前外侧入路与后外侧入路半髋关节置换术治疗老年移位股骨颈骨折的临床疗效比较

Anterolateral approach versus posterolateral approachfor hemiarthroplasty in the treatment of elderlypatients with displaced femoral neck fracture

目的 比较前外侧入路与后外侧入路半髋关节置换术治疗老年移位股骨颈骨折的临床疗效。方法 选取收治的老年股骨颈骨折患者96例为研究对象,所有患者行半髋关节置换术。根据手术入路方式分为前外侧入路组40例、后外侧入路组56例,比较2组临床疗效。结果 前外侧入路组患者的术中出血量、切口长度、手术时间、术后下地活动时间、术后住院时间指标水平均优于后外侧入路组,差异有统计学意义(P<0.05);术后1、2 d,前外侧入路组C反应蛋白、血清肌酸激酶指标水平均低于后外侧入路组,差异有统计学意义(P<0.05);术后12、24、48 h,前外侧入路组疼痛评分均低于后外侧入路组,差异有统计学意义(P<0.05);出院时、术后4周,前外侧入路组患者Harris髋关节功能评分均高于后外侧入路组,差异有统计学意义(P<0.05);前外侧入路组术后并发症总发生率为5.0%,低于后外侧入路组的19.6%,差异有统计学意义(P<0.05)。结论 相较于后外侧入路,采用前外侧入路半髋关节置换术治疗老年移位股骨颈骨折对患者创伤更小,疗效更好,术后恢复更快。

Objective To compare the clinical effect between anterolateral approach and posterolateral approach for hemiarthroplasty in the treatment of elderly patients with displaced femoral neck fracture.Methods A total of 96 elderly patients with femoral neck fracture were selected as research objects,and all of them were treated with hemiarthroplasty.According to the surgical approaches,there were 40 cases in the anterolateral approach group and 56 cases in the posterolateral approach group.The clinical efficacy was compared between the two groups.Results The intraoperative blood loss,incision length,surgical time,postoperative bed-off activity time and postoperative hospital stay of patients in the anterolateral approach group were significantly better than those in the posterolateral approach group(P<0.05);on the first and the second days after operation,the levels of C-reactive protein and serum creatine kinase in the anterolateral approach group were significantly lower than those in the posterolateral approach group(P<0.05);at 12,24 and 48 hours after surgery,the pain scores in the anterolateral approach group were significantly lower than those in the posterolateral approach group(P<0.05);at hospital discharge and 4 weeks after surgery,the scores of Harris hip joint function in the anterolateral approach group were significantly higher than those in the posterolateral approach group(P<0.05);the total incidence of postoperative complications in the anterolateral approach group was 5.0%,which was significantly lower than 19.6%in the posterolateral approach group(P<0.05).Conclusion Compared with the posterolateral approach,the anterolateral approach for hemiarthroplasty can cause less trauma in the treatment of elderly patients with displaced femoral neck fracture, with a better efficacy and faster postoperative recovery.