后外侧微创入路与后外侧常规入路全髋关节置换术在治疗老年股骨颈骨折中的疗效比较

Comparison of the efficacy of total hip replacement between posterolateral minimally invasive approach and posterolateral conventional approach in the treatment of femoral neck fractures in elderly patients

目的对比后外侧微创入路与后外侧常规入路行全髋关节置换术治疗老年股骨颈骨折的效果。方法将2016年1月1日-2019年10月31日于南京中医药大学附属姜堰医院骨伤科就诊的107例老年股骨颈骨折患者作为研究对象,对所有患者的临床及随访资料进行回顾性分析,按照治疗方式的不同将其分为微创组(53例)及常规组(54例)。微创组采用后外侧微创入路行全髋关节置换术,常规组则采用后外侧常规入路行全髋关节置换术。对比2组患者围术期相关指标(手术时间、术中出血量、术后15 d柄假体颈干角及髋臼外展角角度)及手术前后的疼痛视觉模拟评分(VAS)、髋关节(Harris)评分和并发症的发生率。结果微创组手术中出血量少于常规组(P<0.05),常规组住院时间长于微创组(P<0.05);手术后微创组VAS评分低于常规组,Harris评分高于常规组(P<0.05);治疗后常规组并发症总发生率(16.67%)高于微创组(5.66%)(P<0.05)。结论后外侧微创入路行全髋关节置换术治疗老年股骨颈骨折,能有效减少患者术中出血量,缓解患者的疼痛感,改善其髋关节功能,且术后并发症发生率较低。

Objective To compare the efficacy of total hip replacement between posterolateral minimally invasive approach and posterolateral conventional approach in the treatment of femoral neck fractures in elderly patients.Methods 107 cases of elderly patients with femoral neck fracture treated in Department of Orthopedics and Traumatology,Jiangyan Hospital Affiliated to Nanjing University of Traditional Chinese Medicine from January 1,2016 to October 31,019 were selected as the research subjects,and their clinical and follow-up data were retrospectively analyzed.According to different treatment methods,they were divided into minimally invasive group(53 cases)and conventional group(54 cases).The minimally invasive group used the posterolateral minimally invasive approach for total hip replacement,while the conventional group used the posterolateral conventional approach for total hip replacement.The perioperative related indexes(operation time,intraoperative blood loss,stem neck angle and abduction angle of acetabulum 15 days after operation),visual analogue scale(VAS)of pain and hip joint(Harris)score before and after operation and the incidence of complications were compared between the two groups.Results The intraoperative blood loss of the minimally invasive group was less than that of the conventional group(P<0.05),the hospitalization time were shorter than that of the conventional group(P<0.05),the VAS score was lower than that of the conventional group,and the Harris score was higher than that of the conventional group(P<0.05).The complications of the conventional group were higher than that of the minimally invasive group(5.66%vs 16.67%)(χ~2=4.143,P=0.042).Conclusion The posterolateral minimally invasive approach for total hip replacement in the treatment of femoral neck fractures in elderly patients can effectively reduce the amount of intraoperative blood loss,relieve the patient’s pain,improve their hip joint function,and have a low incidence of postoperative complications.