两种入路半髋置换治疗高龄股骨粗隆间骨折  

Comparison of two approaches for hemiarthroplasty for femoral intertrochanteric fractures in elderly

作　　者：陈涛[1] 刘炯[1] 赵滨[1] 田智勇[1] 陈德斌[1] 姜昱林 乔俊钊 CHEN Tao;LIU Jiong;ZHAO Bin;TIAN Zhi-yong;CHEN De-bin;JIANG Yu-lin;QIAO Jun-zhao(Department of Orthopedics,The Fourth People's Hospital of Guiyang City,Guiyang550000,China)

机构地区：[1]贵阳市第四人民医院骨一科,贵州贵阳550000

出　　处：《中国矫形外科杂志》2024年第2期127-132,共6页Orthopedic Journal of China

基　　金：贵阳市科技计划项目(编号:筑科合同[2018]1-22号)。

摘　　要：[目的]评价上关节囊入路(supercapsular approach,SC)半髋关节置换治疗高龄不稳定型股骨粗隆间骨折的临床疗效。[方法]回顾性分析2017年4月—2020年3月在本科采用半髋关节置换治疗不稳定型股骨粗隆间骨折50例患者的临床资料。依据医患沟通结果,25例采用SC入路,另外25例采用后外侧入路(posterolateral approach,PL)。比较两组围手术期、随访及影像资料。[结果]SC组手术时间[(60.5±8.5)min vs(74.0±6.5)min,P<0.05]、切口长度[(8.2±0.5)cm vs(12.1±1.1)cm,P<0.05]、术中失血量[(200.8±29.7)ml vs(297.2±23.0)ml,P<0.05]、下地行走时间[(1.8±0.7)d vs(3.2±0.8)d,P<0.05]、住院时间[(9.6±1.4)d vs(11.7±2.0)d,P<0.05]均显著优于PL组。所有患者均获随访12个月以上,SC组恢复完全负重活动时间显著早于PL组[(5.6±1.0)周vs(6.8±1.2)周,P<0.05]。与术前相比,末次随访时,两组Harris评分、髋伸-屈ROM、内-外旋ROM均显著增加(P<0.05)。末次随访时,SC组Harris评分[(79.4±2.6)vs(73.9±3.3),P<0.05]、髋伸-屈ROM[(97.0±5.0)°vs(93.2±4.3)°,P<0.05]、内-外旋ROM[(57.6±5.9)°vs(52.2±5.7)°,P<0.05]均显著优于PL组。影像方面,随时间推移,两组双侧肢长差均显著减小(P<0.05),两组双侧肢长差、骨折复位、假体位置的差异均无统计学意义(P>0.05),两组均无髋关节脱位、假体松动发生。[结论]SC入路半髋关节置换治疗高龄不稳定型股骨粗隆间骨折,较PL入路而言,具有微创、手术时间短、术中出血量少、术后疼痛轻、康复快等优势。[Objective]To evaluate the clinical efficacy of supercapsular approach(SC)for hemiarthroplasty(HA)in the treatment of unstable femoral intertrochanteric fractures in the elderly.[Methods]A retrospective study was conducted on 50 patients who received hemiarthroplasty for unstable femoral intertrochanteric fractures in our department from April 2017 to March 2020.Based on doctor-patient communication,25 patients had HA performed though the SC approach,while other 25 patients were through the posterolateral approach(PL).The perioperative,follow-up and imaging data of the two groups were compared.[Results]The SC group was significantly superior to the PL group in terms of operation time[(60.5±8.5)min vs(74.0±6.5)min,P<0.05],incision length[(8.2±0.5)cm vs(12.1±1.1)cm,P<0.05],intraoperative blood loss[(200.8±29.7)ml vs(297.2±23.0)ml,P<0.05],the ambulation time[(1.8±0.7)days vs(3.2±0.8)days,P<0.05]and hospital stay[(9.6±1.4)days vs(11.7±2.0)days,P<0.05].All patients were followed up for more than 12 months,and the SC group returned to full weight-bearing activity significantly earlier than the PL group[(5.6±1.0)weeks vs(6.8±1.2)weeks,P<0.05].The Harris score,hip extension-flexion ROM,and internal-external rotation ROM significantly increased in both groups at the last follow-up compared with those preoperatively(P<0.05).By the time of the last follow-up,the SC group was significantly better than the PL group in terms of Harris score[(79.4±2.6)vs(73.9±3.3),P<0.05],hip extension-flexion ROM[(97.0±5.0)°vs(93.2±4.3)°,P<0.05],internal-external rotation ROM[(57.6±5.9)°vs(52.2±5.7)°,P<0.05].Regarding image,the leg length discrepancy(LLD)decreased significantly over time in both groups(P<0.05).However,there were no significant differences in LLD,quality of fracture reduction and prosthetic position between the two groups at any time points accordingly(P>0.05),no hip dislocation or prosthesis loosening occurred in anyone of both groups.[Conclusion]The SC approach used in HA has the advantages of minimally

关 键 词：高龄 股骨粗隆间骨折 上关节囊入路 后外侧入路 半髋关节置换 

分 类 号：R683.42[医药卫生—骨科学]