A Biomimetic Hip Joint Simulator and its Application in in vitro Study of the Integrity of Replacement Cemented Hip

A biomimetic hip joint simulator that can be used to evaluate the outcome of the cemented total hip replacement has been designed, manufactured and evaluated. The simulator produces motion in the extension/flexion plane, with a socket to rotate internal/externally. At the same time a dynamic loading cycle is applied. A validation test was performed on a cemented femoral stem within a novel composite femur. The hone quality has a strong effect on the stem migration and on the integrity of the interfaces. The migration of the stem is a combination of 3-D translation and rotation of the stem. Under the same loading conditions, weak bone allows more stem migration than strong bone. There is a great decrease in the strength of the stem-cement interface after the dynamic test, and the weak bone composite exhibited a greater reduction in interfacial strength than the strong bone composite. The decrease of the interfacial strength indicates that the primary bonding between the stem and the cement mantle had deteriorated and the integrity of stem-cement interface was damaged. The study demonstrates the value of using a hip joint simulator to investigate stem migration and interface integrity within the cemented hip replacement, suggesting that method can be used for in vitro evaluation of the biomaterials used in the cemented hip replacements.

Effects of dexmedetomidine combined with intraspinal anesthesia on perioperative brain injury, stress hormones and t lymphocyte subsets in elderly patients undergoing hip replacement

Objective: To investigate the effect of dexmedetomidin combined with intraspinal anesthesia on perioperative brain injury, stress hormone and T lymphocyte subsets in elderly patients undergoing hip replacement. Methods: A total of 106 elderly patients undergoing hip replacement were randomly divided into the observation group and the control group, 53 cases in each group. All patients received intraspinal anesthesia, and the observation group was given dexmedetomidine assisted anesthesia. The detection results of perioperative jugular bulb venous oxygen saturation (SjvO2), jugular oxygen content (CjvO2), cerebral arterial-venous oxygen content difference (D (a-jv) O2), cerebral oxygen extraction rate (CERO2), cerebral arterial oxygen content (CaO2), S-100β protein of internal jugular vein, norepinephrine (NE), adrenaline (E), cortisol (Cor) and T lymphocyte subsets were compared between the two groups. Results: The SjvO2, CjvO2and CaO2in the observation group at the time of 30 min in the operation and immediately after operation were significantly higher than those in the control group, while the D (a-jv) O2and CERO2were significantly lower than those in the control group. The S-100β protein at the time of 30 min in the operation in the observation group was significantly lower than that in the control group. The NE, E and Cor in the observation group at the time of 30 min in the operation and immediately after operation were significantly lower than those in the control group. The CD3+, CD4+, CD8+ and CD4+/CD8+in the observation group at the time of immediately after operation and 24 h after operation were significantly higher than those in the control group. Conclusion: Dexmedetomidine combined with intraspinal anesthesia can reduce perioperative brain injury, relieve stress response and improve the immune function of the elderly patients with hip replacement.

Nomogram to predict postoperative complications in elderly with total hip replacement

BACKGROUND By analyzing the risk factors of postoperative complications in elderly patients with hip replacement,We aimed to develop a nomogram model based on preoperative and intraoperative variables and verified the sensitivity and specificity for risk stratification of postoperative complications in elderly with total hip replacement patients.AIM To develop a nomogram model for risk stratification of postoperative complications in elderly with total hip replacement patients.METHODS A total of 414 elderly patients who underwent surgical treatment for total hip replacement hospitalized at the Affiliated Hospital of Guangdong Medical University from March 1,2017 to August 31,2019 were included into this study.Univariate and multivariate logistic regression were conducted to identify independent risk factors of postoperative complication in the 414 patients.A nomogram was developed by R software and validated to predict the risk of postoperative complications.RESULTS Multivariate logistic regression analysis revealed that age(OR=1.05,95%CI:1.00-1.09),renal failure(OR=0.90,95%CI:0.83-0.97),Type 2 diabetes(OR=1.05,95%CI:1.00-1.09),albumin(ALB)(OR=0.91,95%CI:0.83-0.99)were independent risk factors of postoperative complication in elderly patients with hip replacement(P<0.05).For validation of the nomogram,receive operating characteristic curve revealed that the model predicting postoperative complication in elderly patients with hipreplacement was the area under the curve of 0.8254 (95%CI: 0.78-0.87), the slope of the calibrationplot was close to 1 and the model passed Hosmer-Lemeshow goodness of fit test (χ^(2) = 10.16, P =0.4264), calibration in R E_(max) = 0.176, E_(avg) = 0.027, which all demonstrated that the model was ofgood accuracy.CONCLUSIONThe nomogram predicting postoperative complications in patients with total hip replacementconstructed based on age, type 2 diabetes, renal failure and ALB is of good discrimination andaccuracy, which was of clinical significance.

Leg-length equalization for total hip joint replacement patients

Objective To investigate the methods to maintain leg equalization for patients undergoing primary total hip joint replacement. Methods 40 patients,45 hips with various diseases were treated by total hip joint replacement from Jan 2000 to Sep 2001.Before operation, the perpendicular length from center of femoral head to the summit of great tuberosity and the tip of less tuberosity to the line of bilateral ischial tuberosity were measured; the length from anterior superior iliac spine to medial malleolus were measured at same time.Leg length was decided and corrected according to these lines. Results Before operation, shortening of limbs were presented in 39 hips, 1 to 4 cm, average 2.4 cm.After operation, discrepancy of both legs was 0～0.8 cm.Apparent limps were not observed in all patients. Conclusion This measurement is a useful method to maintain and recover leg length in total hip joint replacement.

Good accuracy of the alpha-defensin lateral flow test for hip periprosthetic joint infection: A pilot study in a retrospective cohort of 52 patients

BACKGROUND The alpha-defensin lateral flow(ADLF)test is a new diagnostic tool for periprosthetic joint infection(PJI).Test accuracy for combined cohorts of hip and knee PJI has been reported to be good.AIM To assess the accuracy of the ADLF test for hip PJI,and to compare three different diagnostic criteria for PJI.METHODS A cohort of 52 patients was identified,with a painful or poor-functioning total hip-or hemi-arthroplasty,that underwent aspiration and a subsequent ADLF test.PJI was diagnosed with Musculoskeletal Infection Society(MSIS)criteria,and sensitivity,specificity,overall accuracy,positive predictive value and negative predictive value were calculated.Furthermore,test specifics were compared with the European Bone and Joint Infection Society(EBJIS)and 2018 International Consensus Meeting(ICM)criteria for PJI.RESULTS Using MSIS criteria,sensitivity was 100%(CI:54%-100%)and specificity was 89%(CI:76%-96%).Six true positives and 5 false positives were found,including one case of metallosis.Using EBJIS criteria,more PJIs were found(11 vs 6),sensitivity was lower(71%,CI:42%-92%)and specificity was higher(97%,CI:86%-100%),with 4 false negatives and one false positive result.Using 2018 ICM criteria,sensitivity was 91%(62%-100%)and specificity 100%(91%-100%).The results in this cohort are comparable to previous studies.CONCLUSION Overall test accuracy of the ADLF test was good in this cohort,with a sensitivity of 100%and specificity of 89%.Using different PJI definition criteria,sensitivity and specificity changed slightly but overall accuracy remained around 90%.Using the ADLF test in metallosis cases can result in false positive results and should be performed with caution.

A method to calculate the acetabular cup anteversion after total hip replacement based on 3D coordinate system

Aim: To explore an accurate method to calculate acetabular cup anteversion after total hip arthroplasty. Method: 1) A 3D coordinate system was established with the center of the hip joint rotation center base as coordinate center. The acetabular exit plane and Pettersson formula acetabular anteversion and Riten Pradhan formula acetabular anteversion and acetabular true anteversion were drawn;2) Determine the mathematical expression of Pettersson formula acetabular anteversion α and Riten Pradhan formula acetabular anteversion β in the coordinate system. The true acetabular anteversion is projection angle of Pettersson formula acetabular anteversion α on cross-section in the presence of acetabular abduction δ, determining mathematical expression of the acetabular anteversion θ by trigonometric functions. Results: Real acetabular cup anteversion θ = arctg (tgβ/cosδ). Conclusion: The true acetabular cup anteversion and Pettersson formula anteversion and Riten Pradhan for mula anteversion were quite different. The difference was increased with the acetabular cup abduction angle increased. The formula was simple and accurate and worthy of clinical reference.

Preoperative and postoperative risk factors for periprosthetic joint infection in primary total hip arthroplasty:A 1-year experience

BACKGROUND Periprosthetic joint infection(PJI)in primary total hip replacement(THR)is one of the most important threats in orthopedic surgery,so one important surgeon’s target is to avoid or early diagnose a PJI.Although the incidence of PJI is very low(0.69%)in our department,with an average follow-up of 595 d,this infection poses a serious threat due to the difficulties of treatment and the lower functional outcomes after healing.AIM To study the incidence of PJI in all operations occurring in the year 2016 in our department to look for predictive signs of potential infection.METHODS We counted 583 THR for 578 patients and observed only 4 cases of infection(0.69%)with a mean follow-up of 596 d(min 30,max 1451).We reviewed all medical records to collect the data:duration and time of the surgery,presence,type and duration of the antibiotic therapy,preoperative diagnosis,blood values before and after surgery,transfusions,presence of preoperative drugs(in particularly anticoagulants and antiaggregant,corticosteroids and immunosuppressants),presence of some comorbidities(high body mass index,blood hypertension,chronic obstructive pulmonary disease,cardiac ischemia,diabetes,rheumatological conditions,previous local infections).RESULTS No preoperative,intraoperative,or postoperative analysis showed a higher incidence of PJI.We did not find any class with evident major odds of PJI.In our study,we did not find any border value to predict PJI and all patients had similar values in both groups(non-PJI and PJI).Only some categories,such as female patients,showed more frequency of PJI,but this difference related to sex was not statistically significant.CONCLUSION We did not find any category with a higher risk of PJI in THR,probably due to the lack of few cases of infection.

Effect of different hip replacement methods under minimally invasive anterolateral approach on bone metabolism and joint pain in patients with femoral neck fracture

Objective: To explore the effect of different hip replacement methods under minimally invasive anterolateral approach on bone metabolism and joint pain in patients with femoral neck fracture. Methods: A total of 110 patients with femoral neck fracture who were treated in Ruijin Hospital North, Shanghai Jiaotong University School of Medicine between July 2015 and January 2017 were collected and divided into control group and observation group by random number table, each with 55 cases. Control group accepted half hip replacement under minimally invasive anterolateral approach, and observation group accepted total hip replacement under minimally invasive anterolateral approach. The differences in contents of bone metabolism and joint pain-related indexes were compared between the two groups before and after surgery. Results: Before surgery, serum contents of bone formation indexes, bone resorption indexes, inflammatory indexes and pain mediators were not statistically significant between the two groups. 1 month after surgery, serum bone formation indexes PINP, BAP and BGP contents of observation group were higher than those of control group;serum bone resorption indexes β-CTX and TRACP-5b contents were lower than those of control group;serum inflammatory indexes IL-1 and TNF-α contents were lower than those of control group;serum pain mediators 5-HT and PGE2 contents were lower than those of control group. Conclusion: Total hip replacement under minimally invasive anterolateral approach is more effective to promote the formation of bone formation/bone resorption balance and reduce the joint pain.

Survival outcomes of cemented compared to uncemented stems in primary total hip replacement

Total hip replacement(THR) is a successful and reliable operation for both relieving pain and improving function in patients who are disabled with end stage arthritis.The ageing population is predicted to significantly increase the requirement for THR in patients who have a higher functional demand than those of the past. Uncemented THR was introduced to improve the long term results and in particular the results in younger, higher functioning patients. There has been controversy about the value of uncemented compared to cemented THR although there has been a world-wide trend towards uncemented fixation. Uncemented acetabular fixation has gained wide acceptance, as seen in the increasing number of hybrid THR in joint registries, but there remains debate about the best mode of femoral fixation.In this article we review the history and current worldwide registry data, with an in-depth analysis of the New Zealand Joint Registry, to determine the results of uncemented femoral fixation in an attempt to provide an evidence-based answer as to the value of this form of fixation.

Physiologic postoperative presepsin kinetics following primary cementless total hip arthroplasty:A prospective observational study

BACKGROUND Presepsin is an emerging biomarker in the diagnosis of sepsis.In the field of orthopaedics,it could be useful in diagnosing and managing periprosthetic joint infections.AIM To define the normal postoperative presepsin plasmatic curve,in patients undergoing primary cementless total hip arthroplasty(THA).METHODS Patients undergoing primary cementless THA at our Institute were recruited.Inclusion criteria were:Primary osteoarthritis of the hip;urinary catheter time of permanence<24 h;peripheral venous cannulation time of permanence<24 h;no postoperative homologous blood transfusion administration and hospital stay≤8 d.Exclusion criteria were:The presence of other articular prosthetic replacement or bone fixation devices;chronic inflammatory diseases;chronic kidney diseases;history of recurrent infections or malignant neoplasms;previous surgery in the preceding 12 mo;diabetes mellitus;immunosuppressive drug or corticosteroid assumption.All the patients received the same antibiotic prophylaxis.All the THA were performed by the same surgical and anaesthesia team;total operative time was defined as the time taken from skin incision to completion of skin closure.At enrollment,anthropometric data,smocking status,osteoarthritis stage according to Kellgren and Lawrence,Harris Hip Score,drugs assumption and comorbidities were recorded.All the patients underwent serial blood tests,including complete blood count,presepsin(PS)and C-reactive protein 24 h before arthroplasty and at 24,48,72 and 96 h postoperatively and at 3,6 and 12-mo follow-up.RESULTS A total of 96 patients(51 female;45 male;mean age=65.74±5.58)were recruited.The mean PS values were:137.54 pg/mL at baseline,192.08 pg/mL at 24 h post-op;254.85 pg/mL at 48 h post-op;259 pg/mL at 72 h post-op;248.6 pg/mL at 96-h post-op;140.52 pg/mL at 3-mo follow-up;135.55 pg/mL at 6-mo follow-up and 130.11 pg/mL at 12-mo follow-up.In two patients(2.08%)a soft-tissue infection was observed;in these patients,higher levels(>350 pg/mL)were recorded at 3-mo follow-up.CONCLUSION The dosage of plasmatic PS concentration is highly recommended in patients undergoing THA before surgery to exclude the presence of an unknown infection.The PS plasmatic concentration should be also assessed at 72 h postoperatively,evaluate the maximum postoperative PS value,and at 96 h post-operatively when a decrease of presepsin should be found.The lack of a presepsin decrease at 96 h post-operatively could be a predictive factor of infection.

ANALYSIS AND RESEARCH OF COMPUTER-AIDED MODEL OF HIP JOINT BASED ON REVERSE ENGINEERING

Former research work about the modeling of hip joint focus on the uppersegment of femoral, and assumes the acetabulum cup is sphere concave, and the acetabulum prosthesesis semisphere. A method of acquiring the point data on the surface of the hipbone using the reverseengineering technology is presented. After analyzing the acetabulum surface fitting error, arotation ellipsoid CAD model is applied to fit the acetabulum surface, and then optimizationtechnique is used to find the geometric parameters of the model. The fitting error between thesphere and rotation ellipsoid is compared and gets the result that the fitting error of rotationellipsoid is smaller than sphere, and the rotation ellipsoid can describe the shape of theacetabulum better.

Distal femur complex fractures in elderly patients treated with megaprosthesis:Results in a case series of 11 patients

BACKGROUND Surgical treatment of complex fractures of the distal femur in the elderly is controversial.Osteoporosis and pre-existent osteoarthritis are common comorbidities in the elderly which add to the need for early walking and rapid restoration of function and also pose significant obstacles to achievement of satisfactory results with standard fixation techniques.Recently,several authors have suggested that primary arthroplasty could be a viable alternative option to standard fixation techniques in selected patients with complex distal femur fractures.AIM To present our experience with 11 cases of distal femur fractures treated with knee arthroplasty and large femoral resection in a population of patients over the age of 85.METHODS Data from 11 consecutive patients(10 females,1 male)presenting with acute intra-articular supracondylar or intercondylar distal femur fractures and with pre-existent primary osteoarthritis who were treated with primary knee arthroplasty were recorded.We collected standard demographic data,comorbidities and patient reported outcomes including Visual Analogical Scale(VAS),Oxford Knee Score(OKS)and Barthel’s Index.Post-operative joint range of motion(ROM)and standard radiographic data were also collected.RESULTS At a mean follow-up of 23.2 mo,all of the implants were well-positioned and osteointegrated.Furthermore,all the patients were alive and walking either independently or with walking aids.There was a marked improvement in pain(VAS 4.5 postop vs 1.9 at the last follow-up),OKS score(29.5 postop vs 36.81 at the last follow-up),ROM(96.2°postop vs 102°at the last follow-up)and restoration of pre-injury ambulatory status(average Barthel Index 77.3).The radiographic evaluations showed good restoration of the articular geometry.No deaths and no complications were recorded.CONCLUSION In conclusion,we believe that knee megaprosthesis in the case of complex fractures of the distal femur is a valid surgical choice.This is particularly true in elderly patients with severe osteoporosis and pre-existing osteoarthritis.It is important to note that this surgery should be performed by surgeons with proven experience in prosthetic hip and knee surgery and that a scrupulous selection of the cases is completed.

Anterior muscle sparing approach for total hip arthroplasty

The purpose of this review is to examine the validity of positive claims regarding the direct anterior approach(DAA) with a fracture table for total hip arthroplasty. Recent literature regarding the DAA was searched and specific claims investigated including improved early outcomes, speed of recovery, component placement, dislocation rates, and complication rates. Recent literature is positive regarding the effects of total hip arthroplasty with the anterior approach. While the data is not definitive at present, patients receiving the anterior approach for total hip arthroplasty tend to recover more quickly and have improved early outcomes. Component placement with the anterior approach is more often in the "safe zone" than with other approaches. Dislocation rates tend to be less than 1% with the anterior approach. Complication rates vary widely in the published literature. A possible explanation is that the varianceis due to surgeon and institutional experience with the anterior approach procedure. Concerns remain regarding the "learning curve" for both surgeons and institutions. In conclusion, it is not a matter of should this approach be used, but how should it be implemented.

Developing an enhanced recovery after surgery program for oncology patients who undergo hip or knee reconstruction surgery

Enhanced recovery after surgery(ERAS)protocols are applied in orthopedic surgery and are intended to reduce perioperative stress by implementing combined evidence-based practices with the cooperation of various health professionals as an interdisciplinary team.ERAS pathways include pre-operative patient counselling,regional anesthesia and analgesia techniques,post-operative pain management,early mobilization and early feeding.Studies have shown improvement in the recovery of patients who followed an ERAS program after hip or knee arthroplasty,compared with those who followed a traditional care approach.ERAS protocols reduce post-operative stress,contribute to rapid recovery,shorten length of stay(LOS)without increasing the complications or readmissions,improve patient satisfaction and decrease the hospital costs.We suggest that the ERAS pathway could reduce the LOS in hospital for patients undergoing total hip replacement or total knee replacement.These programs require good organization and handling by the multidisciplinary team.ERAS programs increase patient's satisfaction due to their active participation which they experience as personalized treatment.The aim of the study was to develop an ERAS protocol for oncology patients who undergo bone reconstruction surgeries using massive endoprosthesis,with a view to improving the surgical outcomes.

Evaluation of Light Specific Gravity Ropivacaine Combined with Sufentanil in Hip Arthroplasty at An Advanced Age

combined with sufentanil in elderly patients undergoing hip replacement.Methods:89 elderly patients with hip arthroplasty from July 2019 to September 2020 were randomly divided into experimental group and control group.The experimental group was anesthetized with light specific gravity ropivacaine combined with sufentanil.The control group was anesthetized with equal specific gravity ropivacaine to compare the effect of anesthesia and the incidence of adverse reactions.Results:there was no significant difference in sensory recovery time and motor recovery time between the experimental group and the control group(P>0.05),and the incidence of adverse reactions between the two groups was low.The sensory block time in the experimental group was shorter than that in the control group(PP>0.05).Conclusion:ropivacaine combined with sufentanil subarachnoid anesthesia is more effective in elderly patients undergoing hip arthroplasty,and the safety of the anesthesia scheme is higher,which will not lead to serious adverse reactions during operation.Moreover,the application of the anesthesia scheme can effectively improve the analgesic effect during and after operation,and the clinical application value is high.

后外侧入路与改良Hardinge入路在全髋关节置换术中的应用比较

目的比较后外侧入路与改良Hardinge入路在全髋关节置换术(THA)中的应用效果。方法选取2019年7月—2022年6月于新泰市人民医院行THA治疗的89例患者作为研究对象,对照组(44例)采用后外侧入路进行THA手术,观察组(45例)采用改良Hardinge入路进行THA手术。比较两组术中与术后情况(手术操作时间、出血量,以及引流量、离床时间、住院时间)、Harris髋关节功能量表(HHS)评分、Barthel指数(BI指数)评分、生活质量综合评定量表(GQOLI-74)评分,以及术后并发症情况。结果观察组、对照组手术出血量分别为(255.50±25.85)、(326.47±28.42)mL,引流量分别为(120.45±25.65)、(165.00±23.44)mL,观察组手术出血量、引流量低于对照组(P均<0.05)。观察组、对照组离床时间分别为(3.92±0.46)、(4.06±0.50)d,住院时间分别为(12.00±2.32)、(15.02±3.00)d,观察组离床时间、住院时间短于对照组(P均<0.05)。两组术后6个月时HHS量表、BI指数、GQOLI-74量表评分比较差异均无统计学意义。观察组术后并发症发生率(4.44%)较对照组(22.73%)低(P<0.05)。结论采用后外侧入路与改良Hardinge入路进行THA手术均能够改善患者的髋关节功能,提高其日常生活活动能力与生活质量,但与后外侧入路相比,改良Hardinge入路有效减少了术中出血量与术后引流量,降低术后并发症风险,加快康复进程,具有临床应用与推广价值。

循证护理用于全髋关节置换术后麻醉恢复室患者的效果分析

目的 探讨循证护理用于全髋关节置换术后麻醉恢复室患者的效果。方法 选取我院2021年2月至2023年2月收治的全髋关节置术患者86例,术后均进入麻醉恢复室,随机分为观察组(43例,常规护理+循证护理)和对照组(43例,常规护理),比较两组的生理功能、并发症情况及护理满意度。结果 出室时,观察组血压、呼吸、活动力、意识评分均高于对照组(P<0.05)。观察组并发症发生率为4.65%,低于对照组的23.26%(P <0.05)。观察组护理满意度为97.67%,高于对照组的79.07%(P <0.05)。结论 循证护理可改善全髋关节置换术后麻醉恢复室患者的生理功能,减少并发症发生,提高患者护理满意度。

早期抗阻训练在髋关节置换术患者中的应用价值

目的 探讨早期抗阻训练在髋关节置换术患者中的应用价值。方法 选取2021年1月—2022年6月中国人民解放军联勤保障部队天津康复疗养中心的80例髋关节置换术患者,依据随机数字表法分为2组。对照组的40例患者进行常规训练,观察组的40例患者进行早期抗阻训练。比较2组的关节功能总优良率,术前、术后的Charnley髋关节功能评分及假体周围骨密度。结果 观察组术后6、12个月关节功能总优良率分别为95.00%、100%,高于对照组的77.50%、87.50%(P<0.05);术前,2组Charnley髋关节功能评分及假体周围骨密度比较,差异无统计学意义(P>0.05);观察组术后6、12个月后Charnley髋关节功能评分及假体周围骨密度均高于对照组(P<0.05)。结论 早期抗阻训练在髋关节置换术患者中的应用效果较好,可更为有效地改善患者关节功能及假体周围骨密度,在髋关节置换术患者中的应用价值较高。

Running-in friction of hip joint replacements can be significantly reduced:The effect of surface-textured acetabular cup

Hip joint replacements represent the most effective way of treatment for patients suffering from joint diseases.Despite the rapid improvement of implant materials over the last few decades,limited longevity associated with wear-related complications persists as the main drawback.Therefore,improved tribological perfor-mance is required in order to extend the service life of replacements.The effect of surface texturing of ultra-high molecular weight polyethylene(UHMWPE)acetabular cup was investigated in the present study.Unique tilling method was utilized for manufacturing the dimples with controlled diameter and depths on the contact surface of the cup.The experiments with four commercial femoral components and two model lubricants were realized.The main attention was paid to a coefficient of friction considering the differences between the original and the dimpled cups.Results showed remarkable lowering of friction,in general.Focusing on the simulated human synovial fluid,friction was reduced by 40%(alumina ceramic),38.8%(zirconia toughened ceramic),25.5%(metal),and 9.9%(oxinium).In addition,the dimples helped to keep the friction stable without fluctuations.To conclude,the paper brings a new insight into frictional behaviour of the hip replacements during running-in phase which is essential for overall implant lifespan.It is believed that proper surface texturing may rapidly improve the life quality of millions of patients and may lead to considerable financial savings.

不同方法治疗老年股骨转子间不稳定骨折疗效对比

目的对比分析生物型加长柄关节置换与股骨近端防旋髓内钉内固定治疗老年股骨转子间不稳定骨折的临床效果。方法选取2019年6月至2021年6月安阳市第三人民医院收治的104例老年股骨转子间不稳定骨折患者作为研究对象,根据不同手术治疗方式将其分为置换组(52例)和固定组(52例),置换组患者采用生物型加长柄关节置换术治疗,固定组患者采用股骨近端防旋髓内钉内固定术治疗,对比观察两组患者围术期相关指标、髋关节恢复情况、生活质量及术后不良事件发生情况。结果置换组患者术中出血量明显多于固定组、手术时间明显长于固定组(t=5545、5150,P均<0001),而首次下床活动时间及住院时间与固定组无明显差异(t=1933、1619,P=0056、0109)。术后12个月,置换组患者髋关节恢复优良率为8077%,明显高于固定组患者的髋关节恢复优良率6154%(χ^(2)=4685,P=0030);置换组患者健康调查量表36(SF-36)中的躯体功能、躯体疼痛、总体健康、生理功能评分均明显高于固定组(t=3062、2868、3028、3440,P=0003、0005、0003、0001)。置换组患者术后不良事件发生率为577%,明显低于固定组患者的术后不良事件发生率2115%(χ^(2)=5283,P=0022)。结论与股骨近端防旋髓内钉内固定相比,生物型加长柄关节置换虽会增加老年股骨转子间不稳定骨折患者术中出血量,延长手术时间,但能够提高患者髋关节功能及生活质量,降低不良事件发生风险,临床效果更佳。