摘要
背景:传统后外侧人工双极股骨头置换切口大,需切断外旋肌群,康复时间慢;Super PATH技术切口小、不切断任何肌肉、保留了关节囊,可快速康复,但需特殊器械、假体,价格昂贵;改良普通器械,利用Super PATH技术,使用普通双极股骨头置换,技术可行,便于推广。目的:通过与传统后外侧入路对比,探讨改良、利用普通器械,使用普通一体柄双极股骨头,通过Super PATH入路,治疗老年股骨颈骨折的疗效。方法:自2015年3月至2017年6月,收治62例高龄股骨颈骨折患者,随机分成2组,试验组30例采用Super PATH入路,改良普通器械,使用普通一体柄人工双极股骨头进行股骨头置换;对照组32例采用后外侧入路,使用普通器械及普通一体柄双极股骨头进行置换。通过观察切口长度、手术时间、术中出血量、置换前后血红蛋白变化、置换后下地时间、目测类比评分、Harris髋关节功能评分,进行对照研究,评价置换效果。结果与结论:(1)所有患者获得10-38个月的随访;(2)在手术切口长度、术中出血量、置换前后血红蛋白变化、置换后下地时间、置换后1周目测类比评分、置换后1,3个月Harris髋关节功能评分方面,2组差异均有显著性意义(P<0.05),试验组要优于对照组;(3)而在手术时间方面,试验组长于对照组(P<0.05);(4)在置换后3个月目测类比评分以及置换后6个月Harris评分方面,2组差异无显著性意义(P>0.05);(5)提示与后外侧入路相比,改良器械后利用普通一体柄人工双极股骨头Super PATH入路进行微创人工双极股骨头置换,具有切口小、损伤小、失血量少的优点,术后可快速恢复,即可减轻术后疼痛,又可缩短住院时间,方法可行。
BACKGROUND： Traditional posterolateral bipolar prosthetic replacement has a large incision and needs to cut the external rotator muscles, and the rehabilitation time is long. Super PATH has a small incision, is minimally invasive and articular capsule is retained, which can accelerate the rehabilitation, but needs expensive special equipments and prosthesis. It is feasible to popularize the modified artificial bipolar femoral head through Super PATH approach. OBJECTIVE： To compare the curative effectiveness between Super PATH approach and posterolateral approach with artificial bipolar femoral head, and to investigate the surgical technique and efficacy of modified artificial bipolar femoral head through Super PATH approach in the treatment of senile femoral neck fracture. METHODS： Sixty-two patients with senile femoral neck fracture admitted from March 2015 to June 2017 were randomly divided into trial（n=30） and control（n=32） groups. The trial group was treated with advanced instruments, conventional bipolar femoral head using Super PATH approach, and the control group was treated with conventional bipolar femoral head by posterolateral approach. The length of incision, operation time, intraoperative blood loss, change in hemoglobin, ambulation time, Visual Analogue Scale score and Harris Hip Score were compared to evaluate the curative efficacy. RESULTS AND CONCLUSION：（1） All patients were followed up for 10-38 months.（2） There was a significant difference in the incision length, intraoperative blood loss, hemoglobin before and after operation, ambulation time, Visual Analogue Scale score at 1 week postoperatively, and Harris Hip Score at postoperative 1 and 3 months between two groups（P 0.05）, and the trial group was better than the control group.（3） The operation time in the trial group was significantly longer than that in the control group（P 0.05）.（4） There was no significant difference in the Visual Analogue Scale score at 3 months postoperatively and Harris Hip Score at postoperative 6 months between two groups（P 0.05）.（5） These findings indicate that after the improvement, the common bipolar femoral head replacement performed by Super PATH approach in the treatment of senile femoral neck fracture has advantages of smaller incision, less trauma and less blood loss compared with the posterolateral approach, which alleviate postoperative pain and shorten hospitalization time. Therefore, it is recommended in clinical practice.
作者
夏良政
李胜华
袁中山
邓英虎
朱东起
叶文胜
许安平
余涛
黄德宁
Xia Liang-zheng;Li Sheng-hua;Yuan Zhong-shan;Deng Ying-hu;Zhu Dong-qi;Ye Wen-sheng;Xu An-ping;Yu Tao;Huang De-ning(Orthopedic Center,Tongling People’s Hospital,Tongling 244000,Anhui Province,Chin)
出处
《中国组织工程研究》
CAS
北大核心
2018年第19期2953-2960,共8页
Chinese Journal of Tissue Engineering Research
基金
铜陵市卫计委(卫科研[2014]08)~~
