Clinical Analysis Of Replacement Of The Hip Joint In The Treatment Of Femoral Neck Fractures In Senile Patients

Objective:To explore the effect of artificial femoral head replacement (AFHR) and total hip replacement(THR) for senile patients with femoral neck fracture.Methods:The clinical data of patients(65 cases, aged over 65)with femoral neck fracture treated with THR or AFHR between December 2005 and December 2009 were analyzed retrospectively. All experimental prosthetic are from the United States, Johnson corporation produced. Fixation of bone cement (aged Over 75) and biological fixation (under the age of 75).After treatment in the perioperative period, the line hip replacement for femoral neck fracture,total hip replacement group (26 cases),femoral head replacement group (39 cases).Intraoperative use of epidural anesthesia and general anesthesia, anesthesia satisfaction of the District of conventional sterilization technique, sterile shop towel, take the lateral position, limbs in the last.Application of posterior surgical approach (modified Gibson approach),taking posterior superior iliac spine in front of 6-7cm incision near the iliac crest, through the greater trochanter to the distal edge, along the axis of the femur cut down the 6-15cm open the skin, subcutaneous, superficial fascia, exposed gluteus maximus, medius, in front of the tensor fascia lata and iliotibial tract. exposed external rotation by the gluteus maximus muscle. cut external rotation muscles and protect vessels and nerves.Exposed joint capsule.Along the femoral neck "T" shaped incision of the joint capsule to expose the femoral head, femoral neck and trochanter.In the femur 1.0 cm above the lesser trochanter to truncate the femoral neck, the femoral head to be cut out.Clean-up acetabular soft tissue, with a filed order of the expansion acetabular subchondral bone was visible to the spotting, according to the conditions to decide whether application of bone cement, the installation of acetabular prosthesis.Line with proximal femoral marrow device to open pulp, filed with the marrow cavity expansion step by step from small to big, washed with saline, to prevent pulmonary embolism, install the femoral head mold and returned, check the stability of the prosthesis activity buckling 120., Outreach 45., Adduction 20., Internal rotation 45. Axial traction no dislocation of about 0.5 cm.The center of the ball should be flush with the top of the greater trochanter.Remove the femoral head test mode, the installation of non-cemented prosthesis.After hitting a reset, will external rotation muscles with no.1 absorbable suture, suture muscle only in the original point, repair of articular capsule and the external rotation muscles, to prevent postoperative dislocation, deep in the joints and subcutaneous placement negative pressure drainage.Simple femoral head prosthesis replacement and to place the same way as above, just omit the acetabular prosthesis implant and placement.Postoperative should still be effective treatment, control of the original merger of preoperative disease, poor heart and lung function on high-risk patients should be sent after ICU monitoring, strict observation of circulation, respiratory function, to be in a stable condition and then transferred to the general wards.Low-dose low molecular weight heparin, intermittent compression methods such as air bags can prevent deep vein thrombosis.Intraoperative and postoperative antibiotics 3～5 d, limbs remain neutral stand outside,24～48 h, as the drainage tube drainage.24～48 h depending on quantity extraction of the drainage pipe.Active or passive hip started functional exercise. Photo by patients after routine hip x-ray film showed good position,3-4d beginning or crutches leading scorer out of bed in the other functional training. Conducted by the non-weight bearing, to the part of the load. To full weight-bearing walking exercise standing.Elderly patients had varying degrees of osteoporosis, symptomatic treatment with drugs after surgery.Result:65 patients were hospitalized an average of 15 days,patients (45 case)were 6 months to 3 years follow-up, mean follow-up time was 2.1 years. Harris hip score after 1 year on average, femoral head (82.75±2.3) points, total hip replacement (81.25±2.1). Using SPSS 16.0 software for statistical analysis, paired t test method for statistical testing. Two treatments showed no difference statistically (P> 0.05). Two treatment methods, patients after 6 months,1 year,3 years was better than preoperative Harris score, were significantly improved quality of life.Conclusion:The treatment of hip replacement is an effective method of femoral neck fracture.The effect was good, we said:to ensure sound effect, must pay attention to patients during surgery before the choice, pay attention to the comprehensive patient assessment and treatment of other diseases,fully estimate of possible circumstances, a comprehensive evaluation of the physical condition of the patients with the premise. Intraoperative standardized operation, reasonable arrangements for surgical procedures, pay attention to the repair section of capsule to achieve immediate fixation; early postoperative functional exercise on measures such patients; prevent infection, embolism and other complications in the near future.Only effective prevention of complications, good effect can be achieved.Early restoration of limb functions, improve the quality of life.Through statistical analysis shows that artificial femoral head arthroplasty and total hip arthroplasty for femoral neck fractures, in the past, long-term treatment effects on P> 0.05, no significant difference statistically, but they have to because of the choice of treatment characteristics of each patient's disease, bone conditions and their own circumstances. The key to success is a reasonable perioperative treatment.