Objective To analyse the treatment results of proximal humerus fracture in over sixty-years-old patients. Methods From January 1999 to January 2003, 32 cases suffered from fractures of the proximal humerus were studied, which involved 13 males (mean age 73.2 years, range 60-88 years), and 19 females (mean age 75.5 years, range 60-94 years). There were 22 cases (65.7%) with two-part fractures, among them, 68.1% was surgical neck fracture. 3 cases with two-part and 1 with three-part fracture were treated conservatively because of either their poor health condition or their refusal to operation. The other 28 patients were operated. According to the Neer classification, through the statistic and analysis for the method and outcome, all the cases were evaluated in term of the American UCLA scale system. Results 25 of the 28 operated patients were available at the final follow-up, the mean period was 1.5 years with a range of 1 to 3 years. All the fractures had united. 5 patients with healing time more than 3 months were those fractures classified as three or four-part, which needed the tension-band fixation. All the patients complained with joint stiffness in different degree, 6 of the patients with three or four-part remained with sustaining shoulder contracture. According to the UCLA, the good-excellent rate was 81.2% in the two-part fractures, and only 33.3% in the three or four-part fractures. Conclusion The treatment methods of proximal humerus fracture in aged patients should be selected according to individual condition. The tension band fixation is a good choice for those who can't accept the joint replacement, though the outcome after the four-part fractures fixation is less satisfactory. Joint contracture and humeral head necrosis may be the common complications among the patients rated as three or four-part fractures. After operation, early and complete rehabilitation are closely related to the treatment results.

Objective To investigate the result of McBride operation for treatment of hallux valgus with more than 5 years follow-up. Methods There were totally fifity patients who underwent McBride operation in this study. The follow-up period varied from 5 years to 10 years and 2 months (average 7 years and 1 month). The symptoms and deformity before and after operation were compared statisticly. Results The angle between first phalanx and metatarsal is strongly correlated with the angle between first and second metatarsal.The coefficience of pre- and post-operation is 0.84 and 0.71 respectively.There were 64 feet whose symptoms were eliminated and the deformity were corrected basically. The effective rate was 71.1% according to the assessment criteria discribed by doctor ZHU Lihua. The common complications were pain residue, local numbness, hallux valgus recurrence, hallux varus and claw toes. The measurment showed the angle between first phalanx and metatarsal significantly decreased after operation and the angle between first and second metatarsal also decreased following the hallux valgus correction. Conclusion McBride operation is a good and reliable method to treat young patients with mild to moderate hallux valgus. Complications are related to congenital foot deformity, severe valgus deformity and normal structure injuries during the operation.

Objective To observe the difference of bone mineral den sity(BMD )between the young and the aged people,old healthy people and old patients with hip fra cture;the incidence of hip frac-ture in the aged was also observed in order t o find out the relationship of hip fracture with osteoporosis in the aged.Met hods BMDof lumbar(L 2~4 ),femoral neck,Wards triangle and trochanteric area was measured in the healthy males(63case)and fe males(58cases)with in the age range of 20t o35years,and the BMD was evalu ated in the healthy male and female over60y ears with hip fractures.The445cases of hip fracture were reviewed from19 91to2000,of them218were males and226females with the average age o f 73.6years in males and71.9years in fe males.Results Allof quantitati ve data was analysed sta tistically.There was sig nificant difference in BMD between the young and the aged people(P

Objective To investigate the treatment effect of the proximal humeral internal locking system (PHIL()S) on the elderly patients with displaced proximal humeral fractures.MethodsFrom Feb 2004 to Mar 2007, 36 patients (mean age: 72.2 years) with proximal humeral fractures were treated with PHILOS plate fixation which included 14 cases with 2-part, 17 cases with three-part and 5 cases with four-part fractures according to Neer classification.Operation time,intraoperative blood loss, blood transfusion, perioperative complications and function evaluation of the operated shoulder joint were calculated with 14.5 months follow-up at average.Results The average operation time and blood loss were (61.5± 11.6) min and ( 165.2±91.2) ml, respectively. 1 case with accidents of blood vessel and 1 case with pneumonia were found without neurovascular injuries. All fractures were radiographically healed in an average of 3-5 months.No necrosis of humeral head appeared and 30 (83.3％) cases were excellent or good according to Neer scoring system. Two part fracture and early operation ( within 3 days after operation) might improve the postoperative function of shoulder joint, but the patient's age, gender and ASA score were not statistically with Neer score.Conclusions PHILOS plate fixation is a suitable procedure for displaced proximal humeral fractures via stable fixation and early rehabilitation, especially for elderly patients combined with osteoporosis.

Objective:To investigate the efficacy and safety of perioperative aspirin use in elderly patients with osteoporotic vertebral fractures(OVF)undergoing vertebroplasty(VP).Methods:This was a retrospective cohort study.Clinical data of 136 OVF patients treated with VP in our department from Jan.2016 to Dec.2020 were analyzed.Differences in clinical data, treatment efficacy, intraoperative and postoperative complications and hematomas were compared between the aspirin group(n=71, receiving aspirin100 mg/d before VP and not taking other anticoagulant drugs)and the control group(n=65, not taking aspirin).Results:There was no significant difference in the analgesic score or physical activity scale score between the two groups before, 1 week after surgery and at the last follow-up( P>0.05). There were significant differences in the visual analog score(VAS), the analgesic score and the physical activity scale score before, 1 week after surgery and at the last follow-up within the aspirin group(7.12±1.33, 2.37±1.01 vs.2.63±1.04, 3.01±0.95, 1.56±0.65 vs.1.61±0.57, 2.75±0.53, 1.32±0.63 vs.1.44±0.52, P<0.01). No surgical site infection, injury of large vessels, intraspinal hematoma or pulmonary embolism was found in the aspirin group or the control group during the follow-up period.There was no difference in intraoperative or postoperative blood loss(12±3.5 ml vs.11.0±3.6ml, t=1.60), cement injection volume for a single vertebral body(4.5±1.9 ml vs.4.0±1.7 ml, t=1.40), cement spillage(14 cases or 19.7% vs.9 cases or 17.0%, χ2=0.15), nerve root irritation(3 cases or 4.2% vs.1 case 1.9%, χ2=0.43), re-fractures(5 cases 7.0 vs.3 cases 5.7%, χ2=0.10)or spinal epidural hematoma(8 cases or 11.3% vs.5 cases or 9.4%, χ2=0.11)between the aspirin group and the control group(all P>0.05). Conclusions:In OVF patients taking perioperative aspirin, the postoperative pain score, pain medication administration and mobility are significantly improved after VP, compared with pre-treatment.Surgical efficacy and safety show no significant difference between patients with and without aspirin administration.

Objective To observe the BMD threshold of hip fracture in the elderly, analyze the pre-imposing factors leading to femoral neck fracture or intertrochanteric fracture, and provide some evidences for fracture prevention. Methods The BMD examination were performed on 496 fractured patients over 60 years old which were grouped after admission according to their age, gender and fracture types, and then the results were statistically analyzed. Results The BMD of fracture cases in the elderly over 60 years old was 2.5 s less than peak bone volume. There is no obvious difference in BMD between femoral neck fracture and intertrochanteric fracture among various age groups. According to our study, most hip fractures happened at the age of 60-79 years, accounting for 73%of all hip fractures. Conclusions Decreased bone mass or osteoporosis is an important factor leading to hip fracture in the elderly. The fracture types (femoral neck fracture or intertrochanteric fracture) depend mainly on the impaction force to the hip, not only on the BMD change.

Objective:To investigate the impact of osteoporosis on clinical outcomes in elderly patients treated with short segment transforaminal lumbar interbody fusion.Methods:From May 2016 to May 2018, elderly patients who had undergone transforaminal lumbar interbody fusion(TLIF)in our hospital were retrospectively analyzed.Based on bone mineral density(BMD), patients were divided into the osteoporosis group(the OP group, n=75, T≤-2.5 in BMD)and the control group(the CO group, n=103, T>-1.0 in BMD). General patient information, clinical data and postoperative follow-up clinical results were compared between the two groups.Results:Eventually 178 cases were enrolled, including 68 with lumbar disc herniation and 110 with lumbar spinal stenosis.Preoperative Visual Analogue Scale(VAS)scores were 7.35±1.30 in the lower back and 7.32±1.30 in the leg for the OP group and 7.35±1.33 and 7.22±1.40, respectively, for the CO group, and there was no significant difference between the two groups( t=0.140 and 0.468, P=0.989 and 0.640). The proportions of cage collapse and internal fixation loosening were 70.7%(53/75)and 37.3%(28/75)in the OP group, which were higher than 22.3%(23/103)and 14.6%(15/103)in the CO group( χ2=41.440 and 12.280, both P=0.000). However, there was no significant difference between the OP group and the CO group in 1-and 2-year postoperative interbody fusion rates(postoperative 1-year rate: 89.3% or 67/75 vs.91.3% or 94/103, χ2=0.187, P=0.666; postoperative 2 year rate: 94.6% or 71/75 vs.95.1% or 98/103), χ2=0.021, P=0.885). There was no significant difference in VAS score and Oswestry disability index(ODI) between the OP group and the CO group at 6 months, 1 year and 2 years after surgery(all P>0.05). Conclusions:Although there are some osteoporosis-related complications such as cage subsidence and screw loosening, short-segment TLIF can still achieve good clinical results in elderly patients with osteoporosis.

ObjectiveTo analyze therapeutic effects of conservative treatment and the causes of malunion of intertrochanteric fracture in elderly patients, and try to find the way to deal with the problems. MethodsFifteen cases aged 75 to 101 years with intertroehanterie fracture treated conservatively were included.Their average age was 88.8 years.All fractures were classified according to Evens-Jensen.Because of the medical complication or other reasons, they were conservatively treated by methods of traction, wearing shoes et al. X-ray examination was taken at regular time and their final functions were assessed. ResultsTwo cases were died 1-3 months after admission, and the fractures were only partially healed. The remaining thirteen cases got complete healing. Among the fifteen cases, the deformity did not happen in 4 cases of IA without fixation and 1 case of IIB with bone traction. All others got the deformity of varus, shorting and external rotation in different degree, which interfered the lower extremity motor function. ConclusionsThe fracture position not kept and fixed satisfactorily during treatment would lead to more joint deformity and deteriorated hip joint function for the displaced intertroehanterie fractures in elderly patients.

Objective To compare of the effect of intravenous zoledronic acid and calcitonin on the elderly with osteoporotic intertrochanteric fractures.Methods From June 2009 to November 2012,610 patients with osteoporotic intertrochanteric fractures were treated with closed reduction and internal fixation.543 consecutive patients were grouped sequentially according to the admission time.From June 2009 to April 2011,control group (n=325)received calcitonin for osteoporosis (male 107,female 218,mean age 75.02±5.65 years).The number of Evans-Jensen type Ⅰ,Ⅱ,and Ⅲ type patients were 87,136,and 102,respectively.Average lumbar bone mineral density (BMD) and hip BMD were 0.737±0.08 g/cm2 and 0.725±0.05 g/cm2,respectively.From May 2011 to November 2012,218 patients (male 82,female 136,mean age 74.71±5.32 years) received zoledronic acid for osteoporosis.The number of Evans-Jensen type Ⅰ,Ⅱ,and Ⅲ type patient were 62,91 and 65,respectively.Average lumbar BMD and hip BMD were 0.738±0.05 g/cm2 and 0.722±0.06 g/cm2,respectively.All patients received once-yearly intravenous zoledronic acid in one week after operation.The BMD during hospitalization and one year after operation were compared between the two groups.Harris score and VAS score were applied to evaluate the function and pain degree of the operated hip joint.Results The average follow-up time were 12.8 months (range,5 to 22 months) in control group and 12.5 months (range,4 to 19 months) in treatment group.The average fracture union time,Harris score,VAS score were 14.25±1.38 weeks,68.88±5.71 points,and 0.36±0.55 points respectively in treatment group and 14.39± 1.12 weeks,69.47±4.60 points,and 0.33±0.48 points respectively in control group.There were no statistical differences between two groups in fracture union time,Harris score and VAS score.The average lumbar BMD and hip BMD were 0.76±0.06 g/cm2 and 0.75±0.04 g/cm2 in treatment group,which were 0.75±0.07 g/cm2 and 0.74± 0.07 g/cm2 in control group one year after operation,respectively.Compared with the baseline,the BMD of lumbar spine and hip one year after operation slightly increased without statistically significant difference in control group.The BMD increased significantly in treatment group.Conclusion Early administration of intravenous zoledronic acid does not influence bone healing and it could increase BMD one year after closed reduction and internal fixation.

Objective To evaluate the surgical results of spinal stenosis in the elderly and to investigate the indications , surgical technique and factors which may contribute to the outcome. Methods A retrospective study was held, 304 patients aged 65 and over who had different kinds of decompression laminectomy for lumbar spinal stenosis between Jan 1990 and Jun 2005 were recruited. The mean patient age at surgery was 70.4 years (65-86 years old). Results One hundred and seventy-five cases had co-existing illnesses, 62 had concomitant degenerative spondylolisthesis, 138 had spinal instrumentation. Functional results were graded as excellent, good, fair and poor: 86. 8% excellent or good, 11. 2% fair and 6 cases poor. Four patients had re-operations because of post operation hematomas. Multivariate analysis revealed that age, sex, co-morbidity score, number of levels decompressed, and degenerative spondylolisthesis did not predict bad outcomes. Conclusions The surgical results of spinal stenosis in the elderly are favourable and comparable to those reported for the general population . Carefully perioperative preparation is very important in the treatment of elderly patient with lumbar spinal stenosis.