改良标准后外侧入路人工股骨头置换治疗老年股骨颈骨折

The SuperPATH approach artificial femoral head replacement in the treatment of elderly femoral neck fracture

目的探讨改良标准后外侧入路(SuperPATH入路)人工股骨头置换治疗老年股骨颈骨折的临床疗效。方法按照手术入路不同将46例老年股骨颈骨折患者分为A组(采用SuperPATH入路人工股骨头置换治疗)和B组(采用后外侧常规入路人工股骨头置换治疗),每组23例。记录两组手术情况,术后1、7 d及1个月采用疼痛VAS评分评估疼痛改善情况,术后6周、末次随访时采用髋关节Harris评分评价髋关节功能。结果患者均获得随访,时间10~16个月。切口长度、手术时间、术中出血量、术后下地时间A组均短(少)于B组(P<0.05)。术后1、7 d疼痛VAS评分和术后6周髋关节Harris评分A组均优于B组(P<0.05);术后1个月疼痛VAS评分及末次随访髋关节Harris评分两组比较差异均无统计学意义(P>0.05)。末次随访时,未发生假体松动、失败、翻修等情况;患者均可扶拐负重行走,患侧髋关节功能正常,X线片显示假体位置均正常。结论SuperPATH入路人工股骨头置换治疗老年股骨颈骨折具有手术切口小、损伤小、出血少以及患者术后下地时间早等优点,早期疗效优于后外侧入路。

Objective To investigate the clinical efficacy of the SuperPATH approach artificial femoral head replacement in the treatment of elderly femoral neck fracture.Methods The 46 elderly patients with femoral neck fractures were treated by artificial femoral head replacement,who were divided into group A(using SuperPATH approach)and group B(using conventional posterolateral approach),according to the treatment methods,with 23 cases in each group.The surgery situation was recorded.The pain VAS was used to evaluate the pain improvement situation at 1,7 d and 1 month postoperatively.At postoperative 6 weeks and the last follow-up,the hip function was assessed with Harris score of the hip joint.Results Both groups were followed up for 10~16 months.The incision length,operation time,intraoperative bleeding volume and postoperative landing time in group A were all shorter(less)than those in group B(P<0.05).The pain VAS at 1,7 d after operation and the Harris hip function score at 6 weeks after operation in group A were better than those in group B(P<0.05).There were no significant differences between two groups in pain VAS at 1 month postoperation and Harris hip function score at the last follow-up(P>0.05).At the last follow-up,there was no the loosening and failure of the prosthesis,and revision surgery.The patients could walk with weight-bearing under the crutch help,the hip function of the affected side was normal,X-ray film showed that the prostheses position were all normal.Conclusions In the treatment of elderly femoral neck fractures,the artificial femoral head replacement with SuperPATH approach has the advantages of small surgical incision,less injury,less bleeding and early postoperative landing time of the patients.The early curative effect is better than the posterolateral approach.