老年骨质疏松性髋部骨折危险预测

目的综合考虑引起老年人髋部骨折的两个重要因素，设计新预测指标ＢＭＤ／Ｉ，利用多测量区分析提高老年人骨质疏松性髋部骨折危险预测的准确性和可靠性。方法用ＤＥＸＡ测量骨折组和对照组的髋部骨密度，根据有关物理定律推导新预测指标的计算公式。结果利用判别分析得到预测老年人骨质疏松性髋部骨折危险性的判别函数组及预测正确率。讨论多测量区分析较通常采用的单测量区分析预测正确率明显提高，判别函数组可作为计算机辅助诊断的基础，预测结果可供临床医生参考     

老年性骨质疏松与髋部骨折

本研究采用随机分组设计比较了102名绝经后妇女中股骨颈骨折及股骨粗隆间骨折患者与正常对照组的Singh指数、股骨颈皮质骨指数和股骨外侧皮质骨厚度,结果表明两骨折组与正常对照组之间均有非常显著(P<0.01)或显著(P<0.05)之统计学差异,认为骨质疏松是老年人髋部骨折的主要影响因素之一,而采用X线平片评定股骨近端的骨量改变对于预测髋部骨折之危险性具有一定价值.     

老年人髋部骨折156例临床治疗分析

目的 报告老年人髋部骨折的临床治疗方法，分析老年髋部骨折特点及诊治注意事项。方法 自1997年1月－1999年12月共治疗60岁以上（60－93岁）髋部骨折156例。男性55例，平均年龄71．8岁；女性101例，平均年龄73．1岁。骨折类型：股骨颈骨折94例，男性20例，女性74例；股骨粗隆间骨折62例，男性35例，女性27例。本组接受非手术治疗41例；手术治疗115例，其中行各种内固定手术45例，人工股骨头置换68例，股骨头颈切除2例。部分病例同时给予骨质疏松药物治疗。结果 获得随访110例。随访时间0．5－3．5年。术后下肢静脉栓塞2例，股骨头缺血坏死2例，内固定物松动，滑脱2例，断裂1例，人工股骨头下沉致疼痛4例，术后近期死亡2例（死于心肌梗塞及呼吸道感染），97例（88．2％）恢复行走功能。结论 （1）老年人髋部骨折以女性多见，占64．7％；男性少见，占35．3％。这与女性绝经后骨折疏松症的发生密切相关。而老年股骨颈骨折多见于女性，股骨粗隆间骨折则多见于男性。70岁以后，老年髋部骨折发生率明显上升。这与老年性骨质疏松症的发生明显相关。说明随着年龄的增加，骨折的发生率明显增高，骨折危险性增加。（2）老年人髋部骨折属于骨质疏松性骨折，股骨粗隆间骨折一般都有明确外伤史；而股骨颈骨折常由轻微外力（扭转）所致，因此在诊断时须防止漏诊或误诊，影响治疗效果。（3）老年人多伴有心血管系统或呼吸系统疾病，骨折后长期卧床具致使的威胁，因此在治疗上如无禁忌应争取早期手术，早期下床活动。（4）在治疗骨折的同时，应注意对骨质疏松症的治疗，这对减轻全身骨痛，促进骨折愈合，防止再骨折均有重要意义。     

骨密度在髋部骨质疏松性骨折风险评估中的价值

目的评估骨密度在髋部脆性骨折风险预测中的临床价值。方法回顾性研究2014年6月至2019年6月在我院创伤骨科住院的老年髋部骨折患者72例,作为病例组,其中股骨转子间骨折31例,股骨颈骨折41例;对照组选择同期我院骨外科门诊老年体检者63例。使用DXA方法测量患者腰椎和健侧髋部(全髋部、转子间、股骨颈、Ward’s区)的骨密度;对照组测量腰椎和左侧髋部骨密度,统计分析测量结果。结果①骨折组腰椎、髋部骨密度均显著低于对照组,差异有统计学意义(P0.01);②转子间骨折组和股骨颈骨折组在腰椎和髋部区域骨密度比较差异均无统计学意义(P 0.05);③骨折组与对照组在转子间区的T值降低比例最大为122.1%,腰椎降低幅度最小为31.3%,余髋部的T值均有不同程度降低;④骨折后髋部和腰椎T值比存在倒置现象;⑤对照组和骨折组髋部骨质疏松程度比较,差异有统计学意义(P0.01);两组患者腰椎骨质疏松程度比较,差异无统计学意义(P0.05)。结论①髋部骨折患者骨密度均显著低于体检者,提示骨密度与髋部骨折具有一定相关性,但与髋部骨折类型无关;②在髋部骨折风险评估中,髋部骨密度相比腰椎更有价值;③当髋部与腰椎T值比出现倒置时,将不可避免发生髋部骨折;④骨量正常的部分患者发生了脆性骨折,而骨质疏松的部分患者却未发生骨折,表明影响骨折发生的因素除了骨密度外,可能和骨骼的微结构有关。     

髋部骨密度与髋部骨折风险的相关性分析

目的探讨不同年龄，不同性别髋部骨折患者的髋部骨密度值与髋部骨折风险的相关性。方法抽取髋部骨折98例，50岁以上85例，其中男性33例，女性52例，股骨颈骨折占44例，粗隆间骨折41例。按照骨质疏松诊断标准共分为2组：T〈-2．0（骨折组），T〉-2．0（骨折组），按性别、年龄、身高、体重与骨折组按1：1配对，以T〈-2．0（非骨折组），T〉-2．0（非骨折组）分别作为对照组。结果年龄50岁以上非暴力髋部骨折患者，T〈-2．0（骨折组）和T〈-2．0（非骨折组）做对照研究，骨折组的骨密度值要低于非骨折组，对骨折风险预测有显著性差异。男性和女性之间做对照研究，有明显的统计学意义。年龄50岁以上非暴力髋部骨折患者，T〉-2．0（骨折组）和T〉-2．0（非骨折组）做对照研究，骨折组的骨密度值要低于非骨折组，对骨折风险预测有显著性差异。男性和女性之间做对照研究，有明显的统计学意义。年龄50岁以下的患者为13例，其中男性11例，女性2例，均为年轻的受暴力致伤的患者，骨密度值检测对骨折风险评估没有显著性差异。结论（1）对于非暴力髋部骨折，低BMD与髋部骨折有明显的相关性，且呈指数级相关。（2）骨折危险性的评估没有明确的BMD阈值。（3）骨折患者与非骨折患者BMD有相互重叠。（4）女性自50岁左右髋部骨折的发生率要高于男性。（5）小于50岁的较年轻患者BMD和骨折危险性的相关性不明确。     

应用有限元分析骨质疏松性髋部骨折的研究进展

有限元分析方法是随着电子计算机的发展而迅速发展起来的一种现代计算方法,早期的有限元主要关注于某个专业领域,比如应力或疲劳。新兴的有限元方法使多物理场的模拟成为可能。骨质疏松是一种全身性的骨代谢疾病,其发病率呈逐年上升趋势,严重威胁着老年人的身体健康。骨质疏松性髋部骨折给患者带来了巨大痛苦。本文通过回顾近年来相关研究,分析有限元方法在骨质疏松性髋部骨折的研究进展。     

骨质疏松并髋部骨折的治疗

目的　通过对 6 2例骨质疏松并髋部骨折的治疗 ,探论其手术治疗的必要性及优越性。方法　回顾分析了其的骨质疏松程度、术前并存症、手术方式、术后并发症。结果　手术组平均住院 2 2d ,并发症发生率 1 2 3% ;非手术组平均住院 87d ,3例死于肺部感染和全身衰竭 ,并发症发生率为 2 8 6 %。结论　骨质疏松并髋部骨折的手术治疗是必要的 ,也是安全的     

老年性骨质疏松与髋部骨折

本研究采用随机分组设计比较了１０２名绝经后妇女中股骨颈骨折及股骨粗隆间骨折患者与正常对照组的Ｓｉｎｇｈ指数、股骨颈皮质骨指数和股骨外侧皮质厚度，结果表明两骨折组与正常对照组之间均有非常显著（Ｐ〈０．０１）或显著（Ｐ〈０．０５）之统计学差异，认为骨质疏松是老年人髋部骨折的主要影响因素之一，而采用Ｘ线平片评定股骨近端的骨量改变对于预测髋部骨折之危险性具有一定价值。     

骨质疏松性髋部骨折相关因素临床研究进展

骨质疏松症之所以严重危害老年人,尤其是老年女性身体健康,最重要的原因在于其伴发的骨折。骨质疏松性骨折多发于桡骨远端、脊柱和髋部。其中,髋部骨折的治疗费用、入院率、致残率和病死率远较其它部位的骨质疏松性骨折高。因此,其相关因素的研究,对于正确评价骨折危...     

The Impact of Aprotinin on Renal Function After Liver Transplantation: An Analysis of 1043 Patients

Renal dysfunction is frequently seen after orthotopic liver transplantation (OLT). Aprotinin is an antifibrinolytic drug which reduces blood loss during OLT. Recent studies in cardiac surgery suggested a higher risk of postoperative renal complications when aprotinin is used. The impact of aprotinin on renal function after OLT, however, is unknown. In 1,043 adults undergoing OLT, we compared postoperative renal function in patients who received aprotinin (n = 653) or not (n = 390). Using propensity score stratification (C-index 0.82) and multivariate regression analysis, aprotinin was identified as a risk factor for severe renal dysfunction within the first week, defined as increase in serum creatinine by >or= 100% (OR = 1.97, 95% CI = 1.14-3.39; p = 0.02). No differences in renal function were noted at 30 and 365 days postoperatively. Moreover, no significant differences were found in the need for renal replacement therapy (OR = 1.52, 95% CI = 0.94-2.46; p = 0.11) or in 1-year patient survival rate (OR = 1.14, 95% CI = 0.73-1.77; p = 0.64) in patients who received aprotinin or not. In conclusion, aprotinin is associated with a higher risk of transient renal dysfunction in the first week after OLT, but not with a higher need for postoperative renal replacement therapy or an increased risk of mortality.     

Infection with human immunodeficiency virus in the Pittsburgh transplant population. A study of 583 donors and 1043 recipients, 1981-1986

We performed a retrospective serologic survey of 583 organ donors and 1043 transplant recipients for antibodies to human immunodeficiency virus type 1 (HIV-1). Two (0.34%) of the 583 donors and 18 (1.7%) of the 1043 recipients had HIV-1 antibodies by enzyme immunoassay and by Western blot. Two of 5 seropositive recipients tested also had blood cultures positive for HIV-1. Seven (0.7%) of the 1043 transplant recipients had antibodies to HIV-1 before transplantation; 2 of these had hemophilia A, and 5 had previous transfusions. Eleven (1.3%) of 860 recipients followed for 45 days or more seroconverted to HIV-1 a mean of 96 days after transplantation. Likely sources of HIV-1 infection for 3 of these 11 recipients included a seropositive organ donor in 1 patient and high-risk blood donors in 2 patients. A definite source of HIV-1 infection was not found for the other 8 recipients, 3 of whom seroconverted to HIV-1 after institution of blood donor screening for HIV-1 antibodies. Seroconversion to HIV-1 was less common in kidney recipients than in liver, heart, or multiple-organ recipients (P less than 0.02). Nine (50%) of the 18 HIV-1 seropositive transplant recipients died a mean of 6 months after transplant surgery, and 9 (50%) are still alive a mean of 43 months after transplantation. AIDS-like illnesses occurred in 3 of the dead and 1 of the living patients and included pneumocystis pneumonia (3 cases), miliary tuberculosis (1 case), and recurrent cytomegalovirus infection (1 case). These data suggest that the course of HIV-1 infection is not more severe in transplant recipients receiving cyclosporine than in other hosts and that, despite screening of blood and organ donors, a small number of transplant recipients will become infected with HIV-1.     

Reduction of Plasma Fibrinogen, Immunoglobulin G, and Immunoglobulin M Concentrations by Immunoadsorption Therapy with Tryptophan and Phenylalanine Adsorbents

Abstract Immunoadsorption (1A) therapy with tryptophan (TR-350) or phenylalanine (PH-350) adsorbents has been used to reduce the concentration of serum antibodies in human lymphocyte antigen (HLA)-immunized patients. Other forms of plasma purification have been reported to reduce the level of fibrinogen, which affects the blood properties. In this study we investigated the effects of IA therapy using both adsorbents on plasma fibrinogen and immunoglobulins G and M in 13 patients (8 patients were treated with TR-350, and 5 patients were treated with PH-350). During each session 1 plasma volume (2.8 ± 0.4 L of plasma) was processed through the immunocolumn and then returned to the patient together with the blood cells. Compared with the pretreatment values, the plasma fibrinogen, IgG, and IgM concentrations were significantly reduced after IA therapy (p < 0.01 for TR-350; p < 0.04 for PH-350). There was a positive correlation between the degree of reduction of plasma proteins and the number of IA treatments given. A nonpara-metric test (Wilcoxon's signed-rank test or the Mann-Whitney test) was used for statistical analysis. We conclude from our study that IA therapy effectively lowers the plasma levels of fibrinogen, IgG, and IgM and thus can be considered a valuable alternative to other blood purification methods.     

The multiply injured child

Blunt trauma is the principal cause of childhood death in many developed countries. This review outlines the differences between adults and children with respect to resuscitation and treatment of orthopaedic injuries in a child with polytrauma. Recent advances in techniques of fracture stabilization are reported.     

A comparison of the inhibitory effects of four volatile anaesthetics on the metabolism of chlorzoxazone, a substrate for CYP2E1, in rabbits

Background: Halothane inhibits in vitro and in vivo activity of cytochrome P-450 (CYP) 2E1. There are several fluorinated volatile anaesthetics besides halothane, and most of them are defluorinated by CYP2E1. It is unclear whether other fluorinated anaesthetics inhibit the in vivo activity of CYP2E1.
Methods: We compared the inhibitory effects of therapeutic concentrations of four inhalational anaesthetics, halothane, enflurane, isoflurane, and sevoflurane, on chlorzoxazone metabolism in rabbits receiving artificial ventilation.
Results: All four inhalational anaesthetics decreased arterial blood pressure and increased plasma chlorzoxazone concentration. However, no significant differences in the plasma chlorzoxazone concentration were found between the four anaesthetics. The estimated chlorzoxazone clearance increased after beginning inhalation with all four agents, but no significant difference in clearance was noted between agents.
Conclusions: At therapeutic concentrations, the in vivo inhibitory effect on chlorzoxazone metabolism was similar for all four inhalational anaesthetics examined, even though their chemical characteristics and extent of hepatic metabolism differ considerably.     

Development of Selective Low-Density Lipoprotein (LDL) Apheresis System: Immobilized Polyanion as LDL-Specific Adsorption for LDL Apheresis System

Abstract: Low-density lipoprotein (LDL) is widely recognized as one of the major risk factors for developing coronary heart diseases. Despite intensive development of LDL-lowering drugs, there still exist those patients with refractory hyperlipidemia whose plasma LDL levels are not sufficiently lowered by drugs. LDL apheresis, direct removal of plasma LDL from circulating blood, is thought to be the most promising treatment for such refractory patients. Various techniques, such as the use of an im-munoadsorbent utilizing an anti-LDL antibody, have been used in an attempt to achieve the selective removal of LDL. However, none were widely used because of complications, poor selectivity, and so forth. To establish a safe and effective LDL apheresis system, we chose a synthetic affinity adsorbent as the LDL-removing device. Synthetic polyanion compounds were used as the affinity ligands for LDL adsorbent to simulate the anion-rich sequence of LDL binding sites in the human LDL receptor. Among various polyanion compounds, those polyanions with sulfate or sulfonate groups and hydrophilic backbone were found to have strong affinity for LDL. In contrast, polyanions with carboxyl groups showed poor affinity. Dextran sulfate (DS) was selected as the affinity ligand of LDL adsorbent for its high affinity and low toxicity. The influence of its charge density and molecular weight on its affinity for LDL was suitable. The affinity rapidly increased as the charge density increased, then, reached a constant value. Little affinity was found for either the DS monomer (glucose sulfate) or DS with a molecular weight higher than 10⁴ daltons whereas DS with molecular weights in the midrange showed strong affinity. DS with a midrange molecular weight was immobilized on cellulose hard gel to give LDL adsorbent clinical application. The adsorbent demonstrated an excellent selectivity for LDL and very low density lipoprotein (VLDL) in vitro. Adsorption of high-density lipoprotein and major plasma proteins was almost negligible. Additional study of the LDL-binding mechanism revealed that DS directly interacts with positively charged sites on LDL, which demonstrates that the nature of the interaction is the same as that of LDL receptor. An LDL adsorption column (Liposorber) packed with an LDL adsorbent and polysulfone hollow-fiber plasma separator (Sulflux) was developed as an efficient LDL apheresis system. Clinical investigation proved that this system is capable of intensively lowering the plasma LDL level without affecting major plasma components.