摘要
目的比较侧卧位直接前方入路与后外侧入路人工全髋关节置换术(total hip arthroplasty,THA)治疗股骨颈骨折的临床效果。方法回顾性分析2019年8月-2021年9月新乡医学院第一附属医院骨外科行THA治疗的84例股骨颈骨折患者临床资料,男性49例,女性35例;年龄38~78岁,平均61.9岁;道路交通伤37例,高处坠落伤15例,摔伤25例,其他7例;体质量指数19.5~24.7kg/m^(2),平均22.3kg/m^(2);骨折部位:左侧44例,右侧40例;Garden分型:Ⅱ型54例,Ⅲ型30例;合并疾病:糖尿病15例,心脏病13例,高脂血症11例,高血压21例。按照入路方式不同分为直接前方入路组(n=41)和后外侧入路组(n=43),对比两组围术期指标、健康调查量表(SF-36)评分、髋臼杯的外展角和股骨柄假体颈干角、视觉模拟评分(visual analogue scale,VAS)、西安大略麦克马斯特大学骨关节炎指数(Western Ontario and McMaster Universities arthritis index,WOMAC)评分和骨代谢指标:骨特异性碱性磷酸酶(bone alkaline phosphatase,BAP)、Ⅰ型胶原羧基端前肽(propeptide of typeⅠprocollagen,PICP)、骨钙素(bone glaprotein,BGP)、Ⅰ型前胶原氨基端前肽(procollagen amino terminal propeptide,PINP),观察两组患者治疗期间及随访期间并发症发生情况。结果直接前方入路组切口长度短于后外侧入路组[(10.1±2.0)cm vs.(12.5±3.1)cm],术中失血量、术后引流量少于后外侧入路组[(407.6±64.2)mL vs.(441.8±87.2)mL,(111.3±12.8)mL vs.(152.8±19.3)mL],手术时间长于后外侧入路组[(103.1±12.6)min vs.(92.5±13.7)min],住院时间短于后外侧入路组[(7.0±2.1)d vs.(9.5±2.0)d],下床时间短于后外侧入路组[(2.4±0.4)d vs.(4.4±0.3)d](P<0.05)。直接前方入路组术后6个月总体健康(83.2±7.1)分、精神健康(85.9±6.2)分、活力(85.2±7.2)分、躯体疼痛(79.7±6.9)分、社会功能(79.0±7.0)分、生理功能(77.3±4.5)分、生理职能(82.2±5.9)分、情感职能(81.3±8.6)分评分高于后外侧入路组[(72.1±4.8)�
Objective To compare the clinical outcome of total hip arthroplasty(THA)in the treatment of femoral neck fractures via direct anterior approach and posterolateral approach in lateral position.Methods Clinical data of 84 patients with femoral neck fractures who were treated with THA at the Department of Orthopaedic Surgery,the First Affiliated Hospital of Xinxiang Medical College from Aug.2019 to Sep.2021 were retrospectively analyzed.There were 49 males and 35 females aged 38-78 years(61.9 years on average).The body mass index was 19.5-24.7 kg/m^(2)(mean 22.3 kg/m^(2)).The involved fracture side was left in 44 cases and right in 40 cases,with the Garden classification being type II in 54 cases and type III in 30 cases.Among them,15 cases combined with diabetes,13 with heart disease,11 with hyperlipidemia and 21 with hypertension.Patients were divided into direct anterior approach group(n=41)and posterolateral approach group(n=43)according to different surgical approaches.The perioperative indexes,short-form-36 health survey(SF-36)score,abduction angle of the acetabular cup and femoral stem angle of the femoral stem prosthesis,visual analogue scale(VAS)score,the Western Ontario and McMaster Universities arthritis index(WOMAC)and bone metabolism indexes,as well as bone specific alkaline phosphatase(BAP),carboxyterminal propeptide of typeⅠprocollagen(PICP),osteocalcin(BGP),type I procollagen amino terminal propeptide(PINP)were compared between the two groups.In-hospital and follow-up complications were observed.Results Compared with the posterolateral approach group,the direct anterior approach group had a shorter incision length(cm,10.1±2.0 vs.12.5±3.1),less intraoperative blood loss(mL,407.6±64.2 vs.441.8±87.2)and postoperative drainage volume(mL,111.3±12.8 vs.152.8±19.3),longer operation time(min,103.1±12.6 vs.92.5±13.7),shorter length of hospital stay(d,7.0±2.1 vs.9.5±2.0),and shorter duration to get out of bed(d,2.4±0.4 vs.4.4±0.3),all P<0.05.The scores of general health(83.2±7.1 vs.72.1±4.8),me
作者
茹庆超
徐海斌
张志昌
黄媛霞
Ru Qingchao;Xu Haibin;Zhang Zhichang;Huang Yuanxia(Department of Orthopaedic Surgery,the First Affiliated Hospital of Xinxiang Medical College,Xinxiang,Henan 453100,China)
出处
《创伤外科杂志》
2023年第5期346-353,共8页
Journal of Traumatic Surgery
基金
河南省医学科技攻关计划项目(SB201901059)。
关键词
股骨颈骨折
全髋关节置换
入路
疗效
Femoral neck fractures
Total hip joint placement
Surgical approach
Curative effect
