直接前入路全髋关节置换术治疗股骨颈骨折的效果

Effects of direct anterior approach total hip replacement on femoral neck fractures

目的分析直接前入路(DAA)全髋关节置换术治疗股骨颈骨折的临床效果。方法抽取聊城市妇幼保健院2018年2月至2020年2月收治的行全髋关节置换术的股骨颈骨折患者82例,回顾性分析其临床资料,其中42例采取DAA入路,纳入观察组,40例采取传统后外侧入路,纳入对照组。比较两组患者围术期参数(手术时长、术中失血量、术后引流量、术后下床活动时间、完全负重时间),术后1、3、7 d视觉模拟评分法(VAS)评分,术后1、3、6个月髋关节功能评分,及术后6个月患者步态参数[单腿支撑时间、单腿支撑时间占步态周期百分比(foot off)、步频]。结果两组手术时长比较差异未见统计学意义(P>0.05),观察组术中失血量、术后引流量、术后下床活动时间、完全负重时间均短于对照组(P均<0.05)。观察组术后1、3、7 d VAS评分均低于对照组(P均<0.05)。观察组术后1、3、6个月Harris量表评分均高于对照组(P均<0.05)。观察组术后6个月单腿支撑时间、foot off、步频均大于对照组(P均<0.05)。结论相比传统后外侧入路,DAA全髋关节置换术治疗股骨颈骨折创伤小,术后疼痛轻且恢复快,髋关节功能恢复更佳。

Objective To analyze the effects of direct anterior approach(DAA)total hip replacement on patients with femoral neck fractures.Methods A total of 82 patients with femoral neck fractures treated by total hip replacement in Liaocheng Maternal and Child Health Hospital from February 2018 to February 2020 were selected,and their clinical data were retrospectively analyzed.Among them,42 cases treated by DAA approach were included in observation group,and 40 cases treated by traditional posterolateral approach were included in control group.The perioperative parameters(surgical time,intraoperative blood loss,postoperative drainage volume,postoperative ambulation time,full weight-bearing time),1-,3-,and 7-day postoperative visual analogue scale(VAS)score,1-,3-,and 6-month postoperative hip function,and gait parameters,including single leg support time,percentage of single leg support time and gait cycle(foot off),step frequency 6 months after surgery,were compared between the two groups.Results There was no significant difference in surgical time between the two groups(P>0.05);the intraoperative blood loss,postoperative drainage volume,ambulation time and full weight-bearing time of observation group were less than those in control group(all P<0.05).The VAS scores of observation group were lower than those of control group 1,3 and 7 d after surgery(all P<0.05).Harris scale scores of observation group were all higher than those in control group 1 month,3 months and 6 months after surgery(all P<0.05).The single leg support time,foot off and step frequency in observation group were longer or higher than those in control group 6 months after surgery(all P<0.05).Conclusions Compared with traditional posterolateral approach,DAA total hip replacement for femoral neck fractures has less trauma,milder postoperative pain and faster recovery,and better hip function recovery.