Principles of management of long bone fractures and fracture healing

This article describes the management of long bone fractures to the lower limb. It covers initial management in the emergency department through to definitive treatment by the orthopaedic surgeon. Bone healing is covered and how different treatment techniques can influence bone healing.     

Recombinant human bone morphogenetic protein‐7 enhances fracture healing in an ischemic environment

Ischemia predisposes orthopedic trauma patients to delayed fracture healing or nonunion. The goal of this study was to test the ability of bone morphogenetic protein 7 (BMP7) to stimulate fracture repair in an ischemic environment. Ischemic fractures were generated in male adult mice by resecting the femoral artery prior to the creation of a nonstabilized tibia fracture. Recombinant human BMP7 (rhBMP7, 50 µg) was injected into the fracture site immediately after surgery. At 7 days after injury, more tissue vascularization was observed in rhBMP7 treated fractures. Histomorphometric analyses revealed that rhBMP7 induced more cartilage at day 7, more callus and bone at days 14 and 28, and more adipose tissue and fibrous tissue at days 7, 14, and 28 compared to controls (n = 5/group/time). At day 28, all fractures treated with rhBMP7 (50 µg, n = 5) healed, whereas only three of five control fractures exhibited slight bony bridging. In addition, we found that rhBMP7 (both 10 and 50 µg) significantly increased the amount of cartilage compared to controls in stabilized fractures, confirming its chondrogenic effect. Lastly, using bone marrow transplantation, we determined that no donor‐derived osteocytes or chondrocytes were present in rhBMP7‐treated fractures, suggesting rhBMP7 did not recruit mesenchymal stem cells from the bone marrow to the fracture site. In conclusion, our results indicate that rhBMP7 is a promising treatment for fractures with severely disrupted blood supply. © 2009 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 28:687–696, 2010     

多方位参与的联合疼痛管理在长骨骨折病人中的应用

目的 观察多方位参与的联合疼痛管理（good pain management, GPM）在长骨骨折病人中的应用效果。方法 将我院收治的76例长骨骨折病人随机分为观察组38例和对照组38例。术后疼痛护理中：对照组病人行常规疼痛管理,观察组病人行多方位参与的联合疼痛管理。采用中文版休斯顿疼痛情况满意度调查表（Houston pain outcome instrument, HPQI）分别对两组病人的疼痛护理满意度进行调查;并于疼痛管理干预前后采用特质应对方式问卷（TCSQ）调查两组病人对疾病的应对方式。结果 观察组病人疼痛控制感知状况、疼痛教育状况及疼痛护理总体满意度的满意率依次为89.47%、94.74%、100.00%,均高于对照组的60.53%、68.42%、65.79%（P均＜0.05）。疼痛管理干预后,观察组病人的积极应对得分和消极应对得分均优于对照组（P均＜0.05）。结论 长骨骨折病人疼痛护理中应用多方位参与的联合疼痛管理能有效缓解病人的疼痛体征,提高疼痛护理满意度,促使病人更积极地应对疾病。     

仙灵骨葆胶囊对骨质疏松性骨折大鼠骨生长因子及骨折愈合的影响

目的 探讨仙灵骨葆胶囊对骨质疏松性骨折大鼠骨生长因子BMP-2、IGF-1表达及骨折愈合的影响。方法 48只雌性SD大鼠随机分为：假手术组、模型组、雌二醇组、仙灵骨葆组，12只/组，采用“双侧卵巢切除术+右侧股骨干骨折髓内固定术”构建骨质疏松性骨折大鼠模型，评估骨折愈合情况，检测股骨骨痂BMD、股骨骨生物力学指标和血清骨代谢相关指标，检测骨痂BMP-2、IGF-1蛋白表达。结果 模型组较假手术组骨折愈合评分、股骨痂BMD、股骨骨生物力学指标（最大载荷、最大应力、最大位移）、骨痂BMP-2和IGF-I阳性表达均显著降低（P<0.05），雌二醇组、仙灵骨葆组较模型组骨折愈合评分、股骨痂BMD、股骨骨生物力学指标、骨痂BMP-2和IGF-I阳性表达均显著升高（P<0.05），均以仙灵骨葆组最高。模型组较假手术组血清骨代谢指标（BGP、PICP、TRACP-5b）均显著升高（P<0.05），雌二醇组、仙灵骨葆组较模型组血清骨代谢指标均显著降低（P<0.05），以仙灵骨葆组最低。结论 仙灵骨葆胶囊可能通过介导提高骨质疏松性骨折大鼠骨生长因子BMP-2和IGF-1表达，改善骨代谢，加速骨痂形成，增加骨密度，提高骨生物力学，促进骨折愈合。     

Osteosynthesis of ununited femoral neck fracture by internal fixation combined with iliac crest bone chips and muscle pedicle bone grafting

Background:Ununited femoral neck fracture is seen commonly in developing countries due to delayed presentation or failure of primary internal fixation. Such fractures, commonly present with partial or total absorption of femoral neck, osteonecrosis of femoral head in 8–30% cases with upward migration of trochanter posing problem for osteosynthesis, especially in younger individuals. Several techniques for treatment of such conditions are described like osteotomies or nonvascularied cortical or cancellous bone grafting provided varying degrees of success in terms of fracture union but unsatisfactory long term results occurred due to varying incidence of avascular necrosis (AVN) of femoral head. Moreover, in presence of AVN of femoral head neither free fibular graft nor cancellous bone graft is satisfactory. The vascularied bone grafting by deep circumflex iliac artery based on iliac crest bone grafting, free vascularied fibular grafting and muscle pedicle periosteal grafting showed high incidence of success rate. Osteosynthesis is the preferred treatment of choice in ununited femoral neck fracture in younger individuals.Results:The mean followup is 12.5 years (range 3-35). The union of fractures occurred in 202 (82.8%), delayed union in 18 (7.3%), and established nonunion in 24 (9.8%) patients. Full weight bearing was permitted at 16–22 weeks after union of fractures. Mean Harris hip score at the longest followup was 85.5. Among the complications, superficial wound infection occurred in 20 (8.2%), deep infection in seven (2.9%), and coxa vara in 39 (16%) patients. Preoperative radiodensity of femoral head disappeared mostly after the union of fracture whereas fresh radiodensity of femoral head appeared in 20 (8%) patients; nine (45%) of them developed segmental collapse.Conclusion:Ununited femoral neck fractureis characterized by absorption of femoral neck, posterior cortical defect, smoothening and overriding of fracture surfaces with intervening fibrous tissues associated with or without AVN of femoral head. The above method of osteosynthesis rectified the above pathology and provided satisfactory results with union of fractures in 90.1% patients at long term followup.     

VEGF with AMD3100 endogenously mobilizes mesenchymal stem cells and improves fracture healing

A significant number of fractures develop non‐union. Mesenchymal stem cell (MSC) therapy may be beneficial, however, this requires cell acquisition, culture and delivery. Endogenous mobilization of stem cells offers a non‐invasive alternative. The hypothesis was administration of VEGF and the CXCR4 antagonist AMD3100 would increase the circulating pool of available MSCs and improve fracture healing. Ex‐breeder female wistar rats received VEGF followed by AMD3100, or sham PBS. Blood prepared for culture and colonies were counted. P3 cells were analyzed by flow cytometry, bi‐differentiation. The effect of mobilization on fracture healing was evaluated with 1.5 mm femoral osteotomy stabilized with an external fixator in 12–14 week old female Wistars. The mobilized group had significantly greater number of cfus/ml compared to controls, p = 0.029. The isolated cells expressed 1.8% CD34, 35% CD45, 61% CD29, 78% CD90, and differentiated into osteoblasts but not into adipocytes. The fracture gap in animals treated with VEGF and AMD3100 showed increased bone volume; 5.22 ± 1.7 µm³ and trabecular thickness 0.05 ± 0.01 µm compared with control animals (4.3 ± 3.1 µm³, 0.04 ± 0.01 µm, respectively). Radiographic scores quantifying fracture healing (RUST) showed that the animals in the mobilization group had a higher healing score compared to controls (9.6 vs. 7.7). Histologically, mobilization resulted in significantly lower group variability in bone formation (p = 0.032) and greater amounts of bone and less fibrous tissue than the control group. Clinical significance: This pre‐clinical study demonstrates a beneficial effect of endogenous MSC mobilization on fracture healing, which may have translation potential to prevent or treat clinical fractures at risk of delayed or non‐union fractures. © 2018 The Authors. Journal of Orthopaedic Research® Published by Wiley Periodicals, Inc. on behalf of Orthopaedic Research Society. J Orthop Res 37:1294–1302, 2019.     

单臂外固定支架联合植骨治疗胫骨骨折骨不连

[目的]探讨单臂外固定支架联合植骨治疗胫骨骨折骨不连的优越性、安全性及疗效。[方法]自1996年以来应用单臂外固定支架治疗胫骨骨折骨不连43例，通过断端创新，自体髂骨植骨和轴向加压促进骨折愈合，早期活动以恢复关节功能。[结果]经术后6～15个月、平均10．3个月的随访，43例均获临床愈合，愈合时间为4—12个月，平均6．8个月，功能评价优35例，良7例，差1例。[结论]单臂外固定支架联合植骨治疗胫骨骨折骨不连，自体髂骨植骨和轴向加压促进骨折愈合，早期无痛关节活动有利于关节功能恢复，是一种即简便又切实可行的治疗方法。     

Extracorporeal shockwave therapy: A systematic review of its use in fracture management

Extracorporeal shockwave therapy is increasingly used as an adjuvant therapy in the management of nonunions, delayed unions and more recently fresh fractures. This is in an effort to increase union rates or obtain unions when fractures have proven recalcitrant to healing. In this report we have systematically reviewed the English language literature to attempt to determine the potential clinical efficacy of extracorporeal shockwave therapy in fracture management. Of 32 potentially eligible studies identified, 10 were included that assessed the extracorporeal shockwave therapy use for healing nonunions or delayed unions, and one trial was included that assessed its use for acute high-energy fractures. From the included, studies'' overall union rates were in favor of extracorporeal shockwave therapy (72% union rate overall for nonunions or delayed unions, and a 46% relative risk reduction in nonunions when it is used for acute high-energy fractures). However, the methodologic quality of included studies was weak and any clinical inferences made from these data should be interpreted with caution. Further research in this area in the form of a large-scale randomized trial is necessary to better answer the question of the effectiveness of extracorporeal shockwave therapy on union rates for both nonunions and acute fractures.     

骨质疏松性骨折愈合过程中的骨重建因子

一般性骨折愈合过程分为血肿机化演进期、原始骨痂形成期和骨痂改造塑形期;而骨质疏松性骨折愈合过程分为纤维骨痂期、软骨骨痂期和骨性骨痂期。骨质疏松性骨折愈合的组织学观察表明,纤维骨痂期主要是成纤维细胞合成Ⅲ型胶原;软骨骨痂期主要是成软骨细胞合成、分泌Ⅱ型胶原;骨性骨痂期主要是随着软骨内成骨的出现和发展,Ⅱ型胶原消失,逐渐由抗张力性能较强的Ⅰ型胶原所取代。一般来说,实验性骨质疏松性骨折的愈合方式与一般性骨折愈合方式相似,软骨内成骨和膜内成骨共同参与了骨质疏松性骨折的修复过程,但以软骨内成骨为主。     

肱骨近端、髋部骨折老年女性骨密度和骨代谢指标对比研究

目的对髋部、肱骨近端骨折老年女性的骨密度和骨代谢指标进行对比分析,进一步揭示上述骨折部位女性患者骨密度和骨代谢指标特征性变化情况。方法经患者及家属同意,共纳入62例老年髋部骨折女性患者(其中股骨颈骨折39例,股骨粗隆间骨折23例)、肱骨近端骨折21例,收集患者年龄、检测患者骨密度、血清骨转换指标(Ⅰ型胶原氨基端延长肽,P1NP;Ⅰ型胶原C端肽β降解产物,β-CTX)。结果肱骨近端骨折女性患者平均年龄为(66.1±8.0)岁,明显小于股骨颈骨折、粗隆间骨折女性患者(P<0.05);肱骨近端骨折女性髋部(T=-1.19±0.66)、腰椎骨密度(T=-1.67±1.00)明显高于粗隆间骨折女性髋部(T=-2.36±1.17)、腰椎骨密度(T=-2.61±1.42)(P<0.05),同时显著高于股骨颈骨折患者髋部骨密度(T=-2.33±0.99)。股骨颈骨折、股骨粗隆间骨折患者髋部、腰椎骨密度相比差异无统计学意义;三组间血清P1NP比较差异没有统计学意义,粗隆间骨折女性血清β-CTX(732.18±334.37μg/L)要明显高于肱骨近端骨折患者(529.66±292.34μg/L)(P<0.05)。结论相对于髋部骨折患者,肱骨近端骨折老年女性患者年龄较低,骨密度相对较高;骨吸收活跃可能是导致粗隆间骨折女性骨密度下降的原因。     

血清骨膜素水平与老年髋部骨折患者骨密度相关性研究

目的探索老年髋部骨折患者骨膜素(sP ostn)水平与骨密度的相关性。方法纳入108例患有骨质疏松性髋部骨折的老年女性和106名年龄不匹配的无骨折女性作为对照。在2 d内骨折后测量其临床特征、骨密度(bone mineral density,BMD)和骨转换标志物(包括sP ostn水平)。对于108例患者,检测1年内的随访sP ostn水平。结果骨折后sP ostn的初始水平显著高于对照组。在整个队列中,sP ostn与股骨颈BMD,骨Ⅰ型胶原N-端前肽(PINP)和Ⅰ型胶原交联C-末端肽(β-CTX)相关(P均0. 05)。多变量分析后,sP ostn仍然是股骨颈BMD的独立危险因素。骨折后7 d内采样的sP ostn从第2天开始急剧增加,然后减少并在360 d保持在略高的水平。sP ostn的变化与骨折后第7天β-CTX(P0. 05)和PINP(P0. 05)的变化呈正相关。结论高sP ostn水平是老年女性急性髋部骨折患者股骨颈低BMD的独立预测因素。     

老年股骨颈与粗隆间骨折患者血尿酸水平的比较研究

目的通过比较老年股骨颈与股骨粗隆间骨折患者的血尿酸(SUA)水平,研究尿酸与骨代谢的相关性。方法笔者收集自2014-01—2016-06诊治的437例股骨颈或股骨粗隆间骨折,其中股骨颈骨折264例,股骨粗隆间骨折173例,空腹血检测SUA水平。结果股骨颈骨折患者的年龄为(75.6±9.1)岁,股骨粗隆间骨折患者的年龄为(80.5±7.3)岁,股骨颈骨折患者年龄小于股骨粗隆间骨折,差异有统计学意义(P0.001)。男性患者的SUA水平为(298.6±93.4)μmol/L,女性患者的SUA水平为(261.7±85.2)μmol/L,男性患者SUA水平高于女性,差异有统计学意义(P0.001),各年龄段男女患者的SUA水平与该结果保持一致。股骨颈与粗隆间骨折患者的SUA水平较高,两者间比较差异无统计学意义(P=0.063),且各年龄段中男(女)性股骨颈与粗隆间骨折患者的SUA水平差异无统计学意义。结论年龄是骨质疏松独立的危险因素,股骨粗隆间骨折患者的年龄明显高于股骨颈骨折患者,提示其骨质疏松程度更高。但SUA水平在2组患者间差异无统计学意义,初步说明尿酸与骨代谢无关。在临床中仍应积极控制尿酸水平,避免高尿酸血症引起的相关并发症。     

绝经后骨质疏松性椎体压缩性骨折患者血清雌激素、前脂肪因子-1水平与骨代谢和骨密度相关性研究

目的 研究绝经后骨质疏松性椎体压缩性骨折（osteoporotic vertebral compression fracture,OVCF）患者血清雌激素、前脂肪因子-1（preadipose factor-1,Pref-1）水平与骨代谢和骨密度的相关性。方法 纳入湛江中心人民医院2019年1月至2020年11月期间确诊的64例绝经OVCF患者为OVCF组,同时纳入绝经后的健康女性45名为对照组,比较OVCF组和对照组血清中雌二醇、Pref-1水平,并根据OVCF患者血清中雌二醇、Pref-1的水平分为高低亚组,进行患者骨代谢、骨密度等一系列指标的比较,通过Preason相关性分析雌二醇、Pref-1的水平与骨代谢、骨密度指标的相关性。结果 OVCF患者血清中雌二醇水平较对照组显著降低（t=13.275,P<0.05）,Pref-1水平显著上升（t=10.360,P<0.05）;雌二醇高表达组较低表达组患者血清中25-（OH）VitD、N-MID的水平以及腰椎骨密度、髋部骨密度均显著上升（t=7.378,5.472,10.290,9.774,P<0.05）,PINP、β-CTX水平均显著降低（t=6.447,9.103,P<0.05）;Pref-1高表达组较低表达组患者血清中25-（OH）VitD、N-MID的水平以及腰椎骨密度、髋部骨密度均显著下降（t=8.350,7.426,12.376,10.450,P<0.05）,PINP、β-CTX水平均显著升高（t=8.266,11.205,P<0.05）;OVCF患者血清雌二醇水平与25-（OH）VitD、N-MID以及腰椎骨密度、髋部骨密度均呈正相关（r>0,P<0.05）,与PINP、β-CTX水平呈负相关（r<0,P<0.05）;Pref-1与25-（OH）VitD、N-MID的水平及腰椎骨密度、髋部骨密度均呈负相关（r<0,P<0.05）,与PINP、β-CTX水平呈正相关（r>0,P<0.05）。结论 绝经后OVCF患者血清雌激素显著下调,Pref-1水平明显上调,且二者与骨代谢和骨密度指标之间存在密切相关性,对二者水平的医学干预或能为OVCF的临床治疗带来新的契机。     

老年股骨转子间骨折骨质量 X线评估与骨折愈合关系分析

目的分析老年股骨转子间骨折的骨质量与骨折愈合关系,探讨手术失败原因及防范补救措施。方法回顾性分析1997年1月～2003年7月间本科收治并随访1年以上的477例65岁以上股骨转子间骨折患者,并按照骨质量状况将其分组,分析不同骨质疏松程度对转子间骨折手术后骨折愈合的影响。结果轻度骨质疏松组A级愈合者164例(93.2%),B级愈合者12例(6.8%)。中度骨质疏松组A级愈合者182例(68.9%),B级愈合者72例(27.3%),C级愈合者10例(3.8%)。重度骨质疏松组B级愈合者20例(54.1%),C级愈合者17例(45.9%)。各组间差异有极显著性(P<0.01)。结论动力髋螺钉(DHS)固定术对高龄转子间骨折患者是必要的,但骨质量对骨折愈合有显著影响。临床上应根据骨质疏松程度采取不同治疗措施,以获得最佳效果。     

BMPR1A antagonist differentially affects cartilage and bone formation during fracture healing

A soluble form of BMP receptor type 1A (mBMPR1A‐mFC) acts as an antagonist to endogenous BMPR1A and has been shown to increase bone mass in mice. The goal of this study was to examine the effects of mBMPR1A‐mFC on secondary fracture healing. Treatment consisted of 10 mg/kg intraperitoneal injections of mBMPR1A‐mFC twice weekly in male C57BL/6 mice. Treatment beginning at 1, 14, and 21 days post‐fracture assessed receptor function during endochondral bone formation, at the onset of secondary bone formation, and during coupled remodeling, respectively. Control animals received saline injections. mBMPR1A‐mFC treatment initiated on day 1 delayed cartilage maturation in the callus and resulted in large regions of fibrous tissue. Treatment initiated on day 1 also increased the amount of mineralized tissue and up‐regulated many bone‐associated genes (p = 0.002) but retarded periosteal bony bridging and impaired strength and toughness at day 35 (p < 0.035). Delaying the onset of treatment to day 14 or 21 partially mitigated these effects and produced evidence of accelerated coupled remodeling. These results indicate that inhibition of the BMPR1A‐mediated signaling has negative effects on secondary fracture healing that are differentially manifested at different stages of healing and within different cell populations. These effects are most pronounced during the endochondral period and appear to be mediated by selective inhibition of BMPRIA signaling within the periosteum. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:2096–2105, 2016.     

经皮自体红骨髓植入治疗胫骨中下段骨折延迟愈合及不愈合

目的 探讨经皮自体红骨髓植入治疗胫骨中下段骨折延迟愈合及不愈合的疗效.方法 对胫骨中下段骨折延迟愈合18例、骨折不愈合5例患者,将自体红骨髓植入至骨折断端,定期摄X线片复查.结果 23例均获得随访,时间4～16个月,患者骨折均愈合,愈合时间3～12个月,未见骨折畸形愈合、异位骨化及感染等并发症.结论 经皮自体红骨髓植入治疗胫骨中下段骨折延迟愈合及不愈合是一种有效、安全、简易、实用的方法.     

Predictors of fracture healing in patients with recalcitrant nonunions treated with autologous culture expanded bone marrow‐derived mesenchymal stromal cells

The study reports the prospective outcome of treating severe recalcitrant fracture nonunion in patients with autologous bone marrow‐derived mesenchymal stromal cells (BMSC) from 2003 to 2010 and analyze predictors of union. Autologous BMSC were culture expanded and inserted at nonunion site with or without carriers in addition to surgical stabilization of the fracture. Radiological union was ascertained by musculoskeletal radiologists on plain radiographs and/or CT scans. A logistic regression analysis was performed with cell‐expansion parameters (cell numbers, cell doubling time) and known clinical factors (e.g., smoking and diabetes) as independent variables and fracture union as the dependent variable to identify the factors that influence bony healing. An Eq5D index score assessed the effect of treatment on general quality of health. A total of 35 patients (mean age 51+/?13 years) with established nonunion (median 2.9 years, 1–33) and, at least one failed nonunion surgery (median 4,1–14) received treatment. Fracture union was achieved in 21 patients (60%; 95%CI 44–75) at 2.6 years. Multiple penalized logistic regression revealed faster cell doubling time (p = 0.07), absence of diabetes (p = 0.003), less previous surgeries (p = 0.008), and lower age at cell implantation (p = 0.02) were significant predictors for fracture union. A significant increase in Eq5D index (p = 0.01) was noted with a mean rise of the score by 0.34 units (95%CI 0.11–0.58) at 1 year following the study. In summary, the study revealed cell doubling time as a novel in vitro parameter in conjunction with age, multiple surgeries, and diabetes as being significant predictors of the fracture union. © 2018 The Authors. Journal of Orthopaedic Research® Published by Wiley Periodicals, Inc. J Orthop Res 37:1303–1309, 2019.     

海水浸泡开放性骨折伤愈合过程中组织病理学和血管内皮细胞生长因子(VEGF)表达

目的通过观察普通开放骨折、海水浸泡开放骨折愈合过程的组织学变化和骨痂中血管内皮细胞生长因子(VEGF)的表达,了解海水浸泡开放性骨折愈合过程VEGF的作用与机制。方法新西兰大白兔59只,随机分为普通开放骨折组(对照组)24只和海水浸泡开放骨折组(实验组)35只。造成桡骨横行1.5mm缺损完全开放骨折,普通开放骨折伤组旷置3h,海水浸泡开放骨折伤组海水浸泡伤口3h,之后依次缝合伤口。于第1、3、7、14、21、28、45天处死动物。观察海水浸泡开放骨折伤在骨折愈合中不同时间的病理过程。采用RT-PCR方法检测普通开放骨折、海水浸泡开放骨折不同阶段骨痂中的VEGF的表达及变化。结果海水浸泡开放骨折伤骨痂形成延迟,骨折后第28天,对照组断端间骨痂为骨性骨痂者8例,为软骨者4例,实验组断端间骨痂为骨性骨痂者6例,为软骨者14例。海水浸泡骨折伤愈合过程中新生骨痂的VEGF表达在骨折后逐渐升高,术后14d达到高峰,之后逐渐下降,但在28d时仍保持较高水平,与一般开放骨折愈合过程的VEGF表达无显著差异(P>0.05)。结论海水浸泡使骨折骨痂形成不良率增高,骨折愈合过程有延迟倾向;但骨折愈合过程中VEGF表达无明显变化。     

The use of two nutritional indicators in identifying long bone fracture patients who do and do not develop infections

One hundred consecutive orthopedic long bone fracture patients requiring surgical fixation were nutritionally assessed using both the nutritional index of Rainey-MacDonald et al. and total lymphocyte count. The ability of these two parameters to identify correctly those patients who do and do not develop postoperative complications was assessed using several error rate measures, which included sensitivity, specificity, positive predictive value, negative predictive value, and accuracy. Fourteen of our patients developed postoperative complications. All complications observed were infections. The accuracy of the nutritional index and total lymphocyte count in predicting patient outcome was 78 and 51%, respectively. The positive and negative predictive values calculated for the nutritional index were 36 and 94%, respectively. Total lymphocyte count analysis resulted in positive and negative predictive values of 15 and 87%, respectively. In our sample of patients, the nutritional index was a better predictor of patient outcome than total lymphocyte count, as indicated by the higher accuracy rate calculated for the nutritional index. Based upon positive predictive value results, neither of these indicators was most accurate in identifying patients who did develop infections. Not unexpectedly, both indicators were best in identifying those patients who did not develop postoperative infections.     

不同骨密度骨质疏松性椎体压缩骨折骨组织形态与骨代谢标志物分析

目的 观察不同骨密度骨质疏松椎体压缩骨折(osteoporotic vertebral compression fracture,OVCF)骨组织形态学特征及骨代谢标志物变化规律.方法 将136例OVCF患者按不同骨密度(T值)分为3组:I组,-3.5相似文献