RESUMEN
Total hip arthroplasty (THA) is a well developed technique to which the spatial orientation of acetabular component is crucial. Since the idea of "safe zone" being proposed, such idea has long been obeyed by hip surgeons but has also been challenged in recent years. This is because post-operative instability could happen even if acetabular components are placed within "safe zone" . The latest researches have demonstrated that sagittal spinal balance and spino-pelvic mobility can affect the spatial orientation of acetabular components. Factors including spinal degenerative changes, long lumbosacral changes and spinal ankyloses can lead to sagittal spinal imbalance and/or influence spino-pelvic mobility, which subsequently affect pelvic retroversion. Proper pelvic retroversion is a way to compensate for sagittal spinal imbalance and is beneficial to post-operative stability. It is necessary for hip surgeons to rethink "safe zone" before performing THA and understand spinal balance as well as spinopelvic mobility. The goal is to reduce the rate of dislocation. This review started by introducing the related spinopelvic parameters frequently seen in papers published recently and the definitions of acetabular cup orientations. After the spinal sagittal balance and its compensatory mechanisms session, discussed its clinical relevance, as well as the significance of spinal mobility, in spinopelvic motion under three different postures.
RESUMEN
Total hip arthroplasty (THA) is a well developed technique to which the spatial orientation of acetabular component is crucial.Since the idea of "safe zone" being proposed,such idea has long been obeyed by hip surgeons but has also been challenged in recent years.This is because post-operative instability could happen even if acetabular components are placed within "safe zone".The latest researches have demonstrated that sagittal spinal balance and spino-pelvic mobility can affect the spatial orientation of acetabular components.Factors including spinal degenerative changes,long lumbosacral changes and spinal ankyloses can lead to sagittal spinal imbalance and/or influence spino-pelvic mobility,which subsequently affect pelvic retroversion.Proper pelvic retroversion is a way to compensate for sagittal spinal imbalance and is beneficial to post-operative stability.It is necessary for hip surgeons to rethink "safe zone" before performing THA and understand spinal balance as well as spinopelvic mobility.The goal is to reduce the rate of dislocation.This review started by introducing the related spinopelvic parameters frequently seen in papers published recently and the definitions of acetabular cup orientations.After the spinal sagittal balance and its compensatory mechanisms session,discussed its clinical relevance,as well as the significance of spinal mobility,in spinopelvic motion under three different postures.
RESUMEN
Objective To investigate the perioperative management of hip fracture in the elderly aged 80 years and over Methods An retrospective data of the elderly aged 80 years and over who received surgical treatment between Jan 1996 and Jun 2003 were reviewed The surgical procedure was determined according to the fracture type, osteoporosis and patients' health status Data of comorbidities, in hospital complications and other important data were collected Follow up lasting more than 6 months was made to evaluate the recovery Results Eighty two cases were femoral neck fracture while 88 cases were intertrochanteric fracture Their ages ranged from 80 to 96 years with an average of 84 9 years One hundred and twenty eight cases (75 3%) had preoperative comorbidities in which the circulation system was most often involved Thirty six cases (21 2%) had postoperative complications , among which the central nervous system and circulation system were most often involved The average in hospital time was 18 6 days , and 2 cases died of cerebral embolism and respiratory dysfunction in perioperative period respectively Totally 81 5% of them showed a good functional recovery in the follow up Conclusions The right operative intervention to the very aged hip fracture patients is feasible and effective Monitering the perioperative medical conditions and careful nursing should be emphasized
RESUMEN
Objective To analyze the prevention and management of in-hospital complications to the surgical treatment of hip fractures in elder patients (≥80 years). Methods An retrospective data of 198 hip fracture patients with surgical treatment between Jan. 1996 and Mar. 2004 was reviewed. Their age ranged from 80 to 98 years with an average of 85.2 years. 93 cases were femoral neck fracture (Garden type Ⅰ 2 cases, type Ⅱ 10 cases, type Ⅲ 52 cases and type Ⅳ 29 cases) while 105 were intertrochanteric fracture ( Evan type Ⅰ 3 cases, typeⅡ 37 cases, type Ⅲ 39 cases and type Ⅳ 26 cases). Local anaesthesia, general anaesthesia and epidural anaesthesia were used in 2, 38 and 158 cases respectively. Femoral neck fractures were treated with bipolar femoral head replacement in 77 patients, total hip replacement in 13 patients, and compressive cannulated screw fixation in 3 patients respectively. Intertrochanteric fractures were treated with close reduction and dynamic hip screw (DHS) internal fixation. Results The average operation duration and blood loss were 53 min and 110 ml respectively in the bipolar femoral head replacement group, 94 min and 165 ml in the total hip replacement group, 35 min and 30 ml in the screw fixation group and 40 min and 60 ml in the DHS group. 17 cases under cemented hip replacement suffered obviously transient arterial blood pressure drop. 36 cases (18.2%) had postoperative complications, among which the mental system and circulation system were more inclined to be involved. The average in-hospital time was 18.6 days and 2 cases died in hospital. The average time from admission to operation (waiting time ) was 6 days. Among 46 cases longer than 7 days, 9 cases (19.6%) had postoperative complications. Among 152 cases no longer than 7 days, 27 cases (17.8%) had postoperative complications. It showed no statistical significant difference between the two groups in complication incidence. Conclusion To gain good results in elderly patients of hip fracture by operation, less invasive and quick anaesthetic technique and operative procedures are encouraged. Meticulous preoperative preparation, active preventing and treating the intraoperative and postoperative complications should be emphasized on.