切换至 "中华医学电子期刊资源库"
高级检索
中华关节外科杂志(电子版)

中华关节外科杂志(电子版) ›› 2023, Vol. 17 ›› Issue (02) : 186 -194. doi: 10.3877/cma.j.issn.1674-134X.2023.02.006

临床论著

老年髋部骨折后血钠紊乱与死亡风险的相关研究
王晓伟, 王晔来, 徐宇航, 征华勇, 张建政, 刘智, 孙天胜†()   
  1. 100700　北京，解放军总医院骨科医学部
  • 收稿日期:2021-01-27 出版日期:2023-04-01
  • 通信作者: 孙天胜
  • 基金资助:
    高危战创伤损伤控制理论与关键技术研究(BLJ18J006)

Correlation of serum sodium disorder with mortality after hip fracture in elderly patients

Xiaowei Wang, Yelai Wang, Yuhang Xu, Huayong Zheng, Jianzheng Zhang, Zhi Liu, Tiansheng Sun†()   

  1. Orthopedic Medicine Department of the General Hospital of PLA, Beijing 100700, China
  • Received:2021-01-27 Published:2023-04-01
  • Corresponding author: Tiansheng Sun
全文 ( ) 下载PDF ( ) 导出引用
引用本文：

王晓伟, 王晔来, 徐宇航, 征华勇, 张建政, 刘智, 孙天胜. 老年髋部骨折后血钠紊乱与死亡风险的相关研究[J]. 中华关节外科杂志(电子版), 2023, 17(02): 186-194.

Xiaowei Wang, Yelai Wang, Yuhang Xu, Huayong Zheng, Jianzheng Zhang, Zhi Liu, Tiansheng Sun. Correlation of serum sodium disorder with mortality after hip fracture in elderly patients[J]. Chinese Journal of Joint Surgery(Electronic Edition), 2023, 17(02): 186-194.

目的

了解老年髋部骨折后血钠紊乱发生率，研究血钠紊乱的危险因素以及血钠紊乱与髋部骨折术后死亡风险的关系。

方法

回顾性采集分析2012年1月至2016年12月解放军总医院第7医学中心髋部骨折数据库的老年髋部骨折患者资料。纳入标准：年龄≥60岁、伤前可行走、单一髋部骨折、钠离子资料完整。排除标准：病理性骨折、高能量损伤。记录入院时血钠浓度，按血钠浓度分为低钠血症、高钠血症和正常血钠组。使用多因素logisitc回归分析血钠紊乱与髋部骨折术后死亡风险的关系。

结果

共入组患者1 001例，男327例，女674例，年龄范围60~99岁，入院时血钠浓度116~155 mmol/L。血钠紊乱患者166例(16.6%)，其中低钠血症126例，发生率为12.6%，轻度低钠98例(9.8%)，中度低钠18例(1.8%)，重度低钠10例(1.0%)；高钠血症40例，发生率为4.0%。并存病数量≥ 4[比值比(OR)＝1.578，95%置信区间(CI)(1.028，2.423)，P＝0.037]是发生血钠紊乱的独立危险因素，而白蛋白水平[OR＝0.950，95%CI(0.910，0.991)，P＝0.018]与血钠紊乱呈负相关。低钠血症患者术后30 d、1年死亡率分别是9.5%、26.2%，高钠血症患者术后30 d、1年死亡率分别为5%、15.0%，正常组患者术后30 d、1年死亡率分别是3.5%和14.1%，3组差异有统计学意义(30 d：χ2＝7.813，P＝0.020；1年：χ2＝12.053, P＝0.002)。校正混淆因素后，只有低钠血症是术后30 d(OR＝2.557，P＝0.014)和1年(OR＝1.755，P＝0.022)死亡的独立危险因素。轻度低钠血症患者术后30 d和1年死亡率分别为6.1%、24.5%；中重度低钠血症患者术后30 d和1年死亡率分别为21.4%、32.1%；轻度低钠和中重度低钠患者术后30 d死亡率差异有统计学意义(χ2＝4.278，P＝0.039)。

结论

血钠紊乱在老年髋部骨折患者中发病率高，其中低钠血症发生率远远超过高钠血症，并存病数量、白蛋白水平与血钠紊乱密切相关，低钠血症是术后30 d、1年死亡的独立危险因素，且随着低钠程度的不断加重，术后死亡风险逐渐增加(1年：χ2＝0.660，P＝0.417)。

关键词: 髋骨折, 低钠血症, 高钠血症
Objective

To clarify the incidence of serum sodium disorder after hip fracture in elderly patients, and investigate the risk factors of serum sodium disorder as well as the association between the disorder of serum sodium and mortality after hip fracture.

Methods

Data from the Hip Fracture Database of the Seventh Medical Center of the General Hospital of PLA of hip fracture in the elderly from January 2012 to December 2016 were retrospectively collected and analysed. Inclusion criteria: age ≥60 years old, able to walk before injury, single hip fracture, and with complete data of serum sodium. Exclusion criteria: pathological fracture, high-energy impact. The serum sodium on admission was recorded, and the patients were divided into hyponatremia group, hypernatremia group and normal group. The serum sodium correlation between disorder of serum sodium and hip fracture was analysed by multivariate logistic regression analysis.

Results

A total of 1 001 patients were enrolled, including 327 males and 674 females, and aged 60 to 99 years.The serum sodium in the patients was found 116 to 155 mmol / L. A total of 166 patients (16.6%) were with disorder of serum sodium after admission, of whom 126 were in hyponatremia (12.6%), with 98 in mild hyponatremia (9.8%), 18 in moderate hyponatremia (1.8%) and 10 in severe hyponatremia (1.0%). A total of 40 patients were found in hypernatremia (4.0%). The number of comorbidities over four diseases [odds ratio(OR )=1.578, 95% confidence interval (CI) (1.028, 2.423), P =0.037)] was found as an independent risk factor for the disorder of serum sodium, while serum albumin level (OR=0.950, 95% CI(0.910, 0.991), P =0.018) was negatively correlated with the disorder of serum sodium. The 30-day and one-year mortality in patients with hyponatremia were 9.5% and 26.2%, respectively. The 30-day and one-year mortality in patients with hypernatremia were 5% and 15.0%, respectively. The 30-day and one-year mortality rates in patients with normal serum sodium were 3.5% and 14.1%, respectively. There were statistically significant difference among these groups (30-day: χ2=7.813, P =0.020; one year: χ2=12.053, P =0.002). Multivariate analysis reported that hyponatremia was an independent risk factor for mortality at 30-days (OR=2.557, P=0.014) and at one year(OR=1.755, P=0.022)various confounding factors being adjusted. The 30-day and one-year mortality rates in patients with mild hyponatremia were 6.1% and 24.5%, while those in the patients with moderate or severe hyponatremia were 21.4% and 32.1%, respectively. There was statistically significant difference between patients with mild hyponatremia and patients with moderate or severe hyponatremia at 30-day after operation(χ2=4.278, P=0.039).

Conclusions

The incidence of serum sodium disorder is high in elderly patients after hip fracture. Number of coexisting diseases and level of serum albumin are closely related to the disorder of serum sodium. Hyponatremia is an independent risk factor of postoperative mortality in 30-day and one-year after surgery. With an aggravation of low serum sodium, the risk of mortality increases gradually after the surgery of hip fracture.

Key words: Hip fractures, Hyponatremia, Hypernatremia
表1 髋部骨折后血钠紊乱危险因素分析
Table 1 Risk factors for disorder of serum sodium after hip fracture
变量Variable 正常组Normal group 血钠紊乱组Serum sodium disorder group 未校正OR(95%CI) Unadjusted OR(95%CI) P值 校正后OR(95%CI) adjusted OR(95%CI) P值
例数Case number 835 166        
年龄Age [岁，M(P25，P75)] 81.00(75.00，85.00) 82.00(77.00，87.00) 1.03(1.01，1.06) 0.003 1.024(1.00，1.05) 0.052
男性Male [例(%)] 266(31.95) 61(36.74) 1.24(0.88，1.76) 0.220    
股骨转子间骨折Intertrochanteric fracture [例(%)] 472(56.53) 111(66.87) 1.55(1.09，2.19) 0.015 1.270(0.89，1.86) 0.221
并存病Comorbidities [例(%)]            
高血压病Hypertension 486(58.20) 101(60.84) 1.12(0.79，1.57) 0.528    
冠心病Coronary disease 221(26.46) 44(26.51) 1.00(0.69，1.46) 0.990    
心律失常Arhythmia 106(12.69) 26(15.66) 1.28(0.80，2.03) 0.303    
脑卒中Cerebral apoplexy 293(35.09) 65(39.16) 1.19(0.84，1.67) 0.324    
痴呆Dementia 70(8.38) 9(5.42) 0.63(0.31，1.18) 0.200    
糖尿病Diabetes 222(26.59) 48(28.97) 1.12(0.77，1.62) 0.543    
COPD 83(9.94) 20(12.05) 1.24(0.74，2.09) 0.415    
肾功能不全 49(5.87) 8(4.82) 0.81(0.38，1.75) 0.595    
肺部感染 109(13.05) 22(13.25) 1.02(0.62，1.66) 0.945    
并存病数量≥4[例(%)] 116(13.89) 35(21.08) 1.66(1.09，2.52) 0.019 1.58(1.03，2.42) 0.037
白细胞White blood cells [×109/L，M(P25，P75)] 8.57(7.01，10.37) 8.69(6.65，10.60) 1.03(0.10，1.10) 0.308    
血红蛋白Hemoglobin [g/L，M(P25，P75)] 112.00(99.00，124.00) 107.00(93.00，119.00) 0.99(0.98，0.99) 0.001 1.00(0.98，1.01) 0.438
白蛋白Albumin [g/L，M(P25，P75)] 37.50(34.58，40.00) 36.60(32.90，38.85) 0.93(0.90，0.97) 0.000 0.95(0.91，0.99) 0.018
尿素氮Urea nitrogen [mmol/L, M(P25，P75)] 6.32(5.00，8.15) 6.20(3.91，8.70) 1.01(0.96，1.05) 0.757    
肌酐Creatinine [μmol/L, M(P25，P75)] 66.20(54.48，86.00) 66.00(52.50，88.95) 1.00(1.00，1.00) 0.659    
表2 血钠紊乱与髋部骨折术后30 d死亡风险
Table 2 Serum sodium disorders and risk of mortality at 30 d after hip fracture surgery
变量Variable 例数Case number 未校正OR(95%CI) Unadjusted OR P值 校正OR(95%CI) adjusted OR(95%CI) P值
正常组Normal group 835 1   1  
低钠组Hyponatremia group 126 2.93(1.45，5.90) 0.003 2.557(1.21，5.41) 0.014
高钠组Hypernatremia group 40 1.46(0.34，6.36) 0.612 1.39(0.30，6.37) 0.672
年龄Age - 1.06(1.01，1.11) 0.009 1.03(0.98，1.08) 0.224
男性Male 327 1.37(0.73，2.56) 0.328 1.49(0.76，2.91) 0.250
股骨转子间骨折Intertrochanteric fracture 583 1.50(0.79，2.88) 0.219 1.17(0.59，2.31) 0.611
高血压病Hypertension 587 1.49(0.77，2.85) 0.234 1.55(0.73，3.30) 0.253
冠心病Coronary disease 265 1.69(0.89，3.18) 0.106 1.33(0.63，2.82) 0.451
心律失常Arhythmia 132 2.38(1.17，4.84) 0.017 1.67(0.75，3.73) 0.209
脑卒中Cerebral apoplexy 358 0.96(0.51，1.82) 0.898 0.84(0.41，1.75) 0.642
痴呆Dementia 79 1.57(0.60，4.11) 0.357 1.32(0.45，3.90) 0.617
糖尿病Diabetes 271 1.18(0.61，2.30) 0.623 1.30(0.60，2.83) 0.502
COPD 103 1.15(0.44，3.00) 0.768 0.90(0.32，2.52) 0.837
肾功能不全Renal dysfunction 57 2.29(0.87，6.07) 0.095 1.45(0.48，4.39) 0.515
肺部感染Pneumonia infection 131 3.09(1.57，6.08) 0.001 2.59(1.19，5.67) 0.017
并存病数量≥4 Comorbidities≥4 151 2.28(1.14，4.55) 0.019 0.86(0.28，2.71) 0.802
白蛋白Albumin - 0.88(0.82，0.94) <0.001 0.91(0.85，0.98) 0.010
ASA分级(Ⅲ+Ⅳ) ASA classification 493 2.21(1.15，4.23) 0.017 1.59(0.79，3.23) 0.015
表3 血钠紊乱与髋部骨折术后1年死亡风险
Table 3 Serum sodium disorders and risk of mortality at one year after hip fracture surgery
变量Variable 例数Case number 未校正OR(95%CI) Unadjusted OR(95%CI) P值 校正OR(95%CI) Adjusted OR(95%CI) P值
正常组Normal group 835 1   1  
低钠组Hyponatremia group 126 2.16(1.39，3.35) 0.001 1.75(1.09，2.83) 0.022
高钠组Hypernatremia group 40 1.07(0.44，2.61) 0.878 1.07(0.44，2.61) 0.904
年龄Age - 1.05(1.03，1.08) 0.000 1.03(1.00，1.06) 0.024
男性Male 327 1.73(1.22，2.44) 0.002 1.88(1.27，2.77) 0.001
股骨转子间骨折Intertrochanteric fracture 583 1.49(1.04，2.13) 0.029 1.19(0.80，1.75) 0.385
高血压病Hypertension 587 1.17(0.82，1.66) 0.384 1.21(0.79，1.84) 0.385
冠心病Coronary disease 265 1.69(1.17，2.42) 0.005 1.60(1.03，2.47) 0.035
心律失常Arhythmia 132 1.81(1.16，2.82) 0.009 1.40(0.84，2.31) 0.196
脑卒中Cerebral apoplexy 358 1.33(0.94，1.88) 0.112 1.19(0.79，1.79) 0.392
痴呆Dementia 79 1.94(1.11，3.33) 0.016 1.80(0.97，3.34) 0.064
糖尿病Diabetes 271 1.23(0.85，1.791) 0.269 1.78(0.95，2.31) 0.081
COPD 103 1.75(1.07，2.86) 0.026 1.41(0.81，2.45) 0.228
肾功能不全Renal dysfunction 57 1.824(0.97，3.42) 0.061 1.06(0.51，2.23) 0.870
肺部感染Pneumonia infection 131 2.03(1.31，3.14) 0.002 1.61(0.96，2.68) 0.040
并存病数量≥4 Comorbidities≥4 151 2.07(1.16，3.13) 0.001 0.80(0.41，1.55) 0.502
白蛋白Albumin - 0.868(0.83，0.90) <0.001 0.88(0.84，0.92) <0.001
ASA分级(Ⅲ+Ⅳ) ASA classification 493 1.829(1.29，2.59) 0.001 1.32(0.89，1.96) 0.012
表4 低钠程度与术后30 d、1年死亡风险(校正后)
Table 4 Hyponatremia level and risk of postoperative death at 30 d and one year (adjusted)
变量Variable 术后30 d Postoperative 30 d 术后1年Postoperative one year
OR(95%CI) P值 OR(95%CI) P值
无低钠Normal 1   1  
轻度低钠Mild Hyponatremia 1.78(0.69，4.57) 0.231 1.87(1.11，3.16) 0.019
中重度低钠Severe Hyponatremia 6.66(2.42，18.35) 0.000 2.47(1.07，5.73) 0.035
年龄Age 1.03(0.99，1.08) 0.190 1.03(1.01，1.06) 0.013
性别(男) Gender(male) 1.34(0.69，2.61) 0.392 1.75(1.20，2.53) 0.003
骨折类型(股骨转子间) Intertrochanteric fracture 1.36(0.69，2.70) 0.375 1.35(0.93，1.97) 0.114
并存病Comorbidities        
高血压病Hypertension 1.44(0.68，3.06) 0.338 1.09(0.73，1.64) 0.668
冠心病Coronary disease 1.31(0.62，2.77) 0.477 1.49(0.97，2.28) 0.068
心律失常Arhythmia 2.03(0.92，4.52) 0.081 1.54(0.94，2.57) 0.086
脑卒中Cerebral apoplexy 0.93(0.45，1.92) 0.846 1.27(0.86，1.89) 0.228
痴呆Dementia 1.48(0.52，4.22) 0.467 1.97(1.09，3.56) 0.025
糖尿病Diabetes 1.29(0.60，2.78) 0.517 1.41(0.92，2.15) 0.117
COPD 1.02(0.37，2.84) 0.968 1.57(0.92，2.67) 0.100
肾功能不全Renal dysfunction 1.76(0.59，5.25) 0.307 1.47(0.73，2.96) 0.277
肺部感染Pneumonia infection 2.74(1.27，5.93) 0.010 1.82(1.11，2.97) 0.017
并存病数量≥4 Comorbidities≥4 0.74(0.25，2.38) 0.655 0.73(0.38，1.38) 0.326
ASA分级(Ⅲ+Ⅳ) ASA classification 1.60(0.79，3.23) 0.189 1.37(0.93，2.01) 0.010
[1]
Cervellin G, Mitaritonno M, Pedrazzoni M, et al. Prevalence of hyponatremia in femur neck fractures: a one-year survey in an urban emergency department[J/OL]. Adv Orthop, 2014, 2014: 397059. DOI: 10.1155/2014/397059.
[2]
Ravel VA, Streja E, Mehrotra R, et al. Serum sodium and mortality in a national peritoneal dialysis cohort[J]. Nephrol Dial Transplant, 2017, 32(7):1224–1233.
[3]
Oh SW, Koo HS, Han KH, et al. Associations of sodium intake with obesity, metabolic disorder, and albuminuria according to age[J/OL]. PLoS One, 2017, 12(12): e0188770. DOI: 10.1371/journal.pone.0188770.
[4]
Morley JE. Dehydration, hypernatremia, and hyponatremia[J]. Clin Geriatr Med, 2015, 31(3): 389-399.
[5]
Katsoulis M, Benetou V, Karapetyan T, et al. Excess mortality after hip fracture in elderly persons from Europe and the USA: the CHANCES project[J]. J Intern Med, 2017, 281(3): 300-310.
[6]
Tolouian R, Alhamad T, Farazmand M, et al. The correlation of hip fracture and hyponatremia in the elderly[J]. J Nephrol, 2012, 25(5): 789-793.
[7]
Hoorn EJ, Liamis G, Zietse R, et al. Hyponatremia and bone: an emerging relationship[J]. Nat Rev Endocrinol, 2011, 8(1): 33-39.
[8]
Naka T, Kohagura K, Kochi M, et al. Hyponatremia and mortality among very elderly residents in a geriatric health service facility[J]. Clin Exp Nephrol, 2018, 22(6): 1404-1410.
[9]
Shah A, Sabir S, Artani M, et al. Significance of hyponatremia as an independent factor in predicting short-term mortality in patients with hemorrhagic stroke[J/OL]. Cureus, 2019, 11(4): e4549. DOI: 10.7759/cureus.4549.
[10]
Cervellin G, Mitaritonno M, Pedrazzoni M, et al. Prevalence of hyponatremia in femur neck fractures: a one-year survey in an urban emergency department[J/OL]. Adv Orthop, 2014, 2014: 397059. DOI: 10.1155/2014/397059.
[11]
Ayus JC, Fuentes NA, Negri AL, et al. Mild prolonged chronic hyponatremia and risk of hip fracture in the elderly[J]. Nephrol Dial Transplant, 2016, 31(10): 1662-1669.
[12]
Filippatos TD, Makri A, Elisaf MS, et al. Hyponatremia in the elderly: challenges and solutions[J]. Clin Interv Aging, 2017, 12: 1957-1965.
[13]
Boyer S, Gayot C, Bimou C, et al. Prevalence of mild hyponatremia and its association with falls in older adults admitted to an emergency geriatric medicine unit (the MUPA unit)[J/OL]. BMC Geriatr, 2019, 19(1): 265. DOI: 10.1186/s12877-019-1282-0.
[14]
Wilson JM, Boissonneault AR, Schwartz AM, et al. Frailty and malnutrition are associated with inpatient postoperative complications and mortality in hip fracture patients[J]. J Orthop Trauma, 2019, 33(3): 143-148.
[15]
《老年患者低钠血症的诊治中国专家建议》写作组. 老年患者低钠血症的诊治中国专家建议[J]. 中华老年医学杂志，2016, 35(8): 795-804.
[16]
Sterns RH. Evidence for managing hypernatremia: is it just hyponatremia in reverse？[J]. Clin J Am Soc Nephrol, 2019, 14(5): 645-647.
[17]
Bliemel C, Buecking B, Oberkircher L, et al. The impact of pre-existing conditions on functional outcome and mortality in geriatric hip fracture patients[J]. International Orthopaedics (SICOT), 2017, 41(10): 1995-2000.
[18]
Helminen H, Luukkaala T, Saarnio J, et al. Comparison of the Mini-Nutritional Assessment short and long form and serum albumin as prognostic indicators of hip fracture outcomes[J]. Injury, 2017, 48(4): 903-908.
[19]
Tinning CG, Cochrane LA, Singer BR. Analysis of hyponatraemia associated post-operative mortality in 3897 hip fracture patients[J]. Injury, 2015, 46(7): 1328-1332.
[20]
Cumming K, McKenzie S, Hoyle GE, et al. Prognosis of hyponatremia in elderly patients with fragility fractures[J]. J Clin Med Res, 2015, 7(1): 45-51.
[21]
Madsen CM, Jantzen C, Lauritzen JB, et al. Hyponatremia and hypernatremia are associated with increased 30-day mortality in hip fracture patients[J]. Osteoporos Int, 2016, 27(1): 397-404.
[22]
Braun MM, Barstow CH, Pyzocha NJ. Diagnosis and management of sodium disorders: hyponatremia and hypernatremia[J]. Am Fam Physician, 2015, 91(5): 299-307.
[1] 中华医学会骨科学分会关节外科学组, 广东省医学会骨质疏松和骨矿盐疾病分会, 广东省佛山市顺德区第三人民医院. 中国髋部脆性骨折术后抗骨质疏松药物临床干预指南(2023年版)[J]. 中华关节外科杂志(电子版), 2023, 17(06): 751-764.
[2] 刘丹丹, 宋鸣, 李霞, 徐夏君. 老年髋部骨折术后便秘的影响因素及其列线图预测模型[J]. 中华关节外科杂志(电子版), 2023, 17(05): 607-612.
[3] 王波, 许珂, 刘林, 张斌飞, 庄岩, 许鹏. 全髋关节置换术在老年髋臼骨折中的应用[J]. 中华关节外科杂志(电子版), 2023, 17(03): 385-390.
[4] 李凯, 刘振东, 贾大洲, 李小磊, 王静成. 股骨粗隆间骨折术后非感染性发热因素及风险模型[J]. 中华关节外科杂志(电子版), 2022, 16(05): 547-554.
[5] 唐大军, 余建翔, 马方全. 比较两种假体半髋置换治疗高龄不稳定转子间骨折[J]. 中华关节外科杂志(电子版), 2022, 16(01): 119-123.
[6] 姚依村, 林培芬, 叶冬平, 曹良国, 王文, 李爱国, 梁伟国. 高龄转子间骨折防旋髓内钉术后肺部感染原因分析[J]. 中华关节外科杂志(电子版), 2021, 15(06): 748-752.
[7] 吕春生. 髋部骨折术前下肢深静脉血栓发生的危险因素分析[J]. 中华关节外科杂志(电子版), 2021, 15(05): 623-627.
[8] 胡志富, 孙朝军, 李红, 孙哲, 赵昌, 许靖. 全髋置换治疗老年股骨头坏死并转子间骨折的疗效[J]. 中华关节外科杂志(电子版), 2021, 15(05): 614-617.
[9] 匡芸芸, 张悦, 张其梦, 张玉梅. 延续管理对老年COPD髋部骨折术后患者肺功能恢复的临床分析[J]. 中华肺部疾病杂志(电子版), 2023, 16(02): 251-253.
[10] 杨卿, 梁智星, 易述红, 易慧敏, 张彤, 傅斌生, 曾凯宁, 冯啸, 张英才, 姚嘉, 唐晖, 刘剑戎, 魏绪霞, 陈规划, 杨扬. 合并高钠血症供肝在劈离式肝移植中的应用[J]. 中华肝脏外科手术学电子杂志, 2022, 11(06): 586-591.
[11] 黄秉志, 陈楠楠. 髋部骨折术后肺炎发生的危险因素分析[J]. 中华老年骨科与康复电子杂志, 2022, 08(06): 338-344.
[12] 李泽佳, 康新民, 王临青, 朱德祥, 王国玉. 老年髋部骨折的防治进展[J]. 中华老年骨科与康复电子杂志, 2022, 08(03): 188-192.
[13] 石文俊, 商培洋, 成翔宇, 石继祥, 刘孚瑛, 庞金辉, 张磊, 章筛林. 加速康复外科理念在高龄髋部骨折围术期的应用效果[J]. 中华老年骨科与康复电子杂志, 2022, 08(01): 10-17.
[14] 马腾, 黄强, 许毅博, 路遥, 薛汉中, 李忠, 张堃. 经皮双改锥微创与切开复位治疗难复性股骨粗隆间骨折的比较[J]. 中华老年骨科与康复电子杂志, 2021, 07(06): 326-332.
[15] 孙振晓, 刘化学, 任德菊. 烦渴-间歇性低钠血症-精神病综合征诊断学特征并文献复习[J]. 中华诊断学电子杂志, 2022, 10(04): 266-269.
阅读次数
全文


摘要

版权所有 中华医学会 中华医学电子音像出版社有限责任公司  京ICP备14006079号-1  网络出版服务许可证：(署)网出证(京)字第075号