前方入路半髋关节置换治疗股骨颈骨折伴认知功能障碍

Femoral neck fracture associated with cognitive impairment treated with direct anterior approach hip arthroplasty

目的评价直接前方入路(DAA)行半髋关节置换术治疗合并神经认知功能障碍的老年股骨颈骨折的临床疗效。方法选取2017年7月至2020年5月中山市中医院80例老年股骨颈骨折合并神经认知功能障碍患者,骨折分型为GardenⅢ、Ⅳ型,年龄≥80岁,符合认知功能障碍诊断标准,根据患者住院号末位数奇偶性,分为两组,采用DAA行半髋关节置换术的病例为DAA组(n=40);采用后外侧入路(PLA)行半髋关节置换术的病例为PLA组(n=40),比较两组患者的切口长度、失血量、手术时间、下床时间、住院时间、术周两后VAS评分、术后两周Harris评分、并发症发生率,采用t检验或卡方检验分析比较两组的数据。结果80例患者74例得到随访,随访率为92.5%,平均随访时间(12.3±3.5)月。两组切口长度为(8.0±2.1)cm、(12.0±2.0)cm,术中失血量为(70.0±20.5)ml、(185.0±25.0)ml,手术时间为(60.0±20.1)min、(55.0±18.2)min,术后下床时间(20.4±12.2)h、(68.4±28.2)h,住院时间(9.5±2.5)d、(14.3±5.5)d,术后两周疼痛视觉模拟评分(VAS)(4.0±1.8)分、(5.9±2.0)分,术后两周Harris评分(82.9±6.4)分、(72.9±6.0)分,术后3月VAS评分(2.0±0.8)分、(2.2±1.2)分,术后3月Harris评分(88.9±6.4)分、(86.9±5.8)分,两组并发症发生率分别为7.9%、30.8%,其中脱位发生率分别为0、8.3%。两组资料,切口长度(t=8.381)、失血量(t=9.210)、下床时间(t=8.871)、住院时间(t=4.876)、术周两后VAS评分(t=4.300)、术后两周Harris评分(t=6.925)、并发症发生率(χ^(2)=7.402)等指标差异有统计学意义(均为P<0.05)。结论采用DAA入路治疗合并认知功能障碍的老年股骨颈骨折患者,手术微创、住院时间短、并发症少、脱位率低,与后外侧入路相比优势明显。

Objective To evaluate the clinical efficacy of the direct anterior approach(DAA)for hemiarthroplasty for femoral neck fracture in elderly patients with comorbid neurocognitive impairment.Methods From July 2017 to May 2020,80 elderly patients with femoral neck fracture and neurocognitive impairment in Zhongshan Hospital of traditional Chinese medicine were selected,and the fractures were classified as garden types III and IV,aged≥80 years,met the diagnostic criteria for cognitive impairment,and were divided into two groups according to the patients'odd paired end of hospitalization number,the cases that underwent hemiarthroplasty using the direct anterior approach were those in the DAA group(n=40),while the others underwent hemiarthroplasty using the posterolateral approach were the posterolateral approach(PLA)group(n=40),incision length,blood loss,time to get out of bed,hospital stay length,VAS score two weeks after operation,Harris score two weeks after operation,and complication rate of the two groups were compared by SPSS 19.0 statistical software,and comparisons of the metrology data between groups were performed by t test.Comparisons between the two groups were performed by chi square analysis.ResultsSeventy-four of 80 patients were followed up,and the follow-up rate was 92.5%,with a mean follow-up time of(12.3±3.5)months.The incision length in both groups were(8.0±2.1)cm,(12.0±2.0)cm,intraoperative blood loss were(70.0±20.5)ml,(185.0±25.0)ml,operative time were(60.0±20.1)min,(55.0±18.2)min,postoperative ambulation time was(20.4±12.2)h,(68.4±28.2)h,hospital stay were(9.5±2.5)d,(14.3±5.5)d,and VAS score at two weeks after operation were(4.0±1.8),(5.9±2.0),two weeks after operation(82.9±6.4),(72.9±6.0),and VAS at three months after surgery were(2.0±0.8),(2.2±1.2),and at three months after surgery were(88.9±6.4),(86.9±5.8);the incidence of complications in the two groups were 7.9%,30.8%,respectively,in which dislocation occurred in zero and 8.3%of the patients,respectively.The data of the two groups had significant differences(all P<0.05),including incision length(t=8.381),blood loss(t=9.210),time to get out of bed(t=8.871),hospital stay length(t=4.876),VAS score two weeks after operation(t=4.300),Harris score two weeks after operation(t=6.925),and complication rate(χ^(2)=7.402).Conclusion In elderly femoral neck fracture patients with cognitive impairment treated with the DAA approach,the procedure is minimally invasive,with short hospital stay,few complications,low dislocation rate,and a significant superiority compared with the posterolateral heel approach.