OBJECTIVE: To systematically evaluate the clinical efficacy of high-quality direct anterior approach (DAA) and other approaches for the treatment of elderly patients with femoral neck fracture. METHODS: Literatures published in English or Chinese about the direct anterior approach and other approaches for hemiarthroplasty in femoral neck fracture were searched on Cochrane Library, PubMed, EMBASE, Web of science, Wanfang, CNKI databases from their establishment to May 2019. According to the inclusion and exclusion criteria, two researchers independently screened the literatures, and extracted the data. The quality of RCT were evaluated by Cochrane Risk of Bias Assessment Tool, and non-RCT were evaluated by the NOS scale. Meta-analysis was performed using the RevMan 5.3 software. RESULTS: A total of 9 articles were included with 901 cases, in which 429 cases used DAA, and 472 used other approaches. DAA had a significantly lower dislocation rate compared to subgroup of posterior and posterolateral approach [=0.19, 95%CI (0.06, 0.61), =0.005]. No significant differences were found between DAA group and subgroup of direct lateral and anterolateral approach[=1.08, 95%CI(0.20, 5.76), =0.93]. Also there were no relevant differences between the DAA group and control in infection rate[=1.07, 95%CI(0.47, 2.43), =0.88], perioperative fracture rate[=0.95, 95%CI(0.36, 2.50), =0.92], re operation rate[=0.76, 95%CI(0.30, 1.89), =0.55], overall complication rate [=0.88, 95%CI (0.63, 1.22), =0.44], mortality [=1.33, 95%CI (0.84, 2.11), =0.23], operative time[MD=1.43, 95%CI(-5.85, 8.71), =0.70]. CONCLUSION The current evidenceindicates that the DAA was associated with a significantly lower dislocation rate compared to posterior capsular approaches for hemiarthroplasty. There was no significant difference in dislocation rate with the lateral and anterolateral approach.
Aged ; Antiviral Agents ; Arthroplasty, Replacement, Hip ; Femoral Neck Fractures ; surgery ; Hemiarthroplasty ; Hepatitis C, Chronic ; Humans ; Reoperation ; Treatment Outcome

PURPOSE: To evaluate the therapeutic effect of topical testosterone gel application to periocular area in dry eye. METHODS: Thirty-four eyes of 17 patients with refractory dry eye were included. Five patients had Sjogren's syndrome and 12 were non-Sjogren's syndrome patients. Testosterone gel was applied on the periocular area three times a day. Symptom score corneal sensitivity test (CST), tear film break-up time (BUT), basal tear secretion test (BST), fluorescein staining, tear clearance test (TCR), and conjunctival impression cytology were checked and evaluated before, one month after and two months after treatment. RESULTS: The mean symptom score before topical testosterone gel application was 3.44+/-0.70; it was 2.88+/-0.84 at 1 month after application and 2.03+/-1.09 at 2 months after application. The improvement of tear film parameters including BUT, tear clearance rate, fluorescein staining score, conjunctival metaplasia and goblet cell density was statistically significant (P<0.05) at one and two months after treatment but neither BST nor CST was improved with statistically significance. There was no difference in the therapeutic effect of topical testosterone gel between Sjogren's syndrome and non-Sjogren's dry eye patients. CONCLUSIONS: The function of tear film and the integrity of ocular surface improved after topical application of testosterone gel in dry eye patients. Topical testosterone gel application may be an effective adjuvant therapy for the treatment of dry eye.
Dry Eye Syndromes* ; Fluorescein ; Goblet Cells ; Humans ; Metaplasia ; Sjogren's Syndrome ; Tears ; Testosterone*