直接前路与后外侧入路人工股骨头置换治疗老年移位性股骨颈骨折的临床疗效对比

Comparison of therapeutic effects of hemiarthroplasty between direct anterior approach and posterolateral approach in the treatment of displaced femoral neck fractures in elder patients

目的比较直接前路与后外侧入路人工股骨头置换术治疗老年移位性股骨颈骨折的临床治疗效果。方法选取2013年6月至2015年6月我科诊治的老年单侧移位性股骨颈骨折患者73例,其中采用直接前路36例(直接前路组),后外侧入路37例(后外侧入路组),分析其手术用时、切口长短及愈合时间、手术出血及伤口引流量、下床时间及住院天数,术后3天、7天疼痛视觉评分(VAS),术前、术后1、3、6、9、12个月及末次随访时髋关节Harris评分,术后脱位发生率及其他并发症发生情况。采用欧洲生活质量评分(EQ-5D评分)评价末次随访时患者健康生活质量。结果患者均获得随访,随访时间12~17个月,平均13.6个月。直接前路组的手术用时、切口长度、术中出血量及术后引流量小于后外侧入路组(P<0.05),两组下地行走时间、伤口愈合时间无统计学差异(P>0.05);直接前路组术后3天、7天疼痛视觉评分优于后外侧入路组;术后1月、3月、6月直接前路组Harris评分高于对照组,术后9、12个月及末次随访时两组Harris评分基本接近。两组患者术后末次随访时健康生活质量无统计学差异(P>0.05)。直接前路组1例患者出现伤口局部红肿,后外侧入路组1例患者出现假体脱位,1例出现切口周缘麻木,两组患者无肺栓塞、下肢静脉血栓形成并发症。结论直接前路和后外侧入路均能有利于髋关节运动功能的恢复,早期临床疗效较好。直接前路手术创伤小,出血少,假体脱位发生率低,术后早期疗效好等优势,但直接前路手术对术者的手术技术要求较高。

Objective To compare therapeutic effects of hemiarthroplasty between direct anterior approach and posterolateral approach in the treatment of displaced femoral neck fractures in elder patients. Methods A retrospective study was performed on 73 elder patients with the diagnosis of displaced femoral neck fracture that underwent hemiarthroplasty in our hospital from Jun 2013 to Jun 2015. 36 patients treated with hemiarthroplasty using direct anterior approach（DAA group） and 37 patients treated with posterolateral approach（PLA group） were involved in this study. Surgical time,incision length, intraoperative blood loss, postoperative drainage volume, postoperative time in bed, incision healing time, length of stay, Harris score, and postoperative complications of the two groups were observed and recorded. The health-related quality of patients＇ life was evaluated by using the EQ-5D index. Results All patients were followed up for 12 ~ 17 months（13.6 months on average）. Surgical time, length of incision, intraoperative blood loss and postoperative drainage volume in DAA group were superior over PLA group（P〈0.05）. No statistical differences were observed in terms of postoperative time in bed, incision healing time and health-related quality of patients＇ life between the two groups. Higher Harris score was observed in the DAA group within the first 6 months, while similar Harris score was observed after that between two groups. There were 1 case with incision swelling in DAA group, and 1 case with prosthesis dislocation and 1 case with peripheral numbness of incision in PLA group. Conclusion Both direct anterior approach and posterolateral approach hemiarthroplasty have good clinical curative effects in treatment of displaced femoral neck fractures. Direct anterior approach is superior over posterolateral approach with the advantages of minor trauma and less bleeding, but it requires skilled operation technique.