高龄股骨颈骨折患者接受直接前方入路和后外侧入路人工全髋关节置换术的疗效比较

Direct anterior approach and posterolateral approach in total hip arthroplasty in the treatment of femoral neck fractures of the elderly

目的探讨高龄股骨颈骨折患者接受直接前方入路 (direct anterior approach,DAA) 和后外侧入路 (posterolateral approach,PLA) 人工全髋关节置换术 (total hip arthroplasty,THA) 的临床疗效。方法回顾性分析我院 2015 年 8 月至 2018 年 4 月行 THA 的病例共 45 例,DAA 组 21 例,PLA 组 24 例。男女比例:DAA 组为 5∶16,PLA 组为 7∶17;年龄范围:DAA 组为 72~92 岁,PLA 组为 72~89 岁;Garden 2 型、3 型、4 型的占比:DAA 组为 2∶5∶14,PLA 组为 3∶6∶15;平均 BMI:DAA 组为 (27.7±1.2) kg / m^2,PLA 组为 (28.5±1.8) kg / m^2。对比分析两组患者的手术时间、术中失血量、术后下地时间、住院时间、术后髋关节 Harris 评分,随访患者术后并发症的发生情况。结果与 PLA 组相比,DAA 组的手术时间更长 (P=0.02),术中失血量、术后下地时间、住院时间更短 (P=0.01);术后患者髋关节 Harris 评分随着时间推移逐步上升,与 PLA 组相比,DAA 组患者术后 6 周、3 个月、6 个月的髋关节 Harris 评分更高 (P=0.01),术后12 个月时两组患者髋关节 Harris 评分比较差异无统计学意义 (P>0.05);DAA 组中 1 例术后出现假体周围大转子骨折,1 例出现股外侧皮神经损伤;DAA 组术后切口均为一期愈合;PLA 组中 1 例出现术后切口感染;PLA 组和 DAA 组中均未出现股骨无菌性假体松动等术后远期并发症。结论 DAA THA 具有手术失血量少、术中组织损伤小、术后下地时间早、住院时间短等优点,且患者术后疼痛较轻,髋关节功能恢复较好,与 PLA 术式相比,短期临床疗效更好,长期临床疗效还需进一步随访考证。

Objective To compare effects of direct anterior approach (DAA) and posterolateral approach(PLA) in total hip arthroplasty (THA) in the treatment of femoral neck fractures of the elderly.Methods Clinical data of 45 THA cases were retrospectively analyzed from August 2015 to April 2018.DAA group (n=21):male to female ratio 5:16;average age 72-92 years;garden type 2,3,4 accounted for 2:5:14;average BMI (27.7±1.2) kg / m^2.PLA group (n=24):male to female ratio 7:17;average age 72-89 years;garden type 2,3,4 accounted for 3:6:15;average BMI (28.5±1.8) kg / m^2.Operation time,intraoperative blood loss,off-bed time,hospital stay,postoperative Harris score,and complications were followed up.Results Compared with the PLA group,the operation time of the DAA group was longer (P=0.02),while intraoperative blood loss,off-bed time,hospital stay were less /shorter (P=0.01).Postoperative Harris score changed gradually over time.Compared with the PLA group,hip scores of the DAA group were higher 6 weeks,3 months,and 6 months after surgery (P=0.01),while no statistically significant differences were noted between the two groups 12 months after surgery (P > 0.05).All incisions healed at the first stage in the DAA group with large trochanteric fracture around the prosthesis in 1 patient and lateral femoral cutaneous nerve injury in 1 patient.Postoperative incision infection occurred in 1 patient in the PLA group.Femoral aseptic prosthesis loosening was observed in neither groups.Conclusions DAA has advantages of less blood loss,less intraoperative tissue injury,less postoperative pain,earlier postoperative off-bed,shorter hospital stay,and better recovery of hip functions in THA.However,long-term clinical efficacy needs further follow-up observation.