仰卧位常规器械OCM入路与后外侧入路全髋关节置换术的疗效对照

目的:比较仰卧位常规器械OCM入路与后外侧入路全髋关节置换术的临床疗效。方法 :2017年2月至2019年1月因髋关节疾病行髋关节置换患者67例,其中微创组21例采用OCM入路,男12例,女9例;股骨颈骨折10例,股骨头无菌性坏死5例,髋关节骨性关节炎6例。传统组46例采用传统后外侧入路,男28例,女18例;股骨颈骨折24例,股骨头无菌性坏死12例,髋关节骨性关节炎10例。所有患者使用生物型陶-陶人工关节假体。观察比较两组患者手术时间、术中出血量、切口长度、手术前后肌酸激酶(CK-NAC)、下地活动时间、住院时间、术后假体的外展角及前倾角。比较两组术前及术后12个月Harris评分。结果:所有病例获得随访,时间14～26(18.4±3.6)个月。两组患者术中出血、术后前倾角及外展角比较,差异均无统计学意义(P0.05)。两组病例手术时间、切口长度、术后肌酸激酶、下地时间、住院时间差异均有统计学意义(P0.05)。两组术前及术后12个月Harris功能评分差异均无统计学意义(P0.05)。结论:两种入路人工全髋关节置换术均可获得满意的疗效,OCM入路损伤小,术后康复快,是可靠的手术入路。     

经股骨大粗隆后方骨折块入路行人工股骨头置换术治疗老年股骨粗隆间骨折

目的比较采用传统后外侧入路和经股骨大粗隆后方骨折块入路2种入路方式行人工股骨头置换术治疗老年股骨粗隆间骨折的疗效。方法笔者自2010-02—2014-02采用人工股骨头置换术治疗111例老年股骨粗隆间骨折,26例伴有股骨大粗隆后方骨折块均采用经股骨大粗隆后方骨折块入路行人工股骨头置换术,并将骨折块用克氏针张力带固定(A组);其余85例均采用传统的后外侧入路行工股骨头置换术(B组)。观察比较2组切口长度、手术时间、术中出血量、术后引流量、输血率、住院时间、股骨头脱位率等。结果 2组均获得随访平均12(11~13)个月,2组在切口长度、手术时间、输血率、住院时间方面比较差异无统计学意义(P0.05)。A组在术中出血量、术后引流量方面均明显低于B组,术后3、6个月髋关节功能Harris评分明显高于B组,差异均有统计学意义(P0.05)。A组术后股骨头脱位率低于B组,但差异无统计学意义(P0.05)。结论经股骨大粗隆后方骨折块入路行人工股骨头置换术不切断外旋肌群,不切除关节囊,术后髋关节稳定性好,远近期髋关节功能恢复良好,术后并发症发生率低,对于合并后方骨折块的股骨粗隆间骨折行人工股骨头置换是一种较为理想的入路。     

Comparison of total hip arthroplasty with minimally invasive SuperPath approach vs. conventional posterolateral approach in elderly patients: A one-year follow-up randomized controlled research

ObjectiveTo compare difference between SuperPath approach and conventional posterolateral approach in total hip arthroplasty (THA) in elderly patients.MethodsThe present prospective randomized controlled single blinded study enrolled a total of 96 elderly patients who received THA in our hospital during April 2015 to December 2018. All patients were randomly divided into the SuperPath group and the conventional group. General demographic characteristics and intraoperative data, as well as hospitalization time were recorded. Harris scores were used for measurement of hip function and visual analogue scale (VAS) was used for pain measurement. Serum levels of C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) and creatine phosphokinase (CK) were measured before and 24 h after surgery. Gait analysis was conducted by the method of footprints.ResultsThe mean surgical time was remarkably longer, the mean blood loss and incision length were significantly lower and the hospitalization time was also shorter in the SuperPath group compared with the conventional group. Both levels of CRP and CK were remarkably lower in the SuperPath group. At time points of 7 d and 1 mon after surgery, the VAS scores were significantly lower, and at 7 d, 1 mon and 3 mon the Harris scores were markedly higher in the SuperPath group compared with the conventional group. The step length and stride speed were significantly larger in the SuperPath group at 7 d and 1 mon after surgery than the conventional group. Joint dislocation was found in 2 cases of patients in the conventional group and no dislocation case was found in the SuperPath group. The angles of anteversion showed no significant difference, while the angles of abduction were significantly lower in the SuperPath group.ConclusionPatients with SuperPath approach had lower levels of CRP, ESR and CK, better hip function and less pain, as well as better gait condition than patients with conventional posterolateral approach in elderly patients.     

经皮辅助关节囊入路治疗老年股骨颈骨折的早期疗效

目的探讨经皮辅助关节囊(SuperPATH)微创入路初次人工股骨头置换术治疗老年股骨颈骨折的可行性及早期疗效。 方法回顾性分析2015年10月年2016年11月期间,在仪征市人民医院骨科严格按照纳入和排除标准收集的老年股骨颈骨折,采用SuperPATH微创入路初次人工股骨头置换,共纳入患者21例,其中男5例,女16例;左髋6例,右髋15例;平均年龄为(74±9)岁。观察切口长度、手术时间、术中出血量及并发症等情况。采用髋关节Harris评分标准评定术前、术后3 d及术后3个月患髋功能。计量资料用W检验观察数据是否成正态分布;髋关节Harris评分采用重复测量的方差分析比较,组间两两比较采用t检验。 结果21例患者均获3～6个月随访。手术切口平均长度(7.0±1.5)cm,住院平均时间(9.6±1.8)d,手术平均时间(64±13)min,术中平均出血量(138.7±30.5)ml,下床负重活动平均时间(2.4±0.8)d。患者随访期限内均未发生皮肤坏死、感染、骨折、深静脉血栓(DVT)、关节脱位及下肢不等长等严重并发症。术后3 d患侧髋关节Harris评分平均为(67.3±6.3)分,与术前(12.1±4.3)分比较差异有统计学意义(t＝23.132,P<0.05);术后3个月患侧髋关节Harris评分平均为(84.7±4.5)分,与术后3 d比较差异有统计学意义(t＝9.075,P<0.05)。 结论SuperPATH微创入路初次人工股骨头置换术治疗老年股骨颈骨折早期疗效有明显优势,具有创伤小、切口小、出血少、术后疼痛轻、可早期下床、患者满意度高,能降低术后关节脱位等并发症,符合微创外科和快速康复外科的发展理念。     

Minimally invasive direct anterior approach versus standard lateral approach in the management of tumors of the femoral neck

BackgroundTo compare the clinical outcomes of patients with benign or aggressive tumors of the femoral neck who underwent surgical curettage with the use of the direct anterior approach (DAA) and a standard lateral approach.MethodsThose patients from 2010 to 2017 were retrospectively enrolled. The patients were divided into two groups: group A, consisting of patients who had undergone surgery via the lateral approach; and group B, consisting of patients who had undergone the same procedure via the DAA.ResultsFifty-eight patients were divided into group A (n = 46) and group B (n = 12). The median follow-up was 43 months (15–97 months). There was no significant difference in the 1-year and 3-year recurrence rates (p = 0.74). Group B had comparable operation time and a significantly shorter incision length, less intraoperative blood loss, less postoperative drainage, a shorter hospital stay and less pain on the first postoperative day. Group B also had better hip function as assessed by the Harris Hip Score one month and one year postoperatively. One patient in group B experienced intraoperative incomplete fracture of the femoral neck, which was treated conservatively.ConclusionsSurgical curettage for patients with benign or aggressive tumors of the femoral neck via the DAA had a comparable local control rate and a better perioperative and functional outcome than via the lateral approach. Certain quality of the femoral neck should be required to avoid pathological fracture, which is difficult to treat by internal fixation in the DAA.     

动力髋螺钉加防旋螺钉与3枚空心螺钉治疗股骨颈粉碎性骨折的疗效比较

目的:比较3枚空心螺钉与动力髋螺钉(dynamic hip screw,DHS)加防旋螺钉治疗股骨颈粉碎性骨折的临床疗效.方法:自2008年1 月至 2012年12月,治疗股骨颈粉碎性骨折67例,根据不同内固定方式分为两组,其中36例采用DHS加防旋螺钉固定治疗(DHS组),男24例,女 12 例,年 龄22~58岁,平均43.7岁;31例采用3枚空心螺钉固定治疗(空心钉组),男22例,女9例,年 龄24~56岁,平均43.0岁.观察并比较两组患者切口大小、手术时间、术中出血量、输血率、术后住院时间、下地行走与患肢负重时间、骨折愈合时间、并发症发生率,采用髋关节Harris 评分对两组患者的功能进行比较.结果:两组患者术后切口均Ⅰ期愈合.两组手术时间、术中出血量、术中输血率及术后住院时间比较,差异无统计学意义(P>0.05).切口长度:DHS组(5.00±0.86) cm,空心钉组(3.30±0.57) cm,两组比较差异有统计学意义(P<0.01).所有患者获1年以上随访,两组随访时间差异无统计学意义(P>0.05).术后下地行走时间:DHS组为(19.0±3.5) d,空心钉组为(37.0±6.3) d,差异有统计学意义(P<0.01).患肢部分负重时间和完全负重时间:DHS组分别为术后(23.0±7.0) d、(138.0±13.0) d,空心钉组分别为术后(38.0±5.7) d、(164.0±12.0) d,差异均有统计学意义(P<0.01).骨折愈合时间:DHS组为(151±11) d,空心钉组为(162±11) d,差异有统计学意义(P<0.01).末次随访时髋关节Harris 评分:DHS组为(91.0±5.7)分;空心钉组为(85.0±12.0)分,差异有统计学意义(P<0.01).两组术后并发症比较,差异无统计学意义(P>0.05).结论:对于股骨颈粉碎性骨折的治疗,DHS 联合防旋螺钉优于3枚空心螺钉固定,具有术后患肢负重更早,骨折愈合更快,髋关节功能更好的优点.     

直接上方入路与后外侧入路在高龄股骨颈骨折半髋置换术中的早期疗效比较

目的:对比分析直接上方入路(direct superior approach,DSA)与后外侧入路(posterior lateral approach,PLA)在高龄股骨颈骨折半髋置换术中的早期临床疗效。方法:回顾性分析2020年1月至 2021 年12月收治的72例接受半髋置换手术老年股骨颈骨折患者的临床资料,其中36例采用微创DSA入路,男10例,女26例,年龄(82.82±4.05)岁;36例采用传统PLA入路,男14例,女22例,年龄(82.79±3.21)岁。比较两组患者围手术期相关指标、不同时间点Harris评分。结果:DSA组手术时间(79.41±17.39) min,比PLA组(98.45±26.58) min更短;切口长度(8.33±2.69) cm,比PLA组(11.18±1.33) cm短;术中失血量(138.46±71.58) ml,比PLA组(173.51±87.17) ml更少;初次下地时间(3.04±0.95) d,比PLA组(4.52±1.10) d更早;住院时长(8.70±1.89) d,比PLA组(10.67±2.35) d短(P<0.05)。两组术前Harris评分差异无统计学意义(P>0.05),术后1个月DSA组Harris功能和总分高于PLA组(P<0.05),而术后12个月两组比较,差异无统计学意义(P>0.05)。结论:在半髋置换手术中,DSA入路较PLA入路在手术时间、术中出血量、切口长度、初次下地时间、住院时长以及术后1个月的Harris评分等临床指标更优,在促进高龄股骨颈骨折患者术后早期康复上具有明显优势。     

Comparative study of anterolateral approach versus posterior approach for total hip replacement in the treatment of femoral neck fractures in elderly patients

Objective： To compare the clinical outcome of anterolateral minimally invasive approach versus conventional posterior approach for total hip replacement against femoral neck fractures in elderly patients.
Methods： The retrospective study was carried out on 42 patients who suffered from displaced femoral neck fractures （19 cases of Garden type Ⅲ, 23 cases of Garden type Ⅳ） treated by total hip replacement via anterolateral minimally invasive approach or conventional posterior approach by the same experienced surgeon. The average age of the patients was 78.1 years （range： 65-89 years）. They were divided into anterolateral mini-invasive group （22 cases） and posterior group （20 cases）. The mean time of follow-up was 13 months （range： 6-36 months）. The anterolateral approach described by Hardinge goes through between anterior 1/3 and posterior 2/3 of the gluteus medius muscle, reaching the femoral neck from anterior capsule. The traditional posterior approach described by Moore （Southern incision） goes through the insertions of short external rotation muscles, reaching the femoral neck from posterior capsule. The related variables under observation were length of incision, operation time, postoperative limp, length of hospital stay and bed stay and dislolcation rate.
Results： The length of the skin incision varied between 7 cm and 12 cm with the anterolateral minimally invasive technique, compared to 15-22 cm in the conventional procedure. It took less time （average 15 minutes） to complete the anterolateral minimally invasive approach （72 15 min）, compared with the conventional approach （87 min ±10 min）. The average Harris hip score was 91.23±10.20 in anterolateral approach, 90.03±11.05 in the posterior approach. The average length of hospital stay for patients with the anterolateral approach was （6.4±2.2） days （range： 4-9 days）, while that in posterior approach was （9.2 ±3.1） days （range： 6-13 days）. The average length of bed stay was （3.4±1.1） days （range： 2-5 days） in anterolateral group and （6.2±2.8） days （range： 3-10 days） in posterior group. No patients in anterolateral group experienced dislocation. One （5%） hip in posterior approach had dislocation. Conclusions： Anterolateral mini-invasive approach can decrease trauma, operation time, length of hospital stay and bed stay and rehabilitation time. The stability and minimal muscular damage permit the acceleration of postoperative rehabilitation, which can subsequently reduce the perioperative risk in the treatment of femoral neck fractures in the elderly undergoing total hip replacement.     

Mini-Incision Posterior Approach for Hip Arthroplasty

Objective To reduce the trauma to soft tissues through a shortened incision for a posterior approach for hip replacement. Indications Patients requiring primary hip replacement or revision. Contraindications Open wounds in area of incision. Planned femoral osteotomy. Surgical Technique Incision of 10-15 cm, splitting of the gluteus maximus, and division of the piriformis insertion allow exposure of the posterior capsule which is opened. The femoral neck is divided and the femoral head removed to expose the acetabulum and proximal femur. An anterior capsulectomy and retraction allow appropriate visualization of the acetabulum. Insertion of blunt Hohmann, Müller, and modified Müller retractors facilitates exposure of the proximal femur. Results Between 1993 and 1995, 102 consecutive unilateral elective hip replacements were performed using the described approach (patients' age range 48-96 years). The mean blood loss was 347 ml, 13% of patients received a transfusion. Mean surgical time was 37 min, mean hospital stay 3.5 days. One patient suffered a dislocation postoperatively. There were no infections, loosening, intraoperative fractures, pulmonary embolisms, deep vein thromboses or nerve injuries detected.     

股骨颈系统和空心加压螺钉治疗青壮年不稳定性股骨颈骨折短期随访

目的：探讨股骨颈动力交叉螺钉系统（femoral neck system,FNS）与3枚空心加压螺钉（cannulate compression screw,CCS）治疗青壮年不稳定性股骨颈骨折的疗效。方法：回顾分析2018年8月至2021年8月收治的52例青壮年不稳定性股骨颈骨折患者临床资料,根据内固定方式分为两组,25例行FNS固定,27例行闭合复位3枚CCS倒三角形分布内固定。记录并比较两组患者的手术时间、切口长度、术中出血量、住院费用、骨折复位质量;术后定期随访患者,比较两组患者骨折愈合时间、术后完全负重时间、术后并发症发生（骨不连、股骨颈短缩、股骨头坏死等）。术后6个月采用Harris评分评估髋关节功能。结果：两组患者手术均顺利完成,FNS组患者出血量多于CCS组、切口长度大于CCS组、住院费用高于CCS组（P<0.01）。两组患者手术时间及术中复位Garden指数比较差异均无统计学意义（P>0.05）。两组患者均获得随访,时间6~32个月。FNS组骨折愈合时间少于CCS组,术后完全负重时间早于CCS组,髋关节Harris评分高于CCS组（P<0.01）。两组患者随访期间均未发生内固定断裂并发症,FNS组发生股骨头缺血性坏死4例、股骨颈短缩2例,其中3例因股骨头缺血性坏死行全髋关节置换术;CCS组发生骨不连2例、股骨头缺血性坏死9例、股骨颈短缩11例,其中5例因骨不连、股骨头缺血性坏死行全髋关节置换术。结论：FNS具有操作简单、兼具旋转稳定和成角稳定,使患者能尽早开始功能锻炼,降低不稳定性股骨颈骨折术后并发症发生率,是治疗青壮年不稳定性股骨颈骨折的新选择。     

“Polarsystem” dual mobility hip prosthesis and “minimally invasive surgery” (MIS)

Abstract: The authors describe the surgical technique for minimal invasive surgery using a dual mobility total hip prosthesis by posterior external approach and cutaneous incision of 5 to 10 cm length. Six hundred total hip prosthesis were implanted between 2002 and 2005, 450 due to osteoarthrisis and 150 to neck fractures. The results show a duration of hospital stay reduced to 5 to 8 days, a reduction of blood loss with a transfusion in 15 to 35% of the cases, and a dislocation rate of 0.7%, with one dislocation for osteoarthrisis (0.22%) and three for fractures (2%). We report two revision surgeries due to femoral fractures at the beginning of our experience, and two deep infections. The compatibility between the minimal invasive surgical technique and the dual mobility which is known to rarely induce dislocation, have been discussed.     

骨科机器人辅助股骨颈动力交叉钉系统治疗股骨颈骨折

目的:比较骨科机器人辅助股骨颈动力交叉钉系统(femoral neck system,FNS)和传统徒手操作FNS治疗股骨颈骨折的临床疗效。方法:回顾性分析2021年6月至2022年6月北京积水潭医院智能骨科连续收治的62例<65岁股骨颈骨折患者的临床资料,按照是否采用骨科机器人辅助手术分为两组:试验组30例,年龄34～56岁,采用骨科机器人辅助导航,闭合或有限切开复位后行FNS内固定;对照组32例,年龄33～54岁,采用传统徒手操作,闭合或有限切开复位后行FNS内固定。分析比较两组住院时间、手术时间、术中出血量、术中透视次数。术后6个月采用髋关节Harris评分评估两组髋关节功能恢复情况。结果:62例股骨颈骨折均顺利完成手术。试验组和对照组术中出血量比较,差异无统计学意义(P>0.05)。试验组手术时间短于对照组[42.1 (28.5,50.7) min vs.53.4(36.9,62.5) min,Z=-2.338,P=0.019];试验组术中X线透视次数少于对照组[8.0(6.0,11.0)次vs.15.0(13.0,17.0)次,Z=-5.960,P<0.00...     

后外侧入路微创髋关节置换术治疗老年股骨颈骨折

目的探讨一种安全、创伤小的髋关节置换术治疗老年股骨颈骨折。方法观察后外侧入路微创髋关节置换术治疗老年股骨颈骨折的手术时间,切口大小,出血量等指标,并与传统髋关节置换术治疗老年股骨颈骨折相比较。结果后外侧入路微创髋关节置换术治疗老年股骨颈骨折具有创伤小,出血少,术后疼痛轻,康复快等优点。结论后外侧入路微创髋关节置换术治疗老年股骨颈骨折较传统术式更安全。     

微创小切口和常规切口全髋关节置换术的疗效比较

目的比较微创小切口和常规切口全髋关节置换术的临床疗效。方法2004年6月至2008年6月,采用全髋关节置换术治疗98例患者。其中48例行单侧后路微创小切口全髋关节置换术,男26例,女22例;年龄45～85岁,平均66.8岁;股骨颈骨折19例,股骨头坏死19例,骨关节炎10例。另50例接受常规切口全髋关节置换术,男23例,女27例;年龄46～86岁,平均66.6岁;股骨颈骨折15例,股骨头坏死17例,骨关节炎8例,髋臼发育不良6例,类风湿关节炎4例。比较术中和术后各相关指标及并发症的发病率。结果全部获得随访,随访时间为6～15个月,平均8个月。微创组的手术切口长度、手术时间、术后2d C反应蛋白水平、术后2d红细胞沉降率、术后2d后大腿周径增加值均明显优于常规组,两组比较均有统计学差异（P〈0.01）。两组的术中失血量、输血量、术后4周Harris评分均无统计学差异（P〉0.05）。微创组的皮肤损伤8例,常规组19例,有统计学差异（P〈0.01）,两组的异位骨化、深静脉血栓、血肿等术后并发症均无统计学差异（P〉0.05）。两组均无一例发生神经损伤、血管损伤、脱位及感染。结论微创小切口与常规切口全髋关节置换术比较,具有创伤小、手术时间短、感染概率低、人工关节稳定性强、患者恢复时间短等优势,手术切实可行。     

In-hospital cost comparison between the standard lateral and supercapsular percutaneously-assisted total hip surgical techniques for total hip replacement

Purpose

The purpose of this study was to compare the in-hospital costs associated with the tissue-sparing supercapsular percutaneously-assisted total hip (SuperPath) and traditional Lateral surgical techniques for total hip replacement (THR).

Methods

Between April 2013 and January 2014, in-hospital costs were reviewed for all THRs performed using the SuperPath technique by a single surgeon and all THRs performed using the Lateral technique by another surgeon at the same institution.

Results

Overall, costs were 28.4 % higher in the Lateral group. This was largely attributable to increased costs associated with transfusion (+92.5 %), patient rooms (+60.4 %), patient food (+62.8 %), narcotics (+42.5 %), physical therapy (+52.5 %), occupational therapy (+88.6 %), and social work (+92.9 %). The only costs noticeably increased for SuperPath were for imaging (+105.9 %), and this was because the SuperPath surgeon performed intraoperative radiographs on all patients while the Lateral surgeon did not.

Conclusions

The use of the SuperPath technique resulted in in-hospital cost reductions of over 28 %, suggesting that this tissue-sparing surgical technique can be cost-effective primarily by facilitating early mobilisation and patient discharge even during a surgeon’s initial experience with the approach.

     

后路微创髋关节置换与后侧髋关节置换术后临床效果比较

目的比较经皮穿刺辅助保留关节囊全髋(SuperPATH)入路与后外路髋关节置换的术后临床疗效。 方法收集来自南方医科大学第五附属医院,广州市正骨医院以及广州市陆军总医院3个单位关节外科共102例接受单侧髋关节置换患者,纳入标准包括：初次人工全髋关节置换;股骨头缺血坏死3、4期;患者年龄大于50岁,小于80岁;股骨颈骨折Garden Ⅲ,Ⅳ型。排除标准为：随访资料不完整;髋臼发育不良Crowe 3型和4型;髋关节强直。使用随机数字表随机分为2组,实验组56例接受Surperpath入路微创人工全髋关节置换;对照组56例接受常规后外侧入路人工全髋关节置换,通过SPSS 13.0两组样本t检验比较实验组与对照组手术切口长度,术中出血量,手术时间以及术后功能评分。 结果SuperPATH微创髋关节置换组较后侧入路髋关节置换组手术切口长度较短(t＝25.960, P<0.01),术中出血量较少(t＝12.600,P<0.01),术后功能评分较高(术后1月t＝3.340,术后6月t＝0.410,P<0.01),手术时间较对照组长(t＝10.550,P<0.01)。 结论Super PATH微创髋关节置换术创伤较小,术中出血量较少,术后功能恢复良好,切口较少,对于熟练掌握该手术的医生针对适应症明确的患者可选该手术方式。     

Minimally invasive medial hip approach for femoral head fixation: How much can we see and what is the anatomical at risk? – A cadaveric injection study

IntroductionMost Pipkin I and II femoral head fractures are treated with either an anterior or a posterior approach. A medial hip approach is commonly used in children, and some surgeons have suggested it for femoral head fixation. The objectives of this study were to identify the structures at risk with the medial hip approach and to demonstrate the areas of the femoral head exposed using this approach.MethodsThe first part of this study involved vascular injection conducted in four fresh human cadavers using the medial hip approach. The surgical technique was described and the structures at risk, mainly arteries, were identified. The second part was done in 14 hips to identify and measured the maximum exposure area of the femoral head with the medial hip approach.ResultsThe structures at risk with the medial hip approach were the medial femoral circumflex artery (MFCA) after it branches from the deep femoral artery and runs posteromedially across the femoral neck medial to the iliopsoas tendon and the deep branch of the MFCA lies over the posterior hip capsule. The femoral head exposure area in anterior view with anteroinferior articular cartilage exposure was 4.57 ± 1.09 cm². In the medial view with the hip in internal rotation and in external rotation, the inferomedial articular cartilage exposure was 2.50 ± 1.52 cm² and 6.48 ± 2.29 cm², respectively, and the combined area of exposure was 9.49 ± 2.86 cm² . In the posterior view, the posteroinferior articular exposure was 1.69 ± 1.16 cm². The medial hip approach allowed visualization of the small area of the posteroinferior articular cartilage in all specimens. The percentages of visualization of the femoral head articular cartilage in anterior view, medial view and posterior view were 50.07% ± 13.53, 45.56% ± 12.76 and 18.07% ± 11.27%, respectively.ConclusionsThe structures at risk with the medial hip approach is the MFCA along the anterior acetabular rim and the deep branch on the posteromedial aspect of the femoral neck. It is an alternative which provides excellent access in Pipkin I and some part of Pipkin II, but it requires that the MFCA be protected by the use of meticulous surgical techniques.     

Comparison of Dislocation and Outcome Between Piriformis-Sparing and Conventional Posterior Approach After Bipolar Hemiarthroplasty for Femoral Neck Fracture in Patients Over 60 Years

BackgroundHemiarthroplasty is a treatment option for femoral neck fractures in patients aged more than 60 years and postoperative dislocation after a posterior approach is not uncommon. The piriformis tendon is one of the structures providing posterior hip stability. However, evidence of piriformis-sparing approach in hemiarthroplasty is unclear regarding a reduced dislocation rate.MethodsBetween January 2017 and December 2019, 321 patients underwent a posterior approach in consecutive cohorts for a hemiarthroplasty for femoral neck fractures with the minimum 24 months follow-up time (24-60 months). There were two cohorts: (1) 129 underwent the conventional posterior (CP) approach and (2) 192 underwent the piriformis-sparing (PS) approach. The differences in dislocation rate, postoperative Harris Hip Society at 1 and 2 years and other surgical complications were compared in both groups.ResultsThere were 6 dislocations of 129 (4.7%) underwent the CP approach and 0 dislocation from 192 underwent the PS approach that had posterior hip dislocations (P = .004). In addition, the CP group had a significantly higher mortality rate (14.7% versus 7.3%, P = .031) and lower functional outcomes as assessed by mean Harris Hip Scores at 1 year (73 versus 78, P = .005) and 2 years postoperatively (73 versus 80, P < .001) relative to the PS group.ConclusionPS hemiarthroplasty was associated with a lower dislocation and mortality rate. Moreover, this approach gained a superior early to the mid-term functional outcome than the conventional posterior approach in elderly femoral neck fractures.Level of EvidenceII, prospective cohort study.     

Blood loss and transfusion rate compared among different dosing regimens of tranexamic acid administration in patients undergoing hip hemiarthroplasty for femoral neck fracture: A randomized controlled trial

BackgroundIntravenous tranexamic acid (TXA) administration is a proven safe and effective method for reducing both blood loss and transfusion in total joint arthroplasty. However, data specific to its efficacy in hip hemiarthroplasty (HHA) for femoral neck fracture are scarce. Furthermore, no study has investigated the efficacy of an additional dose of TXA administration. Accordingly, this study aimed to assess blood loss and the transfusion rate compared among different regimens of TXA administration in patients undergoing HHA for femoral neck fracture.MethodsBetween January 2019 to December 2020, 90 HHA patients were randomized into one of three groups (30 patients/group). Control group patients received intravenous normal saline solution (NSS) 20 mL before skin incision, and NSS 20 mL at 3 hours after surgery. one-dose (1D) group patients received 750 mg of intravenous TXA before skin incision, and NSS 20 mL at 3 hours after surgery. Two-dose (2D) group patients received 750 mg of intravenous TXA before skin incision, and 750 mg of TXA at 3 hours after surgery. The primary outcome was blood transfusion rate. Intraoperative blood loss, hemoglobin levels at 24- and 48-hours postoperation, and calculated total blood loss were compared among the three groups.ResultsThe mean age of the study population was 79.7 years, and 76.7% of participants were women. The transfusion rate in the control, 1D and 2D groups was 43.3%, 16.7%, and 3.3%, respectively. Total hemoglobin loss; total red blood cell loss; intraoperative blood loss; hemoglobin level at 24- and 48-hours postoperation; change in hemoglobin level between 0 and 24 hours, and between 0 and 48 hours; blood transfusion rate; and, the number of patients who did not require blood transfusion were all significantly improved in the 2D group compared to baseline. No parameters were significantly improved in the 1D group compared to controls.ConclusionsThe results of this study demonstrate both the efficacy of TXA administration in HHA, and the superiority of two-dose TXA administration over one-dose TXA administration in HHA for femoral neck fracture.     

经皮加压钢板与空心加压螺钉治疗中青年移位股骨颈骨折的疗效比较

目的：比较经皮加压钢板与空心加压螺钉治疗中青年移位股骨颈骨折的疗效。方法 ：回顾分析2015年1月至2020年7月收治68例移位型中青年股骨颈骨折患者,其中31例采用经皮加压钢板（percutaneous compression plate,PCCP）固定,37例采用空心加压螺钉（cannulated compression screw,CCS）固定。收集两组患者性别、年龄、致伤原因、合并症、骨折分型及受伤原因等一般资料比较。两组患者的手术时间、术中出血量、住院时间、完全下地负重时间、骨折愈合时间、疼痛视觉模拟评分（visual analogue scale,VAS）、Harris髋关节评分及并发症。结果：两组患者均获2年以上随访。两组患者的手术时间、术中出血量、骨折复位质量、住院时间及VAS比较,差异无统计学意义（P>0.05）。PCCP组骨折愈合时间短于CCS组（t=-4.404,P=0.000）。PCCP组完全下地负重时间明显短于CCS组（t=-9.011,P=0.000）。术后2年PCCP组的髋关节Harris评分优于CCS组（P=0.002）。PCCP组有3例（9.68...