MDT模式下不同手术入路行人工股骨头置换术治疗老年股骨颈骨折的疗效对比

目的 比较多学科协作诊疗（multi-disciplinary treatment,MDT）模式下,德国慕尼黑骨科手术（orthop?dische chirurgie München,OCM）入路与后外侧（posterolateral,PLA）入路行人工股骨头置换术治疗老年股骨颈骨折的临床疗效。方法 选取2020年12月至2022年1月永康市骨科医院收治的行人工股骨头置换术患者60例,按手术入路方式分为OCM组和PLA组,每组各30例。比较两组患者的切口长度、术中出血量、手术时间、术后下地时间、住院时间和术后1d、3d、7d血红蛋白值;记录两组患者术后1周、3个月、6个月Harris评分和术后1d、3d、7d视觉模拟评分（visual analogue scale,VAS）并进行比较,同时记录并发症发生情况。结果 两组患者的切口长度、术后下地时间、术后1d、3d血红蛋白值、术后1d与3d的VAS、术后1周Harris评分比较,差异有统计学意义（P<0.05）;PLA组术后出现1例后脱位,及时手法复位后未再发生脱位;两组患者均无深静脉血栓、神经损伤麻痹、感染等并发症发生。结论 MDT模式下采用OCM入路与PLA入路行人工股骨头置换术治疗老年股骨颈骨折均能取得良好疗效,但OCM入路从肌间隙进入,不破坏后方结构,降低了术后脱位的风险,且具有围手术期快速康复的优势,早期临床疗效更佳,值得临床推广。

Comparison of the curative effect of artificial femoral head replacement with different surgical approaches in the treatment of elderly femoral neck fractures under MDT mode

Objective To compare the clinical efficacy of artificial femoral head replacement by orthop?dische Chirurgie München (OCM) approach and posterolateral (PLA) approach in the treatment of elderly displaced femoral neck fractures under multi-disciplinary treatment (MDT) mode. Methods A total of 60 patients admitted to Yongkang Orthopaedic Hospital from December 2020 to January 2022 who underwent artificial femoral head replacement were selected and divided into the OCM group and the PLA group according to the surgical access, with 30 patients in each group. The incision length, intraoperative bleeding, operative time, postoperative time on the floor, hospital stay and postoperative haemoglobin values at 1st, 3rd and 7th days were compared between the two groups; the postoperative Harris score at 1 week, 3 months and 6 months and visual analogue scale (VAS) at 1st, 3rd and 7th days were recorded and compared between the two groups, and the occurrence of complications was also recorded. Results There were statistically significant differences in the length of incision, the time of going down after the operation, the hemoglobin value on the 1st and 3rd day after the operation, VAS on the 1st and 3rd day after the operation, and the Harris score at 1 week after the operation (P<0.05); 1 case of posterior dislocation occurred in the PLA group after surgery, and no further dislocation occurred after timely manual reduction; no deep vein thrombosis, nerve injury, paralysis, infection and other complications occurred in the two groups. Conclusion Both the OCM approach and the PLA approach for artificial femoral head replacement in the MDT mode can achieve good results in the treatment of elderly femoral neck fractures. However, the OCM approach enters the muscle space without destroying the posterior structure and reduces the risk of postoperative dislocation. And it has the advantage of rapid recovery in the perioperative period, and the early clinical effect is better, which is worthy of clinical promotion.