前外侧入路微创全髋关节置换和半髋关节置换术后股骨颈骨折愈合及患肢疼痛程度的比较

Comparison of femoral neck fracture healing and affected limb pain after anterolateral-approach minimally invasive total hip replacement and hemiarthroplasty

目的:研究前外侧入路微创全髋关节置换和半髋关节置换术后股骨颈骨折愈合及患肢疼痛程度的差异。方法:选择2013年5月~2015年12月期间在我院接受髋关节置换手术的92例股骨颈骨折患者,随机分为全髋组和半髋组,全髋组患者接受前外侧入路微创全髋关节置换术,半髋组患者接受前外侧入路微创半髋关节置换术,术后1个月时采集血清并测定骨代谢标志物、骨细胞细胞因子、P物质(SP)、降钙素基因相关肽(CGRP)的含量。结果:术后1个月时,全髋组患者血清中Ⅰ型胶原氨基端前肽(PINP)、Ⅰ型胶原羧基端前肽(PICP)、骨形态发生蛋白(BMP)、转化生长因子-β(TGF-β)、成纤维细胞生长因子(FGF)、胰岛素样生长因子-I(IGF-I)、IGF-Ⅱ的含量显著高于半髋组,抗酒石酸酸性磷酸酶5b(TRAP5b)、组织蛋白酶K(CatK)含量显著低于半髋组;手术后当天,两组血清中疼痛介质SP、CGRP的含量无显著差异;手术后36h时,全髋组患者血清中SP、CGRP的含量均显著低于半髋组。结论:前外侧入路微创全髋关节置换术后的骨代谢情况优于半髋关节置换术、疼痛程度弱于半髋关节置换术。

Objective：To study the differences in femoral neck fracture healing and affected limb pain after anterolateral-approach minimally invasive total hip replacement and hemiarthroplasty.Methods：A total of 92 patients with femoral neck fracture who received hip replacement in our hospital between May 2013 and December 2015 were selected and randomly divided into total hip and half hip group,total hip group received anterolateral-approach minimally invasive total hip replacement,half hip group received anterolateral-approach minimally invasive hemiarthroplasty,and 1 month after operation,serum was collected to detect the levels of bone metabolism markers,osteocyte cytokines,SP and CGRP.Results：A month after operation,serum PINP,PICP,BMP,TGF-β,FGF,IGF-I and IGF-Ⅱlevels of total hip group were significantly higher than those of half hip group while TRAP5 band CatK levels were significantly lower than those of half hip group;the day after operation,serum pain media SP and CGRP levels were not significantly different between the two groups of patients;36hafter operation,serum SP and CGRP levels of total hip group were significantly lower than those of half hip group.Conclusions：The bone me-tabolism after anterolateral-approach minimally invasive total hip replacement is better than that after hemiarthroplasty,and the degree of pain is less than that after hemiarthroplasty.