直接前入路和微创后外侧入路人工股骨头置换术治疗高龄股骨颈骨折患者的疗效比较

doi:10.13418/j.issn.1001-165x.2018.06.016

Abstract

Abstract:

Objective　The aim of this study is to compare the clinical efficacy after bipolar hemiarthroplasty（BHA） via the direct anterior approach（DAA）or posterolateral piriformis-sparing approach（Mis-PLA） following the elderly patients with femoral neck fracture.　Methods　44 elderly patients with femoral neck fracture were divided into a DAA group (n =22) and a Mis-PLA group (n=22) according to the surgical approach. The two groups of patients were followed up for 2 years after the operation. The clinical data，postoperative pain and complications，the time to keep the seat for 1 hour and walking independently，the postoperative Harris score of functional activity in 6 weeks and 2 years and the death rate of patients 2 years after operation were compared between the two groups.　Results　（1）Compared with the Mis-PLA group, the patients in group DAA had longer surgical duration, but the number of patients with pneumonia 72 hours after the operation was less，the VAS score of DAA patients decreased after 24 hours of operation, and the time of keeping the seat for 1 hour and walking independently was earlier than that of the Mis-PLA group (P < 0.05).（2）6 weeks after the operation, the Harris score of Climbing stairs and wearing socks and shoelaces in the DAA group was better than that in the Mis-PLA group (P < 0.05), but there was no statistical difference in the Harris score of the staircase (P >0.05). After 2 years, there was no significant difference in Harris scores between the two groups (P>0.05).（3）After 2 years of follow-up, there was no significant difference in mortality between the 2 groups (P>0.05).　Conclusions　In the elderly patients with femoral head replacement, DAA approach can be more effective than Mis-PLA approach for reducing the incidence of complications associated with long-term bed rest, relieving postoperative pain, and improving the postoperative hip function.

Key words: Elderly patients, Femoral neck fracture, Bipolar hemiarthroplasty, Direct anterior approach, Posterolateral piriformis-sparing approach

ZHANG Ying-jian，LI Zhi-yong，WU Shu-wen，FANG Guang-wen，SHANG Fu-qing，LIU Wei. Comparison of the direct anterior and posterolateral piriformis-sparing approach in bipolar hemiarthroplasty for the elderly patients with femoral neck fracture[J]. Chinese Journal Of Clinical Anatomy, 2018, 36(6): 678-682.

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Comparison of the direct anterior and posterolateral piriformis-sparing approach in bipolar hemiarthroplasty for the elderly patients with femoral neck fracture

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