微创直接前侧入路与后外侧入路髋关节置换术治疗股骨颈骨折的效果对比观察  

Comparison and observation on the effects of direct anterior approach and posterolateral approach for minimally invasive hip arthroplasty in the treatment of femoral neck fractures

作　　者：马邹 张上上[1] 张鹏[1] 朱江伟[1] 陈果 易林洪 斯焱[1] MA Zou;ZHANG Shangshang;ZHANG Peng;ZHU Jiangwei;CHEN Guo;YI Linhong;SI Yan(Department of Geriatric Orthopedics,Sichuan Provincial Orthopedic Hospital,Chengdu 610041,China)

机构地区：[1]四川省骨科医院老年骨科,成都610041

出　　处：《国际骨科学杂志》2022年第5期307-313,共7页International Journal of Orthopaedics

基　　金：2020年省四川干部保健科研课题(川干研2020-606)。

摘　　要：目的比较微创直接前侧入路(DAA)与后外侧入路全髋关节置换术对股骨颈骨折的治疗效果。方法选取四川省骨科医院2018年12月到2021年12月收治的股骨颈骨折患者113例为研究对象,按非随机同期对照试验方法分为DAA组(54例)和后外侧组(59例)。DAA组行DAA全髋关节置换术,后外侧组行后外侧入路全髋关节置换术。对比两组患者围术期指标(手术时间、术中出血量、切口长度、术后卧床时间)及术后7 d血清指标[白细胞介素-6(IL-6)、5-羟色胺(5-HT)、前列腺素E2(PGE2)]水平,比较两组患者术后1 d、3个月假体角度(前倾角、外展角),记录两组患者术前及术后3个月骨愈合指标[Ⅰ型前胶原氨基前肽(PINP)、骨钙素(BGP)、抗酒石酸酸性磷酸酶-5b(TRACP-5b)]、关节恢复情况[Harris髋关节功能评分、Berg平衡量表(BBS)]及术后3个月内并发症发生情况。结果DAA组患者手术时间长于后外侧组,切口长度短于后外侧组(P均<0.05),两组患者术中出血量、术后卧床时间无统计学差异(P均>0.05)。术后7 d,两组患者血清指标(IL-6、5-HT、PGE2)水平无统计学差异(P均>0.05)。术后3个月,两组患者假体角度(前倾角、外展角)均较术后1 d显著改善(P均<0.05),但组间比较无统计学差异(P均>0.05);DAA组患者部分骨愈合指标(PINP、BGP)、部分Harris髋关节功能评分(疼痛、使用功能、畸形评分)、BBS评分显著高于后外侧组,TRACP-5b水平显著低于后外侧组(P均<0.05);两组患者Harris髋关节功能评分中的关节活动度评分无统计学差异(P>0.05)。术后3个月内,两组患者并发症(脱位、迟发性感染、股外侧皮神经损伤)发生情况无统计学差异(P>0.05)。结论DAA与后外侧入路髋关节置换术治疗股骨颈骨折术后短期效果均较好,但DAA在骨愈合、肢体功能恢复方面更有优势,有一定的临床应用前景。Objective To compare the therapeutic effects of minimally invasivetotal hip arthroplasty through a direct anterior approach(DAA)or posterolateral approach on femoral neck fractures.Methods A total of 113 patients with femoral neck fractures treated in Sichuan Provincial Orthopedic Hospital between December 2018 and December 2021 were selected as the research subjects.The patients were divided into the DAA group(54 cases)and posterolateral group(59 cases)according to the non-randomized concurrent controlled trial.The DAA group underwent total hip arthroplasty via DAA,and the posterolateral group received total hip arthroplasty via the posterolateral approach.The perioperative indicators(surgical time,intraoperative blood loss,incision length,and postoperative bed rest time)and levels of serum indicators[interleukin-6(IL-6),5-hydroxytryptamine(5-HT),and prostaglandin E2(PGE2)]were compared between the two groups of patients 7 days after surgery.The prosthesis angles(anteversion angle and abduction angle)in the two groups were compared 1 day and 3 months after surgery.The bone healing indicators[procollagen typeⅠN-terminalpropeptide(PINP),bone gla protein(BGP),tartrate-resistant acid phosphatase 5b(TRACP-5b)],and joint recovery[Harris hip function score,Berg Balance Scale(BBS)]before surgery and 3 months after surgery and the occurrence of complications within 3 months after surgery were recorded in the two groups.Results The surgical time in the DAA group was longer than in the posterolateral group,and the incision length was shorter than in the posterolateral group(all P<0.05).However,intraoperative blood loss and postoperative bed rest time between the two groups were not statistically different(all P>0.05).At 7 days after surgery,the levels of the serum indicators(IL-6,5-HT,PGE2)showed no statistical differences between the two groups(all P>0.05).At 3 months after surgery,the prosthesis angles(anteversion angle,abduction angle)in the two groups were smaller than those one day after surgery(all P<0.05).However,

关 键 词：直接前侧入路 后外侧入路 微创 股骨颈骨折 围术期 

分 类 号：R687.3[医药卫生—骨科学]