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Objective:To investigate the efficacy of a proximal femoral locking plate (LPFP) versus a proximal femoral anti-rotation intramedullary nail (PFNA) in the treatment of femoral intertrochanteric fractures in older adult patients. Methods:A total of 130 older adult patients with femoral intertrochanteric fractures who received treatment in Linghu People's Hospital of Huzhou from May 2017 to June 2020 were included in this study. They were randomly assigned to undergo treatment with either a PFNA (observation group, n = 65) or an LPFP (control group, n = 65). Intraoperative blood loss, incision length, operative time, and time to fracture healing were determined in each group. At 1, 3, and 6 months after surgery, the Harris hip score was used to evaluate hip joint recovery. Coxa vara, incision infection, and internal fixation loosening were compared between the two groups. Results:Intraoperative blood loss in the observation group was less than that in the control group [(189.26 ± 48.15) mL vs. (96.47 ± 40.21) mL, t = -11.93, P < 0.001]. Incision length, operative time, and time to fracture healing in the observation group were significantly shorter than those in the control group [(4.03 ± 1.48) cm vs. (12.16 ± 1.55) cm, (72.13 ± 28.75) minutes vs. (120.34 ± 29.01) minutes, (9.89 ± 1.52) weeks vs. (13.63 ± 1.74) weeks, t = -30.59, -9.52, -13.05, all P < 0.001]. At 1 month after surgery, there was no significant difference in Harris hip score between the two groups ( t = 1.28, P > 0.05). At 3 and 6 months after surgery, the Harris hip score gradually increased in the control and observation groups ( F = 13.44, 8.26, both P < 0.001). At 3 and 6 months after surgery, Harris hip scores in the observation group were significantly higher than those in the control group [(85.17 ± 4.29) points vs. (79.50 ± 4.12) points, (95.30 ± 1.04) points vs. (87.69 ± 1.25) points, t = 7.69, 37.73, both P < 0.001]. The incidence of complications in the observation group was significantly lower than that in the control group [1.54% (1/65) vs. 10.77% (7/65), χ2 = 4.80, P = 0.029). Conclusion:Compared with LPFP, PFNA can effectively reduce intraoperative blood loss in older adult patients with femoral intertrochanteric fractures, accelerate the progress of fracture healing, promote the recovery of the hip joint, and has fewer complications. Therefore, PFNA is worthy of popularization.
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Objective:To investigate the intervention effect of decision aid on the fear of falling in elderly patients after total hip arthroplasty.Methods:This study was a quasi experimental research. From June 2021 to November 2021, 84 patients after total hip arthroplasty who were admitted to the Department of Orthopedics of Zhengzhou Central Hospital Affiliated to Zhengzhou University were selected as the research objects. According to the order of admission, they were divided into the control group (42 cases, 2 cases fell off ) and the observation group (42 cases). The control group was given routine nursing care and guidance for fear of falling, while the observation group was given a decision-making aid intervention program on the basis of the control group. The time to first getting out of bed, the scores of Modified Falls Efficacy Scale (MFES), Generalized Anxiety Disorder (GAD-7) and Harris Hip Score (HHS) were compared between two groups.Results:The time to get out of bed for the first time in the observation group was (42.71 ± 6.41) h, lower than that in the control group (49.95 ± 5.73) h, and the difference was statistically significant ( t=5.38, P<0.05). Twelve weeks after discharge, the GAD-7 score in the observation group was (4.64 ± 1.43), which was lower than that of the control group (6.85 ± 1.83), and the difference was statistically significant ( t=6.10, P<0.05). The score of the MFES in the observation group was [8.50(8.00,10.00)], which was higher than that in the control group [7.50(7.00,8.00)], and the difference was statistically significant ( Z=-6.26, P<0.05). The hip joint function score of the observation group was (81.74 ± 4.24), which was higher than that of the control group (74.30 ± 4.51), and the difference was statistically significant ( t=7.69, P<0.05). Conclusions:Decision support can advance the time of downward movement of elderly patients after total hip arthroplasty, reduce their anxiety and fear of falling, and improve hip function.
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Objective:To observe the the effects of Incontro, Alleanza, Responsabilita, Autonomia (IARA) intervention on kinesiophobia and hip function in patients undergoing total hip replacement.Methods:Totally 136 paitents undergoing total hip replacement in our hospital from Mar 2019 to Mar 2020 were selected and assigned into 2 groups randomly (68 cases each group) according to the random number table. The control group received nursing care according to the routine nursing path of total hip arthroplasty, the observation group was given IARA intervention on the basis of routine nursing. Score of Tampa Scale for Kinesiophobia and Harris Hip Score between the 2 groups were compared before and after intervention.Results:The scores of terror in observation group were 52.12±8.32, 43.77±6.05, 39.55±6.29, 33.64±5.92 at before operation, 1d, 7d, and 1 month after operation; those in control group were 53.54±7.29, 52.56±5.82, 46.25 ±7.33, 44.73±6.37, respectively; which in observation group decreased more significantly with time ( Finter group and Finter time values were 31.041, 15.094, P<0.001); the hip function score in observation group at 15 days before operation, 7 d, 1 month after operation were 47.57±5.24, 57.04±6.74, 85.58±7.22 respectively, those in control group were 48.23±6.38, 53.51±7.24, 73.32±7.93; which in observation group increased more significantly with time ( Finter group and Finter time values were 30.008, 13.034, 15.094, P<0.001). Conclusion:IARA intervention can reduce the severity of kinesiophobia in patients undergoing total hip replacement, and improve their hip function after surgery.
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BACKGROUND: Hip arthroplasty is now an effective method of effectively solving the problem of femoral neck fracture in the elderly, but there is a risk of big trauma, high joint dislocation and postoperative complications. OBJECTIVE: To explore the application value of 3D printing guide plate in hip arthroplasty in the elderly by retrospective study and literature retrieval. METHODS: (1) Clinical data of 25 elderly patients with femoral neck fracture undergoing hip arthroplasty from February 2017 to October 2018 in Liaoning Jinqiu Hospital were retrospectively analyzed. In the guide plate group, 13 patients received hip arthroplasty using 3D printing guide plate. In the non-guide plate group, printing guide plate was not used in 12 cases. The application value of SuperPATH technique with 3D printing guide plate in hip arthroplasty in the elderly was observed. (2) Wanfang database was retrieved by the first author for studies published from 2000 to 2019. The key words were “3D, hip”. According to the inclusion criteria, 31 articles were selected to analyze the application value of 3D printing guide plate in hip arthroplasty in the elderly. RESULTS AND CONCLUSION: (1) The results of retrospective analysis showed that the operation time and the times of X-ray fluoroscopy were less in the guide plate group than those in the non-guide plate group (P 0.05). (2) Literature search results showed that 3D guide plates could be used to compensate for some defects of surgery in hip arthroplasty. There are many approaches to implement joint arthroplasty. Both conventional and minimally invasive approaches have direct anterior approach and posterolateral approach. According to several literature analysis, direct anterolateral approach can reduce trauma, and minimally invasive approach can reduce the risk of surgery. The above results show that the use of 3D printing guide plate in elderly hip arthroplasty can reduce the operation time and the times of intraoperative X-ray fluoroscopy, and the effect is better. 3D guide plate has application value in hip arthroplasty, and it has advantages in combination with minimally invasive techniques.
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BACKGROUND: The purpose of placing drainage tube after total hip arthroplasty is to drain the accumulated blood in the hip, so as to accelerate the recovery of patients. However, since tranexamic acid has been infused intravenously during the operation, and the effect of blood loss can be reduced exactly. It remains poorly understood that whether it is necessary to place a drainage tube routinely after the operation. OBJECTIVE: To investigate whether the drainage tube should be placed on the basis of hemostasis by intravenous drip of tranexamic acid in total hip arthroplasty. METHODS: From June 2017 to March 2019, 132 patients with primary unilateral total hip arthroplasty admitted to the Second Hospital of Shanxi Medical University were selected. During the operation, tranexamic acid was infused intravenously. Drainage tube was placed in 62 patients (drainage group) after total hip arthroplasty, and not placed in 70 patients (non-drainage group). The blood loss, blood transfusion rate, blood transfusion volume, hemoglobin value and complications were compared between the two groups. The average hospital stay of the two groups was compared. Harris score of hip joint was followed up after operation. The experiment was approved by the Ethics Committee of the Second Hospital of Shanxi Medical University. RESULTS AND CONCLUSION: (1) There was no significant difference in blood loss, blood transfusion rate, blood transfusion volume, and hemoglobin value between the two groups (P > 0. 05). (2) There was no significant difference in deep vein thrombosis of both lower limbs between the drainage group (four cases) and the non-drainage group (two cases) (P > 0. 05). (3) There were three cases of bleeding, three cases of infection, two cases of swelling and ecchymosis in the drainage group, and one case of bleeding and one case of swelling and ecchymosis in the non-drainage group. There were significant differences in incision complications between the two groups (P 0. 05). (6) The results showed that there was no need to place drainage tube after intravenous drip of tranexamic acid during total hip arthroplasty.
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Objective To investigate the clinical effect of total hip arthroplasty ( THA) in the treatment of hip osteoarthritis ( HOA) and its effect on the quality of life of the patients. Methods Thirty?seven patients ( 42 hips) who underwent THA surgery in the Second Affiliated Hospital of Liaoning University of Traditional Chinese Medicine from November 2011 to December 2015 were enrolled in this study. The function of hip joint, hip joint activity and the quality of life of the patients and other indicators were observed before operation,at 3 months,6 months after operation. Results The Harris scores of 37 patients before operation, at 3 months, 6 months after operation were (72.0±7.4) points,(86.1±8.3) points,(45.8±9.5)points respectively,the difference was statistically significant among the three groups ( F=71. 302,P<0. 05) . At 3 months and 6 months after operation,the score significantly improved compared to that before operation ( P<0. 05);At 3 months and 6 months after operation,the angles of the hips in 37 patients were significantly improved ( F=144. 921,41. 195, 351. 648,372. 766, 317. 518, 226. 381, P<0. 05 ) . The hip function was evaluated at 6 months after the operation,and 37 patients (42 hips) were evaluated,26 hips (61. 90％) were excellent. 12 hips (28. 57％) were good,4 hips ( 9. 52％) were fine,and 0 poor hips. At 6 months after operation,the SF?36 scale evaluation of quality of life, body pain, emotional restrictions, mental health, physical limitations, activities, social activities, vitality,general health, physical health, mental health scores were significantly improved compared with the preoperative ones ( F=19. 731, 19. 142, 11. 303, 22. 63821. 563, 20. 936, 13. 372, 14. 985, 6. 773, 13. 028, P<0. 05) . Conclusion THA treatment for patients with HOA can significantly improve the function of the hip joint and improve the quality of life of the patients.
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Objective To explore a layered nursing intervention based on risk assessment strategies application effect in elderly patients with hip replacement. Methods Chosen during January 2013 to December 2014 rows of orthopaedic trauma treated 224 patients of senile hip replacement as the research objectto divide into observation group and control group 112 caseseach according to admission time.Observation group applied based on risk assessment strategy stratification nursing intervention, the control group used conventional care. Compared two groups of patients with postoperative pain degree, hip function, complications, and patient satisfaction. Results For 24 h, 48 h, 72 h after the operation, Visual Analog Scale (VAS) scores of observation groupwere 2.25 ± 0.35, 2.01 ± 0.31, 1.92 ± 0.23, which were significantly lower than 3.53 ± 0.51, 2.84±0.45, 2.70±0.35 of the control group (t=21.900, 16.075, 21.900, P<0.01);3 months and 12 months after the surgery, the index of the Harris hip score observation group was 71.32 ± 7.45, 93.44 ± 9.65, which were obviously higher than 60.47 ± 6.65, 83.75 ± 9.21 of control group (t=11.498, 7.688, P<0.01);8.04%(9/112) incidence of complications such as infection of incision, increase of observation group was obviously lower than 20.54%(23/112) of the control group(χ2=7.146, P<0.05);97.32%(109/112) satisfaction was significantly higher than 78.57% (88/112) of the control group (χ2= 18.572, P < 0.05). Conclusions Stratified nursing intervention based on risk assessment strategy can help to alleviate the degreeof pain, improve hip function, reduce postoperative complications and improve patient satisfaction.
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Objective To explore the effect of multifunctional rehabilitation wheelchair on early rehabilitation of elderly patients after anesthesia recovery with hip fracture surgery.Methods Toally 34 elderly inpatients with hip fracture surgery treated with regular function exerciser between November 2013 to October 2014 were assigned as the control group and another 34 elderly inpatients with hip fracture surgery during November 2014 and November 2015 as the observation group.The control group was treated with routine nursing and early on-bed rehabilitation exercise and the latter with early off-bed exercises on a muhifunctional wheelchair.The two groups were compared in terms of hip function and daily life activities ability before surgery and 14 d after operation.Result The Harris hip function cores and activities of daily living scores of the observation group after surgery were significantly higher than those of the control group (P ＜0.05).Conclusion Multifunctional rehabilitation wheelchair can be effective in the improvement of the hip function and daily life activities for the elderly patients with hip fracture surgery.
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Dynamic knee valgus is considered a risk factor of noncontact ACL injuries. The aim of this study was to determine the association between hip and hindfoot dynamic alignment and dynamic knee valgus.This cross-sectional study involved 88 high school female basketball players (175 legs). Subjects performed single-leg squatting and drop landing which provided a hip-out distance (HOD) and a knee-in distance (KID) via 2D video images. Hip and hindfoot dynamic alignment was evaluated by a dynamic Trendelenburg test (DTT) and a heel-floor test (HFT), respectively, during squatting and landing.The DTT-positive group (dynamic hip mal-alignment with lower non-weightbearing pelvis) demonstrated greater HOD and KID values for both squatting (p＜0.001) and landing (p＜0.001) than the DTT-negative group. The HFT-positive group (5<sup>o</sup> or greater hindfoot valgus) demonstrated greater KID values for both squatting (p＜0.01) and landing (p＜0.001), but smaller HOD value for squatting (p＜0.01) than the HFT-negative group.In conclusion, dynamic hip mal-alignment may be associated with both greater HOD and KID, but hindfoot valgus only with greater KID.
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[Objective]To evaluate the therapeutic effects of minimally invasive replacement in complicated femoral intertrochanteric fractures.[Method]A retrospective analysis was done for 49 patients with femoral intertrochanteric fractures in the author's department from March 2005 to August 2008.According to different ways of replacement,the patients were divided into Group A(n=21),open repositioning and Group B(n=28),minimally invasive replacement respectively.And PFN or Gamma nail was fixed after that.Operation time,bleeding volume,length of stay,time of weight loading and average time of fracture union,incidence rate of complications and hip function were recorded.[Result]There great significant differences in operation time,bleeding volume and average time of fracture union between Group B and Group A respectively(P0.05).Hip score(Harris) in Group B was significantly higher than that in group A(P