侧卧位DAA入路全髋关节置换治疗股骨颈骨折学习曲线

Learning curve of total hip arthroplasty in treating femoral neck fracture via lateral recumbent direct anterior approach

目的评估侧卧位直接前入路(DAA)全髋关节置换(THA)治疗股骨颈骨折学习曲线的可行性和安全性。方法选择2015年9月至2019年7月收治的股骨颈骨折行侧卧位DAA入路THA治疗患者60例,其中前30例患者为A组,后30例患者为B组。比较2组患者的手术时间、切口长度、出血量、住院时间、髋臼假体安放角度和并发症情况。结果B组手术时间明显少于A组,差异有统计学意义(P<0.05);B组出血量明显少于A组,差异有统计学意义(P<0.05);2组患者住院时间差异无统计学意义(P>0.05);B组患者髋臼假体位置安放的正确率明显高于A组(P<0.05);A组患者术后3例患者发生股外侧皮神经损伤,余未见明显并发症。结论侧卧位DAA入路THA是一种可替代传统术式治疗股骨颈骨折的有效手术方法,其并发症的发生风险没有预期的那么高,但是术前需认真规划,谨防DAA可能发生的并发症。

Objective To investigate the feasibility and safety of total hip arthroplasty(THA)in treating femoral neck fracture via lateral decubitus direct anterior approach(DAA).Methods A total of 60 patients with femoral neck fracture who were treated by lateral decubitus DAA THA in our hospital from September 2015 to July 2019 were enrolled in the study,who were lateral decubitus DAA THA treatment were selected as the research objects,of which the first 30 patients were in group A and the last 30 were in group B.The operative time,incision length,blood loss,length of stay,angle of acetabular prosthesis and complications of the two groups were compared.Results There was no significant difference in general data between the two groups(P>0.05).The operative time of group B was significantly less than that of group A,with statistically significant difference(P<0.05).The amount of blood loss in group B was significantly less than that in group A,and the difference was statistically significant(P<0.05).There was no significant difference in length of stay between the two groups(P>0.05).The correct rate of acetabular prosthesis placement in group B was significantly higher than that in group A(P<0.05).In group A,3 patients suffered from lateral femoral cutaneous nerve injury after operation,and no obvious complications were observed.Conclusion Lateral decubitus DAA THA is an effective surgical method that can replace traditional surgical treatment for femoral neck fractures.The risk of complications is not as high as expected,but careful planning should be carried out before operation in order to prevent complications of DAA.