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Artificial femoral head replacement therapy in patients over 90 years of hip fracture_5793

By Valerie Allen,2014-10-30 10:02
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Artificial femoral head replacement therapy in patients over 90 years of hip fracture_5793

    Artificial femoral head replacement therapy in patients over 90 years of hip fracture

     Author: Yu-Tian Liang GUO Yi-chu, Pei-Fu Tang Sheng-Qun Yang Tao Yu

     Key words Hip fracture

     Abstract: [Objective] report of artificial femoral head replacement therapy in

    patients over 90 years of hip fractures. [Method] This group of 23 patients (24 hips), 7 males and female 16 cases. Age 90 ~ 100 years old, with an average age of 94. Fracture classification: 10 cases of femoral neck fractures according to Garden classification, ?

    in 6 cases, ? type 4 cases; 13 cases of intertrochanteric fracture (1 case of bilateral), according to Evans classification, ? A type 6 cases, ? B type in 6 cases, ? type 1 case.

    In addition to two cases have been bumps in the outdoors, the other fractures occurred indoors. After admission for temporary use in patients with skin traction brake limbs, and then seize the time to undertake the necessary preoperative examination to understand the patient's health. Fight in a short time invited relevant sections of the joint consultation, the patient's general condition assessment, demonstrated ability to tolerate surgery. This group of patients both in the pre-fracture co-existence of

    different degrees of medical illness, but after symptomatic treatment is relatively stable, most of them self-care, after assessment concluded that no absolute contraindication for surgery. Surgery are general anesthesia with endotracheal intubation, intraoperative monitoring ECG monitor. Take lateral position, hip, posterolateral

    incision, femoral neck fractures in patients with operation and other operation of the same age. Intertrochanteric fractures, isolated fractures of the femur needs to be large and small tuberosity re-reset, tied with wire fixation, from the parts of the femur bone

    defects filled with bone cement to rebuild. Intertrochanteric fracture surgery in patients with appropriate blood transfusion, this group of eight cases of intraoperative blood transfusion 200 ~ 800 ml, an average of 400 ml. Articular cavity built-in vacuum

    drainage tube, 48 ~ 72 h after the removal. [Results] 23 patients were successfully passed the surgery, after bed time, 2 ~ 7 d, an average of 4 d, duration of hospitalization 15 ~ 28 d, an average of 21 d. Complications: 6 cases occurred after a

    transient mental disorder, after treatment a gradual recovery; 1 patient with mild limb deep vein thrombosis, symptomatic treatment did not affect the treatment effect; 1 cases of 95-year-old female patient with intertrochanteric-type ? B fractures, 3 weeks

    after operation died of multiple organ failure. In 16 cases (9 cases of intertrochanteric fractures, 7 cases of femoral neck fractures) has followed up the results, followed up for 5 to 36 months, an average of 8 months. 10 cases (6 cases of intertrochanteric fractures, four cases of femoral neck fractures) basic to the situation before fracture, 5 cases (2 cases of intertrochanteric fractures, 3 cases of femoral neck fractures) live part of the self-care, and 1 case of intertrochanteric 6 months after fracture patients die of other diseases. [Conclusion] The artificial femoral head replacement therapy in patients over 90 years of hip fractures, satisfactory effect can be getting out of bed early, reduce

    complications, lower mortality, improved quality of life, to alleviate the burden of care of family life.

     Key words: 90 years of age; hip fracture; Artificial femoral head

     Cemented hemiarthroplasty for hip fractures in the elderly patients over 90 years

    old

     Abstract: [Objective] To review the effect of 23 cemented hemiarthroplasties in elderly patients over 90 years old with hip fractures. [Method] There were 23 eases (24 hips) in this group including 7 males and 16 females, aged 90 ~ 100 years with an average of 94

    years. There were 6 eases of type III and 4 eases of type IV of femoral neck fractures according to the classification of Garden; and 6 eases of type III A, 6 eases of type III B and 1 ease of type IV of intertrochanteric fractures according to the classification of

    Evans. After patients had admitted to hospital, the affected extremity was maintained with skin traction, medical disorders were treated properly, and no absolute contraindication was found after thorough examination. Femoral hemiarthroplasty was

    performed after the patient 's general condition reached stable. All patients were generally anesthetized and monitored with cardioelectrography. The separated greater and lesser trochanteric fragments were reduced and fixed with steel wires. Bone defect

    in the femoral calcar was crammed with bone cement. Blood was transfused in 8 patients with intertrochanteric fracture between 200 ~ 800 ml with an average of 400 ml during the operation. Suction drainage was removed 48 ~ 72 hours after the

    operation. [Result] All operations were successful, and the patients got out of the bed after 2 ~ 7 days with an average of 4 days. The period of hospitalization was between 15 ~ 28 days with an average of 21 days. Complications were as following: psychological

    disorders were found in 6 eases after the operation, but gradually recovered after appropriate treatments; 1 patient got deep phlebitis, but the affected extremity had not been harmed after proper treatment, 1 95 yearold patient with type III B

    intertrochanteric fracture died of multiple organs failure 3 weeks after the operation. Sixteen patients, of which 9 were with intertrochanteric fractures, and 7 with femoral neck fractures, were followed up for 5 to 36 months with an average of 8 month.

    According to the result, daily activities resumed completely in 10 cases (6 intertrochanteric fractures and 4 femoral neck fractures), daily activities resumed partly in 5 cases (2 intertrochamteric fractures and 3 femoral neck fractures), 1 patient

    with intertrochanteric fracture die of other diseases 6 months after the operation. [Conclusion] It 's an effective method to treat hip fractures in patients over 90 years with artificial femoral head reduction. The result is satisfactory and it has advantaged

    such as less complications, less mortality rate, better life quality, and the burden of patient 'family could been reduced.

     Key words: Elderly; Hip fracture; Artificial joint

     Since January 2000 ~ May 2004, by using artificial femoral head replacement

    surgery in patients over 90 years of hip fracture, 23 cases received a good effect, the report is as follows.

     A clinical data

     11 General Information

     The group of 23 patients (24 hips), 7 males and female 16 cases. Age 90 ~ 100 years

    old, with an average age of 94. Fracture classification: 10 cases of femoral neck fractures according to Garden classification, ? in 6 cases, ? type 4 cases; 13 cases of

    intertrochanteric fracture (1 case of bilateral), according to Evans classification, ? A

    type 6 cases, ? B type in 6 cases, ? type 1 case. In addition to two cases of outdoor

    falls, the other fractures occurred indoors. 5 cases of transient dizziness occurred a fall; four cases have been carpet trips; three cases out of bed space when the foot pedal; nine

    cases of self-slip falls. This group of patients both in the pre-fracture co-existence of

    different levels of old age, the coexistence of three kinds of diseases, in 8 cases; four kinds of diseases, 9 cases; 5 more than the disease in 6 patients, but the majority can

    live part of the pre-injury self. 23 cases (24 hips) are used with bone cement artificial femoral head replacement, of which 13 patients (14 hips) for domestic bipolar artificial femoral head, 11 cases for the German Link, bipolar femoral head.

     12 Perioperative

     Over 90 years old patients with hip fracture surgery success lies in perioperative treatment. (1) preoperative treatment: patients admitted to hospital after the temporary limb skin traction braking. The governing physicians to know the patient's

    health condition, in addition to information on the fracture of the information, even more important to understand what patients with the coexistence of disease, current treatment of how and what drugs to take. Some patients say their family members

    should not know about. Already mastered the disease, as soon as possible request the physician consultations, assist in evaluating the patient's body situation and recommended to continue treatment. For the preoperative examination, preoperative

    preparation, once completed, should be operative as soon as possible, because elderly patients with bed rest, the patient's condition rapidly, to avoid any unnecessary delays in the inspection timing of surgery; (2) intraoperative treatment: surgery to deal with

    the main control by the anesthesiologist, including endotracheal intubation anesthesia, ECG monitor monitoring, control blood pressure, heart rate, adjust the liquid out of capacity. With the surgeon about is this: after anesthesia, it should seize the time as

    soon as surgery, surgery to operate should be: fast, light, accurate and less blood loss, shorter operative time; (3) after treatment: prevention of applications antibiotics (dosage must be mastered: General with adult 1 / 3 or 1 / 4 can), symptomatic

    supportive therapy, because the elderly patients with poor postoperative gastrointestinal function may be appropriate to use some of the energy mixture, add white protein, vitamins and so on. Intra-articular drainage tube 24 ~ 72 h extraction.

    The most important thing is to get up early after operation, if the patient's general conditions permit, after the first 2 d can be sat up in bed by nurses or family members to help buckle back expectoration, will urge its deep breathing and prevent pulmonary

    complications. After 3 d, could be someone from the bed under the protection of the activities. Reposted elsewhere in the paper for free download http://

     13 surgical operation points

     Femoral neck fracture of artificial femoral head replacement and other surgical

    operations in patients with age is basically the same, not separate repeat. The intertrochanteric fracture surgery in the operation of relatively complex, because part of intertrochanteric comminuted fracture, bone defects more, large and small

    displacement of tuberosity fractures, femoral neck, intertrochanteric often intercalation site. The author's approach is: The femur large and small tuberosity reduction, respectively, cerclage wire or "8" bundle fixed. From the parts of the femur

    bone defects filled with bone cement. Insertion of artificial femoral head anteversion determination: In the hip, knee flexion 90 ?, foot and parallel to the ground, this time

inserting the artificial femoral head in the femoral condyle to forward the plane is

    about 15 ~ 20 ?, shall be the appropriate pre - angle. The choice of the femoral head:

    removal of the femoral head diameter should be less than 1 ~ 2 mm. Reset after the artificial femoral head flexion, extension, or a little adduction activities, without

    dislocation, that the joints fitted. Articular cavity built-in suction drainage tube, suture

    joint capsule, layered closure of incision.

     2 Treatment outcome

     23 cases (24 hips) have successfully passed the surgery, operative time was 40 ~ 75

    min; an average of 55 min. Femoral neck fracture surgery in patients with neither blood transfusion, eight cases of intertrochanteric fractures in patients with blood transfusion, blood transfusion volume of 200 ~ 800 ml, an average of 400 ml. After bed

    time, 2 ~ 7 d, an average of 4 d, duration of hospitalization 15 ~ 28 d, an average of 21 d. Complications: 6 cases occurred after a transient mental disorder, which gradually improved after treatment; one cases of mild inflammation of deep veins, symptomatic

    treatment did not affect the treatment effect; one cases of 95-year-old woman with

    intertrochanteric fracture ? B patients admitted to hospital 3 weeks after injury, when the symptoms have been hypostatic pneumonia, postoperative pulmonary infection

    occurred, despite an active anti-infective treatment, but ultimately failed to save the lives of patients at 3 weeks after operation died of multiple organ dysfunction failure. In 16 cases (9 cases of intertrochanteric fractures, 7 cases of femoral neck fractures)

    were followed up for 5 to 36 months, an average of 8 months. 10 cases (6 cases of intertrochanteric fractures, four cases of femoral neck fracture) returned to pre-

    fracture status; 5 cases (2 cases of intertrochanteric fractures, 3 cases of femoral neck

    fracture) Life can be part of the self; one cases of intertrochanteric fractures in patients 6 months after the operation died of other diseases. In this group one cases of 90-year-

    old blind patient, the left lower limb polio, falls caused by femoral neck fracture, after injury had refused treatment and persuaded his family and the author's efforts, its success was a special bipolar hemiarthroplasty surgery (Figure 1,2), after 3 d starting from the bed under the other arm activities.

     In this group a 97-year-old female patient, within six months after another Bilateral intertrochanteric fractures, the authors have successfully carried out for patients with bilateral intertrochanteric fracture hemiarthroplasty (Figure 3), postoperative

    recovery well, after 2 months of life most of the self.

     3 Discussion

     With the development of society, longevity for the elderly on the rise, due to the elderly proximal femur osteoporosis, hip fracture patients will also increase, and of 90-

    year-old hip fracture patients over the choice of treatment is a more difficult problem , while in patients over 90 years old intertrochanteric fractures and femoral neck fracture in a non-stability of the multi-fracture, screw fixation may lead to cutting, nail

    plate loosening lead to treatment failure, it is difficult to achieve the purpose of an early out of bed. Chan et al 1 that the use of bone cement semi-joint arthroplasty for

    elderly patients with intertrochanteric fracture fixation is superior to the former can

    quickly walking function recovery, reduce bone atrophy and improve the general condition. 2 Rodop other uses bipolar artificial femoral head treated 54 cases of unstable intertrochanteric fractures, aged 64 ~ 91 years old, with an average 756-year-

    old, to discharge 98% of patients can help-line device to walk.

     3 Haidukewych such as artificial joint replacement treatment of 60 patients

with failed internal fixation of intertrochanteric fracture patients, aged 54 ~ 96 years

    old, with an average 78-year-old, 32 cases of total joint replacement, semi-joint

    replacement in 28 cases, all patients had preoperative hip pain due to a serious loss of walking function. 54 cases were followed up for an average 5 a, 10 cases with other

    diseases, died; 20 patients resumed normal function; 13 cases of Rotary cane can be in the indoor activities; seven cases of life part of the self-care; 4 cases of the disease can

    not be due to other medical activities. There are the artificial femoral head using a

    special treatment of elderly patients with intertrochanteric fracture 4, the authors

    view that the general artificial femoral head can retain the femur large and small tuberosity, to avoid further trauma. Over the age of 90 hip fracture patients, treatment

    is not the main purpose of how the fracture reduction and fixation, but rather how can the patient get out of bed early, because there are a considerable number of patients after internal fixation of fractures will take some time for bed, and possibly not until

    the fracture healing was complications lost their lives. Therefore, authors chose the artificial femoral head replacement, artificial femoral head replacement from the operative time, intraoperative blood transfusion such as with Richard screw fixation

    methods showed no significant differences, but the artificial femoral head replacement surgery may be an early out of bed. Of course, in patients over 90 years of age the risk of hemiarthroplasty compared with patients below 80 years of age significantly

    increased not only requires a multidisciplinary collaborative treatment, and the need to obtain support and cooperation of the families. If we can properly grasp the surgical indications, perioperative management do a good job, artificial femoral head

    replacement therapy in patients over 90 years of hip fracture can be obtained satisfactory results.

     References:

     1 Chan KC, Gill GS.Cemented hemiarthroplasties for elderly patients with intertrochanteric fractures [J]. Clin Orthorp ,2000,371:206-215.

     2 Rodop O, Kiral A, Kaplan H, et al.Primary bipolar hemiprosthesis for unstable intertrochanteric fractures [J]. Inter Orthop (SICOT) ,2002,26:233-237.

     3 Haidukewych GJ, Berry DJ.Hip arthroplasty for salvage of failed treatment

    of intertrochanteric hip fractures [J]. J Bone Joint Surg ,2003,85:899-904.

     4 Yi Shan Jun, Pan had spring, Liting Lin, et al. Tailor-made prosthetic

    replacement for treatment of aged management of unstable intertrochanteric fractures

    [J]. Chinese Journal of Orthopedic Surgery, 2004,12 (21-22) :1651-1653. Reposted

    elsewhere free papers on the Download Center http://

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