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Dexmedetomidine-induced anesthesia in elderly patients undergoing hip replacement surgery

World Journal of Clinical Cases 2023年第16期11卷 3756-3764页

作者： Jun-Qing Li Hao Yuan Xiao-Qiang Wang Meng Yang Department of Anesthesiology Fuyang Hospital Affiliated to Anhui Medical UniversityFuyang 236000Anhui ProvinceChina

BACKGROUND A femoral neck fracture is a common and frequently reported issue in orthopedics, with a greater rate of incidence among the elderly. Due to their advanced age and the presence of some primary diseases, both anesthesia and surgery are increasingly difficult in elderly patients with a femoral neck fractures. In fact,general anesthesia can easily induce complications such as cognitive dysfunction,which is not conducive to postoperative *** To analyze the efficacy of dexmedetomidine in inducing anesthesia for elderly patients undergoing hip replacement *** A total of 98 elderly patients undergoing hip replacement in our hospital from June 2020 to June 2021 were randomly divided into control group(49 cases) and observation group(49 cases). The control group was given general anesthesia, and the observation group was combined with dexmedetomidine for anesthesia on the basis of the control group. Both groups were observed until the patients were discharged. The vital signs, serum inflammatory factors and renal function indexes of the two groups were compared before, during and 6 h after *** postoperative recovery and adverse events of the two groups were statistically *** Compared with the mean arterial pressure of the two groups, the intraoperative and postoperative 6 h was higher than that before the operation, the intraoperative was lower than the postoperative 6 h(P < 0.05);the blood oxygen saturation of the two groups was higher than that before operation and 6 h after operation, and the observation group was higher than the control group 6 h after operation(P < 0.05). The heart rate of the two groups was lower during and 6 h after operation than that before operation, and higher at 6 h after operation than that during operation(P < 0.05).The levels of serum C-reactive protein, tumor necrosis factor-α, interleukin-1β and kidney injury molecule-1 in the two groups were higher during operation and 6 h after operati

关键词： hip replacement Old age Dexmedetomidine Anesthetic effect Vital signs

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Bilateral pericapsular end nerve blocks for steroid-induced avascular necrosis following COVID-19 infection requiring bilateral total hip replacement

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World Journal of Anesthesiology 2024年第1期13卷 1-8页

作者： Somita Christopher Sweety Dutta Thota Venkata Sanjeev Gopal Department of Anaesthesiology Care HospitalsHyderabad 500025India

BACKGROUND Osteonecrosis or avascular necrosis(AVN)of the hip was one of the dreaded complications of coronavirus disease 2019(COVID-19),which emerged in patients who received steroid *** have been a mainstay in the treatment protocol of COVID-19 *** corticosteroid drugs used in patients suffering from COVID-19 were intravenous(IV)or oral dexamethasone,methylprednisolone or *** use of such high doses of corticost-eroids has shown very positive results and has been lifesaving in many ***,long-term consequences were drug-induced diabetes,osteoporosis,Cushing syndrome,muscle wasting,peripheral fat mobilization,AVN,hirsutism,sleep disturbances and poor wound healing.A significant number of young patients were admitted for bilateral total hip replacements(THR)secondary to AVN following steroid use for COVID-19 *** To assess the efficacy of bilateral pericapsular end nerve group(PENG)blocks in patients posted for bilateral THR post-steroid therapy after COVID-19 infection and assess the time taken to first ambulate after *** This prospective observational study was conducted between January 2023 and August 2023 at Care Hospitals,Hyderabad,*** young patients 30-35 years of age who underwent bilateral THR were studied after due consent over 8 *** the patients received spinal anaesthesia for surgery and bilateral PENG blocks for postoperative *** The duration of surgery was 2.5 h on *** out of twenty patients(85%)had a Visual Analog Score(VAS)of less than 2 and did not require any *** patient was removed from the study,as he required *** remaining two patients had a VAS of more than 8 and received IV morphine post-operatively as a rescue analgesic *** out of seventeen patients(88.2%)could be mobilized 12 h after the *** Osteonecrosis or AVN of the hip was one of the dreaded complications of COVID-19

关键词： Avascular necrosis Pericapsular end nerve group block Analgesia hip replacement COVID-19 Steroids

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Application of Functional Exercise Nursing Plan Based on Evidence-based Nursing After hip replacement

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Journal of Clinical and Nursing Research 2020年第3期4卷 25-28页

作者： Rongrong Dong Huaqin Chen Yancheng First People’s Hospital Yancheng 224000Jiangsu ProvinceChina

Objective:To explore the effect of functional exercise nursing plan based on evidence-based nursing in patients after hip ***:A total of 150 patients who underwent hip replacement in the orthopedic second ward of our hospital during the research period from January 2010 to January 2020 were selected as the research *** random number expression method was applied to achieve grouping of *** them,the control group received conventional rehabilitation treatment;the experimental group guided rehabilitation exercises according to the functional exercise nursing plan after hip replacement,and the rehabilitation conditions of the two groups were ***:Compared with the patients in the control group,the bed time(7.45±2.10)days and average hospital stay(15.84±3.29)of the experimental group were relatively *** incidence of complications in the experimental group and the control group was 6.67%and 16.00%,which are significantly *** difference in Harris hip score before surgery was small,and the difference when discharge and after discharge was gradually increased,showing a better care effect in the experimental *** was no significant difference in preoperative quality of life scores between the two groups before surgery(P>0.05).The life quality of the experimental group was significantly higher than that of the control group at discharge,1 month after discharge and 3 months after discharge,and showed most significantly after 3 ***:The effect of functional exercise nursing plan based on evidence-based nursing in patients after hip replacement is remarkable,which can promote the recovery of patients,improve the quality of life,reduce the hospitalization time,reduce the incidence of postoperative complications,and has a positive significance in promoting clinical development in China.

关键词： Functional exercise nursing plan hip replacement Postoperative effect

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A Biomimetic hip Joint Simulator and its Application in in vitro Study of the Integrity of replacement Cemented hip

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Journal of Bionic Engineering 2005年第4期2卷 177-185页

作者： Liu Chao-zong S. M. Green N. D. Watkins A. W. McCaskie Department of Materials University of Oxford Parks Road Oxford OX1 3PH UK Centre for Biomedical Engineering University of Durham Durham DH1 3LE UK DePuy CMW Blackpool FY4 4QQ UK Department of Orthopaedic Surgery University of Newcastle Newcastle upon Tyne NE2 4HH UK

A biomimetic hip joint simulator that can be used to evaluate the outcome of the cemented total hip replacement has been designed, manufactured and evaluated. The simulator produces motion in the extension/flexion plane, with a socket to rotate internal/externally. At the same time a dynamic loading cycle is applied. A validation test was performed on a cemented femoral stem within a novel composite femur. The hone quality has a strong effect on the stem migration and on the integrity of the interfaces. The migration of the stem is a combination of 3-D translation and rotation of the stem. Under the same loading conditions, weak bone allows more stem migration than strong bone. There is a great decrease in the strength of the stem-cement interface after the dynamic test, and the weak bone composite exhibited a greater reduction in interfacial strength than the strong bone composite. The decrease of the interfacial strength indicates that the primary bonding between the stem and the cement mantle had deteriorated and the integrity of stem-cement interface was damaged. The study demonstrates the value of using a hip joint simulator to investigate stem migration and interface integrity within the cemented hip replacement, suggesting that method can be used for in vitro evaluation of the biomaterials used in the cemented hip replacements.

关键词： hip joint simulator stem migration interface failure hip replacement bone

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Relationship between preoperative psychological stress and shortterm prognosis in elderly patients with femoral neck fracture

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World Journal of Psychiatry 2024年第6期14卷 838-847页

作者： Wen-Hui Fu Zhi-Long Hu Yuan-Jun Liao Ri-Jiang Chen Jian-Bin Qiu Wu-Tang Que Wan-Tao Wang Wei-Hua Li Wei-Bin Lan Department of Orthopedics Longyan First Affiliated Hospital of Fujian Medical UniversityLongyan 361000Fujian ProvinceChina

BACKGROUND Older adults are at high risk of femoral neck fractures(FNFs).Elderly patients face and adapt to significant psychological burdens,resulting in different degrees of psychological stress *** hip replacement is the preferred treatment for FNF in elderly patients;however,some patients have poor postoperative prognoses,and the underlying mechanism is *** speculated that the postoperative prognosis of elderly patients with FNF may be related to preoperative psychological *** To explore the relationship between preoperative psychological stress and the short-term prognosis of elderly patients with *** In this retrospective analysis,the baseline data,preoperative 90-item Symptom Checklist score,and Harris score within 6 months of surgery of 120 elderly patients with FNF who underwent total hip arthroplasty were *** analyzed the indicators of poor short-term postoperative prognosis and the ability of the indicators to predict poor prognosis and compared the correlation between the indicators and the Harris *** Anxiety,depression,garden classification of FNF,cause of fracture,FNF reduction quality,and length of hospital stay were independent influencing factors for poor short-term postoperative prognoses in elderly patients with FNF(P<0.05).The areas under the curve for anxiety,depression,and length of hospital stay were 0.742,0.854,and 0.749,*** sensitivities of anxiety,depression,garden classification of FNF,and prediction of the cause of fracture were 0.857,0.786,0.821,and 0.821,*** specificities of depression,FNF quality reduction,and length of hospital stay were the highest at 0.880,0.783,and 0.761,***,depression,and somatization scores correlated moderately with Harris scores(r=-0.523,-0.625,and-0.554;all P<0.001).CONCLUSION Preoperative anxiety,depression,and somatization are correlated with poor short-term prognosis in elderly patients with FNF and warrant consid

关键词： Psychological stress Old age Femoral neck fracture hip replacement Short-term prognosis Correlation

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Total hip arthroplasty following the failure of intertrochanteric nailing:First implant or salvage surgery?

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World Journal of Orthopedics 2023年第10期14卷 763-770页

作者： Giuseppe Solarino Davide Bizzoca Pasquale Dramisino Giovanni Vicenti Lorenzo Moretti Biagio Moretti Andrea Piazzolla University of Bari Aldo Moro Bari 70154Italy Orthopaedic and Trauma Unit Policlinico di Bari Bari 70124Italy UOSD Vertebral Surgery Policlinico di BariBari 70124Italy

BACKGROUND Proximal femur fractures,including both intracapsular(femoral neck fractures)and extracapsular fractures(intertrochanteric femoral fractures,IFFs),affect around 1.5 million people per year *** failures of intertrochanteric nailing in IFFs could be managed with revision total hip arthroplasty(THA).AIM To describe the surgical complexity and the procedure-related complication rates in patients with trochanteric nailing failure and treated with *** Patients referred to our level I trauma center between April 2012 and July 2018 with failed cephalomedullary nailing following trochanteric fractures were retrospectively *** patients underwent a salvage surgical procedure,i.e.,cephalomedullary nail removal and conversion to *** same surgical and anesthesiology team performed the surgical procedures under spinal *** patients underwent clinical and radiographic follow-ups for at least 24 *** and re-operations were *** Seventy-four patients met the inclusion criteria(male:29;female:45;mean age:73.8-years-old;range:65-89)and were included in the current *** average operative time was 117 min(76-192 min).The average blood loss was 585 mL(430-1720 mL).Among the 74 patients,43(58.1%)required transfusion of three or more blood *** patients died within the 4th d after surgery because of pulmonary embolism,and 1 patient died 9 mo after surgery due to ischemic myocardial *** complication rate in the 71 patients who completed the minimum 24-mo follow-up was 22.5%.In 3 cases out of 71(4.2%)periprosthetic acetabular fracture was observed during the *** of these periacetabular fractures occurred *** intraoperative periprosthetic femur fracture was observed in 5 patients out of 71(7.0%).Four of these patients needed a re-operation to fix the fracture with plates and cerclages;in one of these patients,femoral stem revision was also *** 4 patients ou

关键词： Femoral nailing Total hip arthroplasty Proximal femur fractures Osteoporosis Fragility fractures Geriatric patients hip traumatology hip replacement

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Risk Factors for Surgical Site Infection after hip Arthroplasty: A Multicentric Study

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Surgical Science 2016年第2期7卷 58-64页

作者： Gabriel B. Tofani Gustavo P. Irffi Lucas F. Silva Cynthia C. M. da Silva Bráulio R. G. M. Couto Gilberto D. Miranda Carlos E. F. Starling Institute of Biological Sciences Centro Universitário de Belo Horizonte—UniBH Belo Horizonte Brazil Institute of Engineering and Technology Centro Universitário de Belo Horizonte—UniBH Belo Horizonte Brazil Faculdade de Ciências Médicas e da Saúde de Juiz de Fora—SUPREMA Juiz de Fora Brazil Hospitals Life Center Vera Cruz and Baleia Belo Horizonte Brazil

The objective of this study is to answer three main questions: What is the risk of wound infection for patients undergoing hip arthroplasty? What are the main etiologicagents of surgical site infection (SSI)? What are the risk factors most associated with surgical site infection? Method: This was a multicentric, retrospective cohort study which analyzed data collected in five general hospitals in Belo Horizonte, Brazil, between the period of January 2009 and December 2013. The continuous parameters studied were age, length of hospital stay before surgery, duration of surgery, number of professionals at surgery and number of hospital admissions. Categorical variables were surgical wound classification (clean, clean contaminated, contaminated, dirty/infected), American Society of Anesthesiologists (ASA) score (I, II, III, IV, V), type of surgery (elective, emergency), general anesthesia (yes, no), prophylactic antibiotic (yes, no), trauma surgery (yes, no) and Nosocomial Infections Surveillance (NNIS) risk index (IRIC = 0, 1, 2, 3). Results: Estimated SSI risk was 3.2% (95% C.I. = 2.6% to 4.1%) and risk of osteomyelitis was 0.6% (95% C.I. = 0.4% to 1.1%). ASA score > 2, general anesthesia, length of hospital stay before surgery higher than four days, more than two professionals at surgical field and duration of surgery higher than five hours were risk factors for SSI after hip prosthesis (p hip. Conclusion: Despite the modified NNIS index being a risk factor for SSI, none of its independent variables was statistically significantly in the logistic model (p > 0.100). Each modified NNIS risk category increased the chance of a patient being infected by almost three times, when compared with the previous category (OR = 2.82;p = 0.011).

关键词： Surgical Site Infection hip Arthroplasty hip replacement Risk Factors

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Evaluation of Light Specific Gravity Ropivacaine Combined with Sufentanil in hip Arthroplasty at An Advanced Age

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Journal of Advances in Medicine Science 2021年第1期4卷 19-22页

作者： Daxu Peng Qingchen Liu Xiuyang Cao Guanwen Deng Shaoguan Shaokang Hospital ShaoguanGuangdong512400China Affiliated Hospital of North China University of Technology TangshanHeibei063000China Lechang Traditional Chinese Medicine Hospital ShaoguanGuangdong512400China

combined with sufentanil in elderly patients undergoing hip ***:89 elderly patients with hip arthroplasty from July 2019 to September 2020 were randomly divided into experimental group and control *** experimental group was anesthetized with light specific gravity ropivacaine combined with *** control group was anesthetized with equal specific gravity ropivacaine to compare the effect of anesthesia and the incidence of adverse ***:there was no significant difference in sensory recovery time and motor recovery time between the experimental group and the control group(P>0.05),and the incidence of adverse reactions between the two groups was *** sensory block time in the experimental group was shorter than that in the control group(PP>0.05).Conclusion:ropivacaine combined with sufentanil subarachnoid anesthesia is more effective in elderly patients undergoing hip arthroplasty,and the safety of the anesthesia scheme is higher,which will not lead to serious adverse reactions during ***,the application of the anesthesia scheme can effectively improve the analgesic effect during and after operation,and the clinical application value is high.

关键词： Light specific gravity ropivacaine Sufentanil Elderly patients hip replacement Safety

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