ABSTRACT
Objective:To explore the efficacy of enhanced recovery after surgery (ERAS) in the perioperative treatment of elderly patients with intertrochanteric fracture in a primary hospital.Methods:Retrospectively analyzed were the data of 104 elderly patients with intertrochanteric femoral fracture who had been treated by fixation with proximal femoral nail antirotation (PFNA) at Joint & Trauma Surgery, Shangyu People's Hospital of Shaoxing from January 2017 to January 2019. According to whether the ERAS concept was applied perioperatively, the patients were divided into 2 groups. In the ERAS treatment group of 53 cases, there were 27 males and 26 females with an age of (72.7±1.5) years. By the AO classification, 27 cases were type 31-A1, 16 cases were type 31-A2, and 10 cases were type 31-A3. Internal diseases were complicated in 37 cases. The time from injury to operation was (65.8±3.9) h. In the conventional treatment group of 51 cases, there were 31 males and 20 females with an age of (72.6±1.5) years. By the AO classification, 21 cases were type 31-A1, 19 cases were type 31-A2, and 11 cases were type 31-A3. Internal diseases were complicated in 37 cases. The time from injury to operation was (111.5±5.9) h. The postoperative pain visual analogue scale (VAS), hospital stay, complications, Harris hip score at the last follow-up, and one-year mortality were compared between the 2 groups.Results:Except for the time from injury to operation, there was no significant difference in the other preoperative general data between the 2 groups, showing comparability ( P>0.05). All the 104 patients were followed up for 12 to 24 months (average, 14.8 months) after operation. The VAS pain score [(3.2±1.2) points], hospital stay [(6.6±2.2) d], complication rate [5.7% (3/53)], and hip Harris score at the last follow-up [(90.7±1.3) points] in the ERAS treatment group were significantly better than those in the conventional treatment group [(3.9±1.0) points, (12.7±1.8) d, 19.6% (10/51), and (86.5±3.8) points] ( P<0.05). There was no significant difference in the one-year mortality between the ERAS treatment group [18.9% (10/53)] and the conventional treatment group [27.5% (14/51)] ( P>0.05). No such complications were followed up as injury to nerve or blood vessel, wound infection, fracture nonunion or femoral head necrosis in this cohort. Conclusion:In the perioperative treatment of elderly patients with femoral intertrochanteric fracture in a primary hospital, compared with conventional treatment, application of ERAS concept can shorten the patients' hospital stay, reduce the incidence of postoperative complications, achieve rapid recovery, and improve the patients' satisfaction.
ABSTRACT
Objective By measuring the height loss of humeral head and combined with the clinical curative effect of the contrast,to investigate the correlation between the medial column support with locking proximal humerus plate fracture efficacy.Methods From June 2009 to August 2012,70 cases with proximal humeral fractures underwent internal fixation with locking plates were retrospectively analyzed.Based on the presence of medial support,all the cases were divided into 2 groups according to the proximal humeral fracture block.By measuring the change of postoperative loss of lateral humeral head height and evaluating the shoulder function,to comparative analysis of the effect of medial column support in the recovery reduction maintenance and patient function.Results There were 66 cases access the follow-up of this study,loss of 4 cases in follow-up,with an average follow-up period of 13 months (range,10-18).Thirty-eight cases of medial support group loss to follow-up 3,and no medial support group 32 cases lost to follow-up 1.Intraoperative iliac bone graft in 7 cases,including 3 cases of medial support and 4 cases of no inner support.All cases achieved clinical bone healing in the last follow-up time.Medial support can effectively reduce the degree of reduction and loss,and the average height loss of humerus head is 1.4mm (standard deviation.1.0 mm).The average height loss of humerus bead is 6.2 mm (standard deviation.3.7 mm) in no support group,which was substantially higher than the medial support group.The inner support group had no obvious complications,and in the absence of 31 cases of medial support,3 cases showed screws wear out of the articular surface,2 cases showed screws loose.In 3 cases of screw penetrating the articular surface were underwent two operation to remove or replace screws.In the medial support group,according to the Neer centesimal system score,the results were excellent in 32 cases,good in 3.The excellent and good rate was 100％.In the no medial support group,the results were excellent in 25 cases,good in 1,and fair in 5.The excellent and good rate was 83.8％.Conclusion Locking plate in tension side does not fully support the humeral head.The medial column support can obtain better maintenance of reduction and postoperative effect through improving the medial column mechanical stability.