直接前入路、后外侧入路全髋关节置换术对老年股骨颈骨折患者的疗效比较  

Comparison of the effects of direct anterior and posterolateral total hip arthroplastyon elderly patients with femoral neck fractures

作　　者：王勇[1] 陈建文[1] 陈海铭 郑文源 WANG Yong;CHEN Jianwen;CHEN Haiming;ZHENG Wenyuan(Department of Orthopedic Hand Surgery,Yulin First People's Hospital,Yulin 537000,Guangxi,China)

机构地区：[1]玉林市第一人民医院骨伤手外科,广西玉林537000

出　　处：《中南医学科学杂志》2023年第6期923-927,959,共6页Medical Science Journal of Central South China

基　　金：玉林市科学研究与技术开发计划项目(玉市科20220624)。

摘　　要：目的比较直接前入路、后外侧入路全髋关节置换术对老年股骨颈骨折患者的疗效。方法回顾性分析90例老年股骨颈骨折行全髋关节置换术患者临床资料,根据入路方式,将其分为前入路组46例和后外侧入路组44例。比较两组患者围术期指标、术后X线假体位置信息、髋关节功能、平衡功能、炎症因子水平、骨代谢指标水平以及并发症发生情况。结果与后外侧入路组比较,前入路组手术时间增长(P<0.05);术中出血量、术后住院时间减少(P<0.05);术后1个月骨钙素、髋关节和平衡功能评分升高,抗酒石酸酸性磷酸酶5b、Ⅰ型胶原C端肽水平降低(P<0.05)。前入路组术后血清炎症因子水平低于后外侧入路组(P<0.05)。两组术后X线假体位置信息、并发症发生率比较,差异均无统计意义(P>0.05)。结论两种入路方式均可有效改善老年股骨颈骨折患者髋关节功能,但直接前入路较后外侧入路手术损伤小,短期恢复快。Aim To compare the effects of direct anterior and posterolateral total hip arthroplasty on elderly patients with femoral neck fractures.Methods The clinical data of 90 elderly patients with femoral neck fracture undergoing total hip arthroplasty were retrospectively analyzed.According to the approach method,they were divided into anterior approach group(46 cases)and posterolateral approach group(44 cases).Perioperative indexes,early postoperative X-ray prosthesis position information,hip function,balance function,levels of inflammatory factors,bone metabolism indexes and complications were compared between the two groups.Results Compared with the anterolateral approach group,the operative time of the anterolateral approach group was increased(P<0.05).Intraoperative blood loss and postoperative hospital stay were decreased(P<0.05).One month after surgery,the levels of osteocalcin,hip joint and balance function scores were increased,and tartrate-resistant acid phosphatase 5b and C-terminal peptide of type I collagen were decreased after operation(P<0.05).The levels of postoperative inflammatory factor in the anterior approach group were lower than those in the posterolateral approach group(P<0.05).There were no significant differences in the postoperative X-ray prosthesis position information and incidence of complications between the two groups(P>0.05).Conclusion Both approaches can effectively improve hip joint function in elderly patients with femoral neck fractures,but direct anterior approach has less damage and faster short-term recovery compared to the posterior lateral approach.

关 键 词：股骨颈骨折 全髋关节置换术 直接前入路 后外侧入路 髋关节功能 老年 

分 类 号：R687.4[医药卫生—骨科学]