直接前入路和微创后外侧入路人工股骨头置换术治疗高龄股骨颈骨折患者的疗效比较  

Comparison of the direct anterior and posterolateral piriformis-sparing approach in bipolar hemiarthroplasty for the elderly patients with femoral neck fracture

作　　者：张英剑[1] 李志永[1] 吴树文[1] 方广文[1] 商福青 刘嵬[1] ZHANG Ying-jian;LI Zhi-yong;WU Shu-wen;FANG Guang-wen;SHANG Fu-qing;LIU Wei(Department of Orthopaedics,Tianjin Baodi Hospital,Tianjin 301800,China)

机构地区：[1]天津市宝坻区人民医院骨科

出　　处：《中国临床解剖学杂志》2018年第6期678-682,689,共6页Chinese Journal of Clinical Anatomy

基　　金：天津市卫生局科技基金资助(2011KZ05)

摘　　要：目的本研究旨在比较直接前入路(directanteriorapproach,DAA)和微创后外侧入路(posterolateralpiriformis-sparingapproach,Mis-PLA)人工股骨头置换术治疗高龄股骨颈骨折患者的疗效。方法44例高龄单侧股骨颈骨折患者按照行人工股骨头置换术入路随机分为DAA组(n=22)和Mis-PLA组(n=22)。2组均完成术后2年随访调查,比较2组患者手术情况、术后早期疼痛及并发症情况、术后早期坐位的能力、弃拐独立行走的时间、术后6周及2年患者功能活动Harris评分及术后2年死亡率。结果(1)与Mis-PLA组相比,DAA组患者手术时间较长,术后72h患肺炎的人数较少,术后24hVAS评分减低,术后患者可坐位1h的时间及弃拐独立行走的时间较早(P<0.05)。(2)术后6周,DAA组在穿袜系鞋带及坐椅子方面Harris评分优于Mis-PLA组(P<0.05),两组上楼梯方面Harris评分无统计学差异(P>0.05)。术后2年,两组患者在功能活动Harris评分均无统计学差异(P>0.05)。(3)术后随访2年,2组患者死亡率差异无统计学意义(P>0.05)。结论DAA入路股骨头置换术在治疗高龄股骨颈骨折患者中,可以较Mis-PLA入路更有效地降低术后长期卧床的相关并发症的发生率,减轻患者术后疼痛,更早更快地改善患者术后髋关节功能。Objective The aim of this study is to compare the clinical efficacy after bipolar hemiarthroplasty(BHA)via the direct anterior approach(DAA)or posterolateral piriformis-sparing approach(Mis-PLA)following the elderly patients with femoral neck fracture. Methods 44 elderly patients with femoral neck fracture were divided into a DAA group(n =22) and a Mis-PLA group(n=22) according to the surgical approach. The two groups of patients were followed up for 2 years after the operation. The clinical data,postoperative pain and complications,the time to keep the seat for 1 hour and walking independently,the postoperative Harris score of functional activity in 6 weeks and 2 years and the death rate of patients 2 years after operation were compared between the two groups. Results(1)Compared with the Mis-PLA group,the patients in group DAA had longer surgical duration, but the number of patients with pneumonia 72 hours after the operation was less,the VAS score of DAA patients decreased after 24 hours of operation, and the time of keeping the seat for 1 hour and walking independently was earlier than that of the Mis-PLA group(P <0.05).(2)6 weeks after the operation, the Harris score of Climbing stairs and wearing socks and shoelaces in the DAA group was better than that in the Mis-PLA group(P < 0.05), but there was no statistical difference in the Harris score of the staircase(P >0.05). After 2 years, there was no significant difference in Harris scores between the two groups(P>0.05).(3)After 2 years of follow-up, there was no significant difference in mortality between the 2 groups(P>0.05). Conclusions In the elderly patients with femoral head replacement, DAA approach can be more effective than Mis-PLA approach for reducing the incidence of complications associated with long-term bed rest, relieving postoperative pain, and improving the postoperative hip function.

关 键 词：高龄 股骨颈骨折 人工股骨头置换术 直接前入路 微创后外侧入路 

分 类 号：R683.42[医药卫生—骨科学]