直接前侧入路路径下全髋关节置换术与半髋关节置换术治疗老年股骨颈骨折的临床效果

Clinical Effect of Total Hip Arthroplasty and Hemiarthroplasty under Direct Anterior Approach Pathway in the Treatment of Elderly Femoral Neck Fracture

目的:探究直接前侧入路(direct anterior approach,DAA)路径下全髋关节置换术(total hip arthroplasty,THA)与半髋关节置换术(hemiarthroplasty,HA)在老年股骨颈骨折(femoral neck fracture,FNF)患者中的应用效果。方法:选取2020年1月—2023年1月南京医科大学附属南京医院骨科收治的70例老年FNF患者为研究对象,基于随机数表法将患者分为治疗1组(HA)与治疗2组(THA),各35例。比较两组围手术期指标、肌肉组织损伤、骨代谢、远期髋关节功能。结果:治疗2组手术时间长于治疗1组,术中出血量、术后引流量多于治疗1组,差异有统计学意义(P<0.05);但两组术后初次下床行走时间、术后并发症发生率、股骨假体中心性固定率、术后住院时间比较,差异无统计学意义(P>0.05)。术后3 d,两组肌酸激酶(creatine kinase,CK)、C反应蛋白(C-reactive protein,CRP)高于术前,且治疗2组高于治疗1组,差异有统计学意义(P<0.05);术后3个月,两组Ⅰ型前胶原氨基端前肽(N-terminal propeptide of typeⅠprecollagen,PⅠNP)、Ⅰ型胶原交联羧基末端肽(C-terminal telopeptides of typeⅠcollagen,CTX)低于术前,骨特异性碱性磷酸酶(bone-specific alkaline phosphatase,BAP)高于术前,差异有统计学意义(P<0.05);但两组术后3个月PⅠNP、CTX、BALP比较,差异无统计学意义(P>0.05)。术后5个月、8个月、12个月,两组Harris评分高于术后3个月,且治疗2组高于治疗1组,差异有统计学意义(P<0.05)。结论:DAA路径下THA与HA均具有良好的治疗效果,HA围手术期指标具有优势,适用于身体状况较差的患者;而THA远期髋关节功能恢复更具有优势,适用于活动需求较大患者。

Objective:To investigate the application effect of total hip arthroplasty(THA)and hemiarthroplasty(HA)under direct anterior approach(DAA)pathway in the treatment of elderly femoral neck fracture(FNF).Method:A total of 70 patients with FNF who admitted to the Department of Orthopedics,Nanjing First Hospital,Nanjing Medical University from January 2020 to January 2023 were selected as the research objects,the patients were divided into the treatment group 1(HA)and the treatment group 2(THA)based on the random number table method,with 35 cases in each group.The perioperative indexes,muscle tissue injury,bone metabolism and longterm hip function were compared between two groups.Result:The operation time of the treatment group 2 was longer than that of the treatment group 1,and the intraoperative blood loss and postoperative drainage volume were more than those of the treatment group 1,the differences were statistically significant(P<0.05);however,there were no significant differences in the time of first ambulation,the incidence of postoperative complications,the rate of central fixation of femoral prosthesis and the time of postoperative hospitalization between two groups(P>0.05).At 3 d after operation,the creatine kinase(CK)and C-reactive protein(CRP)in two groups were higher than those before operation,and those in the treatment group 2 were higher than those in the treatment group 1,the differences were statistically significant(P<0.05);at 3 months after operation,the N-terminal propeptide of typeⅠprecollagen(PⅠNP)and C-terminal telopeptides of typeⅠcollagen(CTX)in two groups were lower than those before operation,and the bone-specific alkaline phosphatase(BAP)were higher than those before operation,the difference was statistically significant(P<0.05);however,there were no significant differences in the PⅠNP,CTX and BALP between two groups at 3 months after operation(P>0.05).At 5 months,8 months and 12 months after operation,the Harris scores of two groups were higher than those at 3 months after operation,and those in the treatment group 2 were higher than those in the treatment group 1,the differences were statistically significant(P<0.05).Conclusion:Both THA and HA under DAA pathway have good therapeutic effects,and HA has advantages in perioperative indicators,and it is suitable for patients with poor physical conditions;THA has more advantages in recovery of long-term hip function,and it is suitable for patients with high mobility needs.