摘要
目的:探讨不同入路全髋关节置换术治疗GardenⅢ、Ⅳ型股骨颈骨折效果及对肌肉组织损伤、骨代谢的影响。方法:选择济宁市第二人民医院2018年1月-2020年6月收治的股骨颈骨折行全髋关节置换术(THA)的患者93例,按照手术方式不同将患者分为DAA组45例与PLA组48例,DAA组给予直接前入路THA,PLA组采用后外侧入路THA。比较两组手术相关指标、疼痛及髋关节功能评分、并发症发生情况、肌肉组织损伤及骨代谢指标。结果:与PLA组比较,DAA组手术时间更长、术中出血量更少、切口长度更短,差异均有统计学意义(P<0.05),两组髋臼前倾角及髋臼外展角比较,差异均无统计学意义(P>0.05)。两组术前视觉模拟评分(VAS)及Harris评分比较,差异均无统计学意义(P>0.05);两组术后VAS评分及Harris评分均优于术前,差异均有统计学意义(P<0.05);术后1、3 d,DAA组VAS评分均低于PLA组(P<0.05);术后2周及3个月,DAA组Harris评分均高于PLA组(P<0.05),术后6个月两组Harris评分比较,差异无统计学意义(P>0.05)。两组并发症发生率比较,差异无统计学意义(P>0.05)。两组术前肌酸激酶(CK)、C反应蛋白(CRP)比较,差异均无统计学意义(P>0.05),术后1、3 d,两组CK、CRP较术前均明显升高,且PLA组均高于DAA组,差异均有统计学意义(P<0.05)。两组术前Ⅰ型前胶原氨基前肽(PINP)、Ⅰ型前胶原羧基端肽(PICP)及抗酒石酸酸性磷酸酶-5b(TRACP-5b)比较,差异均无统计学意义(P>0.05),术后3个月两组PINP、PICP、TRACP-5b均优于术前,且DAA组均优于PLA组,差异均有统计学意义(P<0.05)。结论:直接前入路全髋关节置换术治疗GardenⅢ、Ⅳ型股骨颈骨折有利于髋关节功能早期恢复,减少患者疼痛及肌肉组织损伤,改善患者骨代谢。
Objective:To investigate the effect of different approaches of total hip arthroplasty in the treatment of Garden typeⅢandⅣfemoral neck fractures and its influence on muscle tissue injury and bone metabolism.Method:A total of 93 patients with femoral neck fracture who underwent total hip arthroplasty(THA)in Jining NO.2 People’s Hospital from January 2018 to June 2020 were selected and divided into DAA group(n=45)and PLA group(n=48)according to different operation methods.DAA group was given direct anterior approach THA and PLA group was given posterolateral approach THA.The operation related indexes,pain and hip function scores,complications,muscle tissue injury and bone metabolism indexes were compared between the two groups.Result:Compared with PLA group,the operation time was longer,the amount of intraoperative bleeding was less and the length of incision was shorter in DAA group,the differences were statistically significant(P<0.05),but there were no significant differences in acetabular anteversion and abduction angle between the two groups(P>0.05).There were no significant differences in preoperative VAS score and Harris score between the two groups(P>0.05);the postoperative visual analogue scale(VAS)scores and Harris scores of the two groups were better than those before operation,and the differences were statistically significant(P<0.05);the VAS scores of DAA group were lower than those of PLA group 1 and 3 days after operation(P<0.05);the Harris scores of DAA group were higher than those of PLA group at 2 weeks and 3 months after operation(P<0.05),there was no significant difference in Harris score between the two groups at 6 months after operation(P>0.05).There was no significant difference in the incidence of complications between the two groups(P>0.05).There were no significant differences in creatine kinase(CK)and C-reactive protein(CRP)between the two groups before operation(P>0.05),but CK and CRP were significantly increased in the two groups 1 and 3 days after operation,and those of PLA group were higher than those of DAA group(P<0.05).There were no significant differences in N-terminal peptide of typeⅠprocollagen(PINP),carboxyl terminal propeptide of typeⅠprocollagen(PICP)and tartrate resistant acid phosphatase-5b(TRACP-5b)between the two groups before operation(P>0.05),3 months after operation,PINP,PICP and TRACP-5b in the two groups were better than those before operation,and those of DAA group were better than those of PLA group,the differences were statistically significant(P<0.05).Conclusion:Direct anterior total hip arthroplasty in the treatment of Garden typeⅢandⅣfemoral neck fractures is conducive to early recovery of hip function,reduce pain and muscle tissue damage,and improve bone metabolism.
作者
崔涛
唐绪军
CUI Tao;TANG Xujun(Rencheng District People’s Hospital of Jining,Shandong Province,Jining 272100,China;不详)
出处
《中国医学创新》
CAS
2022年第7期68-72,共5页
Medical Innovation of China
关键词
全髋关节置换术
股骨颈骨折
直接前入路
骨代谢
Total hip arthroplasty
Femoral neck fracture
Direct anterior approach
Bone metabolism
