ObjectiveTo investigate the effectiveness of multidisciplinary doctor-nurse collaboration team on the perioperation management of geriatric patients with hip fractures.MethodsThe clinical data of 489 geriatric patients with hip fractures (femoral neck fracture and intertrochanteric fracture) between January 1st 2016 and January 1st 2018 was retrospectively analyzed. Among them, 279 patients were treated with the multidisciplinary doctor-nurse collaboration care (observation group) and 210 patients were treated with the conventional therapeutics and nursing care (control group). There was no significant difference in gender, age, cause of injury, type and classification of fracture, the interval between injury and admission, and Charlson index between the two groups (P>0.05). The surgery rates, time from hospitalization to operation, length of stay, and the incidences of perioperative complications were compared between the two groups.ResultsThe surgery rate was 90.32% (252/279) in observation group and 80.48% (169/210) in control group, showing significant difference between the two groups (χ2=9.703, P=0.002). The time from hospitalization to operation and length of stay in observation group [(5.39±2.47), (10.56±3.76) days] were significant shorter than those in control group [(6.13±2.79), (12.27±3.11) days] (t=−3.075, P=0.002; t=−5.330, P=0.000). The incidence of respiratory complications was 46.15% in control group and 30.56% in observation group; the incidence of cardiovascular system complications was 69.23% in control group and 51.19% in observation group; the incidence of cerebrovascular system complications was 20.12% in control group and 11.11% in observation group; the incidence of deep venous thrombosis was 40.24% in control group and 25.40% in observation group. The incidences of perioperative complications were significantly lower in observation group than in control group (P<0.05).ConclusionMultidisciplinary doctor-nurse collaboration team is conducive not only to improve the surgery rates, but also to reduce perioperative complications as well as shorten the length of stay and preoperative waiting time.
Objective To summarize the latest developments in the enhanced recovery after surgery (ERAS) in the geriatric hip fractures and its perioperative therapy management. Methods The recent original literature on the ERAS in the geriatric hip fractures were extensively reviewed, illustrating the concepts and properties of the ERAS in the geriatric hip fractures. Results It has been considered to be associated with the decreased postoperative morbidity, reduced hospital length of stay, and cost savings to implement ERAS protocols, including multimodal analgesia, inflammation control, intravenous fluid therapy, early mobilization, psychological counseling, and so on, in the perioperative (emergency, preoperative, intraoperative, postoperative) management of the geriatric hip fractures. The application of ERAS in the geriatric hip fractures guarantees the health benefits of patients and saves medical expenses, which also provides basis and guidance for the further development and improvement of the entire process perioperative management in the geriatric hip fractures. Conclusion Significant progress has been made in the application of ERAS in the geriatric hip fractures. ERAS protocols should be a priority for perioperative therapy management in the geriatric hip fractures.
ObjectiveTo summarize the research progress on the application of tranexamic acid (TXA) in traumatic orthopedic surgery in recent years.MethodsThe domestic and foreign literature in recent years was reviewed, and the efficacy and safety of TXA in traumatic orthopedic surgeries with different regimen, dose and route of administration were comprehensively summarized and compared.ResultsThe application of TXA in traumatic orthopedic surgeries increased gradually in recent years. Intravenous or topical administration of TXA efficaciously reduced blood loss and transfusion requirements during hip fracture surgery without significantly increasing the risk of thromboembolic events. However, the efficacy was not clear in other traumatic orthopedic surgeries such as pelvic and acetabular fractures.ConclusionMore studies are needed to confirm the efficacy and safety of TXA in traumatic orthopedic surgeries.
Objective To investigate the effect of virtual reality (VR) sham feeding on gastrointestinal function in elderly patients with hip fracture. Methods Elderly patients with hip fracture admitted to Trauma Center, West China Hospital, Sichuan University between June and December 2024 who met the case selection criteria were selected. Patients who were willing to complete the postoperative VR operation were assigned to the experimental group (VR group), and the other patients were assigned to the control group by 1∶1 manual interval matching according to sex, age (±5 years), and body mass index (±2 kg/m2). The control group received fasting and nutrition management strategy during perioperative period of accelerated rehabilitation. In the VR group, VR sham feeding intervention was performed on the basis of the control group. The time of first postoperative exhaust and defecation, postoperative gastrointestinal symptoms, postoperative nutrition (hemoglobin, serum albumin) and inflammatory indicators (white blood cell count, erythrocyte sedimentation rate, C-reactive protein, interleukin-6), postoperative appetite and postoperative complications (bleeding, fever, delirium, aspiration, vertigo) were compared between the two groups. Results A total of 70 patients were enrolled, with 35 in each group. There were statistically significant differences (P<0.05) between the VR group and the control group in the time of postoperative first exhaust [(9.17±4.81) vs. (13.66±5.97) h], time of postoperative first defecation [(49.00±28.61) vs. (66.83±29.93) h], degree of abdominal distension 3 d after surgery (grade 0/1/2: 26/7/2 vs. 16/12/7 cases), appetite score 1 d after surgery (62.86±12.85 vs. 54.71±11.50), appetite score 3 d after surgery (76.29±9.95 vs. 62.43±8.86), albumin level 3 d after surgery [(33.18±3.41) vs. (31.40±3.07) g/L], and hospitalization days [(7.97±1.38) vs. (9.06±2.43) d], while there was no statistically significant difference in other indicators (P>0.05). Conclusions The incidence of postoperative gastrointestinal dysfunction is high in elderly patients with hip fracture. VR sham feeding can promote the early recovery of gastrointestinal function, alleviate postoperative abdominal distension, significantly improve postoperative appetite, and increase albumin level after surgery.
目的 探讨老年髋部骨折围手术期的治疗策略。 方法 回顾性分析2004年1月-2009年1月手术治疗的96例老年髋部骨折患者的临床资料。 结果 术前81.25%(78/96)合并内科疾病的患者，均安全度过手术期。术后发生并发症20例，发生率为20.83%。术前有并存疾病者手术治疗优良率为84.61%，术前无并存疾病者手术治疗优良率为94.44%；术前有无并存疾病患者的手术优良率比较，差异有统计学意义(Plt;0.05)。 结论 老年髋部骨折患者术前合并疾病较多，应视其个体情况，采取积极恰当的围手术期处理，积极控制和治疗合并疾病，才能降低围手术期并发症的发生率，取得优良的治疗效果。
ObjectiveTo research on the condition of constipation during the first 30 days after hip fracture. MethodsOne hundred and four patients with hip fracture treated between May 2014 and March 2015 participated in this study. We judged whether there was constipation by recording the defecation pattern and stool consistency in three time periods: from admission to the time just before surgery, from the end of surgery to the time of discharge, and from discharge to 30 days after injury. The defecation pattern was assessed using Bristol Stool Scale and a scale of four-stage defecation was used to assess the stool consistency. ResultsThere were 51.9% (54) of the patients who developed constipation during the first time period, 69.0% (69) during the second time period, and 63.4% (59) in the third time period. The proportion increased by 17% during the second period over the first (P=0.003), while there was no significant difference between the latter two time periods (P=0.581). Normal defecation pattern was re-established 9.7 days after surgery, though 23.7% (22) of the patients did not re-establish normal defecation pattern within the first 30 days after injury. ConclusionThe incidence of constipation during the first 30 days after hip fracture is high. The results imply that further studies are needed to prevent constipation.
ObjectiveTo evaluate the effect of early preoperative mobilization on the rehabilitation of the elderly patients with hip fractures after operation.MethodsThe clinical data of 16 elderly patients with hip fractures between February 2017 and April 2018 who met the selection criteria was retrospectively analyzed. There were 8 males and 8 females, with an average age of 80.3 years (range, 69-90 years). There were 8 cases of intertrochanteric fracture and 8 cases of femoral neck fracture. The preoperative American Society of Anesthesiologists (ASA) scored 2.94±0.43. There were 3 cases of cardiovascular and cerebrovascular diseases, 6 cases of essential hypertension, 5 cases of respiratory diseases, 3 cases of diabetes, and 2 cases of other system diseases. The time from injury to admission was 4 hours to 14 days with an average of 39.5 hours. On the day of admission or on the first day after admission, the patient started to exercise on the floor underwent analgesia treatment. And the patients were treated with closed reduction (9 cases) or artificial hip arthroplasty (7 cases). The time from admission to operation was 4 to 25 days, with an average of 7.4 days. At the time of admission, after the first ground movement before operation, on the second day after operation, and at last follow-up, the Barthel Index was used to assess the patients’ self-care ability, and Barthel effectiveness (BE) was calculated. The complications were observed and recorded during follow-up.ResultsAll 16 patients underwent operation successfully. The hospital stay was 8 to 24 days, with an average of 14.1 days. All patients were followed up 2.5-16.0 months with an average of 6.5 months. One patient developed postoperative pulmonary infection; the remaining patients had no surgical-related complications. No patient died during the follow-up. The Barthel Index scored 30.63±5.56 at admission, 53.13±9.50 after the first ground movement before operation, 60.63±6.09 on the second day after operation, and 96.25±4.84 at last follow-up. There were significant differences in Barthel Index scores between different time points (P<0.05). The BE was 0.23±0.06 after the first ground movement before operation, 0.30±0.04 on the second day after operation, and 0.66±0.06 at last follow-up. There were significant differences in BE between different time points (P<0.05).ConclusionFor elderly patients with hip fractures who have long waiting time before operation, early preoperative mobilization has a positive impact on patients’ activities of daily living.
Objective To review the research progress of rapid surgery for hip fracture in elderly patients. Methods The published studies, expert consensus, and guidelines at home and abroad were systematically summarized from the aspects of the characteristics of aging population, the benefits of rapid surgery, the disadvantages of delayed surgery, and the recommendations of current guidelines, so as to further guide clinical practice. Results Hip fracture is a common fracture type in the elderly population. As elderly patients generally have poor physique and often have a variety of underlying diseases, such as hypostatic pneumonia, bedsore, lower limb vein thrombosis, and other complications in conservative treatment, its disability rate and mortality are high, so surgical treatment is the first choice. At present, most relevant studies and expert consensus and guidelines at home and abroad support rapid surgery, that is, preoperative examination should be started immediately after admission, and adverse factors such as taking anticoagulant drugs, serious cardiovascular diseases, and severe anemia should be clearly and actively corrected, and surgery should be completed within 48 hours after admission as far as possible. Rapid surgery can not only significantly reduce the mortality of patients, but also reduce the length of hospital stay and the incidence of perioperative cognitive impairment, which is conducive to the recovery of patients with pain during hospitalization and postoperative function, and improve the prognosis of patients. Conclusion In order to avoid many problems caused by delayed surgery, the elderly patients with hip fracture should be operated as soon as possible under the condition of actively correcting the adverse factors. Comprehensive evaluation and preparation, the development of an individualized surgical plan, and the formation of a multidisciplinary medical team can reduce surgical risks and improve effectiveness.
Objective To compare the effectiveness of proximal femoral nail antirotation (PFNA) and reconstruction nail with minimally invasive technique for ipsilateral femoral shaft and extracapsular hip fractures in young and middle-aged patients. Methods Sixty-nine young and middle-aged patients with ipsilateral femoral shaft and extracapsular hip fractures were treated between January 2000 and August 2010, and their data were analyzed retrospectively. Of them, fractures were fixed by reconstruction nail in 44 cases (reconstruction nail group) and by PFNA in 25 cases (PFNA group). There was no significant difference in gender, age, weight, injury cause, fracture type, or disease duration between 2 groups (P gt; 0.05). The operation time, blood loss, fracture healing time, complications, and functional outcomes were compared between 2 groups to evaluate the effectiveness. Results The operation time and blood loss in the PFNA group were significantly less than those in the reconstruction nail group (P lt; 0.05). The follow-up time was 12-38 months (mean, 20 months ) in the PFNA group and was 12-48 months (mean, 22 months) in the reconstruction nail group. No complication occurred as follows in 2 groups: wound infection, deep venous thrombosis, pulmonary embolism, breakage of the implants, avascular necrosis of the femoral head, or serious rotation and shortening deformity of lower limbs. In the PFNA group and the reconstruction nail group, 1 patient underwent technical difficulty in nail implant and 7 patients underwent technical difficulty in proximal locking screw, respectively; 3 patients and 6 patients had intra-operative iatrogenic fracture of femoral shaft, respectively; and delayed union of femoral shaft was observed in 1 patient and 2 patients, respectively. The complication rate was 20% (5/25) in the PFNA group and 34% (15/44) in the reconstruction nail group, showing no significant difference (χ2=1.538, P=0.215). No significant difference was found in fracture healing time between 2 groups (P gt; 0.05). At last follow-up, there was no significant difference in Harris hip score and Evanich knee score between 2 groups (P gt; 0.05). Conclusion PFNA or reconstruction nail with minimally invasive technique is a good method to treat ipsilateral femoral shaft and extracapsular hip fractures, but the PFNA is superior to the reconstruction nail because of simple operation.