ABSTRACT
BACKGROUND: In recent years, there are many minimally invasive approaches for total hip arthroplasty. CHOW et al. operated the total hip arthroplasty with SuperPATH approach (supercapsular percutaneously assisted total hip arthroplasty) in 2010, which has the characteristics of not cutting off extortor and retaining the hip joint capsule. This approach is beneficial to early postoperative activities for patients, and has a lower risk for hip joint dislocation compared with other approaches. OBJECTIVE: To compare and analyze the short-term clinical outcomes of SuperPATH and traditional posterolateral total hip arthroplasty in the treatment of senile femoral neck fractures. METHODS: This study retrospectively analyzed 72 patients aged over 65 years old with femoral neck fractures from August 2017 to March 2019 in Affiliated Hospital of Chengdu University. The patients were grouped according to patients’ wishes. Of them, 30 cases received total hip arthroplasty through SuperPATH approach; 42 cases received total hip arthroplasty through posterolateral approach. Operation time, intraoperative blood loss, declined value of hemoglobin in 4 days of postoperation and time to weight-bearing activity were recorded between two groups. Hip Harris score after 1, 2 weeks and 3 months postoperation was used to assess the recovery of hip function. RESULTS AND CONCLUSION: (1) All patients were followed up for 3-6 months. (2) In the second week after operation, all the patients were discharged without complications such as deep vein thrombosis, sciatic nerve injury, periprosthetic fracture, periprosthetic loosening or periprosthetic infection. In the posterolateral approach group, there were two patients with posterior dislocation of the hip, all of whom were treated by manual reduction under general anesthesia. (3) Compared with the posterolateral approach group, operation time was longer; the declined value of hemoglobin in 4 days of postoperation was significantly lesser; time to weight-bearing activity was earlier in the SuperPATH approach group (P 0.05). (4) Harris score was significantly higher in the SuperPATH approach group than in the posterolateral approach group at 1 and 2 weeks after operation (P 0.05). (5) It is concluded that total hip arthroplasty through SuperPATH approach is a minimally invasive operation, can effectively reduce surgical injury, accelerate hip function recovery, and reduce the postoperative pain and discomfort of hip joint and the incidence of dislocation of hip joint in the treatment of senile femoral neck fractures compared with posterolateral approach. Nevertheless, because of the difficulty of operation, the long learning curve and the prolongation of operation time, intraoperative blood loss has not been significantly reduced. The operation by experienced surgeons can effectively reduce the incidence of complications.
ABSTRACT
Objective To explore the advantages and security of orthopaedic TiRobot used to assist internal fixation with sacroiliac lag screws.Methods From December 2015 to August 2017,11 patients with fracture of pelvic posterior ring or sacroiliac separation were treated by internal fixation with sacroiliac lag screws assisted by an orthopaedic TiRobot at Department of Orthopaedic Surgery,Affiliated Hospital to Chengdu University.They were 7 men and 4 women,aged from 23 to 61 years (average,42.5 years).According to AO classification,there were one case of type B1.2,one case of type B2.2,6 cases of type C1.2,2 cases of type C1.3 and one case of type C2.3.The number of sacroiliac lag screws inserted,time for planning insertion approaches,fluoroscopy frequency,fluoroscopy time,exposure time of C-arm X-ray,operation time,blood loss and reduction quality were documented.Results The 11 patients were followed up for 5 to 22 months (average,9.5 months).A total of 15 sacroiliac screws were inserted.In the operations,time for planning insertion approaches averaged 8.5 minutes (from 9 to 25 minutes),fluoroscopy frequency 8.5 times (from 4 to 15 times),fluoroscopy time 5.5 minutes (from 3.2 to 6.5 minutes),exposure time of C-arm X-ray machine 5.8 seconds (from 2.4 to 16.3 seconds),operation time 34.5 minutes (from 25 to 45 minutes),and blood loss 35 mL (from 10 to 80 mL).All the screw positions were satisfactory,with no penetration into the sacral canal,sacral foramen or bone cortex.No postoperative neurovascular injury happened.All the incisions primarily healed.All the fractures united well after 4 to 7 months (average,5.6 months),without any screw loosening.By the Matta scoring for fracture reduction,9 cases were excellent,one was good and one fair.By the Majeed functional scoring for pelvic fractures,8 cases were rated as excellent and 3 as good at the last follow-up.Conclusion Orthopaedic TiRobots can be used to assist internal fixation with sacroiliac lag screws in the treatment of pelvic posterior ring injuries,with advantages of limited invasion,time,hemorrhage,and high safety and accuracy as well.
ABSTRACT
Objective To compare intramedullary nail (IN) and dynamic hip screw (DHS) regarding their effects on hip abduction following fixation of intertrochanteric fractures.Methods From January 2008 to December 2015,310 patients with intertrochanteric firacture were treated at our department.They were divided into 2 groups depending on the manner of treatment.198 patients (71 males and 127 females) were subjected to intramedullary nailing,with an average age of 74.7 ± 5.6 years;there were 50 cases of 31-A 1,134 ones of 3 1-A2 and 14 ones of 3 1-A3 according to the AO classification.112 patients (35 males and 77 females) were subjected to dynamic hip screwing,with an average age of 74.1 ± 6.7 years;there were 24 cases of 31-A1,78 ones of 31-A2 and 10 ones of 31-A3.The 2 groups were compared in terms of time for weight-bearing ambulation and stand on one leg,gait,pelvic tilt,range of hip active abduction,muscle strength of the abductor and hip function at the final follow-up.Results Of this series,284 patients were followed up for 1.5 to 8.5 years (average,3.6 years) and 26 patients died.The IN group achieved significantly better outcomes in terms of time for weight-bearing ambulation (37.6 ±4.9 d),time for stand on one leg (60.1 ± 9.5 d),cases of normal gait and normal pelvic tilt (171 and 179),muscle strength of the abductor (62.3 ±4.4 N · m),and range of hip active abduction than the DHS group (53.0 ±8.4 d;71.0 ± 12.0 d;67 and 85;56.6 ± 3.3 N · m,respectively) (P ＜ 0.05).There was no significant difference between the 2 groups in the hip function at the final follow-up(91.4％ versus 84.5％ in the excellent and good rate)(P ＞ 0.05).Conclusion Compared with dynamic hip screwing,intramedullary nailing has a limited effect on hip abduction so that the patients may benefit from quicker functional recovery and faster improvement in quality of life.