不同入路人工股骨头置换术治疗移位性股骨颈骨折的临床比较

Clinical comparison of different approaches of hemiarthroplasty on displaced femoral neck fracture

目的 比较不同入路人工股骨头置换术(HHA)对移位性股骨颈骨折(FNF)的治疗效果。方法 选取2019年1月至2021年5月收治的140例移位性FNF患者作为研究对象,采用抽签法分为A组和B组,每组70例,2组均行HHA治疗,A组采用直接前入路(DAA),B组采用后外侧入路。比较2组围术期指标、术后24、48、72 h时疼痛程度[采用视觉模拟评分法(VAS)评估]及术前、术后6个月时髋关节功能[采用髋关节Harris评分表(HHS)评估]。结果 A组手术切口长度较B组短,术中出血量较B组少,术后可持续坐位1 h所需时间、首次下床活动时间较B组短,手术时间较B组长,差异均有统计学意义(P<0.05);A组术后24、48、72 h时VAS评分均较B组低,差异有统计学意义(P<0.05);术后6个月,2组HHS评分均高于术前,且A组高于B组,差异有统计学意义(P<0.05)。结论 相较于后外侧入路,采用DAA的HHA治疗对移位性FNF患者造成的手术创口较小,术中出血量较少,能缩短患者坐立、下床活动时间,减轻术后疼痛程度,促进髋关节功能改善,但DAA的手术时间较长,部分患者无法耐受,临床需根据患者具体情况选择HHA的入路方式。

Objective To compare the therapeutic effects of different approaches of hemiarthroplasty(HHA)on displaced femoral neck fractures(FNF).Methods A total of 140 patients with displaced FNF admitted from January 2019 to may 2021 were selected as the study subjects.They were allocated to group A(n=70)and group B(n=70)by drawing lots.Patients in both groups were treated with HHA,and the direct anterior approach(DAA)and posterior lateral approach were adopted in group A and B,respectively.The perioperative indexes,pain degree at 24h,48h and 72h postoperatively assessed by visual analogue scale(VAS),and hip joint function preoperatively and 6 months postoperatively were assessed by hip Harris scale(HHS)were compared between groups.Results Compared with those of group B,patients in group A presented significantly shorter incision length,less amount of intraoperative bleeding,shorter duration to achieve 1h continuous sitting,shorter time of off-bed activities and longer operation time(P<0.05).VAS scores at 24h,48h and 72h postoperatively in group A were significantly lower than those in group B(P<0.05).At 6 months postoperatively,the HHS scores in both groups were significantly higher than those before operation,which were significantly higher in group A than in group B after operation(P<0.05).Conclusion Compared with the posterior lateral approach,HHA patients with DAA causes a smaller surgical wound and less intraoperative bleeding in patients with displaced FNF.It can shorten the time of sitting,standing and getting out of bed,reduce the degree of postoperative pain,and promote the improvement of hip function.However,the operation time of DAA is long,and some patients cannot tolerate it.The approach to HHA should be selected based on individualized conditions.