直接上方入路与后外侧入路在高龄股骨颈骨折半髋置换术中的早期疗效比较  

Comparison of early clinical effects between direct superior approach and posterolateral approach in hemiarthroplasty of femoral neck fracture in the elderly

作　　者：彭祥 双峰[1] 李浩[1] 邵银初 胡炜 单记春 杨迪 万得恩 许文波 PENG Xiang;SHUANG Feng;LI Hao;SHAO Yin-chu;HU Wei;SHAN Ji-chun;YANG Di;WAN De-en;XU Wen-bo(Department of Orthopedics,908th Hospital of PLA Joint Logistics Support Force,Nanchang 330002,Jiangxi,China)

机构地区：[1]中国人民解放军联勤保障部队第九O八医院骨科,江西南昌330002

出　　处：《中国骨伤》2023年第11期1021-1025,共5页China Journal of Orthopaedics and Traumatology

基　　金：江西省卫健委课题(编号:20163018,202211373,202211380);第九〇八医院苗子基金课题(编号:2022YNKT030)。

摘　　要：目的:对比分析直接上方入路(direct superior approach,DSA)与后外侧入路(posterior lateral approach,PLA)在高龄股骨颈骨折半髋置换术中的早期临床疗效。方法:回顾性分析2020年1月至2021年12月收治的72例接受半髋置换手术老年股骨颈骨折患者的临床资料,其中36例采用微创DSA入路,男10例,女26例,年龄(82.82±4.05)岁;36例采用传统PLA入路,男14例,女22例,年龄(82.79±3.21)岁。比较两组患者围手术期相关指标、不同时间点Harris评分。结果:DSA组手术时间(79.41±17.39) min,比PLA组(98.45±26.58) min更短;切口长度(8.33±2.69) cm,比PLA组(11.18±1.33) cm短;术中失血量(138.46±71.58) ml,比PLA组(173.51±87.17) ml更少;初次下地时间(3.04±0.95) d,比PLA组(4.52±1.10) d更早;住院时长(8.70±1.89) d,比PLA组(10.67±2.35) d短(P<0.05)。两组术前Harris评分差异无统计学意义(P>0.05),术后1个月DSA组Harris功能和总分高于PLA组(P<0.05),而术后12个月两组比较,差异无统计学意义(P>0.05)。结论:在半髋置换手术中,DSA入路较PLA入路在手术时间、术中出血量、切口长度、初次下地时间、住院时长以及术后1个月的Harris评分等临床指标更优,在促进高龄股骨颈骨折患者术后早期康复上具有明显优势。Objective To compare and analyze the early clinical effect of direct superior approach(DSA)and posterior lateral approach(PLA)in hemiarthroplasty for elderly patients with femoral neck fracture.Methods The clinical data of 72 elderly patients with femoral neck fracture who underwent hemiarthroplasty from January 2020 to December 2021 were retrospectively analyzed.Among them,36 patients were operated through minimally invasive DSA including 10 males and 26 females with an average age of(82.82±4.05)years old;the other 36 patients underwent traditional PLA including 14 males and 22 females with an average age of(82.79+3.21)years old.The perioperative related indexes and Harris scores during follow-up between two groups were compared.Results Comparison of operation time between two groups,(79.41±17.39)min of DSA group was shorter than(98.45±26.58)min of PLA group;incision length(8.33±2.69)cm was shorter than(11.18±1.33)cm of PLA group;intraoperative blood loss(138.46±71.58)ml was less than(173.51±87.17)ml of PLA group,initial landing time(3.04±0.95)d was earlier than(4.52±1.10)d of PLA group,hospitalization time(8.70±1.89)d was shorter than(10.67±2.35)d of PLA group(P<0.05).There was no statistical difference in Harris score between two groups before operation(P>0.05),but Harris score in DSA group was higher than that of PLA group at 1 month after operation(P<0.05),but at 12 months after operation,the difference was not statistically significant between two groups(P>0.05).Conclusion Compared with PLA,DSA is superior in clinical indexes such as operation time,intraoperative blood loss,incision length,first landing time,length of hospitalization and Harris score in the first month after operation in hemi hip replacement,and has comparative advantages in promoting early postoperative rehabilitation of elderly patients with femoral neck.

关 键 词：直接上方入路 后外侧入路 高龄股骨颈骨折 半髋置换术 早期临床疗效 

分 类 号：R683.4[医药卫生—骨科学]