比较OCM入路与改良Hardinge入路在半髋关节置换术中治疗高龄股骨颈骨折的临床效果  

Comparing the clinical outcomes of OCM approach versus modified Hardinge approach in bipolar hemiarthroplasty for treating elderly patients with femoral neck fractures

作　　者：郑鸿鸣[1] 朱东波[1] 孔丹辉[1] 吴树华[1] 贺双军[1] 王遥伟[1] 周立建[1] 夏炎[1] Zheng Hongming;Zhu Dongbo;Kong Danhui;Wu Shuhua;He Shuangjun;Wang Yaowei;Zhou Lijian;Xia Yan(Department of Orthopedics,Danyang People's Hospital(Affiliated Danyang Hospital of Nantong University),Danyang Jiangsu,212300,China)

机构地区：[1]江苏省丹阳市人民医院(南通大学附属丹阳医院)骨科,江苏丹阳212300

出　　处：《生物骨科材料与临床研究》2024年第5期21-26,共6页Orthopaedic Biomechanics Materials and Clinical Study

基　　金：丹阳市重点研发计划(社会发展)(SSF202303,SSF202307)。

摘　　要：目的比较OCM入路与改良Hardinge入路在双极头半髋关节置换术中对高龄股骨颈骨折患者早期临床效果的差异。方法回顾性分析2021年3月至2022年12月期间江苏省丹阳市人民医院收治的105例高龄股骨颈骨折患者进行双极头半髋关节置换术的疗效。根据手术入路的不同,将患者分为OCM组(45例)和改良Hardinge组(60例)。评价指标包括手术一般情况(手术时间、切口长度、术后住院时间、下地时间),围手术期出血情况(术前血红蛋白,术中出血量,术后1、3 d的血红蛋白下降量及隐性失血量),血清学指标(肌酸激酶和C反应蛋白),VAS疼痛评分,Harris髋关节功能评分及并发症等关键指标。结果两组患者随访6~20个月,平均(11.02±2.72)个月。两组患者在手术时间、输血率上,差异无统计学意义(P>0.05)。OCM组的切口长度、术后住院时间、下地时间、术中出血量、术后血红蛋白下降量、隐性失血量、术后3 d的血清学指标和VAS评分,以及术后3个月内的Harris评分均显著优于改良Hardinge组(P<0.05)。但术后6周的VAS评分及6个月的Harris评分比较,差异无统计学意义(P>0.05)。两组均未出现深静脉血栓形成、切口感染、脱位及神经损伤等严重并发症,两组的假体周围骨折、肌间静脉血栓、Trendelenburg步态、双下肢不等长的发生率比较,差异无统计学意义(P>0.05)。结论对于高龄股骨颈骨折患者,采用OCM入路双极头半髋关节置换术较改良Hardinge入路在减少手术创伤和加速术后恢复方面表现显著,有更优的早期临床效果,值得临床推荐。Objective To compare the early clinical outcomes of the OCM approach versus and the modified Hardinge approach in bipolar hemiarthroplasty for elderly patients with femoral neck fractures.Methods This retrospective study analyzed the efficacy of bipolar hemiarthroplasty performed on 105 elderly patients with femoral neck fractures between March 2021 and December 2022 at Danyang People's Hospital.Patients were divided into the OCM group(45 cases)and the modified Hardinge group(60 cases)based on the surgical approach.Evaluation indicators included general surgical conditions(operation time,incision length,postoperative hospital stay,time to ambulation),perioperative blood loss(preoperative hemoglobin,intraoperative blood loss,postoperative day 1 and day 3 hemoglobin drop,and hidden blood loss),serum indicators(creatine kinase and C-reactive protein),VAS pain score,Harris hip function score,and complication rates.Results Follow-up of all patients ranged from 6 to 20 months,with a mean of(11.02±2.72)months.There were no significant differences in operation time and transfusion rate between the two groups(P>0.05).The OCM group showed significant advantages over the modified Hardinge group in terms of incision length,postoperative hospital stay,time to ambulation,intraoperative blood loss,postoperative haemoglobin drop,occult blood loss,serum indicators within three days postoperatively,VAS pain scores,and Harris hip scores within three months postoperatively(P<0.05).However,there were no significant differences in VAS pain scores at six weeks postoperatively and Harris hip scores at six months postoperatively(P>0.05).No major complications such as deep vein thrombosis,wound infection,dislocation or nerve injury occurred in either group.The incidence rates of periprosthetic fractures,intermuscular venous thrombosis,Trendelenburg gait,and limb length discrepancy(less than 10 mm)showed no significant differences between the two groups.Conclusion Compared to the modified Hardinge approach,the OCM approach provides better

关 键 词：股骨颈骨折 半髋关节置换术 OCM入路 改良HARDINGE入路 高龄患者 

分 类 号：R683.42[医药卫生—骨科学]