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.

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.

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.

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.

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.

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.

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.

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.

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。

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。

不同手术治疗髋部骨折的疗效及对患者髋关节功能、骨代谢指标的影响

目的 比较不同手术治疗髋部骨折的疗效及对患者髋关节功能、骨代谢指标的影响。方法 采用随机数字表法将108例髋部骨折患者分为内固定组和置换组,各54例。内固定组以股骨近端髓内钉-螺旋刀片内固定治疗,置换组予以人工关节置换术治疗,2组术后均随访6个月。比较2组临床疗效、本体感觉平衡功能相关指标、骨代谢指标、髋关节功能、并发症。结果 术后6个月,置换组优良率高于内固定组(P <0.05);与术前比较,术后6个月2组血清骨钙素(BGP)、甲状旁腺激素(PTH)、骨碱性磷酸酶(BALP)水平、Harris髋部评分、髋部功能恢复量表(FRS)评分升高,置换组高于内固定组(P <0.05);2组Berg平衡量表评分升高,但置换组Berg平衡量表评分低于内固定组(P <0.05);置换组骨密度升高,且高于内固定组(P <0.05);随访期间,置换组总并发症发生率低于内固定组(P <0.05)。结论 股骨近端髓内钉-螺旋刀片内固定可改善髋部骨折患者平衡能力,但人工关节置换术可有效改善患者骨代谢指标,促进其髋关节功能恢复,降低并发症的发生,疗效相对更好。

吸气肌训练联合负重训练用于髋关节置换术后康复训练中对患者关节功能恢复及肺部感染发生率的影响

【目的】探讨吸气肌训练联合负重训练用于髋关节置换术后康复训练中对患者关节功能恢复及肺部感染发生率的影响。【方法】选择2020年1月至2022年1月在榆林市星元医院接受髋关节置换术的100例患者,按照随机数字表法分为观察组和对照组,每组50例。髋关节置换术后7 d,对照组给予常规呼吸训练联合负重康复训练,观察组在对照组基础上联合吸气肌训练。比较两组干预前后肺功能指标[第1秒用力呼气容积(FEV_(1))、用力肺活量(FVC)、最大呼气流速峰值(PEF)以及最大呼气压(MIP)]、髋关节功能、生活质量以及并发症发生率。【结果】干预后,两组肺功能指标、髋关节功能各项评分、生活质量各项评分均上升(P<0.05),且观察组上升更为明显(P<0.05);观察组并发症发生率显著低于对照组(P<0.05)。【结论】将吸气肌训练联合负重训练用于髋关节置换术围术期患者中,可促进患者肺功能以及髋关节功能恢复,提高患者生活质量,降低肺部感染等并发症发生率,具有较高临床应用价值。

多学科协作护理在老年髋关节置换术中的应用分析

目的:探讨多学科协作护理在老年髋关节置换术中的应用效果。方法:选定在医院接受髋关节置换术的66例高龄患者,用随机数表法分为对照组(常规护理,33例)和观察组(MDT临床护理,33例),对比两组手术相关指标、自我护理能力、疼痛程度及围手术期并发症发生率。结果:观察组患者手术、苏醒时间及术中出血量均优于对照组(P<0.05);观察组患者ESCA评分比对照组更高(P<0.05);观察组患者干预后24 h、48 h的VAS分值均低于对照组(P<0.05);观察组患者围手术期并发症发生率低于对照组(P<0.05)。结论:MDT临床护理用于行髋关节置换术的老年患者,可优化手术相关指标,缓解术后疼痛,有利于改善患者自我护理能力,减少术后并发症。

个性化坐卧式下肢康复训练机器人对老年人工髋关节置换术后患者的影响

目的探究个性化坐卧式下肢康复训练机器人对老年人工髋关节置换术(THA)后训练依从性、髋关节功能及肌力影响。方法选取2021年4月至2022年6月医院收治的96例老年THA患者,按照随机数字表法分为两组,常规组接受常规康复训练,研究组于常规组基础上接受个性化坐卧式下肢康复训练。比较两组训练依从率,干预前后Harris髋关节功能评分(HSS)、膝关节屈伸肌群峰力矩及生活质量测定量表(WHOQOL-BREF评分),观察两组康复期间并发症发生情况。结果研究组依从率高于常规组,并发症发生率低于常规组(P<0.05);研究组干预4周后HSS各维度评分及WHOQOL-BREF各维度评分均高于常规组(P<0.05);研究组干预4周后伸膝肌群、屈膝肌群峰力矩高于常规组(P<0.05)。结论个性化坐卧式下肢康复训练机器可有效提高老年THA后患者康复训练依从性,增强膝关节屈伸肌群肌力,改善髋关节功能,并能降低并发症发生率,提升生活质量。

微创直接前方入路全髋关节置换术治疗股骨颈骨折患者的临床疗效

目的探讨股骨颈骨折患者进行全髋关节置换术时选择微创直接前方入路的临床效果。方法本研究回顾性分析凌源市中心医院2022年1月—2023年4月收治的50例行全髋关节置换术的股骨颈骨折患者的临床资料,所有骨折患者根据手术方法不同分为传统对照组和微创观察组,每组25例;采用传统后外侧入路全髋关节置换术设为对照组;采用微创直接前方入路全髋关节置换术设为观察组。比较两组骨折患者的手术情况、髋关节功能评分、简明健康状况量表(SF-36)、并发症总发生率。结果相比对照组,观察组术中出血量及术后引流量更少,手术切口长度及平均住院时间更短(均P<0.05)。术前,两组髋关节整体功能评分未见统计学差异(P>0.05);术后,观察组髋关节功能综合评分高于对照组(P<0.05)。术后,观察组SF-36评分高于对照组(P<0.05)。观察组围手术期的并发症(出血、骨穿孔以及麻木)总发生率低于对照组(P<0.05)。结论对于股骨颈骨折患者,进行全髋关节置换术时,相比传统后外侧入路,微创直接前方入路可进一步提高临床整体疗效,更好改善患者的髋关节功能,围手术期并发症发生率更低,患者恢复的总体健康状况更佳。

并发症警示教育联合集束化护理在髋关节置换术患者中的应用

目的探讨髋关节置换术患者采用并发症警示教育联合集束化护理的效果。方法选取2020年2月至2022年6月在郑州市第六人民医院接受治疗的髋关节置换术患者共计100例,以随机数字表法分为干预组(n=50)与对照组(n=50),对照组采用常规护理干预,干预组采用并发症警示教育联合集束化护理干预,对两组髋关节功能、自我管理效能、并发症、日常生活能力(ADL)进行比较。结果干预3个月后,两组患者的髋关节功能评分量表(Harris)评分均有所提高,且干预组高于对照组,差异有统计学意义(P<0.05)。干预3个月后,两组患者的自我效能评分量表(GSES)评分均有所提高,且干预组高于对照组,差异有统计学意义(P<0.05)。干预组并发症发生率(6.00%)低于对照组(30.00%),差异有统计学意义(P<0.05)。干预3个月后,两组患者的Barthel指数量表(MBI)评分均有所提高,且干预组高于对照组,差异有统计学意义(P<0.05)。结论并发症警示教育联合集束化护理干预应用于髋关节置换术患者中,能够提升髋关节功能,增强自我管理效能,减少并发症发生,提高日常生活能力。

臀大肌止点部分切断与全髋关节置换术后假体脱位的相关性分析

目的探讨术中臀大肌止点部分切断与老年患者初次行后外侧入路的全髋关节置换术(THA)后假体脱位的相关性。方法回顾性分析2012年6月至2021年12月于浙江大学医学院附属第二医院骨科行初次行后外侧入路THA的患者资料。依据术后是否发生髋关节脱位将其分为脱位组(44例)与正常组(132例),并记录包括性别、年龄、身高、体重、体质量指数(BMI)及术中是否有臀大肌止点部分切断等。统计患者手术假体放置情况,包括髋臼前倾角、髋臼外展角、股骨侧偏心距、髋臼侧偏心距。结果正常组中臀大肌部分切断的患者有17例;保留组有115例。脱位组中部分切断组有13例;保留组有31例。脱位组中臀大肌部分切开的患者所占比例多于正常组(P=0.011)。脱位组的女性患者占比多于正常组,差异有统计学意义(P=0.006)。比较股骨侧偏心距时脱位组较正常组小[(33.8±9.5)mm比(38.3±7.0)mm,P=0.005]。比较髋臼侧偏心距时脱位组较正常组小[(70.2±9.7)mm比(73.8±7.5)mm,P=0.029]。脱位组中假体位于安全区内有33例;安全区外有11例;正常组安全区内有95例;安全区外有37例;差异无统计学意义(P=0.627)。结论术中臀大肌部分切断、女性、偏小的髋臼侧偏心距以及偏小的股骨侧偏心距与THA术后脱位有着密切关系。

超声引导下髋关节囊周围神经联合股外侧皮神经阻滞对髋关节置换术病人镇痛效果及应激反应、术后认知功能的影响

目的 探讨超声引导下髋关节囊周围神经(PENG)联合股外侧皮神经(LFCN)阻滞对髋关节置换术病人镇痛效果及应激反应、术后认知功能的影响。方法 2020年9月~2022年9月我院行髋关节置换术的病人102例,采用随机数表法分为对照组(51例)和研究组(51例),对照组给予超声引导下髂筋膜间隙阻滞(FICB),研究组给予超声引导下PENG联合LFCN阻滞,比较两组围术期相关指标、术后镇痛效果、应激反应指标以及术后认知功能。结果 两组手术时间比较,差异无统计学意义(P>0.05)。研究组术后48小时内舒芬太尼用量、镇痛泵使用次数低于对照组,术后首次下床活动时间、住院时间短于对照组,差异有统计学意义(P<0.05)。两组术后6小时、12小时、24小时、48小时静息状态视觉模拟评分法(VAS)评分,术后48小时运动状态VAS评分比较,差异无统计学意义(P>0.05),研究组术后6小时、12小时、24小时运动状态VAS评分低于对照组,差异有统计学意义(P<0.05)。对照组阻滞即刻(T1)、阻滞30分钟(T1)(T2)、阻滞结束时(T3)时心率(HR)、平均动脉压(MAP)较入室时(T0)均升高,差异有统计学意义(P<0.05),研究组HR、MAP与对照组比较明显较低,差异有统计学意义(P<0.05)。两组术后6小时、12小时、24小时、48小时简易智力状态检查量表(MMSE)评分较术前均降低,但研究组MMSE评分明显高于对照组,差异有统计学意义(P<0.05)。结论 对髋关节置换术病人采用超声引导下PENG联合LFCN阻滞,可减少阿片类药物的用量和镇痛泵使用次数,减轻术后运动状态疼痛,减轻应激反应,且对认知功能影响较小,促进病人更快康复。