经梨状肌入路全髋关节置换术治疗老年股骨颈骨折  

The transpiriformis approach total hip arthroplasty in the treatment of elderly femoral neck fractures

作　　者：高志祥 戴亦心 姚凯 张少云 李碧蓉[1] 贾乐 孔向东 肖聪[1] GAO Zhi-xiang;DAI Yi-xin;YAO Kai;ZHANG Shao-yun;LI Bi-rong;JIA Le;KONG Xiang-dong;XIAO Cong(Dept of Orthopaedics,the Third Hospital of Mianyang City,Sichuan Mental Health Center,Mianyang,Sichuan 621000,China)

机构地区：[1]绵阳市第三人民医院·四川省精神卫生中心骨科,四川绵阳621000

出　　处：《临床骨科杂志》2024年第4期500-504,共5页Journal of Clinical Orthopaedics

基　　金：四川省医学会骨科(尚安通)专项科研基金(编号:2020SAT46、2021SAT19);四川省绵阳市卫生健康委员会科研基金(编号:202007)。

摘　　要：目的探讨经梨状肌入路全髋关节置换术(THA)治疗老年股骨颈骨折的疗效。方法采用经梨状肌入路(观察组,46例)和传统后外侧入路(传统组,51例)THA治疗97例老年股骨颈骨折患者。比较两组切口长度、术中出血量、手术时间、住院时间、术后首次下地时间、疼痛VAS评分、术后并发症发生情况。采用Harris评分评价髋关节功能。结果患者均获得随访,时间6~8个月。切口长度、术中出血量、手术时间、住院时间:观察组均短(少)于传统组(P<0.01)。术后首次下地时间:观察组早于传统组(P<0.01)。疼痛VAS评分:术后第1、3、7天观察组均低于传统组(P<0.01)。Harris评分:术后1周、1个月观察组均高于传统组(P<0.01);术后3、6个月两组比较差异均无统计学意义(P>0.05)。术后并发症发生率:观察组低于传统组(P<0.05)。结论经梨状肌入路THA治疗老年股骨颈骨折,能明显缩短住院时间,减轻患者术后疼痛,减少术后并发症的发生,促进患者早日行走,短期疗效较好。Objective To investigate the efficacy of transpiriformis approach total hip arthroplasty(THA)on elderly patients with femoral neck fractures.Methods Ninety-seven elderly patients with femoral neck fractures underwent THA,they were treated with transpiriformis approach(observation group,46 cases)or the conventional posterolateral approach(conventional group,51 cases).Parameters such as incision length,intraoperative blood loss,surgery duration,hospitalization time,time to first weight-bearing,pain VAS and occurrence of complications were compared between the two groups.Hip joint function was evaluated using the Harris score.Results All patients were followed up for 6~8 months.The observation group exhibited shorter incision lengths,less intraoperative blood loss,shorter surgical duration and hospital stay,compared with the conventional group(P<0.01).The time of first weight-bearing:the observation group was earlier than the conventional group(P<0.01).Pain VAS:at postoperative 1,3,7 d,the observation group were lower than the conventional group(P<0.01).Harris scores in the observation group were higher than the conventional group at 1 week and 1 month postoperatively(P<0.01);however,there was no statistical significance between two groups at 3,6 months postoperatively(P>0.05).The incidence rate of complications in the observation group was lower than that in the conventional group(P<0.05).Conclusions For femoral neck fractures in elderly patients,THA with transpiriformis approach can obviously shorten the hospitalization duration,relieve postoperative pain,reduces the occurrence of complications,and facilitates walking of patients,with good short-term effect.

关 键 词：股骨颈骨折 全髋关节置换术 后外侧入路 经梨状肌入路 

分 类 号：R683.42[医药卫生—骨科学] R687.4[医药卫生—外科学]