RESUMO
Objective To explore the application effect of enhanced recovery after surgery (ERAS) on elderly patients with intertrochanteric fractures during perioperative period.Methods Seventy-two elderly patients with unilateral fresh femoral intertrochanteric fractures admitted from July 2016 to August 2017 were selected.The patients were divided into ERAS group and regular group according to the treatment approach.In the ERAS group (n =35),there were 15 males and 20 females,aged 65-92 years (mean,78.6 years),with 19 patients on the left side and 16 on the right side.The injury causes included sprain in 25 patients and fall from height in 10.According to Evans classification,there were 4 patients with type 1,10 with type 2,12 with type 3 and 9 with type 4 in the ERAS group.Seventeen patients in the ERAS group (49％) had internal chronic diseases.In the regular group (n =37),there were 18 males and 19 females,aged 65-96 years (mean,77.6 years),with 21 patients on the left side and 16 on the right side.The injury causes included sprain in 26 patients and fall from height in 11.According to Evans classification,there were 4 patients with type 1,11 with type 2,13 with type 3,and 9 with type 4.Eighteen patients (49％) in the regular group had internal chronic diseases.The regular group adopted the conventional approach,while the ERAS group additionally adopted the concept of ERAS.The intraoperative blood loss,average blood transfusion volume,operation time,postoperative hospital stay,postoperative complication incidence,and postoperative hip function Harris score of the two groups were recorded.Results All patients were followed up for an average of 14.8 months (range,12-18 months).The patients acquired primary healing.The operation time was (40.4 ± 10.7)minutes,intraoperative blood loss (202.1 ± 57.0) ml,blood transfusion volume (0.82 ± 0.20) U and postoperative hospitalization time (6.1 ±0.8)days in ERAS group,which showed significant difference in comparison withregular group,with operation time,intraoperative blood loss,blood transfusion volume and postoperative hospitalization time for (50.5 ± 12.4) minutes,(260.3 ± 75.2) ml,(1.23 ± 0.34) U and (12.6 ±0.4)days respectively (P＜0.05 or 0.01).The incidence of complications was 32％ (12/37) in the regular group,and was 9％ (3/35) in ERAS group (P ＜ 0.05).Harris score of hip joint function was (95.3 ±0.9) points in ERAS group and (86.9 ± 0.7) points in regular group (P ＜ 0.05).Conclusions For elderly patients with intertrochanteric fractures during the perioperative period,application of ERAS can obviously reduce intraoperative blood loss and average blood transfusion,shorten the operation time and postoperative hospital stay,reduce the incidence of postoperative complications,and promote the rehabilitation of the hip function of the patients.
RESUMO
Objective To measure the parameters of anterior bow of the femoral medullary cavity by means of 3D spiral CT reconstruction and to provide the anatomical basis for the design of the femoral component prosthesis.Methods 105 healthy Chinese left femurs were scanned in standard neutral position by 3D spiral CT.Parameters of the anterior bow of the femoral medullary were measured by medical imagine software.Results The parameter values of the male femur were statistically bigger than those of the female,including the length of the femoral medullary and the distance from the point of maximum curvature to plane above lesser trochanter (P＜0.001).No significant differences between male and female in the position index of the point of maximum curvature were observed (P＞0.05).The relative curvature of the female femoral anterior arch was statistically bigger than that of the male (P＜0.001).The femoral curvature subtense and the length of the femoral medullary showed no significant correlation (r=0.106,P=0.281).Conclusion There are certain anatomic differences in the anterior bow of the femoral medullary between male and female.Appropriate length of femoral component should be considered in total hip replacement operation.And it is necessary to design the femoral components fitting the features of the femurs according gender difference.