直接上方入路髋关节置换术治疗股骨颈骨折的疗效分析

Curative effect analysis of direct upper approach hip replacement in treatment of femoral neck fracture

目的探讨直接上方入路(DSA)髋关节置换术治疗股骨颈骨折患者的临床效果,并分析该术式对患者的肢体功能恢复优势。方法前瞻性地选择2018年5月至2022年3月在徐州市第一人民医院治疗的股骨颈骨折患者102例,其中男性53例,女性49例;年龄51~79岁,平均年龄65.1岁;体质量55~66 kg,平均体质量61.5 kg;Garden分型Ⅲ型76例,Ⅳ型26例。随机将其分为2组。治疗A组实施后外侧入路全髋关节置换术治疗,治疗B组则实施DSA全髋关节置换术治疗。比较两组患者围术期指标、关节恢复情况、视觉模拟量表(VAS)评分、健康调查简表(SF-36)评分及并发症发生情况。结果治疗B组手术时长(93.36 min±9.25 min)显著高于治疗A组(84.54 min±8.42 min),切口长度(8.13 cm±0.27 cm)显著短于治疗A组(9.86 cm±0.75 cm)(P<0.05)。术后两组患者关节恢复情况较术前均显著改善(P<0.05),且治疗B组Harris髋关节功能评分(39.27分±3.45分、3.78分±0.74分、38.54分±4.83分、4.46分±1.63分)及Berg平衡量表(BBS)评分(47.59分±5.54分)显著优于治疗A组(32.36分±3.84分、3.24分±0.51分、33.25分±4.43分、3.56分±1.43分、42.25分±4.64分)(P<0.05)。VAS评分相较于术前,术后7 d、14 d、30 d、90 d两组患者均出现了明显改善,且治疗B组评分(3.42分±1.21分、2.06分±0.54分、0.12分±0.08分、0.10分±0.02分)较治疗A组低(4.56分±1.53分、3.86分±0.89分、0.76分±0.24分、0.15分±0.05分)(P<0.05)。SF-36评分相较于术前,术后3、6、12个月两组患者均出现了明显改善,且治疗B组评分(96.56分±6.86分、121.72分±12.85分、138.56分±8.33分)较治疗A组更优(91.65分±5.65分、112.96分±11.54分、134.71分±9.05分)(P<0.05)。治疗B组患者术后迟发性感染、神经肌肉损伤、脱位等不良并发症总发生率(3.92%)均显著低于治疗A组(9.81%)(χ^(2)=3.991,P<0.05)。结论DSA髋关节置换术治疗股骨颈骨折的疗效显著,不仅可促进患者的关节恢复,还可减缓术后疼痛,提升其生存质量,降低术后不良并发症发生率,安全性良好,值得推广。

Objective To explore the clinical effect of direct superior approach(DSA)hip replacement in treatment of patients with femoral neck fracture,and analyze the advantages of limb function recovery.Methods From May 2018 to March 2022,a total of 102 patients with femoral neck fracture were prospectively enrolled,which included 53 males and 49 females,aged 51-79 years old with mean age of 65.1 years old;body mass was 55-66 kg with mean body mass of 61.5 kg.There were 76 cases of Garden typeⅢand 26 of Garden typeⅣ.All patients were randomly divided into 2 groups,group A was treated with total hip arthroplasty via posterolateral approach,and group B performed DSA total hip arthroplasty.The perioperative indicators,joint recovery,visual analogue scale(VAS)score,short form 36(SF-36)score and complications were compared between 2 groups.Results The operative time of group B(93.36 minutes±9.25 minutes)was significantly longer than that of group A(84.54 minutes±8.42 minutes),and incision length of group B(8.13 cm±0.27 cm)was remarkably shorter than that of group A(9.86 cm±0.75 cm)(P<0.05).The joint recovery of 2 groups was significantly improved after treatment(P<0.05),Harris hip function score(39.27 scores±3.45 scores,3.78 scores±0.74 scores,38.54 scores±4.83 scores,4.46 scores±1.63 scores)and Berg balance scale(BBS)score(47.59 scores±5.54 scores)in group B were significantly better than those in group A(32.36 scores±3.84 scores,3.24 scores±0.51 scores,33.25 scores±4.43 scores,3.56 scores±1.43 scores,42.25 scores±4.64 scores)(P<0.05).Compared with those before treatment,VAS scores of 2 groups were significantly improved at 7-day,14-day,30-day and 90-day after treatment,and scores of group B(3.42 scores±1.21 scores,2.06 scores±0.54 scores,0.12 scores±0.08 scores,0.10 scores±0.02 scores)were lower than those of group A(4.56 scores±1.53 scores,3.86 scores±0.89 scores,0.76 scores±0.24 scores,0.15 scores±0.05 scores)(P<0.05).Compared with before treatment,the SF-36 scores of 2 groups were significantly improved at 3,6 and 12 months post operation.Those scores of group B(96.56 scores±6.86 scores,121.72 scores±12.85 scores,138.56 scores±8.33 scores)were better than those of group A(91.65 scores±5.65 scores,112.96 scores±11.54 scores,134.71 scores±9.05 scores)(P<0.05).The total incidence of adverse complications in group B(3.92%),including delayed infection,neuromuscular injury and dislocation,was significantly lower than that in group A(9.81%)(χ^(2)=3.991,P<0.05).Conclusion It is demonstrated that DSA hip replacement of femoral neck fracture showed significant efficacy,and could promote joint recovery,relieve postoperative pain,improve quality of life,and reduce incidence of postoperative complications,which is safe and worth promoting.