不同入路人工股骨头置换术治疗单侧股骨颈骨折的疗效研究

Efficacy of artificial femoral head replacement through different approaches in the treatment of unilateral femoral neck fracture

目的 探讨不同入路人工股骨头置换术治疗GardenⅢ、Ⅳ型单侧股骨颈骨折的疗效。方法 回顾性分析我院收治的76例GardenⅢ、Ⅳ型单侧股骨颈骨折患者的临床资料,根据手术入路分为直接前方入路(DAA)组(40例)和后外侧入路(PA)组(36例)。比较2组患者手术时间、术中出血量、切口长度、首次下地时间、住院时间及弃助行器时间等围术期相关指标;通过视觉模拟量表(VAS)评分比较2组患者的术后疼痛程度;通过Charnley评分比较2组患者手术前后的髋关节功能;比较2组患者的并发症发生情况。结果 DAA组患者的手术时间长于PA组,术中出血量少于PA组,切口长度短于PA组,首次下地时间、住院时间及弃助行器时间均短于PA组,差异均有统计学意义(P <0.05)。2组患者术后1 d、3 d、1个月和3个月的VAS评分比较,差异均无统计学意义(P> 0.05);DAA组患者术后1个月的Charnley评分高于PA组,差异有统计学意义(P <0.05);2组患者术前和术后3个月的Charnley评分比较,差异无统计学意义(P> 0.05)。DAA组患者术后并发症发生率为17.50%(7/40),PA组患者术后并发症发生率为25.00%(9/36),2组比较差异无统计学意义(P> 0.05)。结论 经DAA和PA人工股骨头置换术治疗GardenⅢ、Ⅳ型单侧股骨颈骨折均有较好的临床疗效,患者髋关节功能均恢复较好,且安全性高,但DAA术中出血量更少,创伤更小,术后早期恢复更快。

Objective To investigate the efficacy of artificial femoral head replacement through different approaches in the treatment of Garden type Ⅲ and Ⅳ unilateral femoral neck fractures. Methods The clinical data of 76 patients with Garden type Ⅲ and Ⅳ unilateral femoral neck fractures admitted to our hospital were retrospectively analyzed. According to surgical approaches,they were divided into the direct anterior approach( DAA) group( 40 cases) and the posterolateral approach( PA) group( 36 cases). The perioperative related indexes such as operation time,intraoperative bleeding volume,incision length,first time to the ground,hospital stay and time to abandon walker of the two groups were compared. The degree of postoperative pain of the two groups was compared by visual analogue scale( VAS)score. The hip joint function of the two groups before and after operation was compared by Charnley score. The complications of the two groups were compared. Results The operation time of the DAA group was longer than that of the PA group,the intraoperative bleeding volume was less than that of the PA group,the incision length was shorter than that of the PA group,and the first time to the ground,hospital stay and time to abandon walker of the DAA group were shorter than those of the PA group,the differences were statistically significant( P < 0. 05). There was no statistically significant difference in the VAS scores 1 day,3 days,1 month and 3 months after operation between the two groups( P > 0. 05). The Charnley score of the DAA group was higher than that of the PA group 1 month after operation,and the difference was statistically significant( P < 0. 05). There was no statistically significant difference in the Charnley score before operation and3 months after operation between the two groups( P > 0. 05). The incidence of postoperative complications was 17. 50%( 7/40) in the DAA group and 25. 00%( 9/36) in the PA group,there was no statistically significant difference in the incidence of postoperative complications between the two groups( P > 0. 05). Conclusion DAA and PA approach artificial femoral head replacement all have good clinical efficacy in the treatment of Garden type Ⅲ and Ⅳ unilateral femoral neck fractures,the hip joint function of patients has recovered well with high safety. However,DAA has less intraoperative bleeding volume,less trauma and faster early recovery after operation.