不同入路路径人工髋关节置换治疗老年股骨颈骨折的效果及对血清BALP、DPD、TRACP5b水平的影响

Efficacy of artificial hip replacement with different approaches on femoral neck fracture in the elderly and its impacts on serum levels of BALP,DPD and TRACP5b levels

目的探讨直接前侧入路与传统后外侧入路行人工髋关节置换治疗老年股骨颈骨折的效果及对血清骨特异性碱性磷酸酶(BALP)、脱氧吡啶酚(DPD)、抗酒石酸盐酸性磷酸酶异构体(TRACP5b)水平的影响。方法选取我院自2018年1月至2019年1月收治的75例老年股骨颈骨折患者,按照随机数字表法分为对照组37例、观察组38例。对照组采用传统后外侧入路人工髋关节置换术,观察组采用直接前侧入路人工髋关节置换术,比较两组一般手术情况、骨代谢指标、髋关节功能及术后并发症。结果观察组切口长度小于对照组,术后住院时间短于对照组(P<0.05);术后3个月,两组血清BALP水平升高,DPD、TRACP5b水平下降,且观察组血清BALP水平高于对照组,DPD、TRACP5b水平低于对照组(P<0.05);观察组术后3 d、术后1周、术后1个月的Harris评分高于对照组(P<0.05);观察组术后并发症总发生率为13.16%,低于对照组的35.14%(P<0.05)。结论直接前侧入路人工髋关节置换治疗老年股骨颈骨折切口小,术后住院时间短,且可改善患者骨代谢,促进髋关节功能恢复,减少术后并发症发生。

Objective To investigate the efficacy of artificial hip replacement through direct anterolateral approach and conventional posterolateral approach on femoral neck fracture in the elderly,and its impacts on serum levels of bone-specific alkaline phosphatase(BALP),deoxypyridinoline(DPD)and tartrate-resistant acid phosphatase 5b(TRACP5b).Methods A total of 75 elderly patients with femoral neck fracture admitted to our hospital from January 2018 to January 2019 were selected and divided into the control group(n=37)and the observation group(n=38).The control group was treated with artificial hip replacement through conventional posterolateral approach,while the observation group was treated with artificial hip replacement through direct anterolateral approach.The general operation condition,bone metabolism index,hip joint function and postoperative complications were compared between the two groups.Results The incision length and postoperative hospitalization time in the observation group were shorter than those in the control group(P<0.05).Three months after operation,the serum BALP levels in the two groups both increased,while the levels of DPD and TRACP5b decreased.The serum BALP level in the observation group was higher than that in the control group,while the levels of DPD and TRACP5b were lower than those in the control group(P<0.05).Harris scores in the observation group were higher than those in the control group at 3 days,1 week and 1 month after operation(P<0.05).The overall incidence of postoperative complications in the observation group was 13.16%,which was lower than 35.14%in the control group(P<0.05).Conclusion Direct anterior approach artificial hip replacement for elderly patients with femoral neck fracture has the advantages of small incision and short postoperative hospitalization time.Meanwhile,it improves bone metabolism of patients,promotes recovery of hip joint function and reduces the incidence of postoperative complications.