不同入路行人工髋关节置换术治疗老年髋部骨折疗效比较  

Effect Comparison on Artificial Hip Arthroplasty for Hip Fractures in Elderly by Different Surgical Approaches

作　　者：何锡志 邹华章[1] 伍伟挺 

机构地区：[1]广东省增城市新塘医院外二科,增城511340

出　　处：《中国现代手术学杂志》2015年第6期443-447,共5页Chinese Journal of Modern Operative Surgery

摘　　要：目的比较前方入路和后外侧入路行人工髋关节置换术治疗老年髋部骨折的疗效。方法回顾性分析2011年6月~2013年8月在我院行人工髋关节置换术的142例髋部骨折患者的临床资料,均为老年人（60~101岁）,其中股骨颈骨折105例,粗隆间骨折37例。按手术入路分两组,每组71例,分别采用前方入路和后外侧入路。比较两组切口长度、手术时间、术中出血量、术后卧床时间及Harris评分。结果两组患者均顺利完成手术,前方入路组皮肤切口长度短于后外侧入路组（（10.2±2.3）cm vs.（15.5±3.2）cm,P=0.011）,术中出血量少于后外侧入路组（（142.8±23.7）ml vs.（256.5±65.3）ml,P=0.019）,术后平均卧床时间短于后外侧入路组（（2.1±1.5）d vs.（4.5±2.2）d,P=0.027）。而两组手术时间比较,差异无统计学意义（P=0.765）。术后前方入路组患者随访68例（95.8%）,平均随访（28.6±6.9）个月;后外侧入路组随访67例（94.4%）,平均随访（27.2±7.6）个月。术后前方入路组Harris评分为（91.9±10.1）分,后外侧入路组为（88.5±11.6）分,组间比较差异无统计学意义（P〉0.05）。术后1个月行X线检查评估假体位置,前方入路组和后外侧入路组臼杯位置外展分别为40.6°±14.7°和39.6°±15.9°,组间比较差异无统计学意义（t=0.966,P=0.703）,内曲分别为76.8°±23.0°和54.6°±21.7°,组间比较差异具有统计学意义（t=3.563,P=0.023）。结论老年髋部骨折采用前方入路行髋关节置换术是安全有效的,可以减轻手术创伤,减少出血,缩短卧床时间。Objective To compare the effect of hip arthroplasty with direct anterior （DA） approach and posterolateral （PL） approach for treating hip fractures in elderly. Methods The clinical data of 142 old pa- tients （ aged from 60 to 101 years） with hip fracture admitted from June 2011 to August 2013 were analyzed ret- rospectively, including femoral neck fracture in 105 cases and intertrochanteric fracture in 37 cases. They were divided into two groups according to surgical approach, with 71 cases for each group, and were performed artifi- cial hip joint replacement by DA approach （DA group） and PL approach （PL group） respectively. The incision length, operative duration, intra-operative blood loss, post-operative duration of bed staying and Harris score were compared between two groups. Results All 142 cases were accomplished hip arthroplasty successful- ly. The incision length of DA group was （10.2 ± 2.3 ） cm, and was shorter than （15.5 ± 3.2） cm of PL group （P =0.011 ）. The intra-operative blood loss of DA group was less than that of PL group（ （142.8 ± 23.7）ml vs. （256.5 ± 65.3 ） ml, P = 0. 019）, and the post-operative bed staying time was shorter in DA group than that in PL group （（2. 1±1.5） d vs. （4.5 ±2.2） d, P =0.027）. There was no statistic difference in operative dura- tion between two groups （ P = 0.765 ）. 68 cases of DA group were followed up for （28.6 ± 6.9） months aver- agely, and 67 cases of PL group were followed up for （ 27.2 ± 7.6 ） months averagely. No statistic difference was found in Harris score between DA and PL group （（91.9±10.1） vs. （88.5±11.6）, P〉0.05）. Conclu- sion The hip arthroplasty via DA approach can relieve the surgical trauma, decrease intra-operative blood loss and shorten the bed staying, and it is an effective and safe surgical approach for old patients with hip fractures.

关 键 词：髋骨折 关节成形术 置换 髋 手术入路 

分 类 号：R687.3[医药卫生—骨科学]