两种入路半髋置换治疗高龄股骨粗隆间骨折△（开放获取）

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

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。

Abstract:

[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-pa- tient communication, 25 patients had HA performed though the SC approach, while other 25 patients were through the posterolateral ap- proach (PL). The perioperative, follow-up and imaging data of the two groups were compared. [Results] The SC group was significantly su- perior 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 Har- ris score, hip extension-flexion ROM, and internal-external rotation ROM significantly increased in both groups at the last follow-up com- pared 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 rota- tion 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. [Conclu- sion] The SC approach used in HA has the advantages of minimally invasive surgery, shorter operation time, less intraoperative bleeding, less postoperative pain and faster recovery over the PL approach for the treatment of unstable femoral intertrochanteric fracture in the elderly.