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31.
《Gait & posture》2020
BackgroundHip osteoarthritis is a major musculoskeletal disorder in the elderly. Evidence is given for the efficacy of exercise interventions in terms of self-reported physical functioning and pain. However, it has not yet been fully examined whether exercises influence gait.Research questionThe purpose of this RCT therefore was to evaluate effects of a 12-week exercise program on kinematic gait variables in subjects with hip osteoarthritis.Methods210 participants were randomly assigned to exercise, non-treated control, or placebo ultrasound groups. The 12-week exercise intervention combined a weekly group session with home-based exercises (2/week), which entailed exercises for motor learning, flexibility, strengthening, and balance. Placebo ultrasound was given once a week. A 6-camera motion capture system was used for data collection. Data were derived from shod walking at self-selected speeds. Spatio-temporal and hip and knee joint angles of the stance phase were calculated. Data were averaged across five trials. Measurements were taken prior to and immediately after the intervention period. ANOVA/Kruskall-Wallis-Tests were used to analyze between-group effects for differences between test days. Pairwise comparisons were subsequently conducted in case of significant model effects. Data were analyzed per protocol (n = 185).ResultsNo statistically significant differences were detected for any of the outcome measures.SignificanceAlthough hip muscle strength and gait quality are related, strength training of the hip-surrounding musculature without specific gait training elements cannot improve spatio-temporal gait characteristics or hip and knee joint angles in subjects with mild to moderate hip osteoarthritis. If gait should explicitly be improved through exercise, interventions must incorporate a relevant portion of gait-related tasks. 相似文献
32.
目的 检索、获取全髋关节置换患者术后早期抗阻训练的相关证据,并对最佳证据进行总结。方法 使用计算机检索BMJ Best Practice、UpToDate、澳大利亚乔安娜布里格斯研究所循证卫生保健中心数据库、美国国立临床诊疗指南数据库、英国国家医疗保健优化研究所指南库、苏格兰校际指南网络、新西兰指南协作组网站、Cochrane Library、PubMed、EBSCO、荷兰学术期刊全文数据库、中国知网、万方、维普和中国生物医学文献数据库及骨科相关网站关于全髋关节置换患者术后早期抗阻训练的相关证据,包括指南、最佳实践、临床决策、系统评价、专家共识及相关原始研究,检索时限为2009年1月1日—2020年4月20日。由3名研究者对纳入的文献质量进行评价,并提取符合质量标准的文献证据。结果 共纳入文献20篇,包括指南2篇、临床决策1篇、随机对照试验研究6篇、系统评价7篇、专家共识2篇、病例对照研究1篇、队列研究1篇。结合专业人员的判断,围绕抗阻训练的评估、时间、强度、方式、地点、方案、不良反应及监测8个方面,共汇总13条最佳证据。 结论 总结的关于全髋关节置换患者术后早期抗阻训练的最佳证据,可为医护人员的临床应用提供循证依据。 相似文献
33.
Niall P McGoldrick Eabhann M O’Connor Nikos Davarinos Rose Galvin John F Quinlan 《World journal of orthopedics》2015,6(11):977-982
AIM: To examine the cost benefit conferred by the perioperative administration of intravenous tranexamic acid (TXA) in lower limb arthroplasty.METHODS: This study evaluates the use of TXA in 200 consecutive lower limb arthroplasties performed in a single surgeon series. The initial 100 patients (control group) underwent surgery without perioperative administration of TXA while the subsequent 100 patients (TXA group) all received 1 g TXA at the time of induction of anaesthesia. Pre- and post-operative haemoglobin, platelet count, haematocrit, the use of blood product post-operatively, length of stay were examined. A financial analysis of both groups was then undertaken.RESULTS: The mean age of patients in both groups was 63 ± 13 years. There were no significant differences between groups in terms of gender (P = 0.47), proportion of total hip replacement to total knee replacement (P = 0.25) or pre-operative haemoglobin (P = 0.43). In the control group, the transfusion rate was 22%. In the TXA group, the transfusion rate dropped to 2% (P < 0.001). The mean post-operative haemoglobin was 10.82 ± 1.55 g/dL in the control group vs 11.33 ± 1.27 g/dL in the TXA group (P = 0.01). The total cost of transfused blood products was €11055 and €603 respectively. The mean length of stay in the control group was 6.53 ± 5.93 d vs 5.47 ± 4.26 d in the TXA group (P = 0.15) leading to an estimated financial saving of €114586. There was one pulmonary embolus in the control group and one deep venous thrombosis in the TXA group.CONCLUSION: Intravenous TXA reduces blood loss in lower limb arthroplasty. This leads to lower transfusion rates, shorter length of stay in hospital and significant financial savings. 相似文献
34.
Bartosz Slomka Witold Rongies Janusz Sierdzinski Wlodzimierz Dolecki Marta Worwag Ewa Trzepla 《Acta orthopaedica et traumatologica turcica》2019,53(1)
Objective
The aim of the study was to assessment the impact of hip osteoarthritis on postural stability.Methods
One hundred and twenty-five randomly selected women 20–85 years old (mean age of 49 ± 24.4 years) were assigned to three groups based on age, health status and activity level. Group 1 (cases) – elderly women with diagnosed hip osteoarthritis, group 2 (control) - women without hip osteoarthritis, and group 3 (control) - healthy young women. Assessment of postural stability were measured using a WIN-POD Pel 38 electronic podometer. Statistica 10 software was used to perform t-test resulting in significance level of p < 0.05.Results
Significant differences in pedobarographic balance measurements were observed between the study groups with eyes opened or closed (deviation length eyes open: group 1–3 and 2–3 p < 0.0001; eyes closed group 1–2 p = 0.19; 1–3 and 2–3 p < 0.0001; deviation area eyes open: group 1-3 and 2–3 p < 0.0001; eyes closed group 1–3 and 2–3 p < 0.0001; deviation velocity eyes open: group1-3 and 2–3 p < 0.0001; eyes closed group 1–2 p < 0.010, 1–3 and 2–3 p < 0.0001). The poorest postural stability was observed in patients with hip osteoarthritis (deviation length eyes open vs eyes closed 180.8/201.7 p = 0.028, deviation area 128.7/145.7 p = 0.771, deviation velocity 5.1/6.1 p < 0.0001), and the best postural stability was observed in young women (deviation length 111.3/137.5 p < 0.0001, deviation area 57/76.9 p = 0.003, deviation velocity 3.4/4.2 p < 0.0001).Conclusion
(1) Osteoarthritic degeneration of the hip joint results in a significant disturbance in proprioception. This finding was reflected by the inferior stability parameters collected from subjects with hip osteoarthritis when asked to stand with their eyes closed. These finding were not observed in the other groups. (2) The disorder of the body stability of people with osteoarthritis may be a relative indication for the implantation of hip arthroplasty. 相似文献35.
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38.
目的探讨氨甲环酸(tranexamic acid,TXA)降低老年股骨转子间骨折围术期失血量的安全性及有效性。方法按照随机数字表法将2016年3月至2018年1月收治的200例老年股骨转子间骨折患者分为A、B、C、D组,每组50例。A组为对照组,共50例,其中男22例,女28例,平均年龄(77.74±6.53)岁,骨折按AO/OTA分型:A型17例,B型19例,C型14例。B组术前30 min静滴TXA 1 g,共50例,其中男27例,女23例,平均年龄(79.25±6.55)岁,骨折按AO/OTA分型:A型19例,B型15例,C型16例。C组术毕在骨折断端筋膜处注射TXA 1 g,共50例,其中男19例,女31例,平均年龄(74.35±5.97)岁,骨折按AO/OTA分型:A型13例,B型22例,C型15例。D组术前30 min静滴TXA 1 g,术毕在骨折断端筋膜处注射TXA 1 g,共50例,其中男24例,女26例,平均年龄(76.62±6.21)岁,骨折按AO/OTA分型:A型21例,B型18例,C型11例。记录各组总失血量、隐形失血量;术后1天和3天血红蛋白、红细胞压积、D-二聚体及纤维蛋白原、并发症发生率及输血率。结果B组(815.33±278.79)ml、C组(935.15±207.54)ml、D组(795.56±243.18)ml的总失血量低于A组(1096.88±223.79)ml,各组相比差异有统计学意义(P=0.024);B组(501.95±260.72)ml、C组(679.22±215.64)ml、D组(456.18±215.64)ml的隐性失血量低于A组(832.60±253.41)ml,各组相比差异有统计学意义(P=0.005);术后1天B组(110.84±11.73)g/L、C组(105.26±13.70)g/L、D组(109.40±13.81)g/L的血红蛋白值均高于A组(103.68±10.85)g/L,各组相比差异有统计学意义(P=0.014)。与C组相比,B组与D组在降低围术期总失血量和隐性失血量更有效果。术后3天四组的血红蛋白、红细胞压积、D-二聚体、纤维蛋白原、术后下肢深静脉血栓发生率及切口并发症发生率相比差异无统计学意义(P>0.05)。所有患者均无肺栓塞发生。结论老年转子间骨折患者围术期使用TXA均可降低围术期总失血量和隐性失血量,对术后康复有一定的积极作用,且不增加深静脉血栓发生率,静脉或联合应用效果更优。 相似文献
39.
《The surgeon》2022,20(2):94-102
BackgroundHip fractures are a significant cause of morbidity and mortality in elderly patients. Timely surgical fixation and early mobilisation are the cornerstone to successful outcomes. The Irish Hip Fracture Database (IHFD) was established in 2012 and publishes annual reports on hip fracture care. This paper describes the trends in surgical fixation in Ireland during a 7-year period (2013–2019), assesses for compliance with guidelines and compares the most recent published reports from ten international hip fracture registries.MethodsAll published IHFD reports were systematically reviewed and tabulated. Data corresponding to demographics, fracture type, surgical fixation and post-operative management was plotted and analysed. Ten international hip fracture registries were identified and reviewed. Data was extracted corresponding to the IHFD dataset.ResultsA total of 21,684 hip fractures were recorded during this period. The majority of patients were female (70.16%), >80 years old (58.26%), admitted from their own home (82.13%) and ASA grade 3 (53%). The majority of undisplaced and displaced intracapsular fractures were treated with hemiarthroplasty, 62% and 88% respectively. There has been a decline in the use of dynamic hip screw (DHS) for intertrochanteric fractures with intramedullary nails being favoured.ConclusionDespite greater awareness of hip fracture care through the IHFD and the introduction of Best Practice Tariffs (BPT), further improvements are needed. Ireland compares well to international standards but has low rates of compliance to NICE guidelines for surgical fixation. 相似文献
40.