摘要
目的比较侧卧位直接前方入路(DAA)与改良Hardinge入路保留关节囊全髋关节置换术(THA)治疗老年股骨颈骨折的效果。方法回顾性分析2021年6月至2023年6月期间因股骨颈骨折在郑州市骨科医院关节2科经侧卧位DAA行保留关节囊THA的32例患者资料(观察组),男10例,女22例;年龄(69.0±2.5)岁。选择同期接受改良Hardinge入路保留关节囊THA的32例患者作为对照(对照组),男15例,女17例;年龄(69.4±2.5)岁。比较两组患者的手术时间、手术切口长度、术中出血量、术后引流量、住院时间、疼痛视觉模拟评分(VAS)、髋关节Harris评分及随访期间并发症的发生情况等。结果两组患者术前一般资料比较差异均无统计学意义(P>0.05,),具有可比性。所有患者的随访时间为(18.3±6.0)个月。观察组患者的手术切口长度[(7.81±2.58)cm]显著短于对照组患者[(13.50±2.46)cm],术中出血量[(140.6±10.8)mL]和术后引流量[(150.4±16.9)mL]均显著少于对照组患者[(180.4±15.7)、(190.6±18.9)mL],术后1、6个月疼痛VAS评分[(3.84±1.74)、(2.84±1.39)分]显著低于对照组患者[(5.41±2.16)、(4.69±1.81)分],术后1、6个月髋关节Harris评分[(85.5±9.3)、(89.6±8.8)分]显著高于对照组患者[(75.2±10.8)、(83.6±9.1)分],差异均有统计学意义(P<0.05);而两组患者的手术时间、住院时间、髋臼假体前倾角及外展角、术后12个月的疼痛VAS评分和髋关节Harris评分比较差异均无统计学意义(P>0.05)。两组患者随访期间均未发生髋关节脱位、假体周围骨折及感染等并发症。结论侧卧位DAA保留关节囊THA治疗老年股骨颈骨折的早期效果优于改良Hardinge入路保留关节囊THA,前者能够显著减少手术创伤,促进患者术后早期康复。
Objective To compare the direct anterior approach(DAA)and the modified Hardinge approach at lateral decubitus position in capsule-preserving total hip arthroplasty(THA)for femoral neck fractures in the elderly.Methods A retrospective study was conducted to analyze the data of 32 patients(observation group)who had undergone capsule-preserving THA via the DAA at lateral decubitus position for femoral neck fractures at DepartmentⅡof Joint Surgery,Zhengzhou Orthopaedic Hospital from June 2021 to June 2023.There were 10 men and 22 women,with an age of(69.0±2.5)years.Another 32 patients who received capsule-preserving THA via the modified Hardinge approach at lateral decubitus position during the same period were selected as the control group.There were 15 men and 17 women,with an age of(69.4±2.5)years.Surgical time,incision length,intraoperative blood loss,postoperative drainage volume,hospital stay,visual analogue scale(VAS),Harris hip score,and incidence of complications during follow-up were compared between the 2 groups.ResultsNo significant differences in the baseline characteristics were observed between the 2 groups,indicating comparability(P>0.05).The follow-up time for all patients was(18.3±6.0)months.The observation group had a significantly shorter surgical incision length[(7.81±2.58)cm]than the control group[(13.50±2.46)cm],significantly less intraoperative blood loss[(140.6±10.8)mL]and postoperative drainage[(150.4±16.9)mL]than the control group[(180.4±15.7)mL,(190.6±18.9)mL],significantly lower VAS pain scores at postoperative 1 and 6 months[(3.84±1.74)points and(2.84±1.39)points]than the control group[(5.41±2.16)points and(4.69±1.81)points],and significantly higher Harris hip scores at postoperative 1 and 6 months[(85.5±9.3)points and(89.6±8.8)points]than the control group[(75.2±10.8)points and(83.6±9.1)points](P<0.05).In contrast,no statistically significant differences were observed between the 2 groups in terms of surgical time,hospital stay,anteversion or abduction angle of the acetabular prosthesis,or VAS pain score or Harris hip score at postoperative 12 months(P>0.05).No complications such as hip dislocation,periprosthetic fracture,or infection occurred in either group during the follow-up period.ConclusionIn capsule-preserving THA for femoral neck fractures in the elderly,the early therapeutic efficacy of the DAA at lateral decubitus position is superior to that of the modified Hardinge approach at lateral decubitus position,because the former significantly reduces surgical trauma and facilitates early postoperative recovery.
作者
李科伟
张乾龙
孙博
王爱国
梅伟
王金良
Li Kewei;Zhang Qianlong;Sun Bo;Wang Aiguo;Mei Wei;Wang Jinliang(DepartmentⅡof Joint Surgery,Zhengzhou Orthopaedic Hospital,Zhengzhou 450052,China)
出处
《中华创伤骨科杂志》
北大核心
2025年第12期1027-1033,共7页
Chinese Journal of Orthopaedic Trauma
基金
河南省医学科技攻关计划项目(LHGJ20220894)。
