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

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.

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.

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

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。

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.

老年股骨颈骨折患者术前希望水平及影响因素分析

目的调查老年股骨颈骨折患者术前希望水平并分析其影响因素,为提高老年股骨颈骨折患者术前希望水平及促进术后康复提供实践与理论依据。方法采用方便抽样法,选取2020年1月—2021年12月医院骨科收治符合条件的年龄≥65岁206例老年股骨颈骨折术前的患者为研究对象,采用一般资料调查表、Herth希望量表(HHI)、一般自我效能感量表(GSES)进行问卷调查,采用非条件Logistic回归分析找出患者术前希望水平的影响因素。结果206例老年股骨颈骨折患者术前HHI量表总分(31.73±9.68)分;各维度得分情况为:对现实和未来的积极态度(9.14±1.10)分、采取积极的行动(11.69±5.36)分、与他人保持亲密的关系(10.89±3.22)分;其中高希望水平63(30.58%)例,中等希望水平131(63.59%)例,低希望水平12(5.83%)例。多元逐步回归分析结果显示,年龄、合并症指数、经济状况、居住情况、自我效能是老年股骨颈骨折患者术前希望水平的显著预测因子(P<0.05)。结论老年股骨颈骨折患者术前会出现不同希望水平,医护人员应关注影响患者术前希望水平的相关因素,重点加强对高龄、合并症多、经济困难、独居、自我效能水平低等因素存在的老年股骨颈骨折患者的关爱,采取针对性的护理策略,提高患者术前的希望水平。

股骨颈动力交叉钉系统联合富血小板血浆治疗股骨颈骨折

背景:对于青壮年的股骨颈骨折患者,治疗目的首要是尽早实现解剖复位固定,促进骨折愈合。目前研究表明,股骨颈骨折后骨不连的发生率为10%-30%,而股骨头坏死的发生率高达15%-30%,这对于患者预后来讲面临着巨大的风险。目的:研究富血小板血浆联合股骨颈动力交叉钉系统治疗年轻股骨颈骨折的临床疗效。方法:纳入2020年1月至2021年1月在南京医科大学第二附属医院接受治疗的52例股骨颈骨折患者临床资料,年龄18-55岁。其中18例常规行闭合复位3枚空心螺钉内固定治疗(A组),18例行闭合复位股骨颈动力交叉钉系统内固定治疗(B组),16例行闭合复位股骨颈动力交叉钉系统内固定联合富血小板血浆治疗(C组)。术后采用股骨颈正侧位X射线片来评估骨折复位的质量,采用Fernandez-Esteve骨痂评分评定术后6个月、1年骨折愈合情况,采用髋关节Harris评分评定术后6个月、1年的髋关节功能,同时比较分析股骨头短缩的发生率。结果与结论:(1)52例患者均顺利完成手术,未出现感染、再骨折、下肢深静脉血栓等并发症,术后获得至少1年的随访;(2)术后骨折愈合时间C组优于A、B组(P<0.05);术后6个月、1年时髋关节Harris评分C组高于A、B组(P<0.05);术后6个月Fernandez-Esteve骨痂评分C组高于A、B组(P<0.05);术后C组股骨头短缩发生率低于A组(P<0.05);(3)提示应用股骨颈动力交叉钉系统联合富血小板血浆治疗年轻患者的股骨颈骨折,有助于提高治疗效果,促进骨折愈合,降低股骨头短缩的发生,改善患者预后。

股骨颈动力交叉钉系统与空心加压螺钉治疗老年股骨颈骨折短期随访的对比

背景:股骨颈骨折是老年人常见的骨折,内固定治疗作为现在的主流治疗方式之一,仍需进一步追求坚强固定,尽可能减少并发症的发生。目的:比较股骨颈动力交叉钉系统和空心加压螺钉治疗老年股骨颈骨折的短期疗效。方法:回顾性分析2020年4月至2021年6月符合标准的35例老年股骨颈骨折患者资料,按治疗方法分为2组,股骨颈动力交叉钉系统组16例,空心加压螺钉组19例。两组患者的性别、年龄、受伤侧、受伤方式、骨折分型等一般资料差异无显著性意义。记录比较两组患者的手术时间、出血量、术后住院日、复位质量、愈合时间、Harris评分及术后并发症发生情况,分析两组疗效的差别。结果与结论:(1)16例股骨颈动力交叉钉系统组患者中除1例内固定失效,其余获得了8-25个月随访,平均11.9个月;19例空心加压螺钉组患者获得了7-26个月随访,平均16.3个月;(2)两组患者的手术时间、出血量、术后住院日、复位质量、骨折愈合时间、末次Harris评分及术后并发症均无显著性差异;(3)股骨颈动力交叉钉系统组术后1个月Harris评分优于空心加压螺钉组,差异有显著性意义(P=0.039);(4)股骨颈动力交叉钉系统组发生内固定失效1例,术后2个月行全髋关节置换,股骨颈短缩1例;空心加压螺钉组发生股骨颈短缩合并退钉1例;(5)提示在老年患者股骨颈骨折治疗上,股骨颈动力交叉钉系统和空心加压螺钉都有微创、快速、便于操作的优点,股骨颈动力交叉钉系统在早期康复中有更坚强的固定强度,允许患者早期负重,表现出更好的髋关节功能。

黄芪活骨颗粒联合改良空心钉内固定术治疗中青年股骨颈骨折的临床效果

目的探析黄芪活骨颗粒联合改良闭合复位空心钉内固定术治疗中青年股骨颈骨折的临床效果。方法选取2018年6月—2021年8月日照市中医医院收治的67例中青年股骨颈骨折患者为研究对象,随机分为两组。对照组32例采用黄芪活骨颗粒联合传统空心钉内固定术治疗,观察组35例采用黄芪活骨颗粒联合改良空心钉内固定术治疗。比较两组患者的围术期指标、随访指标及临床疗效。结果观察组的手术时间长于对照组,术中出血量少于对照组,切口长度短于对照组,组间差异有统计学意义(P<0.05)。观察组的骨折愈合时间短于对照组,末次随访时HHS评分高于对照组,晚期并发症发生率低于对照组,组间差异有统计学意义(P<0.05)。观察组的治疗总显效率为94.29%,高于对照组的78.13%,差异有统计学意义(P<0.05)。结论采用黄芪活骨颗粒联合改良空心钉内固定术治疗中青年股骨颈骨折的效果良好,可缩短患者骨折愈合时间,改善其髋关节功能,降低并发症发生风险,值得临床推广使用。

直接前入路与后外侧入路人工全髋关节置换术治疗老年股骨颈骨折的早期疗效对比分析

目的探讨在股骨颈骨折老年患者接受人工全髋关节置换术治疗期间,以直接前入路及后外侧入路方式施治的价值。方法回顾性分析2020年1月—2022年1月单县中心医院接受人工全髋关节置换术施治的股骨颈骨折老年患者80例的临床资料,采取数字奇偶法分为对照组与观察组,各40例。对照组采用后外侧入路术式,观察组采用直接前入路术式,对比两组手术相关指标差异。结果观察组手术切口长度短于对照组,出血量、术后引流量均低于对照组,下地时间早于对照组,差异有统计学意义(t=12.824、10.468、4.776、12.099,P<0.05);观察组手术时间为(115.34±23.17)min长于对照组(79.47±20.65)min,差异有统计学意义(t=7.309,P<0.05);观察组并发症发生率低于对照组,差异有统计学意义(χ^(2)=5.165,P<0.05);术后1、3 d,观察组血清学指标CK、CRP、IL-6水平均低于对照组,差异有统计学意义(t=15.828、24.388、12.711、12.880、15.864、23.277,P<0.05);术后1、2个月,观察组髋关节功能评分均高于对照组,差异有统计学意义(t=3.948、4.876,P<0.05)。结论通过以直接前入路及传统后外侧入路方式实施人工全髋关节置换术均可得到一定手术效果,然而应用直接前入路方式所得早期疗效更为显著。

硬膜外阻滞和蛛网膜下腔麻醉在超高龄老人下肢骨折手术中的应用比较

目的比较硬膜外阻滞和蛛网膜下腔麻醉在超高龄老人下肢骨折手术中的应用价值。方法根据不同麻醉方式将2019年4月至2021年12月阜阳市第五人民医院收治的85例股骨颈骨折超高龄患者分为观察组(n=45)与对照组(n=40)。观察组患者术中采用蛛网膜下腔麻醉,对照组患者术中采用硬膜外阻滞。观察2组患者麻醉前(T0)、给药后15 min(T1)、给药后30 min(T2)时收缩压(systolic blood pressure,SBP)、舒张压(diastolic blood pressure,DBP)、心率(heart rate,HR)水平。观察2组患者运动、感觉神经阻滞起效和维持所需的时间,并比较2组患者的并发症发生情况、麻醉效果、治疗前与治疗1 d后视觉模拟评分(visual analogue scale,VAS)。结果麻醉前2组患者T0时SBP、DBP、HR比较,差异无统计学意义(P>0.05),麻醉后T1、T2时观察组患者SBP、HR、DBP波动幅度低于对照组,差异有统计学意义(P<0.05)。观察组患者运动、感觉神经阻滞起效时间短于对照组,差异无统计学意义(P>0.05)。对照组患者运动、感觉神经阻滞维持时间长于观察组,差异有统计学意义(P<0.05)。观察组患者不良反应率(4.44%)低于对照组(12.50%),但差异无统计学意义(χ^(2)=1.818,P=0.177)。观察组患者麻醉有效率为97.77%,高于对照组的85.00%,差异有统计学意义(χ^(2)=7.069,P=0.007)。2组患者治疗前VAS评分比较,差异无统计学意义(P>0.05),治疗1 d后观察组患者VAS评分低于对照组,差异有统计学意义(P<0.05)。结论蛛网膜下腔麻醉能有效稳定超高龄患者血流动力学水平,术中血压波动不大,阻滞起效快和维持时间长,并发症风险降低,且麻醉效果更好。