To explore the relationship between preoperative traction and osteonecrosis of femoral head(ONFH)in patients with stable femoral neck fractures.Data from medical charts for 115 patients admitted to our institution wit...To explore the relationship between preoperative traction and osteonecrosis of femoral head(ONFH)in patients with stable femoral neck fractures.Data from medical charts for 115 patients admitted to our institution with Garden II femoral neck fracture operated from January 2012 to December 2013 were extracted.Seven-year retrospective comparative study in the first affiliated hospital of Soochow University.Patients were divided into two groups by preoperative treatment:a preoperative traction group(group I)and a T-shaped shoe fixation group(group II).There were 14 patients lost to follow-up.101 patients with Garden II femoral neck fracture followed until July 2016 were available for complete analysis.Intervention:patients received skeletal traction or T-shaped shoe fixation preoperatively.All patients accepted internal fixation with multiple annulated screws.Main outcome measurements:the incidence of osteonecrosis of femoral head was analyzed based on preoperative traction,gender and implant removal.The average follow-up of these patients was 35 months(range,24-48 months).There was no implant failure or nonunion in our study.Nine patients(8.91%)had avascular necrosis.8(15.38%)patients in group I had osteonecrosis of femoral head,whereas only onepatient(2.04%)in group II had osteonecrosis of femoral head.Patients with preoperative traction had significantly higher incidence of osteonecrosis of femoral head compared with T shaped shoe fixation(P=0.032).No significant difference was found between the incidence of osteonecrosis of femoral head based on gender,age,injury-to-surgery interval time,implant removal or weight-bearing time.In patients with femoral neck fracture,preoperative traction may increase the incidence of osteonecrosis.Preoperative traction may not benefit patients with Garden II femoral neck fracture.The weight of traction may be a risk factor to osteonecrosis of femoral head.展开更多
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 e...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展开更多
cases (97 hips) with avascular necrosis of femoral head caused by variors factors treated by the free transferring fibular graft with vascular pedicle in the Second Teaching Hospital of Xi'an Medical University ar...cases (97 hips) with avascular necrosis of femoral head caused by variors factors treated by the free transferring fibular graft with vascular pedicle in the Second Teaching Hospital of Xi'an Medical University are reported. All patients have ben followed up for 2 to 11 years. Excellent and good rate of operative results was 86. 6%. A long observation indicated that this procedure was superior to the other operations for the osteonecrosis of femoral head. Successful interim and final operative results can warrant its continued use in management of this kind of patients.展开更多
目的观察“糖果钢丝”环扎术对股骨距环扎固定联合阿仑膦酸钠对骨质疏松性股骨颈基底部骨折骨转换生化标志物(bone turnover markers,BTMs)及预后的影响。方法筛选2019年5月至2022年5月符合纳入标准的64例骨质疏松性股骨颈基底部骨折患...目的观察“糖果钢丝”环扎术对股骨距环扎固定联合阿仑膦酸钠对骨质疏松性股骨颈基底部骨折骨转换生化标志物(bone turnover markers,BTMs)及预后的影响。方法筛选2019年5月至2022年5月符合纳入标准的64例骨质疏松性股骨颈基底部骨折患者,随机分为观察组和对照组,每组32例。对照组予以股骨头置换术,术后连续服用碳酸钙D3片3个月;观察组在对照组的基础上予以股骨距“糖果钢丝”环扎固定术,术后连续服用阿仑膦酸钠片3个月。比较2组手术时间、术中出血量、手术切口长度、开始下地时间、住院时间,并分别比较治疗前和治疗3个月后2组患者假体周围骨密度(bone mineral density,BMD)、血清Ⅰ型原胶原N-端前肽(serum N-terminal peptide of type Ⅰ collagen,S-PINP)、血清Ⅰ型胶原C-末端肽交联(serum C-terminal telopeptide of type Ⅰ collagen,S-CTX);并随访12个月分析患者术后Harris髋关节功能评分、疼痛视觉模拟评分(visual analogue scale,VAS)、改良Barthel指数(modified Barthel index,MBI)评分改善情况及术后并发症发生情况。结果2组患者手术时间、术中出血量、切口长度比较无显著差异(P>0.05),2组患者术后开始下地时间和住院时间比较观察组显著低于对照组(P<0.05)。2组骨转换生化标志物S-PINP和S-CTX均较术前升高,但观察组骨形成生化标志物S-PINP显著高于对照组,骨吸收生化标志物S-CTX显著低于对照组,差异有统计学意义(P<0.05)。2组假体周围BMD均较治疗前升高,且观察组显著高于对照组,差异有统计学意义(P<0.05)。随访12个月时Harris评分、BMI评分均较术前提高,且观察组显著高于对照组,VAS评分均较术前降低,且观察组显著低于对照组,差异有统计学意义(P<0.05)。术后随访期间观察组并发症发生率低于对照组,但差异无统计学意义(P<0.05)。结论“糖果钢丝”环扎技术联合阿仑膦酸钠可以有效改善骨质疏松性股骨颈骨折术后骨转换状态,促进骨重塑,提供更加稳定的股骨柄骨长入环境,对患者预后恢复疗效显著。展开更多
This editorial reviews and summarises the current evidence(meta-analyses and Cochrane reviews) relating to the use of hip hemi-arthroplasty for neck of femur fractures. Regarding the optimal surgical approach,two rece...This editorial reviews and summarises the current evidence(meta-analyses and Cochrane reviews) relating to the use of hip hemi-arthroplasty for neck of femur fractures. Regarding the optimal surgical approach,two recent meta-analyses have found that posterior approaches are associated with: higher rates of dislocation compared to lateral and anterior approaches; and higher rates of re-operation compared to lateral approaches. Posterior approaches should therefore be avoided when performing hip hemi-arthroplasty procedures. Assessing the optimal prosthesis head component,three recent meta-analyses and one Cochrane review have found that while unipolar hemiarthroplasty can be associated with increased rates of acetabular erosion at short-term follow-up(up to 1 year),there is no significant difference between the unipolar hemi-arthroplasty and bipolar hemi-arthroplasty for surgical outcome,complication profile,functional outcome and acetabular erosion rates at longer-term follow-up(2 to 4 years). With bipolar hemi-arthroplasty being the more expensive prosthesis,unipolar hemi-arthroplasty is the recommended option. With regards to the optimal femoral stem insertion technique,three recent metaanalyses and one Cochrane Review have found that,while cemented hip hemi-arthroplasties are associated with a longer operative time compared to uncemented Hip Hemi-arthroplasties,cemented prostheses have lower rates of implant-related complications(particularly peri-prosthetic femoral fracture) and improved postoperative outcome regarding residual thigh pain and mobility. With no significant difference found between the two techniques for medical complications and mortality,cemented hip hemi-arthroplasty would appear to be the superior technique. On the topic of wound closure,one recent meta-analysis has found that,while staples can result in a quicker closure time,there is no significant difference in post-operative infections rates or wound healing outcomes when comparing staples to sutures. Therefore,either suture or staple wound closure techniques appear equally appropriate for hip hemiarthroplasty procedures.展开更多
基金the National Natural Science Foundation of China(No.81871789,No.81802200)the Natural Science Foundation of Jiangsu Province(No.BK20180052)Gusu Health Talents Program(No.GSWS2020023).
文摘To explore the relationship between preoperative traction and osteonecrosis of femoral head(ONFH)in patients with stable femoral neck fractures.Data from medical charts for 115 patients admitted to our institution with Garden II femoral neck fracture operated from January 2012 to December 2013 were extracted.Seven-year retrospective comparative study in the first affiliated hospital of Soochow University.Patients were divided into two groups by preoperative treatment:a preoperative traction group(group I)and a T-shaped shoe fixation group(group II).There were 14 patients lost to follow-up.101 patients with Garden II femoral neck fracture followed until July 2016 were available for complete analysis.Intervention:patients received skeletal traction or T-shaped shoe fixation preoperatively.All patients accepted internal fixation with multiple annulated screws.Main outcome measurements:the incidence of osteonecrosis of femoral head was analyzed based on preoperative traction,gender and implant removal.The average follow-up of these patients was 35 months(range,24-48 months).There was no implant failure or nonunion in our study.Nine patients(8.91%)had avascular necrosis.8(15.38%)patients in group I had osteonecrosis of femoral head,whereas only onepatient(2.04%)in group II had osteonecrosis of femoral head.Patients with preoperative traction had significantly higher incidence of osteonecrosis of femoral head compared with T shaped shoe fixation(P=0.032).No significant difference was found between the incidence of osteonecrosis of femoral head based on gender,age,injury-to-surgery interval time,implant removal or weight-bearing time.In patients with femoral neck fracture,preoperative traction may increase the incidence of osteonecrosis.Preoperative traction may not benefit patients with Garden II femoral neck fracture.The weight of traction may be a risk factor to osteonecrosis of femoral head.
文摘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
文摘cases (97 hips) with avascular necrosis of femoral head caused by variors factors treated by the free transferring fibular graft with vascular pedicle in the Second Teaching Hospital of Xi'an Medical University are reported. All patients have ben followed up for 2 to 11 years. Excellent and good rate of operative results was 86. 6%. A long observation indicated that this procedure was superior to the other operations for the osteonecrosis of femoral head. Successful interim and final operative results can warrant its continued use in management of this kind of patients.
文摘目的观察“糖果钢丝”环扎术对股骨距环扎固定联合阿仑膦酸钠对骨质疏松性股骨颈基底部骨折骨转换生化标志物(bone turnover markers,BTMs)及预后的影响。方法筛选2019年5月至2022年5月符合纳入标准的64例骨质疏松性股骨颈基底部骨折患者,随机分为观察组和对照组,每组32例。对照组予以股骨头置换术,术后连续服用碳酸钙D3片3个月;观察组在对照组的基础上予以股骨距“糖果钢丝”环扎固定术,术后连续服用阿仑膦酸钠片3个月。比较2组手术时间、术中出血量、手术切口长度、开始下地时间、住院时间,并分别比较治疗前和治疗3个月后2组患者假体周围骨密度(bone mineral density,BMD)、血清Ⅰ型原胶原N-端前肽(serum N-terminal peptide of type Ⅰ collagen,S-PINP)、血清Ⅰ型胶原C-末端肽交联(serum C-terminal telopeptide of type Ⅰ collagen,S-CTX);并随访12个月分析患者术后Harris髋关节功能评分、疼痛视觉模拟评分(visual analogue scale,VAS)、改良Barthel指数(modified Barthel index,MBI)评分改善情况及术后并发症发生情况。结果2组患者手术时间、术中出血量、切口长度比较无显著差异(P>0.05),2组患者术后开始下地时间和住院时间比较观察组显著低于对照组(P<0.05)。2组骨转换生化标志物S-PINP和S-CTX均较术前升高,但观察组骨形成生化标志物S-PINP显著高于对照组,骨吸收生化标志物S-CTX显著低于对照组,差异有统计学意义(P<0.05)。2组假体周围BMD均较治疗前升高,且观察组显著高于对照组,差异有统计学意义(P<0.05)。随访12个月时Harris评分、BMI评分均较术前提高,且观察组显著高于对照组,VAS评分均较术前降低,且观察组显著低于对照组,差异有统计学意义(P<0.05)。术后随访期间观察组并发症发生率低于对照组,但差异无统计学意义(P<0.05)。结论“糖果钢丝”环扎技术联合阿仑膦酸钠可以有效改善骨质疏松性股骨颈骨折术后骨转换状态,促进骨重塑,提供更加稳定的股骨柄骨长入环境,对患者预后恢复疗效显著。
文摘This editorial reviews and summarises the current evidence(meta-analyses and Cochrane reviews) relating to the use of hip hemi-arthroplasty for neck of femur fractures. Regarding the optimal surgical approach,two recent meta-analyses have found that posterior approaches are associated with: higher rates of dislocation compared to lateral and anterior approaches; and higher rates of re-operation compared to lateral approaches. Posterior approaches should therefore be avoided when performing hip hemi-arthroplasty procedures. Assessing the optimal prosthesis head component,three recent meta-analyses and one Cochrane review have found that while unipolar hemiarthroplasty can be associated with increased rates of acetabular erosion at short-term follow-up(up to 1 year),there is no significant difference between the unipolar hemi-arthroplasty and bipolar hemi-arthroplasty for surgical outcome,complication profile,functional outcome and acetabular erosion rates at longer-term follow-up(2 to 4 years). With bipolar hemi-arthroplasty being the more expensive prosthesis,unipolar hemi-arthroplasty is the recommended option. With regards to the optimal femoral stem insertion technique,three recent metaanalyses and one Cochrane Review have found that,while cemented hip hemi-arthroplasties are associated with a longer operative time compared to uncemented Hip Hemi-arthroplasties,cemented prostheses have lower rates of implant-related complications(particularly peri-prosthetic femoral fracture) and improved postoperative outcome regarding residual thigh pain and mobility. With no significant difference found between the two techniques for medical complications and mortality,cemented hip hemi-arthroplasty would appear to be the superior technique. On the topic of wound closure,one recent meta-analysis has found that,while staples can result in a quicker closure time,there is no significant difference in post-operative infections rates or wound healing outcomes when comparing staples to sutures. Therefore,either suture or staple wound closure techniques appear equally appropriate for hip hemiarthroplasty procedures.
文摘股骨头合并同侧股骨颈骨折是一种严重而复杂的创伤,保髋手术大多会失败。其治疗的难点及预后的关键在股骨颈骨折上。鉴于股骨颈骨折的发生与股骨头骨折-脱位之间存在明显的、前后关联的贯序特点,笔者认为以股骨头毁损三联征(disastrous triad of femoral head,DTFH)来概括这种类型的损伤,更能反映其损伤机制和预后特点。结合临床观察和文献资料,DTFH可分为3个类型:Ⅰ型,普通型DTFH,股骨颈骨折的发生紧随于股骨头骨折-脱位之后,是同一暴力造成的损伤;Ⅱ型,医源型DTFH,是在股骨头骨折-脱位的诊疗过程中发生了医源性股骨颈骨折;Ⅲ型,应力型DTFH,发生于股骨头骨折-脱位的治疗之后,在股骨头骨折面的远侧缘发生应力性股骨颈骨折。本文对各型DTFH的临床特点进行了初步的讨论。
