外侧小切口与后路小切口全髋关节置换术治疗股骨颈骨折的效果比较

Comparison of effect of total hip arthroplasty via small lateral incision versus mini posterior incision on femoral neck fractures

目的比较外侧小切口全髋关节置换术(THA)与后路小切口THA治疗股骨颈骨折的临床效果。方法抽取2015年3月至2018年9月运城市第一医院收治的股骨颈骨折后拟行THA的老年患者76例, 根据患者病情及手术意愿进行分组, A组36例行外侧小切口THA, B组40例行后路小切口THA。观察记录两组患者的手术时间、术中出血量及术后引流量, 采用视觉模拟评分法(VAS)评估两组患者的疼痛程度, 采用髋关节Harris评分评估两组患者术后假体情况及临床疗效, 观察并记录两组患者术后并发症发生情况。结果两组患者手术时长比较差异未见统计学意义(P>0.05), B组术中出血量、累积引流量[(478.44±65.43)、(254.88±38.77)ml]少于A组[(557.73±75.44)、(297.44±42.19)ml], P<0.05。术后3 d及出院后1个月, B组患者VAS评分均低于A组(P均<0.05);出院后6个月, 两组VAS评分、髋关节Harris评分、临床疗效、并发症发生率比较差异未见统计学意义(P>0.05)。结论两种入路THA远期临床效果相似, 但后入路小切口THA术后早期疼痛较轻、术后引流量少。

Objective To compare the clinical effects of total hip arthroplasty(THA)via small lateral incision and mini-posterior incision in the treatment of femoral neck fractures.Methods Seventy-six patients with femoral neck fractures treated in Yuncheng First Hospital from March 2015 to September 2018 were selected.And they were grouped according to their own willingness.In group A,there were 36 patients who underwent THA via small lateral incision.In group B,there were 40 patients who underwent THA via mini-posterior incision.The operation time,intraoperative blood loss and postoperative drainage volume of the two groups were observed and recorded.The visual analogue scale(VAS)was used to evaluate the pain degree of the patients.The Harris score of hip joint was used to evaluate the postoperative prosthesis and clinical effect of the two groups.Postoperative complications of the two groups were observed and recorded.Results There was no significant difference in operation time between the two groups(P>0.05).The intraoperative blood loss and cumulative drainage volume in the group B were(478.44±65.43)ml and(254.88±38.77)ml,respectively,lower than(557.73±75.44)ml and(297.44±42.19)ml in the group A(P<0.05).VAS score of the group B was lower than that of the group A 3 days after operation and 1 month after discharge(all P<0.05).There was no significant difference in VAS score,hip joint Harris score,clinical efficacy and complication rate between the two groups 6 months after discharge(P>0.05).Conclusions The long-term clinical effects of THA with two approaches are similar.However,THA via mini-posterior incision has less postoperative pain and less blood loss.