Objectives: Femoral neck fractures are becoming more common within nowadays. This research is to explore the clinical effect of primary total hip replacement (THA) via direct anterior approach (DAA) and posterolateral...Objectives: Femoral neck fractures are becoming more common within nowadays. This research is to explore the clinical effect of primary total hip replacement (THA) via direct anterior approach (DAA) and posterolateral approach (PLA) in the treatment of femoral neck fracture. Methods: Retrospective analysis of 100 cases of elderly patients with femoral neck fracture who underwent total hip arthroplasty admitted to Tianyou Hospital affiliated to Wuhan University of Science and Technology from January 2019 to January 2022. 50 patients treated with DAA approach were included in the observation group, and 50 patients treated with PLA approach were included in the control group. The operation indexes, postoperative acetabular abduction angle and anteversion angle, hip joint function, Harris score and complications were compared between the two groups. Result: The length of incision in the observation group was shorter than that in the control group, and the amount of intraoperative bleeding and postoperative hospital stay were shorter than those in the control group (P < 0.05);There was a statistically significant difference between the two groups in the ratio of acetabular abduction angle and its safe zone, and the length difference of both lower limbs (P < 0.05), while there was no statistically significant difference between the two groups in the ratio of acetabular anteversion angle and its safe zone, eccentricity, and its recovery rate (P > 0.05);Harris score of hip joint: 6 months after operation, the anterior approach group was significantly higher than the posterolateral approach group (P < 0.05), and there was no statistical difference between the two groups 12 months after operation (P > 0.05);The total incidence of complications in the observation group was lower than that in the control group, with a statistically significant difference (P Conclusion: DAA and PLA approaches for total hip replacement can restore the hip joint structure of patients with femoral neck fractures and achieve good results, but DAA approach has greater advantages in early postoperative recovery, improvement of hip joint function, small surgical injury, high application value, so it is recommended.展开更多
[目的]探讨缺血性股骨头坏死(avascular necrosis of femoral head,ANFH)塌陷程度与金属对金属全髋表面置换术(metal—on—metal hip resurfacing,MOMHR)疗效的关系,为术前合理选择缺血性股骨头坏死患者提供依据。[方法]从2003...[目的]探讨缺血性股骨头坏死(avascular necrosis of femoral head,ANFH)塌陷程度与金属对金属全髋表面置换术(metal—on—metal hip resurfacing,MOMHR)疗效的关系,为术前合理选择缺血性股骨头坏死患者提供依据。[方法]从2003年11月~2006年9月,先后对27例(36髋)缺血性股骨头坏死患者行混合型金属对金属全髋表而置换术(conserve plus,wright),平均年龄43岁(28~54岁),平均体重指数(RMI)27.3(20.5~44.8)。按国际骨循环研究会(association for research circulation osseous,ARCO)的建议分类法,将手术病例分为ⅢA、ⅢB、ⅢC、Ⅳ期四组,并分别进行术前、后的Harris评分,术后疼痛情况,术前后膝关节屈曲度及双下肢长度差异的测量及X线分析。[结果]平均随访29.6个月(16~50个月)。最后一次随访时,36髋中3髋发生轻微疼痛,1髋严重疼痛。X线结果显示2例髋臼假体周围1、2区可见透光区;1例股骨假体松动而行全髋置换(THR)翻修术;1例股骨假体内翻成角10°,但未见假体松动迹象,全组无股骨颈骨折、股骨颈狭窄及假体断裂等并发症发生。术后ⅢA+ⅢB期组在Harris评分、疼痛发生及双下肢长度差异方面的恢复程度均显著高于ⅡC+Ⅳ期组(P〈0.05),而在屈曲度改善方面ⅢA+ⅢB期组却显著低于ⅢC+Ⅳ期组(P〈0.05)。[结论]对于ARCOⅢ、Ⅳ期缺血性股骨头坏死患者,塌陷程度≤4mm且未累及髋臼病变的病例应用金属对金属全髋表面置换,术后的早期疗效较为满意。展开更多
目的:比较人工全髋关节置换(total hip arthroplasty,THA)与人工股骨头置换(hemiarthroplasty,HA)对高龄股骨颈骨折的疗效。方法:2007—2013年于南京医科大学第一附属医院接受HA的高龄股骨颈骨折患者385例,其中年龄80~85岁、骨折分型为G...目的:比较人工全髋关节置换(total hip arthroplasty,THA)与人工股骨头置换(hemiarthroplasty,HA)对高龄股骨颈骨折的疗效。方法:2007—2013年于南京医科大学第一附属医院接受HA的高龄股骨颈骨折患者385例,其中年龄80~85岁、骨折分型为GardenⅢ、Ⅳ型并获得随访的患者共82例。同期行THA的高龄股骨颈骨折患者共679例,根据患者骨折分型、性别、年龄、身高、体重进行配对,选取同期82例THA患者进行对比研究。记录患者术前察尔森合并症指数(Charlson comorbidity index,CCI)、手术时间、切口长度、出血量、术后并发症、末次随访髋关节Harris评分(Harris hip score,HHS)、住院时间和住院费用。结果:所有患者均获随访,平均4.7年。两组患者末次随访时HHS及术后并发症差异无统计学意义(P>0.05)。HA组在显性失血量、隐性失血量、切口长度、手术时间、住院时间、住院费用方面优于THA组(P<0.05),两组患者术前CCI差异有统计学意义(P<0.05)。结论:HA具有疗效可靠、手术创伤小、住院时间短及住院费用低的优点,是高龄股骨颈骨折的一种良好治疗方式。展开更多
文摘Objectives: Femoral neck fractures are becoming more common within nowadays. This research is to explore the clinical effect of primary total hip replacement (THA) via direct anterior approach (DAA) and posterolateral approach (PLA) in the treatment of femoral neck fracture. Methods: Retrospective analysis of 100 cases of elderly patients with femoral neck fracture who underwent total hip arthroplasty admitted to Tianyou Hospital affiliated to Wuhan University of Science and Technology from January 2019 to January 2022. 50 patients treated with DAA approach were included in the observation group, and 50 patients treated with PLA approach were included in the control group. The operation indexes, postoperative acetabular abduction angle and anteversion angle, hip joint function, Harris score and complications were compared between the two groups. Result: The length of incision in the observation group was shorter than that in the control group, and the amount of intraoperative bleeding and postoperative hospital stay were shorter than those in the control group (P < 0.05);There was a statistically significant difference between the two groups in the ratio of acetabular abduction angle and its safe zone, and the length difference of both lower limbs (P < 0.05), while there was no statistically significant difference between the two groups in the ratio of acetabular anteversion angle and its safe zone, eccentricity, and its recovery rate (P > 0.05);Harris score of hip joint: 6 months after operation, the anterior approach group was significantly higher than the posterolateral approach group (P < 0.05), and there was no statistical difference between the two groups 12 months after operation (P > 0.05);The total incidence of complications in the observation group was lower than that in the control group, with a statistically significant difference (P Conclusion: DAA and PLA approaches for total hip replacement can restore the hip joint structure of patients with femoral neck fractures and achieve good results, but DAA approach has greater advantages in early postoperative recovery, improvement of hip joint function, small surgical injury, high application value, so it is recommended.
文摘[目的]探讨缺血性股骨头坏死(avascular necrosis of femoral head,ANFH)塌陷程度与金属对金属全髋表面置换术(metal—on—metal hip resurfacing,MOMHR)疗效的关系,为术前合理选择缺血性股骨头坏死患者提供依据。[方法]从2003年11月~2006年9月,先后对27例(36髋)缺血性股骨头坏死患者行混合型金属对金属全髋表而置换术(conserve plus,wright),平均年龄43岁(28~54岁),平均体重指数(RMI)27.3(20.5~44.8)。按国际骨循环研究会(association for research circulation osseous,ARCO)的建议分类法,将手术病例分为ⅢA、ⅢB、ⅢC、Ⅳ期四组,并分别进行术前、后的Harris评分,术后疼痛情况,术前后膝关节屈曲度及双下肢长度差异的测量及X线分析。[结果]平均随访29.6个月(16~50个月)。最后一次随访时,36髋中3髋发生轻微疼痛,1髋严重疼痛。X线结果显示2例髋臼假体周围1、2区可见透光区;1例股骨假体松动而行全髋置换(THR)翻修术;1例股骨假体内翻成角10°,但未见假体松动迹象,全组无股骨颈骨折、股骨颈狭窄及假体断裂等并发症发生。术后ⅢA+ⅢB期组在Harris评分、疼痛发生及双下肢长度差异方面的恢复程度均显著高于ⅡC+Ⅳ期组(P〈0.05),而在屈曲度改善方面ⅢA+ⅢB期组却显著低于ⅢC+Ⅳ期组(P〈0.05)。[结论]对于ARCOⅢ、Ⅳ期缺血性股骨头坏死患者,塌陷程度≤4mm且未累及髋臼病变的病例应用金属对金属全髋表面置换,术后的早期疗效较为满意。
文摘目的:比较人工全髋关节置换(total hip arthroplasty,THA)与人工股骨头置换(hemiarthroplasty,HA)对高龄股骨颈骨折的疗效。方法:2007—2013年于南京医科大学第一附属医院接受HA的高龄股骨颈骨折患者385例,其中年龄80~85岁、骨折分型为GardenⅢ、Ⅳ型并获得随访的患者共82例。同期行THA的高龄股骨颈骨折患者共679例,根据患者骨折分型、性别、年龄、身高、体重进行配对,选取同期82例THA患者进行对比研究。记录患者术前察尔森合并症指数(Charlson comorbidity index,CCI)、手术时间、切口长度、出血量、术后并发症、末次随访髋关节Harris评分(Harris hip score,HHS)、住院时间和住院费用。结果:所有患者均获随访,平均4.7年。两组患者末次随访时HHS及术后并发症差异无统计学意义(P>0.05)。HA组在显性失血量、隐性失血量、切口长度、手术时间、住院时间、住院费用方面优于THA组(P<0.05),两组患者术前CCI差异有统计学意义(P<0.05)。结论:HA具有疗效可靠、手术创伤小、住院时间短及住院费用低的优点,是高龄股骨颈骨折的一种良好治疗方式。