老年髋部骨折患者髋关节置换术前营养状况对术后切口愈合的影响

目的探讨老年髋部骨折患者髋关节置换术前营养状况对术后切口愈合的影响,并分析影响此类患者切口愈合的危险因素。方法纳入自2017-01—2019-12行人工髋关节置换术的232例髋部骨折,根据MNA-SF量表标准评估术前患者营养状况并进行分组,其中营养正常组148例,营养不良组84例。比较两组切口愈合不良发生情况,采用多因素Logistic回归分析术后切口愈合不良的危险因素。结果营养正常组切口一期愈合135例,二期愈合13例(9例切口延迟愈合,4例切口持续渗出,3例切口裂开,2例切口脂肪液化)。营养不良组切口一期愈合65例,二期愈合19例(17例切口延迟愈合,7例切口持续渗出,5例切口裂开,2例脂肪液化,1例切口浅表感染)。营养不良组切口延迟愈合发生率高于营养正常组,差异有统计学意义(P0.05)。营养正常组切口愈合时间为9～21(12.4±2.1)d,营养不良组切口愈合时间为9～28(14.2±3.7)d;Breslow检验结果显示营养不良组切口愈合时间明显延长,差异有统计学意义(P0.05)。多因素Logistic回归分析结果显示,术前低白蛋白水平、营养不良以及术中出血量较大是老年髋部骨折患者髋关节置换术后切口愈合不良的主要危险因素。结论部分老年髋部骨折患者髋关节置换术前存在营养不良状态,术前营养不良是此类患者术后切口愈合欠佳的危险因素,因此术前应常规对患者进行营养状况评估并及时对营养不良患者进行干预。     

老年髋部骨折合并糖尿病围手术期治疗探讨

目的探讨老年髋部骨折合并糖尿病治疗的经验。方法从2000年8月～2004年8月，对24例老年髋部骨折合并糖尿病患者进行围手术期处理，其中男13例，女11例，平均年龄72岁（63—85岁）。结果本组病例切口均顺利愈合，术后3—15天出院；全部获得随访，平均随访时间6个月；无一例死亡。骨愈合时间3～10个月。所有病例术后骨折均愈合，髋关节优良满意率为98．4％。结论对于髋部骨折合并糖尿病患者，良好的围手术期康复治疗能够保证老年患者顺利进行手术、切口和骨折快速愈合、恢复良好关节功能、降低并发症及致残率，提高生存质量，延长寿命。     

老年髋部骨折患者术后1年死亡率与术前血清指标及术后营养指导的相关性分析

目的:分析老年髋部骨折患者术前血清营养学指标及术后营养指导对术后1年死亡率的影响.方法:将2015年1月至2017年12月行手术治疗的396例老年髋部骨折患者纳入研究,其中女267例,男129例,年龄68-80(75.48±2.62)岁;病程2～10(6.12±1.35)d;所有患者术后进行为期1年随访,根据患者是否死...     

血清Chemerin、Ghrelin水平与胫骨干骨折延迟愈合的相关性分析

目的检测Chemerin、Ghrelin因子在胫骨干骨折患者血清中表达情况,探讨Chemerin、Ghrelin与胫骨干骨折延迟愈合的相关性。方法纳入自2019-01—2020-05手术治疗的109例胫骨干骨折,术后根据胫骨干骨折影像学愈合RUST评分分组,骨折正常愈合组71例,骨折延迟愈合组38例。采用酶联免疫吸附法检测两组血清Chemerin、Ghrelin水平,采用ROC曲线分析术后1周血清Chemerin、Ghrelin表达对胫骨干骨折延迟愈合的诊断价值。结果骨折正常愈合组与骨折延迟愈合组术后4周内血清Chemerin水平呈先升高后降低趋势,骨折延迟愈合组术后1、2、4周血清Chemerin水平均高于骨折正常愈合组;两组术后4周内血清Ghrelin水平呈先下降后升高趋势,骨折延迟愈合组术后1、2、4周血清Ghrelin水平均低于骨折正常愈合组,差异有统计学意义(P0.05)。术后1周联合检测血清Chemerin、Ghrelin预测胫骨干骨折延迟愈合的敏感度为89.47%,特异性为88.73%,曲线下面积为0.927。结论胫骨干骨折延迟愈合患者血清Chemerin水平呈高表达,Ghrelin水平呈低表达,二者联合检测对胫骨干骨折延迟愈合具有较高诊断价值,可作为预测胫骨干骨折延迟愈合的潜在标志物。     

微创治疗老年髋部骨折的效果分析

目的对微创手术治疗老年髋部骨折的临床效果进行分析及探讨。方法将60例老年髋部骨折的患者随机分为观察组及对照组各30例,2组患者分别采用微创固定治疗及钢板内固定,观察2组患者的临床治疗效果。结果对2组患者进行Par-ker髋关节功能评分,其中观察组患者优良率为93.33%,对照组患者优良率为73.33%,2组患者优良率差异具有统计学意义(P<0.05),观察组患者骨折愈合时间为(2.8±1.2)个月,对照组患者术后康复时间为(4.2±1.5)个月,2组患者骨折康复时间差异具有统计学意义(P<0.05),观察组患者术后出现1例感染,对照组患者术后出现3例感染,2例骨不连及2例骨折愈合畸形,不良反应率2组患者差异具有统计学意义(P<0.05)。结论对老年髋部骨折患者采用微创固定治疗具有安全可靠、操作方便、临床治疗效率高等优点,值得临床应用。     

Mini-Cog量表预测老年髋部骨折术后谵妄风险

[目的]研究老年髋部骨折患者术后谵妄状态的发生率及相关危险因素。探究Mini-Cog量表评分与谵妄发生的关系。[方法] 70例接受手术治疗的老年髋部骨折患者,收集患者术前血清钠离子浓度、术前牵引制动、术前卧床天数、手术时间、术后3 d血色素下降值、吗啡类药物使用、术后入外科监护室、术后7 d内是否出现谵妄等信息,计算患者Charlson共病指数,进行MMSE量表和Mini-Cog量表评分并记录所用时间。[结果]术后7 d内有28例(40.00%)患者出现谵妄状态。与非谵妄组相比,谵妄组患者术前卧床时间长(P<0.05),术前血清钠离子浓度值低(P<0.05),术后3 d血色素下降多(P<0.05),术前Charlson共病指数高(P<0.05);此外,谵妄组评估术前认知状态的MMSE和Mini-Cog量表评分显著低于非谵妄组(P<0.05)。逻辑回归分析显示:术后谵妄与术前卧床时间、术前血清钠离子浓度、术后3 d血色素下降值、术前Charlson共病指数、术前MMSE量表评分和Mini-Cog量表评分相关。完成Mini-Cog量表时间(3.88±1.67) min,显著低于MMSE量表(12.28±4.84) min (P<0.001)。[结论]老年髋部骨折患者术后谵妄状态的发生与术前卧床时间、术前血清钠离子浓度、术前Charlson共病指数、术前MMSE量表评分和Mini-Cog量表评分相关。评估认知功能障碍的Mini-Cog量表可以简单有效地筛选老年髋部骨折术后谵妄发生的高危患者。     

微创动力内固定架治疗老年髋部骨折的疗效观察

[目的]探讨初步应用微创动力内固定架治疗老年髋部骨折的疗效.[方法]自2008年12月～ 2010年2月,本院对18例老年髋部骨折患者采用微创动力内固定架治疗.其中男11例,女7例.年龄55 ～ 88岁,平均71.2岁.股骨颈骨折3例,股骨粗隆间骨折12例,股骨粗隆下骨折3例.[结果]手术切口4.5～6.1 cm,平均5.2cm.术中出血量平均200 ml.手术时间平均68 min.术后肿胀消退时间平均2.5d.切口均一期愈合.随访18～ 32个月,平均24个月,均临床痊愈,无骨折不愈合或感染,骨折愈合时间平均3.5个月.髋关节功能根据Harris评价,优、良17例,优良率94.4％.[结论]微创动力内固定架治疗老年髋部骨折软组织损伤轻、创伤反应小、术后恢复快、并发症少,符合生物学要求,是一种理想的新型钢板内固定技术.     

个体化预测老年髋部骨折患者术后谵妄风险

[目的]通过分析老年髋部骨折患者术后谵妄的相关危险因素,建立并验证个体化预测老年髋部骨折术后谵妄风险的列线图模型。[方法]纳入2013年1月～2018年3月于淄博市中心医院行手术治疗的老年髋部骨折患者257例,收集临床资料。应用单因素及多因素Logistic回归模型,分析老年髋部骨折患者术后谵妄的独立危险因素。应用R软件构建预测老年髋部骨折患者术后谵妄风险的列线图模型,并进行验证。[结果]多因素Logistic回归分析显示,年龄(OR=1.143,95%CI:1.076～1.214)、2型糖尿病(OR=4.591,95%CI:2.14～9.846)、ASA评分III级(OR=4.262,95%CI:1.600～11.352)、ASA评分IV级(OR=5.396,95%CI:1.868～15.583)、全身麻醉(OR=1.281,95%CI:1.066～1.540)及手术时间(OR=1.018,95%CI:1.001～1.035)是老年髋部骨折患者术后谵妄的独立危险因素(P0.05)。对列线图模型进行验证,ROC曲线显示该模型预测老年髋部骨折患者术后谵妄风险的曲线下面积为0.818(95%CI:0.752～0.885);校准曲线为斜率接近于1的直线,Hosmer-Lemeshow拟合优度检验(x~2=8.760,P=0.363)均显示该模型预测老年髋部骨折患者术后谵妄风险具有良好准确度。[结论]本研究基于年龄、2型糖尿病、ASA分级、麻醉方式及手术时间这5项老年髋部骨折患者术后谵妄的独立危险因素,构建的预测老年髋部骨折患者术后谵妄风险的列线图模型,具有良好的区分度与准确度,可为临床个体化防治老年髋部骨折患者术后谵妄提供科学指导。     

老年髋部骨折患者股骨上端机械强度的测定

目的了解老年髋部骨折和老年骨质疏松的关系.方法选择我院1996～2001年间收治的50岁以上的老年髋部骨折202例,测定其健侧股骨上端机械强度(Singh指数),同时选择门诊50岁以上其它原因摄骨盆X线片而无骨盆和股骨上端骨折的患者105例,测定其右侧股骨上端机械强度,测得的数值作对比分析.结果 50～60岁组和61～70岁组有非常显著差异性(P＜0.01),而70岁以上二者无显著差异性(P＞0.05).结论老年髋部骨折患者其股骨上端机械强度明显下降,测定Singh指数对预测髋部骨折有重要意义.     

髋部骨折患者中股骨颈强度的测定

目的：了解老年髋部骨折和老年骨质疏松的关系。方法：选择1998年至2003年收治的50岁以上老年髋部骨折80例,测定其健侧股骨上端强度（Singh指数）,同时选择门诊50岁以上其他原因摄骨盆X线片而无骨盆和股骨上端骨折的患者90例,测定其左侧股骨上端强度,将测得的数值作对比分析。结果：50～60岁组和61～70岁组股骨上端强度与对照组比较差异有统计学意义（P〈0.01）,而70岁以上组的强度与对照组比较差异无统计学意义（P〉0.05）。结论：老年髋部骨折患者其股骨上端强度明显下降,测定Singh指数对预测髋部骨折有重要意义。     

The influence of preoperative nutritional status in wound healing after replacement arthroplasty

Patient nutritional status was evaluated preoperatively using the serological parameters serum albumin, serum transferrin, and total lymphocyte count in 40 patients who underwent replacement arthroplasty (33 hips and 7 knees). Using the standard criteria, the overall incidence of malnutrition was 40% (16 cases). Ten percent (4 patients) had a negative value in the Rainey McDonald nutritional index. On follow-up, no patient had delayed wound healing or wound infection. Attention to surgeon-dependent factors can offset the high risk of delayed wound healing imposed by patient-dependent factors.     

Serum 25-OHD insufficiency as a risk factor for hip fracture

The aging population and an increasing number of hip fractures worldwide have made prevention of hip fractures a matter of importance. The prevalence of hypovitaminosis D in patients with acute hip fracture has been reported widely in recent years, and the vitamin D nutritional status in such reports is usually evaluated based on serum 25-hydroxyvitamin D (25-OHD). The aim of this article is to review the relationship of serum 25-OHD and osteoporotic fracture and the prevalence of 25-OHD insufficiency in patients with hip fracture, including assessment of nutritional status, oral status, activity, and dementia. We conclude that the serum 25-OHD level may be a useful index for risk of hip fracture in elderly people.     

Preoperative nutritional evaluation as a prognostic tool for wound healing

In 170 patients given primary hip or knee joint prosthesis surgery, we determined the relation between variables connected with the preoperative nutritional state and delayed healing of the surgical wound. 46 patients had a lymphocyte count of less than 1500 cells/mm 3 (normal 1500-3300 cell/mm 3 ), 18 an albumin level of less than 3.5 g/dL (normal 3.5-5 gr/dL), and 35 patients had a transferrin level of less than 200 mg/dL (normal 200-400 mg/dL). We found an association between the preoperative lymphocyte count and delay in wound healing, whereas preoperative serum albumin and transferrin levels had no significant predictive value. In addition, a preoperative lymphocyte count of less than 1500 cells/mm 3 was associated with a 3 times higher frequency of healing complications.     

Serum zinc as a prognostic tool for wound healing in hip hemiarthroplasty

Malnutrition in patients who had surgery leads to the risk of postoperative complications, especially impaired wound healing. Preoperative serum zinc levels and other nutritional parameters were analyzed to establish criteria that would enable delayed healing to be predicted. A prospective study of 97 patients who had hemiarthroplasty for hip fracture is reported. Univariate analysis established the relationship between serum zinc, nutritional parameters, and other demographic variables with delayed healing. Significant variables were included in a multivariate analysis. Univariate and multivariate analyses identified a significant correlation between impaired wound healing and serum zinc levels. The logistic regression equation for probability of delay was: P = 1/[1 + e]. Serum zinc levels less than 95 microg/dL increased risk of delayed healing 11.76 times. Serum zinc levels were shown to have predictive value for delayed wound healing in patients who had hemiarthroplasty for hip fracture.     

A prospective assessment of nutritional status and complications in patients with fractures of the hip

A group of 40 consecutive patients with hip fractures were studied and confirmed to have a high incidence of protein-calorie malnutrition. The prospective nutritional assessment performed for this study included: serum albumin, serum transferrin, anthropometric measurements, skin testing for delayed hypersensitivity, total lymphocyte count, and a 24-h urine collection for metabolic and nitrogen balance determinations. At 3 months after their hip fracture, 37.5% returned to their premorbid ambulatory status; 42.5% sustained a decrement in their ambulatory status or independence; 12.5% died; 7.5% were lost to follow-up. Of the nutritional parameters studied, albumin was significantly associated with mortality (p = 0.004). Considering those patients with an albumin less than 3.0, a mortality rate of 70% was observed in follow-up (maximum of 11 months), compared with a mortality rate of 18% in patients with an albumin greater than or equal to 3.0. It is concluded that the serum albumin has value as a nutritional index without specialized nutritional parameters, and that a more aggressive approach to nutritional support is needed for the hypoalbuminemic patient with a hip fracture, particularly for those with a serum albumin below 3.0.     

Preoperative nutritional evaluation as a prognostic tool for wound healing

In 170 patients given primary hip or knee joint prosthesis surgery, we determined the relation between variables connected with the preoperative nutritional state and delayed healing of the surgical wound. 46 patients had a lymphocyte count of less than 1500 cells/mm3 (normal 1500-3300 cell/mm3), 18 an albumin level of less than 3.5 g/dL (normal 3.5-5 gr/dL), and 35 patients had a transferrin level of less than 200 mg/dL (normal 200-400 mg/dL). We found an association between the preoperative lymphocyte count and delay in wound healing, whereas preoperative seru albumin and transferrin levels had no significant predictive value. In addition, a preoperative lymphocyte count of less than 1500 cells/mm3 was associated with a 3 times higher frequency of healing complications.     

老年髋部骨折患者术前营养不良的危险因素分析

目的分析老年髋部骨折患者术前营养不良的危险因素。 方法回顾性分析2011年1月至2015年12月间东南大学附属中大医院收治的798例年龄≥65岁髋部骨折患者的临床资料,采用多因素Logistic回归分析老年髋部骨折患者术前营养不良的危险因素。 结果老年髋部骨折患者术前营养状况较差,营养不良患者约占34.80~78.43%。老年股骨转子间骨折患者营养状况比股骨颈骨折患者更差,血红蛋白[（108±18）g/L,（123±16）g/L,t=11.617,P<0.001]、白蛋白[（34±6）g/L,（36±5）g/L,t=5.133,P<0.001]两指标差异均有统计学意义。高龄老年患者术前营养状况比普通老年患者更差,血红蛋白[（112±18）g/L,（121±18）g/L,t=6.772,P<0.001]、总淋巴细胞计数[（1.1±0.7）cells/ml,（1.3±0.6)cells/ml,t=3.247,P=0.001]和白蛋白[（34±5）g/L,（36±6）g/L,t=4.577,P<0.001]差异均有统计学意义。多因素Logistic回归分析示年龄（OR：0.567,95% CI：0.419~0.768,P<0.001）和脑梗塞（OR：0.699,95% CI：0.500~0.980,P=0.037）是老年髋部骨折患者术前营养不良的主要危险因素。 结论老年髋部骨折术前营养状况较差,特别是股骨转子间骨折患者和高龄老年患者,年龄和脑梗塞是老年髋部骨折患者术前营养不良的主要危险因素。     

两种手术方式治疗中老年股骨转子间骨折的疗效比较

目的 比较解剖型锁定钢板(LCP)和股骨近端防旋髓内钉(PFNA)治疗中老年股骨转子间骨折的疗效.方法 将86例中老年股骨转子间骨折患者按照手术方式的不同分为LCP组(47例)和PFNA组(39例).比较两组手术时间、术中出血量、骨折愈合时间、并发症情况,末次随访时采用Harris评分标准评价髋关节功能.结果 4例随访...     

Vitamin D status and bone turnover in women with acute hip fracture

Hypovitaminosis D is common in elderly women. Few data are available on vitamin D status and bone turnover in women with acute hip fracture. The aims of this study were to determine whether elderly Italian women with an acute hip fracture also had low vitamin D levels and an increase of bone turnover compared with elderly women with osteoporosis but without fractures. Seventy-four women with acute osteoporotic hip fracture and 73 women with postmenopausal osteoporosis were studied. All women were self-sufficient and had adequate sunlight exposure. To exclude the effect of trauma on serum 25-hydroxycolecalciferol levels and bone markers (bone alkaline phosphatase and C-terminal telopeptides of Type I collagen as indices of bone formation and bone resorption), blood samples were drawn within 24 hours of the fracture. Current data indicated that in our patients the prevalence of hypovitaminosis D is common although to a lesser extent than in women who are housebound. Women with acute hip fractures had a higher prevalence of vitamin deficiency defined as serum 25-hydroxycolecalciferol lower than 12 ng/mL, compared with women with osteoporosis. Moreover, the presence of fracture did not influence the rate of bone formation, whereas the increase in bone resorption could be attributed to an older age of women with acute hip fracture because of similar values of parathyroid hormone levels in the two groups.     

Low serum zinc level as a predictive factor of delayed wound healing in total hip replacement

Delayed wound healing after total arthroplasty puts the patient at risk for superficial and deep infection, with substantial economic and social consequences. The objective of this study was to assess serum zinc levels as a tool for predicting such a delay in patients with primary osteoarthritis or osteoarthritis secondary to avascular necrosis. We conducted a prospective study of 80 total hip arthroplasties, analyzing possible correlations between delayed healing and serum zinc, nutritional parameters, and other demographic and epidemiological variables. The predictive value of preoperative serum zinc levels and lymphocyte counts was confirmed; thus, an arthroplasty procedure could be timed to minimize risk.