SuperPATH与传统后外侧入路全髋关节置换治疗老年股骨颈骨折的对比  被引量:24

Total hip arthroplasty for senile femoral neck fractures:SuperPATH approach versus traditional posterolateral approach

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作  者:胡正霞[1] 兰海[1] 员晋[1] 李开南[1] Hu Zhengxia;Lan Hai;Yuan Jin;Li Kainan(Department of Orthopedics,Affiliated Hospital of Chengdu University,Chengdu 610081,Sichuan Province,China)

机构地区:[1]成都大学附属医院骨科,四川省成都市610081

出  处:《中国组织工程研究》2020年第24期3834-3839,共6页Chinese Journal of Tissue Engineering Research

基  金:四川省科技计划项目(2018JY0154),项目名称:3D打印超弹性骨材料组织工程人工骨实验研究(面上),项目负责人:兰海。

摘  要:背景:近年来全髋关节置换出现多种微创入路,其中CHOW等于2010年提出Superpath入路。该入路具有不切断外旋肌群并保留髋关节囊的特点,有利于患者术后早期下地活动,相对于其他手术入路,出现髋关节脱位的风险明显降低。目的:对比分析SuperPATH入路与传统后外侧入路全髋关节置换治疗老年股骨颈骨折的近期疗效。方法:回顾性分析2017年8月至2019年3月成都大学附属医院骨科治疗的72例65岁以上股骨颈骨折行全髋关节置换的患者,依据患者意愿分组,其中30例采用SuperPATH入路,42例采用传统后外侧入路。记录2组患者手术时间、术中失血量、术后第4天血红蛋白下降值及开始负重活动时间,于术后第1,2周及第3个月分别采用Harris评分评价患者髋关节功能恢复情况。结果与结论:①所有患者均获得满意随访,随访时间3-6个月;②术后第2周所有患者均顺利出院,期间均无深静脉血栓形成、坐骨神经损伤、假体周围骨折、假体松动及假体周围感染等并发症发生,其中传统后外侧入路组有2例患者出现髋关节后脱位,均急诊在全麻下行手法牵引复位;③与对照组相比,SuperPATH组患者的手术时间更长,术后第4天血红蛋白下降值减小,开始负重活动时间较早,差异均有显著性意义(P<0.01);但2组术中失血量比较差异无显著性意义(P>0.05);④SuperPATH组术后第1,2周Harris评分均高于对照组,差异均有显著性意义(P<0.01);术后第3个月2组Harris评分差异无显著性意义(P>0.05);⑤提示与后外侧入路相比,SuperPATH入路全髋关节置换治疗股骨颈骨折为微创手术,可有效减少手术创伤并加快术后髋关节功能恢复,减轻术后髋关节疼痛不适,降低髋关节脱位发生率;但由于手术难度大,学习曲线长,手术时间明显延长,导致术中出血量并无明显减少,由经验丰富的关节外科医生施行手术可有效降低并发症的发生。BACKGROUND:In recent years,there are many minimally invasive approaches for total hip arthroplasty.CHOW et al.operated the total hip arthroplasty with SuperPATH approach(supercapsular percutaneously assisted total hip arthroplasty)in 2010,which has the characteristics of not cutting off extortor and retaining the hip joint capsule.This approach is beneficial to early postoperative activities for patients,and has a lower risk for hip joint dislocation compared with other approaches.OBJECTIVE:To compare and analyze the short-term clinical outcomes of SuperPATH and traditional posterolateral total hip arthroplasty in the treatment of senile femoral neck fractures.METHODS:This study retrospectively analyzed 72 patients aged over 65 years old with femoral neck fractures from August 2017 to March 2019 in Affiliated Hospital of Chengdu University.The patients were grouped according to patients’wishes.Of them,30 cases received total hip arthroplasty through SuperPATH approach;42 cases received total hip arthroplasty through posterolateral approach.Operation time,intraoperative blood loss,declined value of hemoglobin in 4 days of postoperation and time to weight-bearing activity were recorded between two groups.Hip Harris score after 1,2 weeks and 3 months postoperation was used to assess the recovery of hip function.RESULTS AND CONCLUSION:(1)All patients were followed up for 3-6 months.(2)In the second week after operation,all the patients were discharged without complications such as deep vein thrombosis,sciatic nerve injury,periprosthetic fracture,periprosthetic loosening or periprosthetic infection.In the posterolateral approach group,there were two patients with posterior dislocation of the hip,all of whom were treated by manual reduction under general anesthesia.(3)Compared with the posterolateral approach group,operation time was longer;the declined value of hemoglobin in 4 days of postoperation was significantly lesser;time to weight-bearing activity was earlier in the SuperPATH approach group(P<0.01).However,in

关 键 词:SuperPATH入路 后外侧入路 全髋关节置换 老年 股骨颈骨折 

分 类 号:R459.9[医药卫生—治疗学] R318[医药卫生—临床医学]

 

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