微创直接前入路与后外侧入路全髋关节置换术早期疗效的比较

目的探讨微创直接前入路(direct anterior approach,DAA)全髋关节置换术治疗老年股骨颈骨折的价值。方法回顾性比较2016年9月~2017年12月微创DAA人工全髋关节置换术(DAA组)与后外侧入路同时重建外旋肌群(对照组)治疗股骨颈骨折的疗效,观察指标包括手术时间、手术切口长度、术中出血量、术后引流量、下地时间、髋臼外展角、柄假体颈干角、髋臼前倾角、髋臼假体直径、术后72 h疼痛视觉模拟评分(Visual Analogue Score,VAS)以及术后1、6个月Harris髋关节评分(Harris Hip Score,HSS)。结果DDA组手术切口长度(9.5±1.2)mm,明显短于对照组(15.1±1.1)mm(t=-21.920,P=0.00);术后引流量(263.7±115.1)ml,明显少于对照组(428.0±165.8)ml(t=-4.996,P=0.00);术后下地时间(1.9±0.9)d,明显短于对照组(4.6±0.6)d(t=-16.769,P=0.00);术后72 h内VAS评分(2.3±0.5)分,明显小于对照组评分(2.6±0.5)分(t=-2.552,P=0.013);术后1个月HHS评分(75.7±5.9)分,明显高于对照组(70.2±7.1)分(t=3.703,P=0.000);术后6个月2组HHS评分分别为(94.4±2.1)、(93.4±2.3)分,差异无统计学意义(t=1.947,P=0.055)。DAA组1例发生无移位大转子骨折,2个月后恢复,对照组发生1例脱位,并发症发生率分别为2.9%(1/35)、2.2%(1/45),差异无统计学意义(Fisher精确检验,P=1.000)。结论DAA全髋关节置换术治疗股骨颈骨折,手术切口较小,术后疼痛轻,术后首次下地时间早,早期髋关节功能好,早期的临床疗效好。

Comparison of Early Effects of Total Hip Replacement Between Direct Anterior Approach and Posterior Lateral Approach

Objective To investigate the value of minimally invasive direct anterior approach(DAA)total hip replacement for femoral neck fracture in elderly patients.Methods From September 2016 to December 2017,minimally invasive DAA total hip replacement(DAA group)and posterior lateral approach operation with reconstruction of the external rotation muscle group(control group)for the treatment of femoral neck fracture were retrospectively compared.The observation parameters included operation time,incision length,intraoperative bleeding volume,postoperative drainage,out-of-bed time,acetabulum abduction angle,femoral stem prosthesis angle,acetabulum anteversion angle,diameter of acetabulum prosthesis,the pain Visual Analogue Score(VAS)at 72 hours after operation,and Harris Hip Score(HHS)at 1 and 6 months postoperatively.Results The incision length of DAA group was(9.5±1.2)mm,which was significantly shorter than that of the control group[(15.1±1.1)mm,t=-21.920,P=0.000].The postoperative drainage volume was(263.7±115.1)ml,which was significantly less than that of the control group[(428.0±165.8)ml,t=-4.996,P=0.000].The postoperative out-of-bed time was(1.9±0.9)d,which was significantly shorter than that of the control group[(4.6±0.6)d,t=-16.769,P=0.000].The VAS score at 72 hours after operation of DAA group(2.3±0.5)points was significantly lower than that of the control group[(2.6±0.5)points,t=-2.552,P=0.013].The HHS score(75.7±5.9)points was significantly higher than that of the control group[(70.2±7.1)points,t=3.703,P=0.000].There was no significant difference in the HHS score between the two groups at 6 months after operation[(94.4±2.1)points vs.(93.4±2.3)points,t=1.947,P=0.055].One case in the DAA group had greater trochanter fracture without displacement and recovered 2 months later.One case in the control group had dislocation.The incidence of complications was 2.9%(1/35)and 2.2%(1/45),respectively.The difference was not statistically significant(Fisher’s exact test,P=1.000).Conclusion DAA total hip replacement has advantages of short length of incision,less postoperative pain,early postoperative walk,and early recovery of postoperative hip function.