Bilateral sequential femoral neck stress fractures in young adult with HIV infection on antiretroviral therapy: A case report

BACKGROUND Femoral neck stress fractures are rarely encountered among young adults and are often associated with either repetitive excessive loading or underlying bone pathology.Preliminary research has indicated human immunodeficiency virus(HIV)/antiretroviral therapy(ART)as predisposing agents to osteopenia and osteoporosis related complications.We report a case of HIV/ART induced insufficiency fracture in a resource limited setting in Central India.Our aim is to increase awareness and promote screening of HIV/ART related osteopenia and osteoporosis in order to prevent catastrophic orthopaedic complications.CASE SUMMARY A 35-year-old HIV positive male presented with a stress fracture of left femoral neck.The patient was on ART and reported no comorbidities.He went on to be successfully managed surgically.However,during work-up osteopenia of the contralateral proximal femur was recognised using Singh’s Index.Six months post-op the patient presented with right-sided femoral-neck stress fracture.At this stage the patient was nonconcordant with ART and denied surgical fixation.CONCLUSION In the absence of co-morbidities,several mechanisms of HIV/antiretroviral therapy may have played a role in predisposing our patient towards such a presentation.We recommend routine screening all HIV-infected patients for osteopenia,especially in younger individuals.In low resource settings and district hospitals,pelvis radiograph&Singh’s index can be used for screening.

Teriparatide anabolic therapy as potential treatment of type Ⅱ dens non-union fractures

Odontoid fractures account for 5% to 15% of all cervical spine injuries and 1% to 2% of all spine fractures. Type Ⅱ fractures are the most common fracture pattern in elderly patients. Treatment(rigid and non-rigid immobilization, anterior screw fixation of the odontoid and posterior C1-C2 fusion) remains controversial and represents a unique challenge for the treating surgeon. The aims of treatment in the elderly is to quickly restore pre-injury function while decreasing morbidity and mortality associated with inactivity, immobilization with rigid collar and prolonged hospitalization. Conservative treatment of type Ⅱ odontoid fractures is associated with relatively high rates of non-union and in a few cases delayed instability. Options for treatment of symptomatic non-unions include surgical fixation or prolonged rigid immobilization. In this report we present the case of a 73-year-old woman with post-traumatic odontoid nonunion successfully treated with Teriparatide systemic anabolic therapy. Complete fusion and resolution of the symptoms was achieved 12 wk after the onset of the treatment. Several animal and clinical studies have confirmed the potential role of Teriparatide in enhancing fracture healing. Our case suggests that Teriparatide may have a role in improving fusion rates of C2 fractures in elderly patients.

Effect of mid-frequency pulse therapy combined with external fixation on bone metabolism, inflammatory response and oxidative stress in patients with osteoporotic distal radial fractures

Objective:To study the effect of mid-frequency pulse therapy combined with external fixation on bone metabolism, inflammatory response and oxidative stress in patients with osteoporotic distal radial fractures.Methods: A total of 72 patients with osteoporotic distal radial fractures who were treated in the hospital between September 2015 and January 2017 were collected and divided into control group (n=36) and observation group (n=36) according to the random number table method. Control group received routine external fixation, and observation group received mid-frequency pulse therapy combined with external fixation. The differences in serum levels of bone metabolism indexes, inflammatory factors and oxidative stress indexes were compared between two groups of patients before and after treatment.Results: Before treatment, differences in serum levels of bone metabolism indexes, inflammatory factors and oxidative stress indexes were not statistically significant between the two groups. After 1 month of treatment, serum BGP, TAC and SOD levels of both groups of patients were higher than those before treatment whileβ-CTX, AKP, TRAP, CRP, IL-1β, IL-6 and MDA levels were lower than those before treatment, and serum BGP, TAC and SOD levels of observation group were higher than those of control group whileβ-CTX, AKP, TRAP, CRP, IL-1β, IL-6 and MDA levels were lower than those of control group.Conclusion: Mid-frequency pulse therapy combined with external fixation can promote fracture healing and reduce postoperative inflammatory response and oxidative stress response in patients with osteoporotic distal radial fracture.

Intramedullary nailing for pathological fractures of the proximal humerus caused by multiple myeloma: A case report and review of literature

BACKGROUND Multiple myeloma(MM)bone disease is indicative of MM,and reduces patient life quality.In addition to oncological,antineoplastic systemic therapy,surgical therapy in patients with MM is an essential treatment within the framework of supportive therapy measures and involves orthopedic tumor surgery.Nevertheless,there are few reports on intramedullary(IM)nailing in the treatment of MM-induced proximal humeral fracture to prevent fixation loss.We here describe a case of pathological fracture of the proximal humerus caused by MM successfully treated with IM nailing without removal of tumors and a review of the current literature.CASE SUMMARY A 64-year-old male patient complaining of serious left shoulder pain and limited movement was admitted.The patient was finally diagnosed with MM(IgAλ,IIIA/II).After treatment of the pathological fracture with IM nailing,the patient's function recovered and his pain was rapidly relieved.Histopathological examination demonstrated plasma cell myeloma.The patient received chemotherapy in the Hematology Department.The humeral fracture displayed good union during the 40-mo follow-up,with complete healing of the fracture,and the clinical outcome was satisfactory.At the most recent follow-up,the patient's function was assessed using the Musculoskeletal Tumor Society score,which was 29.CONCLUSION Early surgery should be performed for the fracture of the proximal humerus caused by MM.IM nailing can be used without removal of tumors.Bone cement augmentation for bone defects and local adjuvant therapy can also be employed.

Osteoporosis and fractures in liver disease: Relevance, pathogenesis and therapeutic implications

It is being increasingly recognized that patients with liver disease develop bone loss that can be severe enough to lead to atraumatic fractures and thus markedly diminish life quality and expectancy. The estimated prevalence for liver-related osteoporosis is between 20-420/100000 of the general population, and fractures between 60-880/100000. It should be kept in mind that up to 40% of patients with chronic liver disease may experience a fracture. The pathogenic mediators include fibronectin, insulin like growth factor-I, and various cytokines, but decreased vitamin D and/or treatment with corticosteroids contribute to worsening bone health. Despite the advances in bone biology that have shed some light on the pathogenesis of this bone loss, treatment options remain nonspecific and tightly linked to treatments of other forms of osteoporosis. Thus, treatment should include calcium and vitamin D supplementation in all patients with chronic liver disease. Therapy with bisphosphonates should be considered, especially in patients receiving corticosteroids. This review focuses on the prevalence of this entity as well as the evidence available with regard to the pathogenesis of bone loss in liver disease, the diagnostic steps required in all patients, and the therapeutic options available.

Trochanteric Buttress Plate Combined with Proximal Femoral Nail for Unstable Intertrochanteric Fractures. [Innovative Technique]

Introduction: Proximal femoral nail is a better choice of implant for the treatment of an unstable trochanteric fracture, however it is associated with screw migration and cutout because of greater trochanteric comminution and coronal split. This study is to evaluate the results of Trochanteric Buttress Plate (TBP) combined with PFN in an unstable IT fractures for buttressing lateral wall and reinforcing fixation. Materials and Methods: We carried out a consecutive study of 32 patients of Unstable intertrochanteric fracture femur with lateral wall comminution. It was studied at Ashwini Sahakari Rugnalaya and Sanshodhan Kendra Solapur India and Government medical college Chandrapur India from April-2015 to December-2017 using innovative Trochanteric buttress plate along with PFN. Eighteen male and fourteen female in the age group of 55 to 80 years were included in the study. There were 26 cases of A3 and six cases of A2 were fixed by PFN combined with trochanteric buttress plate to augment the comminuted lateral wall. Results: The bone healing is observed in all the cases in the mean period of 12.6 weeks. Four patients developed complications, including lateral migration of neck screws (n = 2), superficial infection (n = 2). Patients were followed up for a mean of 10.6 months. At the end of follow-up the Salvati and Wilson hip function was 36 (out of 40) in 87.5% of patients [twenty eight patients]. The clinical, radiological and functional outcomes were found to be satisfactory. Conclusion: The stabilization of lateral trochanteric wall with trochanteric buttress plate restores anatomy, increases the stability of construct and prevents inherent complication of screw migration and cutout.

Treatment of comminuted trochanteric fractures and non-union of trochanteric osteotomy in revision total hip arthroplasty

Objective: To explore the clinical efficacy of the treatment of comminuted trochanteric fractures and trochanteric osteotomy non union in revision total hip arthroplasty with tension band fixation. Methods: A retrospective review of 295 revision total hip operations performed between 1992 and 1998 was undertaken. Twenty hips of 19 patients with comminuted fractures or nonunion of the greater trochanter were stabilized with tension band technique. Multiple 2.0 mm k wires and tension band wires were placed through the intact cortex distally and the abductor tendon proximally in the pattern "8". Results: The average follow up was 30 months. The Harris Hip Score improved on average from 45 preoperatively to 89 at follow up. Sixteen hips with intra operative trochanteric fracture through osteolytic bone and four hips with symptomatic trochanteric nonunion were approached with tension band fixation. Perioperative loss of fixation in one patient required a repeated surgery. The same fixation at the second operation achieved an uneventful healing. Two patients had a 2 cm proximal migration of one K wire without loss of bony fixation. The trochanteric fractures healed with no further proximal wire migration. One patient had loss of fixation with trochanteric escape at 6 weeks post operatively. The patient has abductor weakness with Trendleburg limp but without pain. On average, radiographic examination showed that healing occurred at 16.6 weeks postoperatively. Six patients developed grade 1 heterotopic ossification and two patients grade 3. All were asymptomatic. None of the 19 patients experienced a dislocation during the follow up. Conclusions: Tension band fixation for greater trochanter can enhance the success rate of revision total hip arthroplasty without a deficient abductor mechanism.

A comparative study of variable angle volar plate and bridging external fixator with K-wire augmentation in comminuted distal radius fractures

Purpose:Comminuted intraarticular distal radial fractures are difficult to treat conservatively and require operative treatment.This study compared the functional outcomes between variable angle volar plating and external fixator with K-wire augmentation in open reduction and internal fixation.Methods:A total of 62 adult patients with comminuted intraarticular distal radius fracture were randomized into 2 groups:volar plate group and external fixator group.These patients aged between 18 and 60 years had unilateral fractures,and agreed to be included in the study.Patients with a history of fracture,bilateral fracture,associated other injuries,delayed injury for more than 2 weeks,open fracture,pre-existing arthrosis or disability,psychiatric illness and pathological fracture were excluded.Patients were followed up at 6 weeks,3 months,6 months and 1 year.The assessment of pain,functional activity,range of motion and grip strength was done at each stage of follow-up.The pain and functional activities were assessed by patient rated wrist evaluation(PRWE)score and disabilities of the arm,shoulder and hand(DASH)score.Results:Patients in volar plate group had superior PRWE score and DASH score at each stage of followup.At 1 year follow-up,the mean PRWE score were 7.48 for volar plate group and 7.35 for external fixator group;while the mean DASH score was 4.65 for volar plate group and 5.61 for external fixator group.They had better flexion and extension range of movement.They also had better pronation and supination range of motion at initial follow-up,however the difference get attenuated by 1 year.Volar plate group had significantly better grip strength than external fixator group.Complication rates were higher in external fixation group.Conclusion:Fixation with variable angle volar plate results in early wrist mobilization,better range of movement,less pain and disability and early return of function.

Study on mechanism involved in posto perative reha-bilitation of comminuted fracture of patella

Objective To investigate mechanism involved i n knee joint rehabilition by compreh ensive rehabilitation therapy foll owing com-minuted fracture of patella surgery.Method25patients suffered from comminute d fracture of patella received rehabilitation training,drugs administration and physical therapy.Results Knee joint function was evaluated,e xcellent 22cases,good 2cases,favo rable 1case,good rate was 96%.Conclusion Rehabilitation of knee joint is satisfying in patients underwent compre hensive rehabilitation treatment.So,comprehensive rehabilitation treatment is valuable in clinic.

The finite element analysis of cemented long and short stem prosthetic replacement in aged patients with comminuted intertrochanteric fracture

Objective To investigate the stress distribution of the femur after cemented prosthetic replacement in aged patients with comminuted intertrochanteric fracture and to analyze the difference of stress distribution between cemented long

Comparative study of perpendicular versus parallel double plating methods for type C distal humeral fractures

Background Double plate osteosynthesis is the standard treatment for intra-articular fractures of the distal humerus.However,there is still controversy concerning dual plate positions in terms of providing optimal stability.The purpose of this retrospective study was to compare the clinical outcomes in patients with type C intra-articular distal humeral fractures using perpendicular and parallel plating methods.Methods Between March 2008 and June 2011,a total of 45 patients with type C distal humerus fractures were treated using two different dual plating methods.Of them,24 patients were treated by perpendicular plating （group Ⅰ） and 21 patients were treated by parallel plating （group Ⅱ）.The surgical time,blood loss,and union time were compared between the two groups.The fiexion-extension arc,the total range of flexion and extension at the end of follow-up were compared between the two groups.The Mayo Elbow Performance Score （MEPS） was used to determine the elbow functional results.Results All patients were followed up.The mean duration of follow-up was 16 months （range 12-25 months） in group Ⅰ and 15.5 months in group Ⅱ （range 12-25 months）.There were no significant differences in the surgical time,blood loss,and the bone union time between the two groups.In group Ⅰ,the mean elbow flexion-extension arc was 101° and the mean MEPS was 85 points.The rate of excellent and good results was 87.5%.In group Ⅱ,the mean flexion-extension arc was 100° and the mean MEPS was 86.1 points.The rate of excellent and good results was 90.5%.There were no significant differences in the MEPS,flexion-extension arc,and the total range of flexion and extension between the two groups.Conclusions Perpendicular and parallel plate configurations with the appropriate surgical techniques can provide anatomical reconstruction and stable fixation of type C intra-articular distal humeral fractures and allow early mobilization of the elbow after an operation.The occurrence of post-operative elbow stiffness can be reduced and good outcomes can be obtained.

Clinical observation on electroacupuncture plus hydro-acupuncture for low back pain caused by compression fractures

Objective： To observe the effect of electroacupuncture （EA） at Jiaji （EX-B 2） points plus hydro-acupuncture with sinomenine hydrochloride for low back pain caused by compression fractures in the elderly. Methods： Ninety-five elderly in-patients with low back pain caused by compression fractures were randomly divided into an observation group and an EA group according to the visit sequence. Both groups received the same basic treatment. In the EA group, 48 cases were treated with EA at Jiaji （EX-B 2） points plus the basic therapy; 47 cases in the observation group received the basic treatment plus EA and hydro-acupuncture with sinomenine hydrochloride at Jiaji （EX-B 2） points. The levels of osteoprotegerin （OPG） and interleukin-1β（IL-1β） in peripheral blood were measured by enzyme-linked immunosorbent assay （ELISA） before and at the 21st day of treatment in both groups. Oswestry disability index （ODI） and visual analog scale （VAS） scores were used to analyze the clinical efficacy. Results： After treatment, the OPG content in the observation group was higher with statistical significance compared with that before treatment in the observation group and after the treatment in the EA group, respectively （both P〈0.05）; the content of IL-1β, ODI and VAS scores were lower than those before treatment in the observation group and after treatment in the EA group with statistical significances （all P〈0.05）. Conclusion： The combination of EA and hydro-acupuncture with sinomenine hydrochloride at Jiaji （EX-B 2） points is effective for low back pain caused by compression fractures in the elderly, and is superior to EA at Jiaji （EX-B 2） points alone.

Low-velocity simultaneous bilateral femoral neck fracture following long-term antiepileptic therapy:A case report

BACKGROUND Simultaneous bilateral femoral neck fractures are relatively rare injuries.They are usually associated with underlying metabolic bone disorders or systemic diseases.Long-term use of narcotics and bisphosphonates can also result in similar fracture patterns;however,association of this fracture type with longterm use of antiepileptic drugs is not very common.Only one such case has been reported in the literature.This article describes the second.CASE REPORT We report a case of simultaneous displaced bilateral femoral neck fractures in a 50-year-old epileptic patient,who had taken phenytoin for the past 3 years.The fractures were a result of low-velocity injury following a fall from the bed.The fractures were managed with a bilateral hemi-replacement arthroplasty.Oral bisphosphonates were given to improve the bone quality in the post-operative period.The patient had a good post-operative outcome,that was sustained throughout the entire follow-up period of 1 year.CONCLUSION Antiepileptic drugs should be supplemented with bisphosphonates and vitamin D to improve bone quality and prevent fractures in epileptic patients.

IRRIGATION AND TRACTION THERAPY FOR OPEN FRACTURE WITH LARGE－SIZED FULL－THICKNESS SKIN－DEFICIT AND SEVERELY INFECTED WOUND

In this paper the results of skeletal traction and irrigation therapy (STIT) used for open fracture complicated with large-sized full-thickness skin-deficit and infection wounds (OFIW) were presented. Fourteen patients of OFIW were treated by the plaster cast and wound dressing (PCWD), and 30 patients of OFIW were treated by STIT. The results indicated that after one week of treatment, the white blood cell count in the STIT group, compared to 17. 6±l. 0×109/L from before treatment, returned to 8. 8±0. 8×109/L,and in contrast, the cell count of the PCWD group was about 13. 0±1. 4×109/L. All of wound exudate culture in the STIT group was negative, and those of 7 cases (7/14) in PCWD group were positive (P<0. 0l). The symptoms and signs such as pain, fever and septic exudate on the wound in the STIT group were much milder than those in the PCWD group. There were 5 cases (35. 7%) of toxicemia and septicemia, 2 cases (14. 3%) of osteomyelitis, 2 cases (14. 3 %) of amputation, 1 case (7. 1%) of delayed union and 3 cases (21. 4 %) of malunion in the PCWD group, and no complications in the STIT group.

Preventing Lower Extremity Deep Vein Thrombosis After Hip Fracture Surgery in Elderly Patients by Acupoint Application Combined with Pneumatic Compression Therapy

Objective:To investigate and analyze the long-term clinical effects of acupoint application combined with pneumatic compression therapy in the prevention of deep venous thrombosis after hip fracture surgery among the elderly.Methods:Sixty elderly patients who had undergone hip fracture surgery from February 2021 to February 2022 were selected as the research subjects.The patients were divided into two groups via drawing lots.Both the groups received nursing care,but the patients in the observation group were treated with TCM acupoint application combined with pneumatic compression therapy,whereas the control group received pneumatic compression therapy.The evaluation indicators included the patients’quality of life and complications.Results:The incidence of lower extremity deep vein thrombosis in the observation group was more than twice(0.3%),whereas the incidence of lower extremity complications in the control group was more than 6 times(20%).There was a significant difference between the two groups(p<0.05).Conclusion:Traditional Chinese medicine acupoint application combined with pneumatic compression therapy is beneficial for the prevention of postoperative lower extremity deep vein thrombosis among elderly patients.In addition,the patients’overall quality-of-life scores in both physiological and psychological aspects improved significantly,which carries significant clinical reference value.

Investigation of Therapeutic Effect of Traditional Mongolian Osteopathy Manual Reduction with Medicinal Wine Spraying Massage and Small Splint External Fixation Therapy for Treatment of Neerll-type Distal Humerus Fracture

Objectives:To investigate the effect of traditional Mongolian osteopathy manual reduction with medicinal wine spraying massage and small splint external fixation therapy for treatment of Neerll-type distal humerus fractures.Methods:Sample selection was carried out during time period from November 2014 to May 2019.Sixty-six patients admitted to our hospital were selected as sample patients.The control group was given plaster treatment,while the observation group was given traditional Mongolian osteopathy manual reduction with medicinal wine spraying massage and small splint external fixation therapy.Efficacy for the two groups of patients was observed.Results:In this study,the total effective rate of observation group patients with treatment of traditional Mongolian osteopathy manual reduction with medicinal wine spraying massage and small splint external fixation therapy was 100%.Meanwhile,total effective rate of patients in control group was 87.88%.The difference was significant,P<0.05.Conclusions:In this study of clinical treatment,traditional Mongolian osteopathy manual reduction with medicinal wine spraying massage and small splint external fixation therapy could provide better therapeutic effect for treatment of patients with Neerll-type distal humerus fracture.At the same time,it reduces economic burden of patients.It has higher promotion value for clinical practice.

Comparison of locomotion therapy between pelvis traction therapy to treat fracture of thoracolumber

Compare the effects of locomotion therapy and pelvis traction therapy to treat Ⅰ～Ⅱ° thoracolumbar compression fracture.Methods Ninety-two cases with Ⅰ～Ⅱ° thoracolumbar compression fracture were selected and divided into 2 groups with locomotion therapy and pelvis traction thepapy respectively.Results Thoracolumbar height was measured according to X-ray results after 1 year follow-up.The height was (17.2±2.3)mm preoperatively and (24.4±3.1)mm postoperatively in locomotion therapy group while (16.8±2.6)mm preoperatively and (23.9±2.7)mm postoperatively in the pelvis traction therapy group.Conclusion There is no significant difference between effects on two groups.5 refs.

Krachow法缝合联合钢丝垂直间断治疗老年髌骨下极粉碎性骨折的疗效

目的研究Krachow法缝合联合钢丝垂直间断固定治疗老年髌骨下极粉碎性骨折的疗效。方法选取2019年1月至2022年3月收治的102例老年髌骨下极粉碎性骨折患者作为研究对象。按随机数字表法分为两组,观察组51例,采用Krachow法缝合联合钢丝垂直间断固定,对照组51例,采用钢丝垂直间断固定。统计分析两组临床疗效、膝关节活动范围(ROM)、膝关节功能Bostman评分及并发症情况。结果观察组临床疗效优良率为88.24%,对照组优良率为64.71%,差异有统计意义(P<0.05)。观察组膝关节ROM、Bostman评分分别为131.51°±6.80°、(28.65±2.20)分,对照组膝关节ROM、Bostman评分分别为115.87°±5.91°、(23.58±2.51)分,差异有统计意义(P<0.05)。观察组并发症总发生率为9.80%,对照组并发症总发生率为27.45%,差异有统计意义(P<0.05)。结论Krachow法缝合联合钢丝垂直间断固定治疗老年髌骨下极粉碎性骨折复位良好,固定牢靠,对周围软组织影响小,并发症少,有利于膝关节功能恢复。

针刺联合补肾活血方治疗骨质疏松性胸腰椎骨折的疗效观察及对骨代谢水平的影响

目的观察针刺联合补肾活血方治疗骨质疏松性胸腰椎压缩性骨折的临床疗效及对患者血清骨代谢指标的影响。方法选择108例骨质疏松性胸腰椎骨折患者,随机分为对照组和联合组,每组54例。两组均进行椎体后凸成形术治疗和常规护理,对照组口服补肾活血方治疗,联合组采用针刺联合口服补肾活血方治疗。比较两组疼痛缓解时间、下床活动时间和骨折愈合时间,观察两组治疗前和随访结束时疼痛数字评估表(numerical rating scale,NRS)评分、中国人骨质疏松症简明生存质量量表(Chinese osteoporosis quality of life short questionnaire,COQOL)评分和Oswestry功能障碍指数(Oswestry disability index,ODI)的变化,观察两组治疗前和随访结束时骨折椎体的椎形态及骨密度检测结果的变化,观察治疗前后两组血清高迁移率族蛋白-1(high mobility group protein-1,HMGB-1)、C-反应蛋白(C-reactive protein,CRP)、P物质(substance P,SP)、皮质醇(cortisol,Cor)、骨形态发生蛋白-7(bone morphogenetic protein-7,BMP-7)、骨钙素N端中分子片段(osteocalcin n-terminal molecular fragment,N-MID)、网膜素-1(omentin-1)、Ⅰ型胶原C端肽(typeⅠcollagen C-terminal peptide,CTX-1)水平的变化,比较两组临床疗效。结果联合组疼痛缓解时间、下床活动时间和骨折愈合时间短于对照组(P<0.05),联合组治疗后HMGB-1、CRP、SP、Corh和CTX-1水平以及随访结束时伤椎楔变角、Cobb角、ODI评分、NRS评分和COQOL评分均低于对照组(P<0.05),联合组治疗后N-MID、Omentin-1和BMP-7水平以及随访结束时骨折椎体椎前缘高度和BMD水平高于对照组(P<0.05)。联合组总有效率高于对照组(P<0.05)。结论在椎体后凸成形术治疗和常规护理基础上,针刺联合补肾活血方治疗骨质疏松性胸腰椎骨折可减少炎症反应和应激反应,降低疼痛介质指标水平,改善骨性标志物及骨代谢水平,促进椎体愈合,提高腰椎功能、临床疗效及生活质量。

四肢创伤开放性并粉碎性骨折患者发生谵妄的列线图预测模型构建

目的分析四肢创伤开放性并粉碎性骨折患者发生谵妄的危险因素,构建并验证风险预测模型。方法回顾性分析2021年3月至2023年3月西安高新医院收治的108例四肢创伤开放性并粉碎性骨折患者的病历资料,其中男76例、女32例,年龄(54.17±14.62)岁。依据80/20定律随机分为训练集(86例)和验证集(22例)。统计患者术后1个月内谵妄的发病情况,根据患者术后是否发生谵妄分为谵妄组与非谵妄组,筛查四肢创伤开放性并粉碎性骨折患者术后发生谵妄的危险因素,构建并验证风险预测模型。采用t检验、χ^(2)检验、logistic回归模型、受试者操作特征曲线(ROC)、Hosmer-Lemeshow检验。结果86例四肢创伤开放性并粉碎性骨折患者中18例患者术后发生谵妄,发生率为20.93%(18/86)。谵妄组患者的年龄、脑卒中史占比、术中低氧血症占比、血清可溶性肿瘤坏死因子1(sTNFR1)水平均高于非谵妄组(均P<0.05)。年龄(OR=3.187,95%CI 1.176~8.633)、脑卒中史(OR=3.684,95%CI 1.359~9.979)、术中低氧血症(OR=4.958,95%CI 1.830~13.431)、血清sTNFR1(OR=4.591,95%CI 1.695~12.435)均是四肢创伤开放性并粉碎性骨折患者术后发生谵妄的危险因素(均P<0.05)。风险预测模型预测训练集86例四肢创伤开放性并粉碎性骨折患者术后发生谵妄的灵敏度为0.825(95%CI 0.741~0.922),特异度为0.829(95%CI 0.753~0.906),曲线下面积为0.892(95%CI 0.808~0.915)。风险预测模型预测验证集22例四肢创伤开放性并粉碎性骨折患者术后发生谵妄的灵敏度为0.799(95%CI 0.706~0.881),特异度为0.732(95%CI 0.658~0.827),曲线下面积为0.839(95%CI 0.791~0.915)。结论年龄、脑卒中史、术中低氧血症、血清sTNFR1均与四肢创伤开放性并粉碎性骨折患者术后发生谵妄有关,构建风险预测模型有助于早期预测术后谵妄的发生风险。