老年股骨颈骨折直接前路髋关节置换技术规范专家共识(2023版)  

Chinese expert consensus on the technical standard of direct anterior hip arthroplasty for elderly femoral neck fracture(version 2023)

作　　者：许中华 陶伦 刘载阳 李阳 李杰 张珺 张峡 王敏 李长青 陈光兴 杨柳 张大伟 曹晓瑞 张国强[5] 李凭跃 包倪荣 李川 周胜虎 常正奇 吴波 钱文伟[11] 王卫国[12] 吕明[13] 唐浩[13] 李虎[14] 何川[15] 陈云苏[16] 李慧武[17] 胡宁[18] 聂茂[19] 谢峰 曹治东 康鹏德[22] 斯焱[23] 朱晨 许伟华[25] 刘先哲[25] 毛新展[26] 谢杰 张晓岗[28] 胥伯勇[28] 杨佩[29] 王伟[29] 李晓峰[30] 冯尔宥 张振[32] 刘保一[33] 马建兵[34] 李辉[34] 马元琛[35] 孙立[36] 张志峰[37] 耿硕[38] 黎观保 王禹基[40] 李二虎 周宗科[22] 黄伟[18] 周一新[13] 曹力[28] 柴伟[5] 熊雁 张瑗 中华医学会骨科学分会髋关节学组 全军骨科专委会青年关节学组 重庆市医学会骨科专业委员会 重庆市医师协会骨科医师分会 重庆市医学会运动医疗分会 Xu Zhonghua;Tao Lun;Liu Zaiyang;Li Yang;Li Jie;Zhang Jun;Zhang Xia;Wang Min;Li Changqing;Chen Guangxing;Yang Liu;Zhang Dawei;Cao Xiaorui;Zhang Guoqiang;Li Pingyue;Bao Nirong;Li Chuan;Zhou Shenghu;Chang Zhengqi;Wu Bo;Qian Wenwei;Wang Weiguo;Lyu Ming;Tang Hao;Li Hu;He Chuan;Chen Yunsu;Li Huiwu;Hu Ning;Nie Mao;Xie Feng;Cao Zhidong;Kang Pengde;Si Yan;Zhu Chen;Xu Weihua;Liu Xianzhe;Mao Xinzhan;Xie Jie;Zhang Xiaogang;Xu Boyong;Yang Pei;Wang Wei;Li Xiaofeng;Feng Eryou;Zhang Zhen;Liu Baoyi;Ma Jianbing;Li Hui;Ma Yuanchen;Sun Li;Zhang Zhifeng;Geng Shuo;Li Guanbao;Wang Yuji;Li Erhu;Zhou Zongke;Huang Wei;Zhou Yixin;Cao Li;Chai Wei;Xiong Yan;Zhang Yuan;Hip Joint Group of Chinese Orthopedics Association of Chinese Medical Association;Youth Arthrology Group of Orthopedic Committee of PLA;Orthopedic Committee of Chongqing Medical Association;Branch of Orthopedic Surgeons of Chongqing Medical Doctor Association;Sport Medicine Branch of Chongqing Medical Association(Second Affiliated Hospital,Army Medical University,Chongqing 400037,China;Daping Hospital,Army Medical University,Chongqing 400042,China;First Affiliated Hospital,Army Medical University,Chongqing 400038,China;Xijing Hospital,Air Force Medical University,Xi′an 710032,China;Chinese PLA General Hospital,Beijing 100853,China;General Hospital of Chinese PLA Southern Theater Command,Guangzhou 510010,China;General Hospital of Chinese PLA Eastern Theater Command,Nanjing 210016,China;8920th Hospital of Joint Logistic Support Force of PLA,Kunming 650032,China;9940th Hospital of Joint Logistic Support Force of PLA,Lanzhou 730050,China;10960th Hospital of Joint Logistic Support Force of PLA,Jinan 250031,China;Peking Union Medical College Hospital,Beijing 100730,China;Peking China‑Japan Friendship Hospital,Beijing 100029,China;Beijing Jishuitan Hospital,Beijing 100035,China;Peking University People′s Hospital,Beijing 100044,China;Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine,Shanghai 200025,China;Shanghai Sixth People′s Hospital,Shanghai Ji

机构地区：[1]陆军军医大学第二附属医院,重庆400037 [2]陆军军医大学大坪医院,重庆400042 [3]陆军军医大学第一附属医院,重庆400038 [4]空军军医大学西京医院,西安710032 [5]中国人民解放军总医院,北京100853 [6]解放军南部战区总医院,广州510010 [7]解放军东部战区总医院,南京210016 [8]解放军联勤保障部队第九二〇医院,昆明650032 [9]解放军联勤保障部队第九四〇医院,兰州730050 [10]解放军联勤保障部队第九六〇医院,济南250031 [11]北京协和医院,北京100730 [12]北京中日友好医院,北京100029 [13]北京积水潭医院,北京100035 [14]北京大学人民医院,北京100044 [15]上海交通大学医学院附属瑞金医院,上海200025 [16]上海交通大学医学院第六人民医院,上海200233 [17]上海交通大学医学院附属第九人民医院,上海200011 [18]重庆医科大学附属第一医院,重庆400016 [19]重庆医科大学附属第二医院,重庆400010 [20]重庆医科大学附属第三医院,重庆401120 [21]重庆大学附属中心医院,重庆400014 [22]四川大学华西医院,成都610041 [23]四川省骨科医院,成都610041 [24]中国科技大学第一附属医院,合肥230001 [25]华中科技大学同济医学院附属协和医院,武汉430022 [26]中南大学湘雅二医院,长沙410012 [27]浙江大学医学院第一附属医院,杭州310003 [28]新疆医科大学第一附属医院,乌鲁木齐830054 [29]西安交通大学第二附属医院,西安710004 [30]南昌大学第一附属医院,南昌330006 [31]福建医科大学附属协和医院,福州350001 [32]大连医科大学附属第一医院,大连116011 [33]大连大学附属中山医院,大连116001 [34]西安交通大学附属红会医院,西安710054 [35]广东省人民医院,广州519041 [36]贵州省人民医院,贵阳550499 [37]内蒙古医科大学第二附属医院,呼和浩特010110 [38]哈尔滨医科大学附属第一医院,哈尔滨150081 [39]玉林市中西医结合骨科医院,玉林537599 [40]常州市第二人�

出　　处：《中华创伤杂志》2023年第11期961-973,共13页Chinese Journal of Trauma

基　　金：国家卫生健康委能力建设和继续教育专项(NCME003002007002C012);国家级继续医学教育项目(2022‑04‑07‑168);重庆市技术创新与应用发展重点项目(2022TIAD‑KPX0221);重庆市科卫联合医学科研重点项目(2022ZDXM011);重庆市中青年医学高端人才工作室。

摘　　要：老年股骨颈骨折(FNF)是目前全球范围内的重大健康挑战,医院资源消耗大、并发症发生率高、结果和转归欠理想。髋关节置换术(HJA)是当前治疗老年FNF的主流方法,但传统的手术入路和技术方法仍然面临一系列瓶颈问题,如脱位、跛行、肢体不等长等。近年来,直接前路(DAA)‑HJA成为关节置换领域的新方法。DAA入路由于通过神经肌肉间隙完成手术,符合软组织保留和术后加速康复理念,可提升HJA治疗老年FNF的临床效果。但DAA‑HJA治疗老年FNF的标准技术与规范流程尚缺乏统一认识。因此,中华医学会骨科学分会髋关节学组、全军骨科专业委员会青年关节学组、重庆市医学会骨科专业委员会、重庆市医师协会骨科医师分会、重庆市医学会运动医疗分会组织相关专家,依据循证医学方法制订《老年股骨颈骨折直接前路髋关节置换技术规范专家共识(2023版)》,主要针对DAA‑HJA在老年FNF中应用的适应证、手术设计与假体选择、手术技术与操作流程、术后管理等方面提出13条推荐意见,旨在推广规范化、系统化、个体化诊疗理念,改善患者功能预后。Femoral neck fracture(FNF)in the elderly patients is currently a major health challenge worldwide,with excessive consumption of medical resources,high incidence of complications as well as suboptimal outcome and prognosis.Hip joint arthroplasty(HJA)has been the mainstream treatment for FNF in the elderly,but the conventional surgical approaches and techniques are still confronted with a series of bottlenecks such as dislocation,limp and limb length discrepancy.In recent years,direct anterior approach(DAA)for HJA(DAA‑HJA)has been a major new choice in the field of joint replacement,which achieves improved clinical effectiveness of HJA in the treatment of elderly FNF,due to the fact that DAA approach involves the neuromuscular interface and accords with the idea of soft tissue retention and enhanced recovery after surgery.However,there is still a lack of unified understanding of standard technique and procedure of DAA‑HJA in the treatment of elderly FNF.Therefore,relevant experts from the Hip Joint Group of Chinese Orthopedics Association of Chinese Medical Association,Youth Arthrology Group of Orthopedic Committee of PLA,Orthopedic Committee of Chongqing Medical Association,Branch of Orthopedic Surgeons of Chongqing Medical Doctor Association and Sport Medicine Committee of Chongqing Medical Association were organized to formulate the"Chinese expert consensus on the technical standard of direct anterior hip arthroplasty for elderly femoral neck fracture(version 2023)"based on evidence‑based medicine.This consensus mainly proposed 13 recommendations covering indications,surgical plans,prosthesis selections,surgical techniques and processes,and postoperative management of DAA‑HJA in elderly patients with FNF,aiming to promote standardized,systematic and patient‑specific diagnosis and treatment to improve the functional prognosis of the patients.

关 键 词：股骨颈骨折 老年 关节成形术 置换 髋 直接前路 

分 类 号：R687.3[医药卫生—骨科学]