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Objective:To investigate the effect of biological long stem hemiarthroplasty on postoperative hip joint function, serum bone markers, angiotensin Ⅱ (Ang Ⅱ) and cortisol (Cor) levels in elderly patients with intertrochanteric fractures.Methods:A total of 120 elderly patients with intertrochanteric fractures in General Hospital of Northern Anhui Coal and Power Group from June 2017 to June 2019 were selected. According to the principle of non-randomized clinical concurrent controlled study and patient′s voluntariness, they were divided into arthroplasty group and internal fixation group, with 60 cases in each group. Proximal femoral nail antirotation (PFNA) was used in the internal fixation group, and the biological long stem hemiarthroplasty was performed in the arthroplasty group. The related indexes of perioperative operation and complications, the levels of serum AngⅡ and Cor before and after operation, the levels of serum bone markers osteocalcin (OC), calcitonin (CT), alkaline phosphatase (ALP) before and after operation were compared between the two groups. After followed up for 6 months after the operation, Harris hip function score and Barthel index (BI) score, quality of life score (GQOL-74) before and after operation, and the excellent and good rate of hip joint function at 6 months after operation were compared between the two groups.Results:The time of getting out of bed in the arthroplasty group was shorter than that in the internal fixation group, the operation time was longer than that in the internal fixation group, and the amount of blood loss and postoperative drainage were higher than those in the internal fixation group, and the differences were statistically significant ( P<0.05). The postoperative complication rate in the arthroplasty group was lower than that in the internal fixation group: 8.33%(5/60) vs. 25.00%(15/60), and the difference was statistically significant ( χ2 = 6.000, P<0.05). The levels of serum AngⅡ and Cor in the two groups were higher than those before the operation at the 1st and 3rd day after the operation, but the levels of serum AngⅡ and Cor in the arthroplasty group were also higher than those in the internal fixation group: at the 1st day after the operation: (218.68 ± 42.04) mmol/L vs. (158.19 ± 34.36) mmol/L, (327.15 ± 39.08) μg/L vs. (285.42 ± 34.06) μg/L; at the 3rd day after the operation: (169.46 ± 32.73) mmol/L vs. (138.02 ± 25.97) mmol/L, (294.83 ± 33.95) μg/L vs. (262.64 ± 30.57) μg/L, and the differences were statistically significant ( P<0.05). The levels of serum OC, CT, and ALP in the two groups at 1 month and 3 months after operation were higher than those before the operation, the levels of serum OC, CT, and ALP in the arthroplasty group were higher than those in the internal fixation group: at 1 month after operation: (17.40 ± 4.25) μg/L vs. (14.96 ± 3.79) μg/L, (1.34 ± 0.49) ng/L vs. (1.15 ± 0.43) ng/L, (159.49 ± 19.75) U/L vs. (137.24 ± 17.28) U/L; at 3 months after operation: (19.18 ± 5.79) μg/L vs. (16.24 ± 4.36) μg/L, (1.46 ± 0.57) ng/L vs. (1.24 ± 0.50) ng/L, (180.94 ± 22.42) U/L vs. (163.72 ± 19.36) U/L, and the differences were statistically significant ( P<0.05). TheHarris hip function scores at 1, 3 and 6 months after the operation in the two groups were higher than those before the operation, the Harris hip function scoresin the arthroplasty group were higher than those in the internal fixation group, and the differences were statistically significant ( P<0.05). The excellent and good rate of hip joint function at 6 months after operation in the arthroplasty group was higher than that in the internal fixation group: 90.00%(54/60) vs. 75.00%(45/60), and the difference was statistically significant ( χ2 = 4.675, P<0.05). The scores of BI, GQOL-74 at 1, 3, 6 months after operation in the two groups were higher than those before operation, the scores of BI, GQOL-74 at 1, 3, 6 months after operation in the arthroplasty group were higher than those in the internal fixation group, the differences were statistically significant ( P<0.05). Conclusions:Compared with PFNA internal fixation, the treatment of elderly patients with femoral intertrochanteric fracture with biological long stem hemiarthroplasty can promote the recovery of patients, reduce complications, reduce the impact on bone markers, and more effectively improve the patient′s hip joint function, ability of daily living and quality of life, but it is more traumatic to the body and has a strong stress response.
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BACKGROUND: The impact of obesity on total hip arthroplasty has been discussed. However, there is a lack of follow-up study on the patients with different body mass indexes using three-dimensional gait analysis. OBJECTIVE: To investigate the effect of body mass index on the early-term functional recovery after total hip arthroplasty by three-dimensional gait analysis. METHODS: Sixty patients who underwent total hip arthroplasty at Department of Joint Surgery of Affiliated Zhongshan Hospital of Dalian University from January 2017 to June 2018 were enrolled. According to the body mass index at admission, they were divided into overweight group (body mass index ≥ 25 kg/m2) and normal group (body mass index 0.05). The operation time in the overweight group was significantly longer than that in the normal group (P=0.000). (2) In terms of time-distance parameters, there was no significant difference in the stride length, stride frequency and mean velocity between two groups. The stride length in the overweight group was smaller than that in the normal group (1.08±0.18 vs. 1.35±1.45 m). (3) The range of motion of each planes of hip joint in the overweight group was significantly less than that in the normal group (P < 0.05). (4) In terms of kinetic parameters, the peak torque of hip flexion in the overweight group was significantly less than in the normal group (P=0.011). There was no significant difference in the peak torque of hip extension between two groups (P=1.000). (5) To conclude, obesity has certain effect on the early functional recovery after total hip arthroplasty.
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Objective To analyze the effects and influence factors of primary total hip arthroplasty in the treatment of senile femoral neck fractures,and to increase the excellent rate of hip joint function recovery.Methods Retrospective analysis was applied to study the clinical data of one hundred and ten senile femoral neck fractures patients who underwent primary total hip arthroplasty in the 210th Hospital of People's Liberation Army from January 2014 to March 2016,to explore the main factors affecting postoperative recovery of hip joint function.Univariate analysis was used to analyze the factors influencing the clinical efficacy of the patients in terms of gender,age,body mass index,cause of injury,type of fracture and postoperative rehabilitation time,and Logistic regression analysis was used for multivariate analysis.Results The 110 senile femoral neck fractures patients obtained primary total hip arthroplasty,36 cases have seen excellent hip joint function recovery,54 good,15 fair,and 5 poor,with an excellent rate of 81.8 %(90/110).Single factor analyses found that body mass index,preoperative concomitant diseases,surgical approach,operation time,total blood loss, postoperative analgesia,discrepancy in bilateral lower limb lengths,postoperative rehabilitation time and postoperative complications were significantly related to hip joint function recovery(χ2=8.528,12.742,9.912, 8.131,10.404,10.171,12.406,6.412,10.362,P<0.05).According to the multivariate analysis,body mass index,surgical approach,total blood loss,postoperative analgesia,discrepancy in bilateral lower limb lengths,and postoperative rehabilitation time were the main factors affecting hip joint function recovery(Wald χ2=6.213, 4.543,9.156,6.287,5.461,3.698,95%CI=1.17~6.74,1.43~9.15,1.03~5.82,1.29~9.35,0.05~0.62, 0.12~0.93,P<0.05).Conclusion Primary total hip arthroplasty may lead to excellent curative effects for elderly patients with femoral neck fracture.Smaller body mass index,minimally invasive approach,less discrepancy in bilateral lower limb lengths,postoperative analgesia,less total blood loss and longer postoperative rehabilitation time may facilitate postoperative recovery for hip joint function.
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Objective To investigate the clinical effect of internal fixation(IF)and total hip replacement(HA)for treatment of displaced femoral neck fracture in elderly patients.Methods Sixty-three cases with femoral neck fracture hospitalized in Chaoyang Central Hospital from January 2010 to January 2015 were selected as research subjects and were divided into IF group(33 cases)and HA group(30 cases) according to the different treatment methods.The patients in IF group were treated with internal fixation and the patients in HA group were treated with hip replacement.The duration of operation,intraoperative blood loss, length of hospital stay,incidence of postoperative complication and reoperation rate in both groups were recorded.The hip function was evaluated by Harris score,and the hip function of the two groups was compared in 1 year,2 years after operation.Results Compared with HA group,the patients in IF group had shorter operation time,less intraoperative blood loss and shorter hospitalization time((0.8± 0.3)h vs.(1.7± 0.2)h;(110.9 ±9.9)ml vs.(587.2±35.7)ml;(16.4±2.0)d vs.(24.8±3.7)d),the differences among the two groups were statistically significant(P=0.041,0.000,0.038).Th incidence of long term postoperative complication was 27.3%(9/33)in IF group and was 10.0%(3/30)in HA group.The reoperation rate was 24.2%(8/33)in IF group and was 6.7%(2/30)in HA group.The differences between the two groups were statistically significant (P=0.045,0.039).The excellent and good rates of hip joint function in HA group after 1 and 2 years after operation were 83.3% and 80.0%,and 63.6% and 57.6% in IF group in 1 and 2 years after operation respectively.The differences between the two groups were statistically significant(P = 0.043,0.042) .Conclusion Internal fixation and hip replacement in the treatment of displaced femoral neck fractures in the elderly effect have their own advantages and disadvantages.Internal fixation has the advantages of less trauma, less blood loss and rapid recovery,but the long-term complications and reoperation rates are higher than those in HA.The long-term clinical effect of HA for the treatment of femoral neck fracture in elderly patients is better than that of internal fixation and it is worthy of clinical promotion.
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Objective To explore the application of Orem self-care mode on hip function recovery of elderly patients with artificial hip replacement . Methods Fifty elderly patients with hip arthroplasty from 2014 January to December were set as control group and received routine nursing methods from 2015 January to December 50 elderly patients with hip arthroplasty , were set as observation group and received Orem self-care mode . The hip function of the two groups was evaluated by Harris scale. Result The hip joint function of observation group was higher than that of control group and the difference was statistically significant (P<0.05). Conclusion Orem self-care mode applied in nursing of elderly patients with hip arthroplasty can improve the recovery of elderly patients with hip function.
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Objective To compare the therapeutic effect of Pilates and conventional training after total hip arthroplasty (THA).Methods Fifty-eight patients who had undergone minimally invasive total hip replacement surgery were divided into an observation group (n =29) and a control group (n =29) using a random number table.The observation group was given Pilates rehabilitation training,including a series of exercises especially designed for this condition,for 6 months after the operation.The control group was provided with conventional postoperative rehabilitation training including passive range of motion exercise,balance training,etc.,lasting for 1 to 2 months in hospital,followed by self-training after discharge.At 1 month,3 months and 6 months after the operation hip joint function was evaluated in both groups using the Harris hip score and the modified Barthel index (MBI).The time for first out-of-bed activity after the operation,length of hospital stay and postoperative complications of the two groups were also recorded.Results At 1 month after the operation,the average Harris hip score and MBI score of the observation group were significantly better than those of the control group [(59.78 ± 6.22) vs (51.26 ± 3.42) and (52.56 ± 16.67) vs (45.63 ± 15.24),respectively].Two and 4 months later,in the observation group the average Harris hip score had improved significantly to (82.12 ± 3.32) and further to (91.42 ± 5.91),while the MBI score increased significantly to (58.39 ± 13.32) and (81.17 ± 13.87).The same tendency was observed in the control group and at those two time points no significant difference was observed between the observation group and the control group.The patients in the observation group had their first out-of-bed ambulation significantly earlier,a significantly shorter average hospital stay and significantly fewer postoperative complications.Conclusion Pilates training after minimally invasive THA can promote earlier and quicker functional recovery than conventional rehabilitation training.