改良微创SuperCap半髋关节置换术治疗老年股骨颈骨折的早期疗效

目的 探讨改良微创SuperCap半髋关节置换术治疗老年股骨颈骨折的早期临床疗效和手术技巧。方法 回顾性研究。纳入2016 年 9月- 2019年9月蚌埠医学院第一附属医院骨科收治的单侧股骨颈骨折患者19例(19髋),其中男3例、女16例,年龄65～90(76.32±7.50)岁。患者均采用改良微创SuperCap半髋关节置换术治疗,术中使用生物型股骨柄与双极股骨头。观察患者围术期一般情况、关节功能稳定性、术后并发症发生情况。结果 患者均顺利完成手术。手术时间(60.72±6.03)min,切口长度(8.80±0.87)cm,术中出血量(177.22±37.83)mL。术后第1、5天血红蛋白分别为(105.40±14.64)g/L、(99.87±12.93)g/L,VAS分别为(4.03±1.43)、(2.06±1.93)分;术后第1、5天的血红蛋白水平、VAS均低于手术前,手术后第5天的血红蛋白水平、VAS均低于术后第1天,差异均有统计学意义(P值均＜0.05)。19例患者术后均随访3个月。随访期间患者术侧髋关节活动度正常并稳定,无下肢深静脉血栓形成、切口感染,无假体周围骨折、脱位等并发症;术后3个月复查骨盆前后位X线片,见股骨柄假体位于中立位,未见股骨柄下沉及髋关节假体脱位。结论 改良微创SuperCap半髋关节置换术治疗老年股骨颈骨折患者,尤其是伴有神经系统基础疾病的老年股骨颈骨折患者,具有切口小、损伤轻、可以使用常规髋关节生物型假体、完整保留髋关节囊、髋关节稳定性好、术后快速康复等优点,适合在基层医院推广应用。

Early effectiveness of hemiarthroplasty using modified minimally invasive SuperCap approach for elderly femoral neck fracture

Objective To explore the early clinical effects and the operational techniques of hemiarthroplasty using the modified minimally invasive SuperCap approach in elderly patients with femoral neck fracture.Methods This study was a retrospective research that involved 19 elderly patients (19 hips) with unilateral femoral neck fracture who were admitted to the Department of Orthopedics at the First Affiliated Hospital of Bengbu Medical College from September 2016 to September 2019. Three were 3 males and 16 females, with age range of 65-90 (76.32±7.50) years. All patients were treated with modified minimally invasive SuperCap hemiarthroplasty, and biological femoral stem and bipolar femoral head were used during the operation. The perioperative general conditions, postoperative hip stability, and postoperative complications were observed among these patients.Results The operation was successfully performed in all patients. The operation time, incision length, intraoperative blood loss, hemoglobin on postoperative days 1 and 5, and VAS scores on postoperative day 1 and 5 were (60.72±6.03)min, (8.80±0.87)cm,(177.22±37.83)mL,(105.40±14.64)g/L,(99.87±12.93)g/L,(4.03±1.43),(2.06±1.93). The hemoglobin and VAS scores on day 1 and 5 after the surgery were lower than those before the surgery, whereas those on day 5 were lower than those on day 1 after the surgery, and the differences were statistically significant (all P values<0.05). Nineteen patients were followed up for 3 months. During the follow-up period, the patient's hip movement was normal and stable, without deep vein thrombosis, incision infection, periprosthetic fracture, dislocation, nor other complications. At the end of 3 months, the anteroposterior pelvic position X-rays showed that the femoral stems were in the neutral position, without femoral stem sinking nor hip prosthesis dislocation.Conclusions The modified minimally invasive SuperCap hemiarthroplasty for elderly patients with femoral neck fractures, especially those with neurological diseases, has the advantages of small incision, less trauma, use of regular biological prosthesis, hip capsule integrity, excellent joint stability, and enhanced rapid recovery. It is suitable for popularization in grass-roots hospitals in China.