后外侧入路与直接前入路全髋关节置换术治疗老年股骨颈骨折的疗效  

Analysis of the effect of posterior lateral approach and direct anterolateral approach total hip arthroplasty in treating geriatric femoral neck fractures

作　　者：徐继胜[1] 崔峰[1] 李国盛 李腾 经亚威 郭旗[3] 张传林[3] 陈坤峰[2] Xu Jisheng;Cui Feng;Li Guosheng;Li Teng;Jing Yawei;Guo Qi;Zhang Chuanlin;Chen Kunfeng(Department of Children’s Orthopedics Emergency,the First People’s Hospital of Shangqiu,Shangqiu 476000,China;Department of Emergency Surgery,the First People’s Hospital of Shangqiu,Shangqiu 476000,China;Department of Joint Surgery,the First People’s Hospital of Shangqiu,Shangqiu 476000,China)

机构地区：[1]商丘市第一人民医院儿童骨科急诊骨科,商丘476000 [2]商丘市第一人民医院急诊外科,商丘476000 [3]商丘市第一人民医院关节外科,商丘476000

出　　处：《中华实验外科杂志》2024年第12期2868-2871,共4页Chinese Journal of Experimental Surgery

基　　金：河南省医学科技攻关计划项目(LHGJ20191497)。

摘　　要：目的探讨后外侧入路与直接前入路的全髋关节置换术治疗老年股骨颈骨折的疗效分析。方法选取2019年2月至2023年12月商丘市第一人民医院收治的42例股骨颈骨折患者作为研究对象, 根据手术治疗方法分为后外侧入路组和直接前入路组, 每组21例, 后外侧入路组患者行后外侧入路全髋关节置换术, 直接前入路组患者行直接前入路全髋关节置换术。观察两组手术方式患者围手术期指标变化;评估两组患者的疼痛程度和髋关节功能;采用试剂盒检测患者血清氧化应激指标谷胱甘肽过氧化物酶, 超氧化物歧化酶和丙二醛变化;采用酶联免疫吸附试验分析两组患者血清炎性因子白细胞介素-1β、白细胞介素-10和肿瘤坏死因子水平。组间比较采用t检验。结果直接前入路组患者手术切口、手术出血量、住院时间和安全负重时间[(8.16±0.79) cm、(201.14±19.78) ml、(5.10±1.14) d、(32.43±2.68) d]低于后外侧入路组[(8.16±0.79) cm、(201.14±19.78) ml、(6.57±1.25) d、(40.52±3.64) d], 差异有统计学意义(t=8.265、3.845、4.009、8.210, P<0.05)。直接前入路组患者手术时间[(90.33±5.65) min]高于后外侧入路组[(82.80±5.28) min], 差异有统计学意义(t=4.459, P<0.05)。直接前入路组患者视觉模拟疼痛评分[(3.00±0.89)分]低于后外侧入路组[(4.71±1.06)分], 差异有统计学意义(t=5.678, P<0.05)。直接前入路组患者髋关节(Harris)评分[(87.19±4.07)分]高于后外侧入路组[(77.23±5.23)分], 差异有统计学意义(t=6.879, P<0.05)。直接前入路组患者超氧化物歧化酶活性和谷胱甘肽过氧化物酶活性[(100.33±8.99)、(576.95±58.77) U/ml]高于后外侧入路组[(77.10±8.95)、(435.19±56.54) U/ml], 差异有统计学意义(t=8.395、7.798, P<0.05)。直接前入路组患者丙二醛水平[(5.69±0.48) mmol/L]低于后外侧入路组[(7.42±0.57) mmol/L], 差异有统计学意义(t=10.630, P<0.05)。直接前入路组患者血�ObjectiveTo analyze the effect of posterior lateral approach and direct anterolateral approach total hip arthroplasty in treating geriatric femoral neck fractures.MethodsA total of 42 patients with femoral neck fractures admitted to the first people’s hospital of shangqiu city from February 2019 to December 2023 were selected as the research subjects and divided into the posterior lateral approach group and the direct anterolateral approach group,with 21 patients in each group.The patients in the posterior lateral approach group underwent posterior lateral approach total hip arthroplasty,while the patients in the direct anterolateral approach group underwent direct anterolateral approach total hip arthroplasty.The changes in perioperative indicators(operation time,incision size,blood loss,hospital stay,drainage volume)were observed in the two groups of patients;the degree of pain and hip function were evaluated by visual analog scale(VAS)and Harris hip score;the oxidative stress indicators glutathione peroxidase,superoxide dismutase,and malondialdehyde in the blood were detected by kit;the inflammatory factors interleukin-1β,interleukin-10,and tumor necrosis factor in the blood were analyzed by enzyme-linked immunosorbent assay.Quantitative data between groups were compared by t-test.ResultsThe surgical incision,blood loss,hospital stay and safe weight-bearing time of patients in the direct anterior approach group[(8.16±0.79)cm,(201.14±19.78)ml,(5.10±1.14)d,(32.43±2.68)d]were significantly lower than those in the posterolateral approach group[(8.16±0.79)cm,(201.14±19.78)ml,(6.57±1.25)d,(40.52±3.64)d,t=8.265,3.845,4.009,8.210,P<0.05].The operation time in the direct anterior approach group[(90.33±5.65)min]was significantly higher than that in the posterolateral approach group[(82.80±5.28)min,t=4.459,P<0.05].The visual analogue pain score in the direct anterior approach group[(3.00±0.89)points]was significantly lower than that in the posterolateral approach group[(4.71±1.06)points,t=5.678,P<0.05].The

关 键 词：后外侧入路 直接前入路 全髋关节置换术 股骨颈骨折 氧化应激 炎性反应 

分 类 号：R687.3[医药卫生—骨科学]