Bone mineral density in fracture neck of femur patients:What's the significance?

BACKGROUND The National Institute for Health and Care Excellence(NICE)guidelines have advised further research is required into investigating the added prognostic value of bone mineral density(BMD)in the assessment of fracture risk with the Fracture Risk Assessment Tool(FRAX)score.AIM To investigate the significance of BMD in fracture neck of femur patients and compare it to the outcome of the FRAX score.METHODS Inclusion criteria for this study were all patients who underwent dual-energy Xray absorptiometry(DXA)scan following fracture neck of femur between 2015 and 2017.Analysis of BMD,FRAX scores and patient demographic data was undertaken.RESULTS A total of 69 patients were included in the study,mean age 74.1 years.There was no significant difference between mean BMD of the femoral neck in males(0.65)as compared to females(0.61)(P=0.364).Analyses showed no significant correlation between BMD and menopause age(rs=-0.28,P=0.090).A significant difference was seen of the femoral neck BMD between the different fracture pattern types(P=0.026).A stronger correlation was observed between BMD of femoral neck and FRAX major score(rs=-0.64,P<0.001)than with BMD of lumbar spine and FRAX major score(rs=-0.37,P=0.003).CONCLUSION This study demonstrated that BMD of the femoral neck measured by DXA scan is of added prognostic value when assessing patients for risk of fracture neck of femur in combination with the FRAX predictive scoring system.

Bone Density and Mechanical Properties in Femoral Bone of Swim Loaded Aged Mice

Effects of swirnming on bone density and mechanical properties of femur were investigated in aged male and female mice. R/1 strain of senescence accelerated mouse (SAM) at eleven months old was used. Two groups of males and two groups of females each consisting of 7 mice were used. One male and one female groups were loaded with a swim regiment of 40 min a day, 5 days a week for 6 consecutive weeks. The remaining groups were used as the controls. All mice were fed with the standard diet and water ad libitum during the experiments.The results of this study indicated that (i) the hady weight was significantly (P<0.05) lower in the swimming groups than in the control groups in boh sexes. (ii) The bone density was significantly higher (P <0.05) in the swimming groups than in the control groups in boh sexes. However, there was no sighficant difference in cortical thickness index. (iii) In the mechanical properties of bone, there were no significant differences in the level of the maximum breaking force, the ultimate stress and the deformation between the swimndng and the contro groups in beth sexes. However, the elasticity of the bone of the female hoce in the swimming group was significantly higher (P<0.05) than that of the control group.These results suggest that regimented swimming for the aged mice might suppress age-associated bone loss, and the effect of exercise in the females is greater that in the males.

Relationship between peripheral blood neutrophil/lymphocyte ratio and the prognosis of patients with brittle femoral neck fracture

Objective:To explore the relationship between peripheral blood neutrophil/lymphocyte ratio(NLR)and osteoporotic femoral neck fractures and to evaluate the prognosis.Methods:The subjects were 102 patients who received osteoporotic femoral neck fracture in the First Affiliated Hospital of Guangzhou University of Chinese Medicine from 2008 to 2017.Patients were divided into three groups according to the BMD values in the diagnostic criteria of primary osteoporosis:normal bone mass group(T≥-1.0),reduced bone mass group(-2.5<T<-1.0)and osteoporosis group(T≤-2.5).In addition,during postoperative follow-up,patients receiving internal fixation were divided into the high NLR group(NLR>2.33)and the low NLR group(NLR≤2.33)according to their NLR values.The clinical data of patients with osteoporotic femoral neck fracture who underwent peripheral blood routine examination were prospectively analyzed.The statistical indicators included age,gender,fracture cause and other general conditions,fracture type,peripheral blood neutrophil/lymphocyte ratio,bone mineral density(BMD)level and blood lipid level,and prognosis of 102 patients who were followed up for more than 2 years after surgery.The relationship between peripheral blood NLR and the above indexes was observed.Statistical methods including normal data analysis of variance between groups,SNK-q test is compared between two groups,the partial correlation analysis between the two factors,the relationship between multiple factors using multi-factor linear regression analysis,and normal data comparison between the two groups using t test,two sets of independent data frequency distribution of binary classification variables compared by chi-square test.Moreover,NLR is also a major factor affecting the prognosis and rehabilitation of osteoporotic femoral neck fractures.Results:The analysis of variance between the two groups(SNK-q test of the comparison between the two groups),single-factor partial correlation analysis,multi-factor linear regression analysis showed that compared with the normal group and the reduced group,the levels of age,triglyceride and NLR in the osteoporosis group were increased,while BMD was significantly decreased.BMD in patients with osteoporotic femoral neck fracture was negatively correlated with NLR and triglyceride(P<0.05).In multi-factor linear regression analysis,NLR and triglyceride were the main influencing factors of BMD in patients with osteoporotic femoral neck(P<0.05).In addition,increased peripheral blood NLR in patients treated with internal fixation may increase the risk of postoperative femoral head necrosis,nonunion of the broken end of the fracture,and prolong the time of postoperative functional recovery.Conclusion:The level of peripheral blood NLR in patients with osteoporotic femoral neck fracture is increased and correlated with bone mineral density,which suggested that peripheral blood NLR can be used as one of the clinical indicators for early screening and prevention of osteoporotic femoral neck fracture.In addition,peripheral blood NLR is also a major factor affecting the prognosis and rehabilitation of osteoporotic femoral neck fractures.

Periprosthetic joint infections in femoral neck fracture patients treated with hemiarthroplasty–should we use antibiotic-loaded bone cement?

BACKGROUND Hemiarthroplasty is the most common treatment in elderly patients with displaced intra-capsular femoral neck fracture(FNF).Prosthetic joint infection(PJI)is one of the most feared and frequent complications post-surgery because of the frail health status of these patients and the need for fast track surgery.Therefore,priorities should lie in effective preventive strategies to mitigate this burden.AIM To determine how much the implementation of the routine use of antibioticloaded bone cement(ALBC)as a relatively easy-to-apply amendment to the surgical practice reduces the infection rate in our hemiarthroplasty cohort.METHODS We retrospectively assessed all demographic,health status and treatment-related data of our FNF patients undergoing cemented hemiarthroplasty in the period from 2011 to 2017;241 patients were further analyzed after exclusion of patients with cancer-related sequelae and those who died before the end of the 1-year observation period.The PJI rate as diagnosed on basis of the Musculoskeletal Infection Society(MSIS)criteria 2011 was determined for each included patient and compared in function of the bone cement used for hip stem fixation.Patients were split into a group receiving a plain bone cement in the period from January 2011 to June 2013(non-ALBC group)and into a group receiving an ALBC in the period July 2013 to December 2017(ALBC group).Data analysis was performed with statistical software.We further calculated the cost-efficacy of the implementation of routine use of ALBC in the second group balancing the inhospital infection related treatment costs with the extra costs of use of ALBC.RESULTS In total 241 FNF patients who received cemented hemiarthroplasty in the period from January 2011 to January 2017 were eligible for inclusion in this retrospective study.There were 8 PJI cases identified in the ALBC group among n=94 patients,whereas 28 PJI cases were observed in the non-ALBC group among n=147 patients.The statistical analysis showed an infection risk reduction of 55.3%(in particular due to the avoidance of chronic delayed infections)in the ALBC group(95%CI:6.2%-78.7%;P=0.0025).The cost-evaluation analysis demonstrated a considerable cost saving of 3.500€per patient,related to the implementation of routine use of ALBC in this group.CONCLUSION Use of ALBC is a potent infection preventive factor in FNF patients receiving cemented hemiarthroplasties.It was further found to be highly cost-effective.

Effect of different hip replacement methods under minimally invasive anterolateral approach on bone metabolism and joint pain in patients with femoral neck fracture

Objective: To explore the effect of different hip replacement methods under minimally invasive anterolateral approach on bone metabolism and joint pain in patients with femoral neck fracture. Methods: A total of 110 patients with femoral neck fracture who were treated in Ruijin Hospital North, Shanghai Jiaotong University School of Medicine between July 2015 and January 2017 were collected and divided into control group and observation group by random number table, each with 55 cases. Control group accepted half hip replacement under minimally invasive anterolateral approach, and observation group accepted total hip replacement under minimally invasive anterolateral approach. The differences in contents of bone metabolism and joint pain-related indexes were compared between the two groups before and after surgery. Results: Before surgery, serum contents of bone formation indexes, bone resorption indexes, inflammatory indexes and pain mediators were not statistically significant between the two groups. 1 month after surgery, serum bone formation indexes PINP, BAP and BGP contents of observation group were higher than those of control group;serum bone resorption indexes β-CTX and TRACP-5b contents were lower than those of control group;serum inflammatory indexes IL-1 and TNF-α contents were lower than those of control group;serum pain mediators 5-HT and PGE2 contents were lower than those of control group. Conclusion: Total hip replacement under minimally invasive anterolateral approach is more effective to promote the formation of bone formation/bone resorption balance and reduce the joint pain.

Bone three-dimensional microstructural features of the common osteoporotic fracture sites

Osteoporosis is a common metabolic skeletal disorder characterized by decreased bone mass and deteriorated bone structure, leading to increased susceptibility to fractures. With aging population, osteoporotic fractures are of global health and socioeconomic importance. The three-dimensional microstructural information of the common osteoporosis-related fracture sites, including vertebra, femoral neck and distal radius, is a key for fully understanding osteoporosis pathogenesis and predicting the fracture risk. Low vertebral bone mineral density(BMD) is correlated with increased fracture of the spine. Vertebral BMD decreases from cervical to lumbar spine, with the lowest BMD at the third lumbar vertebra. Trabecular bone mass of the vertebrae is much lower than that of the peripheral bone. Cancellous bone of the vertebral body has a complex heterogeneous three-dimensional microstructure, with lower bone volume in the central and anterior superior regions. Trabecular bone quality is a key element to maintain the vertebral strength. The increased fragility of osteoporotic femoral neck is attributed to low cancellous bone volume and high compact porosity. Compared with age-matched controls, increased cortical porosity is observed at the femoral neck in osteoporoticfracture patients. Distal radius demonstrates spatial inhomogeneous characteristic in cortical microstructure. The medial region of the distal radius displays the highest cortical porosity compared with the lateral, anterior and posterior regions. Bone strength of the distal radius is mainly determined by cortical porosity, which deteriorates with advancing age.

Comparison of femoral neck fracture healing and affected limb pain after anterolateral-approach minimally invasive total hip replacement and hemiarthroplasty

Objective:To study the differences in femoral neck fracture healing and affected limb pain after anterolateral-approach minimally invasive total hip replacement and hemiarthroplasty. Methods:A total of 92 patients with femoral neck fracture who received hip replacement in our hospital between May 2013 and December 2015 were selected and randomly divided into total hip and half hip group, total hip group received anterolateral-approach minimally invasive total hip replacement, half hip group received anterolateral-approach minimally invasive hemiarthroplasty, and 1 month after operation, serum was collected to detect the levels of bone metabolism markers, osteocyte cytokines, SP and CGRP.Results:1 month after operation, serum PINP, PICP, BMP, TGF-β, FGF, IGF-I and IGF-II levels of total hip group were significantly higher than those of half hip group while TRAP5b and CatK levels were significantly lower than those of half hip group;the day after operation, serum pain media SP and CGRP levels were not significantly different between the two groups of patients;36 h after operation, serum SP and CGRP levels of total hip group were significantly lower than those of half hip group.Conclusion:The bone metabolism after anterolateral-approach minimally invasive total hip replacement is better than that after hemiarthroplasty, and the degree of pain is less than that after hemiarthroplasty.

Effects of alendronate sodium combined with InterTan on osteoporotic femoral intertrochanteric fractures and fracture recurrence

BACKGROUND Osteoporosis is a global disease affecting 6.6%of the total population.Osteoporosis complications include fractures,increased bone fragility,and reduced bone strength.The most commonly affected parts are the vertebral body,hip,and wrist.AIM To examine the effect of alendronate sodium combined with InterTan for osteoporotic femoral intertrochanteric fractures on bone and fracture recurrence METHODS In total,126 cases of osteoporotic femoral intertrochanteric fractures were selected and divided into two groups according to the 1:1 principle by the simple random method.They were admitted to the Department of Orthopedics,First Affiliated Hospital of Xingtai Medical College,from January 2018 to September 2020.The control group was treated with InterTan fixation combined with placebo,and the observation group with alendronate sodium based on InterTan fixation.Operation-related indicators,complications,and recurrent fractures were compared between the groups.Changes in bone metabolism markers,t value for hip bone mineral density,and Harris Hip Score were observed.RESULTS Operation time,intraoperative blood loss,postoperative ambulation time,and complications were compared between the groups,and no significant difference was found.The fracture healing time was significantly shorter in the observation group than in the control group.β-Collagen-specific sequence(β-CTX)and total aminoterminal propeptide of type I procollagen(T-PINP)in the control group at 3 mo after operation were compared with those before operation,and the difference was not significant.Six months after the operation,theβ-CTX level decreased and T-PINP level increased.β-CTX level at 3 and 6 mo in the observation group after operation was lower,and TPINP level was higher,than that before operation.Compared with the control group,T-PINP level of the observation group was significantly higher andβ-CTX level was significantly lower at 3 and 6 mo after operation.The t value of hip bone mineral density was compared in the control group before and 1 mo after operation,and significant difference was not found.Compared with the control group,the t value of hip bone mineral density in the observation group was significantly higher at 1,3,6,and 12 mo after operation.Compared with the control group,the Harris score of the observation group was significantly higher at 1,3,6,and 12 mo after operation.The recurrence rate of fractures in the observation group within 12 mo was 0.00%,which was significantly lower than 6.35%in the control group.CONCLUSION Alendronate sodium combined with InterTan in the treatment of osteoporotic femoral intertrochanteric fractures can increase bone mineral density,improve hip joint function,promote fracture healing,and reduce fracture recurrence.

三种内固定方法治疗Pauwels Ⅲ型股骨颈骨折伴前内侧骨缺损的有限元分析

背景:不稳定型股骨颈骨折伴前内侧骨缺损是非常少见且难以处理的,治疗此种骨折的最佳内固定方案一直是骨科医生中持续争论的话题。目的:通过有限元分析评估不同内固定方式治疗Pauwels Ⅲ型股骨颈骨折伴前内侧缺损的生物力学性能,以期为临床手术决策提供实验支撑。方法:利用Mimics 21.0、Geomagic和Solidworks软件构建伴有前内侧缺损且Pauwels角为70°的股骨颈骨折模型,模拟3种内固定方法:A组(3枚空心钉+内侧钢板)、B组(股骨颈动力交叉钉+1枚空心钉)和C组(4枚空心钉“菱形固定”)。在3倍体质量2100 N的载荷下分析3组模型股骨、内固定以及股骨头的应力和位移变化。结果与结论:①A组模型的股骨整体应力最小,且受力更加均匀且分散;B组内固定模型的应力较小,说明其具有更好的应力分散和抗剪切的作用;A组股骨应力侧的应力明显小于其余两组,且未发生应力集中现象;②A组无论是整体股骨模型、内固定或是股骨头的位移均小于其余两组,说明空心钉联合内侧钢板能够起到更好的稳定作用,可减少髋内翻的发生;③3枚螺钉联合内侧支撑钢板应用于垂直、不稳定且前内侧骨缺损的股骨颈骨折,可显著提高骨折的稳定性,提高对变形力的抵抗力,是治疗该类型骨折的不错选择。

Effect of dynamic hip screw on the treatment of femoral neck fracture in the elderly

[Abstract] Objective： To discuss the indications, surgical procedures, and curative effect of dynamic hip screw （DHS） in the treatment of femoral neck fracture in the elderly. Methods： A retrospective study was conducted to analyse the clinical data of 42 elderly patients who had been treated for femoral neck fracture with DHS in our department between June 2009 and November 2011. There were 21 males and 21 females with a mean age of 68.5 years （range 60-75 years）. According to the Garden Classification, there were 19 cases of type II, 21 cases of type III and 2 cases of type IV fractures. By the Singh In- dex Classification, there were 3 cases of level 2, 19 cases of level 3 and 20 cases of level 4 fractures. The Harris cri- terion, complications and function recovery after operation were analysed. Results： The average hospitalization time in 42 patients was 11.2 days （range 7-21 days）. All patients were followed up for 12-26 months （mean 18 months）. No lung infection, deep venous thrombosis or other complications occurred. Partial backing-out of the screws was found in 2 cases. The internal fixation device was with- drawn after fracture healing. Internal fixation cutting was found in 1 case, and he had a good recovery after total hip arthroplasty. The time for fracture healing ranged from 3-6 months （average 4.5 months）. According to Harris criteri- on, 15 cases were rated as excellent, 24 good, 2 fair and 1 poor. The Harris scale was significantly improved from 30.52＋2.71 preoperatively to 86.61＋2.53 at 6 months post- operatively （P〈0.05）. Conclusion： DHS, being minimal invasive, al- lowing early activity and weight-bearing, is advisable for treatment of elderly patients with femoral neck fracture. In addition, it can avoid complications seen in artificial joint replacement. It is especially suitable for patients with mild osteoporosis.

Outcome of bone marrow instillation at fracture site in intracapsular fracture of femoral neck treated by head preserving surgery

Purpose： The aim of present study is to evaluate the outcome of bone marrow instillation at the fracture site in fracture of intracapsular neck femur treated by head preserving surgery. Methods： This study included 32 patients of age group 18e50 years with closed fracture of intracapsular neck femur. Patients were randomized into two groups as per the plan generated via www.randomization.com. The two groups were Group A （control）, in which the fracture of intracapsular neck femur was treated by closed reduction and cannulated cancellous screw fixation, and Group B （intervention）, in which additional percutaneous autologous bone marrow aspirate instillation at fracture site was done along with cannulated cancellous screw fixation. Postoperatively the union at fracture site and avascular necrosis of the femoral head were assessed on serial plain radiographs at final follow-up. Functional outcome was evaluated by Harris hip score. Results： The average follow-up was 19.6 months. Twelve patients in each group had union and 4 patients had signs of nonunion. One patient from each group had avascular necrosis of the femoral head. The average Harris hip score at final follow-up in Group A was 80.50 and in Group B was 75.73, which was found to be not significant. Conclusion： There is no significant role of adding on bone marrow aspirate instillation at the fracture site in cases of fresh fracture of intracapsular neck femur treated by head preserving surgery in terms of accelerating the bone healing and reducing the incidence of femoral head necrosis.

Females Had a Worse T-Score at Lumbar Region and Males Had a Worse T-Score at Femoral Region among Chronic Kidney Disease

Background: To evaluate bone-mineral-density-BMD determined by dual-energy X-ray absorptiometry-DEXA and bone turnover markers in chronic-kidney-disease-CKD patients. Method: An observational-clinical study of all patients who were scanned by DEXA-scan in 2018. All patients with low-bone-density or osteoporosis-based on World-Health-Organization-WHO definition were included. Results: 505 patients with abnormal-BMD, 87.3% were in early-stage CKD-stage I - II, 8.5% were in CKD-stage III - V and 4.2% did not have renal tests. 95 (18.8%) were male with a mean age of 57.0 years and 410 (81.2%) were females with a mean age of 55.8 years. Patients of ≥65 years had lower T-score than those who were younger than 65 years-old. Among CKD patients, those with late-CKD (stage III - V) had less BMD-measurements and lower T-score than those with early-CKD (stage I - II). A significant positive correlation exists between parathyroid hormone-PTH-level and the lower T-score. Female had a worse T-score at the lumbar-region whereas male had a worse T-score at the femoral-region. There was no significant difference between males and females for the T-score at hip-region. Conclusion: We observed a distribution of abnormal BMD among different age, sex and CKD groups. Measurements of BMD by DEXA might be a useful test to diagnose osteoporosis in CKD patients. Femoral and total hip areas were more affected, however DEXA might not be able to detect osteoporosis in the lumbar area of CKD patients. T-scores are lower in patients with more severe CKD and lower in elderly patients. PTH level is associated proportionally to the degree of bone loss. Early intervention and proper management must be implemented early among CKD patients with multidisciplinary team approach strategy. More studies are needed to determine if DEXA techniques are enough to distinguish the quantity of bone loss between different stages of CKD.

不同内固定方式治疗股骨颈骨缺损骨折的静力学与模态分析

目的 探讨不同内固定方式治疗股骨颈骨缺损骨折的静力学特征以及固有和约束模态对内固定的影响。方法 首先基于CT图像建立伴有股骨颈内固定系统(femoral neck system,FNS)和倒三角空心钉(cannulated screw,CS)两种不同内固定装置的股骨颈骨折模型与股骨颈骨缺损骨折模型,然后模拟3倍体重载荷下,不同骨折内固定模型的应力、位移分布及峰值以及模态下的位移峰值、频率以及固有和约束模态振型。结果 两种内固定方式下,股骨颈骨缺损骨折的内固定应力峰值(337.69 MPa,618.58 MPa)显著高于股骨颈骨折模型(149.38 MPa,300.57 MPa),股骨头应力峰值(107.75 MPa,93.78 MPa)与位移峰值(5.244 mm,4.415 mm)也都高于股骨颈骨折模型[(95.73 MPa,85.64 MPa),(4.367 mm,3.478 mm)]。在骨折类型相同的情况下,FNS内固定模型相比CS内固定模型具有更低的位移峰值以及更加均匀的应力分布。模态分析结果显示,振动对于内固定的稳定性有一定影响,约束模态的振型频率范围要小于固有模态。固有模态下FNS的位移峰值较CS降低了6.99%,约束模态下位移峰值降低了14.02%。结论 骨缺损会严重破坏内固定的力学环境,无论是普通骨折模型还是骨缺损骨折模型,FNS固定的静态与动态特性都要优于CS固定。临床治疗中要考虑股骨及内固定器械的固有、约束频率所产生的影响,避免因共振而造成内固定失效等问题。

仙灵骨葆胶囊治疗早期股骨头缺血性坏死的疗效观察

目的探讨仙灵骨葆胶囊联合冲击波对早期股骨头缺血性坏死患者血清细胞因子水平和骨密度的影响。方法采用随机数字表法将2020年6月—2022年6月河北中医学院附属医院收治的100例早期股骨头缺血性坏死患者分为A组和B组,各50例。两组均给予冲击波治疗,B组在此基础上给予仙灵骨葆胶囊。两组持续治疗1个月。比较两组治疗1个月后的临床疗效,治疗前、治疗1个月后的髋关节活动度、髋关节功能、疼痛程度、骨密度、影像学指标及血清细胞因子水平。结果治疗1个月后,B组总有效率高于A组[96.00%(48/50)vs 70.00(35/50),P<0.05]。与治疗前比较,治疗1个月后,两组髋关节屈曲、外展、外旋活动度、Harris评分、髋关节股骨粗隆、股骨颈、Ward′s三角骨密度、骨坏死区灰度、股骨头灰度及血清转化生长因子-β(transforming growth factor-β,TGF-β)、骨形态发生蛋白(bone morphogenetic protein,BMP)、骨碱性磷酸酶(bone alkaline phosphatase,BAP)水平均升高,且B组高于A组;视觉模拟评分(visual analogue scale,VAS)、骨坏死区体积及血清N-端骨钙素(N-terminal osteocalcin,N-MID)、总Ⅰ型前胶原氨基端前肽(total type I procollagen amino terminal peptide,P1NP)水平均降低,且B组低于A组(P<0.05)。结论仙灵骨葆胶囊联合冲击波治疗可有效调节早期股骨头缺血性坏死患者相关血清因子水平,改善患者骨密度,进一步可提高患者髋关节功能及活动度,改善影像学指标,并有效缓解患者疼痛度,进而可提高临床疗效。

股骨距环扎固定联合阿仑膦酸钠对骨质疏松性股骨颈骨折BTMs及预后的影响

目的观察“糖果钢丝”环扎术对股骨距环扎固定联合阿仑膦酸钠对骨质疏松性股骨颈基底部骨折骨转换生化标志物(bone turnover markers,BTMs)及预后的影响。方法筛选2019年5月至2022年5月符合纳入标准的64例骨质疏松性股骨颈基底部骨折患者,随机分为观察组和对照组,每组32例。对照组予以股骨头置换术,术后连续服用碳酸钙D3片3个月;观察组在对照组的基础上予以股骨距“糖果钢丝”环扎固定术,术后连续服用阿仑膦酸钠片3个月。比较2组手术时间、术中出血量、手术切口长度、开始下地时间、住院时间,并分别比较治疗前和治疗3个月后2组患者假体周围骨密度(bone mineral density,BMD)、血清Ⅰ型原胶原N-端前肽(serum N-terminal peptide of type Ⅰ collagen,S-PINP)、血清Ⅰ型胶原C-末端肽交联(serum C-terminal telopeptide of type Ⅰ collagen,S-CTX);并随访12个月分析患者术后Harris髋关节功能评分、疼痛视觉模拟评分(visual analogue scale,VAS)、改良Barthel指数(modified Barthel index,MBI)评分改善情况及术后并发症发生情况。结果2组患者手术时间、术中出血量、切口长度比较无显著差异(P>0.05),2组患者术后开始下地时间和住院时间比较观察组显著低于对照组(P<0.05)。2组骨转换生化标志物S-PINP和S-CTX均较术前升高,但观察组骨形成生化标志物S-PINP显著高于对照组,骨吸收生化标志物S-CTX显著低于对照组,差异有统计学意义(P<0.05)。2组假体周围BMD均较治疗前升高,且观察组显著高于对照组,差异有统计学意义(P<0.05)。随访12个月时Harris评分、BMI评分均较术前提高,且观察组显著高于对照组,VAS评分均较术前降低,且观察组显著低于对照组,差异有统计学意义(P<0.05)。术后随访期间观察组并发症发生率低于对照组,但差异无统计学意义(P<0.05)。结论“糖果钢丝”环扎技术联合阿仑膦酸钠可以有效改善骨质疏松性股骨颈骨折术后骨转换状态,促进骨重塑,提供更加稳定的股骨柄骨长入环境,对患者预后恢复疗效显著。

Free vascularized fibular grafting for treatment of old femoral neck fractures

The internal fixation failure for treatment of femoral neck fracture is mainly due to improper fixation, loss of fixation stability and premature ambulation. Bone nonunion and avascular osteonecrosis of the femoral head caused by the internal fixation failure for femoral neck fracture are always the complex topics in orthopedics. With regard to patients who sustain these complications, total hip arthroplasty is a proper choice for elderly patients, but is not acceptable by young patients. We report nine patients with the failure of internal fixation for femoral neck fracture who were treated with free vascularized fibular grafting and internal fixation with cannulated screw from November 2001 to October 2003. All of them achieved good results.

X射线断层融合技术对股骨颈骨折股骨颈动力交叉钉系统内固定后疗效评估的价值

目的:通过常规X射线与X射线断层融合成像两种影像技术的比较,探讨X射线断层融合技术对股骨颈骨折股骨颈动力交叉钉系统(FNS)内固定后骨愈合和骨痂生长情况评估的应用价值。方法:选取2019年10月至2020年6月北京市海淀医院骨科收治的18例股骨颈骨折患者,所有患者均采用FNS内固定治疗,分别于术后1个月和12个月时行普通X射线和X射线断层融合成像,评价两种影像技术对股骨颈骨折FNS内固定术后骨愈合和骨痂生长情况的显示情况,统计两种影像技术对股骨颈骨折FNS内固定图像检测过程的相关参数。结果:在股骨颈骨折患者术后1个月时X射线断层融合成像技术的骨痂检出率均低于术后12个月,且X射线断层融合技术在患者术后1个月和12个月时的骨痂检出率(94.44%和61.11%)均高于X射线(61.11%和33.33%),差异有统计学意义(x2=5.100、5.790,P<0.05);经秩和检验显示,两种影像技术在股骨颈骨折患者术后1个月和12个月时的骨痂生长情况图像质量评分分布差异有统计学意义(Z=2.113,2.018,P<0.05),两种影像技术的术后1个月和12个月骨愈合图像质量比较,差异有统计学意义(Z=2.868、2.258,P<0.05);X射线断层融合技术成像引导的治疗前骨折处检测影像图显示效果理想,图像清晰,较完整清晰地显示出患者的骨折线,术后12个月X射线正侧位可见连续性骨痂通过骨折线,达临床愈合;X射线断层融合技术对股骨颈骨折FNS内固定图像检测过程的空气比释动能、剂量面积乘积以及有效剂量均低于常规X射线成像,差异均有统计学意义(t=5.900、2.466、32.255,P<0.05)。结论:在对股骨颈骨折FNS内固定后患者骨愈合情况的诊断评价中,使用X射线断层融合技术能够更好地对患者的骨痂生长情况进行检测,判定骨愈合程度,尤其是对术后恢复时间更长的判定效果更佳,且安全性较好,在检测过程中辐射损伤较小。

Comparative study of multiple cancellous screws versus sliding hip screws in femoral neck fractures of young adults

Purpose： Both cannulated cancellous screw （CCS） and sliding hip screw （SHS） are used in femoral neck fracture fixations, hut which is superior is yet to be determined. This study was aimed to compare the clinicoradiological outcome of femoral neck fracture treated with SHS or CCS in young adults. Methods： Adults （16-60 years） with femoral neck fracture were divided into Group I fixed with SHS and Group 2 fixed with three CCS after closed reduction. Pain relief, functional recovery and postoperative radiographs at 6 weeks, 3 months, 6 months and then yearly for upto 4 years were analyzed. Results： Group 1 （n = 40） achieved radiological union at mean of Z6 months, with the union rate of 8Z5% （n = 35）, avascular necrosis （AVN） rate of 7.5% （n - 3） and mean Harris Hip Score （HHS） of 86.15 at the end of 4 years. In Group 2 （n = 45） these parameters were union at Z1 months, union rate of 82.22% （n = 37）, AVN rate of 6.67% （n = 3） and HHS of 88.65. Comparative results were statistically insignificant. Conclusion： There is no significant difference in clinicoradiological outcome between the two implants.

miR-3191-5p在早期激素性股骨头坏死患者中的诊断价值分析

目的检测并探讨外周血中微小RNA(miRNA)-3191-5p在激素性股骨头坏死患者中的表达以及诊断价值。方法前瞻性选取2017年3月至2023年2月于监利市人民医院就诊的201例疑似激素性股骨头坏死患者,分为确诊组(99例)和未确诊组(102例);同期选取体检就诊的82例健康人群作为对照组。分别检测并比较三组外周血中miR-3191-5p相对含量,骨密度(BMD)和骨钙素(BGP)水平,分析miR-3191-5p与BMD、BGP的相关性,采用受试者工作曲线(ROC)评估miR-3191-5p在激素性股骨头的诊断价值。结果确诊组血清miR-3191-5p相对表达水平低于未确诊组和对照组,BMD和BGP高于未确诊组和对照组。确诊组轻中度组miR-3191-5p相对表达水平高于重度组,BMD和BGP低于重度组;且miR-3191-5p分别与BMD、BGP均呈显著负相关(P<0.05)。miR-3191-5p区分轻中度与非轻中度、重度和非重度、激素性股骨头坏死和非该病患者的ROC下面积和分别为0.764、0.916和0.911。结论血清miR-3191-5p能够作为激素性股骨头坏死患者早期诊断的敏感生物标志物。

营养状况、骨代谢及股骨颈强度指数和骨髓脂质分数与老年髋部骨折术后关节功能恢复的关系研究

目的探究营养状况、骨代谢及股骨颈强度指数(FSI)和骨髓脂质分数(LF)与老年髋部骨折术后关节功能恢复的关系。方法选取2021年6月至2023年6月于原阳县中心医院接受治疗的髋部骨折手术老年患者160例为研究对象。根据患者髋关节功能恢复情况进行分组,恢复良好患者87例纳入良好组,恢复不良患者73例纳入不良组。对比两组患者一般资料、营养状况、骨代谢及FSI和LF。结果良好组年龄≥75岁比例、体重、体质量指数(BMI)、股骨粗隆间骨折比例、Ⅰ型胶原蛋白N端肽(NTX)、抗酒石酸酸性磷酸酶5b(TPACP-5b)水平表达均低于不良组,差异均有统计学意义(P<0.05);良好组微型营养评定(MNA)评分、FSI、LF、骨钙蛋白(BGP)水平表达均高于不良组,差异均有统计学意义(P<0.05);经Logistic回归分析,MNA评分、LF、FSI、NTX、TPACP-5b、BGP水平表达均为影响老年髋部骨折术后关节功能恢复情况的独立危险因素,差异有统计学意义(P<0.05);经受试者工作特征(ROC)曲线分析,MNA评分、FSI、LF、NTX、TPACP-5b水平表达均对老年髋部骨折术后关节功能恢复情况有较高的预测价值,曲线下面积(AUC)值分别为0.936、0.874、0.866、0.884、0.825;BGP水平表达的AUC值为0.634,可作为次要参考。结论观察行髋部骨折手术的老年患者术后营养状况、骨代谢及股骨颈强度指数和骨髓脂质分数的变化情况,有利于早期预测患者术后髋关节功能恢复情况,从而制定相应防控措施,帮助患者早日康复。