后外侧入路股骨头置换是否切断梨状肌的比较△（开放获取）

(Open Access) Hip hemiarthroplasty through posterolateral approach with or without piriformis transection

摘要:

[目的]比较未切断与切断梨状肌后外侧入路股骨头置换治疗老年股骨颈骨折的临床效果。[方法]回顾性分析 2018 年 1 月—2023年6月收治的老年股骨颈骨折129例患者的临床资料，根据医患沟通结果，59例未切断梨状肌，另外70 例切断梨状肌。比较两组围手术期、随访及影像资料。[结果]两组手术时间、切口长度、术中出血量、切口愈合等级的差异均无统计学意义（P＞0.05），未切断组的下地行走时间[(4.0±1.1)dvs(5.1±1.3)d,P＜0.001]、住院时间[(13.6±1.7) d vs (14.5±2.0) d, P=0.007] 均显著优于切断组。随访时间平均（8.9±2.0）个月，随术后时间推移，两组疼痛VAS评分均减少（P＜0.05），Harris 评分、髋伸屈ROM均增加（P＜0.05）。术后3个月和末次随访时，未切断组的VAS评分[(3.7±0.7)vs(5.4±0.7),P＜0.001; (1.5± 1.2) vs (2.5±1.1), P＜0.001]、Harris 评分 [(88.1±1.4) vs (87.3±1.7), P=0.004; (92.4±1.8) vs (90.1±1.5), P＜0.001]、髋伸屈 ROM [(101.3± 8.0)° vs (90.4±6.0)°, P=0.004; (130.8±5.9)° vs (116.1±6.0)°, P＜0.001] 均显著优于切断组。影像方面，与术前相比，末次随访时，两组患者双侧股骨长度差均显著减小（P＜0.05），与术后即刻相比，末次随访时，两组股骨柄偏移的例数无显著变化（P＞0.05）。 相应时间点，两组双侧股骨长度差、股骨柄位置的差异均无统计学意义（P＞0.05）。[结论]相比传统切断梨状肌方法，未切断梨状肌后外侧入路股骨头置换治疗老年股骨颈骨折，患者下地行走时间较早，住院时间短，有利于加快髋关节功能恢复。

Abstract:

[Objective] To compare the clinical outcome of hip hemiarthroplasty (HA) through posterolateral approach with or without piriformis transection for femoral neck fractures in the elderly. [Methods] A retrospective study was conducted on 129 elderly patients who received HA for femoral neck fractures in our hospital from January 2018 to June 2023. According to the doctor-patient communication, 59 patients had HA performed with non piriformis transection (NPT), while other 70 patients had piriformis transection (PT). The perioperative, follow-up and imaging data of the two groups were compared. [Results] Although there were no significant differences in operation time, incision length, intraoperative blood loss and incision healing grade between the two groups (P＞0.05), the NPT group proved significantly superior to the PT group in terms of postoperative walking time [(4.0±1.1) days vs (5.1±1.3) days, P＜0.001] and hospital stay [(13.6±1.7) days vs (14.5±2.0) days, P=0.007]. As time elapsed in follow-up time period lasted for (8.9±2.0) months in a mean, the VAS score for pain decreased significantly (P＜0.05), while the Harris score and hip extension-flexion ROM increased significantly in both groups (P＜0.05). At 3 months after surgery and the latest follow-up, the NPT group was significantly better than the PT group regarding to VAS score [(3.7±0.7) vs (5.4±0.7), P＜0.001; (1.5±1.2) vs (2.5±1.1), P＜0.001], Harris score [(88.1±1.4) vs (87.3±1.7), P=0.004; (92.4±1.8) vs (90.1±1.5), P＜ 0.001], hip flexion-extension ROM [(101.3±8.0)° vs (90.4±6.0)°, P=0.004; (130.8±5.9)° vs (116.1±6.0)°, P＜0.001]. As for imaging, the leg length discrepancy (LLD) significantly reduced in both groups at the last follow-up compared with that preoperatively (P＜0.05), whereas the number of femoral stem deviation remained unchanged significantly in both groups at the last follow-up compared with that immediately postoperatively (P＞0.05). At any corresponding time points, there were no significant differences in LLD and femoral stem deviation between the two groups (P＞0.05). [Conclusion] Compared with traditional piriformis transection, the HA through posterior approach without piriformis transection has advantages of walking earlier and hospital stays shorter, which is conducive to accelerating the recovery of hip function in the treatment of femoral neck fractures in the elderly.