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.
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.
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。
Objective To explore the clinical effect of multidisciplinary team (MDT) in elderly patients with hip fracture under the model of close-type medical alliance. Methods The elderly patients with hip fracture treated in the Department of Orthopedics of Deyang People’s Hospital between January 2015 and December 2020 were included retrospectively. According to different treatment modes, the patients were divided into traditional mode treatment group (traditional group) and MDT mode treatment group (MDT group). The waiting time for operation, hospitalization time after operation, total hospitalization time, total hospitalization cost, and death and loss of follow-up were analyzed. Results A total of 661 patients were enrolled, including 275 in the traditional group and 386 in the MDT group. There was no significant difference between the two groups in terms of gender, age, Charlson comorbidity index, types of fracture or surgical methods (P>0.05). The waiting time for operation [5.50 (3.50, 7.50) vs. 6.00 (4.00, 6.00) d; Z=−3.473, P=0.001], hospitalization time after operation [7.44 (6.27, 8.67) vs. 8.34 (6.72, 13.70) d; Z=−4.996, P<0.001] and total hospitalization time [12.95 (10.46, 16.30) vs. 15.49 (11.77, 19.91) d; Z=−5.718, P<0.001] in the MDT group were shorter than those in the traditional group. The total hospitalization cost of the MDT group was higher than that of the traditional group, but the difference was not statistically significant [39 300 (33 400, 46 400) vs. 38 000 (31 800, 44 000) Yuan; Z=1.524, P=0.128]. There was no significant difference in the lost follow-up rate between the traditional group and the MDT group (9.82% vs. 6.48%; χ2=2.474, P=0.116). Except in-hospital mortality and 30-day postoperative mortality (P>0.05), there was significant difference between the traditional group and the MDT group in 6-month (6.45% vs. 2.77%; χ2=4.875, P=0.027) and 1-year (11.29% vs. 6.37%; χ2=4.636, P=0.031) postoperative mortality. Conclusion Under the model of close-type medical alliance, MDT can reduce the waiting time for operation, hospitalization time after operation, total hospitalization time, as well as 6-month and 1-year postoperative mortality.
ObjectiveTo summarize the research progress of multidisciplinary team (MDT) co-management models in the clinical treatment of geriatric hip fractures.MethodsThe literature about types and characteristics of MDT for geriatric hip fracture treatment were extensively reviewed, and the advantages of its clinical application were analysed and summarised. Finally, the MDT model and characteristics of geriatric hip fracture in the Zhongda Hospital affiliated to Southeast University were introduced in detail.ResultsClinical models of MDT are diverse and have their own characteristics, and MDT can shorten the length of stay and waiting time before operation, reduce the incidence of internal complications, save labor costs, and reduce patient mortality.ConclusionThe application of MDT in the treatment of geriatric hip fracture has achieved remarkable results, which provides an optimal scheme for the treatment of geriatric hip fracture.
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 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.
ObjectiveTo investigate the clinical features of elderly hip fracture in Leshan area in China. MethodsThe clinical data of patients with hip fractures from June 2006 to January 2013 were retrospectively analyzed. Gender, age, fracture type, injury causes, activities before injury and treatment were analyzed. ResultsThe mean age of patients with a hip fracture was 76.5 years. The overall male to female ratio with hip fracture was 1:1.44. There were 154 patients (50.0%) with femoral neck fracture, 138 patients (44.8%) with intertrochanteric fracture, and 16 patients (5.2%) with subrtrochanteric fracture. A total of 248 patients (77.3%) were poorly educated, and 210 patients (68.2%) had basic medical insurance. The mean time between being injured and hospitalized after injury was 3 days. There were 257 patients (83.4%) with fall damage. ConclusionFemale patients with hip fracture are more than male patients. Fall damage is the main injure type. The features of elderly hip fracture in Leshan include retardation to consult a doctor, poor education of the patients, dependence primarily on basic medical insurance and under-emphasis of anti-osteoporosis therapy.
ObjectiveTo introduce the clinical pathway for geriatric hip fracture regulated by our hospital and report the five-year outcomes after the implementation of the pathway. MethodsThe geriatric hip fracture patients treated between September 2003 and August 2012 were followed up. We did not implement the clinical pathway until January 2007. Statistical analysis was done to evaluate the effect of the clinical pathway on patient outcomes by comparing rate of complication, mortality, and length of hospital stay before and after the implementation of the clinical pathway. ResultsAfter the implementation of the pathway, the in-hospital mortality, one-year mortality and the rate of complication were significantly lower. Besides, the time from admission to operation and the total length of stay in hospital were obviously shortened. ConclusionThe use of clinical pathway for geriatric hip fracture can reduce the rate of complication and mortality, and shorten hospital stay, and the five-year outcomes after the implementation of the pathway are satisfying.