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.

Analgesic Effect of Combined Spinal-Epidural Anesthesia and its Effect on TNF-α and CRP Levels in Elderly Patients with Hip Fracture During Surgical Treatment

Objective:To observe the analgesic effect of combined spinal and epidural anesthesia on older patients undergoing hip fracture surgery.Method:One hundred and twenty elderly hip fracture surgery patients treated in our hospital from January 2021 to December 2022 were selected and randomly divided into two groups,with 60 cases in the experimental group and 60 in the control group.The experimental group was given combined spinal-epidural anesthesia intervention measures,while the control group was given epidural anesthesia intervention measures.The analgesic effect,tumor necrosis factor-alpha(TNF-α),C-reactive protein(CRP)levels,and other observation indicators were analyzed after anesthesia intervention.Result:After the intervention,the analgesic effect and the evaluation results of the subjects in the experimental group were better than those in the control group(P<0.05);the obtained values of TNF-αand CRP levels in the experimental group were higher than those of the control group(P<0.05).Conclusion:The combined spinal-epidural anesthesia intervention demonstrated positive outcomes.The analgesic effect of patients during surgery and their inflammatory factor levels improved,which makes this intervention worthy of clinical application and promotion.

Control study of short-term curative effect of minimally invasive total hip arthroplasty using metal-on-metal large-diameter femoral head for the elderly patients with femoral neck fractures

Objective To discuss the postoperative curative effects of two surgical techniques of minimally invasive total hip arthroplasty (THA) using metal-on-metal largediameter and conventional diameter femoral head for the elderly patients

Clinical analysis of nosocomial infection in 180 elderly patients with hip fractures

Objective To discuss the hip fracture in elderly patients with nosocomial infection,to take effective prevention and control measures. Methods Retrospective analysis of data of the elderly hip fracture combined with nosocomial infection during 2009 - 2010 was performed. Results A total of 180 cases of femoral neck

Effect of early surgery in high surgical risk geriatric patients with femoral neck fracture and taking antiplatelet agents

AIM: To investigate the effect of early surgical intervention on the high surgical risk elderly patients who sustained femoral neck fracture(FNF) and taking concomitant antiplatelet agents. METHODS: Between 2010 and 2012, a prospective study was conducted on 49 geriatric patients, who took antiplatelet agents, sustained FNF and underwent surgery within 72 h [early surgery(ES) group], and these were compared with a retrospective consecutive case series of patients with similar characteristics(45 cases) who had delayed surgery(DS group) after 72 h during an earlier 3-year period. Postoperative outcomeswere followed for one year and compared. RESULTS: There were non-significant differences in perioperative blood loss, blood transfusion, intensive care unit requirement and postoperative mortality(P > 0.05 all). There were 2 patients(4%) in the DS group who died after surgery(P = 0.23). However, the ES group showed a significantly better postoperative outcome in terms of postoperative complications, length of hospital stay, and functional outcome(P < 0.05 all).CONCLUSION: Early hip surgery in geriatric hip fracture patients with ongoing antiplatelet treatment was not associated with a significant increase of perioperative blood loss and postoperative mortality. Moreover, ES resulted in a better postoperative surgical outcome. In early hip surgery protocol, the antiplatelet agents are discontinued and the patient is operated on within 72 h after admission, which is safe and effective for the medically fit patients.

Early Surgery in Femoral Neck Fractures in Elderly: Does Preoperative ASA Score Matter?

Introduction: Early surgical treatment (within 48 hours) has been recommended for femoral neck fractures in order to avoid complications and reduce mortality rate, regardless of presence and severity of comorbidity and preoperative status (ASA score). However some studies evidenced that early surgery doesn’t always have a beneficial effect on mortality and complications. Therefore further studies could be useful in order to better assess risk related factors of patients requiring surgical treatment for femoral neck fracture. The purpose of this study is to evaluate the effect of preoperative ASA score and timing of surgery on mortality, complications and clinical outcome. Methods: All 336 patients operated in our center from January 2013 to December 2014 were selected for this retrospective study. Patients were divided in three groups as follows: group 1 patients treated within 48 hours;group 2 patients treated between 48 to 96 hours;group 3 patients treated over 96 hours. The preoperative ASA score was recorded for each patient. Complication, clinical outcome and mortality at one-year follow-up were evaluated. At follow-up ambulation was graded as: confined to bed, assisted ambulation, and normal ambulation. Complications both local (infections, malunion, dislocation) and systemic (deep vein thrombosis, pulmonary embolism, lung infections, ischemic disorders of heart) were recorded as well as number of transfusions. Statistical analysis was performed with chi square test and P value Results: 308 patients’ data were fully available for this study. At one-year follow-up return to normal ambulation was higher for patients of group 1 as compared with group 2 and 3 and in group 2 as compared with group 3 (P = 0.04). There was no difference in mortality and return to ambulation between patients with ASA score 1 and 2 (P = 0.06);patients with ASA score ≥ 3 showed a statistically significant higher mortality (P = 0.004) and rate of complications (0.0008) regardless of timing of surgery. There was no statistically significance in blood transfusion among the three groups. Discussion and Conclusion: Clinical outcome, complications and mortality have been previously reported from many authors and most studies agreed that early surgical treatment is recommended regardless of age and preoperative status of the patient. The present study suggests that early surgical treatment is actually able to reduce mortality and complications and to improve clinical outcome in patients with better preoperative conditions, while for patients with ASA score ≥ 3 treatment within 48 hours seems not to prevent mortality and complications and improve clinical outcome.

Optimized clinical practice for superaged patients with hip fracture:significance of damage control and enhanced recovery program

With the advent of global aging,the incidence,mortality,and medical costs of hip fracture among aged patients are increasing annually.The number of controlled clinical studies and health economics analyses that conform to evidence-based medicine principles is growing day by day.However,unfortunately,no specific recommendations regarding the procedures for the treatment of hip fracture are available.Meanwhile,the existence of both traditional treatment systems and new treatment theories means that most doctors confront difficult choices in their daily practice.These factors make the therapeutic approach for aged patients,especially among superaged patients with hip fracture,extremely challenging.This study focuses on superaged patients(>80 years as defined by the World Health Organization)with hip fracture and includes their preoperative pathological condition;therapeutic decision-making in terms of the benefit and risk ratio,damage control theory,and enhanced recovery after surgery were also investigated.These patients were discussed specifically by combining the current treatment strategies from several experts and the results of a meta-analysis published recently.The study presents some new ideas and approaches currently recognized in the field,such as preoperative assessment,surgical planning,safety consideration,complication intervention,and enhanced recovery implementation,and further presents some clear interpretations regarding misunderstandings in clinical practice.Finally,optimized treatment according to damage control principles and enhanced recovery after surgery during the perioperative period among superaged hip fracture patients is defined.

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。

全髋置换术和人工股骨头置换术治疗老年股骨颈骨折的疗效比较

目的对比老年股骨颈骨折(FNF)实施人工股骨头置换术(AFHR)与全髋置换术的疗效。方法选取2021年1月—2023年1月本院收治的80例老年FNF患者为研究对象,采用电脑盲选法分为参照组和干预组,每组40例。其中,参照组采用AFHR,干预组采用全髋置换术,浅析组间总疗效与手术相关指标、关节功能恢复、并发症发生率等各项情况。结果干预组总疗效相较于参照组更高(P<0.05);两组住院费用及时间相比,差异无统计学意义(P>0.05);干预组术后引流量与术中出血量相较于参照组均偏多,手术时间偏长(P<0.05)。术前,两组HHS髋关节评分相比,差异无统计学意义(P>0.05);术后,干预组HHS髋关节评分高于参照组(P<0.05)。干预组并发症发生率与参照组相对比偏低(P<0.05)。结论全髋置换术治疗老年NFN患者较AFHR优势更高,AFHR术后引流量与术中出血量少,而全髋置换术治疗能够在强化临床整体疗效的同时,改善患者髋关节功能,降低并发症发生率,远期疗效显著,值得推广与应用。

入院及围术期红细胞分布宽度变化与老年髋部骨折预后的关系

目的探究入院及围术期红细胞分布宽度(RDW)变化与老年髋部骨折预后的关系。方法回顾性收集2018年1月至2020年3月在徐州医科大学附属医院行髋部骨折手术治疗的老年病人650例的病历资料,收集年龄、性别、身体质量指数(BMI)、查尔森合并症指数(CCI)、骨折类型、入院RDW以及围术期ΔRDW(术后最高RDW与入院RDW差值)等信息,通过LASSO回归与多因素Cox回归分析病人病死率相关的危险因素。结果650例病人根据排除标准剔除264例,最终纳入分析共386例。该队列中病人术后1年病死率为10.36%(40/386),2年病死率为16.06%(62/386),4年病死率为23.58%(91/386),随访期病死率为26.17%(101/386)。LASSO回归分析结果显示年龄、CCI、入院血红蛋白、白蛋白、RDW和ΔRDW这6个变量为影响老年髋部骨折手术病人病死率的特征变量;多因素Cox回归分析结果显示年龄75~<85岁[HR=2.17,95%CI:(1.27,3.73),P=0.004]、年龄≥85岁[HR=3.73,95%CI:(2.11,6.62),P<0.001]、CCI≥2分[HR=3.58,95%CI:(2.15,5.95),P<0.001]、入院RDW>13.55%[HR=1.61,95%CI:(1.07,2.41),P=0.022]及ΔRDW>0.89%[HR=3.10,95%CI:(2.00,4.79),P<0.001]是老年髋部骨折手术病人病死率的危险因素。结论年龄≥75岁、CCI≥2分、入院RDW>13.55%以及ΔRDW>0.89%是老年髋部骨折手术病人病死率的独立危险因素。

内固定术与人工髋关节置换术治疗老年髋部骨折患者的临床效果比较

目的 分析内固定术与人工髋关节置换术治疗老年髋部骨折患者的临床效果。方法 选取78例老年髋部骨折患者,根据治疗方法的不同分为置换组(开展人工髋关节置换术, 40例)和内固定组(开展内固定术, 38例)。比较两组的围术期临床指标、并发症发生情况、治疗效果、视觉模拟评分法(VAS)评分和Harris评分。结果 和内固定组比较,置换组患者术后住院时间、负重时间更短,出血量更少(P<0.05)。术后1 d,置换组和内固定组患者的VAS评分比较差异不明显(P>0.05);术后7 d,和内固定组的(3.13±0.84)分比较,置换组患者的VAS评分(1.31±0.71)分更低(P<0.05)。术前,置换组和内固定组患者的Harris评分比较差异不明显(P>0.05);术后6、12个月,和内固定组的(70.29±5.29)、(82.04±5.76)分比较,置换组患者的Harris评分(80.19±7.36)、(91.29±8.35)分均更高(P<0.05)。和内固定组的76.32%比较,置换组患者的优良率92.50%明显更高(P<0.05)。和内固定组的23.68%比较,置换组患者术后并发症发生率5.00%明显更低(P<0.05)。结论 和内固定术比较,老年髋部骨折采用人工髋关节置换术的效果更加明显,可提高关节功能恢复效果,帮助患者缩短康复时间,减少并发症。

手术时机对老年髋部骨折患者临床疗效及预后的影响

目的:探讨手术时机对老年髋部骨折患者术后临床疗效及预后的影响。方法:回顾性分析2022年1月至2023年12月我院收治的188例老年髋部骨折行手术治疗患者的临床资料。根据手术时机分为早期手术组86例(入院至手术时间≤48 h)和延期手术组102例(入院至手术时间>48 h),比较2组患者入院时、术前、术毕时凝血功能指标[活化部分凝血活酶时间(APTT)、凝血酶原时间(PT)、纤维蛋白原(FIB)水平、纤维蛋白原降解产物水平(FDP)、D-二聚体(D-D)水平)]及术后下肢深静脉血栓形成(DVT)发生率、手术时间、围术期输血率、术中出血量、术后转ICU率、术后并发症发生率、住院时间。结果:两组患者骨折类型、麻醉方式、手术方式、手术时间、术前凝血功能指标差异无统计学意义(P>0.05);早期手术组围术期输血率、术中出血量、术后DVT发生率、凝血功能指标、压力性损伤发生率明显低于延期手术组,住院时间明显短于延期手术组(P<0.05);两组术后切口感染率、泌尿系统感染率、心肌梗死发生率、转ICU率差异无统计学意义(P>0.05)。结论:早期手术患者的血流动力学稳定性较高,术后下肢DVT发生率低,安全性高,值得临床推广。

老年伴有并存症的股骨颈骨折髋关节置换疗效分析

[目的]评价老年有并存症的股骨颈骨折、髋关节置换及围手术期的治疗等问题。[方法]将1997年6月～2003年12月收治的486例,65岁以上有并存症,GardenⅢ、Ⅳ型股骨颈骨折患者,分别采用全髋关节置换术(THR)和半髋关节置换术(PR)。[结果]486例随访时间18～72个月,平均36.5±6.2个月,两组在并存症等级、手术时间[THR平均(80.5±20.6)min,PR平均(60.2±10.7)min],失血量[THR平均(380.4±150.6)ml,PR平均(230.5±120.2)ml]方面,差异显著(P<0.05)。功能评价按照Harris[1]评分标准,优良率[THR(92.6±1.5)%],PR[(86.2±1.6)%]有显著性差异(P<0.05)。[结论]根据并存症的等级情况,选择全髋或半髋关节置换是治疗伴有并存症的老年股骨颈骨折的较好的方法,有助于安全度过围手术期,恢复功能活动,提高患者生活质量。

腰丛神经阻滞在高龄患者髋关节手术中的应用

目的评估腰丛神经阻滞在高龄患者髋关节手术中的应用价值。方法将87例行下肢手术的70岁以上老年患者根据不同麻醉方式分为硬膜外组(EA组)、气管插管全身麻醉组(GA组)和喉罩静脉全麻复合单侧腰从+坐骨神经阻滞组(LPB组),比较各组患者的围术期及转归情况。结果 LPB组术中芬太尼用量为(87.50±24.16)μg,明显低于GA组的(106.87±74.54)μg(P<0.05)。GA组患者术后1 d血清尿素氮水平较术前明显升高(P<0.05)。其他围术期指标改变及术后并发症发生情况3组间无明显差异。结论腰丛神经阻滞复合小剂量静脉麻醉药物可以作为高龄患者髋关节手术的麻醉选择。

老年人股骨颈骨折髋关节置换疗效分析

目的 :评价老年人股骨颈骨折髋关节置换临床疗效 ,探讨有关假体选择、并发症、手术时机把握等问题。方法 :回顾分析 1995～ 2 0 0 2年收治的 62例 70岁以上老年人股骨颈骨折应用髋关节置换的治疗方法及效果。结果 :随访 2 2～ 96个月 ,按照Harris[1] 评分标准进行评估显示 ,本组优良率为 83 .9%。全髋置换组明显优于半髋组 ,优良率为 93 .9% ,半髋组则为 46.2 %。结论 :(1)在并存症得到控制稳定后 ,及时地根据病人伤前生活质量来选择全髋或半髋置换是治疗高龄股骨颈骨折的首选方法 ;(2 )强调术中注意观察及处理麻醉开始、扩髓与灌注骨水泥这三个时段病情的变化 ;(3 )陈旧性股骨颈骨折病人术前不适宜牵引。

老年髋关节骨折手术3种不同麻醉方式的预后比较

目的总结近5年北京协和医院老年髋关节骨折患者的围术期资料,比较不同麻醉方式患者的预后及治疗费用。方法回顾2009年7月至2014年6月收治的65岁以上单侧髋关节骨折患者,排除多发伤或先后行两次以上手术者,平均年龄(78.8±7.2)岁。根据麻醉方式分为全身麻醉(121例)、椎管内麻醉(215例)和外周神经阻滞(147例)3组。重点关注患者的术前一般情况、合并症及手术完成情况,比较术中血流动力学、术后ICU停留时间、总住院时间、病死率、并发症及治疗费用。结果与全身麻醉和椎管内麻醉组比较,外周神经阻滞组患者平均年龄较大,ASAⅢ级患者比例较多,更多患者术前合并冠心病、COPD、肺部感染和呼吸衰竭(P<0.05);与其他两组相比,神经阻滞组患者术中的血流动力学更加平稳(P<0.05);在预后方面,与全身麻醉组相比,椎管内麻醉和外周神经阻滞组患者术后ICU停留时间更短(P<0.05),总住院费用更低(P<0.01)。结论对于高龄、ASA分级较高、合并心肺疾病的单侧髋关节骨折患者,手术时更倾向选择外周神经阻滞技术,此种麻醉方法可使患者术中的血流动力学更加稳定,缩短术后ICU停留时间,减少治疗费用。

老年髋部骨折围手术期肺部感染的高危因素分析

目的 探讨老年髋部骨折患者围手术期肺部感染的高危因素.方法 对2002年1月-2011年12月进行手术治疗的老年髋部骨折患者715例进行回顾性分析,选择可能与老年髋部骨折围手术期肺部感染相关的因素作为自变量,围手术期肺部感染情况作为应变量.先用χ2检验进行单因素分析,然后将有统计学意义的单因素应用二分类Logistic回归模型行进一步分析.结果 715例患者中肺部感染组126例,无肺部感染组589例,患者的年龄、受伤至就诊时间、入院至手术时间、原呼吸系统疾病、基础疾病数、手术方式及麻醉方式是老年髋部骨折围手术期肺部感染的危险因素（P〈0.05）.而患者的年龄、原呼吸系统疾病、受伤至就诊时间及手术方式是髋部骨折患者围手术期出现肺部感染的高危因素（P〈0.05）.结论 高龄髋部骨折患者应尽早入院接受正规治疗,术前积极治疗合并症,改善肺功能,减少围手术期肺部感染的发生.

髋部骨折老年患者术后抑郁状况的调查研究

目的了解髋部骨折的老年患者术后抑郁水平及其影响因素。方法运用Harris髋关节功能评分表、Barthel指数和老年抑郁量表(GDS)对70例符合纳入标准的老年髋部骨折患者进行问卷调查。结果有42.9%的患者术后有抑郁情绪,不同年龄、婚姻及居住情况以及有无合并症患者的术后抑郁水平差异有统计学意义,年龄及骨折前活动能力与患者术后抑郁水平明显相关。结论髋部骨折老年患者术后心理健康状况不容乐观,提示临床护理人员在患者住院期间应给予有效的心理支持,促进患者功能锻炼和肢体功能恢复。

加速康复外科理念下多学科共管模式在急诊老年髋部骨折围手术期中的应用

目的探讨加速康复外科(enhanced recovery after surgery,ERAS)理念下多学科共管模式在急诊老年髋部骨折围手术期护理中的应用效果,以期提高老年髋部骨折的治疗效果。方法采用不同病例前-后对照研究方法,将2015年5月—2017年2月在本院急诊住院手术的375例老年髋部骨折患者设为对照组,采用围手术期常规治疗护理;将2017年3月—2018年10月在本院急诊住院手术的401例老年髋部骨折患者设为试验组,采用ERAS理念下多学科共管模式治疗护理程式。比较两组患者入院至手术的时间,48h内手术的比例,术后并发症发生率,总住院时间和围手术期死亡率。结果两组患者入院至手术的时间,48h内手术的比例,术后并发症发生率,总住院时间和围手术期死亡率比较,均P<0.05,差异具有统计学意义,试验组患者入院到手术的时间短于对照组,48h内手术率高于对照组,术后并发症发生率与围手术期死亡率低于对照组。结论急诊老年髋部骨折患者采用ERAS理念下多学科共管模式治疗护理,可提高48h手术率,降低术后并发症发生率,缩短住院时间及降低围手术期死亡率。

老年髋部骨折患者术后并发脑梗塞防治策略

目的探索老年患者髋部骨折术后并发脑梗塞防治策略。方法对38例老年患者髋部骨折术后并发脑梗塞进行临床资料分析,确诊脑梗塞后常规、急性期、后期等系统康复治疗,进行疗效分析。结果术后随访时间6个月～8年,平均5.2年。死亡16例,22例均有不同程度的康复,其中15例生活能自理。结论老年患者髋部骨折术后并发脑梗塞,避免一些医源性因素,术中、术后进行正确预防和治疗,有效地预防和治疗这种并发症。