Objective: To compare the clinical effects of direct anterior approach (DAA) and posterolateral piriformis-sparing approach (Mis-PLA) for minimally invasive surgery of total hip arthroplasty. Methods: The patients who had total hip arthroplasty from March 2015 to February 2016 were randomly divided into 2 groups: DAA group and Mis-PLA group. In the study, 43 patients (45 hips) were performed with total hip replacement via the direct anterior approach (DAA group). As comparison,39 patients (42 hips) were performed with total hip replacement via the posterolateral piriformis-sparing approach (Mis-PLAgroup) at the same period. DAA group:27 male patients (27 hips), and 16 female patients (18 hips),with an average age of (57.4±7.3) years, preoperative Harris score (41.4±8.7), body mass index(BMI)(24.3±2.2) kg/m2; MisPLA group: 25 male patients (26 hips),14 female patients (16 hips), with an average age of (59.2±7.3) years, preoperative Harris score (39.6±8.4), BMI (24.7±2.5) kg/m2. The length of incision, operation time, blood loss,postoperative Harris score were observed and specially the hip functional recovery was fully assessed. Results: (1) All the incisions healed by first intention. No complications were found in both groups. The length of incision:DAA group :(9.2±0.7) cm and Mis-PLA group :(9.5±0.6) cm. No statistical significant differences were found (P=0.053). The operation time:DAA group (74.3±10.1) min and Mis-PLA group(37.5±4.3) min, which showed statistically significant differences(P<0.01). Blood loss:DAA group(229.6±79.2) mL and Mis-PLA group (215.7±56.0) mL. Nostatistical significant differences were found (P=0.366). (2) The patients in both groups were followed up for 6-12 months. The Harris hip scores for 6 weeks’ follow-up:(85.5±4.1) in DAA group and (79.0±4.4) in Mis-PLA group,which indicated statistically significant differences (P<0.01).The Harris scores for the 6-month follow-up:(94.3±2.7) in DAA group and (95.2±1.9) in Mis-PLA group. No statistically significant differences were found (P=0.125). The basic daily hip function analysis for the 6-week follow-up:walking speed: no statistically significant differences were found between the two groups(P=0.298); Climbing stairs: Mis-PLA group’ outcome was better than DAA group’s with statistical differences (P=0.047); Circling,sitting and wearing shoes and socks: outcomes in DAA group exceeded Mis-PLA group’s with statistically significant differences (P<0.01,P=0.016,P<0.01). Conclusion: Total hip arthroplasty through either DAA or Mis-PLA approaches could result in very satisfactory clinical effect. Comparing with DAA, Mis-PLA requires less operation time, shorter learning curve,which indicates that it is a relatively safer approach. The advantages of total hip arthroplasty through direct anterior approach lie in less positional limitation in the early stage of postoperative period,as well as a faster recovery of hip function.
Objective: To evaluate the rate of basicervical fractures and document their diagnosis and treatment. Methods: From January 2005 to May 2016, 28 basicervical fractures of the 832 trochanteric fractures were collected and evaluated. The patients were treated with multiple screws, dynamic hip screw (DHS), intramedullary nail. Via the operation time, postoperative hospitalization, loss of blood duration the operation, hidden blood loss, total blood loss, mean union time and the final follow-up Harris hip score, the characteristics of different internal fixations were compared and analyzed. Results: The incidence of basicervical fractures was 3.37% (28/832) in our study. In the intramedullary nail group (16 patients), the operation time was 55 (20,120) min, the postoperative hospitalization was 3(2, 7) d, the intraoperative blood loss was 50(5,100) mL, the hidden blood loss was 533.37 (376.19, 987.15) mL, and the total blood loss 627.35 (406.19, 1037.16) mL . The union time and final follow-up Harris score were 6 (3, 9) months and 90.25 (74,100) min. In the DHS group (8 patients), the operation time was 87.5 (65,115) min, the postoperative hospitalization was 5.5 (2, 17) d, the intraoperative blood loss was 100 (50,300) mL, the hidden blood loss was 278.11 (202.43, 849.97) mL, and the total blood loss 580.19 (368.55, 899.97) mL . The union time and final followup Harris score were 5.5 (4, 12) months and 85.5 (84, 87) min. In the multiple screws group (4 patients), the operation time was 47.5 (35, 75) min, the postoperative hospitalization was 5 (2, 12) d, the intraope-rative blood loss was 20 (2, 70) mL, the hidden blood loss was 150 (100.00, 412.01) mL, and the total blood loss 195.00 (120.00, 414.01) mL. The union time and final follow-up Harris score were 4 (4, 6) months and 80 (61, 97) min. The patients treated with multiple screws and intramedullary nail had a shorter operation time than the DNS group, but no obvious difference was found between the other two groups (P=0.367). Postoperative hospitalization had no significant difference among the three groups. The intraoperative bleeding was more in the DHS group, the other two groups had no significant difference (P=0.100). However, the hidden blood loss was more in the intramedullary nail group, the other two groups had no significant difference (P=0.134). The total blood loss in the intramedullary nail group was more than multiple screw group, similar to the DHS group (P=0.483). One patient treated with multiple screws underwent internal fixation failure three months after operation. The mean union time and final follow-up Harris scores had no significant difference among the three groups (P>0.05). Conclusion: Through this study, we found that the incidence of basicervical fractures is low. Fractures with no shift can be confirmed by preoperative X-ray. For displaced fractures, preoperative CT + 3D reconstruction is recommended. Surgical treatment by closed reduction and internal fixation with DHS or intramedullary nail is shown to be very effective.
Objective:To evaluate the reliability and validity of the Chinese version of Pittsburgh sleep quality index (PSQI) among the medical students. Methods: A total of 603 undergraduate students were selected from a medical school in Beijing using a stratified-cluster random-sampling strategy, who were assessed by using the Chinese version of PSQI. Then 171 subjects were randomly selected to retest about 1 month later, using a variety of psychometric properties to evaluate reliability and validity of the scale. Results: The average of global PSQI scores was 5.38±2.34, the overall Cronbach’s α coefficient of all the scale items was 0.734, the half-split reliability coefficient was 0.655; the test-retest correlation coefficient was 0.530 for global PSQI score, and there was no statistically significant difference before and after (P>0.05). As for the construct validity, confirmatory factor analysis results indicated that the two factor model (containing sleep efficiency factor and sleep quality factor) was the optimal model (goodness-of-fit index 0.949, root of the mean square residual 0.083, comparative fit index 0.699), and the factor loading for “hypnotic drug use” was the lowest. Using subjective sleep quality of the students as the criteria, the global PSQI score was statistically different between the criteria-based groups (P<0.001). And the area under the receiver operating characteristics (ROC) curve which was plotted using the global score of PSQI was 0.908 (95%CI: 0.880-0.936). Conclusion: The Chinese version of PSQI has been verified, having good reliability and validity among the medical students, and is an effective tool to investigate and screen the sleep quality of medical students in China.