目的 探讨经皮微创技术应用股骨近端解剖锁定钢板治疗高龄骨质疏松粗隆间骨折的治疗。方法 我院自2009年12月—2013年6月共收治高龄骨质疏松粗隆间骨折56例,男35例,女21例;年龄76～94岁,平均81岁。所有患者应用股骨近端解剖锁定钢板通过经皮微创置入技术治疗。根据Harris髋关节功能评分对治疗效果进行评定。结果 56例手术时间30～90 min,平均45 min;术中失血量70～250 mL,平均110 mL。全部患者获随访,时间6～13.5个月,平均9.5个月。X线骨折愈合时间3～6个月,平均3.5个月。其中优41例,良12例。结论 对于高龄骨质疏松患者粗隆间骨折,采用经皮微创置入股骨近端解剖锁定钢板内固定治疗,具有手术创伤小、出血少、安全可靠等优点,有良好的临床应用价值。

Objective To study the application of proximal femur anatomic locking plate with minimally invasive percutaneous plate osteosynthesis (MIPPO) techniques in the treatment of senile osteoporosis curative effect of intertrochanteric fractures in elderly patients. Methods We have treated 56 elderly patients of senile osteoporosis intertrochanteric fractures in December 2009 to June 2013, including 35 male and 21 female cases, aged 76~94, the average of 81. All patients were applied in the proximal femur anatomic locking plate with minimally invasive percutaneous plate osteosynthesis technology according to Harris hip joint function scale curative effect. Results 56 cases of operation time 30~90 min, an average of 45 min. Intraoperative blood loss was 70~250 ml, an average of 110 ml. All patients received follow-up from 6 to 13.5 months, an average of 9.5 months. The X-ray fracture healing time was from 3~6 months, 3.5 months on average. According to the Harris hip joint function scale: 41 cases was excellent, 12 cases was good. Conclusion For the senile osteoporosis intertrochanteric fracture, using the proximal femur anatomic locking plate with minimally invasive percutaneous plate osteosynthesis technology can make minimal trauma, less bleeding reliable fixation,and has good clinical application value.

       目的   探讨高龄妊娠期糖尿病（GDM）产妇糖耐量的特点及其与妊娠结局的关系。方法   选择2020年1月1日—2024年12月31日在广州市第一人民医院规律产检并分娩的高龄产妇727例，包括高龄初产妇226例（GDM 78例）和高龄经产妇501例（GDM 131例），按照75 g OGTT血糖异常项数进行分组：一项血糖异常产妇为GDM I组（高龄初产妇38例，高龄经产妇68例）；两项血糖异常产妇为GDM Ⅱ组（高龄初产妇26例，高龄经产妇51例）；三项血糖异常产妇为GDM Ⅲ组（高龄初产妇14例，高龄经产妇12例）；75 g OGTT正常高龄产妇为对照组。收集研究对象一般资料、75g OGTT血糖及相关妊娠结局进行分析比较。结果   高龄初产妇GDM发生率（34.51%）较高龄经产妇GDM发生率（26.15%）高，差异具有统计学意义（P=0.021）；高龄初产妇GDM Ⅲ型宫内感染（28.57%）、产后出血（14.29%）发生率最高，差异具有统计学意义（P=0.037、0.039）；高龄初产妇GDM I型早产（23.68%）发生率最高，差异具有统计学意义（P=0.013）。高龄初产妇及经产妇GDM Ⅱ型的羊水过多、甲状腺功能减退、宫内感染、早产发生率均呈上升趋势。结论   高龄妊娠糖尿病产妇随OGTT血糖异常项增多出现不良妊娠结局风险升高，其中高龄初产妇的早产、宫内感染及产后出血的发生率更高，因此，针对高龄初产妇，应更加注重孕期血糖及健康管理，以减少不良妊娠结局的发生。

       Objective  To analyze glucose tolerance characteristics in elderly pregnant women with gestational diabetes mellitus（GDM）and relationship with pregnancy outcomes．Methods  From January 1，2020，and December 31，2024，727 elderly pregnant women who underwent routine prenatal examinations and delivered in Guangzhou First People’s Hospital were recruit．Among them，226 were elderly primiparas and 501 were elderly multiparas．GDM was diagnosed in 78 elderly primiparas and 131 elderly multiparas．Based on the results of the 75 g oral glucose tolerance test（OGTT），GDM cases were classified as follows：GDM I（one abnormal glucose value；38 elderly primiparas，68 elderly multiparas），GDM II（two abnormal values；26 elderly primiparas，51 elderly multiparas），and GDM Ⅲ（three abnormal values；14 elderly primiparas，12 elderly multiparas）．Elderly pregnant women with normal OGTT results served as the control group．General clinical data and pregnancy outcomes were collected．The prevalence and characteristics of GDM in elderly primiparas and multiparas were analyzed．Results  The incidence of GDM was significantly higher in elderly primiparas than in elderly multiparas（P=0.021）．The incidence of intrauterine infection and postpartum hemorrhage was highest in elderly primiparas with GDM Ⅲ（P=0.037，0.039）．The incidence of preterm birth was highest in elderly primiparas with GDM I（P=0.013）．The incidence of polyhydramnios，hypothyroidism，intrauterine infection，and preterm birth showed an increasing trend in both elderly primiparas and multiparas with GDM II．Conclusions  Elderly primiparas with more severe glucose tolerance abnormalities are at a higher risk of adverse pregnancy outcomes．Enhanced blood glucose monitoring and comprehensive health management during pregnancy are crucial for reducing the incidence of adverse outcomes in this population．

       目的  探讨功能性经口摄食分级的吞咽管理对高龄吞咽障碍患者的应用效果。方法  选取2022年5月—2024年5月暨南大学附属广州市红十字会医院收治的80例高龄吞咽障碍患者作为研究对象，应用随机数字表法将其分为观察组与对照组，各40例。对照组患者实施常规干预，观察组实施功能性经口摄食分级的吞咽管理干预，对比两组患者干预效果、干预前后的吞咽功能与营养状况、吞咽障碍相关并发症发生率，以及干预前后两组生活质量变化。结果  观察组总有效率为92.50%，高于对照组的72.50%（χ ² =5.541，P=0.019）；两组干预后综合性营养评估法（SGA）、进食评估问卷调查工具-10（EAT-10）评分均降低，且观察组［（6.62±1.24）（15.26±3.42）分］低于对照组［（10.85±2.32）（23.51±4.37）分］，对比差异有统计学意义（t分别为10.170、9.403，P＜0.05）；观察组吞咽障碍相关并发症发生率17.50%低于对照组42.50%（χ ² =5.952，P=0.015）；两组干预后生活质量综合评定量表（GQOLI-74）相关维度物质评分均升高，且观察组患者GQOLI-74相关维度物质生活（16.62±2.24）、心理功能（18.26±4.42）分、社会功能（21.62±3.66）分、躯体功能（23.26±4.37）分均高于对照组［（13.25±3.32）（13.51±2.37）（15.26±2.35）（16.62±3.73）］分，对比差异有统计学意义（t分别为5.322、5.990、9.248、7.309，P＜0.05）。结论  功能性经口摄食分级的吞咽管理对高龄吞咽障碍患者干预效果显著，且可提升其吞咽功能，改善营养状况，同时可辅助降低吞咽障碍相关并发症发生率，提高患者生活质量。

       Objective  To explore the application effect of Functional Oral Intake Scale（FOIS）swallowing management on elderly patients with swallowing disorders．Methods  A total of 80 elderly patients with dysphagia admitted to the Guangzhou Red Cross Hospital Affiliated to Jinan University from May 2022 to May 2024 were selected as research subjects．They were divided into an observation group and a control group，with 40 cases in each group，using a random number table method．The control group received routine intervention，while the observation group received FOIS swallowing management intervention．The intervention effects were compared between the two groups，including pre and post intervention，swallowing function and nutritional status，incidence of swallowing related complications，and changes in quality of life before and after the intervention．Results  The total effective rate of the observation group was 92.50%，which was higher than the 72.50% of control group（χ ² =5.541，P=0.019）．After the intervention，the comprehensive nutrition assessment（SGA）and the feeding assessment instrument-10（EAT-10）were decreased，and the observation group （［6.62±1.24］and［15.26±3.42］） were lower than the control group （［10.85±2.32］and［23.51±4.37］），and the comparative difference was statistically significant（t=10.170，9.403，P＜0.05）．The incidence of complications related to swallowing disorders in the observation group was 17.50%，lower than that in the control group was 42.50%（χ ² =5.952，P=0.015）．After intervention，the scores of GQOLI-74 related dimensions were increased in both groups．In addition，GQOLI-74 related dimensions of material life（16.62±2.24）scores，psychological function（18.26±4.42）scores，social function（21.62±3.66）scores，physical function（23.26±4.37）scores in observation group were higher than those in control group （［13.25±3.32］，［13.51±2.37］，［15.26±2.35］，［16.62±3.73］），and the difference was statistically significant（t=5.322，5.990，9.248，7.309，P＜0.05）．Conclusions  The swallowing management of FOIS has a significant intervention effect on elderly patients with swallowing disorders，and can improve their swallowing function，nutritional status，and assist in reducing the incidence of swallowing disorder related complications，thereby improving the quality of life of patients．