Femoral Head Replacement Research Articles

Effect of salmon calcitonin on postoperative humeral head replacement in elderly patients

To observe the effect of anti-osteoporosis drugs on the curative effect of femoral head replacement in the elderly patients with proximal humerus fracture. From November 2012 to June 2016, 38 patients with proximal humeral fractures received humeral head replacement were divided into the treatment group and the control group according to whether the anti-osteoporosis drugs were used after the operation. The treatment group included 19 cases, of which 11 cases were three part fractures, 18 cases were four part fractures, and bone density was(0.58±0.14) g/cm²; the control group involved 19 cases, of which 10 cases were the three part fractures, 9 cases were four part fractures, and bone density was(0.58±0.11) g/cm². Periprosthetic bone mineral density(BMD) was measured at 4, 8, 12, 24 and 48 weeks after operation, and visual analogue scale(VAS) was used to evaluate the pain and Neer score was used to evaluate the function of the shoulder joint. The incisions of all patients were healed with grade A and no complications occurred. Thirty-five patients were followed up for 1 year. The bone density around the prosthesis of treatment group was higher than that of control group, the difference was statistically significant(P<0.05);VAS in two groups had no statistical significance(P>0.05). The total score and functional score of Neer in the treatment group were better than those in the control group, the difference was statistically significant(P<0.05), and there was no significant difference in pain and activity score between the two groups(P>0.05). According to the Neer score, the results of treatment group was excellent in 10 cases, good in 5 cases, fair in 3 cases;in the control group, 3 cases were excellent, 9 cases were good, and 5 cases were fair;the difference between the two groups was statistically significant(P<0.05). Artificial humeral head replacement combined with anti-osteoporosis drugs in the treatment of proximal humeral fractures in elderly patients can effectively improve the bone density around the prosthesis and restore shoulder function. The early clinical effect is satisfactory.

Massive mass embolism detected by transesophageal echocardiography in bone cement implantation syndrome: a case report

Bone cement implantation syndrome (BCIS) is a known complication in patients undergoing cemented orthopedic surgeries; however, the etiology and pathophysiology of BCIS are not fully understood. We report the case of a patient who developed pulseless electrical activity (PEA) due to BCIS after cemented femoral head replacement. Transesophageal echocardiography (TEE) during PEA revealed a massive embolus extending from the main pulmonary artery to the inferior vena cava. Of note, this embolus disappeared completely and rapidly after return of spontaneous circulation. TEE proved to be useful in the diagnosis and management of this case of PEA.

Effect of dexmedetomidine on inflammatory factors level and cognitive function after femoral head replacement in elderly patients

To analyze the effect of dexmedetomidine on the inflammatory factors level and cognitive function after femoral head replacement in elderly patients. From January 2016 to December 2017, 60 elderly patients(more than 60 years old, and Grade I to II of ASA) treated with femoral head replacement were divided into three groups, and 20 in each group. All patients received midazolam, fentanyl, etomidate, cisatracurium anesthesia induction and sevoflurane inhalation anesthesia maintenance. The patients in group B and group C were first given 1.0 μg·kg⁻¹ of dexmedetomidine 10 minutes during the operation. The maintenance volume was 0.3 μg·kg⁻¹·h⁻¹ of dexmedetomidine(in group B) and 0.6 μg·kg⁻¹·h⁻¹ of dexmedetomidine(in group C) by pumping. The same amount of saline was given to the patients in group A in the same way. The time of extubation, wakefulness and recovery, the simple intelligent mental state score (MMSE), the incidence of postoperative cognitive dysfunction (POCD) and the levels of interleukin-6 (IL-6), interleukin-10 (IL-10) and S100β protein expression in the 3 groups were compared. There were significant differences in the time of spontaneous breathing recovery, eye opening tome and the time of extubation, as well as the dosage of propofol among the three groups(P<0.05). On the 1st, 3rd and 7th day after operation, there was a significant difference in MMSE score of group B and group C compared with that of group A(P<0.05), and MMSE score in group C was significantly higher than that of group B(P<0.05). The incidence of POCD was 0.0% (0/20) and the incidence of adverse reactions was 30%(6/20) in group C, but those were 25% (5/20) and 0.0% (0/20) in group A and 5% (1/20) and 10% (2/20) respectively in group B. The difference was statistically significant (P<0.05). Before induction of anesthesia, there was no significant difference in the levels of IL-6, IL-10 and S100β protein among the three groups(P>0.05); but one hour after the operation, the levels of IL-6 IL-10 and S100β protein in group B and group C was statistically different from those in group A(P<0.05). The IL-6 and S100β protein in group C were significantly lower than those in group B (P<0.05), and IL-10 was significantly higher than that in group B (P<0.05). For elderly patients operated for femoral head replacement, dexmedetomidine can reduce the level of inflammatory factors level and propofol consumption, and the incidence of postoperative POCD is low, indicating a dose dependence of dexmedetomidine. But it is necessary to choose the right dose according to the patient's condition.

The application value in bi-directional quality control module of surgical package in artificial femoral head replacement

Objective To explore the application value and clinical effect of the bi-directional quality control module for Surgical Package in artificial femoral head replacement. Methods A total of 360 patients undergoing artificial femoral head replacement in our hospital from June 2015 to June 2017 were selected and divided into observation group and control group, 180 cases in each group. The observation group,used bi-directional quality control module of surgical bag, while the control group used conventional management model of surgical bag. The operation time, the incidence of surgical bag, postoperative complications and postoperative satisfaction were compared. Results The average operation time in the observation group was (69.2 ± 11.6)min, the average operation time in the control group was (76.8 ± 14.5)min, P <0.01. The total defect rate in the observation group was 2.2%. The total defect rate in the control group was 22.2%, P <0.01; the observation group had less severe pain, incision split, fever, postoperative bleeding, incision infection than the control group, P <0.05. Patient satisfaction score was (89.38±7.83) points in the observation group, (79.18±5.55) points in the control group, P <0.01. Conclusions The bi-directional quality control module of surgical package can shorten the operation time, reduce the defect surgical packages, reduce the incidence of postoperative complications, improve the quality of operation, and improve patient satisfaction in the application of artificial femoral head replacement. It is worthy of clinical application. Key words: Surgical package; Bi-directional quality control module; Artificial femoral head replacement

Clinical application of uncemented distal stem fixation for revising femoral prosthesis of hip arthroplasty in elderly patients

Objective To evaluate the effectiveness of uncemented distal stem fixation for elderly patients needing revision of femoral prosthesis of hip arthroplasty. Methods From July 2005 to January 2013, 22 patients(12 males and 10 females)aged from 70 to 85 years(average: 76 years old)with aseptic loosening of the femoral stem undergone revision via uncemented distal stem fixation were enrolled into this study.Of all patients, 10 had revision on the right side and 12 on the left side; 11 patients received artificial replacement of the femoral head; 9 had total hip replacements; 2 had femoral fractures.According to the Paprosky classification system, 2 cases were type I, 12 were type Ⅱ, 6 were type ⅢA, and 2 were type ⅢB.Femoral stems for revision included MP(Link)and Solution(Depuy). The Harris score, clinical and radiological results were retrospectively analyzed. Results All patients were followed up for 48 to 78 months(mean: 61 months). The average Harris score increased from 38(25-46)to 87(76-94). All prostheses were initially stable, and no infection, dislocation or complication like deep venous thrombosis was observed after revision.All patients were able to walk without assistance; two of them had minor claudication; radiographs after surgery showed well-positioned implants with increased bone density and thickness around the prosthesis and without loosening or subsidence. Conclusions Reliable axial and anti-rotational stability can be achieved by using uncemented distal stem fixation, with good short-and medium-term clinical results for revision in elderly patients with less severe bone defects than those in Paprosky Ⅳ. Key words: Hip joint; Revision; Femur

Nano-sized Al2O3 particle-induced autophagy reduces osteolysis in aseptic loosening of total hip arthroplasty by negative feedback regulation of RANKL expression in fibroblasts

Aseptic loosening is mainly caused by wear debris generated by friction that can increase the expression of receptor activation of nuclear factor (NF)-κB (RANKL). RANKL has been shown to support the differentiation and maturation of osteoclasts. Although autophagy is a key metabolic pathway for maintaining the metabolic homeostasis of cells, no study has determined whether autophagy induced by Al2O3 particles is involved in the pathogenesis of aseptic loosening. The aim of this study was to evaluate RANKL levels in patients experiencing aseptic loosening after total hip arthroplasty (THA) and hip osteoarthritis (hOA) and to consequently clarify the relationship between RANKL and LC3II expression. We determined the levels of RANKL and autophagy in fibroblasts treated with Al2O3 particles in vitro while using shBECN-1 interference lentivirus vectors to block the autophagy pathway and BECN-1 overexpression lentivirus vectors to promote autophagy. We established a novel rat model of femoral head replacement and analyzed the effects of Al2O3 particles on autophagy levels and RANKL expression in synovial tissues in vivo. The RANKL levels in the revision total hip arthroplasty (rTHA) group were higher than those in the hOA group. In patients with rTHA with a ceramic interface, LC3II expression was high, whereas RANKL expression was low. The in vitro results showed that Al2O3 particles promoted fibroblast autophagy in a time- and dose-dependent manner and that RANKL expression was negatively correlated with autophagy. The in vivo results further confirmed these findings. Al2O3 particles induced fibroblast autophagy, which reduced RANKL expression. Decreasing the autophagy level promoted osteolysis and aseptic prosthetic loosening, whereas increasing the autophagy level reversed this trend.

Curative effect of artificial femoral head replacement and its effect on hip joint function and complications of senile patients with femoral intertrochanteric fracture.

Curative effect of artificial femoral head replacement on hip joint function and complications of elderly patients with femoral intertrochanteric fracture were investigated. Eighty patients who were operated for femoral intertrochanteric fractures operation were randomly divided into observation group (n=40) and control group (n=40). The observation group was treated with artificial femoral head replacement, while the control group received internal proximal femur locking plate fixation. In the observation group, the operation time was shorter than that in the control group (P<0.05). The intraoperative bleeding was less than that in the control group (P<0.05). The postoperative indwelling drainage time was shorter than that in the control group (P<0.05). Besides, at 3, 6 and 12 months after operation, 10 m walking speed in the observation group was significantly higher than that in the control group (P<0.05). The 5-time sit-stand time was shorter than that in the control group (P<0.05). At 1 week, 1 month, 3, 6 and 12 months after operation, Harris hip joint scores and visual analogue scale scores in the observation group were both superior to those in the control group (P<0.05). Moreover, the total hospitalization time in the observation group was shorter than that in the control group. Time of walking on crutches and walking without crutches was earlier than that in the control group (P<0.05). The overall proportion of postoperative chronic pain, thrombosis and failed surgery in the observation group was significantly lower than that in the control group (P<0.05). Finally, physical and psychological scores in the observation group after intervention were obviously higher than those in the observation group before intervention and the control group after intervention (P<0.05). Artificial femoral head replacement is characterized by the short operation time, less intraoperative bleeding, fast postoperative recovery of joint function, low degree of pain and fewer complications in the treatment of senile femoral intertrochanteric fracture, which can improve the postoperative life quality of patients.

Injury characteristics and therapeutic strategy of patients injured in "8·8" Jiuzhaigou earthquake

To summarize the injury characteristics and therapeutic strategy of patients injured in "8·8" Jiuzhaigou earthquake. The clinical data of 48 patients injured in "8·8" Jiuzhaigou earthquake who were admitted to Mianyang Central Hospital were analyzed retrospectively. There were 25 males and 23 females with an average age of 36 years (range, 5-87 years). The average interval from injury to admission was 30 hours (range, 3-53 hours). The patients from Sichuan province accounted for 45.8% (22 cases), from other province for 52.1% (25 cases), and from abroad for 2.1% (1 case). Patients were primarily hurted by collapsing houses and flying stones. Thirty-seven patients (77.1%) had single injury, mainly involving 36 patients (75.0%) in limbs, and the other 11 patients (22.9%) had multiple injuries. Ten patients (20.8%) had open fractures, including 1 case rated as typeⅠ, 2 as typeⅡ, 3 as type Ⅲa, 2 as type Ⅲb, and 2 as type Ⅲc according to Gustilo classification criteria. The abbreviated injury scale (AIS) score was 2-3 in 37 patients of single injury, and the injury severity score (ISS) was 8-22 (mean, 13.2) in 11 patients of multiple injuries. Sixteen patients (33.3%) were diagnosed as mental disorders by Hamilton rating scale for anxiety (HAMA), including 8 cases had their anxiety scores≥29, 4 cases of 21-28, 3 cases of 14-20, and 1 case of 7-13. Of the 16 patients, 2 showed suicidal tendency. Except 2 referrals, 30 patients received operation［28 patients (93.3%) for orthopaedic surgeries］and 16 patients received conservative treatment. The procedures included internal fixation, soft tissue debridement, external fixation, bipolar femoral head replacement, embolization of carotid cavernous sinus arteriovenous fistula, and amputation. Among the 46 patients treated in this hospital, 21 discharged from hospital at 2-12 days (mean, 6.7 days) after admission, the others received further rehabilitation in this hospital or local hospital. No undesirable consequence occurred in 16 patients with mental disorders. Five cases of infection occurred out of hospital were cured after debridement. No dead and nosocomial infection case reported. Intensive treatment, specialist management, multidisciplinary team, and early intervention of nosocomial infection and deep venous thrombosis are the key to improve the general level of successful earthquake medical rescue.

Comparison of hip function and quality of life of total hip arthroplasty and resurfacing arthroplasty in the treatment of young patients with arthritis of the hip joint at 5 years

ObjectiveTo compare the medium-term clinical effectiveness of total hip arthroplasty and resurfacing arthroplasty.DesignSingle centre, two-arm, parallel group, assessor blinded, randomised controlled trial with 1:1 treatment allocation.SettingA large teaching hospital in...

Predictors of Gait Recovery after Artificial Femoral Head Replacement in Patients with Femoral Neck Fracture: A Retrospective Study Focusing on Acute Postoperative Pain and Lower-limb Muscle Strength

Predictors of Gait Recovery after Artificial Femoral Head Replacement in Patients with Femoral Neck Fracture: A Retrospective Study Focusing on Acute Postoperative Pain and Lower-limb Muscle Strength

Treatment of osteonecrosis of femoral head in young patients by surface replacement of femoral head

&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Osteonecrosis of hip is a pathological condition that affects usually young adults. Articular surface replacement (ASR) is considered to be a viable option in young patients. The study was done with the aim to analyse and to recommend the management of osteonecrosis of femoral head in young patients by surface replacement of femoral head as ideal procedure.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;The present study was conducted in 30 patients with osteonecrosis of the femoral head who attended to OPD at Santhiram Medical College and General Hospital, Nandyal, A.P during the period of April 2016 to September 2017. Articular surface replacement of the femoral head was the surgical procedure done in all the patients. The success of the treatment was analysed by Harris hip scoring.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Maximum number of patients (60%) was below 40 years of age. Male dominance (77%) was seen in the study. According to Ficat and Arlet classification 12 cases (40%) were under the category of stage II-B and 18 cases (60%) were of stage III. Postoperatively about 90% of patients had postoperative Harris hip score of &amp;gt;80 points. Surgery was succeeded in 10 hips of stage II-B and 15 hips in stage III. According to Harris hip scoring excellent results were obtained in 15 (50%), good in 12 (40%), fair in 2 (6.67%) and poor result 1 (3.3%) patient.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;The study concludes that the surface replacement is an anatomical hip arthroplasty with preservations of more than 70% of bone stock of femoral head and the ability of the patients to sit cross-legged and squat, which is the desire of the Indian population.&lt;/p&gt;

Cementless total hip replacement with femoral calcar reconstruction for unstable intertrochanteric fractures combined with femoral head necrosis

Objective To explore the feasibility and therapeutic effects of total hip replacement (THR) for intertrochanteric fractures combined with late necrosis of the femoral head. Methods From June 2010 to October 2015, 8 patients underwent THR for intertrochanteric fractures combined with necrosis of the femoral head. They were 6 males and 2 females, with an average age of 53.5 years (from 45 to 67 years). According to the Evans-Jensen classification, 2 fractures were type ⅠB, 5 type ⅡA and one type ⅡB. All the 8 fractures were complicated with late femoral head necrosis, 5 cases of which were ischemic. According to the Ficat classification, the ischemic necrosis was type Ⅲ in one and type Ⅳ in 5 cases. In the other 3 cases, the necrosis secondary to the hip osteoarthrosis was type Ⅲ according to the Tonnis classification. The necrotic femoral head was removed after osteotomy of the femoral neck via the posterolateral approach; after reduction of the femoral calcar, the intertrochanteric fracture was reduced and fixated in a press-fit manner through antegrade implantation of a biological stem prosthesis. Functional assessment of the affected hip was carried out at the final follow-up using Harris scoring. Results The 8 patients were followed up for an average of 25.5 months (from 12 to 45 months). After operation, biological press-fit and initial stability of the femoral stem were achieved in all the patients. The X-ray films showed bone ingrowth fixation in all the 8 hips at 3 months postoperatively. The Harris hip scores at the final follow-up averaged 92.3(from 89 to 98). The pa-tients showed fine subjective satisfaction. Follow-ups revealed no infection, prosthetic failure, osteolysis, dislocation or articular instability. Conclusion In treatment of intertrochanteric fractures combined with necrosis of the femoral head, THR can lead to fixation and reduction of the intertrochanteric fracture and re-placement of the necrotic femoral head at one stage, promoting functional recovery of the affected hip. Key words: Hip fractures; Arthroplasty, replacement, hip; Femoral head necrosis

Effects of Dexmedetomidine for postoperative pain management in elderly patients with femoral head replacement

Objective To investigate the effects of different doses of dexmedetomidine combined with sufentanil for postoperative pain management in elderly patients with femoral head replacement(FHR). Methods Between January 2016 and August 2016, 160 elderly patients(>65 years and BMI 20-28 kg/m2)with American Society of Anesthesiologists(ASA)physical classification Ⅰ-Ⅲ scheduled for elective FHR under spinal anesthesia were randomly allocated into four groups(n=40 for each group). Forty patients, who received patient-controlled intravenous analgesia(PCIA)with sufentanil(1.5 μg/kg)and tropisetron(5 mg)diluted by normal saline to 100 ml, were assigned to the control group.The other 120 patients who received Dexmedetomidine in addition to PCIA were allocated to the experimental group.Based on the dose of dexmedetomidine used in PCIA, the experimental group was divided into three subgroups: Group D1(1.0 μg/kg), D2(1.5 μg/kg)and D3(2.0 μg/kg). The background infusion rate was 2 ml/h, demand dose 0.5 ml and lockout interval 15 min.Pain scores at rest were evaluated with a visual analogue scale(VAS)and Ramsay sedation scores were recorded at 4 h, 8 h and 24 h after surgery.Effects of post-operative analgesia and sedation, supplementary doses of analgesics, and adverse events were also recorded and compared. Results Compared with Control group, VAS was significantly lower at 4 h, 8 h and 24 h after surgery in Group D1, D2, and D3(P 0.05). Meanwhile, there were no significant differences in Ramsay scores among the four groups.Doses of supplementary analgesics and rates of adverse events were markedly lower in Group D1, D2 and D3 than in Control group(P<0.05 for all). Conclusions Dexmedetomidine may enhance the analgesic effects of PCIA with sufentanil and reduce the side effects of opioids in elderly patients with FHR. Key words: Dexmedetomidine; Arthroplasty, replacement; Femoral head; Analgesia

An analysis of the effect of artificial lengthening femoral head replacement in elderly patients with stage I of unstable femoral intertrochanteric fracture

Objective To analyze of the effect of artificial lengthening femoral head replacement in elderly patients with stage I of unstable femoral intertrochanteric fracture. Methods 203 patients with stage I of unstable femoral intertrochanteric fracture were selected as the research object, and they were taken artificial lengthening femoral head replacement, among which 65caese were male, female in 138 cases.The Harris scoring, SF-36, VAS pain scores on admission, 2 weeks after operation, postoperative follow-up limb were counted, and the pain of the affected limb and the hip scores were compared amond 3 time periods. Results All 203 cases of senile patients with follow-up, average operation time was 83.64 minutes, the intraoperative blood loss was 355.41mL.The curative effect was evaluated according to the Harris score, SF-36 and VAS pain scoring criteria, and the Harris scores of the affected limbs at admission, at 2 weeks after the operation and after the follow-up were (28.26±5.50)points, (68.26±5.50)points, (93.13±5.31)points, respectively, the differences were statistically significant(t=-71.27, -1 397.55, -46.07, all P<0.01); The VAS pain scores were (8.19±0.48)points, (3.53±0.71)points, (0.23±0.42)points, respectively, the differences were statistically significant (t=88.06, 324.17, 60.84, all P<0.01). The sf-36 scores: physiological[(8.35±1.24)points, (15.23±2.17)points, (19.21±2.12)points], social/family[(7.01±1.13)points, (14.12±2.12)points, (19.85±2.24)points], emotional[(4.83±1.01)points, (10.12±1.22)points, (14.87±1.32)points], function[(6.35±1.21)points, (13.67±1.87)points, (16.81±2.12)points], additional focus[(8.85±1.45)points, (16.38±2.12)points, (20.21±2.42)points], total quality of life [(47.35±4.76)points, (74.69±5.87)points, (89.21±6.12)points], the differences were statistically significant(-39.77, -62.92, -20.21, -44.87, -71.89, -26.79, -45.04, -89.01, -38.25, -45.79, -63.41, -15.29, -45.20, -60.39, -17.54, -52.12, -76.49, -22.58, all P<0.01). Conclusion Artificial lengthening femoral head replacement in elderly patients with stage I of unstable femoral intertrochanteric fracture has good clinical effect, intraoperative high safety, less postoperative complications, postoperative limb functional recovery is good, and it is worthy of clinical promotion and application. Key words: Femoral fractures; Arthroplasty, replacement, hip; Aged

Comparison of the effect of proximal femoral anti-rotation nail and artificial femoral head replacement with bone cement in the treatment of intertrochanteric fracture of femur in elderly patients

Objective To compare the efficacy of proximal femoral anti-rotation nail and artificial femoral head replacement with bone cement in the treatment of intertrochanteric fracture of femur in elderly patients. Methods 70 elderly patients with intertrochanteric fracture of femur were selected as the research subjects, and they were randomly divided into the observation group and the control group according to the digital table, 35 cases in each group.The observation group was treated with proximal femoral anti-rotation nail, the control group was treated with artificial femoral head replacement with bone cement.The clinical efficacy of the two groups was observed and compared. Results The operation time, intraoperative bleeding volume of the observation group were (52.63±13.72)min, (115.26±35.17)mL, respectively, which were significantly better than those of the control group[(86.69±21.15)min, (328.72±47.62)mL, t=3.98, 9.86, all P 0.05). There was no significant difference in the Harris hip score 30 months after operation between the two groups(t=0.18, P>0.05), while the Harris hip score of the observation group after 6 and 12 months were higher than those of the control group, the differences were statistically significant(t=9.04, 3.75, all P<0.05). Conclusion Compared with artificial femoral head replacement with bone cement, proximal femoral anti-rotation nail for elderly patients with intertrochanteric fracture of femur has more significant effect, it is worthy of clinical promotion. Key words: Femoral fractures; Fracture fixation, internal; Bone wires; Arthroplasty, replacement, hip; Aged

Efficacy comparison of different methods to treat femoral intertrochanteric fracture in aged patients

To compare the efficacy of proximal femoral nail anti-rotation (PFNA), locking compression plate (LCP), and artificial femoral head replacement for femoral intertrochanteric fracture in aged patients so as to provide reference for clinical treatment. A retrospective analysis was made on the clinical data of 150 aged patients with femoral intertrochanteric fracture treated between September 2009 and March 2016. PFNA was used in 51 cases (group A), LCP in 53 cases (group B), and artificial femoral head replacement in 46 cases (group C). There was no significant difference in sex, age, side, cause of injury, injury to operation time, type of fracture, and combined medical diseases between groups ( P>0.05). The incision length, operation time, intraoperative blood loss, time for full weight bearing, hip Harris score, and complications were recorded and compared between groups. The patients were followed up 12-23 months (mean, 18.6 months) in group A, 12-25 months (mean, 19.0 months) in group B, and 12-24 months (mean, 18.9 months) in group C. The incision length, operation time, and intraoperative blood loss of group A were significantly less than those of groups B and C ( P<0.05); the operation time of group C was significantly shorter than that of group B ( P<0.05), but there was no significant difference in incision length and intraoperative blood loss ( P>0.05). The time for full weight bearing was significantly shorter in group C than groups A and B, and in group A than group B ( P<0.05). Postoperative complications occurred in 11 patients of group A (21.6%), 14 patients of group B (26.4%), and 2 patients of group C (4.3%), showing significant difference between group C and group A or group B ( P<0.05), but no significant difference was found between groups A and B ( P>0.05). Hip Harris score at 12 months after operation had no significant difference between groups ( P>0.05). PFNA, LCP, and artificial femoral head replacement are all effective methods to treat femoral intertrochanteric fracture in aged patients. PFNA has the advantages of small incision, short operation time, less bleeding and simple procedure, and artificial femoral head replacement has the advantages of early time for full weight bearing, less bed rest time, and less complications. For these patients, PFNA and artificial femoral head replacement are appropriate.

Care of the elderly patients with femoral head replacement

目的 探讨股骨头置换术的临床护理经验。 方法 对股骨头置换术手术后患者的临床资料进行回顾性分析，总结相关护理经验。 结果 股骨头置换术的临床护理可分为术前护理、术中护理、术后护理和出院指导、随访等。术前护理注重心理护理、术前训练、术前准备等；术中护理注重手术中护士配合；术后护理注重病情观察、并发症预防、功能康复、出院指导及随访要求等。 结论 正确护理和病情观察及并发症的预防是手术成功的重要环节，有效的早期康复训练是能否恢复髋关节功能的关键。

The preventive effect of Autar scale formation in of orthopedics operation patients with deep vein thrombosis

Objective To investigate the preventive effect of Autar scale in the Department of orthopedics operation patients with deep vein thrombosis (DVT). Methods A total of 330 cases of patients with orthopedic operation within 24 hours and 24 hours after operation in 10 hospitals from November 2014 to February 2015 were assessed the risk using Autar scale. They were divided into low risk group (score≤10), middle risk group (score 11-14) and high risk group (score≥15) according to the scores. During hospitalization, two weeks, one month, three months after discharge, the incidence of DVT was observed by follow-up. Results According to Autar scale, 97.88% (323/330) patients after surgery were in middle and high risk. According to the Autar score, different surgical methods got different scores, Autar score before operation and the first day after operation was 14.26±4.06,17.88±3.78 in femoral head replacement, while 8.88±4.96, 14.84±3.10 in hip replacement; and the femoral head replacement had the highest risk (χ2=145.131, 241.256, P < 0.01). Within 24 hours after admission, 13.33% (44/330) patients were in high risk, and 11.36% (5/44) patients occurred DVT. After surgery, 52.73% (174/330) patients were in high risk, and 6.32% (11/174) patients occurred DVT. Conclusions Patients with orthopaedic surgery are most in median to high risk of DVT. Using Autar scale for DVT risk assessment of patients undergoing major orthopaedic surgery is effective. It is propitious to nurses to discriminate high risk patients, adopt preventive treatment and nursing intervention in order to decrease the incidence of DVT. Key words: Deep vein thrombosis; Autar scale; Orthopaedic surgery; Risk assessment

Early Clinical Efficacy Comparison Study of Gamma3 Nail, Percutaneous Compression Plate (PCCP) and Femoral Head Replacement (FHR) Treatment on Senile Unstable Intertrochanteric Fractures

ABSTRACTPurpose: This study aimed to analyze the early clinical efficacy of Gamma 3 nail, percutaneous compression plate (PCCP) and femoral head replacement (FHR) treatments on senile unstable intertrochanteric fractures. Materials and Methods: Totally 116 patients were included to perform an retrospective study, which involved analysis of the operation time, intraoperative blood loss, and hemoglobin reduction on the first postoperative day compared with preoperative levels, fracture gap, neck shaft angle and tip apex distance on the first postoperative X-ray, hospital stay, time from surgery to mobilization, Harris hip scores and Barthel index six months after operation, and complications postoperative meanwhile were evaluated respectively among three groups. Results: The Harris hip score and Barthel index and time from surgery to mobilization after FHR treatment were superior to another two surgical methods, but had more blood loss and greater hemoglobin reduction. The mean PCCP hemoglobin reduction was notably shorter than that of the other two groups. Gamma 3 treatment had a lower operation time and blood loss than those treated with PCCP and FHR. Conclusions: Gamma 3 and PCCP treatments are a priority for senile unstable intertrochanteric fractures if patients are in good health and perform fair activities of daily living prior to the operation, but had a significantly longer mobilization time than that in FHR. Therefore, considering the senile patients who unable to tolerate long immobilization time, FHR treatment is a considerable choice for faster recovery of independent function and achieve a good clinical efficacy as well as improve quality of life.

Supercapsular percutaneously-assisted total hip approach for the elderly with femoral neck fractures: study protocol for a prospective, open-label, randomized, controlled clinical trial

Background: Artificial hip replacement by the posterolateral approach is generally introduced as a treatment for femoral neck fracture in the elderly, but it is limited by the need for a large incision, cutting off the extortor, and postoperative hip dislocation. The supercapsular percutaneously-assisted total hip (SuperPATH) approach was developed based on the original lateral approach. The SuperPATH approach for hip replacement is characterized by the reduced chance of damaging blood vessels and nerves, reducing intraoperative blood loss, retaining all the joint capsules and supinator, and significantly reducing the incidence of postoperative hip dislocation. Given these advantages, we hypothesized that the SuperPATH approach for hip replacement can achieve better efficacy in the elderly with femoral neck fractures and promote the recovery of postoperative hip function compared with the posterolateral approach. Methods/Design: This is a prospective, single-center, open-label, randomized controlled clinical trial that will be completed at the Pudong Hospital of Fudan University, Shanghai, China. Forty patients with femoral neck fractures were randomly divided into two groups to undergo femoral head replacement by the SuperPATH approach in the experimental group, and by the conventional posterior approach in the control group. The follow-up period is 1 week and 6 months. The primary outcome measure is Harris hip scores at baseline, and at 1 week and 6 months postoperatively to assess functional recovery of the hip. Secondary outcome measures to evaluate the advantages of the SuperPATH approach include the length of surgical incision, intraoperative blood loss, operative time, 24-hour postoperative drainage, and hospital stay. Other outcome measures include the incidence of adverse events at 1 week and 6 months after surgery. Discussion: The aim of this trial is to test our hypothesis that the SuperPATH approach is safer and more reliable for hip functional recovery compared with the posterolateral approach for the artificial hip replacement in femoral neck fractures of the elderly. Trial registration: ClinicalTrials.gov identifier: NCT03134664. Ethics: The study protocol was approved by the Ethics Committee of the Pudong Hospital of Fudan University, China, and performed in accordance with the guidelines of the Declaration of Helsinki, formulated by the World Medical Association. Informed consent: Written informed consent was obtained from all participants prior to the trial commencement.