两种入路全髋关节置换术治疗老年股骨颈骨折的疗效比较

Comparison of the efficacy of two approaches foRtotal hip arthroplasty in the treatment of femoral neck fractures in the elderly patients

目的比较直接前方入路与后外侧入路全髋关节置换术(THA)治疗老年股骨颈骨折的临床疗效。方法将64例行初次THA的老年股骨颈骨折患者根据入路不同分为观察组(采用直接前方入路THA,32例)和对照组(采用后外侧入路THA,32例)。结果患者均获得随访,时间8~12个月。切口长度、手术时间:两组比较差异均无统计学意义(P>0.05)。术后24 h血红蛋白:两组均较术前降低(P<0.05),观察组高于对照组(P<0.001)。术中出血量、并发症发生率:观察组少(低)于对照组(P<0.05)。疼痛VAS评分和Harris评分:术后24 h、1个月观察组均优于对照组(P<0.001),术后6个月两组比较差异均无统计学意义(P>0.05)。结论与后外侧入路相比,直接前方入路THA治疗老年股骨颈骨折术中出血量少、并发症发生率低、术后短期疼痛程度轻,更利于患者髋关节功能的早期恢复。

Objective To compare the clinical efficacy of the direct anterioRapproach(DAA)and the posterolateral approach foRtotal hip arthroplasty(THA)in the treatment of femoral neck fractures of elderly patients.Methods The 64 elderly patients with femoral neck fractures who underwent primary THA were divided into two groups:observation group(32 cases were treated with THA via DAA)and control group(32 cases were treated with THA via posterolateral approach).Results All patients were followed up foR8~12 months.The incision length and operation time were not statistically different between the two groups(P>0.05).The hemoglobin of 24 h afteRoperation:the two groups were decreased than the preoperation(P<0.05),and the observation group was higheRthan the control group(P<0.001).The intraoperative blood boss and the incidence rate of complications in the observation group were less(lower)than those in the control group(P<0.05).The pain VAS and Harris score:at 24 h and 1 month postoperation,the observation group were all betteRthan the control group(P<0.001),and there were no differences between two groups at 6 months postoperation(P>0.05).Conclusions Compared with the posterolateral approach,the DAA foRprimary total hip arthroplasty in elderly patients can reduce intraoperative blood boss and the incidence of complications,cause mild short-term pain afteRoperation.It is beneficial to the early recovery of hip joint function.