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
AIM: To investigate the effect of early surgical intervention on the high surgical risk elderly patients who sustained femoral neck fracture(FNF) and taking concomitant antiplatelet agents. METHODS: Between 2010 and 2...AIM: To investigate the effect of early surgical intervention on the high surgical risk elderly patients who sustained femoral neck fracture(FNF) and taking concomitant antiplatelet agents. METHODS: Between 2010 and 2012, a prospective study was conducted on 49 geriatric patients, who took antiplatelet agents, sustained FNF and underwent surgery within 72 h [early surgery(ES) group], and these were compared with a retrospective consecutive case series of patients with similar characteristics(45 cases) who had delayed surgery(DS group) after 72 h during an earlier 3-year period. Postoperative outcomeswere followed for one year and compared. RESULTS: There were non-significant differences in perioperative blood loss, blood transfusion, intensive care unit requirement and postoperative mortality(P > 0.05 all). There were 2 patients(4%) in the DS group who died after surgery(P = 0.23). However, the ES group showed a significantly better postoperative outcome in terms of postoperative complications, length of hospital stay, and functional outcome(P < 0.05 all).CONCLUSION: Early hip surgery in geriatric hip fracture patients with ongoing antiplatelet treatment was not associated with a significant increase of perioperative blood loss and postoperative mortality. Moreover, ES resulted in a better postoperative surgical outcome. In early hip surgery protocol, the antiplatelet agents are discontinued and the patient is operated on within 72 h after admission, which is safe and effective for the medically fit patients.展开更多
Background： Few studies have investigated the differences in proximal femoral geometry and risk factors between patients with different types of hip fracture, especially in elderly Chinese. This study aimed to assess...Background： Few studies have investigated the differences in proximal femoral geometry and risk factors between patients with different types of hip fracture, especially in elderly Chinese. This study aimed to assess the differences in proximal femoral geometry parameters between patients with femoral neck fractures and patients with intertrochanteric fractures to provide guidance for individualized customized prosthesis and accurate reconstruction of proximal femurs in elderly Chinese patients. Methods： We retrospectively studied the electronic medical records of 198 elderly patients over 65 years of age who were admitted to the orthopedic department with hip fractures between January 2017 and December 2017 in The Third Hospital, Hebei Medical University. Age, fracture site, gender, and proximal femoral geometry parameters （.neck shaft angle [NSA], center edge angle [CEA], femoral head diameter [FHD], femoral neck diameter [FND], femoral neck axial length [FNAL], hip axial length [HAL], and femoral shaft diameter [FSD]） were recorded. Student＇s t-test was used to compare the continuous variables, Chi-square test was used to analyze categorical variables, and multiple logistic stepwise regression analysis was used to evaluate the influencing factors of hip fracture type. Results： Statistically significant differences in NSA （137.63 ± 4.56° vs. 132.07 ± 4.17°, t = 1.598, P 〈 0.001）, CEA （37.62 ± 6.77° vs. 43.11 ±7.09°, t = 5.597, P 〈 0.001 ）, FND （35.21 ± 3.25 mm vs. 34.09 ±3.82 mm, t = 2.233, P = 0.027）, and FNAL （99.30 ± 7.91 mm vs. 103.58± 8.39 ram, t = 3.715, P 〈 0.001 ） were found between the femoral neck fracture group and femoral intertrochanteric fracture group. FHD, FND, FSD, HAL, and FNAL were different between sexes （all P 〈 0.001 ）. The greater NSA was the risk factor for femoral neck fractures （,odds ratio [OR]： 0.70, P 〈 0.001 ）, greater CEA and longer FNAL were risk factors for femoral intertrochanteric fractures （OR： 1.15, 1.17, all P 〈 0.001）, and greater FND was a protective factor for femoral intertrochanteric fractures （OR： 0.74, P 〈 0.001）. Conclusions： We demonstrate differences in geometric morphological parameters of the proximal femur in different hip fracture types, as well as an effect of sex. These differences should he considered in the selection of prostheses for fracture internal fixation and hip replacements. These data could help guide the design of individualized customized prostheses and improve the accurate reconstruction of the proximal femur for elderly Chinese hip fracture patients.展开更多
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...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。展开更多
目的探讨全髋关节置换术(total hip arthroplasty,THA)治疗老年移位型股骨颈骨折(displacement type transcervical fracture,DTTF)的临床疗效。方法 2014年1月—2016年12月成都医学院第一附属医院骨外科治疗DTTF患者136例,其中男性50例...目的探讨全髋关节置换术(total hip arthroplasty,THA)治疗老年移位型股骨颈骨折(displacement type transcervical fracture,DTTF)的临床疗效。方法 2014年1月—2016年12月成都医学院第一附属医院骨外科治疗DTTF患者136例,其中男性50例,女性86例;年龄63~82岁,平均70.45岁;致伤因素:道路交通伤28例,摔伤84例,坠落伤18例,其他6例。依据随机数字表法分为THA组(n=68)与空心钉内固定组(hollow nail internal fixation,HNIF,n=68)。观察两组术中出血量、手术时间、治疗费用、住院时间等手术相关指标,术后1个月、1年髋关节功能评分,生存质量及日常生活能力,术后并发症等指标。结果 THA组术中出血量(311.86±31.34)m L、手术时间(85.68±8.64)min、输血量(364.63±36.47)m L、术后1d视觉模拟评分(VAS)(5.74±0.58)分、治疗费用(4.60±0.48)万元,均多于HNIF组[术中出血量(141.63±14.22)m L、手术时间(62.86±6.30)min、输血量(182.87±18.42)m L、术后1d VAS评分(4.63±0.47)分、治疗费用(2.74±0.28)万元];THA组住院时间(17.32±1.74)d,少于HNIF组(22.51±2.31)d,差异有统计学意义(P<0.05)。术后1个月,两组髋关节功能、生存质量及日常生活能力评分无差异(P>0.05);术后1年,两组髋关节功能、生存质量及日常生活能力评分均较术后1个月增大,THA组髋关节功能、生存质量及日常生活能力评分大于HNIF组(P<0.05)。THA组术后1年优良率(82.35%)高于HNIF组(48.53%,P<0.05)。THA组术后并发症发病率(2.94%)低于HNIF组(29.41%),差异有统计学意义(P<0.05)。结论 THA治疗老年DTTF可改善患者髋关节功能,提高生存质量及日常生活能力,术后并发症少,可应用于临床。展开更多
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AIM: To investigate the effect of early surgical intervention on the high surgical risk elderly patients who sustained femoral neck fracture(FNF) and taking concomitant antiplatelet agents. METHODS: Between 2010 and 2012, a prospective study was conducted on 49 geriatric patients, who took antiplatelet agents, sustained FNF and underwent surgery within 72 h [early surgery(ES) group], and these were compared with a retrospective consecutive case series of patients with similar characteristics(45 cases) who had delayed surgery(DS group) after 72 h during an earlier 3-year period. Postoperative outcomeswere followed for one year and compared. RESULTS: There were non-significant differences in perioperative blood loss, blood transfusion, intensive care unit requirement and postoperative mortality(P > 0.05 all). There were 2 patients(4%) in the DS group who died after surgery(P = 0.23). However, the ES group showed a significantly better postoperative outcome in terms of postoperative complications, length of hospital stay, and functional outcome(P < 0.05 all).CONCLUSION: Early hip surgery in geriatric hip fracture patients with ongoing antiplatelet treatment was not associated with a significant increase of perioperative blood loss and postoperative mortality. Moreover, ES resulted in a better postoperative surgical outcome. In early hip surgery protocol, the antiplatelet agents are discontinued and the patient is operated on within 72 h after admission, which is safe and effective for the medically fit patients.
文摘Background： Few studies have investigated the differences in proximal femoral geometry and risk factors between patients with different types of hip fracture, especially in elderly Chinese. This study aimed to assess the differences in proximal femoral geometry parameters between patients with femoral neck fractures and patients with intertrochanteric fractures to provide guidance for individualized customized prosthesis and accurate reconstruction of proximal femurs in elderly Chinese patients. Methods： We retrospectively studied the electronic medical records of 198 elderly patients over 65 years of age who were admitted to the orthopedic department with hip fractures between January 2017 and December 2017 in The Third Hospital, Hebei Medical University. Age, fracture site, gender, and proximal femoral geometry parameters （.neck shaft angle [NSA], center edge angle [CEA], femoral head diameter [FHD], femoral neck diameter [FND], femoral neck axial length [FNAL], hip axial length [HAL], and femoral shaft diameter [FSD]） were recorded. Student＇s t-test was used to compare the continuous variables, Chi-square test was used to analyze categorical variables, and multiple logistic stepwise regression analysis was used to evaluate the influencing factors of hip fracture type. Results： Statistically significant differences in NSA （137.63 ± 4.56° vs. 132.07 ± 4.17°, t = 1.598, P 〈 0.001）, CEA （37.62 ± 6.77° vs. 43.11 ±7.09°, t = 5.597, P 〈 0.001 ）, FND （35.21 ± 3.25 mm vs. 34.09 ±3.82 mm, t = 2.233, P = 0.027）, and FNAL （99.30 ± 7.91 mm vs. 103.58± 8.39 ram, t = 3.715, P 〈 0.001 ） were found between the femoral neck fracture group and femoral intertrochanteric fracture group. FHD, FND, FSD, HAL, and FNAL were different between sexes （all P 〈 0.001 ）. The greater NSA was the risk factor for femoral neck fractures （,odds ratio [OR]： 0.70, P 〈 0.001 ）, greater CEA and longer FNAL were risk factors for femoral intertrochanteric fractures （OR： 1.15, 1.17, all P 〈 0.001）, and greater FND was a protective factor for femoral intertrochanteric fractures （OR： 0.74, P 〈 0.001）. Conclusions： We demonstrate differences in geometric morphological parameters of the proximal femur in different hip fracture types, as well as an effect of sex. These differences should he considered in the selection of prostheses for fracture internal fixation and hip replacements. These data could help guide the design of individualized customized prostheses and improve the accurate reconstruction of the proximal femur for elderly Chinese hip fracture patients.
文摘背景: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。
