直接前路人工股骨头置换治疗移位性股骨颈骨折的短期随访  

Short-term outcomes of displaced femoral neck fractures treated with hemiarthroplasty using direct anterior approach

作　　者：李刚 王跃[1,3] Li Gang;Wang Yue(College of Clinical Medicine,Southwest Medical University,Luzhou 646000,Sichuan Province,China;Department of Orthopedics,Chongzhou People’s Hospital,Chengdu 611230,Sichuan Province,China;Department of Orthopedics,Sichuan Provincial People’s Hospital,Chengdu 610072,Sichuan Province,China)

机构地区：[1]西南医科大学临床医学院,四川省泸州市646000 [2]崇州市人民医院骨科,四川省成都市611230 [3]四川省人民医院骨科,四川省成都市610072

出　　处：《中国组织工程研究》2018年第7期1014-1019,共6页Chinese Journal of Tissue Engineering Research

摘　　要：背景:后外侧入路是目前人工股骨头置换治疗移位性股骨颈骨折患者的常规入路,直接前路作为一种逐渐发展的手术入路,其治疗效果目前尚存在争议。目的:探讨直接前路与后外侧入路人工股骨头置换治疗移位性股骨颈骨折的短期疗效。方法:选取2014年1月至2016年1月收治的65例单侧移位性股骨颈骨折患者作为研究对象。随机分为2组,分别进行直接前路人工股骨头置换(直接前路组)和后外侧入路人工股骨头置换(后外侧入路组)。观察2组患者的术中及术后临床资料、术前及末次随访时髋关节Harris评分及并发症发生情况;采用欧洲生活质量评分EQ-5D评分评定患者末次随访时的生活质量。结果与结论:(1)直接前路组的手术时间、切口长度、术中出血量及术后引流量均优于后外侧入路组(P<0.05),2组下床行走时间、伤口愈合时间差异无显著性意义(P>0.05);(2)随访时间5-18个月,直接前路组末次随访时髋关节Harris评分稍高于后外侧入路组,但差异无显著性意义(P>0.05),在Harris评分术后疼痛改善方面直接前路组评分高于后外侧入路组(P<0.05);(3)2组患者术后末次随访时健康生活质量差异无显著性意义(P>0.05);(4)直接前路组1例患者出现伤口局部红肿;后外侧入路组1例患者出现假体脱位,1例患者出现假体周围骨折。2组患者均无肺栓塞、下肢静脉血栓形成等并发症发生;(5)结果表明,2种入路均能促进髋关节功能的恢复,有很好的早期临床疗效。直接前路创伤小,出血少,优于后外侧入路手术,但直接前路手术对术者的技术要求较高。BACKGROUND:Posterolateral approach is the conventional approach which has been used in the treatment of displaced femoral neck fractures treated by hemiarthroplasty.The clinical curative effect of hemiarthroplasty through a direct anterior approach which has gradually developed is still controversial.OBJECTIVE:To compare the clinical effects of displaced femoral neck fractures treated with hemiarthroplasty using direct anterior approach and posterolateral approach.METHODS:A total of sixty-five patients with displaced femoral neck fracture were selected between January 2014 and January 2016 and randomly divided into two groups.The two groups were treated with hemiarthroplasty using direct anterior approach(direct anterior approach group)and posterolateral approach(posterolateral approach group)respectively.Intraoperative and postoperative clinical data,preoperative and final follow-up Harris score and complications were observed between the two groups.The health-related quality of patients’life was evaluated by using the EQ-5D index.RESULTS AND CONCLUSION:Surgical time,length of incision,intraoperative blood loss and postoperative drainage volume in direct anterior approach group were superior over posterolateral approach group(P<0.05).No statistical differences were observed in postoperative time in bed and incision healing time between the two groups(P>0.05).(2)Postoperative pain score in direct anterior approach group was superior over posterolateral approach group at 5-18 months of follow-up(P>0.05).Harris score was higher in the direct anterior approach group than in the posterolateral approach group(P<0.05).(3)No significant difference in health-related quality of patients’life was determined between the two groups(P>0.05).(4)There were one case with incision swelling in direct anterior approach group,one case with prosthesis dislocation and one case with periprosthetic fracture in posterolateral approach group.Pulmonary embolism or venous thrombosis of the lower extremities was not found in both groups.

关 键 词：股骨骨折 关节成形术 置换 髋 假体植入 组织工程 

分 类 号：R318[医药卫生—生物医学工程]