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Object:To explore the clinical effect of periacetabular osteotomy (PAO) in the treatment of developmental dysplasia of hip (DDH).Methods:The clinical data of 305 patients with DDH admitted to Tangshan Second Hospital from January 2012 to June 2018 were analyzed retrospectively. All patients were treated with PAO alone. There were 123 cases of left hip dysplasia, 131 cases of right hip dysplasia and 51 cases of double hip dysplasia (356 hips in total). The patients underwent X-ray examination before and on the second day after operation to compare the acetabular index and the lateral center edge angle (LCEA) and the anterior center edge angle (ACEA) of the acetabulum before and after operation. The ability of daily living and hip joint function were evaluated before and 6 months after operation, and Barthel index and Harris score of hip joint were compared before and after treatment. The measurement data with normal distribution are expressed in xˉ± s, and the paired t test was used for comparison before and after operation. The measurement data of non-normal distribution is expressed by M( Q1, Q3), and the comparison before and after surgery is performed by the rank sum test. Results:On the second day after operation, the LCEA and ACEA of 356 hip joints in 305 patients were greater than those before operation (32.5(20.0,47.5)° vs 8.5(-18.5 23.0)°, 29.0(18.5,52.3)° vs 2.5(-20.8, 24.5)°), while the acetabulum index was lower than that before operation (6.7(-8.4,12.5)° vs 26.8(10.0, 62.3)°), and the differences were statistically significant ( Z values were 51.50, 45.37, 32.22, all P<0.001). After 6 months of follow-up, the Barthel score and Harris score of the hip joint were higher than those before the operation (92.5±1.3) scores vs (65.6±1.5) scores, (96.4±2.5) scores vs (85.1±1.3) scores, and the difference was statistically significant ( t values were 335.56 and 89.70, both P<0.001). Conclusions:PAO can make the acetabulum cover the femoral head well through acetabular transposition, improve the ability of daily living and hip joint function of DDH patients, reduce pain, increase joint range of motion, and correct limb deformities. It is an effective means to treat DDH.
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BACKGROUND: Numerous studies have reported the effectiveness of platelet-rich plasma in promoting and improving bone healing. However, due to the limitations of methods, follow-up and study design, many orthopedicians still doubt the clinical effect of platelet-rich plasma combined with cannulated screw fixation in the treatment of fracture and nonunion. OBJECTIVE: To evaluate the difference in efficacy between platelet-rich plasma combined with cannulated screw fixation and simple cannulated screw fixation in the treatment of femoral neck fracture using meta-analysis system. METHODS: The Cochrane Library, PubMed, Wanfang Medical Network, China National Knowledge Infrastructure, and China Journal Full-text Database were used to search and collect clinical randomized controlled trials of platelet-rich plasma combined with cannulated screw fixation and cannulated screw fixation for the treatment of femoral neck fractures. Two reviewers independently evaluated the quality of the included studies, extracted data and checked each other. Meta-analysis was utilized to analyze the collected data with RevMan 5. 3 software. RESULTS AND CONCLUSION: (1) Seven clinical randomized controlled trials were selected for meta-analysis, totally 760 patients. There were 380 cases undergoing platelet-rich plasma combined with cannulated screw fixation and 380 cases undergoing cannulated screw fixation. (2) The meta-analysis showed that compared with the cannulated screw fixation group, fracture healing time was shorter [MD=-1. 86, 95%CI(-2. 97, -0. 75), P=0. 001]; healing rate was higher [OR=6. 51, 95%CI(3. 36, 12. 62), P < 0. 000 01]; necrosis rate was lower [OR=0. 25, 95%CI(0. 15, 0. 44), P < 0. 000 01]; Harris scores at 1, 3, 6, 9, and 12 months postoperatively were higher [MD=4. 95, 95%CI(4. 12, 5. 77), P < 0. 000 01; MD=19. 78, 95%CI(18. 45, 21. 11), P < 0. 000 01; MD=17. 16, 95%CI(10. 39, 23. 92), P < 0. 000 01; MD=12. 66, 95%CI(10. 60, 14. 71), P < 0. 000 01; MD=10. 17, 95%CI(5. 98, 14. 36), P < 0. 000 01] in the platelet-rich plasma combined with cannulated screw fixation group. (3) Platelet-rich plasma combined with cannulated screw fixation for femoral neck fracture is more effective than that of cannulated screw fixation alone. Combined treatment can accelerate the fracture healing of patients, improve the healing rate, reduce necrosis rate, and promote the recovery of postoperative hip joint function.
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BACKGROUND: In recent years, some scholars have proposed the use of medial femoral neck support plate combined with cannulated screw internal fixation to treat Pauwels type III femoral neck fracture. This method can reduce the incidence of complications such as nonunion of the femoral neck fracture and femoral head necrosis. However, it is still controversial whether this treatment can accelerate fracture healing and reduce femoral head necrosis in clinic. OBJECTIVE: Meta-analysis was performed to evaluate the difference in the efficacy of femoral medial support plate combined with cannulated screw internal fixation and simple cannulated screw internal fixation for the treatment of Pauwels type III femoral neck fracture. METHODS: Cochrane Library, PubMed, Wanfang Medical Network, China National Knowledge Infrastructure, and China Journal Full-text Database were used to search for and collect the clinical Chinese and English literature of the trials regarding Pauwels III femoral neck fracture treated with internal femoral support plate combined with cannulated screw internal fixation and simple cannulated screw internal fixation. Two evaluators independently conducted quality evaluation, data extraction and cross-checking of the included studies, and finally performed meta-analysis on the collected data using RevMan 5.3 software. RESULTS AND CONCLUSION: (1) After screening, 5 related clinical trials were included, including 4 randomized controlled trials and 1 retrospective cohort study, for a total of 243 patients with Pauwels III femoral neck fracture. (2) Meta-analysis results showed that compared with simple cannulated internal fixation, operation time was longer [MD=23.19, 95%C/(8.32, 38.06), P=0.002], intraoperative blood loss was more [MD=83.48, 95%C/(32.08, 134.89), P=0.001], and healing time was shorter [MD=-1.56, 95%C/(-1.89, -1.24), P < 0.000 01], the incidence of complications was lower [RD=-0.07, 95%C/(-0.11, -0.02), P=0.003], and hip Harris score was higher [MD=7.39, 95%C/(3.18, 60), P=0.000 6] in the femoral medial support plate combined with cannulated screw internal fixation. However, there was no statistically significant difference in the excellent and good rate of hip function between the two treatments [OR=1.29, 95%C/(0.02, 74.86), P=0.90]. (3) In the treatment of Pauwels type III femoral neck fracture, compared with simple cannulated nail fixation, cannulated screws combined with medial support plate can shorten healing time, reduce postoperative complications and elevate postoperative Harris score.
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Objective@#To explore the clinical effect of proximal femoral nailing in the treatment of intertrochanteric fracture of the femur and its effect on patients' VAS score.@*Methods@#From January 2017 to December 2017, 49 elderly patients with intertrochanteric fracture in Hangzhou Dajiangdong Hospital were selected in the research.According to internal fixation methods, the patients were divided into two groups.The PFLP group(25 cases) received proximal femoral locking plate, the PFNA group (24 cases) received proximal femoral intramedullary nail by minimally invasive treatment.The therapeutic effect was compared between the two groups.@*Results@#The operating time, intraoperative blood loss, incision length, the weight bearing time, fracture healing time in the PFNA group were (101.33±39.41)min, (261.08±184.98)mL, (7.66±3.04)cm, (5.58±1.47) weeks, (16.66±2.03) weeks, respectively, which were significantly better than those in the PFLP group [(137.36±43.65)min, (456.40±148.18)mL, (14.76±1.76)cm, (11.4±1.44)weeks, (19.36±3.49)weeks] (t=3.184, 4.085, 10.024, 4.085, 10.024, all P<0.05). At 1, 3, 6 months after operation, the VAS scores of the PFNA group were (6.56±2.87)points, (5.87±1.25)points and (2.62±0.98)points, which were better than those of the PFLP group (t=4.855, 7.545, 8.541, all P<0.05). After treatment, the INF-alpha, IL-6, CRP levels in the PFNA group were (22.39±1.85)ng/L, (120.54±5.24)ng/L, (7.79±2.25)mg/L, respectively, which were significantly lower than those in the PFLP group [(33.69±2.25)ng/L, (154.25±5.52)ng/L, (13.96±3.25)mg/L](t=5.287, 4.987, 5.124, all P<0.05).@*Conclusion@#In the treatment of intertrochanteric fracture, PFNA internal fixation has shorter operation time, less intraoperative blood loss, small incision and minimally invasive fixation, and can get out of bed early after operation, functional exercise can promote fracture healing.It has fewer complications and high clinical value.
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Objective To explore the clinical effect of proximal femoral nailing in the treatment of intertrochanteric fracture of the femur and its effect on patients' VAS score.Methods From January 2017 to December 2017,49 elderly patients with intertrochanteric fracture in Hangzhou Dajiangdong Hospital were selected in the research.According to internal fixation methods,the patients were divided into two groups.The PFLP group(25 cases)received proximal femoral locking plate,the PFNA group (24 cases) received proximal femoral intramedullary nail by minimally invasive treatment.The therapeutic effect was compared between the two groups.Results The operating time,intraoperative blood loss,incision length,the weight bearing time,fracture healing time in the PFNA group were (101.33 ± 39.41) min,(261.08 ± 184.98) mL,(7.66 ± 3.04) cm,(5.58 ± 1.47) weeks,(16.66 ± 2.03) weeks,respectively,which were significantly better than those in the PFLP group [(137.36 ± 43.65) min,(456.40 ±148.18)mL,(14.76 ± 1.76)cm,(11.4 ± 1.44)weeks,(19.36 ±3.49)weeks] (t =3.184,4.085,10.024,4.085,10.024,all P ＜ 0.05).At 1,3,6 months after operation,the VAS scores of the PFNA group were (6.56 ±2.87) points,(5.87 ± 1.25) points and (2.62 ± 0.98) points,which were better than those of the PFLP group (t =4.855,7.545,8.541,all P ＜ 0.05).After treatment,the INF-alpha,IL-6,CRP levels in the PFNA group were (22.39 ± 1.85) ng/L,(120.54 ± 5.24) ng/L,(7.79 ± 2.25) mg/L,respectively,which were significantly lower than those in the PFLP group [(33.69 ± 2.25) ng/L,(154.25 ± 5.52) ng/L,(13.96 ± 3.25) mg/L] (t =5.287,4.987,5.124,all P ＜ 0.05).Conclusion In the treatment of intertrochanteric fracture,PFNA internal fixation has shorter operation time,less intraoperative blood loss,small incision and minimally invasive fixation,and can get out of bed early after operation,functional exercise can promote fracture healing.It has fewer complications and high clinical value.
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Objective?To analyze the clinical efficacy and related X-ray findings of patients underwent arthroscopic treatment of femoral acetabular impingement (FAI) syndrome with different anatomical features.?Methods?Twenty-four patients with FAI underwent arthroscopic surgery from September 2015 to December 2016 were selected to analyze the clinical features, postoperative pain, knee joint function, activity and complications.?Results?Compared with those before treatment, the visual analogue scale (VAS) scores of patients at 7 d, 1 month, 3 months and 6 months after treatment were significantly lower than those before treatment, while the Harris scores were significantly increased, at the same time patients’ knee activity was significantly increased, The difference was statistically significant (P < 0.05). The α angle of the hip joint of the cam-type patient was significantly higher than that of the jaw-type, while the eccentricity, acetabular depth, acetabular coverage and centerline (CE) angle were significantly lower than the jaw-type, and the difference was statistically significant (P < 0.05); The α angle of the cam-type patient was significantly higher than that of the healthy person’s hip joint, and the eccentricity was significantly lower than that of the healthy person’s hip joint. The difference was statistically significant (P < 0.05); the acetabular depth and hip of the clamp-type patient Radon coverage and CE angle were higher than those of hip joints in healthy people, and the difference was statistically significant (P < 0.05). There was no significant difference in acetabular anterior tilt between the three groups (P > 0.05). The incidence of complications in 24 patients underwent arthroscopy was 20.83%.?Conclusion?Hip arthroscopic treatment of hip impingement syndrome can shorten the patient’s pain relief, improve knee function and activity, its effect is good, and different hip anatomical X-ray film was significantly different.
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Objective The application of metal augments in the revision of total hip arthroplasty(THA)has achieved re-markable results in the treatment of bone defects.However,there are limited studies compared this effective method with the traditional treatment.The purpose of this article is to investigate the curative effect of both metal augmentation and impacted bone grafting in the revision of acetabular bone defect. Methods We retrospectively analyzed 20 patients(20 hips)with bone defects after THA in Au-thority of Nanjing General Hospital of Nanjing Military Region from August 2010 to February 2017.These 20 patients were allocated into 2 groups:impacted bone grafting group(n=11,filling acetabular bone defect with autogenous iliac bone and artificial bone)and metal aug-mentation group(n=9,filling acetabular bone defect with metal aug-ment).The duration of surgery,blood loss and the hospital for special surgery knee score(HSS)were compared between these two groups and the Harris score was applied to evaluate the hip function and full weight bearing. Results The surgery duration and blood loss of impacted bone grafting group were significantly increased when compared with the metal augmentation group(44.5±7.82 min vs 36.22±5.19 min and 431.82±57.76 mL vs 333.33±72.80 mL respec-tively).there were 3 cases showed mild bone resorption in the I regions in the impacted bone grafting group, while only one case showed mild bone resorption in the II region in the metal augmentation group.The HSS scores in the metal augmentation group were higher than those in the impacted bone grafting group at the time of postoperative 2 weeks(43.89±2.76 vs 40.82±4.42), 3 months (49.89±2.03 vs 45.27±3.90)and 6 months(53.44±2.46 vs 50.55±3.67), the differences were statistically significant(P<0.001). The Harris scores in the metal augmentation group were higher than those in the impacted bone grafting group(P<0.01).The metal augmentation group had a shorter time of getting out of bed compared with the impacted bone grafting group(P<0.01). Conclusion For those patients with upper acetabular bone defect,revision surgery using metal augments can save the operation time.Meanwhile, it is also superior to the impacted bone grafting in the early prosthesis stability and bone ingrowth,and thus enables to shorten the time on getting out of bed and promote functional.
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10.3969/j.issn.2095-4344.2013.26.017
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[Objective] To evaluate the effect of fast rehabilitation nursing pathway in patients after artificial hip replacement.[Methods] 86 patients underwent artificial hip replacement were randomly divided into the control group and the experimental group with 43 cases in each group.The control group received routine care,while the experimental group was given fast rehabilitation nursing pathway.Anxiety and pain at 48h after operation were evaluated,and hip joint function(Harris score)was evaluated six months after operation.[Results] Compared with the control group,anxiety and pain score at 48h after operation decreased markedly,and Harris score six months after operation increased significantly.[Conclusions] Fast rehabilitation nursing pathway can reduce both the short-term and long-term efficacy of patients after artificial hip replacement.
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Objective To summarize the nursing methods and effect of artificial femoral head replacement in treatment of osteoporotic interttochanteric fracture in elderly patients. Methods 55 patients with esteoporotic intertrochanteric fracture were selected in our hospital from February 2007 to February 2011.All patients were cared by targeted preoperative and postoperative nursing,helping them conducting functional training in time,giving discharge counseling and follow-up.The hip functional recovery of patients was evaluated by using the Harris evaluation standard,and the excellent rate of surgery was also evaluated. Results After the targeted care,55 patients went through the perioperative period safely,the average length of stay was ( 14.0 ± 3.1 )days,a total of 5 cases (9.09％)patiants suffered varying degrees of complications which were improved after symptomatic treatment.Patients were followed up for 3 to 36 months,only 2 patients died of cerebral vascular accident,all patients gained good recovery of hip function.Harris score was (84.45 ± 9.38),the excellent rate of surgery reached 78.18％. Conclusions Atificial femoral head replacement proves significant effect in treatment of osteoporotic intertrochanteric fractures in elderly patients,but with the accompanying surgical compliuations,special care and timely functional exercise methods should be paid attention to.