BACKGROUND Hip fractures account for 23.8%of all fractures in patients over the age of 75 years.More than half of these patients are older than 80 years.Bipolar hemiarthroplasty(BHA)was established as an effective man...BACKGROUND Hip fractures account for 23.8%of all fractures in patients over the age of 75 years.More than half of these patients are older than 80 years.Bipolar hemiarthroplasty(BHA)was established as an effective management option for these patients.Various approaches can be used for the BHA procedure.However,there is a high risk of postoperative dislocation.The conjoined tendon-preserving posterior(CPP)lateral approach was introduced to reduce postoperative dislocation rates.AIM To evaluate the effectiveness and safety of the CPP lateral approach for BHA in elderly patients.METHODS We retrospectively analyzed medical data from 80 patients with displaced femoral neck fractures who underwent BHA.The patients were followed up for at least 1 year.Among the 80 patients,57(71.3%)were female.The time to operation averaged 2.3 d(range:1-5 d).The mean age was 80.5 years(range:67-90 years),and the mean body mass index was 24.9 kg/m^(2)(range:17-36 kg/m^(2)).According to the Garden classification,42.5%of patients were typeⅢand 57.5%of patients were typeⅣ.Uncemented bipolar hip prostheses were used for all patients.Torn conjoined tendons,dislocations,and adverse complications during and after surgery were recorded.RESULTS The mean postoperative follow-up time was 15.3 months(range:12-18 months).The average surgery time was 52 min(range:40-70 min)with an average blood loss of 120 mL(range:80-320 mL).The transfusion rate was 10%(8 of 80 patients).The gemellus inferior was torn in 4 patients(5%),while it was difficult to identify in 2 patients(2.5%)during surgery.The posterior capsule was punctured by the fractured femoral neck in 3 patients,but the conjoined tendon and the piriformis tendon remained intact.No patients had stem varus greater than 3 degrees or femoral fracture.There were no patients with stem subsidence more than 5 mm at the last follow-up.No postoperative dislocations were observed throughout the follow-up period.No significance was found between preoperative and postoperative mean Health Service System scores(87.30±2.98 vs 86.10±6.10,t=1.89,P=0.063).CONCLUSION The CPP lateral approach can effectively reduce the incidence of postoperative dislocation without increasing perioperative complications.For surgeons familiar with the posterior lateral approach,there is no need for additional surgical instruments,and it does not increase surgical difficulty.展开更多
Objectives: Femoral neck fractures are becoming more common within nowadays. This research is to explore the clinical effect of primary total hip replacement (THA) via direct anterior approach (DAA) and posterolateral...Objectives: Femoral neck fractures are becoming more common within nowadays. This research is to explore the clinical effect of primary total hip replacement (THA) via direct anterior approach (DAA) and posterolateral approach (PLA) in the treatment of femoral neck fracture. Methods: Retrospective analysis of 100 cases of elderly patients with femoral neck fracture who underwent total hip arthroplasty admitted to Tianyou Hospital affiliated to Wuhan University of Science and Technology from January 2019 to January 2022. 50 patients treated with DAA approach were included in the observation group, and 50 patients treated with PLA approach were included in the control group. The operation indexes, postoperative acetabular abduction angle and anteversion angle, hip joint function, Harris score and complications were compared between the two groups. Result: The length of incision in the observation group was shorter than that in the control group, and the amount of intraoperative bleeding and postoperative hospital stay were shorter than those in the control group (P < 0.05);There was a statistically significant difference between the two groups in the ratio of acetabular abduction angle and its safe zone, and the length difference of both lower limbs (P < 0.05), while there was no statistically significant difference between the two groups in the ratio of acetabular anteversion angle and its safe zone, eccentricity, and its recovery rate (P > 0.05);Harris score of hip joint: 6 months after operation, the anterior approach group was significantly higher than the posterolateral approach group (P < 0.05), and there was no statistical difference between the two groups 12 months after operation (P > 0.05);The total incidence of complications in the observation group was lower than that in the control group, with a statistically significant difference (P Conclusion: DAA and PLA approaches for total hip replacement can restore the hip joint structure of patients with femoral neck fractures and achieve good results, but DAA approach has greater advantages in early postoperative recovery, improvement of hip joint function, small surgical injury, high application value, so it is recommended.展开更多
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 a...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.展开更多
AIM: To determine hip joint center(HJC) location on hip arthroplasty population comparing predictive and functional approaches with radiographic measurements.METHODS: The distance between the HJC and the mid-pelvis wa...AIM: To determine hip joint center(HJC) location on hip arthroplasty population comparing predictive and functional approaches with radiographic measurements.METHODS: The distance between the HJC and the mid-pelvis was calculated and compared between the three approaches. The localisation error between the predictive and functional approach was compared using the radiographic measurements as the reference. The operated leg was compared to the non-operated leg.RESULTS: A significant difference was found for the distance between the HJC and the mid-pelvis when comparing the predictive and functional method. The functional method leads to fewer errors. A statistical difference was found for the localization error between the predictive and functional method. The functional method is twice more precise.CONCLUSION: Although being more individualized, the functional method improves HJC localization and should be used in three-dimensional gait analysis.展开更多
目的探讨SuperPATH入路髋关节置换术治疗股骨颈骨折患者的临床疗效。方法采用回顾性病例对照研究。选取2019年1月~2023年10月在空军军医大学第一附属医院骨科行全髋关节置换术(total hip arthroplasty,THA)的股骨颈骨折患者120例,按照...目的探讨SuperPATH入路髋关节置换术治疗股骨颈骨折患者的临床疗效。方法采用回顾性病例对照研究。选取2019年1月~2023年10月在空军军医大学第一附属医院骨科行全髋关节置换术(total hip arthroplasty,THA)的股骨颈骨折患者120例,按照手术方法分为研究组(n=61例)和对照组(n=59例)。研究组采用SuperPATH入路,对照组采用后外侧入路。比较两组围术期相关指标,术后3 d、术后2周及术后1个月时的疼痛视觉模拟评分(visual analog scale,VAS)、髋关节功能Harris评分,术后1个月时的髋关节活动度,以及并发症发生率。结果围术期相关指标比较,两组手术时间、术中出血量比较均无统计学意义(P>0.05),但研究组切口长度更短,术后下床活动时间及术后住院时间均短于对照组(P<0.05)。研究组术后3 d时的VAS低于对照组(P<0.05);术后3 d、术后2周时的Harris评分高于对照组(P<0.05);其他时点两组比较无统计学差异(P>0.05)。术后1个月时,研究组髋关节屈曲、外旋、内旋、外展、内收活动度明显大于对照组(P<0.05)。研究组并发症发生率为4.92%,数值上低于对照组的11.86%,但两组比较无统计学差异(P>0.05)。结论SuperPATH入路髋关节置换术治疗股骨颈骨折,可改善围手术期各项指标,有效减轻术后疼痛,提高髋关节功能,改善髋关节活动度,值得临床推广应用。展开更多
文摘BACKGROUND Hip fractures account for 23.8%of all fractures in patients over the age of 75 years.More than half of these patients are older than 80 years.Bipolar hemiarthroplasty(BHA)was established as an effective management option for these patients.Various approaches can be used for the BHA procedure.However,there is a high risk of postoperative dislocation.The conjoined tendon-preserving posterior(CPP)lateral approach was introduced to reduce postoperative dislocation rates.AIM To evaluate the effectiveness and safety of the CPP lateral approach for BHA in elderly patients.METHODS We retrospectively analyzed medical data from 80 patients with displaced femoral neck fractures who underwent BHA.The patients were followed up for at least 1 year.Among the 80 patients,57(71.3%)were female.The time to operation averaged 2.3 d(range:1-5 d).The mean age was 80.5 years(range:67-90 years),and the mean body mass index was 24.9 kg/m^(2)(range:17-36 kg/m^(2)).According to the Garden classification,42.5%of patients were typeⅢand 57.5%of patients were typeⅣ.Uncemented bipolar hip prostheses were used for all patients.Torn conjoined tendons,dislocations,and adverse complications during and after surgery were recorded.RESULTS The mean postoperative follow-up time was 15.3 months(range:12-18 months).The average surgery time was 52 min(range:40-70 min)with an average blood loss of 120 mL(range:80-320 mL).The transfusion rate was 10%(8 of 80 patients).The gemellus inferior was torn in 4 patients(5%),while it was difficult to identify in 2 patients(2.5%)during surgery.The posterior capsule was punctured by the fractured femoral neck in 3 patients,but the conjoined tendon and the piriformis tendon remained intact.No patients had stem varus greater than 3 degrees or femoral fracture.There were no patients with stem subsidence more than 5 mm at the last follow-up.No postoperative dislocations were observed throughout the follow-up period.No significance was found between preoperative and postoperative mean Health Service System scores(87.30±2.98 vs 86.10±6.10,t=1.89,P=0.063).CONCLUSION The CPP lateral approach can effectively reduce the incidence of postoperative dislocation without increasing perioperative complications.For surgeons familiar with the posterior lateral approach,there is no need for additional surgical instruments,and it does not increase surgical difficulty.
文摘Objectives: Femoral neck fractures are becoming more common within nowadays. This research is to explore the clinical effect of primary total hip replacement (THA) via direct anterior approach (DAA) and posterolateral approach (PLA) in the treatment of femoral neck fracture. Methods: Retrospective analysis of 100 cases of elderly patients with femoral neck fracture who underwent total hip arthroplasty admitted to Tianyou Hospital affiliated to Wuhan University of Science and Technology from January 2019 to January 2022. 50 patients treated with DAA approach were included in the observation group, and 50 patients treated with PLA approach were included in the control group. The operation indexes, postoperative acetabular abduction angle and anteversion angle, hip joint function, Harris score and complications were compared between the two groups. Result: The length of incision in the observation group was shorter than that in the control group, and the amount of intraoperative bleeding and postoperative hospital stay were shorter than those in the control group (P < 0.05);There was a statistically significant difference between the two groups in the ratio of acetabular abduction angle and its safe zone, and the length difference of both lower limbs (P < 0.05), while there was no statistically significant difference between the two groups in the ratio of acetabular anteversion angle and its safe zone, eccentricity, and its recovery rate (P > 0.05);Harris score of hip joint: 6 months after operation, the anterior approach group was significantly higher than the posterolateral approach group (P < 0.05), and there was no statistical difference between the two groups 12 months after operation (P > 0.05);The total incidence of complications in the observation group was lower than that in the control group, with a statistically significant difference (P Conclusion: DAA and PLA approaches for total hip replacement can restore the hip joint structure of patients with femoral neck fractures and achieve good results, but DAA approach has greater advantages in early postoperative recovery, improvement of hip joint function, small surgical injury, high application value, so it is recommended.
文摘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.
基金Canadian Institute of Health Science(CIHR)and Zimmer,Warsaw,United States
文摘AIM: To determine hip joint center(HJC) location on hip arthroplasty population comparing predictive and functional approaches with radiographic measurements.METHODS: The distance between the HJC and the mid-pelvis was calculated and compared between the three approaches. The localisation error between the predictive and functional approach was compared using the radiographic measurements as the reference. The operated leg was compared to the non-operated leg.RESULTS: A significant difference was found for the distance between the HJC and the mid-pelvis when comparing the predictive and functional method. The functional method leads to fewer errors. A statistical difference was found for the localization error between the predictive and functional method. The functional method is twice more precise.CONCLUSION: Although being more individualized, the functional method improves HJC localization and should be used in three-dimensional gait analysis.
文摘目的探讨SuperPATH入路髋关节置换术治疗股骨颈骨折患者的临床疗效。方法采用回顾性病例对照研究。选取2019年1月~2023年10月在空军军医大学第一附属医院骨科行全髋关节置换术(total hip arthroplasty,THA)的股骨颈骨折患者120例,按照手术方法分为研究组(n=61例)和对照组(n=59例)。研究组采用SuperPATH入路,对照组采用后外侧入路。比较两组围术期相关指标,术后3 d、术后2周及术后1个月时的疼痛视觉模拟评分(visual analog scale,VAS)、髋关节功能Harris评分,术后1个月时的髋关节活动度,以及并发症发生率。结果围术期相关指标比较,两组手术时间、术中出血量比较均无统计学意义(P>0.05),但研究组切口长度更短,术后下床活动时间及术后住院时间均短于对照组(P<0.05)。研究组术后3 d时的VAS低于对照组(P<0.05);术后3 d、术后2周时的Harris评分高于对照组(P<0.05);其他时点两组比较无统计学差异(P>0.05)。术后1个月时,研究组髋关节屈曲、外旋、内旋、外展、内收活动度明显大于对照组(P<0.05)。研究组并发症发生率为4.92%,数值上低于对照组的11.86%,但两组比较无统计学差异(P>0.05)。结论SuperPATH入路髋关节置换术治疗股骨颈骨折,可改善围手术期各项指标,有效减轻术后疼痛,提高髋关节功能,改善髋关节活动度,值得临床推广应用。
