微创直接前侧入路与后外侧入路全髋关节置换术治疗老年人股骨颈骨折的早期临床疗效对照研究

Comparison of early functional recovery between direct anterior minimally invasive surgery and posterolateral approach for total hip arthroplasty in the treatment of femoral neck fracture in the elderly

目的比较微创直接前侧入路(DAMIS)与后外侧入路(PLA)全髋关节置换术治疗老年股骨颈骨折患者的早期临床疗效。方法回顾性研究。纳入2017年10月—2018年9月唐山市第二医院171例股骨颈骨折患者的临床资料,其中89例(89髋)采用DAMIS全髋关节置换术(DAMIS组),男41例、女48例,年龄61~78(68.63±4.35)岁;82例(82髋)采用PLA全髋关节置换术(PLA组),男36例、女46例,年龄62~76(67.93±3.49)岁。比较两组患者手术时间、术中出血量、术后卧床时间及术后1、2周和1、3、6、12个月髋关节功能Harris评分。结果DAMIS组与PLA组患者年龄、性别、体质量指数(BMI)等一般资料差异均无统计学意义(P值均>0.05)。DAMIS组术中出血量(208.09±23.45)mL、术后卧床时间(0.55±0.62)d,均少于PLA组的(293.66±43.45)mL和(1.56±0.93)d,差异均有统计学意义(t=16.198、8.406,P值均<0.01);术后1周、2周、1个月Harris评分分别为(72.66±4.87)、(76.71±4.13)、(81.94±4.73)分,均优于PLA组的(61.38±7.61)、(68.13±6.16)、(74.06±5.16)分,差异均有统计学意义(t=11.446、10.600、10.431,P值均<0.01);而术后3、6和12个月Harris评分差异均无统计学意义(P>0.05)。结论DAMIS全髋关节置换治疗老年股骨颈骨折比PLA出血少、术后卧床时间短、术后康复更快,早期临床疗效值得肯定。

Objective This study aims to compare and analyze the early clinical effect of direct anterior minimally invasive surgery(DAMIS)and the posterolateral approach(PLA)for total hip arthroplasty(THA)on the treatment of geriatric patients suffering from femoral neck fracture.Methods A retrospective study was conducted.A total of 171 femoral neck fracture patients who were treated with THA in Tangshan Second Hospital from October 2017 to September 2018 were included.Among the patients,89 received DAMIS THA(DAMIS group);these patients included 41 males and 48 females aged between 61 and 78 years,with an average age of(68.63±4.35)years.Another 82 patients received THA through PLA(PLA group),and these included 36 males and 46 females aged between 62 and 76 years,with an average age of(67.93±3.49)years.The operative time,intraoperative blood loss,postoperative duration in bed,and Harris scores of the two groups within 1 week,2 weeks,1 month,3 months,6 months,and 12 months after surgery were recorded and compared.Results No significant difference was found among age,gender,body mass index(BMI),and other general information of the two groups(all P values>0.05).The intraoperative blood loss(208.09±23.45)mL and postoperative duration in bed(0.55±0.62)days of the DAMIS group were significantly less than those of the PLA group([293.66±43.45]mL and[1.56±0.93]days),there were statistical differences(t=16.198,8.406,all P values<0.01).The Harris scores of the DAMIS group,namely,(72.66±4.87),(76.71±4.13),and(81.94±4.73),were significantly higher than those of the PLA group with(61.38±7.61),(68.13±6.16),and(74.06±5.16)within 1 week,2 weeks,and 1 month after operation(t=11.446,10.600,10.431,all P values<0.01).Conclusions Compared with PLA-THA,DAMIS-THA has less blood loss,shorter postoperative duration in bed,and faster postoperative enhanced recovery in the treatment of geriatric patients suffering from femoral neck fracture.The optimal early clinical effect of DAMIS deserves affirmation.