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

Management of femoral neck fractures in the young patient: A critical analysis review

Femoral neck fractures account for nearly half of all hip fractures with the vast majority occurring in elderly patients after simple falls.Currently there may be sufficient evidence to support the routine use of hip replacement surgery for low demand elderly patients in all but non-displaced and valgus impacted femoral neck fractures.However for the physiologically young patients,preservation of the natural hip anatomy and mechanics is a priority in management because of their high functional demands.The biomechanical challenges of femoral neck fixation and the vulnerability of the femoral head blood supply lead to a high incidence of non-union and osteonecrosis of the femoral head after internal fixation of displaced femoral neck fractures.Anatomic reduction and stable internal fixation are essentials in achieving the goals of treatment in this young patient population.Furthermore,other management variables such as surgical timing,the role of capsulotomy and the choice of implant for fixation remaincontroversial.This review will focus both on the demographics and injury profile of the young patient with femoral neck fractures and the current evidence behind the surgical management of these injuries as well as their major secondary complications.

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.

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.

The VEGF production by dedifferentiated chondrocytes under synovial fluid stimulation from coxarthrosis and femoral neck fracture patients

Objective To investigate the vascular endothelial growth factor(VEGF)expression level by chondrocytes isolated from patients with osteoarthritis (OA) in hip or femoral neck fracture (FNF) and explore the effect of synovial fluid from OA

Comparison of Proximal Femoral Geometry and Risk Factors between Femoral Neck Fractures and Femoral Intertrochanteric Fractures in an Elderly Chinese Population

Background： Few studies have investigated the differences in proximal femoral geometry and risk factors between patients with different types of hip fracture, especially in elderly Chinese. This study aimed to assess the differences in proximal femoral geometry parameters between patients with femoral neck fractures and patients with intertrochanteric fractures to provide guidance for individualized customized prosthesis and accurate reconstruction of proximal femurs in elderly Chinese patients. Methods： We retrospectively studied the electronic medical records of 198 elderly patients over 65 years of age who were admitted to the orthopedic department with hip fractures between January 2017 and December 2017 in The Third Hospital, Hebei Medical University. Age, fracture site, gender, and proximal femoral geometry parameters （.neck shaft angle [NSA], center edge angle [CEA], femoral head diameter [FHD], femoral neck diameter [FND], femoral neck axial length [FNAL], hip axial length [HAL], and femoral shaft diameter [FSD]） were recorded. Student＇s t-test was used to compare the continuous variables, Chi-square test was used to analyze categorical variables, and multiple logistic stepwise regression analysis was used to evaluate the influencing factors of hip fracture type. Results： Statistically significant differences in NSA （137.63 ± 4.56° vs. 132.07 ± 4.17°, t = 1.598, P 〈 0.001）, CEA （37.62 ± 6.77° vs. 43.11 ±7.09°, t = 5.597, P 〈 0.001 ）, FND （35.21 ± 3.25 mm vs. 34.09 ±3.82 mm, t = 2.233, P = 0.027）, and FNAL （99.30 ± 7.91 mm vs. 103.58± 8.39 ram, t = 3.715, P 〈 0.001 ） were found between the femoral neck fracture group and femoral intertrochanteric fracture group. FHD, FND, FSD, HAL, and FNAL were different between sexes （all P 〈 0.001 ）. The greater NSA was the risk factor for femoral neck fractures （,odds ratio [OR]： 0.70, P 〈 0.001 ）, greater CEA and longer FNAL were risk factors for femoral intertrochanteric fractures （OR： 1.15, 1.17, all P 〈 0.001）, and greater FND was a protective factor for femoral intertrochanteric fractures （OR： 0.74, P 〈 0.001）. Conclusions： We demonstrate differences in geometric morphological parameters of the proximal femur in different hip fracture types, as well as an effect of sex. These differences should he considered in the selection of prostheses for fracture internal fixation and hip replacements. These data could help guide the design of individualized customized prostheses and improve the accurate reconstruction of the proximal femur for elderly Chinese hip fracture patients.

Modified fixation for periprosthetic supracondylar femur fractures:Two case reports and review of the literature

BACKGROUND Periprosthetic supracondylar femoral fractures(PSFs)present a challenge in terms of optimizing fixation in patients with poor bone quality.Surgical treatment and peri-operative management of PSFs in the elderly remain a burden for orthopedic surgeons.Among different treatment options,locking plate(LP)and retrograde intramedullary nail(RIMN)have shown favorable results.However,reduced mobility and protected weight-bearing are often present in the postoperative older population.With a purpose of allowing for early weight-bearing,a modified nail plate combination(NPC)was redesigned for PSF management.CASE SUMMARY In our cases,two elderly osteoporotic female underwent total knee arthroplasty(TKA),and then suffered from low energy trauma onto their knees after falling to the floor.Plain radiographs or computed tomography scans demonstrated oblique or transverse PSFs,both of which occurred at the distal femur above TKA.The modified NPC technique was performed for treatment of PSFs.The patient was made foot flat weight bearing in 1 wk.At 6-mo follow-up,the union was ultimately achieved using modified NPC with satisfactory implant outcomes.CONCLUSION Neither LP nor RIMN alone may provide adequate support to allow for union in circumstances where the patient has severely osteopenic bone.Therefore,developing a modified implant offer an alternative choice for treating PSFs.These two cases revealed that this technique is a viable option for the geriatric osteoporotic PSFs,offering safe,early weight bearing and favorable clinical outcomes.

比较OCM入路与改良Hardinge入路在半髋关节置换术中治疗高龄股骨颈骨折的临床效果

目的比较OCM入路与改良Hardinge入路在双极头半髋关节置换术中对高龄股骨颈骨折患者早期临床效果的差异。方法回顾性分析2021年3月至2022年12月期间江苏省丹阳市人民医院收治的105例高龄股骨颈骨折患者进行双极头半髋关节置换术的疗效。根据手术入路的不同,将患者分为OCM组(45例)和改良Hardinge组(60例)。评价指标包括手术一般情况(手术时间、切口长度、术后住院时间、下地时间),围手术期出血情况(术前血红蛋白,术中出血量,术后1、3 d的血红蛋白下降量及隐性失血量),血清学指标(肌酸激酶和C反应蛋白),VAS疼痛评分,Harris髋关节功能评分及并发症等关键指标。结果两组患者随访6~20个月,平均(11.02±2.72)个月。两组患者在手术时间、输血率上,差异无统计学意义(P>0.05)。OCM组的切口长度、术后住院时间、下地时间、术中出血量、术后血红蛋白下降量、隐性失血量、术后3 d的血清学指标和VAS评分,以及术后3个月内的Harris评分均显著优于改良Hardinge组(P<0.05)。但术后6周的VAS评分及6个月的Harris评分比较,差异无统计学意义(P>0.05)。两组均未出现深静脉血栓形成、切口感染、脱位及神经损伤等严重并发症,两组的假体周围骨折、肌间静脉血栓、Trendelenburg步态、双下肢不等长的发生率比较,差异无统计学意义(P>0.05)。结论对于高龄股骨颈骨折患者,采用OCM入路双极头半髋关节置换术较改良Hardinge入路在减少手术创伤和加速术后恢复方面表现显著,有更优的早期临床效果,值得临床推荐。

老年髋部骨折术前等待时间对术后骨折愈合时间的影响

目的根据江苏大学附属句容医院临床收治的老年髋部骨折患者数据进行分析,来评估老年髋部骨折患者术前等待时间是否对术后骨折愈合时间有影响。方法通过收集2017年9月至2022年11月江苏大学附属句容医院老年髋部骨折的病例资料,筛选出确诊且接受手术治疗的老年髋部骨折患者108例,根据术前等待时间不同,分为早期手术组(60例)和延期手术组(48例),分析两组患者的年龄,性别,住院时间,术后骨折愈合时间是否有区别。结果早期组骨折愈合时间上短于延期组,差异有统计学意义(P<0.05);两组的手术操作时间、手术中出血量、性别、年龄比较,差异无统计学意义(P>0.05)。结论老年髋部骨折患者应在骨折48 h内尽早接受手术,有助于缩短骨折愈合时间,从而减少并发症的发生。

老年股骨颈骨折护理进展的CiteSpace可视化分析

目的 对老年股骨颈骨折护理领域的相关文献进行可视化分析,为今后该领域的临床实践及护理研究工作提供借鉴与参考。方法 在中国知网(CNKI)数据库上检索“老年股骨颈骨折”AND“护理”的相关文献,检索时间段设置为2013年1月—2023年4月,语言限定为中文,将所有符合标准的文献以Refworks格式导出,以“download_XX”命名并保存至input文件夹中,利用CiteSpace软件进行数据格式转换并进行参数设置,时间跨度(time sliceing)为2013—2023年,时间切片(year per slice)为1年,图谱剪裁方式(pruning)以寻径网络(pathfi nder)进行结果视图的裁剪,以保证视图的可读性,其他参数均为默认值。使用Excel表格绘制年发文量的折线图;对年度发文量、发文作者、发文机构、关键词等进行可视化分析,形成网络分析图谱,并研究和解读图谱的相关内容。结果 最终纳入882篇文献,该领域近10年的发文量呈逐年上升趋势,2019年达到发文量122篇的高峰;发文量≥3篇的作者仅3名,内蒙古医科大学附属医院及云南省第一人民医院是该研究领域发文最多的机构,可见该领域的作者群体及研究机构联系都较为分散,缺乏合作。研究热点集中于老年人群、术后并发症、不同护理方式及模式等方面,研究趋势集中于心理状态、中医情志护理、术后康复、生活质量、满意度等方面。结论 随着人口老龄化趋势的不断加剧,老年股骨颈骨折的发病率日渐增高,及时关注该护理领域的研究热点及发展趋势,有利于推动临床实践的发展及护理科研的进步。

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。

全髋关节置换术与半髋关节置换术治疗老年股骨颈骨折的效果对比

目的:探讨全髋关节置换术与半髋关节置换术治疗老年股骨颈骨折的效果影响。方法:选取2020年5月—2023年5月陆军第七十一集团军医院就诊的100例老年股骨颈骨折患者作为研究对象,根据手术方式分为照组和观察组,每组各50例。对照组应用半髋关节置换术,观察组应用全髋关节置换术。比较两组髋关节功能手术前后结果、并发症发生率,不同术式下手术及血液流变学指标。结果:术后6个月,两组髋关节Harris评分较术前均有所降低,且观察组上述评分较对照组低,差异有统计学意义(P<0.05)。观察组髋关节功能优良率高于对照组,差异有统计学意义(P<0.05)。观察组髋臼磨损、髋臼增生、患侧髋部肿胀、假体松动代表的并发症发生率均低于对照组,差异有统计学意义(P<0.05)。观察组术中出血量、术后引流量均大于对照组,差异有统计学意义(P<0.05);观察组手术时间、住院时间均长于对照组,差异有统计学意义(P<0.05)。术前及术后0.5个月,两组全血高切黏度(HBV)、全血低切黏度(LBV)、血浆黏度(PV)比较,差异无统计学意义(P>0.05);术后0.5个月,两组HBV、LBV、PV均有所升高,差异有统计学意义(P<0.05)。结论:老年股骨颈骨折施行全髋关节置换术和半髋关节置换术,前者手术效果更佳,对患者术后髋关节功能恢复更有利,能够降低髋臼磨损、增生等并发症发生率,保障髋臼完好性,并改善血液流变学指标。

舒筋活血汤辅助髋关节置换术治疗老年股骨颈骨折临床研究

目的:观察舒筋活血汤辅助髋关节置换术治疗老年股骨颈骨折的临床疗效。方法:选取128例老年股骨颈骨折患者,以随机数字表法分为观察组和对照组各64例。治疗期间,观察组、对照组均剔除2例,2组均有62例完成研究。2组均行髋关节置换术治疗。对照组术后给予西药治疗,并做好切口换药等护理工作。观察组在对照组基础上给予舒筋活血汤治疗。比较2组临床疗效、Harris评分、血液流变学指标及并发症发生率。结果:术后第35天,观察组总有效率96.77%,高于对照组87.10%,差异有统计学意义(P<0.05)。2组Harris评分均较术后第1天升高,观察组Harris评分高于对照组,差异均有统计学意义(P<0.05)。2组红细胞聚集指数、血浆黏度、全血低切黏度、全血高切黏度、纤维蛋白原水平均较术后第1天降低,观察组上述5项指标水平均低于对照组,差异均有统计学意义(P<0.05)。术后35 d内,观察组并发症发生率6.45%,低于对照组19.35%,差异有统计学意义(P<0.05)。结论:舒筋活血汤辅助髋关节置换术治疗老年股骨颈骨折疗效显著,对髋关节功能及血液流变学指标均有改善作用,并能减少术后并发症发生。

超声引导下PENG阻滞联合喉罩全麻在老年患者股骨颈骨折闭合复位内固定术中的应用效果

目的探讨超声引导下髋关节囊周神经丛(PENG)阻滞联合喉罩全麻对老年患者行股骨颈骨折闭合复位内固定术的麻醉效果。方法选取行股骨颈骨折闭合复位内固定术的100例老年患者为研究对象,随机分为对照组、观察组两组,每组50例。对照组采用喉罩全麻,观察组采用超声引导下PENG阻滞联合喉罩全麻,比较两组静息和咳嗽状态视觉模拟评分(VAS),围术期血流动力学,血清应激反应指标以及麻醉药用量及术后恢复情况。结果术后2、12、24 h,观察组静息状态和咳嗽状态下VAS评分均低于对照组,差异均有统计学意义(t分别=4.20、12.35、14.65、6.49、15.26、10.08,P均<0.05)。观察组手术开始后40 min及麻醉苏醒时肾上腺素(AD)和内皮素(ET)水平低于对照组,差异均有统计学意义(t分别=5.87、2.96、2.61、2.05,P均<0.05)。观察组麻醉后5、60 min平均动脉压(MAP)水平高于对照组,心率(HR)低于对照组,差异均有统计学意义(t分别=-5.33、-4.29、3.87、3.82,P均<0.05)。观察组舒芬太尼、丙泊酚、顺阿曲库铵使用剂量低于对照组,差异均有统计学意义(t分别=7.85、5.92、7.07,P均<0.05)。观察组首次下床活动时间早于对照组,住院时间短于对照组,术后并发症发生率低于对照组,差异均有统计学意义(t分别=18.10、5.57,χ^(2)=4.33,P均<0.05)。结论实施股骨颈骨折闭合复位内固定术的老年患者应用PENG阻滞联合喉罩全麻能有效镇痛和减轻围术期应激反应,还可减少术中麻醉药用量和术后并发症发生率,改善术后苏醒质量。

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。

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。

股骨头双极假体置换与空心钉内固定治疗80岁以上高龄股骨颈骨折的疗效比较

[目的]比较股骨头双极假体置换和螺钉内固定术治疗80岁以上高龄股骨颈骨折临床疗效。[方法]2000年1月-2005年12月本中心手术治疗80岁以上高龄有移位股骨颈骨折53例，男18例，女35例，股骨头双极假体置换36例，螺钉内固定术17例。平均随访26．72个月（12—60个月），并进行Harris髋关节功能评价。[结果]患者平均83．69岁，螺钉内固定组手中出血少，手术时间短。股骨头双极假体置换组3例发生关节脱位，均通过闭合复位成功。随访期间，螺钉内固定组有9例8—12个月X线显示骨折愈合，3例发生骨折不愈合，再移位及螺钉松动，5例发生股骨头坏死（坏死率29．4％），6例因不同原因行2次关节置换。平均Harris评分股骨头双极假体置换组为87．11±7．34，螺钉内固定组为79．71±19．93。组间差别有显著性（P〈0．05）。[结论]股骨头双极假体置换术是治疗80岁以上高龄股骨颈骨折的有效方法，但应注意病例的选择及并存症的处理和并发症的防治。

直接前入路和微创后外侧入路人工股骨头置换术治疗高龄股骨颈骨折患者的疗效比较

目的本研究旨在比较直接前入路(directanteriorapproach,DAA)和微创后外侧入路(posterolateralpiriformis-sparingapproach,Mis-PLA)人工股骨头置换术治疗高龄股骨颈骨折患者的疗效。方法44例高龄单侧股骨颈骨折患者按照行人工股骨头置换术入路随机分为DAA组(n=22)和Mis-PLA组(n=22)。2组均完成术后2年随访调查,比较2组患者手术情况、术后早期疼痛及并发症情况、术后早期坐位的能力、弃拐独立行走的时间、术后6周及2年患者功能活动Harris评分及术后2年死亡率。结果(1)与Mis-PLA组相比,DAA组患者手术时间较长,术后72h患肺炎的人数较少,术后24hVAS评分减低,术后患者可坐位1h的时间及弃拐独立行走的时间较早(P<0.05)。(2)术后6周,DAA组在穿袜系鞋带及坐椅子方面Harris评分优于Mis-PLA组(P<0.05),两组上楼梯方面Harris评分无统计学差异(P>0.05)。术后2年,两组患者在功能活动Harris评分均无统计学差异(P>0.05)。(3)术后随访2年,2组患者死亡率差异无统计学意义(P>0.05)。结论DAA入路股骨头置换术在治疗高龄股骨颈骨折患者中,可以较Mis-PLA入路更有效地降低术后长期卧床的相关并发症的发生率,减轻患者术后疼痛,更早更快地改善患者术后髋关节功能。

雌激素水平与老年妇女股骨颈骨折的相关性分析

目的通过分析雷洛昔芬辅助治疗老年妇女股骨颈骨折的效果分析,探讨雌激素水平与老年妇女股骨颈骨折的相关性。方法老年妇女股骨颈骨折患者110例根据随机数字表法分为治疗组与对照组各55例,两组都采用内固定治疗,对照组术后口服钙尔奇D600片,治疗组术后开始口服盐酸雷洛昔芬,两组患者都服药3个月。结果治疗组术后第1周与术后第3个月的疼痛评分都明显低于对照组,对比差异明显(P<0.05);同时两组组内不同时间点的疼痛评分对比也有统计学意义(P<0.05)。两组术后第1天的患侧髋部骨密度值对比差异无统计学意义,术后第3个月骨密度值都呈现明显上升的趋势(P<0.05),同时治疗组的骨密度值明显高于对照组(P<0.05)。治疗组在术后第1个月与术后第3个月的骨折愈合率分别为58.2%和92.7%,都明显高于对照组,对比差异有统计学意义(P<0.05)。在术后第3个月进行Harris评分,治疗组的优良率为96.4%,对照组优良率为80.0%,治疗组的优良率明显高于对照组(P<0.05)。结论老年妇女股骨颈骨折的发生与体内雌激素水平的下降有一定的相关性,而外源雌激素的加入能缓解疼痛,提高骨密度值,从而促进患者的康复。