人工髋关节置换在老年股骨颈骨折治疗中的作用

目的 探讨人工髋关节置换在治疗老年股骨颈骨折中的作用.方法 比较内固定术组与人工髋关节置换组老年股骨颈骨折治疗效果、并发症发生率、功能情况来评价两种治疗方式的优劣.结果 人工髋关节置换组术后卧床时间为(20.4±3.8)d,内固定组术后卧床时间为(60.0±13.5)d.两组患者均有并发症发生:内固定组出现股骨头坏死、骨折不愈合等并发症,发生率为19.11％(13/68);人工髋关节置换组并发症发生率为7.78％ (7/90);内固定组和人工髋关节置换组功能评估优良率分别为69.12％和93.0％.结论 人工髋关节置换术治疗老年股骨颈骨折效果较好.在符合人工髋关节置换术手术条件的情况下,要优先选用人工髋关节置换术来治疗老年患者股骨颈骨折.     

老年髋关节置换术患者外周血共刺激分子OX40和PD-1与感染的关系

目的 探讨老年髋关节置换术患者外周血共刺激分子OX40和程序性死亡因子1(PD-1)表达水平与感染的关系。方法 选取商丘市第一人民医院2018年2月-2020年12月收治的老年髋关节置换术患者600例为研究对象，依照术后感染情况分为感染组41例与未感染组559例，检测外周血单个核细胞表面共刺激分子OX40及PD-1,归纳术后感染影响因素，采用受试者工作曲线(ROC)评估OX40和PD-1对术后医院感染的预测价值。结果 600例老年髋关节置换术患者共有41例出现感染，发生率为6.83%;共培养分离病原菌68株，其中革兰阳性菌20株、革兰阴性菌46株、真菌2株；单因素及多因素分析结果显示引流管放置时间、合并糖尿病对老年髋关节置换术后感染有一定影响(P<0.05);感染组外周血CD_4⁺、CD_8+、CD_8⁺T淋巴细胞表面共刺激分子PD-1表达水平高于未感染组，OX40表达水平低于未感染组(P<0.05);外周血CD_4+T淋巴细胞表面共刺激分子PD-1表达水平高于未感染组，OX40表达水平低于未感染组(P<0.05);外周血CD_4⁺、CD_8+、CD_8⁺T淋巴细胞表面共刺激分子OX40和PD-1表达水平联合评估预测老年髋关节置换术患者术后感染ROC曲线下面积0.839大于单独检测曲线下面积0.748、0.677、0.720、0.664(P<0.05)。结论 外周血T淋巴细胞表面共刺激分子OX40表达水平降低、PD-1表达水平升高，与老年髋关节置换术患者术后感染的发生具有密切关系，对患者术后感染具有较高的预测价值。     

老年股骨颈骨折患者全髋关节置换术后的综合护理效果

目的分析老年股骨颈骨折患者全髋关节置换术后的综合护理效果。方法抽取2013年9月—2015年9月在沈阳市红十字会医院治疗的老年股骨颈骨折患者76例,入院后均行全髋关节置换术治疗,术后采用抽签法将76例患者分为两组,对照组行常规护理,观察组行综合护理干预,分析两组患者的临床护理效果以及术后并发症的发生情况。结果观察组患者的护理优良率和并发症的发生率分别为86.84%和5.26%,对照组患者的护理优良率及并发症的发生率分别为65.79%和23.68%,差异有统计学意义(P0.05)。结论老年股骨颈骨折患者行全髋关节置换术后加强综合护理,不仅提高了治疗效果,还降低了并发症的发生几率,值得在临床推广应用。     

全髋关节置换术与半髋关节置换术治疗老年股骨颈骨折的疗效对比

目的:探讨全髋关节置换术与半髋关节置换术治疗老年股骨颈骨折的疗效。方法:选取我院2012年3月至2016年3月收治的110例老年股骨颈骨折患者为研究对象,根据不同术式分为研究组和对照组,每组55例,对照组患者实施半髋关节置换术进行治疗,研究组患者实施全髋关节置换术进行治疗,对比两组患者的手术效果及并发症的发生情况。结果:研究组优良率为95.55%,对照组优良率为85.45%,两组比较差异有统计学意义(P0.05),研究组并发症的发生率为10.91%,显著低于对照组的18.18%,两组比较差异有统计学意义(P0.05)。结论:对老年股骨颈骨折患者实施全髋关节置换术,能有效的提高临床优良率,减少并发症的发生。     

全髋关节置换术和半髋关节置换术治疗老年股骨颈骨折的临床疗效分析

目的观察分析全髋关节置换术和半髋关节置换术治疗老年股骨颈骨折的临床效果。方法选取我院2014年2月至2016年2月收治的160例老年股骨颈骨折患者,随机分为两组各80例,观察组患者采用全髋关节置换术治疗,对照组患者采用半髋关节置换术治疗,比较两组的治疗效果。结果观察组患者的优良率97.50%,显著高于对照组的85.00%(P<0.05)。观察组患者的手术时间显著长于对照组(P<0.05)。观察组患者的术后静脉栓塞、髋部疼痛、感染发生率显著低于对照组(P<0.05)。结论针对老年股骨颈骨折患者,全髋关节置换术的治疗效果优于半髋关节置换术,可有效减轻患者疼痛,减少术后并发症,加快康复速度,提高患者生活质量。     

SuperPATH入路微创全髋关节置换术对老年移位性骨折患者的治疗效果及患者预后情况评价

目的 研究老年移位性骨折采用SuperPATH入路微创全髋关节置换术的治疗效果,以及对患者炎症因子、髋关节功能的影响。方法 选取2022年4月至2023年4月南京市六合区人民医院收治的80例老年移位性骨折患者,通过随机数字表法分为对照组与观察组,各40例。对照组患者采用后外侧入路全髋关节置换术治疗,观察组患者采用SuperPATH入路微创全髋关节置换术治疗,两组均于术后随访6个月。对比两组患者术后6个月的临床疗效,手术相关指标,术前及术后7 d炎症因子,术前及术后6个月髋关节功能评分,以及随访期间术后并发症发生情况。结果 观察组治疗总有效率为95.00%,高于对照组的80.00%;与对照组比,观察组患者手术切口长度与住院时间均更短,术中出血量与术后引流量均更少;与术前比,术后7 d两组患者血清C-反应蛋白、白细胞介素-2、白细胞介素-6水平均升高,但观察组均较对照组更低;术后6个月两组患者髋关节功能评分均升高,且观察组较对照组更高;与对照组比,观察组患者并发症总发生率更低（均P<0.05）。结论 与后外侧入路全髋关节置换术对比,老年移位性骨折患者以SuperPATH入路微创全髋关...     

空气波压力治疗仪对髋关节置换术后下肢深静脉血栓形成的干预

目的探讨空气波压力治疗对髋关节置换术后下肢深静脉血栓形成的影响作用。方法将218例髋关节置换术患者随机分为研究组113例和对照组105例,研究组患者髋关节置换术后在常规护理的基础上应用空气波压力治疗仪对下肢进行物理治疗,而对照组患者髋关节置换术后只采用常规护理,分别统计两组患者术后下肢深静脉血栓形成的发生率及血栓栓塞程度,并进行对照比较。结果研究组患者髋关节置换术后下肢深静脉血栓形成的发生率为18.58%,而对照组患者髋关节置换术后下肢深静脉血栓形成的发生率为35.24%,两组比较,2值为7.73,差异有非常显著性(p<0.01);研究组患者髋关节置换术后下肢深静脉血栓栓塞程度轻度发生率为85.71%,中重度发生率为14.29%,而对照组患者髋关节置换术后下肢深静脉血栓栓塞程度轻度发生率为48.65%,中重度发生率为51.35%,两组比较,2值为7.82,差异均有非常显著性(p<0.01)。结论空气波压力治疗仪操作简便易掌握,为降低髋关节置换术后下肢深静脉血栓形成的发病率及减轻血栓栓塞程度开拓了一条新的预防途径,对减少术后并发症、促进患者术后康复具有非常重要的现实意义。     

生物固定假体植入在骨质疏松性髋关节骨折置换术中的应用

目的探讨生物固定假体植入在骨质疏松性髋关节骨折置换术中的应用效果。方法选取2014年2月—2017年2月收治的骨质疏松性髋关节骨折患者80例,根据随机数字表法将其分为对照组和观察组,各40例。患者均行髋关节置换术治疗,对照组使用骨水泥假体植入,观察组使用生物固定假体植入。对比两组Harris评分优良率、髋关节活动度及并发症发生情况。结果观察组Harris评分优良率(92.50%)高于对照组(70.00%),术后3个月两组髋关节活动度大于术前,且观察组大于对照组,观察组并发症发生率(7.50%)低于对照组(25.00%),差异具有统计学意义(均P0.05)。结论髋关节置换术在治疗骨质疏松性髋关节骨折中使用生物固定假体具有较好的临床效果,可提升术后髋关节活动度,术后并发症较少,安全性高。     

髋关节术后病人的并发症及护理

目的探讨人工髋关节置换术的术后并发症的预防和护理方法。方法选择640例行髋关节置换术的患者的临床资料,随机分成两组,对照组320例采用常规护理,观察组320例在此基础上给予针对性的护理,对比两组患者并发症发生率。结果观察组320例患者经过护理仅有5例发生术后并发症,发生率为1.56%,对照组23例发生并发症,发生率为7.18%(P0.05)。结论针对性预见性护理可降低并发症的发生率。     

延续护理对老年全髋关节置换术后患者机体康复的影响

目的:探讨延续护理对老年全髋关节置换术后患者机体康复的影响.方法:对145例接受全髋关节置换术老年患者的临床资料进行回顾性分析,将患者分为两组,对照组75例术后自行进行康复训练且定期至原手术单位门诊复诊;观察组70例术后接受延续护理,在延续护理的帮助下进行康复训练,且定期至原手术单位门诊复诊.比较两组患者术前术后的Harris髋关节评分,观察患者术后并发症发生情况.结果:两组患者手术前至术后满4周时的Harris髋关节评分差异无统计学意义(P>0.05),但术后满8、16、24周时的Harris髋关节评分差异均有统计学意义(均P<0.05),观察组患者优于对照组患者.对照组患者发生6例(8.0％)术后关节脱位,观察组患者无该并发症发生(0.0％),差异有统计学意义(P<0.05).结论:延续护理能改善老年全髋关节置换术患者术后恢复,且具有减少并发症发生的作用.     

Adverse outcomes of frailty in the elderly: the Rotterdam Study

To investigate the prevalence of frailty in a Dutch elderly population and to identify adverse health outcomes associated with the frailty phenotype independent of the comorbidities. Cross-sectional and longitudinal analyses within the Rotterdam Study (the Netherlands), a prospective population-based cohort study in persons aged ≥55 years. Frailty was defined as meeting three or more of five established criteria for frailty, evaluating nutritional status, physical activity, mobility, grip strength and exhaustion. Intermediate frailty was defined as meeting one or two frailty criteria. Comorbidities were objectively measured. Health outcomes were assessed by means of questionnaires, physical examinations and continuous follow-up through general practitioners and municipal health authorities for mortality. Of 2,833 participants (median age 74.0 years, inter quartile range 9) with sufficiently evaluated frailty criteria, 163 (5.8 %) participants were frail and 1,454 (51.3 %) intermediate frail. Frail elderly were more likely to be older and female, to have an impaired quality of life and to have fallen or to have been hospitalized. 108 (72.0 %) frail participants had ≥2 comorbidities, compared to 777 (54.4 %) intermediate frail and 522 (44.8 %) non-frail participants. Adjusted for age, sex and comorbidities, frail elderly had a significantly increased risk of dying within 3 years (HR 3.4; 95 % CI 1.9–6.4), compared to the non-frail elderly. This study in a general Dutch population of community-dwelling elderly able to perform the frailty tests, demonstrates that frailty is common and that frail elderly are at increased risk of death independent of comorbidities.     

经皮冠状动脉介入治疗和衰弱对老年冠心病患者不良预后的交互作用

  目的  探讨经皮冠状动脉介入治疗(percutaneous coronary intervention, PCI)和衰弱对老年冠心病患者近期死亡率以及心源性再住院率的交互作用。  方法  选取池州市人民医院2018年4月1日至2019年11月30日期间在心血管内科住院的老年冠心病患者作为研究对象,收集患者的临床资料,使用衰弱量表对每位患者进行衰弱评估。随访患者出院后的全因死亡情况和心源性再住院情况。采用Kaplan-Meier法生存分析、χ2检验、t检验进行数据分析。  结果  共计273例住院老年冠心病患者纳入研究,76例符合衰弱标准,占比27.84%,160例行PCI,占比58.61%。衰弱相对于非衰弱发生死亡的比例增大到2.77(95% CI:1.41~7.04)倍、发生全因死亡/心源性再住院增大到2.73(95% CI:1.90~3.93)倍。其中,在PCI患者中,衰弱相对于非衰弱组发生死亡和全因死亡/心源性再住院的RR值分别增加到3.02(95% CI:1.32~6.93)和2.96(95% CI:1.89~4.62)。Kaplan-Meier法生存分析的结果显示,衰弱组患者随访期间全因死亡率、全因死亡/心源性再住院率高于非衰弱组(均有P＜0.05)。然而,在非PCI患者中,衰弱组患者随访期间全因死亡率与非衰弱组的差异无统计学意义(χ2=1.95, P=0.163)。  结论  PCI增加了衰弱对老年冠心病患者的近期不良预后的发生风险,PCI与衰弱对老年冠心病患者的不良预后可能存在交互作用。     

Frailty, osteoporosis and hip fracture: Causes, consequences and therapeutic perspectives

Objective: The aim of this review of the literature is to report the factors which both contribute to the frailty syndrome and increase hip fracture risk in the elderly. This work is the fruit of common reflection by geriatricians, endocrinologists, gynecologists and rheumatologists, and seeks to stress the importance of detection and management of the various components of frailty in elderly subjects who are followed and treated for osteoporosis. It also sets out to heighten awareness of the need for management of osteoporosis in the frail elderly.Design: The current literature on frailty and its links with hip fracture was reviewed and discussed by the group.Results: The factors and mechanisms which are common to both osteoporosis and frailty (falls, weight loss, sarcopenia, low physical activity, cognitive decline, depression, hormones such as testosterone, estrogens, insulin-like growth factor-I (IGF-I), growth hormone (GH), vitamin D and pro-inflammatory cytokines) were identified. The obstacles to access to diagnosis and treatment of osteoporosis in the frail elderly population and common therapeutic pathways for osteoporosis and frailty were discussed.Conclusion: Future research including frail subjects would improve our understanding of how management of frailty can can contribute to lower the incidence of fractures. In parallel, more systematic management of osteoporosis should reduce the risk of becoming frail in the elderly population.     

不同年龄段冠心病患者心脏介入术后并发症比较及护理

目的总结不同年龄段冠心病患者心脏介入术后并发症的临床特点及护理经验。方法回顾分析我院行心脏介入术的89例冠心病患者的临床资料,根据年龄分为非老年组及老年组并比较各组患者介入术后并发症的发生情况。结果老年组术后并发症发生率显著高于非老年组(分别为54.8%、25.5%,P<0.01),其中排尿困难、迷走反射、心律失常、术后出血、造影剂肾病及心源性休克为主要并发症,老年组排尿困难、迷走反射、造影剂肾病的发生率显著高于非老年组(均P<0.05)。结论不同年龄段冠心病患者心脏介入术后并发症发生情况不同,其中老年冠心病患者介入术后并发症较非老年患者高,应针对不同年龄阶段患者的特点采取不同策略进行相关并发症的防治以减少并发症的发生。     

老年股骨颈骨折患者髋关节置换术后并发谵妄的危险因素分析

目的探讨老年股骨颈骨折患者髋关节置换术后谵妄的发病率及相关危险因素。方法选择2017年4月至2019年4月于温州市某院进行髋关节置换术治疗的146例老年股骨颈骨折患者纳入研究,统计患者术后谵妄发病率,收集患者临床资料,经logistic多元回归分析老年股骨颈骨折患者髋关节置换术后谵妄的危险因素。结果146例老年股骨颈骨折患者中,髋关节置换术后出现谵妄39例,发病率26.71%;多因素logistic回归分析结果显示:患者年龄≥75岁(OR=7.683)、受伤至手术间隔时间>3 d(OR=7.831)、夜间平均睡眠时间≤5 h(OR=4.137)、全身麻醉(OR=5.023)、麻醉时间≥2 h(OR=5.960)、术中出血量≥300 mL(OR=5.458)、术后低氧血症(OR=12.794)为老年股骨颈骨折患者髋关节置换术后谵妄发病高危因素(P<0.05)。结论高龄、全身麻醉的股骨颈骨折后进行髋关节置换术的患者,是谵妄发病的高危人群。受伤后尽快安排手术、增加睡眠时间、缩短麻醉时间,减少术中出血量、预防术后低氧血症等措施有助于减少术后谵妄发生。     

Role of Cachexia and Fragility in the Patient Candidate for Cardiac Surgery

Frailty is the major expression of accelerated aging and describes a decreased resistance to stressors, and consequently an increased vulnerability to additional diseases in elderly people. The vascular aging related to frail phenotype reflects the high susceptibility for cardiovascular diseases and negative postoperative outcomes after cardiac surgery. Sarcopenia can be considered a biological substrate of physical frailty. Malnutrition and physical inactivity play a key role in the pathogenesis of sarcopenia. We searched on Medline (PubMed) and Scopus for relevant literature published over the last 10 years and analyzed the strong correlation between frailty, sarcopenia and cardiovascular diseases in elderly patient. In our opinion, a right food intake and moderate intensity resistance exercise are mandatory in order to better prepare patients undergoing cardiac operation.     

Frailty status and altered dynamics of circulating energy metabolism hormones after oral glucose in older women

Objectives

Frailty status is associated with altered glucose-insulin dynamics. Here, we sought to investigate whether alteration in the dynamics of other circulating energy metabolism hormones after oral glucose is associated with frailty status.

Design

Substudy of older women in a prospective cohort.

Setting

Baltimore, Maryland.

Participants

Seventy-three community-dwelling women aged 84?C95 years without a diagnosis of diabetes who were enrolled in the Women??s Health and Aging Study II.

Measurements

We examined stimulus-response dynamics of free fatty acids (FFA), gut- (ghrelin, GLP-1) and adipocyte-derived hormones (leptin, adiponectin, resistin), growth hormone (GH), insulin-like growth factor 1 (IGF-1), and interleukin-6 (IL-6) at 0, 30, 60, 120, and 180-minutes after a 75-g glucose challenge according to frailty status (non-frail, pre-frail, or frail).

Results

On average, frail women had higher fasting levels of glucose-raising hormones (FFA, resistin, GH, and IL-6) and lower fasting levels of glucose-lowering hormones (ghrelin, adiponectin, GLP-1 and IGF-1) versus non-frail women but these results were not statistically significant. Frail women also had higher fasting levels of leptin with relative adiposity compared to their counterparts, suggestive of leptin-resistance. integrated area under the curve (AUC) values for each hormone followed similar trends by frailty status. After age and BMI adjustment, frail versus non-frail women were more likely to be in the lowest tertile of fasting ghrelin levels and 120-min ghrelin levels (both p<0.05) in logistic regression analyses. No large differences were found for other hormones in adjusted models.

Conclusions

Our findings suggest dysregulation of the orexigenic hormone ghrelin in the frailty syndrome. Further studies are needed to explore the role of ghrelin dysregulation in the clinical manifestation of frailty.     

Cost-Effectiveness of Preoperative Parenteral Nutrition in Patients Undergoing Major Gastrointestinal Surgery

We used cost-effectiveness analysis to compare three strategies for reducing the incidence of severe nutrition-associated complications (eg, wound dehiscence) in patients undergoing major gastrointestinal surgery: treat all patients with parenteral nutritional support for 10 days before surgery, treat no patients with preoperative parenteral nutritional support, or perform a test which stratifies patients (treating only the “high risk” or “malnourished” patients). The “test” strategy results in the lowest total hospital complication rate when the overall incidence of postoperative nutrition-associated complications is greater than 4% and less than 39%. However, the cost minimizing strategy is “treat none” as long as the overall incidence is less than 78%. In moving from the “treat none” to the “test” strategy, the incremental cost per complication avoided varies from $11,515 (for a 20% overall incidence), to $1,031 (for a 60% overall incidence). These cost-effectiveness ratios for incidence rates above 20% compare favorably to the use of routine screening tests performed on preoperative patients. However, the cost-effectiveness ratios are quite sensitive to the assumptions made concerning the effectiveness of parenteral nutritional support and the predictive properties of the test (derived from previous clinical studies). We conclude that further research is needed to study the overall incidence of severe postoperative nutrition-associated complications for various surgical procedures, to confirm the accuracy of stratification techniques and to confirm previous studies of the effectiveness of preoperative parenteral nutritional support in order to permit third party payers to evaluate the consequences of adopting this intervention as a standard clinical practice. (Journal of Parenteral and Enternal Nutrition 8:632–637, 1984)     

12例人工全髋关节置换术的围手术期护理

目的减少人工全髋关节置换术患者的术后并发症的发生率。方法术前对12例不同病因的人工全髋关节置换术患者进行有针对性的整体评估,给予心理护理、饮食指导,做好各种术前检查及准备工作。术后观察切口及引流情况、生命体征,实施体位护理,预防并发症,指导正确有效的康复锻炼,明确出院指导。结果本组患者行置换术后早期无出现并发症,2～4w出院。结论有效的人工全髋关节置换术的围手术期护理能明显提高术后患者的生活质量。     

不同年龄段冠心病患者心脏介入术后并发症比较及护理

目的总结不同年龄段冠心病患者心脏介入术后并发症的临床特点及护理经验。方法回顾分析我院行心脏介入术的89例冠心病患者的临床资料,根据年龄分为非老年组及老年组并比较各组患者介入术后并发症的发生情况。结果老年组术后并发症发生率显著高于非老年组（分别为54．8％、25．5％,P〈0,01）,其中排尿困难、迷走反射、心律失常、术后出血、造影剂肾病及心源性休克为主要并发症,老年组排尿困难、迷走反射、造影剂肾病的发生率显著高于非老年组（均P〈0．05）。结论不同年龄段冠心病患者心脏介入术后并发症发生情况不同,其中老年冠心病患者介入术后并发症较非老年患者高,应针对不同年龄阶段患者的特点采取不同策略进行相关并发症的防治以减少并发症的发生。