直接前入路与后外侧入路半髋置换术治疗高龄患者股骨颈骨折

Analysis on the therapeutic effects of hip hemiarthroplasty by direct anterior approach or posterolateral approach in elderly patients with femoral neck fractures

目的:对比半髋关节置换术治疗高龄股骨颈骨折患者中应用侧卧位直接前入路(DAA)与后外侧入路的中短期疗效。方法:将40例高龄股骨颈骨折患者随机分成DAA组及对照组,患者均接受人工双极头生物型假体半髋关节置换术,DAA组采用侧卧位直接前入路,对照组采用后外侧入路,分析比较两组患者的疗效。结果:两组患者手术时间差异无统计学意义(P>0.05);DAA组患者术中出血量、术后血红蛋白下降值、卧床时间及住院时间均少于对照组患者(P<0.01);DAA组患者术后1周及术后1个月时髋关节Harris评分高于对照组患者(P<0.01);术后1、3、7 d,DAA组患者VAS得分均低于对照组患者(P<0.01);术后6个月内,DAA组患者并发症发生率低于对照组患者(P<0.05)。结论:在半髋关节置换术治疗高龄股骨颈骨折患者中应用DAA的中短期疗效优于后外侧入路,能够促进患者快速康复。

Objective:To compare the short and middle-term effects of hip hemiarthroplasty by either direct anterior approach(DAA)or posterolateral approach in the treatment of elderly patients with femoral neck fractures.Methods:Forty elderly patients with femoral neck fractures undergone hip hemiarthroplasty were randomly divided into the DAA group and control group.Patients in both groups received artificial bipolar hip hemiarthroplasty in which direct anterior approach was applied to DAA group,and conventional posterolateral approach to the control group.Then the curative effects were analyzed for two groups.Results:The operative time was not different between groups(P>0.05),yet patients in DAA group had lower intraoperative blood loss,decreased postoperative hemoglobin,bed time and hospital stay than those in the control group(P<0.01).Harris scoring of the hip joints was higher in the DAA group than in the control group at 1 week and 1 month after surgery(P<0.01).Scoring by VAS was lower in DAA group than in the control group at day 1,3 and 7 following operation(P<0.01),and patients in DAA group had lower incidence of complications than those in the control group within 6 months after surgery(P<0.05).Conclusion:Hip hemiarthroplasty by DAA can be superior to conventional posterolateral approach in the treatment of elderly patients with femoral neck fractures by short and middle-term effects,and able to facilitate early recovery for such patients.