直接前方入路与后外侧入路全髋关节置换术治疗老年股骨颈骨折患者的效果比较

Comparison of effects of total hip replacement through direct anterior approach and posterolateral approach in elderly patients with femoral neck fractures

目的:比较直接前方入路与后外侧入路全髋关节置换术治疗老年股骨颈骨折患者的效果。方法:选取64例老年股骨颈骨折患者为研究对象,按照随机数字表法分为观察组与对照组各32例。观察组采取直接前方入路全髋关节置换术治疗,对照组采取后外侧入路全髋关节置换术治疗,比较两组手术相关指标(切口长度、手术时间、术后下床活动时间、术后1 d引流量、住院时间),术后1、3、7 d疼痛程度[视觉模拟评分法(VAS)],术后1个月髋关节功能及并发症发生率。结果:观察组手术切口长度、手术时间、术后下床活动时间及住院时间均短于对照组,术后1 d引流量少于对照组,术后VAS评分低于对照组,Harris评分高于对照组,差异均有统计学意义(P<0.05);观察组并发症发生率为6.25%(2/32),低于对照组的25.00%(8/32),差异有统计学意义(P<0.05)。结论:与后外侧入路相比,直接前方入路全髋关节置换术治疗老年股骨颈骨折患者的效果显著,能够减小手术创伤,缩短手术时间、术后下床活动时间及住院时间,减少术后引流量,降低并发症发生率,减轻术后疼痛程度,以及提高髋关节功能。

Objective:To compare effects of total hip replacement through direct anterior approach and posterolateral approach in elderly patients with femoral neck fractures.Methods:64 elderly patients with femoral neck fractures were selected as the research objects,and were divided into observation group and control group according to the random number table method,32 cases in each.The observation group was treated with total hip replacement through the direct anterior approach,and the control group was treated with total hip replacement through the posterolateral approach.The operation-related indicator levels(incision length,operation time,postoperative ambulation time,drainage volume 1 day after the surgery,hospitalization time),the pain degrees 1,3,and 7 days after the surgery[visual analog scale(VAS)],1 month postoperative hip function and the incidence of complications were compared between the two groups.Results:The incision length,the operation time,the postoperative ambulation time and the hospitalization time in the observation group were shorter than those in the control group;the drainage volume 1 day after the surgery n was less than that in the control group;the postoperative VAS score was lower than that of the control group;the Harris score was higher than that of the control group;and the differences were statistically significant(P<0.05).Further,the incidence of complications in the observation group was 6.25%(2/32),which was lower than 25.00%(8/32)in the control group,and the difference was statistically significant(P<0.05).Conclusions:Compared with the posterolateral approach,total hip replacement through the direct anterior approach has a significant effect in the treatment of the elderly patients with femoral neck fractures,which can reduce the surgical trauma,shorten the operation time,the postoperative ambulation time and the hospitalization time,decrease postoperative drainage volume,reduce the incidence of complications,reduce the postoperative pain levels,and improve the hip function.