Complication rates after direct anterior vs posterior approach for hip hemiarthroplasty in elderly individuals with femoral neck fractures

BACKGROUND Dislocation rates after hemiarthroplasty reportedly vary from 1%to 17%.This serious complication is associated with increased morbidity and mortality rates.Approaches to this surgery are still debated,with no consensus regarding the superiority of any single approach.AIM To compare early postoperative complications after implementing the direct anterior and posterior approaches(PL)for hip hemiarthroplasty after femoral neck fractures.METHODS This is a comparative,retrospective,single-center cohort study conducted at a university hospital.Between March 2008 and December 2018,273 patients(a total of 280 hips)underwent bipolar hemiarthroplasties(n=280)for displaced femoral neck fractures using either the PL(n=171)or the minimally invasive direct anterior approach(DAA)(n=109).The choice of approach was related to the surgeons’practices;the implant types were similar and unrelated to the approach.Dislocation rates and other complications were reviewed after a minimum followup of 6 mo.RESULTS Both treatment groups had similarly aged patients(mean age:82 years),sex ratios,patient body mass indexes,and patient comorbidities.Surgical data(surgery delay time,operative time,and blood loss volume)did not differ significantly between the groups.The 30 d mortality rate was higher in the PL group(9.9%)than in the DAA group(3.7%),but the difference was not statistically significant(P=0.052).Among the one-month survivors,a significantly higher rate of dislocation was observed in the PL group(14/154;9.1%)than in the DAA group(0/105;0%)(P=0.002).Of the 14 patients with dislocation,8 underwent revision surgery for recurrent instability(posterior group),and one of them had 2 additional procedures due to a deep infection.The rate of other complications(e.g.,perioperative and early postoperative periprosthetic fractures and infection-related complications)did not differ significantly between the groups.CONCLUSION These findings suggest that the DAA to bipolar hemiarthroplasty for patients with femoral neck fractures is associated with a lower dislocation rate(<1%)than the PL.

Direct anterior compared to posterior approach for hip hemiarthroplasty following femoral neck fractures

The differences in complication rates between the direct anterior and posterior approaches for hemiarthroplasty in elderly patients with femoral neck fractures are not yet fully understood.Dislocation,a severe complication associated with increased mortality and often requiring additional surgery,may occur less frequently with the direct anterior approach compared to the posterior approach.Careful consideration of patient demographics is essential when planning the surgical approach.Future research in this area should focus on robust randomized controlled trials involving elderly patients recovering from femoral neck fractures.

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.

Bipolar hemiarthroplasty for femoral neck fracture using the direct anterior approach

AIM: To evaluate whether walking ability recovers early after bipolar hemiarthroplasty(BHA) using a direct anterior approach.METHODS: Between 2008 and 2010, 81 patients with femoral neck fracture underwent BHA using the direct anterior approach(DAA) or the posterior approach(PA). The mean observation period was 36 mo. The age, sex, body mass index(BMI), time from admission to surgery, length of hospitalization, outcome after discharge, walking ability, duration of surgery, blood loss and complications were compared. RESULTS: There was no significant difference in the age, sex, BMI, time from admission to surgery, length of hospitalization, outcome after discharge, duration of surgery and blood loss between the two groups. Two weeks after the operation, assistance was not necessary for walking in the hospital in 65.0% of the patients in the DAA group and in 33.3% in the PA group(P < 0.05). As for complications, fracture of the femoral greater trochanter developed in 1 patient in the DAA group and calcar crack and dislocation in 1 patient each in the PA group.CONCLUSION: DAA is an approach more useful for BHA for femoral neck fracture in elderly patients than total hip arthroplasty in terms of the early acquisition of walking ability.

Relationship between preoperative psychological stress and shortterm prognosis in elderly patients with femoral neck fracture

BACKGROUND Older adults are at high risk of femoral neck fractures(FNFs).Elderly patients face and adapt to significant psychological burdens,resulting in different degrees of psychological stress response.Total hip replacement is the preferred treatment for FNF in elderly patients;however,some patients have poor postoperative prognoses,and the underlying mechanism is unknown.We speculated that the postoperative prognosis of elderly patients with FNF may be related to preoperative psychological stress.AIM To explore the relationship between preoperative psychological stress and the short-term prognosis of elderly patients with FNF.METHODS In this retrospective analysis,the baseline data,preoperative 90-item Symptom Checklist score,and Harris score within 6 months of surgery of 120 elderly patients with FNF who underwent total hip arthroplasty were collected.We analyzed the indicators of poor short-term postoperative prognosis and the ability of the indicators to predict poor prognosis and compared the correlation between the indicators and the Harris score.RESULTS Anxiety,depression,garden classification of FNF,cause of fracture,FNF reduction quality,and length of hospital stay were independent influencing factors for poor short-term postoperative prognoses in elderly patients with FNF(P<0.05).The areas under the curve for anxiety,depression,and length of hospital stay were 0.742,0.854,and 0.749,respectively.The sensitivities of anxiety,depression,garden classification of FNF,and prediction of the cause of fracture were 0.857,0.786,0.821,and 0.821,respectively.The specificities of depression,FNF quality reduction,and length of hospital stay were the highest at 0.880,0.783,and 0.761,respectively.Anxiety,depression,and somatization scores correlated moderately with Harris scores(r=-0.523,-0.625,and-0.554;all P<0.001).CONCLUSION Preoperative anxiety,depression,and somatization are correlated with poor short-term prognosis in elderly patients with FNF and warrant consideration.

Does total hip arthroplasty provide better outcomes than hemiarthroplasty for the femoral neck fracture? A systematic review and meta-analysis

Purpose By comparing the outcomes of total hip arthroplasty with hemiarthroplasty in elderly patients with a femoral neck fracture to investigate the one-year mortality,dislocation,infection,reoperation rate,and thromboembolic event.Methods The PubMed,EMBASE databases,and Cochrane library were systematically searched from the inception dates to April 1,2020 for relevant randomized controlled trials in English language using the keywords:“total hip arthroplasty”,“hemiarthroplasty”and“femoral neck fracture”to identify systematic reviews and meta-analyses.Two reviewers independently selected articles,extracted data,assessed the quality evidence and risk bias of included trials using the Cochrane Collaboration’stools,and discussed any disagreements.The third reviewer was consulted for any doubts or uncertainty.We derived risk ratios and 95%confidence intervals.Mortality was defined as the primary outcome.Secondary outcomes were other complications,dislocation,infection,reoperation rate,and thromboembolic event.Results This meta-analysis included 10 studies with 1419 patients,which indicated that there were no significant differences between hemiarthroplasty and total hip arthroplasty in reoperation,infection rate,and thromboembolic event.However,there was a lower mortality and dislocation rate association with total hip arthroplasty at the one-year follow-up.Conclusion Based on our results,we found that total hip arthroplasty was better than hemiarthroplasty for a hip fracture at one-year follow-up.

Effect of dynamic hip system blade on the treatment of femoral neck fractures in elderly patients with osteoporosis

Objective：To discuss the curative effect of the dynamic hip system blade （DHS-blade） on the treatment of femoral neck fractures in elderly patients with osteoporosis.Methods：A retrospective study was conducted to analyse the clinical data of 60 elderly patients with osteoporosis who had been treated for femoral neck fractures with DHS-blade in our department between September 2012 and February 2014.There were 22 males and 38 females with a mean age of （66.8±3.2） years.According to the Singh Index Classification,all the patients＇ Singh index was below level 3.The Harris criterion and function recovery after operation were analysed.Results：All patients were followed up for 12-17 months （mean 14 months）.No femoral head necrosis,femoral neck shortening,internal fixation loosening or backing out of the nails occurred.Bone nonunion was found in one case and he had a good recovery after total hip arthroplasty.The time for fracture healing ranged from 3-6 months （average 3.5 months）.According to Harris criterion,35 cases were rated as excellent,22 good,2 fair and 1 poor.The Harris scale was significantly improved from 28.46±2.35 preoperatively to 91.98±3.26 at 6 months postoperatively （P＜0.05）.Conclusion：DHS-blade,being minimally invasive,allowing earlier postoperative exercise and avoiding the complications elicited by traditional internal fixation,is advisable for treatment of femoral neck fractured patients with osteoporosis.

Prosthetic replacement in treatment of subcapital femoral neck fractures in the elderly

Objective: To compare the results of femoral head replacement (FHR) and total hip replacement (THR) in treatment of subcapital femoral neck fractures (SFNF). Methods: Between May 1987 and July 1998, 56 elderly patients (65-90 years; average 73.5 years) with SFNF were treated with prosthetic replacement. Six cases were treated with unipolar FHR, 18 cases with Bateman bipolar FHR, and 32 cases with Bateman bipolar THR. All domestic prostheses were installed with cement. Results: There was no significant difference between the 2 groups in operating time and blood transfusion. Forty-nine patients were followed-up for an average of 5 years and 10 months. No wound infection or death was related to surgery. Complications in Group FHR were significantly higher than that in Group THR. Conclusions: Since FHR is difficult to fit the bony acetabulum, it is only indicated for senile cases with poor conditions. However, the bipolar THR installed with cement is indicated for most elderly patients. Since the femoral head and acetabulum can fit each other completely, it is more stable for taking weight-bearing earlier with less complications.

Analysis of prosthetic replacement in treatment of femoral neck fracture on the hemiplegia side in the elderly

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.

Hip dislocation and femoral component disassembly after bipolar hemiarthroplasty: a report of four cases and introduction of new reduction maneuvers

To the Editor: Bipolar hemiarthroplasty is one of the treatment options for unstable femoral neck fracture in the elderly. Hip dislocation after hip replacement is a common complication but dissociation of a bipolar prosthesis is rare and more serious complication, which always requires open reduction and revision. Some authors have reported dissociation after bipolar hemiarthroplasty of the hip. The present study reported four cases of disassembly after the primary bipolar hemiarthroplasty due to different causes and explained the mechanism. It will beneficial for surgeons who encounter the same situation.

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。

半髋关节置换治疗高龄股骨颈骨折(英文)

Objective:To appraise the clinic effect of hemiarthroplasty for treating the femoral neck fracture.Methods: 65 elderly cases of femoral neck fracture were operated on with hemiarthroplasty from January, 1988 to May,2000. Results: 61 patients were followed up for an average period of about 2 years and 5 months. According to Harris evaluation method, the excellent or good results of unipolar hemiarthroplasty appeared in 88% of the patients, that of bipolar hemiarthoplasty in 94.4 % of the patients. By x2 test, there was no significant difference between the two operative results. ( P ＞ 0.05). Conclusion: The method is a fairly good one for the treatment of elderly patients with femoral neck fracture, in which early operation is important.

牵引床辅助直接前侧入路半髋关节置换术的并发症分析

目的探讨牵引床辅助直接前侧入路半髋关节置换术治疗高龄老年股骨颈骨折的并发症及防治方法。方法回顾性分析2019年6月至2021年8月采用牵引床辅助DAA-HA治疗的196例高龄股骨颈骨折患者临床资料。分析患者并发症的发生原因、治疗方法及预后。结果所有患者平均随访时间21.6个月(12~30个月),发生并发症25例。其中11例(5.6%)发生股外侧皮神经损伤,6例(3.1%)切口渗液,5例(2.6%)假体周围骨折,3例(1.5%)双下肢不等长。随访期内,未发生假体脱位、假体松动、感染等其他并发症。结论牵引床辅助DAA-HA治疗高龄老年股骨颈骨折过程中存在股外侧皮神经损伤、切口渗液、假体周围骨折、双下肢不等长等并发症。规范手术操作流程,提升手术技术,重视患者病情及术后康复过程可减少并发症的发生。

直接前侧入路路径下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临床效果

目的:探究直接前侧入路(direct anterior approach,DAA)路径下全髋关节置换术(total hip arthroplasty,THA)与半髋关节置换术(hemiarthroplasty,HA)在老年股骨颈骨折(femoral neck fracture,FNF)患者中的应用效果。方法:选取2020年1月—2023年1月南京医科大学附属南京医院骨科收治的70例老年FNF患者为研究对象,基于随机数表法将患者分为治疗1组(HA)与治疗2组(THA),各35例。比较两组围手术期指标、肌肉组织损伤、骨代谢、远期髋关节功能。结果:治疗2组手术时间长于治疗1组,术中出血量、术后引流量多于治疗1组,差异有统计学意义(P<0.05);但两组术后初次下床行走时间、术后并发症发生率、股骨假体中心性固定率、术后住院时间比较,差异无统计学意义(P>0.05)。术后3 d,两组肌酸激酶(creatine kinase,CK)、C反应蛋白(C-reactive protein,CRP)高于术前,且治疗2组高于治疗1组,差异有统计学意义(P<0.05);术后3个月,两组Ⅰ型前胶原氨基端前肽(N-terminal propeptide of typeⅠprecollagen,PⅠNP)、Ⅰ型胶原交联羧基末端肽(C-terminal telopeptides of typeⅠcollagen,CTX)低于术前,骨特异性碱性磷酸酶(bone-specific alkaline phosphatase,BAP)高于术前,差异有统计学意义(P<0.05);但两组术后3个月PⅠNP、CTX、BALP比较,差异无统计学意义(P>0.05)。术后5个月、8个月、12个月,两组Harris评分高于术后3个月,且治疗2组高于治疗1组,差异有统计学意义(P<0.05)。结论:DAA路径下THA与HA均具有良好的治疗效果,HA围手术期指标具有优势,适用于身体状况较差的患者;而THA远期髋关节功能恢复更具有优势,适用于活动需求较大患者。

老年股骨颈骨折全髋或半髋关节置换的中远期状态:倾向性评分匹配法评价

背景:关节置换是治疗老年移位性股骨颈骨折的主要手段,全髋关节置换与半髋关节置换的选择是目前具有较大争论的焦点。目的:基于倾向性评分匹配法对比直接前入路下全髋与半髋关节置换治疗老年移位性股骨颈骨折的中远期生存状态。方法:选择2016年1月至2021年1月收治的147例老年移位性股骨颈骨折患者(≥65岁),其中88例行全髋关节置换,59例行人工股骨头置换(半髋关节置换)。对于患者术前合并症采用年龄校正Charlson合并症评分表,计算患者虚弱度,并采用倾向性评分匹配法对两组患者进行1∶1匹配,比较匹配后两组患者的手术时间、出血量、术后住院时间、住院费用、营养指标、术后并发症、死亡率和术后生存时间,其中术后生存时间采用Kaplan-Meier生存分析。结果与结论:①倾向性评分匹配后,两组共有42对匹配成功,匹配后两组患者术前资料均衡可比(P>0.05);②与半髋关节置换组相比,全髋关节置换组手术时间(79.71 min vs.59.07 min,P<0.001)、出血量(839.64 mL vs.597.83 mL,P=0.001)、住院费用(56508.15元vs.41702.85元,P<0.001)明显增加,但全髋关节置换组死亡率低于半髋关节置换组(36%vs.57%,HR=0.44,95%CI:0.23-0.87,P=0.018),平均生存时间长于半髋关节置换组(59.4个月vs.43.7个月,P=0.024);③两组患者在术后住院时间、术前术后营养指标、术后整体并发症发生率上,差异均无显著性意义(P>0.05);但在术后疼痛方面,半髋关节置换组疼痛发生率明显高于全髋关节置换组(24%vs.7%,P=0.035);④整体来看,全髋关节置换具有更好的长期预后生存效果,但对于身体素质差的患者则更适合行半髋关节置换;同时,术后的疼痛可能很大程度上会对患者髋关节置换后的生活质量及存活时间产生影响。

老年股骨颈骨折半髋关节置换术后髋关节脱位的危险因素分析

目的探讨老年股骨颈骨折病人行半髋关节置换术(HA)后髋关节脱位的危险因素。方法2015年1月~2022年10月行HA治疗的股骨颈骨折病人133例,根据病人术后是否发生髋关节脱位,将病人分为脱位组(35例)和非脱位组(98例)。记录两组病人年龄、性别、体重指数(BMI)等人口统计学变量;记录糖尿病、高血压、心脏病、慢性阻塞性肺病(COPD)等合并症情况;记录假体类型、手术入路、软组织修复类型、出血量等手术相关因素;在X线片上测量中心边缘角(CEA)、外展角(ABA)、偏心距、下肢长度差(LLD)、髋臼宽度、髋臼深度、股骨头覆盖率(FCR)等影像学参数。采用Wald法建立logistic回归模型,分析HA后发生脱位的危险因素。结果除脱位组COPD比例显著高于非脱位组(P<0.05)外,两组病人的基线特征比较,差异无统计学意义(P>0.05);两组病人的手术情况、CEA、ABA、LLD、髋臼宽度、偏心距、FCR比较,差异无统计学意义(P>0.05)。脱位组的髋臼深度和深宽比小于非脱位组,两组比较差异有统计学意义(P<0.05);性别、COPD、CEA、髋臼宽深比和LLD是影响HA术后髋关节脱位的独立危险因素(P<0.05)。结论合并COPD、男性、LLD以及过小的CEA和髋臼宽深比是HA术后髋关节不稳的独立风险因素。不推荐存在上述情况的老年病人采用HA治疗股骨颈骨折。

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。

对比前外侧入路半髋关节置换术治疗高龄股骨颈骨折的早期临床价值

目的分析高龄股骨颈骨折实施前外侧入路半髋关节置换术治疗的效果。方法选取2021年10月—2023年10月汶上县人民医院收治的86例高龄股骨颈骨折患者为研究对象,均行半髋关节置换术,根据不同入路方式分为有前侧组、后侧组,各43例。前侧组行前外侧入路,后侧组行后外侧入路。比较两组骨代谢情况、临床指标、髋关节功能、并发症。结果术后,两组骨钙素、I型前胶原羧基端前肽以及I型前胶原氨基端前肽均升高,差异有统计学意义(P均<0.05)。术后,前侧组骨钙素[(30.02±2.97)ng/mL]、I型前胶原羧基端前肽[(27.74±3.52)ng/mL]、I型前胶原氨基端前肽[(27.45±2.35)ng/mL]高于后侧组,差异有统计学意义(t=11.645、8.028、11.093,P均<0.05)。前侧组手术时间长于后侧组,前侧组出血量、引流量低于后侧组,前侧组切口长度、下床和出院时间短于后侧组,差异有统计学意义(P均<0.05)。两组髋关节功能优良率、并发症发生率比较,差异无统计学意义(P均>0.05)。结论两种入路方式均能维持高髋关节优良率,并发症发生风险低,但在恢复周期以及骨代谢方面前外侧入路价值更高,对高龄股骨颈骨折患者更适用。

西藏地区全髋与半髋关节置换术治疗中老年股骨颈骨折的近期临床效果

目的 探讨全髋与半髋关节置换术治疗股骨颈骨折的近期临床效果。方法 本研究采用随机队列研究的方法,共纳入研究样本30例,均为西藏自治区人民医院骨科完成的关节置换手术患者,时间2021年1月-2022年12月,患者按双色球法进行分组,红球代表全髋组,黄球则代表半髋组,为保证数据准确性,将30例患者均分,每组15例,患者依据抽签结果分别入组,两组治疗方法如组名,针对两种治疗方法的近期临床效果进行研究,随访患者手术时间、住院时间、术中出血量、术后康复时间既患者能交替性上下楼梯,能够独立完成下身穿戴,包括穿脱鞋袜,可进行特殊功能性活动(如骑自行车、游泳),术后第7天、术后第1月、术后第2个月、术后第3个月的髋关节Harris评分、SF-36评分,术后并发症发生率等。结果 手术相关指标显示:半髋组手术、住院时间更短,且术中更少出血(P<0.05),但在康复时间上的表现无明显差异(P>0.05);从Harris量表数据来看,全髋组的关节功能表现更为理想,各维度得分均高于半髋组(P<0.05);从SF-36量数据来看,全髋组的生活质量更高,各维度得分均高于半髋组(P<0.05);两组术后均有并发症发生,全髋组1例,半髋组4例,数据对比(6.67%vs26.67%)有显著差异(P<0.05)。结论 全髋关节置换术治疗股骨颈骨折组,患者生活质量更高,并发症更少,但相较于半髋关节置换术,手术时间更长,出血量更多,二者各有优点,其中半髋关节置换术更适合老年患者,故在临床中应根据患者情况酌情选择术式。

人工股骨头置换治疗老年股骨颈骨折-骨水泥与非骨水泥型假体的比较

目的对比骨水泥型和非骨水泥型两种假体在治疗股骨颈骨折中的应用差别。方法回顾了本机构近3年65岁以上股骨颈骨折实施人工股骨头置换的病例共221例,按应用骨水泥型和非骨水泥型假体进行分组。随访时间为1、3、6、12个月。比较两组间的手术时间、出血量、并发症发生率、术后下地时间、髋关节Harris评分等。结果两组在手术时间、术中并发症及下地时间存在差异,出血量、输血量、术后并发症及功能评分无差异。结论两种假体都能很好的应用于股骨颈骨折的治疗,需注意围手术期并发症的发生。