老年股骨颈骨折的小切口微创人工全髋关节置换

目的探讨采用前路小切口人工全髋关节微创置换治疗老年股骨颈囊内骨折的可行性和治疗效果。方法自2002年8月～2003年2月,将47例老年股骨颈囊内移位骨折患者随机分为三组。A组15例,术中控制性降压加小切口微创置换;B组13例,小切口微创置换;C组19例,后路全髋置换。结果平均随访11周(5～22周)。三组手术持续时间相似。A、B组的切口(平均8.0cm)明显比C组(14cm)小(P<0.05)。A组采用控制性降压技术,术中平均出血量比B、C组少。C组手术出血量比其它两组显著增多(P<0.01)。术后A组4例、B组7例需输血,平均350ml;C组19例需输血,平均460ml。C组无论输血病例数或输血量均多于A、B组(P<0.01)。A、B组术后均未发生全身及局部并发症,术后4～6周均可负重行走。C组有1例术后1周内发生深静脉栓塞,1例术后第2天出现言语不清、嗜睡。结论术中控制性降压可减少出血。小切口全髋关节置换具有少出血、创伤小、少输血、恢复快等优点,尤其适合老年股骨颈骨折患者。

Minimally invasive incision in total hip arthroplasty for displaced femoral neck fractures in the elderly

Objective To study the feasibility and therapeutic results of total hip arthroplasty (THA) with minimally invasive incision through anterolateral approach for elderly patients with displaced femoral neck fractures. Methods From August 2002 to February 2003, 47 patients with displaced femoral neck fractures who had been admitted to our department were randomized into 3 treatment groups. In Group A 15 patients were treated with mini invasive THA through anterolaleral approach and together with controlled hypotension during operation, in Group B 13 patients only with mini invasive THA through anterolateral approach, and in Group C 19 patients with mini invasive THA through conventional posterior approach. Results 47 patients were followed up for 5 to 22 weeks (averaging 11 weeks). The operation duration for each group was similar. The incision length in Groups A and B was significantly shorter than that in Group C (P< 0.01). In Group A where the blood pressure was controlled, the blood loss was less than that in Group B and Group C. Blood loss in Group C was significantly greater than that in Groups A and B (P< 0.01). Both the cases and quantity of transfusion in Group C exceeded those in Groups A and B (P< 0.01). No complication occurred in Groups A and B. In Group C, one case had deep vein thrombosis within one week after operation, and barylalia and drowsiness occurred in one case at the second day after operation. Conclusions To control blood pressure during operation can reduce blood loss during operation. Mini invasive THA through anterolateral approach can be performed for elderly patients with displaced femoral neck fractures, for it has the advantages of reducing blood loss, transfusion and invasion as well as accelerating rehabilitation.