摘要
目的探讨微创直接前方入路(DAA)全髋关节置换术(THA)治疗股骨颈骨折(FNF)的临床效果。方法选择2018年2月至2019年12月梧州市工人医院收治的95例FNF患者为研究对象,所有患者行THA,根据手术入路方式将患者分为DAA组(n=50)和后外侧入路(PLA)组(n=45)。记录2组患者的手术时间、切口长度、术中出血量、术后引流量、术后首次下床时间、住院时间及术后并发症;术前及术后第2天,采用酶联免疫吸附法检测患者血清C反应蛋白(CRP)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)水平;术前及术后1、3、6个月,采用Berg平衡量表(BBS)评分评价患者的平衡功能,采用Harris髋关节评分(HHS)评估患者髋关节功能,并以术后3个月HHS评分判定患者临床疗效;术前及术后1个月,测量患者两侧下肢长度,计算两侧下肢长度差;术前及术后1周、1个月,采用视觉模拟评分法(VAS)评估患者的疼痛程度;2组患者分别于术中及术后3个月拍摄骨盆正位X线片,测量髋臼外展角、前倾角。结果2组患者手术时间比较差异无统计学意义(P>0.05);与PLA组比较,DAA组患者切口长度、术后首次下床时间和住院时间短,术中出血量和术后引流量少(P<0.05)。2组患者术前血清CRP、IL-6、TNF-α水平比较差异无统计学意义(P>0.05),2组患者术后血清CRP、IL-6、TNF-α水平均显著高于术前(P<0.05),DAA组患者术后血清CRP、IL-6、TNF-α水平显著低于PLA组(P<0.05)。术前2组患者两侧下肢长度差比较差异无统计学意义(P>0.05),2组患者术后1个月两侧下肢长度差均显著小于术前(P<0.05),2组患者术后1个月两侧下肢长度差比较差异无统计学意义(P>0.05)。2组患者术前VAS评分比较差异无统计学意义(P>0.05);2组患者术后1周、1个月时VAS评分显著低于术前(P<0.05),2组患者术后1个月时VAS评分显著低于术后1周(P<0.05),术后1周、1个月时,DAA组患者VAS评分显著低于PLA组(P<0.05)。2组患者术前HHS、BBS评分比较差异无统计学意义(P>0.05)。2组患者术后1、3、6个月时HHS、BBS评分显著高于术前(P<0.05);术后1、3、6个月,2组患者HHS、BBS评分逐渐升高(P<0.05),且DAA组患者HHS、BBS评分显著高于PLA组(P<0.05)。2组患者术中髋臼外展角、前倾角比较差异无统计学意义(P>0.05);2组患者术后3个月髋臼外展角小于术中,髋臼前倾角大于术中(P<0.05);术后3个月,DAA组患者髋臼外展角大于PLA组,髋臼前倾角小于PLA组(P<0.05)。DAA组和PLA组患者临床疗效优良率分别为88.00%(44/50)、71.11%(32/45),DAA组患者临床疗效优良率显著高于PLA组(P<0.05)。DAA组和PLA组患者术后并发症发生率分别为2.00%(1/50)、13.33%(6/45),DAA组患者术后并发症发生率显著低于PLA组(χ^(2)=4.457,P<0.05)。结论对于行THA的FNF患者,微创DAA具有创伤小、术后炎症反应和疼痛轻、髋关节功能恢复快等优势。
Objective To investigate the clinical effect of minimally invasive total hip arthroplasty(THA)through direct anterior approach(DAA)in the treatment of femoral neck fracture(FNF).Methods A total of 95 patients with FNF admitted to Wuzhou Workers′Hospital from February 2018 to December 2019 were selected as the research subjects.All patients underwent THA,and the patients were divided into the DAA group(n=50)and posterolateral approach(PLA)group(n=45)according to the operative approach.The operation time,incision length,intraoperative bleeding volume,postoperative drainage volume,postoperative first out of bed time,hospitalization time and postoperative complications were recorded.The levels of serum C-reactive protein(CRP),interleukin-6(IL-6)and tumor necrosis factor-α(TNF-α)were detected by enzyme-linked immunosorbent assay(ELISA)before and two days after operation.The balance function of the patients was evaluated by Berg balance scale(BBS)and the hip function was evaluated by Harris hip score(HHS)before and 1,3,6 months after the operation.The clinical efficacy was evaluated by HHS score at three months after operation.The length of both lower extremities was measured before and one month after operation,and the difference of the both lower extremities length was calculated.The pain of patients was evaluated by visual analogue scale(VAS)before and one week and one month after operation.The patients in the two groups received pelvis positive X-ray films during operation and three months after operation,and the acetabular abduction angle and anteversion angle were measured.Results There was no significant difference in the operation time between the two groups(P>0.05).Compared with PLA group,the patients in the DAA group had shorter incision length,first out of bed time and hospitalization time,and had less intraoperative bleeding volume and postoperative drainage volume(P<0.05).There was no significant difference in the levels of serum CRP,IL-6 and TNF-αbetween the two groups before operation(P>0.05).The levels of serum CRP,IL-6 and TNF-αafter operation were significantly higher than those before operation in the two groups(P<0.05).The levels of serum CRP,IL-6 and TNF-αin the DAA group were significantly lower than those in the PLA group after operation(P<0.05).There was no significant difference in the difference of both lower extremity length between the two groups before operation(P>0.05).The difference of both lower extremity length at one month after operation was significantly less than that before operation(P<0.05).There was no significant difference in the difference of both lower extremity length between the two groups at one month after operation(P>0.05).There was no significant difference in the VAS score between the two groups before operation(P>0.05).The VAS score at one week and one month after operation were significantly lower than that before operation in the two groups(P<0.05).The VAS score at one month after operation was significantly lower than that at one week after operation in the two groups(P<0.05).The VAS score in the DAA group was significantly lower than that in the PLA group at one week and one month after operation(P<0.05).There was no significant difference in the HHS and BBS scores between the two groups before operation(P>0.05).The scores of HHS and BBS at one,three and six months after operation were significantly higher than those before operation in the two groups(P<0.05).At one,three and six months after operation,the HHS and BBS scores in the two groups increased gradually(P<0.05),and the HHS and BBS scores in the DAA group were significantly higher than those in the PLA group(P<0.05).There was no significant difference in the intraoperative abduction angle and anteversion angle between the two groups(P>0.05).At three months after operation,the acetabular abduction angle decreased and the anteversion angle increased in the both groups(P<0.05).The acetabular abduction angle in the DAA group was larger than that in the PLA group,and the anteversion angle in the DAA group was smaller than that in the PLA group at three months after operation(P<0.05).The fineness rate of clinical efficacy in the DAA group and PLA group was 88.00%(44/50)and 71.11%(32/45),respectively.The fineness rate of clinical efficacy in the DAA group was significantly higher than that in the PLA group(P<0.05).The incidence of postoperative complications in the DAA group and PLA group was 2.00%(1/50)and 13.33%(6/45),respectively.The incidence of postoperative complications in the DAA group was significantly lower than that in the PLA group(χ^(2)=4.457,P<0.05).Conclusion The DAA has the advantages of less trauma,less postoperative inflammatory reaction and pain,and faster recovery of hip function in the patients with FNF who underwent minimally invasive THA.
作者
周树权
袁富锋
陈雪飞
梁幕华
蒋劲松
ZHOU Shuquan;YUAN Fufeng;CHEN Xuefei;LIANG Muhua;JIANG Jinsong(Department of Osteology,Wuzhou Workers′Hospital,Wuzhou 543001,Guangxi Province,China)
出处
《新乡医学院学报》
CAS
2021年第7期657-661,665,共6页
Journal of Xinxiang Medical University
关键词
股骨颈骨折
全髋关节置换术
微创手术
直接前方入路
后外侧入路
femoral neck fracture
total hip arthroplasty
minimally invasive surgery
direct anterior approach
posterolateral approach
