目的:通过对Gamma3、股骨近端防旋髓内钉(proximal femoral nail anti-rotation,PFNA)及动力髋螺钉(dynamic hip nail,DHS)治疗的老年股骨粗隆间骨折患者围手术期失血量的分析,了解老年股骨粗隆间骨折患者围手术期失血的特点。方法:回...目的:通过对Gamma3、股骨近端防旋髓内钉(proximal femoral nail anti-rotation,PFNA)及动力髋螺钉(dynamic hip nail,DHS)治疗的老年股骨粗隆间骨折患者围手术期失血量的分析,了解老年股骨粗隆间骨折患者围手术期失血的特点。方法:回顾性分析了我科2007年1月1日至2012年12月31日诊治的408例采用Gamma3、PFNA及DHS治疗的老年股骨粗隆间骨折患者的临床资料。使用Gross方程,根据身高、体重、术前和术后的血常规变化,计算围手术期的失血量,并比较Gamma3组、PFNA组及DHS组的失血量区别。结果:Gamma3治疗组患者共96例,平均手术时间为(74.7±25.0)min,平均显性失血量为(103.5±83.0)mL,平均总失血量为(831.9±474.8)mL,平均隐性失血量为(728.3±455.5)mL。PFNA治疗组患者共84例,平均手术时间为(69.0±27.1)min,平均显性失血量为(91.5±111.4)mL,平均总失血量为(825.7±478.0)mL,平均隐性失血量为(734.2±455.7)mL。DHS治疗组患者共40例,平均手术时间为(97.5±25.0)min,平均显性失血量为(283.6±142.1)mL,平均总失血量为(695.7±502.4)mL,平均隐性失血量为(412.1±457.6)mL。结论:通过3种内固定方式的比较发现,DHS治疗粗隆间骨折切口大、手术时间长、术中出血多,Gamma3和PFNA治疗老年股骨粗隆间骨折虽然具有切口小、手术时间短、术中出血少等优点,但围手术期的隐性失血较多,临床应予以足够的重视,以减少术后并发症的发生。展开更多
目的探讨老年髋部骨折患者围手术期感染的危险因素。方法采集西安交通大学医学部附属红会医院收治的符合病例选择标准的221例老年髋部骨折手术患者的临床资料,记录感染发生情况及感染类型,分析骨折类型、手术方式、出血量、卧床时间、...目的探讨老年髋部骨折患者围手术期感染的危险因素。方法采集西安交通大学医学部附属红会医院收治的符合病例选择标准的221例老年髋部骨折手术患者的临床资料,记录感染发生情况及感染类型,分析骨折类型、手术方式、出血量、卧床时间、患者心理状态和疼痛程度等因素与感染的相关性。结果共发生感染17例,总感染率7.7%(17/221)。肺部感染是最主要的感染类型(7/17),其次是压疮、泌尿系感染、手术切口感染等。在合并慢性内科疾病的患者中,并发呼吸系统疾病的感染率最高(12%),其次是糖尿病(6%)。不同手术方式中全髋关节置换围手术期感染率最低(4%),空心钉内固定感染率最高(13%);出血量在800 m L以上感染率较高(18%);随着术后卧床时间的延长,感染率呈上升趋势。围手术期不同焦虑状态或疼痛程度的患者感染率各不相同,严重焦虑状态和严重疼痛患者感染率高达14%和15%。结论老年髋部骨折围手术期感染类型以肺部感染为主,其次为压疮;合并呼吸道原发病的患者感染率高,手术方式、出血量、卧床时间对感染率有一定影响,焦虑、疼痛是老年髋部骨折围手术期感染的重要危险因素。展开更多
In total hip arthroplasty, judgment of the appropriateness of stem hammering is dependent on the experience and feelings of the surgeon and no objective evaluation method has been established. In this study, a frequen...In total hip arthroplasty, judgment of the appropriateness of stem hammering is dependent on the experience and feelings of the surgeon and no objective evaluation method has been established. In this study, a frequency analysis of the hammering sounds in total hip arthroplasty was performed to investigate objective judgment criteria capable of preventing problems during surgery. Stem hammering was applied following the surgeon’s feelings as usual in an operating room. A directional microphone was placed at a distance about 2 m from the surgical field and the peak frequency reaching the maximum amplitude was determined by Fourier analysis. It was clarified that the same peak frequency repeats when appropriate fixation is acquired during surgery, suggesting that intraoperative fracture and postoperative loosening can be prevented by stopping hammering at the time the peak frequency converged. Investigation of changes in the hammering sound frequency may serve as objective judgment criteria capable of preventing problems during surgery.展开更多
BACKGROUND Fractures of the axis are commonly seen in spinal injuries. Upper cervical fractures are usually managed conservatively. However, the complications due to long-term external immobilization cannot be ignored...BACKGROUND Fractures of the axis are commonly seen in spinal injuries. Upper cervical fractures are usually managed conservatively. However, the complications due to long-term external immobilization cannot be ignored. The traditional open surgery has the disadvantages of too much blood loss and soft tissue injury. The aim of our paper is to introduce a minimally invasive surgical treatment for multiple axis fractures.CASE SUMMARY We report a 40-year-old Chinese male who had severe neck pain and difficult neck movement after falling from 3 meters. X-ray and computed tomography(CT) scan revealed an axis injury consisting of an odontoid Type Ⅲ fracture associated with a Hangman fracture categorized as a Levine-Edwards Type Ⅰ fracture. The patient underwent anterior odontoid screw fixation and posterior percutaneous screw fixation using intraoperative O-arm navigation. Neck pain was markedly improved after surgery. X-rays and CT scan reconstructions of 3-mo follow-up showed good stability and fusion. The range of cervical motion was well preserved.CONCLUSION Anterior odontoid screw fixation and posterior direct C2 percutaneous pedicle screw fixation with the aid of O-arm navigation and neurophysiological monitoring can be an interesting alternative option for complicated multiple axis fractures.展开更多
Failure during total hip arthroplasty may lead to bedridden of the elderly. Since the acetabulum cup fix in an anatomically deep region, failures, such as loosening and fracture, occur three times more frequently comp...Failure during total hip arthroplasty may lead to bedridden of the elderly. Since the acetabulum cup fix in an anatomically deep region, failures, such as loosening and fracture, occur three times more frequently compared with failures of the stem fix in the femur. We investigated the possibility of evaluating whether fixation was acquired by frequency analysis of the hammering sound of implanting a cup into the acetabulum. The subjects were 11 patients (11 joints) who underwent total hip arthroplasty, biomechanical test materials, and orthopedic models. Surgeries and experiments were performed by orthopedists specialized in the hip. A system was constructed with a tablet PC and directional microphone, the peak frequency at which the amplitude reached the maximum was determined, and judgment processing (stable, unstable) of cup fixability was performed in real time. The stable maximum peak frequency observed in the clinical trials was 4.42 ± 4.02 kHz. The mean stable maximum peak frequency in the biomechanical tests was 4.46 ± 1.19 kHz in biomechanical test materials and 4.56 ± 2.02 kHz in orthopaedicmodels. When hammering was continued, the frequency leading to fracture decreased in both biomechanical test materials and orthopaedicmodels. In conclusion, in clinical trials and biomechanical studies, variation of the maximum peak frequency decreased when fixation was acquired and the frequency stabilized. It was suggested that this method can serve as a fixability evaluation method of acetabular cups because analysis can be performed in real time during surgery, for which prevention of intraoperative fracture can be expected.展开更多
A retrospective review was made of intraoperative femoral fracture prevalence in seventy nine consecutive, cementless, fully HA-coated stems used for revision hip arthroplasty. Three patients were lost to follow up. I...A retrospective review was made of intraoperative femoral fracture prevalence in seventy nine consecutive, cementless, fully HA-coated stems used for revision hip arthroplasty. Three patients were lost to follow up. Intraoperative fracture occurred in 15 (20%) femurs. Fractures occurred during cement removal (3/15) or insertion of the implant (12/15). All fractures were identified using intraoperative biplane X-ray, and were treated during the same operation. The clinical outcome of both groups (with or without fractures) was similar. The risk of intraoperative fracture was not statistically related to any demographic features or operative technique. Intraoperative radiographs are therefore mandatory in revision hip arthroplasty in order to diagnose and treat the common complication of femur fracture appropriately.展开更多
Intraoperative periprosthetic femoral fractures (IPFF) have been studied extensively for total hip arthroplasties, but not for hemiarthroplasties. Recent series in the literature show an IPFF rate for hemiarthroplasti...Intraoperative periprosthetic femoral fractures (IPFF) have been studied extensively for total hip arthroplasties, but not for hemiarthroplasties. Recent series in the literature show an IPFF rate for hemiarthroplasties ranging from 0% to 14%. The present study was designed to determine the prevalence and outcome after IPFF during non-cemented hemiarthroplasty. In addition, the surgical step at higher risk to produce these fractures was evaluated in an attempt to identify strategies that could minimize the prevalence of this complication. We performed an observational study of 365 consecutive patients undergoing and Austin-Moore hemiarthroplasty from 2005 to 2006 at our institution. The institutional IPFF rate was 6.8% (twenty-five out of 365). The moment at which the fracture was detected was collected: 1) intraoperatively and 2) in the postoperative radiological control. The surgical step in which the fracture occurred was collected: 1) neck osteotomy, 2) broaching, 3) prosthesis introduction, and 4) reduction. Results were compared to a control group according to blood transfusion rate, mortality rate and revision surgery rate. The fractures were detected during the surgery in twenty cases (80%);for the five remaining cases the fracture was only detected in the postoperative radiology. For those detected during the surgery, the two most common manouvers in which the fracture occurred was hip reduction (10 cases) and prosthesis introduction (7 cases). The blood transfusion rate, first-month mortality rate and revision surgery rate showed no statistical difference between the two groups (p = 0.3). In the present series, most of IPFF during Austin-Moore hemiarthroplasty implantation, occurred during arthroplasty reduction. Difficulties during this step should lead the surgeon to reconsider if technical mistakes are present and can be solved. However, if fracture occurs, adequate treatment of IPFF should provide satisfactory results without increasing blood transfusion needs, mortality or revision surgery.展开更多
[目的]探讨侧卧位直接前入路全髋置换术(total hip arthroplasty,THA)中股骨骨折的危险因素。[方法]2018年1月~2020年1月,对261例(273髋)患者行侧卧位直接前入路THA,均使用普通手术床、常规假体柄。按是否发生术中股骨骨折将患者分为两...[目的]探讨侧卧位直接前入路全髋置换术(total hip arthroplasty,THA)中股骨骨折的危险因素。[方法]2018年1月~2020年1月,对261例(273髋)患者行侧卧位直接前入路THA,均使用普通手术床、常规假体柄。按是否发生术中股骨骨折将患者分为两组,采用单项因素和多因素逻辑回归分析骨折发生的相关因素。[结果]261例患者中,34例(35髋)发生股骨骨折,大转子骨折29例,近端劈裂4例,股骨穿孔1例,骨折发生率12.82%。单因素分析表明,骨折组身高低于非骨折组(P<0.05);骨折组的病种构成与非骨折组差异有统计学意义(P<0.05),髋发育不良、髋骨关节炎骨折率显著高于股骨头坏死及股骨颈骨折(P<0.05);骨折组髂前上棘至大转子尖距离(spine-tip distance,STD)明显小于非骨折组(P<0.05);骨折组骨质疏松(osteoporosis,OP)率显著高于非骨折组(P<0.05)。逻辑回归显示,OP和STD与发生骨折之间存在显著相关性(P<0.05);其中,OP是骨折的危险因素(OR=2.414,P<0.05),而STD是骨折的保护因素(OR=0.938,P<0.05)。[结论]OP和STD是侧卧位直接前入路THA治疗股骨骨折最主要的相关因素。展开更多
文摘目的:通过对Gamma3、股骨近端防旋髓内钉(proximal femoral nail anti-rotation,PFNA)及动力髋螺钉(dynamic hip nail,DHS)治疗的老年股骨粗隆间骨折患者围手术期失血量的分析,了解老年股骨粗隆间骨折患者围手术期失血的特点。方法:回顾性分析了我科2007年1月1日至2012年12月31日诊治的408例采用Gamma3、PFNA及DHS治疗的老年股骨粗隆间骨折患者的临床资料。使用Gross方程,根据身高、体重、术前和术后的血常规变化,计算围手术期的失血量,并比较Gamma3组、PFNA组及DHS组的失血量区别。结果:Gamma3治疗组患者共96例,平均手术时间为(74.7±25.0)min,平均显性失血量为(103.5±83.0)mL,平均总失血量为(831.9±474.8)mL,平均隐性失血量为(728.3±455.5)mL。PFNA治疗组患者共84例,平均手术时间为(69.0±27.1)min,平均显性失血量为(91.5±111.4)mL,平均总失血量为(825.7±478.0)mL,平均隐性失血量为(734.2±455.7)mL。DHS治疗组患者共40例,平均手术时间为(97.5±25.0)min,平均显性失血量为(283.6±142.1)mL,平均总失血量为(695.7±502.4)mL,平均隐性失血量为(412.1±457.6)mL。结论:通过3种内固定方式的比较发现,DHS治疗粗隆间骨折切口大、手术时间长、术中出血多,Gamma3和PFNA治疗老年股骨粗隆间骨折虽然具有切口小、手术时间短、术中出血少等优点,但围手术期的隐性失血较多,临床应予以足够的重视,以减少术后并发症的发生。
文摘目的探讨老年髋部骨折患者围手术期感染的危险因素。方法采集西安交通大学医学部附属红会医院收治的符合病例选择标准的221例老年髋部骨折手术患者的临床资料,记录感染发生情况及感染类型,分析骨折类型、手术方式、出血量、卧床时间、患者心理状态和疼痛程度等因素与感染的相关性。结果共发生感染17例,总感染率7.7%(17/221)。肺部感染是最主要的感染类型(7/17),其次是压疮、泌尿系感染、手术切口感染等。在合并慢性内科疾病的患者中,并发呼吸系统疾病的感染率最高(12%),其次是糖尿病(6%)。不同手术方式中全髋关节置换围手术期感染率最低(4%),空心钉内固定感染率最高(13%);出血量在800 m L以上感染率较高(18%);随着术后卧床时间的延长,感染率呈上升趋势。围手术期不同焦虑状态或疼痛程度的患者感染率各不相同,严重焦虑状态和严重疼痛患者感染率高达14%和15%。结论老年髋部骨折围手术期感染类型以肺部感染为主,其次为压疮;合并呼吸道原发病的患者感染率高,手术方式、出血量、卧床时间对感染率有一定影响,焦虑、疼痛是老年髋部骨折围手术期感染的重要危险因素。
文摘In total hip arthroplasty, judgment of the appropriateness of stem hammering is dependent on the experience and feelings of the surgeon and no objective evaluation method has been established. In this study, a frequency analysis of the hammering sounds in total hip arthroplasty was performed to investigate objective judgment criteria capable of preventing problems during surgery. Stem hammering was applied following the surgeon’s feelings as usual in an operating room. A directional microphone was placed at a distance about 2 m from the surgical field and the peak frequency reaching the maximum amplitude was determined by Fourier analysis. It was clarified that the same peak frequency repeats when appropriate fixation is acquired during surgery, suggesting that intraoperative fracture and postoperative loosening can be prevented by stopping hammering at the time the peak frequency converged. Investigation of changes in the hammering sound frequency may serve as objective judgment criteria capable of preventing problems during surgery.
文摘BACKGROUND Fractures of the axis are commonly seen in spinal injuries. Upper cervical fractures are usually managed conservatively. However, the complications due to long-term external immobilization cannot be ignored. The traditional open surgery has the disadvantages of too much blood loss and soft tissue injury. The aim of our paper is to introduce a minimally invasive surgical treatment for multiple axis fractures.CASE SUMMARY We report a 40-year-old Chinese male who had severe neck pain and difficult neck movement after falling from 3 meters. X-ray and computed tomography(CT) scan revealed an axis injury consisting of an odontoid Type Ⅲ fracture associated with a Hangman fracture categorized as a Levine-Edwards Type Ⅰ fracture. The patient underwent anterior odontoid screw fixation and posterior percutaneous screw fixation using intraoperative O-arm navigation. Neck pain was markedly improved after surgery. X-rays and CT scan reconstructions of 3-mo follow-up showed good stability and fusion. The range of cervical motion was well preserved.CONCLUSION Anterior odontoid screw fixation and posterior direct C2 percutaneous pedicle screw fixation with the aid of O-arm navigation and neurophysiological monitoring can be an interesting alternative option for complicated multiple axis fractures.
文摘Failure during total hip arthroplasty may lead to bedridden of the elderly. Since the acetabulum cup fix in an anatomically deep region, failures, such as loosening and fracture, occur three times more frequently compared with failures of the stem fix in the femur. We investigated the possibility of evaluating whether fixation was acquired by frequency analysis of the hammering sound of implanting a cup into the acetabulum. The subjects were 11 patients (11 joints) who underwent total hip arthroplasty, biomechanical test materials, and orthopedic models. Surgeries and experiments were performed by orthopedists specialized in the hip. A system was constructed with a tablet PC and directional microphone, the peak frequency at which the amplitude reached the maximum was determined, and judgment processing (stable, unstable) of cup fixability was performed in real time. The stable maximum peak frequency observed in the clinical trials was 4.42 ± 4.02 kHz. The mean stable maximum peak frequency in the biomechanical tests was 4.46 ± 1.19 kHz in biomechanical test materials and 4.56 ± 2.02 kHz in orthopaedicmodels. When hammering was continued, the frequency leading to fracture decreased in both biomechanical test materials and orthopaedicmodels. In conclusion, in clinical trials and biomechanical studies, variation of the maximum peak frequency decreased when fixation was acquired and the frequency stabilized. It was suggested that this method can serve as a fixability evaluation method of acetabular cups because analysis can be performed in real time during surgery, for which prevention of intraoperative fracture can be expected.
文摘A retrospective review was made of intraoperative femoral fracture prevalence in seventy nine consecutive, cementless, fully HA-coated stems used for revision hip arthroplasty. Three patients were lost to follow up. Intraoperative fracture occurred in 15 (20%) femurs. Fractures occurred during cement removal (3/15) or insertion of the implant (12/15). All fractures were identified using intraoperative biplane X-ray, and were treated during the same operation. The clinical outcome of both groups (with or without fractures) was similar. The risk of intraoperative fracture was not statistically related to any demographic features or operative technique. Intraoperative radiographs are therefore mandatory in revision hip arthroplasty in order to diagnose and treat the common complication of femur fracture appropriately.
文摘Intraoperative periprosthetic femoral fractures (IPFF) have been studied extensively for total hip arthroplasties, but not for hemiarthroplasties. Recent series in the literature show an IPFF rate for hemiarthroplasties ranging from 0% to 14%. The present study was designed to determine the prevalence and outcome after IPFF during non-cemented hemiarthroplasty. In addition, the surgical step at higher risk to produce these fractures was evaluated in an attempt to identify strategies that could minimize the prevalence of this complication. We performed an observational study of 365 consecutive patients undergoing and Austin-Moore hemiarthroplasty from 2005 to 2006 at our institution. The institutional IPFF rate was 6.8% (twenty-five out of 365). The moment at which the fracture was detected was collected: 1) intraoperatively and 2) in the postoperative radiological control. The surgical step in which the fracture occurred was collected: 1) neck osteotomy, 2) broaching, 3) prosthesis introduction, and 4) reduction. Results were compared to a control group according to blood transfusion rate, mortality rate and revision surgery rate. The fractures were detected during the surgery in twenty cases (80%);for the five remaining cases the fracture was only detected in the postoperative radiology. For those detected during the surgery, the two most common manouvers in which the fracture occurred was hip reduction (10 cases) and prosthesis introduction (7 cases). The blood transfusion rate, first-month mortality rate and revision surgery rate showed no statistical difference between the two groups (p = 0.3). In the present series, most of IPFF during Austin-Moore hemiarthroplasty implantation, occurred during arthroplasty reduction. Difficulties during this step should lead the surgeon to reconsider if technical mistakes are present and can be solved. However, if fracture occurs, adequate treatment of IPFF should provide satisfactory results without increasing blood transfusion needs, mortality or revision surgery.
文摘[目的]探讨侧卧位直接前入路全髋置换术(total hip arthroplasty,THA)中股骨骨折的危险因素。[方法]2018年1月~2020年1月,对261例(273髋)患者行侧卧位直接前入路THA,均使用普通手术床、常规假体柄。按是否发生术中股骨骨折将患者分为两组,采用单项因素和多因素逻辑回归分析骨折发生的相关因素。[结果]261例患者中,34例(35髋)发生股骨骨折,大转子骨折29例,近端劈裂4例,股骨穿孔1例,骨折发生率12.82%。单因素分析表明,骨折组身高低于非骨折组(P<0.05);骨折组的病种构成与非骨折组差异有统计学意义(P<0.05),髋发育不良、髋骨关节炎骨折率显著高于股骨头坏死及股骨颈骨折(P<0.05);骨折组髂前上棘至大转子尖距离(spine-tip distance,STD)明显小于非骨折组(P<0.05);骨折组骨质疏松(osteoporosis,OP)率显著高于非骨折组(P<0.05)。逻辑回归显示,OP和STD与发生骨折之间存在显著相关性(P<0.05);其中,OP是骨折的危险因素(OR=2.414,P<0.05),而STD是骨折的保护因素(OR=0.938,P<0.05)。[结论]OP和STD是侧卧位直接前入路THA治疗股骨骨折最主要的相关因素。
