目的 探讨特制牵引床在直接前侧入路（direct anterior approach，DAA）半髋关节置换术治疗高龄股骨颈骨折中的应用价值。 方法 回顾性分析2018年9月~2019年12月我院行DAA半髋关节置换术治疗的高龄股骨颈骨折患者75例。根据术中是否使用牵引床，将患者分为A组（39例，牵引床DAA半髋关节置换术）和B组（36例，无牵引床DAA半髋关节置换术）。两组患者性别、年龄、骨折类型、骨折侧别等一般资料无统计学差异（P>0.05），具有可比性。对比分析两组患者手术指标、疗效、术后Harris髋关节功能评分以及并发症发生情况。 结果 A组术前准备时间明显长于B组，手术时间明显少于B组（P<0.05）。麻醉时间、术中出血量、切口长度两组无统计学差异（P>0.05）。A组股骨假体中心性固定率明显高于B组（P<0.05）。两组双侧肢体长度差小于10 mm比率，术后首次下床站立时间，术后使用助行器行走时间，术后独立行走时间以及术后1个月、1年的Harris评分无统计学差异（P>0.05）。A组并发症发生率为12.8%（5/39，股外侧皮神经损伤2例，大转子骨折2例，切口渗液1例），B组为19.4%（7/36，股外侧皮神经损伤3例，大转子骨折2例，切口渗液2例），P>0.05。 结论 特制牵引床辅助完成DAA半髋关节置换术治疗高龄股骨颈骨折疗效确切，可以缩短手术时间，提高股骨假体中心性固定率，但其术前准备时间较长。
Abstract
Objective To explore the clinical value of customized traction table in hemiarthroplasty through the direct anterior approach (DAA) for the treatment of femur neck fractures in elderly patients. Methods A retrospective analysis of 75 elderly patients with femur neck fractures treated with hemiarthroplasty through DAA were involved in our hospital from September 2018 to December 2019. According to with or without using the traction table, the patients were divided into two groups: Group A (39 cases, DAA hemiarthroplasty with assistance of traction table) and Group B (36 cases, DAA hemiarthroplasty without traction table). There was no significant difference in gender, age, Garden classification, fracture side and other general date between the two groups (P>0.05). The operation indexes, efficacy, postoperative Harris hip score and complications were compared between the two groups. Results Group A had longer preoperative preparation time and less operation time than Group B (P<0.05). There was no significant difference in anesthesia time, intraoperative blood loss and incision length between groups A and B (P>0.05). The central fixation ratio of femoral prosthesis in Group A was higher than that of Group B (P<0.05). The ratio of limb length discrepancy shortened than 10mm, time of first postoperative standing, time of first postoperative walking with crutch, time of first postoperative walking independently, and the Harris score in 1 month and 1 year after the operation were not significantly different (P>0.05). The complication rate was 12.8% (5/39) in Group A and 19.4% (7/36) in Group B (P>0.05). In Group A, lateral femoral cutaneous nerve injury was found in 2 patients, greater trochanteric fracture in 2, and incisional drainage in 1. In Group B, there were 3 patients with lateral femoral cutaneous nerve injury, 2 with greater trochanteric fracture, and 2 with incisional drainages. Conclusions For the treatment of femur neck fractures in elderly, hemiarthroplasty via DAA with assistance of customized traction table has remarkable effectiveness. It can significantly shorten the operation time and improve the central fixation ratio of femoral prosthesis, but it also can prolong the preoperative preparation time.
关键词
牵引床 /
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高龄 /
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股骨颈骨折 /
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直接前入路 /
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半髋置换术
Key words
Traction table /
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Elderly /
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Femoral neck fracture /
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Direct anterior approach /
Hemiarthroplasty
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参考文献
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