Objective: To study the effect of prosthetic replacement in treatment of femoral neck fractures on the hemiplegia side in the elderly. Methods: From May 1990 to May 2000, 189 elderly patients with femoral neck fractur...Objective: To study the effect of prosthetic replacement in treatment of femoral neck fractures on the hemiplegia side in the elderly. Methods: From May 1990 to May 2000, 189 elderly patients with femoral neck fractures were treated with prosthetic replacement in my hospital. Twenty-nine hemiplegia patients, who suffered from stroke previously, had Garden type III and type IV femoral neck fractures on the hemiplegia side. Thirty non-hemiplegia patients were chosen randomly. The two groups were followed-up for 27-98 months (average: 59 months). The age, hospitalization days, operating time, blood loss, blood transfusion, complications during perioperative period and long-term complications were compared between the two groups and the results of femoral head replacement and total hip replacement in the hemiplegia group were also compared. Results: All the patients of the two groups survived the perioperative period. No significant difference was found in the age, hospitalization days, operation time, blood loss and blood transfusion and long-term complications between the two groups (P> 0.05). However there was significant difference in complications during perioperative period between the two groups (P< 0.05). Five patients died in the hemiplegia group with the mortality of 17.2% and two died in the non-hemiplegia group with the mortality of 6.7% 11 months to 5 years after operation. There was significant difference in long-term complications between the femoral head replacement and the total hip replacement in the hemiplegia group (P< 0.05). The result of the total hip replacement was better than that of the femoral head replacement. Conclusions: Prosthetic replacement is a reliable method in treatment of Garden type III and type IV femoral neck fractures on the hemiplegia side in the elderly, and patients are safe during perioperative period. More complications during perioperative period occur in the hemiplegia group, and long-term complications are insignificantly different between the two groups. The mortality rate is higher in the hemiplegia group than in the non-hemiplegia group within 5 years after operation. Since the result of the total hip replacement is better than that of the femoral head replacement, total hip replacement should be chosen firstly to treat Garden type III and type IV femoral neck fractures on the hemiplegia side in the elderly if the muscular strength of the hip is beyond IV degree.展开更多
Objective： To compare the clinical outcome of anterolateral minimally invasive approach versus conventional posterior approach for total hip replacement against femoral neck fractures in elderly patients. Methods： T...Objective： To compare the clinical outcome of anterolateral minimally invasive approach versus conventional posterior approach for total hip replacement against femoral neck fractures in elderly patients. Methods： The retrospective study was carried out on 42 patients who suffered from displaced femoral neck fractures （19 cases of Garden type Ⅲ, 23 cases of Garden type Ⅳ） treated by total hip replacement via anterolateral minimally invasive approach or conventional posterior approach by the same experienced surgeon. The average age of the patients was 78.1 years （range： 65-89 years）. They were divided into anterolateral mini-invasive group （22 cases） and posterior group （20 cases）. The mean time of follow-up was 13 months （range： 6-36 months）. The anterolateral approach described by Hardinge goes through between anterior 1/3 and posterior 2/3 of the gluteus medius muscle, reaching the femoral neck from anterior capsule. The traditional posterior approach described by Moore （Southern incision） goes through the insertions of short external rotation muscles, reaching the femoral neck from posterior capsule. The related variables under observation were length of incision, operation time, postoperative limp, length of hospital stay and bed stay and dislolcation rate. Results： The length of the skin incision varied between 7 cm and 12 cm with the anterolateral minimally invasive technique, compared to 15-22 cm in the conventional procedure. It took less time （average 15 minutes） to complete the anterolateral minimally invasive approach （72 15 min）, compared with the conventional approach （87 min ±10 min）. The average Harris hip score was 91.23±10.20 in anterolateral approach, 90.03±11.05 in the posterior approach. The average length of hospital stay for patients with the anterolateral approach was （6.4±2.2） days （range： 4-9 days）, while that in posterior approach was （9.2 ±3.1） days （range： 6-13 days）. The average length of bed stay was （3.4±1.1） days （range： 2-5 days） in anterolateral group and （6.2±2.8） days （range： 3-10 days） in posterior group. No patients in anterolateral group experienced dislocation. One （5%） hip in posterior approach had dislocation. Conclusions： Anterolateral mini-invasive approach can decrease trauma, operation time, length of hospital stay and bed stay and rehabilitation time. The stability and minimal muscular damage permit the acceleration of postoperative rehabilitation, which can subsequently reduce the perioperative risk in the treatment of femoral neck fractures in the elderly undergoing total hip replacement.展开更多
Objective: To observe the effect of comprehensive treatment for hip fracture in old people. Methods: Three hundred and seventy two old patients with hip fractures were randomly divided into two groups, Group A and Gro...Objective: To observe the effect of comprehensive treatment for hip fracture in old people. Methods: Three hundred and seventy two old patients with hip fractures were randomly divided into two groups, Group A and Group B. Cases in Group A were treated only by operations. Cases in Group B received comprehensive treatment. The Singh Indexes of both uninjured and injured femoral necks were used to judge the osteoporosis levels before operation and one year after the operation. The function of injured hip joints was evaluated one year postoperatively. Results: Complications occurred in 36.56 % of the cases in Group A and 5.91 % of Group B. One year postoperatively, the Singh Index degree distributions of both uninjured and injured femoral necks in Group A had no significant difference compared with those before the operation (P> 0.05 ). In Group B, there was significant difference between one year postoperatively and before operation, and the Singh Index one year after the operation showed better result than that before operation (P< 0.05 ). One year after operation, there was significant difference in the function of injured hip joints between Group A and Group B (P< 0.05 ). Conclusions: Hip fracture in old people should be treated comprehensively according to its internal characteristics, osteoporosis.展开更多
文摘Objective: To study the effect of prosthetic replacement in treatment of femoral neck fractures on the hemiplegia side in the elderly. Methods: From May 1990 to May 2000, 189 elderly patients with femoral neck fractures were treated with prosthetic replacement in my hospital. Twenty-nine hemiplegia patients, who suffered from stroke previously, had Garden type III and type IV femoral neck fractures on the hemiplegia side. Thirty non-hemiplegia patients were chosen randomly. The two groups were followed-up for 27-98 months (average: 59 months). The age, hospitalization days, operating time, blood loss, blood transfusion, complications during perioperative period and long-term complications were compared between the two groups and the results of femoral head replacement and total hip replacement in the hemiplegia group were also compared. Results: All the patients of the two groups survived the perioperative period. No significant difference was found in the age, hospitalization days, operation time, blood loss and blood transfusion and long-term complications between the two groups (P> 0.05). However there was significant difference in complications during perioperative period between the two groups (P< 0.05). Five patients died in the hemiplegia group with the mortality of 17.2% and two died in the non-hemiplegia group with the mortality of 6.7% 11 months to 5 years after operation. There was significant difference in long-term complications between the femoral head replacement and the total hip replacement in the hemiplegia group (P< 0.05). The result of the total hip replacement was better than that of the femoral head replacement. Conclusions: Prosthetic replacement is a reliable method in treatment of Garden type III and type IV femoral neck fractures on the hemiplegia side in the elderly, and patients are safe during perioperative period. More complications during perioperative period occur in the hemiplegia group, and long-term complications are insignificantly different between the two groups. The mortality rate is higher in the hemiplegia group than in the non-hemiplegia group within 5 years after operation. Since the result of the total hip replacement is better than that of the femoral head replacement, total hip replacement should be chosen firstly to treat Garden type III and type IV femoral neck fractures on the hemiplegia side in the elderly if the muscular strength of the hip is beyond IV degree.
文摘Objective： To compare the clinical outcome of anterolateral minimally invasive approach versus conventional posterior approach for total hip replacement against femoral neck fractures in elderly patients. Methods： The retrospective study was carried out on 42 patients who suffered from displaced femoral neck fractures （19 cases of Garden type Ⅲ, 23 cases of Garden type Ⅳ） treated by total hip replacement via anterolateral minimally invasive approach or conventional posterior approach by the same experienced surgeon. The average age of the patients was 78.1 years （range： 65-89 years）. They were divided into anterolateral mini-invasive group （22 cases） and posterior group （20 cases）. The mean time of follow-up was 13 months （range： 6-36 months）. The anterolateral approach described by Hardinge goes through between anterior 1/3 and posterior 2/3 of the gluteus medius muscle, reaching the femoral neck from anterior capsule. The traditional posterior approach described by Moore （Southern incision） goes through the insertions of short external rotation muscles, reaching the femoral neck from posterior capsule. The related variables under observation were length of incision, operation time, postoperative limp, length of hospital stay and bed stay and dislolcation rate. Results： The length of the skin incision varied between 7 cm and 12 cm with the anterolateral minimally invasive technique, compared to 15-22 cm in the conventional procedure. It took less time （average 15 minutes） to complete the anterolateral minimally invasive approach （72 15 min）, compared with the conventional approach （87 min ±10 min）. The average Harris hip score was 91.23±10.20 in anterolateral approach, 90.03±11.05 in the posterior approach. The average length of hospital stay for patients with the anterolateral approach was （6.4±2.2） days （range： 4-9 days）, while that in posterior approach was （9.2 ±3.1） days （range： 6-13 days）. The average length of bed stay was （3.4±1.1） days （range： 2-5 days） in anterolateral group and （6.2±2.8） days （range： 3-10 days） in posterior group. No patients in anterolateral group experienced dislocation. One （5%） hip in posterior approach had dislocation. Conclusions： Anterolateral mini-invasive approach can decrease trauma, operation time, length of hospital stay and bed stay and rehabilitation time. The stability and minimal muscular damage permit the acceleration of postoperative rehabilitation, which can subsequently reduce the perioperative risk in the treatment of femoral neck fractures in the elderly undergoing total hip replacement.
文摘Objective: To observe the effect of comprehensive treatment for hip fracture in old people. Methods: Three hundred and seventy two old patients with hip fractures were randomly divided into two groups, Group A and Group B. Cases in Group A were treated only by operations. Cases in Group B received comprehensive treatment. The Singh Indexes of both uninjured and injured femoral necks were used to judge the osteoporosis levels before operation and one year after the operation. The function of injured hip joints was evaluated one year postoperatively. Results: Complications occurred in 36.56 % of the cases in Group A and 5.91 % of Group B. One year postoperatively, the Singh Index degree distributions of both uninjured and injured femoral necks in Group A had no significant difference compared with those before the operation (P> 0.05 ). In Group B, there was significant difference between one year postoperatively and before operation, and the Singh Index one year after the operation showed better result than that before operation (P< 0.05 ). One year after operation, there was significant difference in the function of injured hip joints between Group A and Group B (P< 0.05 ). Conclusions: Hip fracture in old people should be treated comprehensively according to its internal characteristics, osteoporosis.
