全髋关节置换术麻醉处理——附26例报告

我院于1991年～1996年对26例病人施行了全髋关节置换术,手术全部成功,现将麻醉处理总结如下。1 临床资料1.1 一般资料本组26例中,男17例,女9例;年龄最小24岁,最大76岁,平均年龄53岁;26例中单髋24例,双髋2例,合计28髋关节;疾病种类:风湿性关节炎后遗症髋关节强直5例;髋关节骨性关节炎6例,陈旧性股骨颈头下骨折骨不连1例,股骨头无菌性坏死14例。     

老年病人全髋关节置换术麻醉体会

随着我国渐步入老龄社会，老年病人需行全髋关节置换者日益增多。老年病人常伴有不同程度的全身性疾病，麻醉处理及术中管理要求较高。我院自2006年7月-2008年6月在硬膜外麻醉下对58例老年病人行全髋关节置换术，效果满意，现将麻醉体会报告如下。     

老年全髋关节置换术椎管内麻醉的临床分析

目的 分析老年全髋关节置换术行椎管内麻醉的临床效果.方法 选取2018年7月至2020年7月本院30例行老年全髋关节置换术患者,按随机平均分组原则给予两组患者不同的麻醉手术,观察组行椎管内麻醉,对照组行全身麻醉,观察两组的麻醉效果、认知功能、手术指标、不良事件发生.结果 经过麻醉后,两组的手术用时、术中出血量无统计学意...     

全髋关节置换术和半髋关节置换术治疗老年股骨颈骨折的临床效果

目的:研究分析全髋关节置换术和半髋关节置换术治疗老年股骨颈骨折的临床效果.方法:选取我院2018年9月～2019年9月收治的老年股骨颈骨折患者30例进行研究,将其分组,15例接受全髋关节置换术治疗的患者纳入A组,15例接受半髋关节置换术治疗的患者纳入B组,比较两组患者的髋关节功能评分、临床治疗指标和临床疗效.结果:B组...     

40例全髋关节置换术高龄患者的麻醉分析

目的：探讨全髋关节置换术高龄患者的有效麻醉方法。方法：对40例全髋关节置换术高龄患者行连续硬膜外麻醉，观察评价麻醉效果。结果：硬膜外阻滞完成后血压下降〉20％者10例，占25％，经快速输液或静脉注射麻黄素5—15mg，均恢复正常水平。全组麻醉效果满意，未发生躁动等不适，未发生严重的低血压和严重的呼吸抑制。结论：对全髋关节置换术高龄患者应用硬膜外麻醉，具有阻滞完善、肌松效果好、对循环呼吸干扰小、不受时间限制等优点，是安全有效的麻醉方法。     

全髋关节置换术和半髋关节置换术治疗老年股骨颈骨折的临床疗效分析

目的观察分析全髋关节置换术和半髋关节置换术治疗老年股骨颈骨折的临床效果。方法选取我院2014年2月至2016年2月收治的160例老年股骨颈骨折患者,随机分为两组各80例,观察组患者采用全髋关节置换术治疗,对照组患者采用半髋关节置换术治疗,比较两组的治疗效果。结果观察组患者的优良率97.50%,显著高于对照组的85.00%(P<0.05)。观察组患者的手术时间显著长于对照组(P<0.05)。观察组患者的术后静脉栓塞、髋部疼痛、感染发生率显著低于对照组(P<0.05)。结论针对老年股骨颈骨折患者,全髋关节置换术的治疗效果优于半髋关节置换术,可有效减轻患者疼痛,减少术后并发症,加快康复速度,提高患者生活质量。     

全髋关节置换术高龄患者55例的麻醉体会

全髋关节置换术具有创伤大、失血多、术中可能出现骨水泥不良反应等危险。由于老年患者大部分整体器官功能降低,特别是心肺代偿储备能力降低,多数又合并有其它脏器病变,更增加了手术麻醉的危险性。笔者采用连续硬膜外麻醉对55例全髋关节置换术高龄患者进行了麻醉处理观察,效果满意,现报道如下。     

老年股骨颈骨折髋关节置换术麻醉的体会

本文重点对老年股骨颈骨折行髋关节、股骨头置换术麻醉全过程监护、在麻醉的平稳性预防并发症发生方面的重要相关作用作出评估．提高老年人或患有基础原始疾病的老年患者手术麻醉的安全性。     

全髋关节置换术和半髋关节置换术治疗老年股骨颈骨折的效果分析

目的 探讨全髋关节置换术和半髋关节置换术治疗老年股骨颈骨折的效果,及其对患者炎症因子、血液流变学指标水平的影响。方法 选取2019年1月至2022年12月期间盐城市大丰中医院收治的老年股骨颈骨折患者60例,根据手术方式将其分为对照组(半髋关节置换术)与观察组(全髋关节置换术)进行前瞻性研究,各30例,术后随访3个月。对比两组患者临床相关指标、术前与术后24 h炎症因子水平,术前与术后1周血液流变学指标,以及随访期间并发症发生情况。结果 与对照组比,观察组患者手术时长、首次下床活动时间均更长,总出血量更多;与术前比,术后3个月两组患者髋关节功能(Harris)评分均显著升高,观察组更高;与术前比,术后24 h两组患者血清白细胞介素-6(IL-6)、C-反应蛋白(CRP)水平均显著升高,观察组更高;与术前比,术后1周两组患者全血高切黏度(HBV)、全血低切黏度(LBV)、血浆黏度(PV)均显著升高(均P<0.05);但两组间术前与术后1周HBV、LBV、PV比较,差异均无统计学意义(均P>0.05);观察组患者假体松动、髋臼磨损并发症总发生率较对照组更低,但差异无统计学意义(P...     

老年全髋关节置换术后并发症的护理干预

目的探讨老年全髋关节置换术后并发症的护理干预疗效价值。方法选择2007年10月至2009年1月老年全髋关节置换术患者82例,并随机分为两组：对照组41例,按照THA术后常规治疗及护理;观察组41例,在常规治疗及护理的基础上,对老年全髋关节置换术后并发症进行护理干预。结果观察组术后感染、髋关节脱位、下肢静脉血栓、压力性溃疡的发生率均低于对照组（P〈0．05）。结论老年全髋关节置换术后并发症的护理干预,有效降低了并发症的发生率,大大提高了老年患者的生活质量。     

比较全麻和腰硬联合麻醉用于髋关节置换术的麻醉效果

目的:比较全麻和腰硬联合麻醉用于髋关节置换术的麻醉效果.方法:随机选取2015年9月至2017年9月在我院行髋关节置换术的患者66例参与本次实验,按照随机数字表法将其分为观察组(33例,腰硬联合麻醉)和对照组(33例,静脉复合全身麻醉),对比两组患者的麻醉效果.结果:观察组患者麻醉效果优良率(97.0%)较对照组(81.8%)更高,麻醉起效时间、阻滞完全时间、苏醒时间较对照组更短,麻醉药用量较对照组更少,疼痛程度较对照组更轻,并发症发生率较对照组更低,组间比较P<0.05.结论:腰硬联合麻醉较全身麻醉用于髋关节置换术的麻醉效果更佳,且并发症更少,安全性更高.     

Complications in total hip replacement

AIM: THE PURPOSE of the present study was to present the most common treatment failures and complications associated with total hip replacement. MATERIAL AND METHODS: Between 1986 and 2002, 486 total hip replacements (THR) in 403 patients were performed at the Clinics of Orthopedic and Trauma Surgery (St. George University Hospital, Plovdiv). 315 (61.8%) of the patients underwent THR for coxarthrosis, 171 (35.1%)--for traumatic or pathologic subcapital femoral neck fractures. 312 (64.2%) of the patients were women and 174 (35.8%) were men. Right and left arthroplasties were carried out. Patients' age was in the range of 28 to 53 years (median age 59.6). Complications were diagnosed in 97 (19.9%). Late postoperative complications (53.6%) as aseptic loosening of the prosthetic components, superficial and deep hematogenous infections, prosthetic dislocations and heterotopic ossifications were predominant. RESULTS: Complications were categorized as intraoperative, postoperative and late--a finding, consistent with the data in the literature. Among the intraoperative complications most common were malposition of the capsule (7 patients) and of the stem (4 patients) and longer stem (in 1 patient), but they caused no complaints. The postoperative complications consisted of hematomas and seromas wich were treated with early revision surgery. The main causes for late complications were postoperative ossification in 28 patients. Aseptic loosening of the prosthesis was seen in 11 patients. 8 of them complained of acetabular and 3 of thigh pain. Capsule dislocation was registered in 3 patients. CONCLUSIONS: Complications in THR are not infrequent. Their avoidance is largely dependent on the skill and qualification of the team and the quality of hospital care. Adequate risk assessment and prophylaxis are essential in disease outcome.     

Uncemented total hip replacement.

During the last 20 years almost 3000 uncemented total hip replacements have been used in the treatment of osteoarthritis and rheumatoid arthritis. The development of an axially located prosthesis is outlined, and the causes of failure indicated. Uncemented prostheses have the advantage of a relatively low mortality and morbidity and the rate of infection in particular is low. Interface pain, with or without frank prosthetic loosening, is the commonest cause of failure, but revisional surgery is relatively easy, and usually successful. Loss of function without significant pain may occur after many years from distal migration of the femoral component. The development of an uncemented metal-on-plastic joint has produced better short-term results than the metal-on-metal articulation, probably because of its lower frictional coefficient and the use of a wider range of pelvic and femoral components.     

全髋翻修临床研究并随诊,经验分析

目的回顾与分析66例全髋治疗后发生松动的病例.方法总结1990年2月至2005年6月在骨水泥或非骨水泥全髋置换病病例中单纯发生髋臼假体松动,股骨假体稳定的病例,66例患者(共69个髋)加入本研究,术中进行松动髋臼的单纯置换,术后进行平均6.2年的随访.结果随诊患者的髋关节功能,髋关节松动的发生率均达到良好水平.结论仅有髋臼松动,单纯进行髋臼翻修仍然有让人满意的结果,这种做法值得推广.     

Appropriateness of total hip joint replacement.

OBJECTIVE: To evaluate the appropriateness of the use of total hip joint replacements. DESIGN: Observational study of consecutive patients with a diagnosis of hip osteoarthritis and who had undergone total hip arthroplasty over a 1-year period from seven hospitals. MAIN MEASURES: The appropriateness of the use of hip replacement was judged by explicit criteria developed by a panel of experts using RAND methodology. The length of hospital stay during the admission and complications were recorded 6 months post-operatively. Patients were also surveyed 6 months after discharge to determine whether they believed they had recovered or their satisfaction with the intervention. Appropriateness results of this study were compared with a previous study performed with the same criteria 4 years previously. RESULTS: In total, 784 patients participated in the study. Indications for surgery were considered necessary in 52.2% of cases, appropriate in 21.3%, uncertain in 21.4%, and inappropriate in 5.1%. Differences were found in the rates of appropriateness exclusively from one hospital. At 6 months after discharge, differences between centres were found for the proportion of patients that reported they had recovered from surgery (range 57.7-24.8%) and in the length of hospital stay during admission (range 10-16 days). Improvement in the appropriateness rates were found for all participant hospitals during both periods. CONCLUSIONS: We identified a low percentage of inappropriate indications and differences in some outcomes between centres. Compared with previously, there has been improvement in the use of this technique, although both periods are not methodologically comparable.     

Thromboprophylaxis in patients undergoing total hip replacement

Venous thromboembolism is a common complication following a hip replacement. It was the authors' impression that prophylaxis of deep vein thrombosis has changed in recent years. The authors felt that it was important to repeat a survey, done in 1997, on the use of thromboembolism prophylaxis among British orthopaedic surgeons.     

Rasch scoring of outcomes of total hip replacement

We examined whether there are advantages in terms of outcome assessment of using Rasch methods of scoring the 12-item Oxford Hip Score questionnaire over conventionally summed scores. Data were collected on patients receiving total hip replacement surgery. Three patient groups were created according to surgery type: primary, revision, and re-revision; two groups were created according to satisfaction with surgery: very satisfied and dissatisfied. Analyses were performed to test the relative precision (RP) of Rasch scoring versus conventionally summed scores in discriminating the groups experiencing different types of surgery and level of satisfaction. At the 1-year follow-up, RP ratios favored the Rasch scoring method in both tests of discrimination. Considerable gains in precision were achieved with Rasch scoring methods when groups were compared in a cross-sectional way. Alternative approaches to scoring questionnaires should be investigated to better assess comparisons over time.     

美国:茶水喜欢冰着喝

<正>在美国,茶消耗量占第二位,仅次于咖啡。美国人与中国人饮茶不同,大多数人喜欢饮冰茶,而不是热茶;喜欢罐装、瓶装茶,而不会自己泡茶。许多美国人甚至连茶叶的外形是什么样子也不知道。不过,现在这种状况已在悄悄改动。