不同入路半髋关节置换术治疗高龄股骨颈骨折的早期疗效比较

Comparison on Short-Term Curative Effects of Minimally Invasive Direct Anterior Approach or Posterolateral Approach Hemiarthroplasty in the Treatment of Elderly Patients with Femoral Neck Fractures

目的比较微创直接前入路和后入路半髋关节置换术治疗高龄股骨颈骨折的早期疗效。方法选取2015年至2017年我院收治的72例高龄股骨颈骨折患者,随机平均分为MDAA组(微创直接前入路半髋关节置换术)和PLA组(后入路半髋关节置换术)。比较两组患者术中和出院时情况、术后VAS评分、TUG时间及并发症发生率。结果 MDAA组的术中出血量、手术切口长度和术中输血率均优于PLA组(P<0.05),但两组的手术时间比较无统计学差异(P>0.05)。出院时,MDAA组服用止痛药、依赖双拐或助行器、独立行走的比例以及住院时间、治疗满意率均优于PLA组(P<0.05)。MDAA组治疗后的VAS评分和TUG时间均优于PLA组(P<0.05)。MDAA组的并发症发生率低于PLA组(P<0.05)。结论采用微创直接前入路半髋关节置换术治疗高龄股骨颈骨折创伤小、恢复快、并发症风险低。

Objective To compare the short-term curative effects of minimally invasive direct anterior approach（MDAA） or posterolateral approach（PLA） hemiarthroplasty in the treatment of elderly patients with femoral neck fractures. Methods 72 cases of elderly patients with femoral neck fractures admitted to our hospital from 2015 to 2017 were selected and randomly divided into MDAA group（minimally invasive direct anterior approach） and PLA group（posterolateral approach） equally. The intraoperative and discharge condition,postoperative SAS score, TUG time and incidence of complications were compared between the two groups. Results The intraoperative blood loss, incision length and intraoperative transfusion rate of MDAA group were better than those of PLA group（P〈0.05）, but no statistical difference was found in the operation time between the two groups（P〈0.05）. At discharge, the rates of taking analgesics, relying on bruising or walking aid and independent walking, hospitalization time and treatment satisfaction rate of MDAA group were better than those of PLA group（P〈0.05）. After treatment, the VAS scores and TUG time of MDAA group were better than that of PLA group（P〈0.05）.The incidence of complications of MDAA group was lower than that of PLA group（P〈0.05）. Conclusions Minimally invasive direct anterior approach hemiarthroplasty in the treatment of elderly patients with femoral neck fractures has less trauma, rapid recovery and low risk of complications.