Objective: To compare the clinical efficacy of artificial femoral head replacement and Proximal femoral nail antirotation (PFNA) in the treatment of unstable femoral intertrochanteric fractures in the elderly. Methods...Objective: To compare the clinical efficacy of artificial femoral head replacement and Proximal femoral nail antirotation (PFNA) in the treatment of unstable femoral intertrochanteric fractures in the elderly. Methods: This study retrospectively analyzed 60 elderly patients with unstable intertrochanteric fractures treated with PFNA and artificial femoral head replacement from 2015.06 to 2018.06, of which 34 were in the PFNA group (Group A) and 26 in the artificial femoral head replacement group (Group B). Statistical analysis of relevant surgical indicators such as surgical time, intraoperative blood loss, postoperative blood transfusion, postoperative time to landing, postoperative infection rate, hospital stay, number of secondary operations, postoperative VAS score, and postoperative Hip function score comparison. Results: All 60 patients were followed up for 1 - 24 months. Compared with the artificial femoral head replacement group, the operation time of PFNA group was shorter, the blood loss during operation was less, and the difference was statistically significant (P 0.05). Conclusion: The hip joint function and pain scores of the artificial femoral head replacement group in the early and follow-up periods are better than those of the PFNA group. The artificial femoral head replacement is more suitable for the treatment of elderly unstable intertrochanteric fractures.展开更多
Background Intertrochanteric femur fracture is common in elderly population. Though multiple treatment options are available, the choice of implant remains controversial. The reverse less invasive stabilization system...Background Intertrochanteric femur fracture is common in elderly population. Though multiple treatment options are available, the choice of implant remains controversial. The reverse less invasive stabilization system （LISS） plating was introduced for treatment of a patient with ipsilateral intertrochanteric and midshaft femoral fractures. The aim of this research was to compare such technique to intramedullary nailing （proximal femoral nail, PFN） for intertrochanteric fractures.Methods Fifty-six patients with an age of at least sixty-five years and an AO/OTA type-A1 or A2 fractures were included and divided into LISS and PFN treatment group. Background parameters, fracture and surgery details were documented. Follow-up time was at least 12 months. Radiology, complication, Harris Hip Score and Rapid Disability Rating Score （RDRS） were recorded to evaluate fixation status and hip function for each patient during follow-up.Results There was no significant difference between the two groups in surgical time （（48.0±8.6） minutes, vs.（51.8±10.8） minutes, P=0.3836） and intraoperative blood loss （（149.1±45.1） ml vs. （176.4±25.4） ml, P=0.0712）. The LISS group had less postoperative haemoglobin （Hb） reduction （（10.2±4.5） g/L Hb, vs. （15.1-5.9） g/L Hb, P=0.0475）. There was no complication observed in PFN group. All 31A1 type fracture in LISS group showed 100% maintenance of reduction. One nonunion with locking screw breakage and 2 varus union were found in the LISS group. Postoperative hip function was similar between the two groups.Conclusions Though reverse LISS plating may not be recommended as a routine fixation method for elderly unstable intertrochanteric fractures compared to PFN, it may possibly be reserved for rapid fixation and damage control in polytrauma patients and ORIF of subtrochanteric and reverse oblique intertrochanteric fractures.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
目的比较股骨近端髓内钉InterTAN与动力髋螺钉(dynamic hip screw,DHS)治疗高龄不稳定型股骨转子间骨折的临床疗效。方法将86例高龄不稳定股骨转子间骨折患者按治疗方式分为Inter TAN组与DHS组,每组43例,分别采用InterTAN与DHS内固定治...目的比较股骨近端髓内钉InterTAN与动力髋螺钉(dynamic hip screw,DHS)治疗高龄不稳定型股骨转子间骨折的临床疗效。方法将86例高龄不稳定股骨转子间骨折患者按治疗方式分为Inter TAN组与DHS组,每组43例,分别采用InterTAN与DHS内固定治疗后,观察并比较两组患者手术时间、术中出血量以及术前、术后12个月Harris评分、根据Harris评分得分情况评定的术后12个月时疗效、相关并发症发生率。结果 InterTAN组手术时间、术中出血量、并发症发生率均明显低于DHS组,差异均有统计学意义(均P<0.05)。两组患者术后12个月时的Harris评分均明显高于治疗前,差异均有统计学意义(均P<0.05);InterTAN组术后12个月时的Harris评分明显高于DHS组,差异有统计学意义(P<0.05);InterTAN组疗效优良率高于DHS组,差异有统计学意义(P<0.05)。结论与DHS相比,InterTAN治疗高龄不稳定型股骨转子间骨折操作更为简便,创伤更小,并发症更少,短期疗效优良率、Harris评分更高,可作为优选治疗方法。展开更多
目的探讨早期全负重训练在老年不稳定性股骨转子间骨折患者生物型全髋关节置换术中的应用。方法选择2016年12月至2018年12月青岛市市立医院收治的老年不稳定性股骨转子间骨折患者76例为研究对象,依据随机数字表法将入选患者分为对照组...目的探讨早期全负重训练在老年不稳定性股骨转子间骨折患者生物型全髋关节置换术中的应用。方法选择2016年12月至2018年12月青岛市市立医院收治的老年不稳定性股骨转子间骨折患者76例为研究对象,依据随机数字表法将入选患者分为对照组与观察组,每组各38例。两组患者均行生物型全髋关节置换术。对照组患者于术后6周进行负重训练,观察组患者于术后2周左右在耐受范围内完全负重。比较两组患者术后1个月、3个月和6个月视觉模拟评分法(visual analogue score,VAS)评分、Harris髋关节评分(Harris hip score,HHS)和日常生活活动(activity of daily living,ADL)量表评分。结果观察组患者术后1个月、3个月和6个月VAS评分均显著低于同期对照组(均P<0.05),HHS和ADL量表评分均显著高于同期对照组(均P<0.05)。结论早期全负重训练在老年不稳定性股骨转子间骨折患者生物型全髋关节置换术中具有良好的应用效果,可减轻患者疼痛,改善髋关节功能,提高患者ADL能力。展开更多
文摘Objective: To compare the clinical efficacy of artificial femoral head replacement and Proximal femoral nail antirotation (PFNA) in the treatment of unstable femoral intertrochanteric fractures in the elderly. Methods: This study retrospectively analyzed 60 elderly patients with unstable intertrochanteric fractures treated with PFNA and artificial femoral head replacement from 2015.06 to 2018.06, of which 34 were in the PFNA group (Group A) and 26 in the artificial femoral head replacement group (Group B). Statistical analysis of relevant surgical indicators such as surgical time, intraoperative blood loss, postoperative blood transfusion, postoperative time to landing, postoperative infection rate, hospital stay, number of secondary operations, postoperative VAS score, and postoperative Hip function score comparison. Results: All 60 patients were followed up for 1 - 24 months. Compared with the artificial femoral head replacement group, the operation time of PFNA group was shorter, the blood loss during operation was less, and the difference was statistically significant (P 0.05). Conclusion: The hip joint function and pain scores of the artificial femoral head replacement group in the early and follow-up periods are better than those of the PFNA group. The artificial femoral head replacement is more suitable for the treatment of elderly unstable intertrochanteric fractures.
文摘Background Intertrochanteric femur fracture is common in elderly population. Though multiple treatment options are available, the choice of implant remains controversial. The reverse less invasive stabilization system （LISS） plating was introduced for treatment of a patient with ipsilateral intertrochanteric and midshaft femoral fractures. The aim of this research was to compare such technique to intramedullary nailing （proximal femoral nail, PFN） for intertrochanteric fractures.Methods Fifty-six patients with an age of at least sixty-five years and an AO/OTA type-A1 or A2 fractures were included and divided into LISS and PFN treatment group. Background parameters, fracture and surgery details were documented. Follow-up time was at least 12 months. Radiology, complication, Harris Hip Score and Rapid Disability Rating Score （RDRS） were recorded to evaluate fixation status and hip function for each patient during follow-up.Results There was no significant difference between the two groups in surgical time （（48.0±8.6） minutes, vs.（51.8±10.8） minutes, P=0.3836） and intraoperative blood loss （（149.1±45.1） ml vs. （176.4±25.4） ml, P=0.0712）. The LISS group had less postoperative haemoglobin （Hb） reduction （（10.2±4.5） g/L Hb, vs. （15.1-5.9） g/L Hb, P=0.0475）. There was no complication observed in PFN group. All 31A1 type fracture in LISS group showed 100% maintenance of reduction. One nonunion with locking screw breakage and 2 varus union were found in the LISS group. Postoperative hip function was similar between the two groups.Conclusions Though reverse LISS plating may not be recommended as a routine fixation method for elderly unstable intertrochanteric fractures compared to PFN, it may possibly be reserved for rapid fixation and damage control in polytrauma patients and ORIF of subtrochanteric and reverse oblique intertrochanteric fractures.
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.
文摘目的比较股骨近端髓内钉InterTAN与动力髋螺钉(dynamic hip screw,DHS)治疗高龄不稳定型股骨转子间骨折的临床疗效。方法将86例高龄不稳定股骨转子间骨折患者按治疗方式分为Inter TAN组与DHS组,每组43例,分别采用InterTAN与DHS内固定治疗后,观察并比较两组患者手术时间、术中出血量以及术前、术后12个月Harris评分、根据Harris评分得分情况评定的术后12个月时疗效、相关并发症发生率。结果 InterTAN组手术时间、术中出血量、并发症发生率均明显低于DHS组,差异均有统计学意义(均P<0.05)。两组患者术后12个月时的Harris评分均明显高于治疗前,差异均有统计学意义(均P<0.05);InterTAN组术后12个月时的Harris评分明显高于DHS组,差异有统计学意义(P<0.05);InterTAN组疗效优良率高于DHS组,差异有统计学意义(P<0.05)。结论与DHS相比,InterTAN治疗高龄不稳定型股骨转子间骨折操作更为简便,创伤更小,并发症更少,短期疗效优良率、Harris评分更高,可作为优选治疗方法。
文摘目的探讨早期全负重训练在老年不稳定性股骨转子间骨折患者生物型全髋关节置换术中的应用。方法选择2016年12月至2018年12月青岛市市立医院收治的老年不稳定性股骨转子间骨折患者76例为研究对象,依据随机数字表法将入选患者分为对照组与观察组,每组各38例。两组患者均行生物型全髋关节置换术。对照组患者于术后6周进行负重训练,观察组患者于术后2周左右在耐受范围内完全负重。比较两组患者术后1个月、3个月和6个月视觉模拟评分法(visual analogue score,VAS)评分、Harris髋关节评分(Harris hip score,HHS)和日常生活活动(activity of daily living,ADL)量表评分。结果观察组患者术后1个月、3个月和6个月VAS评分均显著低于同期对照组(均P<0.05),HHS和ADL量表评分均显著高于同期对照组(均P<0.05)。结论早期全负重训练在老年不稳定性股骨转子间骨折患者生物型全髋关节置换术中具有良好的应用效果,可减轻患者疼痛,改善髋关节功能,提高患者ADL能力。
