Supercap入路与后外侧入路半髋置换软组织损伤的比较

Comparison of soft tissue damages of Supercap versus posterolateral approaches in hemiarthroplasty for femoral neck fracture in the elderly

[目的]比较Supercap入路与传统后外侧入路半髋关节置换治疗高龄股骨颈骨折的软组织损伤程度。[方法]将2015年1月～2017年6月87例老年移位股骨颈骨折随机分为两组:44例经微创Supercap入路,43例经传统后外侧入路,均行非骨水泥柄双动头半髋关节置换。比较两组手术时间、术中失血量、切口长度、各随访时间点的VAS (Visual Analogue Scale)评分和术后并发症发生情况,并检测比较肌酸激酶(creatine kinase, CK)、肌酸磷酸激酶(creatine phosphokinase, CPK)、血红蛋白(hemoglobin, Hg)、肌钙蛋白I (troponin I, Tn I)、C反应蛋白(C-reactive protein, CRP)。[结果] Supercap组手术切口长度(5.91±1.15) cm,而后外侧组为(6.47±1.33) cm,两组差异有统计学意义(P<0.05)。两组手术时间、术中出血量、术后各随访点血红蛋白水平及肌钙蛋白I水平差异无统计学意义(P>0.05)。术后1、3、7 d Supercap组VAS评分及C反应蛋白值较后外侧组显著降低(P<0.05),术后14 d两组差异无统计学意义(P>0.05)。术后1、3 d Supercap组肌酸激酶值及肌酸磷酸激酶值显著低于后外侧组(P<0.05),但术后7 d两组差异无统计学意义(P>0.05)。两组间早期并发症的发生率差异无统计学意义(P>0.05)。[结论]对于高龄移位股骨颈骨折行半髋关节置换, Supercap入路的肌肉损伤及炎症反应明显低于传统后外侧入路,提示Supercap是一种侵袭性更小的手术入路,更利于老年患者的术后快速康复。

[Objective] To compare the soft tissue damages during hemiarthroplasty through a minimal invasive Supercap approach versus a conventional posterolateral approach for displaced femoral neck fractures in the elderly. [Methods] Between January 2015 and June 2017, 87 elderly patients with displaced femoral neck fracture were prospectively randomly divided into two groups in the study, including 44 patients who received cementless bipolar hemiarthroplasty through the minimally invasive Supercap approach, and 43 patients who had the same operation through the conventional posterolateral approach. The operation time, intraoperative blood loss, incision length, visual analogue scale(VAS) for pain and complications were compared between the two groups. In addition, the laboratory tests, including creatine kinase(CK), creatine phosphokinase(CPK), hemoglobin(Hg), troponin I(Tn I) and C-reactive protein(CRP), were conducted and assessed between them. [Results] The Supercap group had significantly shorter incision length than the posterolateral group [(5.91±1.15) cm versus(6.47±1.33) cm, P<0.05], although no significant differences were noted regarding to operation time, intraoperative blood loss, Hg and Tn I at different time points postoperatively between the two groups(P>0.05). Compared to the posterolateral group at 1, 3 and 7 days postoperatively, the Supercap group got significant less VAS and CRP(P<0.05), which turned to be no a statistically significant difference between them at 14 days postoperatively(P>0.05). In addition, the Supercap groups had significantly less CK and CPK than the posterolateral group at 1 and 3 days postoperatively(P<0.05), whereas those turned to be no a statistically significant difference between them at 7 days postoperatively(P>0.05). Furthermore, there were no statistically significant differences between the two groups regarding to early complications(P>0.05). [Conclusion] The minimal invasive Supercap approach does reduce the release of muscle marker enzymes due to soft tissue damage, and minimized the inflammatory response related to hemiarthroplasty for displaced femoral neck fractures in the elderly. It implies that the Supercap approach might be superior to the conventional posterolateral approach for less invasive, and facilitating the early postoperative rehabilitation.