SuperPATH入路微创髋关节置换治疗老年性股骨颈骨折术中并发症的原因分析及策略

Reason and strategies of intraoperative complications of minimally invasive hip arthroplasty using SuperPATH approach in the treatment of elderly patients with femoral neck fracture

目的探讨SuperPATH入路微创髋关节置换术治疗老年性股骨颈骨折术中并发症的原因及对策。方法回顾性分析2015年06月至2018年12月间采用SuperPATH入路微创髋关节置换术治疗的120例老年性股骨颈骨折患者的临床资料,其中74例男性,56例女性,平均年龄74.5岁(65-98岁),全髋关节置换术63例,半髋关节置换术57例。结果本组患者均获24月以上随访,其中术中并发症12例,包括髋臼磨穿及骨折、股骨侧裂隙骨折、股骨柄的前倾角过小或内外翻放置等,行相应处理后均恢复正常髋关节功能,术后随访无感染、脱位等并发症,无二次手术。结论SuperPATH入路微创髋关节置换术治疗老年性股骨颈骨折,采用完全肌间隙入路,具有创伤小,出血少,术后功能恢复快,病人满意度好的特点,同时由于手术操作视野小,若手术操作不规范容易产生术中并发症,所以必须经过严格的正规培训及规范的手术操作,才能有效的避免手术并发症的发生。

Objective To investigate the reason and strategies of intraoperative complications of minimally invasive hip arthroplasty through SuperPATH approach in the treatment of elderly patients with femoral neck fracture.Methods From June 2015 to December 2018,total of 120 patients with femoral neck fracture treated by SuperPATH approach were retrospectively analyzed.There were 74 males and 56 females,with an average age of 74.5 years(range 65-98).All the cases underwent SuperPATH approach hip arthroplasty,including 63 cases of total hip arthroplasty(THA)and 57 cases of hemiarthroplasty(HA).Results All of the patients were followed up for at least 24 months,among them,intraoperative complications occurred in 12 cases,including acetabular abrasion and fracture,femoral lateral fissure fractures,too small anterior angle of the femoral components or placed internally and externally.Normal hip function was restored after corresponding treatment.There were no complications such as infection and dislocation,and no secondary operation.Conclusions SuperPATH minimally invasive hip arthroplasty in the treatment of elderly patients with femoral neck fracture adopts intermuscular interspace approach,which has the characteristics of less trauma,less bleeding,quick functional recovery and good patient satisfaction.At the same time,due to the small visual field of operation and the non-standard operation,it is easy to make surgical mistakes,so we must pass through strict formal training and standardized operation to effectively avoid the occurrence of surgical complication.