直接前方入路髋关节置换术治疗老年股骨颈骨折合并帕金森病的短期疗效观察

Direct anterior approach for hip arthroplasty in treatment of femoral neck fracture in elderly patients with Parkinson's disease

目的探讨直接前方入路(DAA)髋关节置换术治疗老年股骨颈骨折合并帕金森病的优势及短期疗效。方法回顾38例行人工髋关节置换术(包括全髋关节置换术和双极骨头置换术)的股骨颈骨折合并帕金森病患者的临床资料。根据其治疗入路方式分为DAA组及后外侧入路(PA组),各19例。比较两组患者切口长度、术中出血量、手术时间及并发症发生情况,术后1个月采用改良Harris评分对髋关节功能恢复进行评价,同时行X线检查,对髋关节的影像学进行评价。结果 DAA组手术切口短于于PA组,差异有统计学意义(P<0.05),DAA组在术中出血量、手术时间与PA组相比差异均无统计学意义(均P>0.05)。DAA组并发症发生率为10.52%,显著低于PA组的36.84%,差异有统计学意义(P<0.05)。术后1个月Harris评分比较,DAA组(82.4±1.7)分明显高于PA组(80.1±1.4)分,差异有统计学意义(P<0.05)。X线检查显示DAA组术后1个月髋关节假体稳定。结论 DAA髋关节置换术治疗老年股骨颈骨折合并帕金森病疗效较好,能明显减少并发症尤其髋关节脱位的发生。

ObjectiveTo evaluate the application of direct anterior approach for hip arthroplasty in treatment of femoral neck fracture in elderly patients with Parkinson＇s disease（PD）.Methods The clinical data of 38 elderly PD patients（Hoehn-Yahr stage IV）with femoral neck fractures undergoing total hip arthroplasty in our hospital from October 2013 to October 2015 were retrospectively analyzed.The patients were divided into anterior approach and posterior approach groups with 19 cased in each group.Direct anterior or posterior hip arthroplasty,including total hip arthroplasty and bipolar arthroplasty,were performed.The patients were followed up for one month.The incision length,intraoperative blood loss,operation time,postoperative complications and incidence of dislocation were compared between the two groups.The clinical results were evaluated using modified Harris scores,X-ray films before and after surgery.Results The incision in the anterior approach group was shorter than that in the posterior approach group（P〈0.05）.There was no significant difference in intraoperative blood loss and operation time between two groups.Harris scores at 1 month after surgery were significantly higher in the anterior group（82.4±1.7）than that in the posterior group（80.1±1.4,P〈0.05）.X-ray examination showed that the hip joint prosthesis was stabilized1 month after surgery in the anterior group.The rate of complications in the anterior group was 5.26%,which was significantly lower than that15.79%in posterior group（P〈0.05）.In the direct anterior approach,there was 1 case of sensory hypoesthesia of the lateral thigh skin caused by the traction injury of the lateral femoral cutaneous nerve.Conclusion Direct anterior approach hip replacement for treatment of femoral neck fracture in elderly patients with Parkinson＇s disease has a good therapeutic efficacy and can significantly reduce the postoperative complications,especially hip dislocation.