老年髋关节骨折手术治疗死亡率分析

目的 总结老年髋关节骨折手术治疗的术后死亡率,探讨术后患者死亡的原因. 方法 对1999年3月至2008年1月得到随访的349例老年(60～98岁)髋关节骨折手术治疗患者进行回顾性研究,总结总体死亡率和术后1年内死亡率,分析其构成特点及术后患者死亡的原因. 结果 手术治疗老年髋关节骨折术后死亡率为8.9%(31/349),术后1年内死亡率为5.4%(19/349).围手术期死亡3例,随访期内死亡28例.死亡原因依次为心血管事件(7例)、呼吸功能衰竭(7例)、慢性疾病引起的多器官功能衰竭(5例)、肿瘤(5例)、脑血管疾病(2例)、肝硬化(2例)、感染中毒性休克(1例)、脑外伤(1例),另1例原因不详.统计结果 显示年龄、性别是影响死亡率的主要因素,股骨近端防旋髓内钉内固定患者死亡率(1.8%)低于股骨近端髓内钉固定患者(17.8%),差异有统计学意义(X2=9.407,P=0.006);女性患者的股骨颈骨折发生率(59.4%)明显高于男性(41.6%),差异有统计学意义(X2=10.040,P=0.006). 结论 与相关文献比较,手术治疗老年髋关节骨折能够获得较低的死亡率.完善术前准备,选择微创的手术方法 有助于降低死亡率.     

Bipolar versus fixed-head hip arthroplasty for femoral neck fractures in elderly patients

Between 2002 and 2007, fifty elderly patients with displaced femoral neck fractures were treated with hip replacement at Emergency Hospital, Mansoura University. Patients were randomly selected, 25 patients had either cemented or cementless bipolar prosthesis, and another 25 patients had either cemented or cementless fixed-head prosthesis. There were 34 women and 16 men with an average age of 63.5 years (range between 55 and 72 years). All patients were followed up both clinically and radiologically for an average 4.4 years (range between 2 and 6 years). At the final follow-up, the average Harris hip score among the bipolar group was 92 points (range between 72 and 97 points), while the fixed-head group was 84 points (range between 65 and 95 points). Radiologically, joint space narrowing more than 2 mm was found in only 8% (2 patients) among the bipolar group, and in 28% (7 patients) of the fixed-head group. Through the follow-up period, total hip replacement was needed in two cases of the bipolar group and seven cases of the fixed-head group. Bipolar hemiarthroplasty offered a better range of movement with less pain and more stability than the fixed-head hemiarthroplasty in elderly patients with displaced femoral neck fractures.     

广州市2888例骨质疏松髋部骨折多中心住院患者医疗资源分析

目的 通过分析过去5年广州市骨质疏松髋部骨折多中心住院患者的基本情况与住院费用结构,了解骨质疏松性髋部骨折住院患者的基本情况及其所需要的医疗资源.方法 2003年1月至2007年12月在广州中医药大学第一、第二附属医院,中山大学附属第二医院与广州医学院第三附属医院共收治2888例年龄≥50岁的髋部骨折住院患者.采用描述性统计分析等方法,回顾分析患者的年龄结构、性别构成、住院时间与住院费用等.结果 过去5年髋部骨折患者住院人数基本维持稳定.每年女性患者人数均显著高于男性患者,男女患者总人数比为1:2.患者最大年龄为111岁,平均年龄为(76.83±9.53)岁.各个年龄段中,以70～79岁与80～89岁年龄段的患者人数最多,分别占总人数的38.09%和34.63%.平均住院时间为(24.23±14.30)d,各个年龄段患者住院时间差异无统计学意义(P＞0.05).低年龄段(50～79岁)股骨颈骨折显著多于转子问骨折(P＜0.01),90岁以上股骨颈骨折少于转子问骨折(P＜0.05).住院总费用平均为(2.65±1.53)万元,其中治疗费用(含内置物)占55.79%,药费占23.69%,手术费用占6.02%,床位费用占4.83%,化验费用占4.07%,检查费用占2.48%,输血输氧及其他占1.79%,放射费用占0.91%,护理费用占0.43%.近5年来,总住院费用平均每年递增1.22%.结论 过去5年骨质疏松髋部骨折住院患者人数基本保持在同一水平,所需医疗费用增幅较小.女性占全部患者的2/3,是今后防治骨质疏松工作的重点.有效控制内置物费用及药费是减少髋部骨折医疗资源、减轻患者与社会经济负担的有效途径.     

双动人工股骨头与全髋关节置换治疗高龄股骨颈骨折的疗效比较

目的 比较双动人工股骨头置换与全髋关节置换治疗高龄股骨颈骨折的疗效，明确双动人工股骨头置换治疗高龄股骨颈骨折的优越性。方法 对1996年1月-2000年1月采用人工髋关节置换治疗的高龄股骨颈骨折87例进行回顾性分析，其中双动人工股骨头置换(FHR)56例，平均随访4年1个月，全髋关节置换(THR)31例，平均随访4年3个月。结果 FHR组术中出血量明显少于THR组，手术时间明显短于THR组，术后早期并发症的发生率明显少于THR组，且两组Harris功能评分无明显差异。结论 高龄股骨颈骨折采用双动人工股骨头置换的手术安全性高，术后并发症少，关节功能好，疗效满意，应优先选用。     

髋部股骨转子间骨折的分型与治疗策略

正2000年全球统计约160万例患者发生髋部骨折,其中20%的骨折患者年龄50岁~([1])。预计到2025年,每年会有约260万患者发生髋部骨折,1年内的死亡率可高达30%~([2])。髋部骨折是全球10大致残疾病之一~([3-4])。由于几乎大部分的髋部骨折患者都需要选择手术治疗,髋部骨折的治疗一     

单极与双极人工股骨头置换(用或不用骨水泥)治疗老年股骨颈骨折

目的：比较单极与双极人工股骨头置换术(用或不用含水泥)治疗老年股骨颈骨折的疗效。方法：自1990年1月至2001年12月住院治疗的股骨颈骨折病例中，选择年龄、性别、随访时间均相仿的病例分为四组。A组为骨水泥型双极人工股骨头置换术患者40例；B组为非骨水泥型双极人工股骨头置换术患者45例；C组为骨水泥型单极人工股骨头置换术患者42例，D组为非骨水泥型单极人工股骨头置换术患者45例，进行回顾性分析。结果：比较四组住院时间、扶双拐下地活动时间、出院时功能评估、远期并发症、髋臼磨损和再手术率，无显著性差异(P＞0．05)。A组和C组的手术时间长、失血量大，分别与B组和D组相比，有显著性差异(P＜0．05)。随访中发现双极假体置换A组和B组步速明显快于单极假体置换C组和D组，有显著性差异(P＜0．05)。未应用含水泥的B组和D组，患者镇痛率多于应用骨水泥的A组和C组，但并不影响治疗效果的评价。四组功能评价优良率为：A组90．0％，B组84．4％，C组88．1％，D组82．2％，无显著性差异(P＞0．05)。结论：人工股骨头置换术是治疗老年人股骨颈骨折的有效方法，可促使者年人早期活动，提高生活质量。本组资料表明四种置换方法无明显差异，对要求术后有较快步行能力的老年患者，应选择双极人工股骨头置换，如有明显骨质疏松和股骨上段髓腔骨皮质薄弱情况的老年患者，骨水泥的应用是必需的。     

Posterior dislocation of the hip with ipsilateral displaced femoral neck fracture

Traumatic posterior dislocation of hip associated with ipsilateral displaced femoral neck fracture is a rare injury. Moreover, the management of such patients evokes strong views regarding primary replacement or preserving the femoral head. We presented a case of young adult with such an injury. He was operated upon with reduction of the dislocation and fixation of femoral neck fracture with the help of cancellous screws. Two years later, the fracture had united and the patient was asymptomatic. We further proposed the mechanism of injury for such a fracture and discussed the management in the changing trauma scenario of the developing world.     

Medium-term mortality after hip fractures and COVID-19: A prospective multi-centre UK study

PurposeThe COVID-19 pandemic has caused 1.4 million deaths globally and is associated with a 3–4 times increase in 30-day mortality after a fragility hip fracture with concurrent COVID-19 infection. Typically, death from COVID-19 infection occurs between 15 and 22 days after the onset of symptoms, but this period can extend up to 8 weeks. This study aimed to assess the impact of concurrent COVID-19 infection on 120-day mortality after a fragility hip fracture.MethodsA multi-centre prospective study across 10 hospitals treating 8% of the annual burden of hip fractures in England between 1st March and 30th April, 2020 was performed. Patients whose surgical treatment was payable through the National Health Service Best Practice Tariff mechanism for “fragility hip fractures” were included in the study. Patients’ 120-day mortality was assessed relative to their peri-operative COVID-19 status. Statistical analysis was performed using SPSS version 27.ResultsA total of 746 patients were included in this study, of which 87 (11.7%) were COVID-19 positive. Mortality rates at 30- and 120-day were significantly higher for COVID-19 positive patients relative to COVID-19 negative patients (p < 0.001). However, mortality rates between 31 and 120-day were not significantly different (p = 0.107), 16.1% and 9.4% respectively for COVID-19 positive and negative patients, odds ratio 1.855 (95% CI 0.865–3.978).ConclusionHip fracture patients with concurrent COVID-19 infection, provided that they are alive at day-31 after injury, have no significant difference in 120-day mortality. Despite the growing awareness and concern of “long-COVID” and its widespread prevalence, this does not appear to increase medium-term mortality rates after a hip fracture.     

股骨颈骨密度和股骨颈轴长与老年 髋部骨折的关系

目的 探讨股骨颈骨密度、股骨颈轴长与髋部骨折的关系，了解股骨颈骨密度、股骨颈轴长预测骨折的能力。方法 通过双能Ｘ线吸收骨密度测量仪测量髋部骨折组患者和同龄男女非骨折对照组的股骨颈轴长、股骨颈骨密度，分析比较两种测量指标预测股骨颈骨折的敏感性。结果 不同性别骨折组患者的股骨颈骨密度均明显低一南年龄、同性别对照组，差异有非常显著性意义（Ｐ〈０．０１），而骨折组与非骨折组男女股骨颈轴和莘差异无显著性意义     

Treatment of ipsilateral hip and femoral shaft fractures with reconstructive intramedullary interlocking nail

Objective: To evaluate the results of reconstructive intramedullary interlocking nail in the treatment of ipsllateral hip and femoral shaft fractures. Methods: From August 1997 to November 2001, 13 patients were treated with the reconstructive intramedullary interlocking nail. Nine patients were associated with ipsllateral femoral neck fractures, three with ipsilateral intertrochanteric fractures, and one with subtrochanteric fracture. Results: The follow-up time was from 6 to 38 months with an average of 14 months. All the femoral shaft and hip fractures healed up well. There was no nonunion of the femoral neck, and only one varns malunion. No patient had avascular necrosis of the femoral head. The average healing time for femoral neck fracture was 4.6 months and for shaft fracture 5.8 months. The joint movement and other functions were fairly resumed. Conclusions: The reconstructive intramedullary interlocking nail, with less trauma, refiable fixation, and high rate of fracture healing, is an ideal method of choice in the treatment of ipsilateral hip and femoral shaft fractures.     

Ten years of hip fractures in Italy: For the first time a decreasing trend in elderly women

AIM:To evaluate the hospitalization rate of femoralneck fractures in the elderly Italian population over ten years.METHODS:We analyzed national hospitalizations records collected at central level by the Ministry of Health from 2000 to 2009.Age-and sex-specific rates of fractures occurred at femoral neck in people≥65 years old.We performed a sub-analysis over a three-year period(2007-2009),presenting data per five-year age groups,in order to evaluate the incidence of the hip fracture in the oldest population.RESULTS:We estimated a total of 839008 hospitalizations due to femoral neck fractures between 2000 and2009 in people≥65,with an overall increase of 29.8%over 10 years.The incidence per 10000 inhabitants remarkably increased in people≥75,passing from158.5 to 166.8(+5.2%)and from 72.6 to 77.5(+6.8%)over the ten-year period in women and men,respectively.The oldest age group(people85 years old)accounted for more than 42%of total hospital admissions in 2009(n=39000),despite representing only 2.5%of the Italian population.Particularly,women aged85accounted for 30.8%of total fractures,although they represented just 1.8%of the general population.The results of this analysis indicate that the incidence of hip fractures progressively increased from 2000 to 2009,but a reduction can be observed for the first time in women≤75(-7.9%between 2004 and 2009).CONCLUSION:Incidence of hip fractures in Italy are continuously increasing,although women aged 65-74years old started showing a decreasing trend.     

Surgical treatment of femoral shaft fractures after total or hemiarthroplasty of the hip

Abstract We report the clinical and radiographical results of surgical treatment of 45 patients with femoral fractures after hip replacement, seen at the Orthopaedic and Trauma Center (CTO) of Florence from 1980 to 1997; fractures treated conservatively were excluded from this retrospective review. There were 30 fractures in patients with homolateral total hip prosthesis and 15 in patients with homolateral hemiarthroplasty of the hip. The mean age of the patients was greater in the second group than in the first group (79 vs. 72 years). Fractures were classified according to Duncan and Masri as types B1 (n=16), B2 (n=13), B3 (n=10) and C (n=6). They were treated surgically by open reduction and internal fixation (ORIF) using cerclage (n=9), plates and screws (n=19), or plates and cerclage (n=2), or revision procedure using long, non-cemented stems (n=13) and a two stages revision in procedure in two cases in whom fractures occurred because of deep infection. At follow-up we evaluated healing, complications, leg length discrepancies, thigh pain, and the patients subjective satisfaction. We found non-union only in 1 case (2.4%). Our results confirm the strict correlation between surgical indications and clinical results: ORIF can be safely proposed only if the stem is well fixed. In fact, all 6 unsatisfactory outcomes (14.3%) were due to technical errors during the surgical procedures: the fractures healed (ORIF was correctly performed) but the stems were unstable and continued to give pain and discomfort.     

Effect of dynamic hip screw on the treatment of femoral neck fracture in the elderly

[Abstract] Objective： To discuss the indications, surgical procedures, and curative effect of dynamic hip screw （DHS） in the treatment of femoral neck fracture in the elderly. Methods： A retrospective study was conducted to analyse the clinical data of 42 elderly patients who had been treated for femoral neck fracture with DHS in our department between June 2009 and November 2011. There were 21 males and 21 females with a mean age of 68.5 years （range 60-75 years）. According to the Garden Classification, there were 19 cases of type II, 21 cases of type III and 2 cases of type IV fractures. By the Singh In- dex Classification, there were 3 cases of level 2, 19 cases of level 3 and 20 cases of level 4 fractures. The Harris cri- terion, complications and function recovery after operation were analysed. Results： The average hospitalization time in 42 patients was 11.2 days （range 7-21 days）. All patients were followed up for 12-26 months （mean 18 months）. No lung infection, deep venous thrombosis or other complications occurred. Partial backing-out of the screws was found in 2 cases. The internal fixation device was with- drawn after fracture healing. Internal fixation cutting was found in 1 case, and he had a good recovery after total hip arthroplasty. The time for fracture healing ranged from 3-6 months （average 4.5 months）. According to Harris criteri- on, 15 cases were rated as excellent, 24 good, 2 fair and 1 poor. The Harris scale was significantly improved from 30.52＋2.71 preoperatively to 86.61＋2.53 at 6 months post- operatively （P〈0.05）. Conclusion： DHS, being minimal invasive, al- lowing early activity and weight-bearing, is advisable for treatment of elderly patients with femoral neck fracture. In addition, it can avoid complications seen in artificial joint replacement. It is especially suitable for patients with mild osteoporosis.     

Pre-operative digital templating in cemented hip hemiarthroplasty for neck of femur fractures

Pre-operative digital templating allows the surgeon to foresee any anatomical anomalies which may lead to intra-operative problems, and anticipate appropriate instruments and implants required during surgery. Although its role is well-established in successful elective total hip arthroplasty, little work has been done on its use in hip hemiarthroplasty in neck of femur fractures. We describe our initial experience of digital templating in 40 consecutive patients who have undergone cemented hip hemiarthroplasty, assessing templating accuracy between templated implant sizes to actual implant sizes. 81% of implanted heads were templated to within two head sizes, and 89% of implanted stems were templated to within two sizes. Although there was a moderately strong correlation of 0.52 between templated and actual head sizes, this correlation was not demonstrated in femoral stem sizes. Mean leg length discrepancy was −2.5 mm (S.D. 8.5), and the mean difference in femoral offset between the operated and non-operated hip was −1 mm (S.D. 4.4). Digital templating is a useful adjunct to the surgeon in pre-operative planning of hip hemiarthroplasty in the restoration of leg length and femoral offset. However, its accuracy is inferior to that of elective total hip arthroplasty.     

老年人股骨颈骨折髋关节置换疗效分析

目的 :评价老年人股骨颈骨折髋关节置换临床疗效 ,探讨有关假体选择、并发症、手术时机把握等问题。方法 :回顾分析 1995～ 2 0 0 2年收治的 62例 70岁以上老年人股骨颈骨折应用髋关节置换的治疗方法及效果。结果 :随访 2 2～ 96个月 ,按照Harris[1] 评分标准进行评估显示 ,本组优良率为 83 .9%。全髋置换组明显优于半髋组 ,优良率为 93 .9% ,半髋组则为 46.2 %。结论 :(1)在并存症得到控制稳定后 ,及时地根据病人伤前生活质量来选择全髋或半髋置换是治疗高龄股骨颈骨折的首选方法 ;(2 )强调术中注意观察及处理麻醉开始、扩髓与灌注骨水泥这三个时段病情的变化 ;(3 )陈旧性股骨颈骨折病人术前不适宜牵引。     

Retrograde cement removal in periprosthetic fractures following hip arthroplasty

Introduction Revision of cemented hip arthroplasty after periprosthetic fractures of the femur is a demanding procedure. Many different technical devices have been developed for this purpose. This paper presents a new surgical technique of cement removal avoiding excessive exposure of the fracture site. Materials and methods In six patients with periprosthetic fractures of the femur following hip arthroplasty (Johansson Type II and III) cement removal was performed by means of advancing a retrograde nail through the intercondylar notch of the knee. Results In all cases the cement was removed completely. Intraoperative complications or significant knee problems were not observed. Conclusion The intracondylar approach provides a simple, rapid and less invasive technique for cement removal in revision hip arthroplasty.     

The role of primary total hip replacement for the treatment of the displaced femoral neck fractures

Summary The management of displaced intracapsular fractures of the hip is still controversial because of the high incidence of complications after internal fixation or hemiarthroplasty. To avoid some of these complications we have used primary total hip replacement for independently mobile patients over 65 years of age.Of 49 patients who were interviewed an average of 4.6 years after total hip replacement, 81.6% had excellent or good results as assessed by the Harris Hip Score. At that time two hips had been revised and another converted to Girdlestone due to deep infection. The survival of the prostheses was at 5 years 91.3%.It is concluded that total hip replacement is an established method of management for a selected group of patients with this injury, but further prospective studies are needed in order to define the groups of patients that benefit the most.     

股骨近端缩短及全髋置换术治疗陈旧股骨颈骨折伴严重髋关节脱位

目的 探讨陈旧股骨颈骨折伴严重髋关节脱位的有效治疗方法及临床疗效。方法 自1996年4月采用股骨近端缩短及全髋置换术治疗7例陈旧股骨颈骨折伴严重的髋关节脱位的患者。结果 7例患者平均为51岁,术后随访平均为27．3个月,在近期随访过程中,按Harris评分由手术前的36．7分增加至术后84．3分,髋臼及股骨柄假体位置良好,未出现假体松动和下沉,也未出现截骨处骨不愈合。结论 股骨近端缩短及全髋置换术治疗陈旧股骨颈骨折伴严重髋关节脱位,近期疗效十分满意,其后期疗效有待进一步随访观察。     

髋关节镜辅助下复位联合空心钉内固定治疗青壮年移位型股骨颈骨折

目的 探讨髋关节镜辅助下复位联合空心钉内固定治疗青壮年移位型股骨颈骨折的临床效果。方法 2011年3月至2016年2月我科采用髋关节镜辅助复位治疗43例青壮年移位型股骨颈骨折病人,男25例,女18例;年龄为21~47岁,平均年龄为38.5岁;Garden Ⅲ型26例,Ⅳ型17例。采用Garden指数评估骨折复位质量,髋关节Harris评分（hip Harris score, HHS）评估患髋功能,疼痛视觉模拟量表（visual analogue scale, VAS）评估患髋疼痛情况。结果 病例均获得随访,随访时间为（40±3）个月（21~80个月）。2例病人出现轻微退钉现象,均无骨折不愈合、复位丢失、髋内翻、内固定断裂等并发症发生。末次随访时均无骨折复位丢失,Garden指数Ⅰ级38例,Ⅱ级4例,Ⅲ级1例,优良率为97.7%;术后18个月的Harris髋关节评分,优29例,良10例,中3例,差1例,优良率为90.7%。术后18个月的Harris评分为（89.63±5.22）分,较术前的（53.42±6.71）分明显提高;VAS评分为（2.37±1.24）分,较术前的（7.85±1.33）分明显降低,差异均有统计学意义（P均＜0.05）。4例Garden Ⅳ型骨折病人出现股骨头坏死,复位质量采用Garden指数评估：Ⅰ级1例,Ⅱ级2例,Ⅲ级1例;股骨头坏死发生时间为术后1.3~3.8年,平均1.8年。结论 采用髋关节镜辅助复位联合内固定治疗青壮年移位型股骨颈骨折,手术创伤小,骨折复位满意,术后髋关节功能恢复良好,且能早期发现并处理关节内合并损伤,是一种安全可行的微创治疗方法。     

金对金解剖直径头微创全髋关节置换术治疗高龄股骨颈骨折的近期疗效对照研究

目的探讨金对金解剖直径头和常规小直径头(28mm)全髋关节置换(total hip arthroplasty,THA)微创技术治疗高龄股骨颈骨折患者的临床疗效。方法 2006年1月至2007年12月间因股骨颈骨折在我中心行微创全髋关节置换手术并获得完整资料的高龄(70岁)患者61例61髋,其中采用常规直径头股骨头全髋关节假体(对照组)30例30髋,采用金对金大直径股骨头全髋关节假体(观察组)31例31髋。分析两组术后2周、6周髋关节活动范围,术后2年假体脱位率以及Harris评分结果的差异。结果术后对照组脱位2例6次,观察组0例。观察组的Harris评分优秀率高于对照组;术后2周(除后伸动作外)和6周的髋关节活动度均大于对照组,两组比较,差异有统计学意义(P0.05)。结论采用金对金解剖直径头THA微创技术治疗高龄股骨颈骨折患者,具有术后早期髋关节稳定性提高、主动活动范围增加、术后脱位率降低等优点,近期疗效满意。