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Objective: To compare the efficacy of direct anterior approach and posterolateral approach total hip arthroplasty in the treatment of femoral neck fracture and analysis of the influencing factors of postoperative hip function. Methods: A total of 96 patients with femoral neck fracture who were treated with total hip arthroplasty in the Affiliated Hospital of Xuzhou Medical University from May 2019 to December 2021 were selected, and they were divided into direct anterior approach group (n=48) and posterolateral approach group (n=48) according to different surgical methods. Perioperative indicators and complications of the two groups were observed, and Harris score and visual analog scale (VAS) were compared between the two groups before and after treatment. The influencing factors of postoperative hip function were analyzed by univariate and multivariate Logistic regression. Results: The time to get out of bed, the length of incision and the length of hospital stay in the direct anterior approach group were significantly shorter than those in the posterolateral approach group, the intraoperative blood loss and postoperative drainage volume were significantly lower than those in the posterolateral approach group, and the operation time was significantly longer than that in the posterolateral approach group (P<0.05) .Harris score at 1, 3 months after surgery in the direct anterior approach group was significantly higher than in the posterolateral approach group, and VAS score was lower than that in the posterolateral approach group (P<0.05) . There was no significant difference in the incidence of postoperative complications between the two groups (P>0.05). There was no significant difference in the excellent and good rate of hip function between the two groups after 6 months of treatment (P>0.05). Multivariate Logistic regression analysis showed that body mass index ≥24 kg/m², postoperative exercise time <3 h/d and combined with osteoporosis were the risk factors for postoperative hip dysfunction in patients with femoral neck fracture undergoing total hip replacement (P<0.05). Conclusion: The direct anterior approach total hip arthroplasty has obvious advantages over total hip arthroplasty with posterolateral approach in the short term, which is manifested as less trauma to patients and less postoperative pain, which is beneficial to the recovery of patients’ hip function. Body mass index ≥24 kg/m², postoperative exercise time <3 h/d, combined with osteoporosis are the risk factors for postoperative hip dysfunction in patients with femoral neck fracture undergoing total hip replacement. [ABSTRACT FROM AUTHOR]

Objective: To investigate the effects of acupoint application combined with staged rehabilitation function training on functional rehabilitation, serum pain factors and bone metabolism markers in patients with femoral neck fracture after operation. Methods:150 patients with femoral neck fracture who were treated in Sichuan Orthopedic Hospital from January 2021 to October 2021 were included. According to the envelope lottery method, the patients were divided into control group (75 cases) and observation group (75cases) The control group received staged rehabilitation function training, and the observation group received acupoint application combined with staged rehabilitation function training. Both groups were intervened for 3 months. After 3 months, the functional rehabilitation, visual pain analogue scale (VAS) score, serum pain factors and bone metabolism markers in the two groups were observed, and the incidence of postoperative complications in the two groups was recorded. Results: 3 months after intervention, Barthel Index and Harris hip score in the two groups were higher than those before treatment, and the observation group was higher than that in the control group (P＜0.05) 1 month after intervention, 2 months after intervention and 3 months after intervention, the scores of visual pain analogue scale (VAS) in the two groups decreased gradually, and the scores in the observation group were lower than those in the control group (P＜0.05) 3months after intervention, bone specific alkaline phosphatase (BALP) and osteoprotegerin (OPG) increased in the two groups, and the observation group was higher than the control group. The levels of tartrate resistant hydrochloric acid phosphatase isomer (TRACP-5b), type I collagen carboxyl terminal peptide β Special sequence (β-CTX) were decreased, and the observation group was lower than the control group (P＜0.05) 3 months after intervention, the levels of bradykinin (BK), prostaglandin E2 (PGE2), 5-hydroxytryptamine (5-HT) and neuropeptide Y (NPY) in two groups were decreased, and the observation group was lower than the control group (P＜0.05). There was no significant difference in the incidence of postoperative complications between the two groups (P＞0.05) Conclusion: Acupoint application combined with staged rehabilitation function training can promote the postoperative functional recovery of patients with femoral neck fracture and reduce postoperative pain, which may be related to regulating the level of markers related to bone metabolism. [ABSTRACT FROM AUTHOR]

Objective:To investigate the effect of dexmedetomidine (Dex) on postoperative recovery quality, quantitative electroencephalogram and delirium in elderly patients with osteoporosis complicated with femoral neck fracture. Methods: 97 elderly patients with osteoporosis complicated with femoral neck fracture who were treated in our hospital from January 2016 to March 2021 were selected, they were randomly divided into control group (48 cases) and Dex group (49 cases) by the random number table method. Total hip arthroplasty was performed in both groups, and Dex group was given 0.5 μg/kg Dex before anesthesia induction, and the control group was given the same amount of normal saline. The wake-up quality, hemodynamic changes and quantitative electroencephalogram frequency of the two groups were observed, and the occurrence of delirium and adverse anesthetic reactions were recorded. Results: Compared with the control group, the respiratory recovery time, extubation time and eye-opening time in Dex group were earlier (P<0.05). The heart rate (HR) at surgical excision of skin (T2)~finish the operation (T4) time point in both groups was lower than that at before anesthesia (T1) time point, and the mean arterial pressure (MAP) was higher than that at T1 time point, the intra-group comparison difference was statistically significant (P<0.05). HR at T2~T4 time point in Dex group was higher than that in control group, MAP was lower than that in control group at corresponding time points (P<0.05). δ wave frequencies of left frontal region, right frontal region, left temporal region and right temporal region in both groups at 1d after operation were increased compared with those before operation, and the Dex group was lower than the control group (P<0.05). The α1 wave frequencies of left frontal region, right frontal region, left temporal region and right temporal region in both groups at 1d after operation decreased compared with those before operation, and Dex group was higher than control group (P<0.05). The incidence of postoperative delirium in Dex group was lower than that in control group (P<0.05). There was no statistical difference in the incidence of adverse anesthetic reactions between the two groups (P>0.05). Conclusion: Dex is given to elderly patients with osteoporosis complicated with femoral neck fracture during operation, can improve the quality of postoper ative recovery without aggravating blood flow fluctuation, alleviate the influence on the δ, α1 wave frequency of the frontal lobe of the patient, and it can reduce the incidence of delirium. [ABSTRACT FROM AUTHOR]