SuperPATH入路初次单侧全髋关节置换术对骨质疏松导致的股骨颈骨折患者肌酸磷酸激酶、Harris评分及改良Barthel指数的影响

Effect of the first unilateral total hip arthroplasty via SuperPATH approach on creatine phosphokinase,Harris score and modified Barthel index in patients with femoral neck fracture caused by osteoporosis

目的调研和分析SuperPATH入路初次单侧全髋关节置换术对骨质疏松导致的股骨颈骨折患者肌酸磷酸激酶、Harris评分及改良Barthel指数的影响。方法回顾性选取2019年3月至2022年3月唐山市第二医院收治的64例骨质疏松导致的股骨颈骨折患者纳入至本次研究,按照治疗方法的不同将其分为对照组(n=32)与观察组(n=32)。对照组给予外侧小切口入路全髋关节置换术,观察组则行SuperPATH入路初次单侧全髋关节置换术。观察两组患者术前、术后1 d、5 d、15 d、3个月、6个月疼痛疼痛视觉模拟评分法(VAS)评分,比较术前、术后1、5、15 d两组患者血清肌酸磷酸激酶水平变化情况,统计术前、术后1 d、5 d、15 d、3个月、6个月的髋关节功能恢复情况以及术前、术后1 d、5 d、3个月、6个月的日常生活活动能力情况。结果术后3、6个月,两组评分较术前降低,观察组患者术后5 d、15 d、3个月、6个月的VAS评分分别为(4.23±0.53)、(3.53±0.43)、(1.83±0.21)、(0.24±0.12)分,均低于对照组[(4.93±0.98)、(4.21±0.94)、(2.45±0.52)、(0.78±0.36)]分,差异均有统计学意义(P<0.05)。术后1、5、15 d,两组血清肌酸磷酸激酶水平较术前升高,且观察组患者的血清肌酸磷酸激酶水平分别为(478.39±234.12)、(216.28±131.27)、(138.23±63.12)U/L,显著低于对照组[(893.47±428.13)、(436.29±261.57)、(198.67±98.47)U/L],差异均有统计学意义(P<0.05)。术后1 d、5 d、15 d、3个月、6个月,两组Harris评分均较术前升高,且观察组患者的Harris评分分别为(52.36±5.23)、(61.24±6.15)、(72.46±5.26)、(86.28±6.31)、(91.21±3.15)分,均明显高于对照组[(41.78±6.29)、(56.39±6.78)、(63.49±6.34)、(70.47±6.21)、(81.47±5.23)分],差异均有统计学意义(P<0.05)。术后1 d、5 d、1个月、6个月,两组改良Barthel指数均较术前升高,且观察组患者的改良Barthel指数分别为(49.23±7.26)、(68.29±7.23)、(76.28±7.31)、(89.46±7.34)分,均高于对照组[(40.58±6.19)、(60.12±6.45)、(70.36±6.73)、(81.37±6.81)分],差异均有统计学意义(P<0.05)。结论在骨质疏松导致的股骨颈骨折患者接受治疗的过程中,采用SuperPATH入路初次单侧全髋关节置换术的临床治疗效果较好,可显著降低血清肌酸磷酸激酶水平,提升Harris评分、改良Barthel指数,可有效改善患者的髋关节功能,值得在临床治疗中推广。

Objective To investigate and analyze the effect of the first unilateral total hip arthroplasty via SuperPATH approach on creatine phosphokinase,Harris score and modified Barthel index in patients with femoral neck fracture caused by osteoporosis.Methods In retrospective study,64 patients with femoral neck fracture caused by osteoporosis admitted to The Second Hospital of Tangshan from March 2019 to March 2022 were included in this study,and were divided into control group(n=32)and observation group(n=32)according to different treatment methods.The control group received lateral small incision total hip arthroplasty,and the observation group underwent the first unilateral total hip arthroplasty with SuperPATH approach.The visual analog pain scale(VAS)scores of before surgery,1 day,5 days,and 15 days,3 months and 6 months after surgery were observed in both groups of patients.The serum creatine phosphokinase levels were compared between two groups of patients before surgery,1 day after surgery,5 days after surgery,and 15 days after surgery.The recovery of hip joint function before surgery,1 day,5 days,15 days,3 months,and 6 months after surgery and daily living ability before surgery,1 day,5 days,3 months,and 6 months after surgery were statistically analyzed.Resluts At 3 and 6 months after surgery,the scores of the two groups were lower compared to before surgery.The VAS scores in the observation group patients at 5 days,15 days,3 months,and 6 months after surgery were(4.23±0.53),(3.53±0.43),(1.83±0.21),and(0.24±0.12)points,respectively,which were lower than those in the control group[(4.93±0.98),(4.21±0.94),(2.45±0.52),and(0.78±0.36)]points,and the differences were statistically significant(P<0.05).At the 1 day,5 days,15 days after surgery,the serum creatine phosphokinase levels in the two groups were higher than before surgery,and the serum creatine phosphokinase levels in the observation group were(478.39±234.12),(216.28±131.27),and(138.23±63.12)U/L,respectively,which were significantly lower than those in the control group[(893.47±428.13),(436.29±261.57),and(198.67±98.47)U/L],and the differences were statistically significant(P<0.05).At 1 day,5 days,15 days,3 months,and 6 months after surgery,the Harris scores of both groups were higher than before surgery,and the Harris scores of the observation group patients were(52.36±5.23),(61.24±6.15),(72.46±5.26),(86.28±6.31),and(91.21±3.15)points,respectively,which were significantly higher than those of the control group[(41.78±6.29),(56.39±6.78),(63.49±6.34),(70.47±6.21),and(81.47±5.23)points],and the differences were statistically significant(P<0.05).At 1 day,5 days,1 month,and 6 months after surgery,the modified Barthel index of both groups were higher than before surgery,and the modified Barthel index of the observation group patients was(49.23±7.26),(68.29±7.23),(76.28±7.31),and(89.46±7.34)points,respectively,higher than the control group[(40.58±6.19),(60.12±6.45),(70.36±6.73),and(81.37±6.81)points],and the differences were statistically significant(P<0.05).Conclusion During the treatment of patients with femoral neck fracture caused by osteoporosis,the initial unilateral total hip replacement via SuperPATH approach has a good clinical effect,which can effectively improve the hip joint function of patients,and is worth promoting in clinical treatment.