Résumé
Objective:To investigate the impact of multidisciplinary diagnosis and treatment on postoperative 30-day mortality and complications in elderly patients with hip fracture.Methods:A retrospective analysis was conducted of the 260 elderly patients with hip fracture who had been treated by the mode of multidisciplinary diagnosis and treatment at Department of Orthopedics, Shenzhen Second People's Hospital from June 2018 to October 2019. The multidisciplinary group consisted of 66 males and 194 females with an age of 78.7 years ± 5.1 years, and 141 femoral neck fractures, 114 intertrochanteric fractures and 5 subtrochanteric fractures. They were compared with the 242 elderly patients with hip fracture (traditional group) who had been treated by the traditional mode from January 2017 to May 2018. The 2 groups were compared in terms of preoperative waiting time, 48-hour operation rate, 30-day mortality, and incidences of postoperative pneumonia and pressure ulcer.Results:There were no statistically significant differences in the preoperative general data or operative procedures between the 2 groups, showing comparability ( P>0.05). For the multidisciplinary group, preoperative waiting time was 41.9 h ± 36.5 h, significantly shorter than that for the traditional group (71.4 h ± 13.9 h), 48-hour operation rate 66.5% (173/260), significantly higher than that for the traditional group(8.7%, 21/242), incidence of postoperative pneumonia 3.1%(8/260), significantly lower than that for the traditional group(9.9%, 24/242), incidence of postoperative pressure ulcer (5.4%, 14/260), significantly lower than that for the traditional group(11.2%, 27/242), and 30-day mortality(2.3%, 6/260), significantly lower than that for the traditional group(5.8%, 14/242) (all P<0.05). Conclusions:Establishment of a mode of multidisciplinary diagnosis and treatment can significantly reduce the prolonged preoperative waiting time for elderly patients with hip fracture, thereby greatly reducing postoperative complications and postoperative 30-day mortality.
Résumé
Objective To study the curative efficacy of arthroscopic debridement in the management of osteoarthritis of the knee. Methods A retrospective analysis was made on clinical records of 44 cases of knee osteoarthritis (62 knee joints) treated with arthroscopic debridement. Results All the patients were followed for 2~2.5 years. The rates of excellent or good results were 85.5% (53/62) at 6 months after the surgery, 77.4% (48/62) at 1 year after the surgery, and 66.1% (41/62) at 2 years, respectively. The curative results were significantly worse at 2 years after the surgery than at 6 months ( ? 2=6.332, P =0.012). Conclusions Arthroscopic debridement is effective for the relief of painful and swollen knee joint, and postpones the appearance of articular cartilage degeneration. The efficacy of the treatment is apparent in mild cases, but the treatment will be less effective as time goes on.
Résumé
The failure of using general intramedullary nail or compression plating to treat femoral shaft fracture often causes delayed union or nonunion. Since 1995, we have treated 15 patients with delayed union and nonunion of femoral shaft fracture with interlocked Grosse-Kempf nail. Good results have been obtained.