骨质疏松股骨颈骨折两种入路全髋置换比较△

Comparison of two approaches for total hip arthroplasty in the treatment of osteoporotic femoral neck fractures

摘要:

[目的]比较直接前入路(direct anterior approach, DAA)与后外侧入路(posterolateral approach, PLA)全髋关节置换术 (total hip arthroplasty, THA) 治疗骨质疏松性股骨颈骨折的临床疗效。[方法] 2019 年 1 月—2021 年 12 月，本院对 68 例骨质疏松性股骨颈骨折患者进行 THA 手术，依据医患沟通结果，33 例采用 DAA 入路，35 例采用 PLA 入路。比较两组临床资料。[结果] 两组患者均顺利完成手术，无术中死亡或其他严重术中并发症。虽然 DAA 组手术时间显著长于 PLA 组 [(106.8± 14.0)min vs (91.2±12.0)min, P＜0.001]，但是 DAA 组在切口长度 [(11.9±1.8)cm vs (14.8±2.2)cm, P＜0.001]、术中失血量 [(172.2±25.9) ml vs (212.0±33.7)ml, P＜0.001]、下地行走 [(26.2±8.3)h vs (44.4±11.8)h, P＜0.001] 和住院时间 [(6.8±0.6)d vs (9.8±1.3)d, P＜0.001] 显著优于 PLA 组。术后 3 d, DAA 组的疼痛 VAS 评分显著低于 PLA 组 [(4.1±0.7) vs (5.5±1.0), P＜0.001]，而 DAA 组的 Harris 评分显著高于 PLA 组 [(73.9±6.5) vs (64.8±5.9), P＜0.001]。随时间推移，两组患者 VAS 评分显著减小 (P＜0.05)，而 Harris 评分显著增加 (P＜0.05)。术后 3 个月及 6 个月两组间 VAS 评分及 Harris 评分差异均无统计学意义 (P＞0.05)。[结论] 相比 PLA 入路，DAA 入路 THA 治疗骨质疏松性股骨颈骨折，具有损伤小、术后早期恢复快的优势。

Abstract:

[Objective] To compare the clinical outcomes of direct anterior approach (DAA) versus posterolateral approach (PLA) for to- tal hip arthroplasty (THA) in the treatment of osteoporotic femoral neck fractures. [Methods] From January 2019 to December 2021, a total of 68 patients received THA for osteoporotic femoral neck fractures in our hospital. According to doctor-patient communication, 33 patients had THA performed through DAA, while the other 35 patients were through PLA. The clinical data of the two groups were compared. [Re- sults] All patients in both groups had THA performed successfully without intraoperative death or other serious intraoperative complica- tions. Although the DDA group consumed significantly longer operation time than the PLA group [(106.8±14.0)min vs (91.2±12.0)min, P＜ 0.001], the DAA group proved significantly superior to the PLA group in terms of incision length [(11.9±1.8)cm vs (14.8±2.2)cm, P＜0.001], intraoperative blood loss [(172.2±25.9)ml vs (212.0±33.7)ml, P＜0.001], postoperative walking time [(26.2±8.3)hours vs (44.4±11.8)hours, P＜ 0.001] and hospital stay [(6.8±0.6)days vs (9.8±1.3)days, P＜0.001]. In addition the DAA group was marked significantly lower VAS scors for pain [(4.1±0.7) vs (5.5±1.0), P＜0.001], whereas significantly higher Harris score [(73.9±6.5) vs (64.8±5.9), P＜0.001] than the PLA group 3 days postoperatively. All patients were followed up for more than 6 months, the VAS scores decreased significantly (P＜0.05), while Harris score increased significantly over time in both groups (P＜0.05), which proved not significantly different between the two groups at 3 and 6 months after surgery (P＞0.05). [Conclusion] The DAA for THA in the treatment of osteoporotic femoral neck fractures takes the advantages of less injury and faster early postoperative recovery over the PLA.