Intraoperative monitoring for safety of total hip arthroplasty using third-generation cementing technique

Background Controversies on the safety of the cement application between cemented and uncemented total hip arthroplasty （THA） have been existing for decades. The purpose of this study was to observe the changes in mean arterial pressure （MAP）, heart rate （HR） and oxygen pressure （PaO2） during cemented THA, and to evaluate the intraoperative safety of using the third-generation cementing technique and investigate whether the intraoperative risk is higher in acute femoral neck fracture patients than non-traumatic patients. Methods Forty-two patients who underwent cemented THA between November 2005 and September 2007 were prospectively included in this study. The third-generation cementing technique as vacuum mixing and pulsatile lavage was used strictly. The MAP and HR were monitored and documented during each operation. Blood gas analysis was performed at exposure, cup implantation, stem implantation and wound closure. MAP, HR and PaO2 were compared between pre- and post-cement application. Comparisons of MAP, HR and PaO2 between patients with acute femoral neck fracture and non-traumatic patiens were performed as well. Results No intraoperative cardiopulmonary complication occurred in these cases. No obvious changes were observed in MAP, HR and PaO2 after cement application. There was no significant difference in MAP, HR and PaO2 between acute femoral fracture patients （18 patients） and non-traumatic patients （24 patients）. Conclusions The results of this study suggested that the invasive blood pressure monitoring and blood gas analysis are essential for patients undergoing cemented THA, especially for patients with femoral neck fracture. The third-generation cementing technique is safe to use in THA. Chin Med J 2009; 122（2）： 174-177     

Free vascularized fibular grafting for treatment of old femoral neck fractures

The internal fixation failure for treatment of femoral neck fracture is mainly due to improper fixation, loss of fixation stability and premature ambulation. Bone nonunion and avascular osteonecrosis of the femoral head caused by the internal fixation failure for femoral neck fracture are always the complex topics in orthopedics.     

混合型髋关节置换治疗老年股骨颈骨折

目的 探讨混合型髋关节置换治疗老年股骨颈骨折的可行性.方法 2002年7月至2007年8月间,采用混合型人工全髋关节置换治疗股骨颈骨折患者96例,其中陈旧性骨折44例,新鲜骨折52例.结果 术后平均随访19个月,平均Harris评分由术前的36.8分增加到术后90.8分.新鲜与陈旧性骨折结果比较差异无统计学意义(P>0.05).结论 混合型人工髋置换术治疗老年股骨颈骨折能达到即时稳定,短期随访结果好. Abstract： Objective To assess the feasibility of primary hybrid total hip replacement in treating femoral neck fracture of elderly patients. Methods Between July 2002 and August 2007, ninety-six consecutive hybrid total hip arthroplasties were performed. Forty-four cases were old fracture and 52 cases were fresh fracture. Results All patients were followed up for 19 months average, the mean preoperative Harris hip score was 36.8 and Harris hip score for the last time or follow-up was 90.8.There was no statistically significant difference between fresh fracture and old fracture(P>0.05).Conclusions Hybrid total hip replacement in treating femoral neck fracture of elderly patients can achieve the immediate postoperative stability and has good short-term outcome.     

Hook-pin and compression screw in the treatment of femoral neck fractures. Clinical trial and biomechanical study.

One hundred and two patients with femoral neck fracture underwent combined hook-pin and compression screw fixation. Eighty-five patients were followed up for over 6 months. The fracture was united in 80 patients. The advantages of this method included less trauma, simple technique and firm internal fixation and early postoperative partial weight-bearing. Biomechanical study showed that this method is superior to Smith-Petersen nailing and two hook-pins methods. The sliding and continuous compression of this method promotes impaction and healing of the fracture.

     

Minimally invasive two-incision total hip arthroplasty: a short-term retrospective report of 27 cases

Background Total hip arthroplasty (THA) is widely applied for the treatment of end-stage painful hip arthrosis. Traditional THA needed a long incision and caused significant soft tissue trauma. Patients usually required long recovery time after the operation. In this research we aimed to study the feasibility and clinical outcomes of minimally invasive two-incision THA. Methods From February 2004 to March 2005, 27 patients, 12 males and 15 females with a mean age of 71 years (55–76), underwent minimally invasive two-incision THA in our department. The patients included 9 cases of osteoarthritis, 10 cases of osteonecrosis, and 8 cases of femoral neck fracture. The operations were done with VerSys cementless prosthesis and minimally invasive instruments from Zimmer China. Operation time, blood loss, length of incision, postoperative hospital stay, and complications were observed. Results The mean operation time was 90 minutes (80–170 min). The mean blood loss was 260 ml (170–450 ml) and blood transfusion was carried out in 4 cases of femoral neck fracture (average 400 ml). The average length of the anterior incision was 5.0 cm (4.6–6.5 cm) and of the posterior incision 3.7 cm (3.0–4.2 cm). All of the patients were ambulant the day after surgery. Nineteen patients were discharged 5 days post-operatively and 8 patients 7 days post-operatively. The patients were followed for 18 months (13–25 months). One patient was complicated by a proximal femoral fracture intraoperatively. No other complications, including infections, dislocations, and vascular injuries, occurred. The mean Harris score was 94.5 (92–96). Conclusions Two-incision THA has the advantage of being muscle sparing and minimally invasive with less blood loss and rapid recovery. However, this technique is time consuming, technically demanding, and requires fluoroscopy.     

全膝关节置换术后股骨颈骨折的临床处理

目的 探讨全膝关节置换(TKA)术后股骨颈骨折的危险因素、治疗方法及预后.方法 2003年1月至2009年8月,天津市人民医院关节外科和天津医科大学附属天津医院关节外科收治的TKA术后股骨颈骨折45例,男8例,女37例,年龄56～81岁,其中同侧股骨颈骨折组36例,对侧股骨颈骨折组9例,骨折距TKA时间1～10年,平均(26.2±1.8)个月.根据骨折部位和类型制定治疗方案,随访并记录术后髋关节Harris评分及并发症.结果 TKA术后股骨颈骨折发生率和骨质疏松成线性相关,同侧骨折组置换侧膝关节稳定程度低于对侧骨折组、未骨折组(P＜0.05＝.45例患者中死亡4例,41例获随访,时间2～7年,平均3.6年.空心钉内固定组12例中7例股骨头坏死.股骨头置换组20例:死亡3例,二次骨折3例.全髋关节置换13例:死亡1例,二次骨折1例.同侧股骨颈骨折空心钉内固定组Harris评分显著低于关节置换组(P＜0.05＝,全髋置换与股骨头置换组比较差异无统计学意义(P＞0.05).并发症:股骨头坏死7例行股骨头置换术,髋关节置换后二次骨折4例采用钢板及钢缆捆绑或LISS治疗.结论 TKA术后股骨颈骨折多由低能损伤所致,骨质疏松是其高危因素,膝关节失稳与同侧股骨颈骨折相关.临床可采用内固定或髋关节置换治疗,内固定术后易出现股骨头坏死,临床宜采用股骨头置换术.

Abstract：

Objective To investigate the risk factors, management and prognosis of femoral neck fracture post total knee arthroplasty (TKA). Methods From January 2003 to August 2009, 45 cases of femoral neck fracture post TKA were treated. There were 8 males and 37 females with an age range of 56 - 81 years old. Among them, there were ipsilateral (n =36) and contralateral (n =9) femoral neck fractures. Due to the fracture site and type, the treatment plans were formulated. And a follow-up was conducted to record the Harris hip score and complications. Results The incidence of femoral neck fracture following TKA and osteoporosis had a linear correlation. And the fracture rate increased with the aggravation of osteoporosis. The stability of ipsilateral fracture group was lower than those of contralateral fracture and no fracture groups. Except for 4 mortality cases, 41 patients were followed up for 2 to 7 years with an average period of 3.6 years. There were 12 patients in the cannulated screw fixation group. The outcomes were fracture healing ( n = 5 ) and femoral head necrosis ( n = 7 ). Twenty-five cases underwent femoral head replacement. And 3 died and second fracture occurred in 3 cases. Eight cases underwent total hip arthroplasty. And 1 died and there was 1 case of second fracture. The Harris scores of the cannulated screw fixation group was significantly lower than the hip replacement groups ( q test, P ＜ 0. 05 ). Complications: After internal fixation, 7 cases suffered femoral head necrosis and underwent femoral head replacement. And secondary fractures after hip replacement occurred in 4 eases and they were treated by plate and cable or LISS ( less invasive stabilization system) systen. Conclusion Femoral neck fracture following TKA is usually caused by a low-energy injury. Osteoperosis is one of its high-risk factors. Knee instabihty is associated with ipsilateral femoral neck fracture. Clinically it can be treated by internal fixation or hip arthroplasty. And internal fixation of femoral neck fracture frequently induces femoral head necrosis. And femoral head replacement is applicable.     

Arch structure of trabeculae of the upper femoral end and its biomechanical significance in hip fractures.

We studied ultrnstrncturally the cancellous bone tissues of the upper femoral ends, collected from 12 patients undergoing endoprosthesis replacement for fractures of the femoral neck and from 7 fresh cadavers. The bone tissues were composed of meshwork of trabeculae, that constituted tier upon tier of anisotropic arch structures of different diameters and sizes. The arch structures of the cancellous bone tissues in the femoral heads assumed round or roundish configurations, whereas those of the femoral head-neck junctions revealed oval outlines and those of the femoral necks showed narrow oval pro files. The fine structures of the trabeculae in the femoral head could be divided into superficial zone, central zone, and transitional zone. Under weight-bearing, the central zone suited to sustain the load, while the superficial zone could produce elastic deformation lest fracture of the trabecaulae should en sue. The long axes of the oval arch structures of the femoral head-neck junction and the narrow oval     

Bone joint

<正>209364 Clinical observation on the different treatments targeted at different types of radial head fracture and radial neck fracture/Zhang Yingze(张英泽,Emergency Center Traumatic Orthop,3rd Hosp Hebei Med Univ,Shijiazhuang 050051)…∥Chin J Surg.-2009,47(12).-896～898Objective To assess the effect of the different treatments targeted at different types of radial head fracture and radial neck fracture.Methods A retrospective study was performed in 87 patients from February 2006 to March 2007.Fifty(four patients with radial head fractures included 36 males and 18 females,aged from 18 to 65 years (the average age was 33);Forty of them resulted from crashing,8 from traffic injury and 6 from falling injury.According to Mason classification system,there were 15 type Ⅰ,23 type Ⅱ and 16 type Ⅲ.Thirty-three patients with radial neck fractures included 21 males and 12 females,aged from 9 to 17 years (the average age was 13),29 of them resulted from crashing,1 from traffic injury and 3 from falling injury.According to O’brien classification system,there were 8 type Ⅰ,14 type Ⅱ and 11 type Ⅲ.Type Ⅰ of radial head fractures and tadial neck fractures were immobilizated with cast,the patients with type Ⅱ of radial head fractures were treated with open reduction and micro-screw or T-trapezoid and bridge-shaped plate fixation and type Ⅲ had operations to fix with bridge-shaped locked plated and repair the broken annular ligament,or replace heads with prosthesis.All patients with type Ⅱ and type Ⅲ of radial neck fractures were treated with closed reduction by leverage and percutaneous intra-medullary nailing.Results The patients were followed up for 4-12 months (mean 7.2 months).The functional recovery degrees were evaluated with Wheeler’s evaluation system.In group of radial head fractures,the results were excellent in 26 patients,good in 20,fair in 6 and poor in 2,the excellent and good rate was 85.2%.In group of radial neck fractures,the results were excellent in 20 patients,goo     

Clinical analysis of valvuloplasty on treatment of infective endocarditis

<正>Objective To discuss the hip fracture in elderly patients with nosocomial infection,to take effective prevention and control measures. Methods Retrospective analysis of data of the elderly hip fracture combined with nosocomial infection during 2009 - 2010 was performed. Results A total of 180 cases of femoral neck fractures     

附加钢板在治疗股骨干骨折髓内钉固定后肥大性骨不连中的应用：与更换钢板的比较

Background Augmentation plating has been used successfully to treat hypertrophic non-union after nail fixation.This study compared the efficacy of augmentation plating and exchange plating for treating hypertrophic non-union of femoral shaft fracture after intramedullary nail fixation.Methods A total of 12 patients received augmentation plating and 15 patients received exchange plating as treatment for femoral shaft hypertrophic non-union.The procedures were conducted at our medical centre between January 2005and January 2012.Clinical follow-up was conducted at 2 weeks,1 month and then monthly until union was achieved to compare union time,operation time,bleeding and complications between the two groups.Results All patients underwent follow-up examinations until fracture union was achieved.The average length of followup time after the second treatment was （18.37±3.28） months.The time needed for union was （4.17±0.94） months in the augmentation plating group and （5.33±1.72） months in the exchange plating group.The operation time was （90.00±17.58） minutes in the augmentation plating group and （160.00±25.35） minutes in the exchange plating group.The amount of blood loss during the operation was （270.00±43.32） ml in the augmentation plating group and （530.00±103.65） ml in the exchange plating group.Both groups showed significant difference （P 〈0.05） in their results.No complications were reported after the second operation.Conclusions Augmentation plating after nail fixation could remove local rotation instability,facilitate simple operation,create minimal damage and enable exercise for early functional recovery.Therefore,augmentation plating is excellent for treating hypertrophic non-union after nail fixation in femoral shaft fracture.     

人工股骨头置换术治疗高龄股骨颈骨折

目的：探讨人工股骨头置换术治疗高龄股骨颈骨折的临床疗效。方法：对12例年龄80～92岁股骨颈骨折患者(头下型9例。经颈型3例)。采用人工股骨头置换术。结果：所有病人均安全度过手术期，无切口感染及严重并发症发生，优良率为91．67％。结论：人工股骨头置换术治疗高龄股骨颈骨折，只要高度重视围手术期的处理。不失为治疗效果良好的方法。     

小切口人工股骨头置换术治疗高龄股骨颈骨折

目的：总结人工股骨头置换术治疗75岁以上高龄老人股骨颈骨折的疗效。方法：2003年12月～2006年12月,45例75岁以上老年股骨颈骨折患者,男24例,女21例,采用改良小切口骨水泥型人工股骨头置换术治疗。结果：平均住院20.6d,患者3周能早期下床活动,住院期间内无一例死亡,按Harris评分为91.3分。结论：人工股骨头置换术是治疗超高龄老人股骨颈骨折的最适当选择。     

生物型双极人工股骨头置换治疗高龄股骨颈骨折的疗效观察

目的观察双极人工股骨头置换治疗老年人股骨颈骨折的疗效。方法回顾性分析应用双极人工股骨头置换治疗16例老年股骨颈骨折患者的临床资料。按Garden分型：Ⅱ型1例,Ⅲ型10例,Ⅳ型5例。结果平均手术时间75min,术中平均出血量200ml。16例患者均获随访,随访时间15～36个月,平均22个月;按Harris髋关节功能评分标准：优12例,良2例,可1例,差1例,优良率为87.5%结论双极人工股骨头置换术是治疗高龄老年股骨颈骨折的良好方法,可在临床推广应用。     

生物型双极人工股骨头置换治疗高龄股骨颈骨折的疗效观察

目的探讨应用双极人工股骨头置换治疗老年人股骨颈骨折的疗效。方法回顾性分析1999年3月至2007年7月应用双极人工股骨头置换治疗16例老年股骨颈骨折患者的临床资料。按Garden分型：Ⅱ型1例,Ⅲ型10例,Ⅳ型5例。结果平均手术时间为75min,术中平均出血量为200mL。16例患者均获随访,随访时间l5～36个月,平均22个月;按Harris髋关节功能评分标准：优12例,良2例,可1例,差1例。结论双极人工股骨头置换术是治疗高龄老年股骨颈骨折的良好方法。     

全髋关节和双极人工股骨头置换术用于老年股骨颈骨折治疗的对比观察

目的比较全髋关节和双极人工股骨头置换术用于老年股骨颈骨折治疗的疗效。方法选取我院行手术治疗的老年股骨颈骨折患者84例,随机分为观察组和对照组,观察组行全髋关节置换术,对照组行双极人工股骨头置换术,比较两组效果。结果观察组总并发症发生率为4．76％,对照组总并发症发生率为21．43％,观察组手术时间、术中出血量和住院时间明显多于对照组（P〈0．05）。结论全髋关节和双极人工股骨头置换术用于老年股骨颈骨折治疗,各有其优越性。     

髋关节成形术治疗老年股骨颈骨折

目的:介绍一种老年人工股骨头置换术的改进方法。方法:2005年3月～2007年3月,采用Gibson人路,保留髋关节囊和旋后肌群,对26例新鲜的老年股骨颈骨折行人工股骨头置换术。结果:26例患者手术时间为45～65分钟,平均53分钟。术中最多出血量为230ml,平均出血量为120ml。所有患者经11个月～24个月随访,平均19个月,术后均未发生远近期髋关节脱位、切口感染及假体松动。术后6、12个月随访时采用髋关节功能评分,分别为92.7分和95.1分。测量双下肢长度患肢比健肢平均长0.4cm。结论:后外侧切口保留关节囊和旋后肌群的人工股骨头置换术,保留了髋关节的外旋力量和关节囊后外侧软组织,重建了髋关节软组织平衡,增加术后髋关节的稳定性,能够更好地恢复髋关节的功能。     

Cemented hemiarthroplasty in traumatic displaced femoral neck fractures and deep vein thrombosis: is there really a link?

INTRODUCTION

Traumatic displaced femoral neck fractures in the elderly can be treated with cemented or uncemented hemiarthroplasty with good outcomes. Earlier studies reported a higher incidence of deep vein thrombosis (DVT) associated with cemented prostheses in elective total hip or knee arthroplasty. In addition, the hypercoagulable state after a traumatic femoral neck fracture and possible thrombogenic properties of bone cement could put these patients at greater risk for thromboembolism. We aimed to compare the incidence of DVT and progression to pulmonary embolism (PE) or mortality in cemented and uncemented hemiarthroplasty.

METHODS

The data of 271 patients treated with cemented or uncemented hemiarthroplasty after a traumatic displaced femoral neck fracture was retrospectively analysed for the incidence of DVT. The level of thrombosis, progression to PE and mortality were compared.

RESULTS

There were 133 (49.1%) patients with cemented hemiarthroplasty, while 138 (50.9%) had uncemented hemiarthroplasty. The patients had an average age of 76.6 (range 53–99) years and 11 (4.1%) patients had DVT. There were no significant differences in development of DVT, level of thrombosis, PE and mortality regardless of whether a cemented or an uncemented prosthesis was used.

CONCLUSION

Cemented hemiarthroplasty is not associated with higher risks of DVT, PE or mortality in patients with traumatic displaced femoral neck fracture. Cemented prostheses can be safely used for this group of patients.     

Early result of hemiarthroplasty in elderly patients with fracture neck of femur

Background:

Fractured neck of femur is a frequent and severe injury in elderly patients with consequent high morbidity and mortality. Hemiarthroplasty is an established treatment modality for displaced intracapsular femoral neck fractures in elderly patients above 60 years. This study analysed the early functional outcome and complications of Austin Moore endoprosthesis in elderly patients above 60 years with fractured neck of femur.

Materials and Methods:

Retrospective data were obtained over a 5 year period from January 2007 to December 2012. Thirty-five elderly patients of 60 years and above with displaced intracapsular fracture neck of femur treated with hemiarthroplasty using Austin Moore endoprosthesis were included. Data were analysed using SPSS version 21.

Results:

A total of 35 patients were involved. The age-range was 60-90 years with mean age of 69.7 ± 7 years. The predominant mechanism of injury was trivial falls in 18 (66.7%) patients. The commonest complication was pressure sore in 2 (5.7%) patients, followed by surgical site infection in 1 (2.9%) patient and periprosthetic fracture in 1 (2.9%) patients. Early post-operative mortality was 2.9%. Post-operative hip functional status according to Postel and Merle d Aubigne revealed that majority (66.6%) of patients had satisfactory hip function.

Conclusion:

Functional outcome of Austin Moore in elderly patients above 60 years with fracture neck of femur was satisfactory in most of the cases with minimal morbidity. Careful patient selection for hemiarthroplasty is vital and may decrease the incidence of complications and ameliorate the outcomes in the treatment of intracapsular femoral neck fractures.     

人工髋关节置换治疗高龄股骨颈骨折

目的: 探讨人工髋关节置换治疗高龄股骨颈骨折的可行性、安全性,提出围手术期处理方法和关节置换方式。方法: 回顾分析2000年3月~2006年9月人工关节置换治疗70岁以上的股骨颈骨折26例的疗效及并发症情况,比较两组人工股骨头置换组20例和全髋置换组6例的平均住院时间、手术时间、术中和术后出血量、输血量、Harris评分、下地时间等的差异。结果: 两组术中、术后均无病死,Harris评分平均改善38.2分,优良率为88.46%,并发症发生5例,发生率19.23%;人工股骨头置换组在手术时间、术中、术后出血量、输血量均明显低于全髋置换组(P<0.01~P<0.001),而Harris评分、下床时间和住院时间两组差异均有统计学意义(P<0.001和P<0.01)。结论: 对高龄股骨颈骨折患者,人工关节置换为有效的治疗方式,能显著改善患者的生存质量,只要经过正确的围手术期处理,该类患者能度过围手术期,取得良好的治疗效果;两种手术方式中人工股骨头置换更适合80岁以上高龄股骨颈骨折患者。     

双极股骨头与全髋关节置换术的疗效比较

目的 比较老年股骨颈骨折患者实施双极股骨头与全髋关节置换术后的疗效.方法 选用笔者科室2009年5月～2013年5月收治的196名老年股骨颈骨折的患者,分别实施双极股骨头与全髋关节置换术;临床和影像学检查随访4年,手术并发症、髋关节功能及髋臼的侵蚀程度在两组均被记录.结果 随访到第4年时,在双极股骨头置换术组,对患者进行了X线片评估,10人出现了髋臼的侵蚀,占12.0％（10/83）.在随访第4个月时,全髋关节置换术组的髋关节Harris评分优于双极股骨头置换术组,并持续到随访的第4年（P＜0.05）,在随访的第1年时,全髋关节置换术组的髋关节功能评分、髋关节疼痛程度评分及髋关节功能均优于双极股骨头置换术组,并持续到随访的第4年（P＜0.05）.结论 对于老年股骨颈骨折患者的术式选择应遵循个体化原则,对没有认知功能障碍、全身状态较好、预期寿命较长及活动量大的患者可实施全髋关节置换术,术后髋关节功能优于双极股骨头置换术.