全髋和半髋关节置换术治疗老年股骨颈骨折疗效分析

目的 对比全髋关节置换术(THA)和半髋关节置换术(HA)治疗老年股骨颈骨折的疗效.方法 对103例股骨颈骨折分别采用THA和HA治疗(THA组42例,HA组61例),对两组手术时间、术中出血量、住院时间、术后Harris评分及并发症发生率进行统计分析.结果 THA组较HA组失血量多(t=6.176,P＜0.05)、手术时间长(t=14.596,P＜0.05)、住院时间长(t =7.349,P＜0.05);出院时两组Harris评分优良率差异有统计学意义,感染率、翻修率和脱位率差异无统计学意义,术后6个月两组差异均无统计学意义,术后3年THA组翻修率和慢性疼痛率较低,而脱位率高于HA组.结论 对老年股骨颈骨折应根据骨折的个体实际情况选择手术方式.     

全髋和半髋关节置换治疗老年股骨颈骨折的疗效比较

目的 比较全髋关节置换和半髋关节置换治疗老年GardenⅢ、Ⅳ型股骨颈骨折的疗效。方法 将86例老年股骨颈骨折患者根据治疗方法不同分为全髋组(采用全髋关节置换术,43例)和半髋组(采用半髋关节置换术,43例)。比较两组手术时间、术中出血量、输血例数、住院时间、术后并发症。采用髋关节Harris评分评价髋关节功能。结果 患者均获得随访,时间3～12个月。手术时间、术中出血量全髋组长(多)于半髋组(P 0. 05)。术后髋关节功能优良率全髋组高于半髋组(P 0. 05)。术后并发症发生率全髋组低于半髋组(P 0. 05)。两组住院时间、输血例数比较差异均无统计学意义(P 0. 05)。结论 全髋关节置换与半髋关节置换治疗老年股骨颈骨折各有优劣,需把握合适的适应证,根据患者的身体条件和对术后功能需求选择合适的手术方案。     

全髋与半髋关节置换治疗股骨颈骨折的临床效果

目的探讨全髋与半髋关节置换治疗股骨颈骨折的临床效果。方法将220例股骨颈骨折患者根据治疗方法不同分成全髋关节置换组(110例)和半髋关节置换组(110例)。比较两组手术情况和并发症发生率,采用Harris髋关节功能评分评价疗效。结果患者均获得随访,时间6～12个月。手术时间、术中出血量、术后下床时间全髋关节置换组均长(多)于半髋关节置换组(P 0. 05)。术后3个月髋关节功能优良率全髋关节置换组为91. 82%,高于半髋关节置换组的82. 73%(P 0. 05)。并发症发生率全髋关节置换组为18. 18%,半髋关节置换组为5. 45%,差异有统计学意义(P 0. 05)。结论全髋与半髋关节置换治疗股骨颈骨折的临床效果均较为理想,可根据患者情况选择不同方式。     

半髋和全髋关节置换术治疗老年股骨颈骨折的疗效比较

目的 比较全髋和半髋关节置换术治疗老年股骨颈骨折的疗效。方法 将78例老年股骨颈骨折患者根据手术方式不同分为全髋组(39例,采用全髋关节置换术治疗)和半髋组(39例,采用半髋关节置换术治疗)。比较两组髋关节置换时关节位置及角度、手术情况、术后不良症状发生情况,采用Harris评分标准评价髋关节功能改善情况。结果 患者均获得随访,时间7～41个月。手术时间、术中出血量、术中补液量、住院时间、术后出血量半髋组明显短(少)于全髋组(P<0.05)。髋关节置换时髋臼前倾角、外展角两组比较差异均无统计学意义(P>0.05)。末次随访时髋关节功能Harris评分优良率半髋组高于全髋组(P<0.05)。术后不良症状发生情况、末次随访时下肢负重情况两组比较差异均无统计学意义(P>0.05)。结论 半髋与全髋关节置换术治疗老年股骨颈骨折均能获得满意疗效,相较于全髋关节置换术,半髋关节置换术手术时间短、操作简单、创伤小,更适合老年患者。     

半髋与全髋关节置换治疗老年股骨颈骨折的疗效比较

目的 比较半髋与全髋关节置换治疗老年股骨颈骨折的疗效.方法 将110例老年股骨颈骨折患者按照随机数字表法分为全髋关节置换组(THA组)和半髋关节置换组(HA组),每组55例.比较两组手术时间、术中出血量、术后引流量、术后并发症发生情况.末次随访时采用Harris评分评价髋关节功能恢复情况.结果 患者均获得随访,时间12...     

人工全髋与半髋关节置换治疗老年移位股骨颈骨折对比研究

目的比较人工全髋关节置换(total hip arthroplasty,THA)及人工半髋关节置换(hemiarthroplasty,HA)治疗老年移位股骨颈骨折的疗效。方法 2004年2月-2008年2月,共110例患者符合选择标准并自愿参加研究。采用随机数字表法根据手术方法不同将患者分为两组,其中56例采用THA治疗(THA组),54例采用HA治疗(HA组)。两组患者性别、年龄、体重、致伤原因、病程、骨折分型等一般资料比较,差异均无统计学意义(P>0.05),具有可比性。结果术后切口均Ⅰ期愈合。两组患者均获随访,随访时间3～7年,平均4年。两组手术时间、术中失血量及引流量比较,差异均有统计学意义(P<0.05)。术后1个月THA组1例(1.8%)发生股骨头后脱位,HA组无并发症发生;两组并发症发生率比较,差异无统计学意义(P=0.15)。末次随访时,THA组髋关节Harris评分为(96±6)分,HA组为(95±7)分,差异无统计学意义(t=0.64,P=0.17)。结论 THA和HA治疗老年移位股骨颈骨折均能获得较好疗效,但HA较THA创伤小,并发症少。     

全髋与半髋关节置换术治疗老年股骨颈骨折的疗效比较

目的 比较全髋关节置换术(THA)与半髋关节置换术(HA)治疗老年股骨颈骨折的疗效。方法 将191例老年股骨颈骨折患者根据手术方式不同以及倾向性评分匹配法按1∶1最近邻匹配得到各项资料相匹配的THA组(采用THA治疗)与HA组(采用HA治疗),各59例。记录两组手术情况以及术后并发症发生情况,比较术后1、6、12个月髋关节Harris评分。结果 患者均获得随访,时间12～24个月。手术时间、术中出血量、术后引流量、住院天数、住院费用：THA组均长(多)于HA组(P<0.05)。髋关节Harris评分：术后1、6个月两组比较差异均无统计学意义(P>0.05);术后12个月THA组高于HA组(P<0.05)。术后两组患者髋关节活动度、假体位置均正常。术后翻修、慢性疼痛发生率THA组均低于HA组(P<0.05),而脱位发生率THA组高于HA组(P<0.05);肺部感染、深静脉血栓发生率两组比较差异均无统计学意义(P>0.05)。结论 THA与HA治疗老年股骨颈骨折各有优势,THA的脱位发生率较高,但是慢性疼痛、翻修风险低,长期效果好,适合活动需求大、预期寿...     

全髋与半髋关节置换术治疗老年移位型股骨颈骨折

[目的]探讨全髋关节置换术(THA)与半髋关节置换术(HA)治疗老年移位型股骨颈骨折的临床疗效。[方法]选择本院老年移位型股骨颈骨折患者102例为研究对象,根据手术方式不同将患者分为THA组和HA组。[结果] THA组手术时间明显长于HA组,术中出血量明显多于HA。THA组术后2年和术后3年的髋关节Harris评分均明显高于HA组(P<0.05)。THA组患者术后脱位率、髋部疼痛发生率高于HA组(均P<0.05),但THA组术后并发症总发生率(26.78%)明显低于HA组(45.65%)(P<0.05)。[结论] THA与HA在治疗老年人移位型股骨颈骨折各有利弊,两者均有较好的短期效果,但长期效果THA优于HA,应综合考虑患者病情选择合适的手术方式。     

全髋与半髋关节置换治疗老年移位型股骨颈骨折疗效对比的Meta分析

目的系统评价全髋关节置换术(THA)与半髋关节置换术(HA)治疗老年移位型股骨颈骨折(DFNF)的疗效。方法应用Review Manager 5.1.4.0统计分析软件对采用THA与HA治疗老年移位型DFNF的临床疗效进行Meta分析。结果共纳入8篇临床随机对照研究(RCT),共1 059例DFNF。THA与HA比较,术后4年内THA髋关节功能Harris评分均高于HA(P=0.03);术后5年内翻修率差异无统计学意义(P=0.97);术后脱位率差异无统计学意义(P>0.10),但在术后5年时THA会增加脱位风险;术后4年内感染率差异无统计学意义(P=0.42)。结论 THA治疗老年移位型股骨颈骨折与HA比较可明显提高患者术后的髋关节功能,减少疼痛,增加关节活动度。从临床疗效方面来看,若患者没有禁忌证,可以优先考虑THA。     

老年人肱骨近端粉碎性骨折的外科治疗

[目的] 比较老年人肱骨近端粉碎性骨折内固定方法，评价“三叶草”型钛钢板内固定结合植骨的治疗效果。[方法] 对47例老年人肱骨近端粉碎性骨折患者分别应用克氏针、螺钉内固定和“三叶草”型钛钢板内固定结合植骨术(自体骨、金世植骨灵)治疗。42例得到随访，平均随访时间2．4a，采用Neer分型和评定标准分析疗效。[结果]钢板内固定、植骨术组全部4个月内骨折愈合，克氏针、螺钉内固定术组7例骨不连；32例(32／42)术后肩关节不同程度僵硬。Neer 3、4部骨折(18例)应用克氏针螺钉内固定，优良率为38．4％和20％；“三叶草”型钛钢板 植骨(24例)，优良率为77．7％和50％。[结论]老年人肱骨近端粉碎性骨折，其主要病理变化是骨质疏松和骨折部位骨缺损，宜早期手术治疗。与克氏针、螺钉内固定方法比较，“三叶草”型钛钢板独特的韧性和构型，其近端“筛孔”任意角度穿钉的锚固作用符合AO内固定原则，同时植骨促进骨愈合，是老年肱骨近端粉碎性骨折有效治疗方法。     

老年股骨颈骨折的住院费用分析

目的通过统计我院近6年932例股骨颈骨折住院患者的治疗方式与住院费用结构,充实我国老年股骨颈骨折治疗费用资料。方法收集广东省中医院的骨科患者资料,对2004至2009年中50岁以上的股骨颈骨折患者的一般情况、住院时间、治疗方式及住院费用进行统计分析。结果 6年中股骨颈骨折女性患者明显多于男性,男女患者总人数比为1∶2.57,平均住院天数为(22.74±14.12)d,人均总费用为(29835.14±15332.82)元。人工关节置换术占所有治疗方式的73.4%,人工股骨头置换的年龄明显高于全髋置换,但平均住院费用低于全髋置换。2005—2009年股骨颈骨折平均住院天数无明显变化,人均住院费用平均年增长速度为5.41%。从住院费用的构成比例上看,治疗费(包括手术材料费及内置物费)占61%,药费占17%,手术费占7%,检查费占3%,床位费、化验费及其他费用各占4%。结论人工关节置换是股骨颈骨折治疗的主要方式,所需医疗费用逐年递增(除2004年),有效控制内置物、手术器械费以及药费是减少老年股骨颈骨折医疗费用,节约医疗资源,减轻患者经济负担的有效的途径。     

老年患者行胰十二指肠切除术临床特征和并发症分析

目的分析行胰十二指肠切除术的老年患者的临床特征和术后并发症的发生情况,探讨老年患者行胰十二指肠切除术的可行性。方法回顾分析2004年至2012年本院94例胰十二指肠切除术患者的临床资料,对年龄≥65岁的老年患者进行分析。结果本研究共纳人老年患者43例,中年患者51例,其中老年组术前合并症发生率(60.47%)显著高于青年组(31.37%)(x~2=7.99,P0.05)。两组均以经典胰十二指肠切除、Child法重建消化系为主,分别占83.72%和70.59%。老年组病例术后胆瘘等并发症发生率为30.23%,与青年组术后并发症的发生率(23.53%)相比无明显统计学差异(X~2=0.54,P=0.46)。结论高龄不是胰十二指肠切除术的手术禁忌证。老年患者强调充分的术前准备,术后加强监测和管理,早期及时处理合并症。     

Fast-track care for patients with suspected hip fracture

Patients over 65 years of age with suspected hip fracture following low-energy trauma often wait a long time for examinations, X-rays, tests and surgery. There may be a connection between long waiting times and complications, including severe pain, mental confusion, infection, pressure sores, and longer hospital stays. This study examines whether implementing prehospital preoperative procedures might lead to reduced waiting times, less postoperative pain, fewer complications and shorter length of care for this patient group. To “fast-track” care for hip fracture patients, the ambulance nurse starts the preoperative procedure (usually performed in the accident and emergency department [A&E]) and transfers patients directly to radiology, bypassing A&E. Results from the fast-track care group were compared to results from a control group, who had been admitted to A&E in the usual way. The study group experienced fewer complications and shorter hospital stays compared to the control group. This finding suggests that fast-track care for hip fracture patients can minimise complications, heighten priorities, and decrease overall length of care. Greater awareness of risk factors for hip fracture patients amongst hospital staff leads to improved patient care. Fast-track care may also decrease the workload in A&E and thus release more time for other patients.     

高龄、跌倒、骨密度对老年脊柱骨折预测的价值分析

目的 探讨高龄、跌倒、骨密度等对老年脊柱骨折的预测诊断价值分析。方法 选择2014年4月至2016年4月在我院体检中心就诊的212名老年女性为研究对象,根据两年后是否发生脊柱骨折分为骨折组79例和未骨折组133例,比较两组患者的高龄、跌倒、骨密度等因素的危险指数,采用 SPSS 22.0和STATA 14.0软件对所得数据进行统计分析。结果 骨折组患者较未骨折组患者具有更高的年龄和跌倒倾向,而两组的骨密度无显著差异（P=0.0614）,骨密度对老年脊柱骨折的预测价值有限,高龄和跌倒对老年脊柱骨折的预测有重要价值。结论 通过骨密度检测评估是否干预老年人脊柱骨折意义有限,高龄和跌倒是老年人脊柱骨折的独立危险因素。     

老年髋部骨折患者骨密度阈值的初步探讨

作者收集３９例６０岁以上髋部骨折病人作为病例组，其中男１７例，女２２例。另选８０例６０岁以上正常老年人作为对照组。其中男女各４０例。采用双能量骨密度仪分别测定其脊柱及髋部各部位的骨密度值。测量结果表明无论是脊柱还是髋部，骨折组骨密度均显著低于对照组（Ｐ＜０．０１）。其中髋部Ｗａｒｄ’ｓ三角区骨密度下降最为明显。骨折组Ｗａｒｄ’ｓ三角区ＢＭＤ值平均为０．４８８８±０．１１０８。作者提出对高危人群进行普查，如发现髋部Ｗａｒｄ’ｓ三角区ＢＭＤ值低于０．５ｇ／ｃｍ２时，对其采取治疗及保护措施是十分必要的。     

粤港澳大湾区50岁以上人群骨质疏松调查研究

目的 基于双能X线骨密度仪(dual energy X-ray absorptiometry, DXA)测量骨密度(bone mineral density, BMD)分析粤港澳大湾区3所医院50岁以上人群骨量状态分布特征及骨质疏松患病率,为疾病区域个性化防治提供数据参考。方法 筛选2015年5月至2020年12月在粤港澳大湾区3所医院就诊的9122例50岁以上人员,采用DXA测量腰椎、全髋及股骨颈BMD T值,比较不同地区、不同年龄段人群骨质疏松患病率及骨量状态分布差异,分析以不同部位T值为参考对骨质疏松检出率的影响。结果 3所医院纳入人群骨质疏松总体患病率为30.7%,男性为12.9%(澳门最高,为44.0%),女性为34.6%(香港最高,为40.2%);骨质疏松患病率均随年龄增长而增加,女性各年龄段患病率高于男性;3所医院相同年龄段不同骨量状态人群构成具有各自特征,不同年龄段间存在差异;骨质疏松检出率以3个部位最低T值为参考时最高。结论 粤港澳大湾区3所医院50岁以上就诊人员骨质疏松患病率较高,各地区间不同骨量状态人群构成差异明显。在进行骨质疏松筛查时应综合多个部位T值信息以提高...     

FRAX评分在中老年人骨质疏松性骨折风险评估中的研究进展

骨质疏松症(osteoporosis)是一种以骨密度降低、骨小梁及其他组织结构损坏,造成骨脆性以及骨折风险增加为特征的全身性骨病。FRAX评分是2008年世界卫生组织推荐的骨折风险预测简易诊断工具,可用于计算10年发生髋部骨折及任何重要的骨质疏松性骨折的发生概率。目前FRAX评分的应用才刚刚起步,评价标准还不完善,使用过程存在一定的局限性。但是长远来看,FRAX评分在骨质疏松性骨折预测方面应用前景广阔,将会成为预防骨质疏松性骨折的有力工具。本文将近年来FRAX评分的应用以及研究进展进行综述。以期在骨质疏松性骨折预防、管理、诊断和治疗方面提供新思路、新视角。     

Femoral nerve block in a representative sample of elderly people with hip fracture: A randomised controlled trial

IntroductionThe number of elderly people with hip fracture and dementia is increasing, and many of these patients suffer from pain. Opioids are difficult to adjust and side effects are common, especially with increased age and among patients with dementia. Preoperative femoral nerve block is an alternative pain treatment.AimTo investigate whether preoperative femoral nerve block reduced acute pain and opioid use after hip fracture among elderly patients, including those with dementia.Patients and methodsIn this randomised controlled trial involving patients aged ≥70 years with hip fracture (trochanteric and cervical), including those with dementia, we compared femoral nerve block with conventional pain management, with opioid use if required. The primary outcome was preoperative pain, measured at five timepoints using a visual analogue scale (VAS). Preoperative opioid consumption was also registered.ResultsThe study sample comprised 266 patients admitted consecutively to the Orthopaedic Ward. The mean age was 84.1 (±6.9) years, 64% of participants were women, 44% lived in residential care facilities, and 120 (45.1%) had dementia diagnoses. Patients receiving femoral nerve block had significantly lower self-rated pain scores from baseline to 12 h after admission than did controls. Self-rated and proxy VAS pain scores decreased significantly in these patients from baseline to 12 h compared with controls (p < 0.001 and p = 0.003, respectively). Patients receiving femoral nerve block required less opioids than did controls, overall (2.3 ± 4.0 vs. 5.7 ± 5.2 mg, p < 0.001) and in the subgroup with dementia (2.1 ± 3.3 vs. 5.8 ± 5.0 mg, p < 0.001).ConclusionPatients with hip fracture, including those with dementia, who received femoral nerve block had lower pain scores and required less opioids before surgery compared with those receiving conventional pain management. Femoral nerve block seems to be a feasible pain treatment for elderly people, including those with dementia.     

Association between benzodiazepines use and risk of hip fracture in the elderly people: A meta-analysis of observational studies

ObjectiveHip fracture is one of the leading causes of disability, cost, morbidity, and mortality. Several studies reported that benzodiazepines (BDZs) have been associated with an increased risk of hip fracture in older individuals. The aim of this study was to evaluate the magnitude of hip fracture risk with BDZs.MethodsA systematic literature search on EMBASE, PubMed, Google Scholar, Scopus was performed between January 1, 1980, and March 31, 2019. The search strategy was based on the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline, and an observational study design was mandatory for articles inclusion. Data were extracted by two authors independently and a random effect model was used to evaluate effect size. The random-effects model (DerSimonian-Laird) was utilized to obtain the overall risk ratio (RR) and its 95% CI for all studies. The Newcastle Ottawa Scale (NOS) was also used to assess the quality of each study.ResultsOf 2315 studies screened, 33 (20 cohorts and 13 case-control) with 169,660 hip fracture cases were included in our analysis. In BDZs users, compared with non-users, the RR for hip fracture was 1.34 (95%CI: 1.26–1.44). The RR for long- and short-short acting BDZs and hip fracture risk were 1.31 (95%CI: 1.18–1.45, P < 0.0001), and 1.15 (95%CI: 1.08–1.22, P < 0.0001), respectively. When stratified by type of users, the current and recent users of BDZs had higher risk of hip fracture (RR: 1.83, 95% CI: 1.46–2.28, P < 0.0001 and RR: 1.61, 95% 1.30–1.99, P < 0.0001) whereas there was no increased risk of hip fracture in past BDZs users (RR: 1.18, 95%CI: 1.07–1.29, P < 0.0001).ConclusionOur meta-analysis showed an increased risk of hip fracture in patients with BDZs compared with non-users. Physicians should be aware of the unwanted consequence of BDZs when they will prescribe BDZs for their patients, especially elderly patients because hip fractures are highly prevalent in the elderly population.