MDT结合OCM入路人工股骨头置换术治疗高龄股骨颈骨折的临床价值

Clinical Value of MDT Combined with OCM Approach for the Hemiarthroplasty in the Treatment of Femoral Neck Fracture in the Eldly Patients.

目的探讨多学科综合诊疗(multi-disciplinary team,MDT)结合慕尼黑骨外科(orthopdische chirurgie München,OCM)入路人工股骨头置换术治疗高龄股骨颈骨折患者的临床价值。方法回顾性分析2017年1月~2018年12月南京医科大学第二附属医院收治的高龄股骨颈骨折患者60例,年龄82~94岁,合并两种以上内科疾病,根据治疗方法不同将其分为观察组和对照组,每组各30例。观察组采用MDT结合OCM入路人工股骨头置换术治疗,对照组采用后外侧入路人工股骨头置换术治疗。比较两组的手术时间、Harris评分、疼痛视觉模拟量表(visual analogue scales,VAS)、术中出血量、住院天数、术后并发症等。结果观察组的住院天数,术后1、6周髋关节Harris评分,术后1、7天疼痛VAS评分分别为8.3±2.7天、66.4±8.8分、80.4±11.5分、2.7±0.8分、1.0±0.4分,均优于对照组(12.4±3.4天、50.1±12.5分、72.5±8.2分、3.6±0.9分、1.5±0.3分),差异均有统计学意义(P均<0.05),但术后12周两组患者Harris评分比较,差异无统计学意义;手术时间和出血量比较差异无统计学意义。术后观察组出现2例小转子处骨折;对照组有3例假体后脱位以及1例深静脉血栓。结论MDT结合OCM入路人工股骨头置换术治疗高龄股骨颈骨折患者,具有提高救治效率、降低并发症发生率以及缩短住院天数的优点,具有良好的临床疗效和社会价值。

Objective To investigate the clinical value of multi-disciplinary team(MDT)combined with orthopdische chirurgie München(OCM)approach for the hemiarthroplasty in the treatment of elderly patients with femoral neck fracture.Methods Sixty elderly patients with femoral neck fracture,aged from 82 to 94 years old,complicated with more than two kinds of medical diseases who were admitted to the Second Affiliated Hospital of Nanjing Medical University from January 2017 to December 2018 were analyzed retrospectively,they were divided into observation group and control group according to different treatment methods,with 30 cases in each group.The observation group were treated with MDT combined with OCM approach for the hemiarthroplasty,and the control group were treated with posterolateral approach for the hemiarthroplasty.The operation time,Harris score,pain visual analogue scales(VAS),intraoperative blood volume,length of hospital stay and postoperative complications were compared between the two groups.Results The length of hospital stay,the Harris score at 1 week and 6 weeks after operation,and the pain VAS at 1 day and 7 days after operation were 8.3±2.7 days,66.4±8.8 points,80.4±11.5 points,2.7±0.8 points,1.0±0.4 points in the observation group,which were respectively better than those in the control group(12.4±3.4 days,50.1±12.5 points,72.5±8.2 points,3.6±0.9 points,1.5±0.3 points),and the differences were statistically significant(P<0.05).However,there was no significant difference in the Harris score between the two groups at 12 weeks after operation;there was also no significant difference in the operation time,intraoperative blood volume between the two groups(P>0.05).After operation,there were 2 cases of lesser trochanter fracture in the observation group;3 cases of prosthesis posterior dislocation and 1 case of deep vein thrombosis in the control group.Conclusion The application of MDT combined with OCM approach for the hemiarthroplasty in the treatment of elderly patients with femoral neck fracture has the advantages of improving the treatment efficiency,reducing the incidence of complications and shortening the length of hospital stay,and has good clinical efficacy and social value.