直接前入路微创全髋关节置换术治疗股骨颈骨折合并骨质疏松患者的临床疗效

Clinical Efficacy of Minimally Invasive Total Hip Arthroplasty Through Direct Anterior Approach in the Treatment of Femoral Neck Fracture with Osteoporosis

目的探讨微创直接前入路全髋关节置换术治疗股骨颈骨折合并骨质疏松的效果。方法非随机选取2019年1月—2023年12月徐州医科大学附属医院收治的60例股骨颈骨折合并骨质疏松患者为研究对象,均行全髋关节置换。根据入路差异,将直接前入路手术患者列入微创组,经后外侧入路为常规组,各30例。比较两组患者的手术相关情况和首次活动情况、髋关节功能、并发症总发生率的差异。结果与常规组相比,微创组手术出血量较少、刀口更小、首次步行时间短,步行距离更长,差异有统计学意义(P均<0.05);术前两组髋关节评分比较,差异无统计学意义(P>0.05);术后微创组髋关节评分为(81.47±6.12)分,高于常规组的(75.65±5.89)分,差异有统计学意义(t=3.753,P<0.05)。微创组术后并发症发生率高于常规组,差异有统计学意义(P<0.05)。结论直接前入路微创全髋关节置换术创伤更小,术后能够获得更好活动能力和髋关节功能,但术后并发症发生率较高,故术前应对骨质疏松程度进行评估,谨慎选择微创术式。

Objective To investigate the effect of minimally invasive direct anterior approach total hip arthroplasty in the treatment of femoral neck fracture with osteoporosis.Methods A total of sixty patients with femoral neck fracture combined with osteoporosis admitted to the Affiliated Hospital of Xuzhou Medical University from January 2019 to De-cember 2023 were non-randomly selected as the study subjects.All patients underwent total hip replacement.Accord-ing to the difference of approaches,the patients with direct anterior approach were included in the minimally invasive group,and the patients with posterolateral approach were included in the conventional group,with thirty cases in each group.The differences in operation-related conditions,first activity,hip joint function and total incidence of complica-tions were compared between the two groups.Results Compared with the conventional group,the minimally invasive group had less blood loss,smaller incision,shorter first walk time and longer walking distance,and the differences were statistically significant(all P<0.05).There was no statistically significant difference in hip joint score between the two groups before operation(P>0.05).The hip joint score of the minimally invasive group was 81.47±6.12,higher than 75.65±5.89 of the conventional group,and the difference was statistically significant(t=3.753,P<0.05).The inci-dence of postoperative complications in minimally invasive group was higher than that in conventional group,and the difference was statistically significant(P<0.05).Conclusion Direct anterior approach minimally invasive total hip ar-throplasty is less invasive,and can achieve better mobility and hip function after surgery.However,the incidence of postoperative complications are high,so the degree of osteoporosis should be evaluated before surgery and minimally invasive surgery should be carefully selected.