高龄股骨颈骨折行SuperPATH入路髋关节置换的短期随访

SuperPATH approach for hip replacement for femoral neck fractures in elderly patients: a short-term follow-up

背景:微创髋关节置换一直是研究的热点,而SuperPATH入路逐渐被认为是真正的微创技术,但目前尚缺乏对该入路临床疗效较长时间的随访研究。目的:探讨SuperPATH入路髋关节置换治疗高龄股骨颈骨折的短期疗效。方法:2016年1月至2018年2月对江苏大学附属金坛医院收治的78例高龄股骨颈骨折患者行SuperPATH入路髋关节置换治疗,男36例,女42例;年龄75-86岁,平均82.4岁;根据Garden分型,Ⅲ型52例,Ⅳ型26例;患者术前均行风险评估,行人工全髋关节置换30例,人工股骨头置换48例;术中使用生物型假体58例,骨水泥假体20例。所有患者对治疗方案均知情同意,且得到医院伦理委员会批准。末次随访采用髋关节Harris评分对不同年龄段、Garden分型、髋关节置换类型、髋关节假体类型患者进行髋关节功能评价。结果与结论:①76例获得随访,时间13-38个月;末次随访根据Harris评分评估疗效,优22例,良50例,中4例,优良率为95%;②末次随访75-79岁组Harris评分(86.91±1.03)分,≥80岁组(84.02±2.26)分,2组间比较差异有显著性意义(t=6.730,P=0.000);③末次随访GardenⅢ型组Harris评分(85.33±4.21)分,GardenⅣ型组(85.05±3.29)分,2组间比较差异无显著性意义(t=2.875,P=0.247);④末次随访股骨头置换组Harris评分(83.19±5.24)分,全髋置换组(82.75±4.88)分,2组间比较差异无显著性意义(t=1.525,P=0.108);⑤末次随访骨水泥假体组Harris评分(82.34±6.24)分,生物型假体组(82.69±5.79)分,2组间比较差异无显著性意义(t=2.978,P=0.219);⑥随访期间,1例患者因不慎摔倒致术侧髋关节脱位,经手法复位后,未出现再次脱位;⑦提示经短期随访分析发现,SuperPATH入路髋关节置换治疗高龄患者股骨颈骨折能够获得良好的治疗效果,且不同Garden分型、髋关节置换类型、髋关节假体类型患者间的疗效并无明显差别;说明该入路微创优势明显,有很好的应用前景。

BACKGROUND: The study of minimally invasive hip arthroplasty has been a hotspot, and SuperPATH approach has gradually been considered as a real minimally invasive technique, but there is still no long-term follow-up study on the clinical efficacy of this approach. OBJECTIVE: To explore short-term follow-up results of SuperPATH approach for hip replacement in the treatment of femoral neck fractures in elderly patients. METHODS: From January 2016 to February 2018, 78 elderly patients with femoral neck fractures were treated with SuperPATH approach for hip replacement in Jintan Hospital Affiliated to Jiangsu University. There were 36 males and 42 females aged from 75 to 86 years old with an average age of 82.4 years old. Fractures were classified according to Garden classification, including 52 cases of type Garden Ⅲ and 26 cases of type Garden Ⅳ. Surgical risk was evaluated before operation. Totally 30 patients received total hip arthroplasty and 48 patients received prosthetic replacement. Bioprosthesis was used in 58 cases and cement prosthesis in 20 cases. All patients signed the informed consent. This study was approved by the Hospital Ethics Committee. Hip joint functions of patients with different age period, Garden classification, hip replacement type, and prosthesis type were evaluated by using Harris score. RESULTS AND CONCLUSION:(1) Seventy-six patients were followed up from 13 to 38 months. According to Harris score, 22 cases were excellent, 50 cases were good and 4 cases were average in the final follow-up. The excellent and good rate was 95%.(2) In the final follow-up, Harris score was (86.91±1.03) in patients aged from 75 to 79 years old,(84.02±2.26) in patients aged more than 80 years old, and had significant differences between two groups (t=6.730, P=0.000).(3) In the final follow-up, Harris score was (85.33±4.21) in the Garden Ⅲ group, and (85.05±3.29) in the Garden Ⅳ group, and there was no significant difference between two groups (t=2.875, P=0.247).(4) In the final follow-up, Harris score was (83.19±5.24) in the prosthetic replacement group, and (82.75±4.88) in the total hip replacement group, and there was no significant difference in Harris score between the two groups (t=1.525, P=0.108).(5) Harris score was (82.34±6.24) in the cement prosthesis group, and (82.69±5.79) in the uncemented prosthesis group, and there was no significant difference in Harris score between the two groups (t=2.978, P=0.219).(6) During follow-up, one patient occurred hip joint dislocation on the operation side due to fall, and no dislocation occurred again after manual reduction.(7) Through long-term follow-up, treatment of femoral neck fracture in elderly patients by SuperPATH approach for hip arthroplasty can obtain good therapeutic effect. Furthermore, there was no significant difference in efficacy between patients with different Garden classification, hip replacement type, and hip prosthesis type. It shows that the approach has obvious advantages in minimally invasive and has a good application prospect.