| 章其祥,陈向阳,吴继彬,冯 硕,郭开今.直接前方入路与后外侧入路全髋关节置换治疗股骨颈骨折的疗效比较及术后髋关节功能的影响因素分析[J].,2023,(4):766-771 |
| 直接前方入路与后外侧入路全髋关节置换治疗股骨颈骨折的疗效比较及术后髋关节功能的影响因素分析 |
| Comparison of Efficacy of Direct Anterior Approach and Posterolateral Approach Total Hip Arthroplasty in the Treatment of Femoral Neck Fracture and Analysis of the Influencing Factors of Postoperative Hip Function |
| 投稿时间：2022-06-29 修订日期：2022-07-25 |
| DOI：10.13241/j.cnki.pmb.2023.04.032 |
| 中文关键词: 全髋关节置换 直接前方入路 后外侧入路 股骨颈骨折 疗效 影响因素 |
| 英文关键词: Total hip arthroplasty Direct anterior approach Posterolateral approach Femoral neck fracture Efficacy Influencing factors |
| 基金项目:江苏省卫生计生委面上项目（H2017081） |
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| 中文摘要: |
| 摘要 目的：比较直接前方入路与后外侧入路全髋关节置换治疗股骨颈骨折的疗效及术后髋关节功能的影响因素分析。方法：选取2019年5月至2021年12月徐州医科大学附属医院收治并行全髋关节置换治疗股骨颈骨折患者96例，按照手术方法的不同分为直接前方入路组（n=48）和后外侧入路组（n=48）。观察两组围术期指标、并发症发生情况，比较两组治疗前后Harris评分、视觉模拟评分法（VAS）。并应用单因素、多因素Logistic回归分析患者术后髋关节功能的影响因素。结果：直接前方入路组下床时间、切口长度、住院时间显著短于后外侧入路组，术中失血量、术后引流量显著低于后外侧入路组，而手术时间显著长于后外侧入路组（P<0.05）。直接前方入路组术后1、3个月Harris评分显著高于后外侧入路组，VAS评分显著低于后外侧入路组（P<0.05）。两组术后并发症发生率比较，无统计学差异（P＞0.05）。两组治疗6个月后髋关节功能优良率比较，差异无统计学意义（P>0.05）。多因素Logistic回归分析结果显示：体质量指数≥24 kg/m2、术后锻炼时间<3 h/d、合并骨质疏松是接受全髋关节置换治疗的股骨颈骨折患者术后髋关节功能不良的危险因素（P＜0.05）。结论：直接前方入路全髋关节置换术较后外侧入路全髋关节置换术短期内优势明显，表现为对患者的创伤更小，术后疼痛程度较轻，有利于患者的髋关节功能恢复。体质量指数≥24 kg/m2、术后锻炼时间<3 h/d、合并骨质疏松是接受全髋关节置换治疗的股骨颈骨折患者术后髋关节功能不良的危险因素。 |
| 英文摘要: |
| ABSTRACT Objective: To compare the efficacy of direct anterior approach and posterolateral approach total hip arthroplasty in the treatment of femoral neck fracture and analysis of the influencing factors of postoperative hip function. Methods: A total of 96 patients with femoral neck fracture who were treated with total hip arthroplasty in the Affiliated Hospital of Xuzhou Medical University from May 2019 to December 2021 were selected, and they were divided into direct anterior approach group (n=48) and posterolateral approach group (n=48) according to different surgical methods. Perioperative indicators and complications of the two groups were observed, and Harris score and visual analog scale (VAS) were compared between the two groups before and after treatment. The influencing factors of postoperative hip function were analyzed by univariate and multivariate Logistic regression. Results: The time to get out of bed, the length of incision and the length of hospital stay in the direct anterior approach group were significantly shorter than those in the posterolateral approach group, the intraoperative blood loss and postoperative drainage volume were significantly lower than those in the posterolateral approach group, and the operation time was significantly longer than that in the posterolateral approach group (P<0.05). Harris score at 1, 3 months after surgery in the direct anterior approach group was significantly higher than in the posterolateral approach group, and VAS score was lower than that in the posterolateral approach group (P<0.05). There was no significant difference in the incidence of postoperative complications between the two groups(P>0.05). There was no significant difference in the excellent and good rate of hip function between the two groups after 6 months of treatment(P>0.05). Multivariate Logistic regression analysis showed that body mass index ≥24 kg/m2, postoperative exercise time <3 h/d and combined with osteoporosis were the risk factors for postoperative hip dysfunction in patients with femoral neck fracture undergoing total hip replacement (P<0.05). Conclusion: The direct anterior approach total hip arthroplasty has obvious advantages over total hip arthroplasty with posterolateral approach in the short term, which is manifested as less trauma to patients and less postoperative pain, which is beneficial to the recovery of patients' hip function. Body mass index ≥24 kg/m2, postoperative exercise time <3 h/d, combined with osteoporosis are the risk factors for postoperative hip dysfunction in patients with femoral neck fracture undergoing total hip replacement. |
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