RESUMEN
Objective To investigate the efficacy and safety of different course duration of rivaroxaban for deep venous thrombosis (DVT) in elderly patients with femoral neck fractures after artificial femoral head replacement.Methods A prospective case control study was conducted on 95 elderly cases of femoral neck fractures treated from February 2015 to July 2017.There were 18 males and 77 females,with average age of 80.8 years (range,70-98 years).There were 85 patients at stage Ⅲ and 10 at stage Ⅳ according to Garden classification.All patients received artificial femoral head replacement and were randomly divided into 3 groups (Group A:34 cases,rivaroxaban treatment for 2 weeks;Group B:31 cases,rivaroxaban treatment for 3 weeks;Group C:30 cases,rivaroxaban treatment for 5 weeks).At 2,3 and 5 weeks after operation,the patients were given 10 mg oral rivaroxaban once daily.General information,blood transfusion rate,hemoglobin volume,platelet count and DVT rate were recorded before and 6 weeks after operation.Results No significant difference among the groups in terms of division,age,body mass index,fracture classification,time interval from injury,intraoperative blood loss,quantity of drainage fluid after operation,and associated underlying diseases was observed (P ＞ 0.05).The blood transfusion rate of Groups A,B and C within 2 weeks after operation was 9％ (3/34),3％ (1/31) and 3％ (1/30) (P ＞ 0.05) respectively.The comparative difference in hemoglobin and platelet count had no statistical significance (P ＞ 0.05).The DTV rate after operation of Groups A,B and C was 21％ (7/34),13％ (4/31) and 0,respectively.There was no significant difference between Groups B and C (P ＞ 0.05),but the difference between Groups A and C was statistically significant (P ＜ 0.05).Conclusions For elderly patients with femoral neck fracture who underwent the artificial femoral head replacement,it is effective to prevent the occurrence of DVT by extending the course of rivaroxaban treatment to 5 weeks.In addition,it does not increase the risk of bleeding.
RESUMEN
Objective To investigate the effect of rehabilitation nursing in perioperative period of elderly patients with femoral neck fractures undergone supercapsular percutaneously assisted total hip (SuperPATH) arthroplasty.Methods A retrospective cohort analysis was made on 30 patients treated by total hip arthroplasty through the SuperPATH approach from January 2016 to July 2016.There were seven males and 23 females,aged 75-91 years (mean,77 years).Nursing methods contained application of pluralistic education before operation,application of body position management,psychologic support joint pain and sleep multidimensional strengthening nursing intervention and dislocation nursing after operation,and recovery training.Self-rating anxiety scale (SAS),self-rating scale of sleep (SRSS),Barthel index and Harris hip score were used to compare clinical manifestations before and after treatment.Results SAS score was 42.5-66.3 points [(50.0 ± 6.2) points] one day before operation,compared to 33.8-53.8 points [(41.5 ± 5.2) points] five day after operation (P ＜ 0.05).SRSS score was 24-37 points [(29.9 ±3.1) points] one day before operation,compared to 14-34 points [(23.2 ± 5.3) points] five day after operation (P ＜ 0.05).Barthel index was 20-40 points [(38.5 ± 4.4) points] one day before operation,was 35-55 points [(49.7 ± 6.3)points] two day after operation and was 55-70 points [(63.5 ± 5.1)] points five day after operation,showing significant differences (P ＜ 0.05).Harris hip score was 4-25 points [(14.8 ±4.2)points] one day after operation,was 59-75 points[(67.3 ± 5.1) points] two day after operation and was 66-85 points [(79.2 ± 4.3) points] two weeks after operation,showing significant differences (P ＜ 0.05).All incision healed primarily.No complications occurred.Conclusion Perioperative rehabilitation nursing of minimally invasive SuperPATH arthroplasty is effective in alleviating patients' anxiety,improving sleep status and self-care ability,enhancing postoperative rehabilitation effect and reducing risk of in-hospital complications.