Predictors and prognostic impact of post-operative atrial fibrillation in patients with hip fracture surgery

BACKGROUND Atrial fibrillation(AF)is the most common arrhythmia developing in postoperative patients.Limited data are available regarding pre-operative risk factors and prognostic impact of post-operative AF(POAF)following hip fracture surgery(HFS)in Korean population.AIM We aimed to investigate the incidence,predictors,and hospital prognosis of POAF in HFS patients.METHODS This study included 245 patients without history of AF who underwent HFS between August 2014 and November 2016.POAF was defined as new-onset AF that occurred during hospitalization after HFS.RESULTS Twenty patients(8.2%)experienced POAF after HFS.POAF developed on median post-operative day 2(interquartile range,1–3).Multivariable logistic regression analysis showed that age[odds ratio(OR),1.111;95%confidence interval(CI),1.022–1.209],chronic obstructive pulmonary disease(COPD)(OR,6.352;95%CI,1.561–25.841)and E/e’ratio(OR,1.174;95%CI,1.002–1.376)were significant predictors of POAF.Patients with POAF had a significantly higher intensive care unit admission rate(55.0%vs 14.7%,P<0.001)and incidence of congestive heart failure(45.0%vs 10.7%,P<0.001).In multivariable logistic regression analysis,POAF was significantly associated with increased incidence of congestive heart failure(OR,4.856;95%CI,1.437–16.411)and intensive care unit admission(OR,6.615;95%CI,2.112–20.718).CONCLUSION POAF was frequently developed in elderly patients following HFS.Age,COPD and elevated E/e’ratio were found as significant predictors of POAF in HFS patients.Patients with POAF significantly experienced intensive care unit admission and incident congestive heart failure during hospitalization.

Analgesic Effect of Combined Spinal-Epidural Anesthesia and its Effect on TNF-α and CRP Levels in Elderly Patients with Hip Fracture During Surgical Treatment

Objective:To observe the analgesic effect of combined spinal and epidural anesthesia on older patients undergoing hip fracture surgery.Method:One hundred and twenty elderly hip fracture surgery patients treated in our hospital from January 2021 to December 2022 were selected and randomly divided into two groups,with 60 cases in the experimental group and 60 in the control group.The experimental group was given combined spinal-epidural anesthesia intervention measures,while the control group was given epidural anesthesia intervention measures.The analgesic effect,tumor necrosis factor-alpha(TNF-α),C-reactive protein(CRP)levels,and other observation indicators were analyzed after anesthesia intervention.Result:After the intervention,the analgesic effect and the evaluation results of the subjects in the experimental group were better than those in the control group(P<0.05);the obtained values of TNF-αand CRP levels in the experimental group were higher than those of the control group(P<0.05).Conclusion:The combined spinal-epidural anesthesia intervention demonstrated positive outcomes.The analgesic effect of patients during surgery and their inflammatory factor levels improved,which makes this intervention worthy of clinical application and promotion.

Association between preoperative high sensitive troponin I levels and cardiovascular events after hip fracture surgery in the elderly

Objective Cardiovascular complications contribute to postoperative morbidity and mortality in elderly hip fracture patients. Limited data are available regarding which preoperative risk factors predict cardiovascular course following hip fracture surgery （HFS）. We used high sensitive troponin I （hs-TnI） assays and clinical parameters to identify preoperative risk factors associated with major adverse cardiac events （MACE） in elderly hip frac^u＇e patients. Method From August 2014 to November 2016, 575 patients with hip fracture were enrolled in a retrospective, single-center registry. A total of 262 of these patients underwent HFS and hs-TnI assays. MACE was defined as postoperative all-cause deaths, heart failure （HF）, new-onset atrial fibrillation （AF）, myocardial infarction （MI） and cardiovascular re-hospitalization that occurred within 90 days postoperative. Results Of 262 HFS patients, MACE developed following HFS in 65 （24.8%）. Patients with MACE were older and had higher rates of renal insufficiency, coronary artery disease, prior HF, low left ventricular ejection fraction and use of beta blockers; higher levels of hs-Tnl and N-terminal pro-brain natriuretic peptide （NT-proBNP） and higher revised cardiac risk index. A preoperative hs-TnI≥ 6.5 ng/L was associated with high risk of postoperative HF, new-onset AF and MACE. In multivariable analysis, pre-operative independent predictors for MACE were age 〉 80 years [adjusted hazard ratio （HR）： 1.79, 95% confident interval （CI）： 1.03-3.13, P = 0.04], left ventricular ejection fraction （LVEF） 〈 50% （adjusted HR： 3.17, 95% CI： 1.47-5.82, P 〈 0.01） and hs-TnI 〉 6.5 ng/L （adjusted HR： 3.75, 95% CI： 2.09~5.17, P 〈 0.01）. Conclusion In elderly patients with hip fracture who undergo HFS, a preoperative assessment of hs-TnI may help the risk refinement of cardiovascular complications.

Preventing Lower Extremity Deep Vein Thrombosis After Hip Fracture Surgery in Elderly Patients by Acupoint Application Combined with Pneumatic Compression Therapy

Objective:To investigate and analyze the long-term clinical effects of acupoint application combined with pneumatic compression therapy in the prevention of deep venous thrombosis after hip fracture surgery among the elderly.Methods:Sixty elderly patients who had undergone hip fracture surgery from February 2021 to February 2022 were selected as the research subjects.The patients were divided into two groups via drawing lots.Both the groups received nursing care,but the patients in the observation group were treated with TCM acupoint application combined with pneumatic compression therapy,whereas the control group received pneumatic compression therapy.The evaluation indicators included the patients’quality of life and complications.Results:The incidence of lower extremity deep vein thrombosis in the observation group was more than twice(0.3%),whereas the incidence of lower extremity complications in the control group was more than 6 times(20%).There was a significant difference between the two groups(p<0.05).Conclusion:Traditional Chinese medicine acupoint application combined with pneumatic compression therapy is beneficial for the prevention of postoperative lower extremity deep vein thrombosis among elderly patients.In addition,the patients’overall quality-of-life scores in both physiological and psychological aspects improved significantly,which carries significant clinical reference value.

Effect of early surgery in high surgical risk geriatric patients with femoral neck fracture and taking antiplatelet agents

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.

Effect of weekend admission on geriatric hip fractures

BACKGROUND The care discrepancy for patients presenting to a hospital on the weekend relative to the work week is well documented.With respect to hip fractures,however,there is no consensus about the presence of a so-called“weekend effect”.This study sought to determine the effects,if any,of weekend admission on care of geriatric hip fractures admitted to a large tertiary care hospital.It was hypothesized that geriatric hip fracture patients admitted on a weekend would have longer times to medical optimization and surgery and increased complication and mortality rates relative to those admitted on a weekday.AIM To determine if weekend admission of geriatric hip fractures is associated with poor outcome measures and surgical delay.METHODS A retrospective chart review of operative geriatric hip fractures treated from 2015-2017 at a large tertiary care hospital was conducted.Two cohorts were compared:patients who arrived at the emergency department on a weekend,and those that arrived at the emergency department on a weekday.Primary outcome measures included mortality rate,complication rate,transfusion rate,and length of stay.Secondary outcome measures included time from emergency department arrival to surgery,time from emergency department arrival to medical optimization,and time from medical optimization to surgery.RESULTS There were no statistically significant differences in length of stay(P=0.2734),transfusion rate(P=0.9325),or mortality rate(P=0.3460)between the weekend and weekday cohorts.Complication rate was higher in patients who presented on a weekend compared to patients who presented on a weekday(13.3%vs 8.3%;P=0.044).Time from emergency department arrival to medical optimization(22.7 h vs 20.0 h;P=0.0015),time from medical optimization to surgery(13.9 h vs 10.8 h;P=0.0172),and time from emergency department arrival to surgery(42.7 h vs 32.5 h;P<0.0001)were all significantly longer in patients who presented to the hospital on a weekend compared to patients who presented to the hospital on a weekday.CONCLUSION This study provided insight into the“weekend effect”for geriatric hip fractures and found that day of presentation has a clinically significant impact on delivered care.

Machine learning applications for the prediction of extended length of stay in geriatric hip fracture patients

BACKGROUND Geriatric hip fractures are one of the most common fractures in elderly individuals,and prolonged hospital stays increase the risk of death and complications.Machine learning(ML)has become prevalent in clinical data processing and predictive models.This study aims to develop ML models for predicting extended length of stay(eLOS)among geriatric patients with hip fractures and to identify the associated risk factors.AIM To develop ML models for predicting the eLOS among geriatric patients with hip fractures,identify associated risk factors,and compare the performance of each model.METHODS A retrospective study was conducted at a single orthopaedic trauma centre,enrolling all patients who underwent hip fracture surgery between January 2018 and December 2022.The study collected various patient characteristics,encompassing demographic data,general health status,injury-related data,laboratory examinations,surgery-related data,and length of stay.Features that exhibited significant differences in univariate analysis were integrated into the ML model establishment and subsequently cross-verified.The study compared the performance of the ML models and determined the risk factors for eLOS.RESULTS The study included 763 patients,with 380 experiencing eLOS.Among the models,the decision tree,random forest,and extreme Gradient Boosting models demonstrated the most robust performance.Notably,the artificial neural network model also exhibited impressive results.After cross-validation,the support vector machine and logistic regression models demonstrated superior performance.Predictors for eLOS included delayed surgery,D-dimer level,American Society of Anaesthesiologists(ASA)classification,type of surgery,and sex.CONCLUSION ML proved to be highly accurate in predicting the eLOS for geriatric patients with hip fractures.The identified key risk factors were delayed surgery,D-dimer level,ASA classification,type of surgery,and sex.This valuable information can aid clinicians in allocating resources more efficiently to meet patient demand effectively.

Early Surgery in Femoral Neck Fractures in Elderly: Does Preoperative ASA Score Matter?

Introduction: Early surgical treatment (within 48 hours) has been recommended for femoral neck fractures in order to avoid complications and reduce mortality rate, regardless of presence and severity of comorbidity and preoperative status (ASA score). However some studies evidenced that early surgery doesn’t always have a beneficial effect on mortality and complications. Therefore further studies could be useful in order to better assess risk related factors of patients requiring surgical treatment for femoral neck fracture. The purpose of this study is to evaluate the effect of preoperative ASA score and timing of surgery on mortality, complications and clinical outcome. Methods: All 336 patients operated in our center from January 2013 to December 2014 were selected for this retrospective study. Patients were divided in three groups as follows: group 1 patients treated within 48 hours;group 2 patients treated between 48 to 96 hours;group 3 patients treated over 96 hours. The preoperative ASA score was recorded for each patient. Complication, clinical outcome and mortality at one-year follow-up were evaluated. At follow-up ambulation was graded as: confined to bed, assisted ambulation, and normal ambulation. Complications both local (infections, malunion, dislocation) and systemic (deep vein thrombosis, pulmonary embolism, lung infections, ischemic disorders of heart) were recorded as well as number of transfusions. Statistical analysis was performed with chi square test and P value Results: 308 patients’ data were fully available for this study. At one-year follow-up return to normal ambulation was higher for patients of group 1 as compared with group 2 and 3 and in group 2 as compared with group 3 (P = 0.04). There was no difference in mortality and return to ambulation between patients with ASA score 1 and 2 (P = 0.06);patients with ASA score ≥ 3 showed a statistically significant higher mortality (P = 0.004) and rate of complications (0.0008) regardless of timing of surgery. There was no statistically significance in blood transfusion among the three groups. Discussion and Conclusion: Clinical outcome, complications and mortality have been previously reported from many authors and most studies agreed that early surgical treatment is recommended regardless of age and preoperative status of the patient. The present study suggests that early surgical treatment is actually able to reduce mortality and complications and to improve clinical outcome in patients with better preoperative conditions, while for patients with ASA score ≥ 3 treatment within 48 hours seems not to prevent mortality and complications and improve clinical outcome.

Two surgical pathways for isolated hip fractures:A comparative study

BACKGROUND Hip fractures(HF)are common among the aging population,and surgery within 48 h is recommended.Patients can be hospitalized for surgery through different pathways,either trauma or medicine admitting services.AIM To compare management and outcomes among patients admitted through the trauma pathway(TP)vs medical pathway(MP).METHODS This Institutional Review Board-approved retrospective study included 2094 patients with proximal femur fractures(AO/Orthopedic Trauma Association Type 31)who underwent surgery at a level 1 trauma center between 2016-2021.There were 69 patients admitted through the TP and 2025 admitted through the MP.To ensure comparability between groups,66 of the 2025 MP patients were propensity matched to 66 TP patients by age,sex,HF type,HF surgery,and American Society of Anesthesiology score.The statistical analyses included multivariable analysis,group characteristics,and bivariate correlation comparisons with theχ^(2)test and t-test.RESULTS After propensity matching,the mean age in both groups was 75-years-old,62%of both groups were females,the main HF type was intertrochanteric(TP 52%vs MP 62%),open reduction internal fixation was the most common surgery(TP 68%vs MP 71%),and the mean American Society of Anesthesiology score was 2.8 for TP and 2.7 for MP.The majority of patients in TP and MP(71%vs 74%)were geriatric(≥65-years-old).Falls were the main mechanism of injury in both groups(77%vs 97%,P=0.001).There were no significant differences in pre-surgery anticoagulation use(49%vs 41%),admission day of the week,or insurance status.The incidence of comorbidities was equal(94%for both)with cardiac comorbidities being dominant in both groups(71%vs 73%).The number of preoperative consultations was similar for TP and MP,with the most common consultation being cardiology in both(44%and 36%).HF displacement occurred more among TP patients(76%vs 39%,P=0.000).Time to surgery was not statistically different(23 h in both),but length of surgery was significantly longer for TP(59 min vs 41 min,P=0.000).Intensive care unit and hospital length of stay were not statistically different(5 d vs 8 d and 6 d for both).There were no statistical differences in discharge disposition and mortality(3%vs 0%).CONCLUSION There were no differences in outcomes of surgeries between admission through TP vs MP.The focus should be on the patient’s health condition and on prompt surgical intervention.

Enhanced recovery after surgery pathway: The use of fascia iliaca blocks causes delayed ambulation after total hip arthroplasty

BACKGROUND Fascia iliaca compartment blocks(FIBs) have been used to provide postoperative analgesia after total hip arthroplasty(THA). However, evidence of their efficacy remains limited. While pain control appears to be satisfactory, quadriceps weakness may be an untoward consequence of the block. Prior studies have shown femoral nerve blocks and fascia iliaca blocks as being superior for pain control and ambulation following THA when compared to standard therapy of parenteral pain control. However, most studies allowed patients to ambulate on post-operative day(POD) 2-3, whereas new guidelines suggest ambulation on POD 0 is beneficial.AIM To determine the effect of FIB after THA in patients participating in an enhanced recovery after surgery(ERAS) program.METHODS We conducted a retrospective analysis of patients undergoing THA with or without FICBs and their ability to ambulate on POD 0 in accordance with ERAS protocol. Perioperative data was collected on 39 patients who underwent THA.Demographic data, anesthesia data, and ambulatory outcomes were compared.RESULTS Twenty patients had FIBs placed at the conclusion of the procedure, while 19 did not receive a block. Of the 20 patients with FIB, only 1 patient was able to ambulate. Of the 19 patients without FIB blocks, 17 were able to ambulate. All patients worked with physical therapy 2 h after arriving in the post-anesthesia care unit on POD 0.CONCLUSION Our data suggests an association between FIB and delayed ambulation in the immediate post-operative period.

Delirium after emergency hip surgery-common and serious, but rarely consented for

A quarter of patients admitted with a proximal femoral fracture suffer from an acute episode of delirium during their hospital stay.Yet it is often unrecognised,poorly managed,and rarely discussed by doctors.Delirium is important not only to the affected individuals and their families,but also socioeconomically to the broader community.Delirium increases mortality and morbidity,leads to lasting cognitive and functional decline,and increases both length of stay and dependence on discharge.Delirium should be routinely and openly discussed by all members of the clinical team,including surgeons when gaining consent.Failing to do so may expose surgeons to claims of negligence.Here we present a concise review of the literature and discuss the epidemiology,causative factors,potential consequences and preventative strategies in the perioperative period.

Advances in the Restoration and Fixation of Lateral Femoral Wall Fracture

Hip fractures,especially intertrochanteric fractures,are more common with aging.After decades of progress,it is a general consensus to carry out internal fixation for this group of patients.However,the recent focus is on unstable intertrochanteric fractures to ensure better prognosis and prevent internal fixation failure.The lateral femoral wall,as a novel concept,is often disregarded.Many scholars have recognized that the lateral wall of the proximal femoral plays a crucial role in the stability of internal fixation for intertrochanteric fractures.In this paper,the historical evolution,definition,clinical significance,injury classification,choice of internal fixation,and possible prognosis of lateral femoral wall fracture are reviewed in order to provide clinicians strong evidence of treatment strategies.

Conversion total hip arthroplasty: Primary or revision total hip arthroplasty

Total hip arthroplasty(THA) is an increasingly common procedure among elderly individuals.Although conversion THA is currently bundled in a diagnosis related group(DRG) with primary THA,there is a lack of literature supporting this classification and it has yet to be identified whether conversion THA better resembles primary or revision THA.This editorial analyzed the intraoperative and postoperative factors and functional outcomes following conversion THA,primary THA,and revision THA to understand whether the characteristics of conversion THA resemble one procedure or the other,or are possibly somewhere in between.The analysis revealed that conversion THA requires more resources both intraoperatively and postoperatively than primary THA.Furthermore,patients undergoing conversion THA present with poorer functional outcomes in the long run.Patients undergoing conversion THA better resemble revision THA patients than primary THA patients.As such,patients undergoing conversion THA should not be likened to patients undergoing primary THA when determining risk stratification and reimbursement rates.Conversion THA procedures should be planned accordingly with proper anticipation of the greater needs both in the operating room,and for in-patient and followup care.We suggest that conversion THA be reclassified in the same DRG with revision THA as opposed to primary THA as a step towards better allocation of healthcare resources for conversion hip arthroplasties.

Advantages and issues of concern regarding approaches to peripheral nerve block for total hip arthroplasty

In older patients with comorbidities,hip fractures are both an important and debilitating condition.Since multimodal and multidisciplinary perioperative strategies can hasten functional recovery after surgery improving clinical outcomes,the choice of the most effective and safest pathway represents a great challenge.A key point of concern is the anesthetic approach and above all the choice of the locoregional anesthesia combined with general or neuraxial anesthesia.

机器学习法优化髋关节置换术围手术期治疗策略

目的:基于机器学习法建立预测模型,探讨其对老年股骨颈骨折髋关节置换术围手术期输血和进入ICU的预测价值。方法:分析南京市第一医院2012年1月至2021年12月的股骨颈骨折行髋关节置换患者500例的临床资料,建立髋关节置换术后输血的预测模型和进入ICU的预测模型,并且评估不同模型的预测效能。探讨影响髋关节置换术围手术期治疗的危险因素,绘制受试者工作特征(ROC)曲线,使用ROC曲线下面积(AUC)、准确率、灵敏度、特异度和F1得分来评价模型的预测性能,获得预测性能最佳的模型预测变量的重要性评分。结果:以输血为结局变量,平衡数据前随机森林的AUC值、准确率及特异度均是4个模型中最高的;平衡数据后支持向量机的AUC值、准确率、特异度以及F1得分均是最高的。以是否进ICU为结局变量,平衡数据前随机森林算法的AUC值最高,随机森林算法表现较好;平衡数据后支持向量机算法的AUC值和F1得分最高,表现最好。以是否输血为结局变量,预测变量重要性评分结果显示,术前血红蛋白和术前肌酐具有较高的重要性。以是否进ICU为结局变量,预测变量重要性评分结果显示,平衡数据前术前血红蛋白、年龄和术前肌酐具有较高的重要性;而平衡数据后术前肌酐和术前白蛋白具有较高的重要性。结论:围手术期重点关注患者的年龄、术前血红蛋白、术前肌酐、术前白蛋白,加强髋关节置换术围手术期管理,有助于老年股骨颈骨折患者的恢复,减少并发症。

痴呆对老年髋部骨折术后并发症的影响

背景:随着人口老龄化,合并痴呆的髋部骨折患者逐渐增加,给外科治疗带来挑战。目的:明确痴呆对老年髋部骨折患者术后并发症的影响。方法:分析2000-2019年在解放军总医院就诊的60岁以上首次髋部骨折患者,以入院时合并痴呆患者为研究对象,以年龄±5岁、性别、骨折类型为条件进行1∶10匹配非痴呆患者,比较两组术后并发症发生差异,包括肺炎、呼吸衰竭、胃肠道出血、泌尿系统感染、伤口感染、下肢深静脉血栓、肺栓塞、心绞痛、心律失常、心力衰竭、心肌梗死、脑卒中、死亡。采用多因素条件logistic回归评估痴呆对主要并发症的影响。结果与结论:纳入2887例患者,其中125例(4.3%)为痴呆患者,匹配1243例非痴呆患者。痴呆患者平均年龄为(80.6±7.4)岁,女性占64.8%,转子间骨折占53.6%,股骨颈骨折占46.4%。25例(20.0%)痴呆患者和123例(9.9%)非痴呆患者发生主要并发症(P<0.01)。痴呆患者髋部骨折术后主要并发症发生风险为200.0/1000(95%CI,139.3-278.6),非痴呆患者为99.0/1000(95%CI,83.6-116.9)。多因素条件logistic回归显示,痴呆患者髋部骨折术后主要并发症的发生风险是非痴呆患者的2倍(OR,2.11;95%CI,1.08-4.10)。结果可见,痴呆是老年髋部骨折患者发生术后并发症的独立危险因素。应对痴呆患者进行术前风险评估,开展相应的防治措施以减少术后并发症。

老年股骨颈骨折围手术期精准护理干预效果观察

目的探讨手术治疗老年股骨颈骨折患者过程中采取精准护理方案的效果及应用意义。方法选择2022年5月—2023年5月因老年股骨颈骨折入院治疗的颈中型骨折、头下型骨折、基底型骨折患者共70例为对象,根据患者入院顺序随机分为对照组与观察组各35例,均行手术方案,围手术期,对照组实施常规护理干预,观察组实施精准护理干预,比较两组患者的心理状态、并发症情况、髋关节功能恢复情况及预后。结果护理干预后,两组心理状况评分均较干预前低(P<0.05),且观察组心理状态评估得分较对照组低,心理状态更好(P<0.05);观察组术后发生并发症例数明显较对照组例数少(P<0.05);观察组髋关节功能恢复程度评分较对照组评分高(P<0.05);两组出院3个月时的生活自理能力评分均高于出院时,股骨头坏死评分低于出院时,且观察组生活自理能力评分较对照组评分高,股骨头坏死评分低于对照组,即观察组预后优于对照组(均P<0.05)。结论实施精准护理干预对改善老年股骨颈骨折患者预后、提高老年患者生活自理能力有积极影响。

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。

ERAS理念联合骨科康复护理对股骨颈骨折患者髋关节置换术后疼痛及恢复情况的影响

目的探究加速康复外科(ERAS)理念联合骨科康复护理对股骨颈骨折患者髋关节置换术后疼痛及恢复情况的影响。方法选取安徽省马鞍山市中医院2019年1月至2022年3月进行治疗的股骨颈骨折患者80例,采用随机数字表法将其分为对照组和观察组,各40例。对照组给予骨科常规康复护理,观察组给予骨科常规康复护理联合ERAS理念进行干预。干预前后比较两组术后恢复情况,包括髋关节功能、髋关节置换效果、视觉模拟评分法(VAS)评分、术后情况、术后并发症发生情况。结果干预后,观察组各项髋关节功能评分均高于对照组,差异有统计学意义(P<0.05)。干预后,两组各项髋关节置换效果评分高于干预前,且观察组高于对照组,差异有统计学意义(P<0.05);两组VAS评分低于干预前,且观察组低于对照组,差异有统计学意义(P<0.05)。干预后,观察组住院天数、术后下床活动时间短于对照组,差异有统计学意义(P<0.05);观察组并发症总发生率低于对照组,差异有统计学意义(P<0.05)。结论ERAS理念联合骨科康复护理能够缩短股骨颈骨折患者的术后住院时间和下床所需时间,缓解术后疼痛,减少并发症,促进术后髋关节恢复。

Total hip arthroplasty for posttraumatic osteoarthritis following acetabular fracture： A systematic review of characteristics, outcomes, and complications

Purpose： Posttraumatic arthritis （PTA） may develop years after acetabular fracture, hindering joint function and causing significant chronic musculoskeletal pain. Given the delayed onset of PTA, few studies have assessed outcomes of delayed total hip arthroplasty （THA） in acetabular fracture patients. This study systematically reviewed the literature for outcomes of THA in patients with PTA and prior acetabular fracture. Methods： Pubmed, EMBASE, SCOPUS, and Cochrane library were searched for articles containing the keywords ＂acetabular＂, ＂fracture＂, ＂arthroplasty＂, and ＂post traumatic arthritis＂ published between 1995 and August 2017. Studies with less than 10 patients, less than 2 years of follow-up, conference abstracts, and non-English language articles were excluded. Data on patient demographics, surgical characteristics, and outcomes of delayed THA, including implant survival, complications, need for revision, and functional scores, was collected from eligible studies. Results： With 1830 studies were screened and data from 10 studies with 448 patients were included in this review, The median patient age on date of THA was 51.5 years, ranging from 19 to 90 years. The median time from fracture to THA was 37 months, with a range of 27-74 months. Mean follow-up times ranged from 4 to 20 years, The mean Harris hip scores （HHS） improved from 41.5 pre-operatively, to 87.6 post-operatively, The most prevalent postoperative complications were heterotopic ossification （28% -63%）, implant loosening （1%-24%）, and infection （0%-16%）. The minimum 5-year survival of implants ranged from 70% to 100%. Revision rates ranged from 2% to 32%. Conclusion： Despite the difficulties associated with performing THA in patients with PTA from previous acetabular fracture （including soft tissue scarring, existing hardware, and acetabular bone loss） and the relatively high complication rates, THA in patients with VIA following prior acetabular fracture leads to significant improvement in pain and function at 10-year follow-up. Further high quality randomized controlled studies are needed to confirm the outcomes after delayed THA in these patients.