不同入路髋关节置换术在股骨颈骨折患者中的应用效果比较

Comparison of Different Approaches for Hip Replacement Surgery in Patients with Femoral Neck Fractures

目的比较不同入路髋关节置换术在股骨颈骨折患者中的应用效果。方法纳入2021年8月至2022年8月安阳钢铁集团有限责任公司职工总医院骨科108例股骨颈骨折患者,按随机数字表法分为观察组和对照组,各54例。两组均接受髋关节置换术,对照组术中采用传统切口后外侧入路,观察组术中采用改良小切口入路。比较两组围手术期指标(手术切口长度、术中出血量、手术时间、术后下地时间);比较两组术前、术后5 d疼痛程度[视觉模拟评分法(VAS)];比较两组术前、术后6个月髋关节功能(Harris评分);统计两组术后并发症发生情况。结果观察组围手术期各项指标均优于对照组(P<0.05);术后5 d,两组VAS评分均较术前降低,且观察组更低(P<0.05);术后6个月,两组髋关节Harris评分均较术前升高,且观察组更高(P<0.05);观察组并发症发生率更低(P<0.05)。结论对于行髋关节置换术的股骨颈骨折患者,改良小切口入路较传统切口后外侧入路在减少手术创伤、缩短手术时间、减轻术后疼痛、降低并发症发生率方面更具优势,可加快患者髋关节功能康复进程。

Objective To compare the application effects of hip replacement surgery with different approaches in patients with femoral neck fractures.Methods From August 2021 to August 2022,a total of 108 patients with femoral neck fracture admitted to the Third Department of Orthopaedics,Anyang Iron and Steel Group Co.,Ltd.Employee General Hospital were included.They were divided into observation group and control group according to the random number table method,with 54 cases in each group.Both groups underwent hip replacement.The control group was treated with traditional incision posterolateral approach,and the observation group was treated with modified small incision approach.The perioperative indexes(incision length,intraoperative blood loss,operation time,postoperative ambulation time)were compared between the two groups.The degree of pain[visual analogue scale(VAS)]was compared between the two groups before and 5 days after operation.The hip joint function(Harris score)was compared between the two groups before and 6 months after operation.The postoperative complications of the two groups were counted.Results The perioperative indexes of the observation group were better than those of the control group(P<0.05).At 5 days after operation,the VAS scores of the two groups were lower than those before operation,and the observation group was lower(P<0.05).At 6 months after operation,the Harris scores of hip joint in both groups were higher than those before operation,and the observation group was higher(P<0.05).Incidence of complications in the observation group was lower(P<0.05).Conclusion For patients with femoral neck fractures undergoing hip replacement surgery,the modified small incision approach has more advantages than the traditional incision posterolateral approach in reducing surgical trauma,shortening surgical time,alleviating postoperative pain,and reducing the incidence of complications,which can accelerate the recovery process of hip joint function in patients.