and the possibility of secondary neurological damage, while the timing, access and choice of surgical treatment are still controversial. Currently, there are no clinical practice guidelines for the treatment of AS combined with lower cervical fracture with or without dislocation. To this end, the Spinal Trauma Group of Orthopedics Branch of Chinese Medical Doctor Association organized experts to formulate Clinical guidelines for the treatment of ankylosing spondylitis combined with lower cervical fracture in adults ( version 2024) in accordance with the principles of evidence-based medicine, scientificity and practicality, in which 11 recommendations were put forward in terms of the diagnosis, imaging evaluation, typing and treatment, etc, to provide guidance for the diagnosis and treatment of AS combined with lower cervical fracture.
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Ankylosing spondylitis (AS) combined with spinal fractures with thoracic and lumbar fracture as the most common type shows characteristics of unstable fracture, high incidence of nerve injury, high mortality and high disability rate. The diagnosis may be missed because it is mostly caused by low-energy injury, when spinal rigidity and osteoporosis have a great impact on the accuracy of imaging examination. At the same time, the treatment choices are controversial, with no relevant specifications. Non-operative treatments can easily lead to bone nonunion, pseudoarthrosis and delayed nerve injury, while surgeries may be failed due to internal fixation failure. At present, there are no evidence-based guidelines for the diagnosis and treatment of AS combined with thoracic and lumbar fracture. In this context, the Spinal Trauma Academic Group of Orthopedics Branch of Chinese Medical Doctor Association organized experts to formulate the Clinical guideline for the diagnosis and treatment of adult ankylosing spondylitis combined with thoracolumbar fracture ( version 2023) by following the principles of evidence-based medicine and systematically review related literatures. Ten recommendations on the diagnosis, imaging evaluation, classification and treatment of AS combined with thoracic and lumbar fracture were put forward, aiming to standardize the clinical diagnosis and treatment of such disorder.
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The acute combination fractures of the atlas and axis in adults have a higher rate of neurological injury and early death compared with atlas or axial fractures alone. Currently, the diagnosis and treatment choices of acute combination fractures of the atlas and axis in adults are controversial because of the lack of standards for implementation. Non-operative treatments have a high incidence of bone nonunion and complications, while surgeries may easily lead to the injury of the vertebral artery, spinal cord and nerve root. At present, there are no evidence-based Chinese guidelines for the diagnosis and treatment of acute combination fractures of the atlas and axis in adults. To provide orthopedic surgeons with the most up-to-date and effective information in treating acute combination fractures of the atlas and axis in adults, the Spinal Trauma Group of Orthopedic Branch of Chinese Medical Doctor Association organized experts in the field of spinal trauma to develop the Evidence-based guideline for clinical diagnosis and treatment of acute combination fractures of the atlas and axis in adults ( version 2023) by referring to the "Management of acute combination fractures of the atlas and axis in adults" published by American Association of Neurological Surgeons (AANS)/Congress of Neurological Surgeons (CNS) in 2013 and the relevant Chinese and English literatures. Ten recommendations were made concerning the radiological diagnosis, stability judgment, treatment rules, treatment options and complications based on medical evidence, aiming to provide a reference for the diagnosis and treatment of acute combination fractures of the atlas and axis in adults.
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Objective:To explore the risk factors of heart failure within 1 year after surgery for hip fracture in the elderly.Methods:A retrospective cohort study was conducted to analyze the clinical data of 476 elderly patients with hip fracture admitted to No.7 Medical Center, Chinese PLA General Hospital from January 2018 to December 2019, including 171 males and 305 females, at age of 60-104 years [(82.5±8.1)years]. There were 271 patients with intertrochanteric fractures and 205 with femoral neck fractures. The patients were divided into heart failure group ( n=111) and non-heart failure group ( n=365) based on the presence of heart failure within 1 year after surgery. The following items were recorded: gender, age, fracture type (intertrochanteric fractures and femoral neck fractures), comorbidities [hypertension, coronary heart disease, arrhythmia, pulmonary infection, chronic obstructive pulmonary disease (COPD), renal insufficiency and diabetes], use of anticoagulants before injury, walking ability and self-care ability before injury, hematological indicators (white blood cell count, hemoglobin, albumin), time from injury to surgery, types of anesthesia (general anesthesia and regional anesthesia), types of surgery (intramedullary nails, dynamic hip screws, cannulated screw and arthroplasty), blood transfusion, length of hospital stay, sorts of perioperative complications (cerebrovascular disease, delirium, pulmonary infection, acute myocardial infarction, malignant arrhythmia, urinary tract infection, venous thromboembolism, acute cholecystitis and intestinal obstruction), and number of perioperative complications. Univariate analysis was used to evaluate the relationship between the above indicators and heart failure within 1 year after surgery in the elderly patients with hip fracture. Multiple Logistic stepwise regression analysis was used to determine the independent risk factors for the heart failure. Results:Univariate analysis showed that age, coronary heart disease, arrhythmia, use of anticoagulants before injury, albumin, blood transfusion, length of hospital stay, and number of perioperative complications≥2 were correlated with heart failure within 1 year after surgery in elderly patients with hip fracture ( P<0.05 or 0.01). Multivariate Logistic stepwise regression analysis showed that coronary heart disease ( OR=1.50, 95% CI 1.10, 2.51, P<0.05), blood transfusion≥2 U ( OR=2.01, 95% CI 1.23, 3.29, P<0.01) and number of perioperative complications≥2 ( OR=2.12, 95% CI 1.27, 3.53, P<0.01) were significantly associated with heart failure within 1 year after surgery in elderly patients with hip fracture. Conclusion:Complications of coronary heart disease, blood transfusion≥2 U and number of perioperative complications≥2 are independent risk factors for heart failure within 1 year after surgery in elderly patients with hip fracture.
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Background: Spinal surgery is associated with severe pain within the first few days after surgery. Opioids are commonly used to control postoperative pain, but these can lead to postoperative nausea and vomiting (PONV). Therefore, use of more effective and better-tolerated agents would be beneficial for these patients. Serotonin receptor antagonists, such as ramosetron, have been used to reduce PONV in patients receiving anesthesia. Objective: We conducted a meta-analysis of published randomized controlled trials (RCTs) to compare the efficacy and tolerance of ramosetron to prevent PONV after spinal surgery. Methods: Medline, Embase, Cochrane Library, and Science Citation Index databases were systematically searched for relevant RCT articles published between January 1979 and November 2020. Full text articles restricted to English language that described RCTs comparing the use of ramosetron with other serotonin antagonists to treat PONV following spinal surgery in adult patients were considered for meta-analysis. Two reviewers independently performed study selection, quality assessment, and data extraction of all articles. Differences were resolved by a third reviewer. Results: The search identified 88 potentially relevant articles, of which only 3 met our selection criteria. Study drugs were administered at the end of spinal surgery in all 3 included articles. The meta-analysis revealed that ramosetron (0.3 mg) reduced the pain score (mean differenceâ¯=â¯-0.66; 95% CI -1.02 to -0.30), lowered the risk of PONV (risk ratioâ¯=â¯0.86; 95% CI, 0.76-0.97), and postoperative vomiting (risk ratioâ¯=â¯0.32; 95% CI, 0.17-0.60), and limited the use of rescue antiemetics (risk ratioâ¯=â¯0.66; 95% CI, 0.45-0.96) after spinal surgery. However, there were no significant differences in the incidence of postoperative nausea, the use of rescue pain medications, the number of rescue analgesics required, and the risk of discontinuation of patient-controlled analgesia between ramosetron and palonosetron (0.075 mg) or ondansetron (4 mg). There were no statistically significant differences in the risk of adverse events among the 3 medications. Conclusions: This meta-analysis of 3 RCTs showed that ramosetron reduced the risk of PONV and POV, limited the use of rescue antiemetics, reduced the postoperative pain score, and did not increase the risk of discontinuing patient-controlled analgesia compared with palonosetron or ondansetron after spinal surgery in 3 RCTs. Therefore, this meta-analysis indicates that ramosetron is an effective and well tolerated antiemetic that can be used to prevent PONV following spinal surgery in adult patients. PROSPERO identifier: CRD42020223596 (Curr Ther Res Clin Exp. 2022; 83:XXX-XXX)© 2022 Elsevier HS Journals, Inc.
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Objective:To investigate the prognosis of hip fracture in elderly patients with dementia.Methods:From January 2012 to December 2017, 91 dementia patients aged (82.7±6.6)y (21 males and 70 females) with hip fracture were enrolled in the study; 91 non-dementia patients matched by age, gender and fracture type were selected as controls. There were 54 cases of intertrochanteric fracture and 37 cases of femoral neck fracture. The length of hospital stay, mortality within 30 days and 1 year, walking ability and risk of reoperation were compared between the two groups. The effect of dementia on the mortality after surgery was analyzed by adjusting confounding factors through multivariate logistic regression analysis.Results:There was no significant difference in the length of hospital stay between dementia group and non-dementia group [(13.95±7.33) vs.(12.63±8.68)d, t=1.12, P=0.266]. The incidence rate of perioperative complications in dementia group was higher than that in non-dementia group [63.7%(58/91) vs. 23.1%(21/91), χ 2 = 44.59, P<0.001]. The incidence of delirium in dementia group was higher than that in non-dementia group [35.3%(42/91) vs.13.2%(12/91), χ 2 = 5.71, P=0.017]. The incidence of pulmonary infection in dementia group was higher than that in non-dementia group [11.0%(10/91) vs. 2.2%(2/91), χ 2= 11.989, P<0.001]. There was no significant difference in 30-day fatality rate [7.7%(7/91) vs. 1.1%(1/91), χ 2= 3.27, P=0.071] between two groups; while the 1-year fatality rate in dementia group was higher than that in non-dementia group [27.5%(25/91) vs. 14.3%(13/91), χ 2= 4.79, P=0.029]. After adjusting for the differences of confounding factors between the two groups, dementia was an independent risk factor for 1-year mortality after hip fracture surgery ( OR = 1.852, 95 %CI:1.048-3.043, P= 0.022). For walking ability of 1 year after operation, 22 (33.3%) patients in dementia group walked independently, 38 (57.6%) patients partially walked independently, 6 (9.1%) patients were in bed; while in non-dementia group, 45 (57.7%) patients walked independently, 27 (34.6%) patients partially walked independently, 6 (7.7%) patients were in bed; there was significant difference between the two groups (χ 2= 8.82, P=0.012). There was no significant difference in reoperation rate between two groups [6.6%(6/91) vs. 5.5%(5/91), χ2=0.10, P=0.756]. Conclusion:Compared to non-dementia patients, dementia patients with hip fracture have poorer prognosis, higher incidence of perioperative complications, pulmonary infection and delirium, higher risk of mortality 1 year after operation, and poorer ability of independent walking.
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Osteoporotic vertebral compression fracture (OVCF) can lead to lower back pain and may be even accompanied by scoliosis, neurological dysfunction and other complications, which will affect the daily activities and life quality of patients. Vertebral augmentation is an effective treatment method for OVCF, but it cannot correct unbalance of bone metabolism or improve the osteoporotic status, causing complications like lower back pain, limited spinal activities and vertebral refracture. The post-operative systematic and standardized rehabilitation treatments can improve curative effect and therapeutic efficacy of anti-osteoporosis, reduce risk of vertebral refracture, increase patient compliance and improve quality of life. Since there still lack relevant clinical treatment guidelines for postoperative rehabilitation treatments following vertebral augmentation for OVCF, the current treatments are varied with uneven therapeutic effect. In order to standardize the postoperative rehabilitation treatment, the Spine Trauma Group of the Orthopedic Branch of Chinese Medical Doctor Association organized relevant experts to refer to relevant literature and develop the "Guideline for postoperative rehabilitation treatment following vertebral augmentation for osteoporotic vertebral compression fracture (2022 version)" based on the clinical guidelines published by the American Academy of Orthopedic Surgeons (AAOS) as well as on the principles of scientificity, practicality and advancement. The guideline provided evidence-based recommendations on 10 important issues related to postoperative rehabilitation treatments of OVCF.
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Objective:To explore the predictive values of neutrophil to lymphocyte ratio (NLR), monocyte to lymphocyte ratio (MLR) and platelet to lymphocyte ratio (PLR) for postoperative delirium in the elderly patients with hip fracture.Methods:The data of 1,278 elderly patients with hip fracture were analyzed retrospectively who had been admitted to Department of Orthopedics, The 7th Medical Center, General Hospital of Chinese People's Liberation Army from January 2012 to December 2018. There were 418 males and 860 females, with a median age of 81 (75, 90) years. There were 728 intertrochanteric fractures and 550 femoral neck fractures. The working characteristic curves (ROC) of NLR, MLR, and PLR used to predict postoperative delirium in the elderly patients with hip fracture were worked out to obtain the best cutoff points (sensitivity, specificity, and area under the curve) respectively. According to the best cutoff points, the NLR, MLR, and PLR were respectively divided into an increase group and a normal group. According to whether postoperative delirium occurred or not, the patients were divided into a delirium group and a delirium-free group. After univariable analysis was conducted to screen out the risk factors, binary logistic regression analysis was conducted of the factors with P<0.05 to determine the risk factors. Results:The median values of NLR, MLR and PLR in the 1,278 elderly patients with hip fracture at admission were 5.43 (3.87, 7.88), 0.40 (0.29, 0.54) and 158.40 (118.00, 222.50), respectively. Postoperative delirium occurred in 153 patients (12.0%). In the study of the predictive values of NLR, MLR, and PLR using ROC curves for postoperative delirium in the elderly patients with hip fracture, the best cutoff points (sensitivity, specificity, and area under the curve) for prediction were 7.613 (57.5%, 77.1%, 0.726), 0.512 (52.3%, 74.0%, 0.663), and 201.125 (68.6%, 73.3%, 0.751), respectively. The risk factors for postoperative delirium were increased NLR ( OR=2.046, 95% CI: 1.322 to 3.166, P<0.001), increased MLR ( OR=1.568, 95% CI: 1.039 to 2.367, P=0.032), and increased PLR ( OR=3.489, 95% CI: 2.290 to 5.317, P<0.001). Conclusion:As NLR≥7.613, MLR≥0.512 and PLR≥201.125 may be risk factors for postoperative delirium in elderly patients with hip fracture, NLR, MLR and PLR may have a positive value in prediction of postoperative delirium.
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Background and Objectives@#Bone marrow mesenchymal stem cells (BMSCs) show considerable promise in regenerative medicine. Many studies demonstrated that BMSCs cultured in vitro were highly heterogeneous and composed of diverse cell subpopulations, which may be the basis of their multiple biological characteristics. However, the exact cell subpopulations that make up BMSCs are still unknown. @*Methods@#and Results: In this study, we used single-cell RNA sequencing (scRNA-Seq) to divide 6,514 BMSCs into three clusters. The number and corresponding proportion of cells in clusters 1 to 3 were 3,766 (57.81%), 1,720 (26.40%), and 1,028 (15.78%). The gene expression profile and function of the cells in the same cluster were similar. The vast majority of cells expressed the markers defining BMSCs by flow cytometry and gene expression analysis. Each cluster had at least 20 differentially expressed genes (DEGs). We conducted Gene Ontology enrichment analysis on the top 20 DEGs of each cluster and found that the three clusters had different functions, which were related to self-renewal, multilineage differentiation and cytokine secretion, respectively. In addition, the function of the top 20 DEGs of each cluster was checked by the National Center for Biotechnology Information gene database to further verify our hypothesis. @*Conclusions@#This study indicated that scRNA-Seq can be used to divide BMSCs into different subpopulations, demon-strating the heterogeneity of BMSCs.
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Objective:To determine the factors related to postoperative 1-year and 5-year mortalities in elderly patients with hip fracture plus chronic obstructive pulmonary disease (COPD).Methods:A retrospective study was conducted of the elderly patients with hip fracture who had sought medical attention at Department of Orthopaedics, The 7th Medical Center of PLA General Hospital from January 2012 to December 2016.Of them, 103 were complicated with COPD, and another 103 without COPD were selected as controls who were matched in age, gender and fracture site. The 2 groups were compared in terms of postoperative 30-day, 1-year and 5-year mortalities; the risk factors were explored for postoperative 1-year and 5-year mortalities in patients with hip fracture plus COPD.Results:The postoperative 30-day, 1-year and 5-year mortalities in the COPD group were 7.8%(8/103), 29.1%(30/103) and 48.5%(50/103), significantly higher than those in the control group except for the 30-day value [1.9%(2/103), 13.6%(14/103) and 31.1%(32/103)] ( P<0.05). Advanced age ( P=0.003), cardiovascular disease ( P=0.006), respiratory disease ( P=0.009), acute exacerbation of COPD (AECOPD) ( P<0.01), American Society of anesthesiologists (ASA) grades Ⅲ+Ⅳ ( P=0.001), delayed surgery (>48 h) ( P=0.015), pre-injury activities of daily living (ADL) score ( P=0.002) and mobility ( P=0.010) were related to an increased risk for 1-year mortality after operation. Advanced age ( OR=1.106, 95% CI: 1.016 to 1.210, P=0.021), AECOPD ( OR=5.053, 95% CI: 1.520 to 16.800, P=0.008), and ASA grades Ⅲ+Ⅳ ( OR=1.657, 95% CI: 1.072 to 3.912, P=0.040) were the risk factors for 5-year mortality in patients with COPD; pre-injury ADL ( OR=0.974, 95% CI: 0.987 to 0.967, P=0.043) was negatively correlated with 5-year mortality. Conclusions:COPD can significantly increase the short-term and long-term mortalities in elderly patients with hip fracture.Cardiovascular disease, AECOPD and ASA grades Ⅲ+Ⅳ are factors related to postoperative 1-year mortality in patients with hip fracture plus COPD. Advanced age, AECOPD and ASA grades Ⅲ+Ⅳ and delayed surgery (>48 h) are risk factors for postoperative 5-year mortality in patients with hip fracture plus COPD. ADL score before injury is negatively correlated with postoperative 1-year and 5-year mortalities.
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Objective:To characterize the geriatric osteoporotic pelvic fractures using 3-D computed tomography (CT) fracture mapping.Methods:Retrospectively analyzed were the 79 elderly patients with pelvic fracture who had been admitted to Department of Orthopaedics, The 7th Medical Center of PLA General Hospital between January 2017 and December 2021. There were 24 men and 55 women, aged from 60 to 98 years (average, 74.3 years). The CT scan data of the pelvis from all patients were imported into the software (Mimics Medical 18.0, Geomagic Studio 2014, Rhinoceros 6.0, and Matlab) to create a 3-D pelvic fracture model. The fracture pieces were imported into a standard pelvic template to obtain the morphology of the fracture lines after fitting. A map of fracture line distribution frequency and a fracture heat map were created by fitting the fracture lines of all patients into a common pelvic template.Results:Of the 79 elderly patients with pelvic fracture, 69 (87.3%) had fractures of both the anterior and the posterior rings. The fracture map and heat map of geriatric pelvic fractures showed the following: the fracture lines of the anterior ring were concentrated in the junction of the cancellous bone and cortical bone of the superior and inferior pubic rami; the fracture lines of the posterior ring were concentrated in the middle and posterior 1/3 of the ilium and in the sacral wing; the fracture frequencies incurred by the pubic bone, sacrum, and ilium were from the highest to the lowest.Conclusions:Fracture mapping can visually characterize the distribution of fracture lines of the geriatric pelvic fractures. Simultaneous fractures of the anterior and posterior rings of the pelvis are the most typical kind of pelvic fractures in the elderly. The junction of the cancellous and cortical bones of the superior and inferior pubic rami and the area surrounding the sacroiliac joint are the most frequent locations for the fractures.
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Objective:To investigate the clinical effect of minimally invasive plate osteosynthesis (MIPO) through anterolateral approach in treatment of middle-distal humeral shaft fracture.Methods:A retrospective case series study was conducted to analyze the clinical data of 21 patients with middle-distal humeral shaft fracture admitted to 7th Medical Center of Chinese PLA General Hospital from August 2015 to March 2018, including 12 males and 9 females, aged 18-68 years [(31.3±3.6)years]. All were closed fracture. According to AO classification, the fracture were classified as type A in 6 patients, type B in 10 and type C in 5. All patients were treated with anterolateral minimally invasive plate fixation. The operation time, intraoperative blood loss and hospital stay were recorded. The fracture healing was observed after operation. The visual analogue scale (VAS), University of California at Los Angeles (UCLA) shoulder rating scale, and Mayo elbow performance score (MEPS) were used to evaluate the effectiveness before operation and at 2 weeks, 3 months and 12 months after operation.Results:All patients were followed up for 12-26 months [(18.2±2.4)months]. The operation time was 50-82 minutes [(68.2±19.4)minutes], with intraoperative blood loss of 40-95 ml [(60.2±21.3)ml]. The hospital stay was 6-16 days [(6.8±1.2)days]. There was no iatrogenic vascular or nerve injury during operation. The patients with radial nerve injury before operation were all adventitia contusion. The nerve function returned to normal within 3 months after operation. All fractures were healed within 5-10 months [(5.3±1.2)months]. At 2 weeks, 3 months and 12 months after operation, the VAS [(3.6±0.8)points, (2.1±0.4)points, (1.8±0.3)points] was lower than that before operation [(8.3±1.6)points] ( P<0.05); UCLA shoulder rating scale [(31.2±1.5)points, (33.6±0.8)points, (34.6±0.5)points] was higher than that before operation [(28.4±2.3)points] ( P<0.05); and MEPS [(80.2±3.4)points, (93.4±2.2)points, (96.4±3.5)points] was higher than that before operation [(60.5±4.5)points] ( P<0.05). At the last follow-up, the UCLA shoulder rating scale and MEPS showed excellent results. Conclusion:For middle and lower humeral shaft fracture especially for the fracture line relatively distal to the shaft, MIPO technique through anterolateral approach can attain satisfactory results in terms of pain, range of motion of shoulder and elbow joint, and joint function.
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Pelvic fragility fractures are increasing with the aging population in China, characterized by high incidence, high mortality and high morbidity just as geriatric hip fractures. In diagnosis of a pelvic fragility fracture in the elderly, the patient's age, comorbidities, osteogenic factors, clinical manifestations and imaging examinations should be taken into consideration, as well as the special anatomical features and morphologies resulted from degenerative anatomy of the pelvis in the aged. Standard pelvic X-rays and CT scans may confirm the diagnosis in most cases, but MRI may prevent missing a fracture of malfunctioning pelvis or an insidious fracture line on the posterior ring. Fragility fractures of pelvis (FFP) classification, base on X-ray and CT checks, is a common guiding system in current clinic. Usually, conservative treatment is indicated for fractures of FFP types Ⅰ-Ⅱ while surgery for those of FFP types Ⅲ-Ⅳ. As far as possible, minimally invasive reduction and simultaneous fixation of the anterior and posterior rings are recommended. This article intends to review the characteristics, classification and development of minimally invasive techniques concerning pelvic fragility fractures in recent years, and to discuss the future trends in treatment of geriatric pelvic fractures.
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Objective:To determine whether subpopulations may exist which are related to regulation of immunization or inflammation in bone marrow mononuclear cells (BMMNCs) from 2 elderly patients with hip fracture and whether there might be any difference in the subpopulations between them.Methods:Two elderly patients with hip fracture were enrolled in this study. Their venous blood was harvested to determine subpopulations of complement (C)3, C4, interleukins (IL)-2, IL-6, IL-10, and lymphocytes. Single cell RNA sequencing (scRNA-Seq) was used to group their BMMNCs. Gene ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) analyses were performed of the top 20 differentially expressed genes for each subpopulation to judge the main function of each subpopulation. The subpopulations and the key genes related to regulation of immunization or inflammation were found out. The relationships were explored between subpopulations and prognosis of the patients.Results:By the venous blood indexes, IL-10 was slightly high in patient A; C3 below normal, C4 close to the lower normal limit, IL-2, IL-6 and IL-10 were significantly high, CD8 +T % was low, and CD4 +/CD8 + high in patient B. After scRNA-Seq and bioinformatics analyses, the BMMNCs in the 2 patients were divided into 5 subpopulations. GO and KEGG enrichment analyses showed that the functions of subpopulation 2 and subpopulation 4 were related to immunization or inflammation. CCL4, CCL5, LTB and CXCR4 in subpopulation 2 and C1QA, C1QB, CD14 and SPP1 in subpopulation 4 were related to the regulation of immunization or inflammation. The final prognosis of patient A was much better. The proportions of BMMNCs involved in subpopulation 2 and subpopulation 4 from patient A were higher than those from patient B [47.00% (1,431/3,045) versus 29.28% (882/3,012); 5.88% (179/3,045) versus 3.85% (116/3,012)]. Conclusions:The BMMNCs from elderly patients with hip fracture can be divided into subpopulations by scRNA-Seq. Some of the subpopulations may be related to regulation of immunization or inflammation, which may affect the post-injury immune inflammatory state and prognosis of the patients.
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Objective:To study the relationship between hyperlactatemia and hip fracture complications, length of hospital stay, and mortality; And to study the predictive value of serum lactic acid on the risk of death after hip fracture surgery.Methods:The data of 1 004 cases of hip fracture admitted to our unit from January 2012 to December 2016 were retrospectively analyzed. The levels of lactate at admission, 1 day, 3 days and 5 days after operation were recorded. According to whether the average lactate level during hospitalization was higher than 2 mmol/L, the patients were divided into hyperlactic acid and control group. Finally, according to receiver operating characteristic (ROC), the predictive value of lactic acid in predicting the risk of death 30 days and 1 year after hip surgery was obtained.Results:Lactate level: 1.84±0.84 mmol/L on admission, 1.89±0.77 mmol/L at 1 day after operation, 1.79±0.78 mmol/L 3 day after operation, and 1.75±0.72 mmol/L at 5 day after operation. The incidence of lactic acid was 27.1% (272/1 004) in 272 patients with average lactic acid higher than 2 mmol/L during hospitalization. The mortality of 30 days (12.5%, 34/272) and 1 year (29.4%, 80/272) in the hyperlactemia group were significantly higher than that of 1.2% (9/732) and 10.8% (79/732) in the control group (30 days, t=61.448, P<0.001; 1 year, t=51.581, P<0.001). The incidence of perioperative complications in the hyperlactemia group was 28.7% (78/272), which was higher than 22.3% (163/732) in the control group ( χ2=4.465, P=0.035). The average length of hospital stay in the hyperlactemia group (13.95±9.02 d) was significantly higher than that in the control group (12.53±7.71 d) ( t=2.775, P=0.036). Lactic acid level could predict the 30 day mortality risk of hip fracture ( P<0.001). The cutoff value was 2.25 mmol/L, the sensitivity and specificity were 0.721 and 0.820, respectively, and the area under the curve was 0.832. Conclusion:The incidence of serum hyperlactatemia after hip fracture was high. Compared to patients with control group, the length of stay was longer, the incidence of complications was higher, and the mortality within 30 days and 1 year after operation were higher in serum hyperlactatemia group. Lactate level (2.25 mmol/L) could be used to predict the risk of mortality within 30 days after hip fracture operation.
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Objective:To investigate the characteristics of fragility fractures of pelvis(FFP) in the elderly and compare the clinical efficacy between conservative treatment and minimally invasive surgery.Methods:A retrospective study was conducted in the 56 elderly FFP patients who had been treated at Department of Orthopaedics, The General Hospital of Chinese People's Liberation Army from January 2017 to January 2019. They were 16 males and 40 females, with an age of 73.4 years (from 65 to 93 years). By the American Society of Anesthesiologists (ASA) classification, there were 12 cases of grade Ⅰ, 16 cases of grade Ⅱ, 20 cases of grade Ⅲ, and 8 cases of grade Ⅳ; by the FFP classification, there were 6 cases of type Ⅰ, 10 cases of type Ⅱ, 36 cases of type Ⅲ, and 4 cases of type Ⅳ. The morphological characteristics and injury mechanisms of FFP were analyzed. According to the treatment methods, the patients were divided into a conservative treatment group of 32 cases and a minimally invasive surgery group of 24 cases. The 2 groups were compared in terms of complication incidence, mortality and the Koval attenuation rate of walking ability after one-year follow-up.Results:There were mostly the fractures of pubic branches on both sides of the pubic symphysis and compression fractures of the sacral wing caused by lateral crush injury. The 2 groups were comparable due to no significant differences in the preoperative general data between them other than FFP classification ( P>0.05). By one year after treatment, the conservative treatment group had a complication incidence of 34.4% (11/32), a mortality of 9.4% (3/32) and a Koval attenuation rate of walking ability of 13.8% (4/29) while the minimally invasive surgery group had a complication incidence of 20.8% (5/24), a mortality of 4.2% (1/24) and a Koval attenuation rate of walking ability of 8.7%(2/23), showing no significant difference between the 2 groups ( P>0.05). Conclusions:The injury mechanism of geriatric FFP is mostly lateral compression injury. The fracture sites are mostly located on both sides of the pubic symphysis, pubic branches and the sacral wing of anterior and posterior rings simultaneously. Although there may be no significant difference in complication incidence, mortality or Koval attenuation rate of walking ability between conservative treatment and minimally invasive surgery after one year, the minimally invasive surgery deals with more unstable fracture types.
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Objective:To study the predictive value of high serum lactate for the risk of death after hip fractures.Methods:Data of hip fracture patients admitted to the authors' unit from January 2012 to December 2016 were analyzed retrospectively.A total of 1004 patients were included.According to the receiver operating characteristic(ROC), the predictive values of lactate for predicting the risk of death 30 days and 1 year after hip surgery were obtained.Results:The mortality rates of patients with serum hyperlactatemia were 10.8% and 23.3% for 30 days and 1 year after surgery, respectively.The 30-day and 1-year mortality rates for patients in the normal group were 1.3% and 11.8%, respectively.The differences between the two groups were statistically significant( χ2=47.764, 27.433, P=0.000 for both). The average survival time was(23.9±16.6)m for patients in the hyperlactatemia group and(28.8±16.5)m for subjects in the normal group, with a significant difference between the two groups( t=4.340, P=0.000). The incidences of complications were 28.6% for the serum hyperlactatemia group and 21.9% for the normal lactate group.There were significant differences between the two groups( χ2=5.249, P=0.022). The average length of stay was(13.6±8.7)d for the hyperlactatemia group and(12.5±7.8)d for the normal group, with the difference showing statistical significance( t=1.988, P=0.047). Lactate levels were able to predict the risk of death 30 days after hip fracture surgery.The predicted cutoff value was 2.35 mmol/L, the sensitivity and specificity were 0.744 and 0.834, respectively, and the area under the curve was 0.829. Conclusions:The incidence of hyperlactatemia after hip fractures is high.Compared with hip fracture patients with normal lactate levels, patients with hyperlactatemia show longer hospital stays, a higher incidence of complications, and higher mortality rates within 30 days and 1 year of surgery.Lactate levels(2.35 mmol/L)may be used to predict the risk of death within 30 days of hip fracture surgery.
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Since December 2019, the corona virus disease 2019 (COVID-19) caused by the 2019 novel coronavirus (2019-nCoV) has been reported in Wuhan, Hubei Province. Almost 70% of patients susceptible to 2019-nCoV are over age of 50 years, with extremely large proportion of critical illness and death of the elderly patients. Meanwhile, the elderly patients are at high risk of osteoporotic fractures especially osteoporotic vertebral compression fractures (OVCF). During the prevention and control of COVID-19 epidemic, orthopedists are confronted with the following difficulties including how to screen and protect OVCF patients, how to accurately diagnose and assess the condition of OVCF patients with suspected or confirmed COVID-19, and how to develop reasonable treatment plans and comprehensive protective measures in emergency and outpatient clinics. In order to standardize the diagnosis and treatment of patients with OVCF diagnosed with COVID-19, the authors jointly develop this expert consensus. The consensus systematically recommends the standardized emergency and outpatient screening and confirmation procedures for OVCF patients with suspected or confirmed COVID-19 and protective measures for emergency and outpatient clinics. Moreover, the consensus describes the grading and classification of OVCF patients diagnosed with COVID-19 according to the severity of illness and recommends different treatment plans and corresponding protective measures based on the different types and epidemic prevention and control requirements.
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There are many reasons which can lead to lumbar disorders, such as intervetebral disc, vertebral body, facet joint, nerve, tendon, paraspinal muscle and so on. However there are many studies focus on the structures of intervertebral disc and vertebral body, while researches on paraspinal muscle are relatively few. In fact, the paraspinal muscle plays an important role in maintaining the stability of the lumbar spine. In recent years, the paraspinal muscle have been examined from morphology, electrophysiology, physical experiment, biopsy and so on, hoping to find out some myogenic factors of lumbar disorders, and to provide reference for improving the prognosis of lumbar posterior surgery. This article reviews the research progress on paraspinal muscles' changes in lumbar disorders and after posterior lumbar surgery.
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Objective To explore the predictive effect of American Society of Anesthesiologists (ASA) classification on prognosis of elderly patients with hip fracture.Methods A retrospective casecontrol study was conducted to analyze the clinical data of 814 elderly patients with hip fracture admitted to the 7th Medical Center of the General Hospital of the PLA from January 2012 to December 2015.There were 272 males and 542 females,with the age range of 60-99 years [(80.0 ± 8.0) years].According to ASA classification,the patients were divided into four groups:23 cases (2.8%) of ASA grade Ⅰ,380 cases (46.7%) of ASA grade Ⅱ,389 cases (47.8%) of ASA grade Ⅲ and 22 cases (2.7%) of ASA grade Ⅳ.Data compared among the groups included gender,age,comorbidities,fracture type,anesthesia methods,surgical methods,length of hospital stay,complications,and 30-day and 1-year mortality rates.Multiple Logistic analysis was conducted to seek independent risk factors for 1-year mortality.Results There were no significant difference among the four groups with regards to gender,fracture type,surgical methods (P > 0.05).With the improvement of ASA classification,the age of patients increased gradually,the length of hospital stay increased,and the rate of nerve block anesthesia increased (allP < 0.01).Incidence of complications of ASA grade Ⅳ patients was the highest [59% (13/22)],followed by 31.4% (122/389) of ASA grade Ⅲ patients,17.6% (67/380) of ASA grade Ⅱ patients,4% (1/23) of ASA grade Ⅰ patients (all P < 0.01).The 30-day and 9-0day mortality of ASA grade Ⅳ patients were 32% (7/22),64% (14/22),ASA grade Ⅲ patients were 4.6% (18/389),17.0% (66/389),ASA grade Ⅱ patients were 3.4% (13/380),12.1% (46/380),and ASA grade Ⅰ patients were 0 and 4% (1/23),respectively.The differences between these groups were significantly different (allP <0.01).Univariate analysis showed that male,advanced age,coronary heart disease,pulmonary infections,chronic obstructive pulmonary diseases (COPD),renal insufficiency,ASA classification,anesthesia methods,and length of hospital stay were related to postoperative 1-year death (P <0.05 or 0.01).A total of 127 patients (15.6%) died within 1 year after operation.Multivariate Logistic regression analysis showed age (OR =1.037,95% CI 1.007-1.068),ASA grade(ASA grade Ⅱ:OR =1.851,95 % CI 1.238-14.386;ASA grade Ⅲ:OR =2.092,95% CI 1.266-16.482;ASA grade Ⅳ:OR =15.368,95% CI 1.626-145.283),length of hospital stay (OR =1.038,95% CI 1.015-1.061) were independent risk factors for 1-year mortality.Conclusions The outcome of the elderly hip fracture is poor.The ASA classification is closely related to the incidence of complications,30-day mortality,and 1-year mortality.Advanced age,ASA grade Ⅱ,Ⅲ and Ⅳ,hospital length of stay are the independent risk factors for poor prognosis of hip fractures.The ASA classification can be used as a screening tool to intervene for the high-risk population as early as possible.