不同入路人工股骨头置换术治疗老年股骨颈骨折合并阿尔茨海默病的疗效对比  

Efficacy comparison of artificial femoral head replacement by different approaches for senile femoral neck fracture complicated with Alzheimer’s disease

作　　者：周恩瑜 邬玉林 刘亮[1] ZHOU En-yu;WU Yu-lin;LIU Liang(Department of Orthopaedics,Ganzi Hospital,West China Hospital of Sichuan University/Sichuan Ganzi Tibetan Autonomous Prefecture People’s Hospital,Kangding Sichuan 626000,China)

机构地区：[1]四川大学华西医院甘孜医院/四川省甘孜藏族自治州人民医院骨科,四川康定626000

出　　处：《局解手术学杂志》2021年第9期812-816,共5页Journal of Regional Anatomy and Operative Surgery

基　　金：四川省医学科研课题计划项目(S2016249)。

摘　　要：目的探讨不同入路人工股骨头置换术治疗老年股骨颈骨折合并阿尔茨海默病(AD)的疗效。方法回顾性分析我院收治的78例老年股骨颈骨折合并AD患者的临床资料。根据手术入路的不同将患者分为2组,直接前方入路(DAA)组42例,后外侧入路(PA)组36例。比较2组患者的手术相关指标、术后恢复指标,通过X射线片计算2组患者的髋关节脱位率、下肢长度差值,比较2组患者手术前后髋关节功能的Harris评分、Charnley评分、视觉模拟量表(VAS)评分以及并发症情况。结果2组患者的手术时间相比,差异无统计学意义(P>0.05);DAA组的切口长度短于PA组,术中出血量少于PA组,住院时间短于PA组,差异均有统计学意义(P<0.05)。DAA组的首次下地时间、首次直腿抬高时间和弃拐独立行走时间均短于PA组(P<0.05)。PA组的髋关节脱位率、下肢长度差值均高/大于DAA组(P<0.05)。2组患者术后1个月及3个月的Harris评分、Charnley评分、VAS评分与术前比较,差异均有统计学意义(P<0.05);DAA组术后1个月的Harris评分和Charnley评分均高于PA组(P<0.05);2组术后3个月的Harris评分、Charnley评分、VAS评分相比,差异均无统计学意义(P>0.05)。2组并发症发生率相比,差异无统计学意义(P>0.05)。结论对于老年股骨颈骨折合并AD患者,采用DAA和PA进行人工股骨头置换术均能够获得较好的治疗效果,安全性均较高,但DAA可减少术中损伤,患者术后早期恢复快,术后髋关节脱位率低。Objective To investigate the efficacy of different approaches for artificial femoral head replacement in the treatment of senile femoral neck fracture complicated with Alzheimer’s disease(AD).Methods The clinical data of 78 elderly patients with femoral neck fracture complicated with AD in our hospital were retrospectively analyzed.According to different surgical approaches,the patients were divided into two groups:direct anterior approach(DAA)group with 42 cases and the posterolateral approach(PA)group with 36 cases.The operation-related indicators and postoperative recovery indicators between the two groups were compared,the dislocation rate of hip and length difference of lower limbs in the two groups were calculated by X-ray film,Harris score,Charnley score and visual analogue scale(VAS)score before and after operation,and the complications were compared between the two groups.Results There was no significant difference in the operation time between the two groups(P>0.05).Compared with the PA group,the DAA group had shorter incision length,less intraoperative blood loss,and shorter hospital stay,with significant differences(P<0.05).The first time to get out of bed,the time of the first straight leg raising,and the independent walking time of abandoning crutches in the DAA group were shorter than those in the PA group(P<0.05).The dislocation rate and length difference of lower limbs in the PA group were higher/greater than those in the DAA plication rate between the two groups(P<0.05).ConclusionFor elderly patients with femoral neck fracture complicated with AD,the DAA and PA approaches in artificial femoral head replacement can achieve good therapeutic effect with high safety,but the DAA approach can reduce intraoperative injury,with early postoperative recovery and low postoperative dislocation rate.

关 键 词：人工股骨头置换术 老年 股骨颈骨折 阿尔茨海默病 直接前方入路 后外侧入路 

分 类 号：R683.3[医药卫生—骨科学]