摘要
目的 探讨采用SuperPATH入路手术治疗老年髋部骨折的可行性及近期疗效。方法 回顾性分析2015年9月至2017年12月采用SuperPATH入路手术治疗的46例老年髋部骨折患者临床资料,其中40例股骨颈骨折行髋关节置换术(股骨颈骨折组),6例股骨粗隆间骨折行髓内钉内固定(股骨粗隆间骨折组)。记录手术切口长度、手术时间、术中出血量、术后输血量、下床时间、骨折愈合时间、并发症发生情况等。结果 股骨颈骨折组切口长度6~8cm,平均(7.83±0.54)cm,手术时间50~145min,平均(91.10±26.85)min,术中出血量20~300 mL,平均(92.75±66.33)mL,术后输血量0~800mL,平均(137.50±239.47)mL,术后X线片上测得的股骨柄假体前倾角8°~17°,平均11.32°±2.56°,下床时间1~2d,平均(1.30±0.46)d。股骨粗隆间骨折组切口长度均为6cm,手术时间90~165min,平均(118.33±24.27)min,术中出血量20~300mL,平均(113.33±101.60)mL,术后输血量0~900mL,平均(150.00±180.28)mL,下床时间4~7d,平均(5.67±1.21)d,术后骨折愈合时间9~12周,平均(10.83±1.37)周。所有患者均无感染、脱位、血管神经损伤或深静脉栓塞等并发症发生。所有患者均获得随访,随访时间33~60个月,平均(47.67±8.48)个月。股骨颈骨折组患者术后平均4周可脱拐行走,步态基本正常。股骨粗隆间骨折组患者术后4周可部分负重活动,术后12周X线片显示骨折线模糊及骨痂生长,髋关节功能恢复良好。末次随访时,所有患髋均获得良好功能,Harris髋关节功能评分优良率达100%。结论 采用SuperPATH入路手术治疗老年髋部骨折安全可行,SuperPATH入路具有手术过程微创、疼痛轻、并发症少、可早期下地活动、功能恢复快等优点。
Objective To investigate the feasibility and short-term efficacy of the SuperPATH approach for treatment of elderly hip fractures.Methods From September 2015 to December 2017,46 cases of hip fractures were treated surgically through the SuperPATH approach.Among them,40 cases of elderly femoral neck fractures underwent joint replacement;6 elderly patients with intertrochanteric femoral fractures were internally fixed with intramedullary nails.The incision length,operation duration,intraoperative blood loss,postoperative blood transfusion,ambulation time,fracture union time and complications were recorded.Results In the hip joint replacement group,the incision length was 6 to 8(7.83±0.54)cm,the operation duration was 50 to 145(91.10±26.85)min,intraoperative blood loss was 20 to 300(92.75±66.33)mL,postoperative blood transfusion was 0 to 800(137.50±239.47)mL,the average anteversion angle of femoral stem prosthesis measured by X-ray film after operation was 8°to 17°(11.32°±2.56°),the ambulation time was 1 to 2(1.30±0.46)days.In the intramedullary nail group,the incision length was 6(6.00±0.00)cm,the operation duration was 90 to 165(118.33±24.27)min,intraoperative blood loss was 20 to 300(113.33±101.60)mL,postoperative blood transfusion was 0 to 900(150.00±180.28)mL,the ambulation time was 4 to 7(5.67±1.21)days,and the postoperative fracture union time was 9 to 12(10.83±1.37)weeks.There were no complications such as infection,dislocation,vascular nerve injury or deep vein thrombosis in both groups.All 46 cases were followed up for 33 to 60(47.67±8.48)months.Patients suffering femoral neck fractures can walk on crutches at an average of 4 weeks after joint replacement,and the gait was basically normal.Those suffering intertrochanteric fractures can be allowed for partially weight-bearing activities 4 weeks after surgery.X-rays at 12 weeks showed that the fracture lines were blurred with callus,and the hip joint function was recovered well.At the last follow-up,the affected hips achieved good function,and the excellent and good rate of Harris scores reached 100%.Conclusion The SuperPATH approach is safe and feasible for elderly hip fractures.It has the advantages of minimally invasive surgery,less pain,less complications,early ambulation,and faster functional recovery.
作者
汪康
李胜华
邓英虎
夏良政
WANG Kang;LI Shenghua;DENG Yinghu;XIA Liangzheng(Department of Orthopaedics, Tongling People′s Hospital, Tongling 244000, China)
出处
《国际骨科学杂志》
2021年第3期171-176,共6页
International Journal of Orthopaedics
基金
铜陵市卫计委科研项目(卫科研[2014]08)。
