Blood transfusion requirements in femoral neck fractures.

Fractures of the femoral neck are common, and their incidence seems likely to increase. A prospective study in 1991 of 80 patients with such fractures suggested that not all need to be cross-matched preoperatively, a finding supported by the existing literature. At the same time, a survey of transfusion protocols in hospitals throughout the country suggested that much blood was being wasted daily in unnecessary cross-matching. This survey was repeated in 1995, and little appears to have changed. The implications of this are discussed.     

Blood transfusion requirements in intracapsular femoral neck fractures

The blood transfusion requirements of 445 patients undergoing operation for intracapsular fractures of the femoral neck were studied. These requirements were correlated with the type of operation carried out, the existence of pre-operative anaemia, and intra-operative blood loss. A total of 127 patients (29 per cent) were transfused with a total of 321 units.     

Screening for osteomalacia in elderly patients with femoral neck fractures

In this study 201 elderly patients with femoral neck fractures were compared with 30 osteomalacic patients with the same injury. Hypocalcaemia and a raised alkaline phosphatase level are common biochemical abnormalities in elderly patients with femoral neck fractures. In only a minority of patients, however, were they associated with histologically proven osteomalacia. By using the combination of hypocalcaemia and a raised alkaline phosphatase it is possible to identify a subgroup (approximately 10% of all admissions) in whom osteomalacia is relatively likely.     

Prediction of survival in patients with femoral neck fractures

A prospective study of factors which might help to predict mortality in patients with intracapsular fractures of the femoral neck has been undertaken. A multivariate analysis technique was used to analyse the collected data, and it was found that mental ability was the most significant variable; this factor had the greatest effect on outcome.     

Intertrochanteric and femoral neck fractures in patients with parkinsonism

Thirty-eight patients with parkinsonism were reviewed after fracture of the hip. The 12-month mortality rate was the same as in other patients with hip fractures but without parkinsonism. However, the morbidity was higher-with loss of independent existence, loss of ambulation and an increased risk of dislocation of the endoprosthesis.     

老年新鲜移位股骨颈骨折的手术治疗分析

[目的]探讨内固定、人工股骨头置换和全髋置换在治疗老年人移位性股骨颈骨折中的价值.[方法]对2003年6月-2008年5月收治的95例65岁以上新鲜移位性股骨颈骨折患者进行随访研究,比较闭合复位内固定、人工股骨头置换和全髋置换术在手术时间、出血量、住院时间、术后1年和3年的功能评价、并发症以及二次手术率方面的差异.[结果]随访时间12～36个月,平均26个月.闭合复位内固定组的手术时间、失血量、住院时间均为最低(P<0.05),但卧床时间最长,并发症和手术翻修率最高,术后3年随访功能最差.全髋置换术卧床时间短,并发症和手术翻修率低,术后髋关节功能最好,但手术创伤较大,对患者身体一般状况要求较高.人工股骨头置换的手术创伤比全髋置换稍小,但并发症发生率、手术翻修率较高,术后功能比全髋置换差.[结论]关节置换是治疗老年移位性股骨颈骨折的有效手术方法.     

Cementless hemiarthroplasty for femoral neck fractures in elderly patients

Objectives:

The use of cement is associated with increased morbidity and mortality rate in elderly patients, hence cementless hemiarthroplasty is suggested. We evaluated the results of cementless hemiarthroplasty for femoral neck fractures in elderly patients with high-risk clinical problems.

Materials and Methods:

Forty-eight patients (29 females, 19 males) with a mean age of 88 years (range: 78 to 102 years). having femoral neck fractures were treated with the use of cementless hemiarthroplasty. Porous-coated femoral stems were used in 30 patients (62%) and modular type femoral revision stems in 18 patients (38%). Bipolar femoral heads were used in all patients. Radiological follow-up after operation was done at the one, three, six months and annually.

Results:

The mean follow-up period was 4.2 years (range: 18 months to eight years). None of the patients died during hospitalization. Medical complications occurred in six patients (12%) within the follow-up period and four patients (8%) died within this period. Only two hips were converted to total hip arthroplasty due to acetabular erosion. Femoral revision was planned for one patient with a subsidence of > 3 mm. None of the patients had acetabular protrusion or heterotopic ossification. The mean Harris-hip score was 84 (range: 52 to 92). Dislocation occured in one patient (2%).

Conclusion:

Cementless hemiarthroplasty is a suitable method of treatment for femoral neck fractures in elderly patients with high-risk clinical problems especially of a cardiopulmonary nature. This method decreases the risk of hypotension and fat embolism associated with cemented hemiarthroplasty.     

Intracapsular fractures of the femoral neck in young patients

The details of the aetiology, treatment and outcome of acute intracapsular fractures for 58 fractures in 57 patients aged less than 60 years, were prospectively studied. The majority of the injuries were sustained by low energy trauma. Eighty-four per cent united uneventfully. There was a non-union rate of 7 per cent, and avascular necrosis rate of 10 per cent. Better results were obtained from closed than open reduction. The results do not support the commonly held view that this injury carries a poor prognosis in young patients.     

Outcomes of elderly patients with nondisplaced femoral neck fractures

Seventy patients with nondisplaced femoral neck fractures treated by cannulated screw fixation were followed up prospectively for 6 months. Preinjury Functional Independence Measure scores and comorbidities were recorded as were operative time, type of anesthesia, estimated blood loss, transfusions, and postoperative complications. Functional Independence Measure scores were reassessed at 3 and 6 months. The mean age of the patients was 78 years. The 6-month mortality was 5.7%. The mean overall Functional Independence Measure scores at 3 and 6 months were 86% and 89% of the initial score respectively. Locomotion Functional Independence Measure scores at 3 and 6 months were 73% and 89% of the initial score, respectively. Multiple regression analysis found patient age and initial overall Functional Independence Measure score to be independent predictors of overall, locomotion, and transfer Functional Independence Measure scores at 3 months. At 6 months, only initial Functional Independence Measure score predicted ultimate Functional Independence Measure scores. This suggests that patient age may affect the speed of recovery but not the ultimate functional result. Of comorbidities, only chronic obstructive pulmonary disease significantly affected functional recovery at 3 months, but not at 6 months. Operative time, estimated blood loss, type of anesthesia, and patient gender did not affect functional outcomes. Patients who sustain a nondisplaced femoral neck fracture experience predictable and lasting loss of function. Low initial functional status predicts a poorer outcome. Age and pulmonary comorbidity affect speed of recovery.     

儿童股骨颈骨折的治疗

目的 探讨儿童股骨颈骨折的治疗方法及其疗效.方法 回顾性分析1986年1月至2007年12月收治的23例儿童股骨颈骨折患儿,男13例,女10例;年龄3～16岁,平均12.8岁.前10年的13例均为高能量损伤;近10年中5例为滑倒跌伤,对其中3例测量身体质量指数和骨矿物质密度.无移位骨折4例,采用非手术治疗;手术治疗19例,其中闭合复位15例、切开复位4例.手术距受伤时间小于24 h者15例(平均11.2 h),超过24 h者4例(1 d后1例、5 d后1例、7 d后1例、3周后1例).闭合复位中关节穿刺减压11例,关节囊切开减压4例.复位采用1～3枚空心螺钉内固定18例,角钢板固定1例.术后以髋关节支具保护.定期随访X线及MRI,评估骨折愈合及股骨头坏死情况.结果 全部患儿均获随访,随访时间13个月～11年,平均4年.保守治疗的4例患儿,术后出现髋外翻1例、肢体短缩畸形1例.手术治疗的19例患儿,18例骨折复位好,一期愈合,其中轻度髋内翻1例、髋外翻1例;1例复位欠佳患儿出现骨折延迟愈合,经再次手术翻修和植骨后愈合.无一例患儿发生股骨头坏死.受伤超过24 h接受手术治疗的4例患儿,1例发生延迟愈合.轻微外伤患儿的身体质量指数和骨矿物质密度均属于偏低或极低范围.结论 儿童股骨颈骨折应早期诊断、早期治疗,争取受伤24 h内采用闭合或切开复位及钛制空心螺钉内固定,配合关节囊穿刺或切开减压,术后以髋关节支具保护.儿童股骨颈骨折受伤机制的改变可能与儿童身体质量指数和骨矿物质密度改变有关.     

人工髋关节置换术治疗股骨颈骨折合并帕金森病的疗效

目的探讨对合并帕金森病的股骨颈Garden Ⅲ或Ⅳ型骨折患者进行关节置换的临床疗效及安全性。方法本组自2006年3月至2009年10月收治股骨颈骨折合并帕金森病患者29例,除2例70岁以下的Ⅱ期患者采用全髋关节置换以外,其余27例均采用人工双极股骨头置换术。所有病例均采用后方入路进行手术,其中17例行内收肌切断术。结果 29例患者中2例分别于术后7个月和9个月死亡。17例帕金森病Ⅱ期和Ⅲ期患者术后站立时间平均为11d,而Ⅳ和Ⅴ期平均下地站立时间为术后21d。并发症中肺部炎症多见,有8例出现咳痰无力和肺炎等。发生脱位1例。术后Harris评分优5例,良13例,可7例,差4例。结论对于合并帕金森病的股骨颈Garden Ⅲ或Ⅳ型骨折患者来说,人工双极股骨头置换是一种较好的选择。但此类患者手术风险大,术后康复难以配合,术后并发症及功能恢复不良发生率较高。     

Prevention of pressure sores in patients with fractures of the femoral neck

A critical appraisal was made of the incidence of pressure sores occurring in the sacral region of patients undergoing treatment for fractures of the neck of the femur in an acute orthopaedic unit. A prospective controlled study was then carried out to investigate the effectiveness of the 'Reston' flotation pad in the prevention of such sores in a similar group of patients.     

人工髋关节置换术治疗高龄股骨颈骨折

目的探讨高龄股骨颈骨折患者理想的治疗方案。方法采用人工髋关节置换治疗70岁以上高龄股骨颈骨折患者37例。结果 37例均获随访,时间6～24个月。患者术后2～3周均恢复行走活动,无1例死亡。按髋关节功能Harris评分标准：优20例,良12例,可3例,差2例,优良率达86%。结论人工髋关节置换术治疗高龄股骨颈骨折患者,可早期下地活动,防止因长期卧床而出现的呼吸道及泌尿系感染等并发症;能早期恢复关节功能,提高生存质量。