后外侧小切口全髋置换术治疗股骨颈骨折

Treatment of femoral neck fractures with posterolateral mini-incision total hip arthroplasty

目的总结后外侧小切口全髋关节置换术治疗股骨颈骨折的经验。方法2002年10月-2005年1月收治的199例（207髋）初次全髋置换，其中46例（46髋）为股骨颈骨折患者，新鲜骨折31髋，陈旧性骨折15髋。采用后外侧小切口全髋关节置换术，观察股骨颈骨折置换的切口长度、手术时间、出血量、引流量、住院天数、术后并发症、功能恢复和评分情况。结果随访时间14～26个月，平均17．2个月。随访期间最后一次Harris评分：新鲜股骨颈骨折患者（84．1±8．6）分，陈旧性股骨颈骨折患者评分（85．8±7．6）分。所有患者术后x线片未见明显假体位置不良。新鲜和陈旧股骨颈骨折的手术切口、手术时间、出血量、引流量、住院天数差异均无统计学意义（P〉0．05）。新鲜和陈旧性股骨颈骨折组各有1例患者脱位。结论后外侧小切口全髋关节置换术具有创伤小、出血及并发症少和功能恢复快的特点，对于股骨颈骨折患者不仅能获得良好的髋关节功能，且减少了并发症的发生。

Objective To introduce the experience of improved posterolateral mini-incision total hip arthroplasty （THA） in treatment of femoral neck fractures. Methods Of 199 patients （207 hips） treated with preliminary THA from October 2002 to January 2005, there were 46 patients （46 hips） with femoral neck fractures including 31 fresh fractures and 15 old ones, which were then treated with posterolateral mini-incision THA. An observation was done on length of incision, operation time, volume of blood loss, drainage volume, hospital stays, postoperative complications, functional recovery and Harris score. Results All patients were followed up for 14-26 months （mean 17.2 months）. The final Harris score during follow-up was （ 84.1 ± 8.6 ） points in the fresh fracture group and （ 85.8 ± 7.6 ） points in the old fracture group. Postoperative X-ray showed sound position of the prosthesis. There was no statistical difference upon length of incision, operation time, blood loss, drainage volume and hospital stays between fresh fracture group and old fracture group （ P 〉 0.05 ）. Dislocation occurred in one patient in each group. Conclusion Posterolateral mini-incision THA is proved to be successful in reducing surgical trauma, accelerating rehabilitation and decreasing blood loss and complications for patients with femoral neck fractures.