直接前方与后外侧入路半髋关节置换术的早期疗效对比分析  

Comparative analysis of the early efficacy of hemiarthroplasty by direct anterior approach and posterolateral approach

作　　者：任秋晓 周甲彬 谭淏文 崔冠兴[2] 韩桂全[2] 张玉莹 REN Qiu-xiao;ZHOU Jia-bin;TAN Hao-wen;CUI Guan-xing;HAN Gui-quan;ZHANG Yu-ying(School of Clinical Medicine,Weifang Medical University,Weifang 261042,China;Department of Joint Surgery,Affiliated Hospital of Weifang Medical University)

机构地区：[1]潍坊医学院临床医学院,261042 [2]潍坊医学院附属医院关节外科

出　　处：《天津医药》2021年第9期977-981,共5页Tianjin Medical Journal

摘　　要：目的比较直接前方入路(DAA)与后外侧入路(PLA)半髋关节置换术治疗老年股骨颈骨折的早期临床疗效。方法将行半髋关节置换术的老年股骨颈骨折患者90例依据不同术式分为DAA组(42例)和PLA组(48例)。比较2组术后一般资料,术前及术后1、3、5 d的视觉疼痛模拟评分(VAS),术前及术后1周、1个月、3个月、6个月的Harris髋关节功能评分(HHS)。比较分析2组术后1周、1个月、3个月、6个月的髋关节外展肌力矩、单腿站立试验结果、Berg平衡量表评分(BBS)、关节位置感觉(JPS)角度。结果DAA组手术时间长于PLA组,但切口长度、术中出血量、术后1 d血红蛋白(Hb)下降值均少于PLA组(P<0.01)。2组HHS评分、力矩随着时间延续均呈增加趋势,而VAS、JPS角度呈降低趋势,且各时点DAA组HHS、力矩高于PLA组,VAS、JPS角度低于PLA组。DAA组各时点的单腿站立试验结果优于PLA组(P<0.01)。DAA组和PLA组并发症发生率(2.4%和4.2%)差异无统计学意义(P>0.05)。结论DAA创伤小、术后髋关节功能和本体感觉恢复快,利于患者的早期康复,应用DAA的早期疗效优于PLA。Objective To compare and analyze the early clinical efficacy of direct anterior approach(DAA)and posterolateral approach(PLA)in hemiarthroplasty for aged patients with femoral neck fractures.Methods A total of 90 aged patients with femoral neck fractures treated with hemiarthroplasty were divided into DAA group(42 cases)and PLA group(48 cases)according to different surgical approaches.The postoperative general data,visual analog scale(VAS)before operation and 1 d,3 d and 5 d after operation,Harris hip function score(HHS)before operation and 1 w,1 month,3 months and 6 months after operation were compared between the two groups.The hip abductor torque,Berg balance scale(BBS),joint position sensation(JPS)angle and the Trendelenburg’s sign were compared and analyzed between the two groups at 1 week,1 month,3 months and 6 months postoperatively.Results The operation time was longer in the DAA group than that in the PLA group,but the incision length,intraoperative blood loss and the decrease in hemoglobin(Hb)on the first day after operation were less in the DAA group than those in the PLA group(P<0.01).The HHS score and torque of the two groups increased with time,while the VAS and angles of JPS decreased.The HHS and torque of the DAA group were higher than those of the PLA group,while the VAS and JPS angles of the DAA group were lower than those of the PLA group.Trendelenburg's sign in the DAA group was superior to that in the PLA group at each time point.The incidence of complications in the DAA group(2.4%)was lower than that in the PLA group(4.2%),with no significant difference(P>0.05).Conclusion DAA has less operative trauma,and faster postoperative rehabilitation in hip joint function and proprioception,which contribute to the speedy recovery of patients.The early efficacy of DAA is better than that of PLA.

关 键 词：股骨颈骨折 关节成形术 置换 髋 本体感觉 老年人 关节功能 直接前方入路 后外侧入路 

分 类 号：R683.421[医药卫生—骨科学]