Evaluation Of The Short-term Curative Effect Of Two Approaches Of Total Hip Replacement Combined With Traditional Chinese Medicine In The Treatment Of Elderly Femoral Neck Fractures

Evaluation of the efficacy of two approaches for primary total hip replacement in the treatment of elderly femoral neck fracturePurpose: Total hip arthroplasty(THA)is the preferred treatment for displaced elderly femoral neck fractures.Evidence has demonstrated that selecting the proper surgical approach is an important factor that can affect the outcome of total hip arthroplasty.A number of surgical approaches to the hip joint exist,each with unique advantages and disadvantages.Generally,hip approaches can be broadly divided into three main categories depending on the anatomical relationship to the greater trochanter;anterior,lateral,and posterior approaches.Overall,posterior approaches provide wider exposure and spare the abductors muscles.However,they sacrifice the posterior capsule and the external rotators and subsequently may be associated with a higher risk of dislocation.Conversely,the lateral approaches provide adequate exposure with a reported lower risk for prosthetic dislocation.However,these approaches have the potential disadvantage of damaging the abductors or its nerve supply which can lead to weakness and limping.Due to the intermuscular nature,direct anterior approach(DAA)is regarded as allowing faster patient recovery to ambulation,normal abductor strength,and decreased dislocation rate.Multiple studies have reported favorable clinical outcomes with the DAA.However,others reported higher complications rate and a relatively slow learning curve.Therefore,we conducted this study to:(I)present our operative experience of the DAA for total hip arthroplasty in the treatment of elderly femoral neck fracture in lateral decubitus position;(II)compare short-term complications and clinical efficacy of this approach to the direct lateral approach.(III)explore the feasibility of transition from the direct lateral approach to direct anterior approach in lateral decubitus position.Material and method: From Dec 2015 to Dec 2016,97 patients were randomly divided into two groups of the DAA group and the DLA group underwent unilateral primary THA procedures.50 patients were performed with total hip arthroplasty via the direct anterior approach(DAA group).As comparison,47 patients were performed with total hip arthroplasty via the direct lateral approach(DLA group).DAA group:19 male patients and 31 female patients,with an average age of(70.10±6.10)years,body mass index(BMI)(23.33±3.3)kg/m2.DLA group: 17 male patients and 30 female patients,with an average age of(70.11±6.09)years,body mass index(BMI)(23.60±3.80)kg/m2.The two groups were homogeneous when compared in relation to mean age,sex and body weight,preoperative ASA status.The Traditional Chinese Medicine was given orally from the second day of operation.The follow-up period was 12 months.The incision length,operation time,intraoperative blood loss,postoperative drainage volume,hospital stay,postoperative 1 week,1month,3 months and 6 months Harris hip score(HHS),postoperative 1day,3 days,5days and 7 days visual analogue score(VAS),postoperative 1 month basic daily hip function analysis(include walking speed,circling,climbing stairs,sitting and wearing shoes and socks),postoperative 1 week,1 month,3 months and 6 months abductor torque of the hip,postoperative 1 week,1month,3 months and 6 months Trendelenburg`s sign,prosthesis position,leg length discrepancy,complications were observed and recorded and chinese medicinal symptom score.Software SPSS 19 was used to analyse and compare the date of the two groups.χ2 test was performed in count data,and t test was used for measurement data.P<0.05 was set as the significant difference.Results: 1.Ganeral date 1.1The length of incision: DAA group(10.14±0.93)cm and DLA group(12.15±1.23)cm.which showed statistically significant differences(p<0.05).1.2The operation time: DAA group(79.68±11.72)min and DLA group(80.17±13.17)min.No statistical significant differences were found(p>0.05)1.3The intraoperative bleeding: DAA group(334.80±108.97)ml and DLA group(405.74±135.133)ml,which showed statistically significant differences(p<0.05).1.4The postoperative drainage: DAA group(212.50±43.12)ml and DLA group(292.77±57.36)ml,which indicated statistically significant(p<0.05).1.5The hospitalization time: DAA group(11.40±5.35)days and DLA group(16.17±5.72)days,which indicated statistically significant(p<0.05).1.6 The visual analogue score(VAS)of group DAA was less than that of group DLA after 1 day,3 days,5 days and 7 days of operation.VAS for 1 day,3 days,5 days,7 days follow-up: 5.36±1.07,3.47±0.89,2.71±0.81 and 1.80±0.63 in DAA group and 6.34±0.65,5.03±0.57,3.47±0.53,3.00±0.49 in DLA group,which indicated statistically significant(p<0.05)for all comparisons).2.Hip function analysis 2.1The Harris hip scores for 1 week,1 month and 3 months follow-up: 69.22±3.13,81.88±4.18 and 90.14±2.66 in DAA group and 62.83±2.81,70.34±5.02,83.13±3.13 in DLA group,which indicated statistically significant(p<0.05 for all comparisons).The Harris hip scores for 6 months and 12 months follow-up: 92.06±3.12,93.06±3.41 in DAA group and 92.87±1.80,93.36±2.50 in DLA group.No statistically significant differences were found(p>0.05).2.2The basic daily hip function analysis for the 1 month follow-up: walking speed:(88.18±9.88)cm/s in DAA group and(88.02±7.15)cm/s in DLA group,no statistically significant differences were found between the two groups(p > 0.05);Circling:(76.18±5.05)cm/s in DAA group and(71.79±7.45)cm/s in DLA group with statistical differences(p<0.05);Climbing stairs: 3.04±1.01 in DAA group and 2.04±1.00 in DLA group with statistical differences(p<0.05);sitting: 4.14±1.39 in DAA group and 3.15±0.78 in DLA group with statistical differences(p<0.05);wearing shoes and socks: 3.72±0.70 in DAA group and 3.19±0.99 in DLA group with statistically significant differences(p<0.05).2.3The abductor torque for 1 week,1 month and 3 months follow-up: 0.17±0.04,0.21±0.06,0.38±0.03 in DAA group and 0.08±0.04,0.14±0.38,0.21±0.04 in DLA group,which indicated statistically significant(p<0.05 for all comparisons).The abductor torque for 6 months and 12 months follow-up: 0.41±0.04,0.50±0.06 in DAA group and 0.41±0.54,0.51±0.05 in DLA group.No statistically significant differences were found(p>0.05).2.4 Trendelenburg`s sign for 1 week and 1 month follow-up: 38.00%,18.00%,8.0 in DAA group and 72.34%,48.94,19.15% in DLA group,which indicated statistically significant(p<0.05,p<0.05).The Trendelenburg`s sign for 3 months,6 months and 12 months follow-up: 8.0%,4.00% and 2.00% in DAA group and 19.15%,6.38% and 4.26% in DLA group.No statistically significant differences were found(p>0.05).3.Evaluation of radiography and leg length discrepancy 3.1 For the cup position,the DAA group mean cup inclination was(38.77±2.21)°,compared to(39.26±3.39)° for the DLA group,which was statistically insignificant(p>0.05).The DAA group mean cup anteversion was(18.80±1.42)° compared to(18.16±1.60)° for the DLA group,which was statistically insignificant(p>0.05).In DAA group 98.0%(49/50)of acetabular prostheses within the Lewinnek safe zone and 97.87%(46/47)were in Lewinnek safe zone in the DLA group which was statistically insignificant(p>0.05).3.2 For the femur prosthesis,96.00%(48/50)were alignment in DAA and 95.74%(45/47)in DLA which was statistically insignificant(p>0.05).3.3 Leg length discrepancy,38 patients in DAA group had leg length discrepancy(LLD)within 3mm,9 patients had LLD 3-5mm,2 patients had LLD 5-10 mm,total 49(98.00%)patients in DAA had LLD within 10 mm.1 patients had LLD 10-20 mm.35 patients in DLA group had leg length discrepancy(LLD)within 3mm,8 patients had LLD 3-5mm,3 patients had LLD 5-10 mm,total 46(97.87%)patients in DLA had LLD within 10 mm.1 patients had LLD 10-20 mm.No statistical significant differences were found between the two groups(p>0.05).4.Complications: In DAA group,2 patients had lateral femotal cutaneous nerve palsy,6 patients had heterotopic ossification,In DLA group,6 patients had great trochanter pain,2 patients had limp,11 patients had heterotopic ossification.Which was statistically insignificant between two groups in the incidence of complications(p<0.05).Conclusion: 1.Direct anterior approach and direct lateral approach for total hip arthroplasty in the treatment of elderly femoral neck fracture in lateral decubitus could result in very satisfactory clinical effect.Direct anterior approach was associated with less operative trauma and bleeding,less pain,shorter length of stay,faster and better recovery of hip function compared to the direct lateral approach.2.The direct anterior approach for total hip arthroplasty in the treatment of elderly femoral neck fracture in lateral decubitus can be transitioned from the direct lateral approach easily and safely,with a faster learning curve.Clinical evaluation on osteoporosis after total hip arthroplasty for elderly femoral neck fracture treated with zhuanggu tabletsPurpose:To evaluate the clinical effect of zhuanggu tablet in the treatment of elderly femoral neck fracture after total hip replacement.Methods and method:From 2015.12 to 2016.12,97 elderly patients with osteoporosis and femoral neck fractures after total hip arthroplasty were divided into two groups randomly.The treatment group was dealed with Zhuanggu tables,nasal salmon calcitonin and Caltrate D600,and the control group with nasal salmon calcitonin and Caltrate D600.TCM Synrdome scores before and after treatments were estimated.And the bone mineral density(BMD)of lumbar spine and healthy side femoral neck was measured by dual-energy X-ray absorptiometry(DEXA).Results: 1.TCM Synrdome scores in two groups decresed apparently(P<0.05),which decresed more apparently in the zhuanggu tablet group than that in control group(P<0.05).2.BMD of lumbar spine and healthy side femoral neck increased in two groups(P<0.05),the zhuanggu tablet group was higher than the control group and there were statistical differences between them(P<0.05).Conclusion:The osteoporosis after total hip arthroplasty of femoral neck fracture in the elderly can be effectively improved by using zhuang tablets combined with nasal salmon calcitonin.