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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 explore the effects and influencing mechanism of HGF regulating β-catenin signaling pathway on the repair of femoral neck fractures in rabbits. Methods: 15 rabbits with femoral neck fractures were randomly divided into semisynthetic extracellular matrix like hydrogel group (sECM group), sECmM+HGF group and demineralized bone matrix group (DBM group). The autologous right side was used as the experimental side and the left side as the control side. The general condition, fracture healing quality score, the maximum load, deflection and stiffness of callus and mRNA expression levels of BMP-2, TGF-β1, PDGF and bFGF and the protein expression levels of COL-I, Wnt5a, β-catenin and Lef-1 in BMSC cells were compared among the groups. Results: The fracture healing quality scores of the experimental side in sECM+HGF group and DBM group were higher than the control side at different weeks after surgery (P<0.05), and were higher than the experimental side in sECM group (P<0.05). At 8 weeks after surgery, the maximum load, deflection and stiffness of the experimental side callus in sECM+HGF group and DBM group were better than those in the control side (P<0.05), and the indicators were better than those of the experimental side in sECM group (P<0.05). At 2 weeks and 4 weeks after surgery, the expressions of BMP-2, TGF-β1, PDGF and bFGF in the experimental side were higher than those in the control side in sECM+HGF group and DBM group (P<0.05), and the expressions were higher than those in the experimental side of sECM group (P<0.05), and the expression of BMP-2 in the experimental side of sECM+HGF group and DBM group was higher than that in the experimental side of sECM group at 8 weeks after surgery (P<0.05). At 2 weeks after surgery, the expression of COL-I in the experimental side of sECM+HGF group and DBM group was higher than that in the control side (P<0.05). The expression of COL-I in the experimental side of sECM+HGF group and DBM group at 2 and 4 weeks after surgery was higher than that in the experimental side of sECM group during the same period (P<0.05). At 8 weeks after surgery, the expression of wnt5a in the experimental side of sECM+HGF group and DBM group was lower than that in the control side (P<0.05) and was lower than that in the experimental side of sECM group, while the expressions of β-catenin and Left-1 were higher than those in the control side (P<0.05) and were higher than those in the experimental side of sECM group (P<0.05). Conclusion: HGF up-regulates the expressions of BMP-2, TGF-β1, PDGF, bFGF and COL-1, and significantly promotes the fracture repair process of rabbits with femoral neck fractures by activating the Wnt/β-catenin signaling pathway. [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]

OBJECTIVE: In hemiarthroplasty, the choice of prosthesis is particularly important, which directly affects the success rate of operation and postoperative complications. Hemiarthroplasty can be divided into bipolar hemiarthroplasty and unipolar hemiarthroplasty. This study systematically evaluated the clinical efficacy and safety of bipolar hemiarthroplasty and unipolar hemiarthroplasty in the treatment of displaced femoral neck fractures in the elderly so as to provide evidence-based support for prosthesis decision-making in hemiarthroplasty. METHODS: The databases including PubMed, The Cochrane Library, OVID, Web of Science, Scopus, China National Knowledge Infrastructure (CNKI), Wanfang Data, and VIP database were searched to collect clinical randomized controlled trials of bipolar hemiarthroplasty and unipolar hemiarthroplasty for displaced neck femoral neck fractures in elderly patients at home and abroad. The Cochrane Handbook risk assessment tool was used to evaluate the quality of the included studies. The results of the included studies were meta-analyzed by RevMan 5.3 software. RESULTS: (1) Eighteen randomized controlled clinical trials with high quality were included, with a total of 1 988 fractures patients, including 998 cases in bipolar hemiarthroplasty group and 990 cases in unipolar hemiarthroplasty group. (2) There were no statistically significant differences in mortality, dislocation of prosthesis, loosening of prosthesis, local infection, hip pain, general complication, and surgical informations between bipolar hemiarthroplasty and unipolar hemiarthroplasty (P > 0.05). (3) Harris score was higher in the bipolar hemiarthroplasty group than that in the unipolar hemiarthroplasty group (MD=1.77, 95%CI:0.94-2.61, P < 0.001). The rate of acetabular erosion in bipolar hemiarthroplasty group was lower than that in unipolar hemiarthroplasty group (RR=0.25, 95%CI:0.13-0.47, P < 0.000 1). However, two studies have reported that bipolar implants may be more costly. CONCLUSION: Compared with unipolar hemiarthroplasty, bipolar hemiarthroplasty has lower acetabular wear rate and better recovery of hip function in elderly patients with displaced fem-oral neck fracture. However, whether bipolar prosthesis has better economic benefits than uni-polar prosthesis needs further evaluation in the future. [ABSTRACT FROM AUTHOR]

Objective: To investigate the effect of open and closed reduction and internal fixation with hollow nails on the quality of fracture reduction and hip joint function in patients with displaced femoral neck fractures. Methods: This study is a retrospective study. The clinical data of 98 patients with displaced femoral neck fractures were selected. According to different surgical methods, the patients were divided into group A (n=50, open reduction) and group B (n=48, Closed reduction), compare the good and good rate, fracture reduction quality, hip joint function, perioperative index, postoperative complication rate and secondary operation rate between the two groups. Results: The excellent and good rate of patients in group A was 78.00% (39/50) at 6 months after surgery, which was higher than 58.33% (28/48) in group B (P<0.05). There was no difference between the two groups in postoperative weight-bearing time and intraoperative fluoroscopy time (P>0.05); the operation time and hospital stay in group B were shorter than those in group A, and the amount of intraoperative blood loss was less than that in group A (P<0.05). The Harris scores of hip joint function at 1 month, 3 months, and 6 months after operation were higher than those before operation in the two groups, and group A was higher than group B (P<0.05). There was no difference in the incidence of secondary operations and complications between the two groups (P>0.05). The number of type I and type II cases in group A were more than that in group B, and the number of type III cases was less than that in group B (P<0.05). Conclusion: Compared with closed reduction cannulated screw internal fixation, open reduction cannulated screw internal fixation is more damaging, but its postoperative fracture reduction quality and hip joint function improvement effect is better, and it does not increase the incidence of complications and secondary complications. The incidence of surgery. [ABSTRACT FROM AUTHOR]

Objective: To investigate the clinical efficacy of total hip and half hip hemiarthroplasty for elderly femoral neck fractures. Methods: 70 cases of femoral neck fracture patients in our hospital were randomly divided into observation group and control group with 35 cases in each group, the observation group was given total hip replacement while the control group was given half hip replacement, the operation time, intraoperative blood loss, postoperative Harris scores and the function of hip joint, postoperative complications, pain rate and revision rate of two groups were compared. Results: In the observation group, the operation time and the amount of bleeding was higher than those of the control group,[(113.6±19.3)min,(432.1±32.7)m L vs(73.1±10.2)min,(201.3±30.1)m L](all P<0.05); The total excellent and good rate and Harris score of hip function assessment in the observation group was significantly better than that of control group [91.4%,(91.13±5.09) points vs 77.14%,(80.15±4.71)points](all P<0.05); The incidence of adverse reaction and the revision rate of the observation group was lower than that of control group(20.00%, 0.00% vs 22.85%, 5.71%), but, there was no significant difference(all P>0.05); The pain rate in observation group was 5.71%, significantly lower than 25.71% of the control group(P<0.05). Conclusion: Both two methods, with their own advantages and disadvantages, were effective in the treatment for the elderly patients with femoral neck fracture, for the elderly patients with sensitive painfulness and more activity, the total hip arthroplasty will be a prior therapy. [ABSTRACT FROM AUTHOR]