改良Osborne术式初次人工全髋置换治疗老年股骨颈骨折

目的比较经改良Osborne术式初次全髋置换治疗老年股骨颈骨折的短期疗效。方法2007年8月—2009年10月64例股骨颈骨折患者随机分为两组,各32例,其中男28例,女36例,平均年龄72．5岁。统一进行初次全髋置换,其中骨水泥型假体40例,非骨水泥型假体44例。分别记录切口长度、手术时间、出血量、引流量、输血量以及有无术后感染、髋脱位等并发症。髋关节功能采用Harris评分,所得数据进行统计学分析比较。结果两组患者均获得12—24个月随访。两组在年龄、骨折类型及假体选择上差异无显著性。改良组各项指标均明显好于传统组。结论改良Osborne术式合理,可靠,可实施微创操作,减少手术时间及术中出血。     

微创后侧入路肌关节囊瓣重建在人工髋关节置换中的疗效观察

目的 比较采用经微创后侧入路联合肌关节囊瓣重建与传统后侧入路人工髋关节置换治疗老年股骨颈骨折的短期疗效.方法 2007年8月至2009年5月将126例老年股骨颈骨折患者随机分为微创后入路组63例,传统后侧入路组63例.行初次全髋置换58例,人工双动股骨头置换68例.其中骨水泥型假体84例,非骨水泥型假体42例.分别记录2组切口长度、手术时间、出血量、引流量、输血量,以及有无术后感染、髋脱位等并发症.髋关节功能采用Harris评分.所得数据进行统计学分析比较.结果 5例患者术后1年内死亡;4例患者失访.余117例患者均获得了12～24个月随访.2组在年龄、骨折类型及假体选择上差异无统计学意义(P均＞0.05).微创后入路组的切口长度为(10.5±2.4)cm,明显短于传统入路组的(17.2±3.6)cm(t=3.012,P=0.004),微创后入路组的平均手术时间也低于传统后入路组(t=2.455,P=0.038);在术中出血量、术后引流量及输血量方面,传统后入路组明显多于微创后入路组,差异均有统计学意义(t值分别为3.211、2.986、3.352,P均＜0.01).结论 采用微创后侧入路联合肌关节囊瓣重建人工髋关节置换治疗老年股骨颈骨折创伤小,操作简单,较传统术式显著减少手术时间及术后失血.

Abstract：

Objective To compare the short-term effects of myocapsular flap repair through minimal posterior approach in Hip arthroplasty with traditional posterior approach in hip arthroplasty in elderly femoral neck fractures. Methods From August 2007 to may 2009, a total of 126 femoral neck fracture patients were randomly divided into two groups, with 63 patients treated with myocapsular flap repair through minimal posterior approach (the modified group), and 63 patients treated with traditional posterior approach (the traditional group). Fifty-eight patients underwent the first-ever total hip replacement and 68 patients underwent artificial double-acting femoral head replacement. Eighty-four cases were inserted with cemented implants and 42 cases with uncemented. Data of incision length, operation time, blood loss volume, drainage amount, blood transfusion volumes were recorded separately. Postoperative complications related to the surgery and hip joint function were also documented. Function of hip joint was scored with Harris scale. All data were statistically analyzed. Results Five patients died within 1 year of surgery, and 4 patients dropped out. All the remained 117 patients were followed up for 12 - 24 months. There were no significant difference in age, type of fracture and artificial the incision length in the modified group was significantly shorter than that in the traditional group([ 10. 5 ± 2. 4 ]cm vs [ 17. 2 ± 3.6 ] cm, t = 3. 012, P = 0. 004). The average operating time was significantly shorter in the modified group compared to the traditional group (t = 2. 455, P = 0. 038). Blood loss, drainage amount, blood transfusion volumes in the modified group were less than those in the traditional group( t = 3.211,2. 986 and 3. 352 ,Ps ＜ 0. 01, respectively). Conclusion Myocapsular flap repair through minimal posterior approach in Hip arthroplasty is a reasonable, mini invasive technique for hip replacement in older with a less blood loss and shorter operating time.fractures     

微创后侧入路肌关节囊瓣重建在人工髋关节置换中的疗效观察

Objective To compare the short-term effects of myocapsular flap repair through minimal posterior approach in Hip arthroplasty with traditional posterior approach in hip arthroplasty in elderly femoral neck fractures. Methods From August 2007 to may 2009, a total of 126 femoral neck fracture patients were randomly divided into two groups, with 63 patients treated with myocapsular flap repair through minimal posterior approach (the modified group), and 63 patients treated with traditional posterior approach (the traditional group). Fifty-eight patients underwent the first-ever total hip replacement and 68 patients underwent artificial double-acting femoral head replacement. Eighty-four cases were inserted with cemented implants and 42 cases with uncemented. Data of incision length, operation time, blood loss volume, drainage amount, blood transfusion volumes were recorded separately. Postoperative complications related to the surgery and hip joint function were also documented. Function of hip joint was scored with Harris scale. All data were statistically analyzed. Results Five patients died within 1 year of surgery, and 4 patients dropped out. All the remained 117 patients were followed up for 12 - 24 months. There were no significant difference in age, type of fracture and artificial the incision length in the modified group was significantly shorter than that in the traditional group([ 10. 5 ± 2. 4 ]cm vs [ 17. 2 ± 3.6 ] cm, t = 3. 012, P = 0. 004). The average operating time was significantly shorter in the modified group compared to the traditional group (t = 2. 455, P = 0. 038). Blood loss, drainage amount, blood transfusion volumes in the modified group were less than those in the traditional group( t = 3.211,2. 986 and 3. 352 ,Ps ＜ 0. 01, respectively). Conclusion Myocapsular flap repair through minimal posterior approach in Hip arthroplasty is a reasonable, mini invasive technique for hip replacement in older with a less blood loss and shorter operating time.fractures