牵引床辅助直接前侧入路半髋关节置换术的并发症分析

李骏然, 李冬梅, 翟婧秀, 杨海涛, 刘弘扬, 梁俊生, 李力更

中国临床解剖学杂志 ›› 2024, Vol. 42 ›› Issue (4) : 468-471.

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中国临床解剖学杂志 ›› 2024, Vol. 42 ›› Issue (4) : 468-471. DOI: 10.13418/j.issn.1001-165x.2024.4.19
临床研究

牵引床辅助直接前侧入路半髋关节置换术的并发症分析

  • 李骏然1,2,    李冬梅2,    翟婧秀2,    杨海涛1,    刘弘扬1,    梁俊生1,    李力更1,2*
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Complications analysis of hemiarthroplasty through direct anterior approach assisted by the traction table 

  • Li Junran1,2, Li Dongmei2, Zhai Jingxiu2, Yang Haitao1, Liu Hongyang1, Liang Junsheng1, Li Ligeng1,2*
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摘要

目的    探讨牵引床辅助直接前侧入路半髋关节置换术治疗高龄老年股骨颈骨折的并发症及防治方法。  方法    回顾性分析2019年6月至2021年8月采用牵引床辅助DAA-HA治疗的196例高龄股骨颈骨折患者临床资料。分析患者并发症的发生原因、治疗方法及预后。  结果    所有患者平均随访时间21.6个月(12~30个月),发生并发症25例。其中11例(5.6%)发生股外侧皮神经损伤,6例(3.1%)切口渗液,5例(2.6%)假体周围骨折,3例(1.5%)双下肢不等长。随访期内,未发生假体脱位、假体松动、感染等其他并发症。  结论    牵引床辅助DAA-HA治疗高龄老年股骨颈骨折过程中存在股外侧皮神经损伤、切口渗液、假体周围骨折、双下肢不等长等并发症。规范手术操作流程,提升手术技术,重视患者病情及术后康复过程可减少并发症的发生。

Abstract

Objective    To explore the complications and prevention methods of hemiarthroplasty(HA) through direct anterior approach(DAA) assisting by the traction table for the treatment of femur neck fractures in elderly patients.    Methods    A The clinical data  of 196 elderly patients with femur neck fractures treated with HA through DAA were retrospectively analyzed  in our hospital from June 2019 to August 2021. The causes, treatment and prognosis of complications were analyzed in each case.    Results    All patients were followed up for 12 to 30 months, averagely 21.6 months, and complications were occurred in 25 cases. Among them, 11 cases (5.6%) had lateral femoral cutaneous nerve (LFCN) injury, 6 cases (3.1%) had incisional oozing, 5 cases (2.6%) had periprosthetic fractures, 3 cases (1.5%) had limb length discrepancy. There was no dislocation, prosthesis loosening, infection or other complications during the follow-ups.    Conclusions    There are many complications such as LFCN injury, incisional oozing, periprosthetic fracture, limb length discrepancy during the treatment of femoral neck fractures in elderly with DAA-HA by assistance of the traction table. Standardization of surgical procedures, improving the surgical technique, paying attention to patient's condition and rehabilitation can reduce its complications.

关键词

并发症 /   /   / 直接前入路 /   /   / 半髋置换术 /   /   / 高龄 /   /   / 股骨颈骨折 /   /   / 牵引床

Key words

  / Complications /   /   / Direct anterior approach /   /   / Hemiarthroplasty /   /   / Elderly /   /   / Femoral neck fracture /   /   / Traction table

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导出引用
李骏然, 李冬梅, 翟婧秀, 杨海涛, 刘弘扬, 梁俊生, 李力更. 牵引床辅助直接前侧入路半髋关节置换术的并发症分析[J]. 中国临床解剖学杂志. 2024, 42(4): 468-471 https://doi.org/10.13418/j.issn.1001-165x.2024.4.19
Li Junran, Li Dongmei, Zhai Jingxiu, Yang Haitao, Liu Hongyang, Liang Junsheng, Li Ligeng. Complications analysis of hemiarthroplasty through direct anterior approach assisted by the traction table [J]. Chinese Journal of Clinical Anatomy. 2024, 42(4): 468-471 https://doi.org/10.13418/j.issn.1001-165x.2024.4.19
中图分类号: R683.42   

参考文献

[1]  张英剑, 李志永, 吴树文, 等. 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[J]. 中国临床解剖学杂志, 2018, 36(06): 678-682, 689. DOI: 10.13418/j.issn.1001-165x. 2018. 06.016.
[2]  Fischer H, Maleitzke T, Eder C, et al. Management of proximal femur fractures in the elderly: current concepts and treatment options[J]. Eur J Med Res, 2021, 26(1): 86. DOI: 10.1186/s40001-021-00556-0.
[3] Rogmark C, Leonardsson O. Hip arthroplasty for the treatment of displaced fractures of the femoral neck in elderly patients[J]. Bone Joint J, 2016, 98b(3): 291-297. DOI: 10.1302/0301-620X.98B3.36515.
[4] 李骏然, 梁俊生, 李冬梅, 等. 特制牵引床在直接前侧入路半髋关节置换术中的应用[J]. 中国临床解剖学杂志, 2023, 41(03): 349-353, 359. DOI: 10.13418/j.issn.1001-165x.2023.3.17.
[5] Rivera F, Comba L C, Bardelli A. Direct anterior approach hip arthroplasty: How to reduce complications - A 10-years single center experience and literature review[J]. World J Orthop, 2022, 13(4): 388-399. DOI: 10.5312/wjo.v13.i4.388.
[6] Rudin D, Manestar M, Ullrich O, et al. The Anatomical Course of the Lateral Femoral Cutaneous Nerve with Special Attention to the Anterior Approach to the Hip Joint[J]. J Bone Joint Surg Am, 2016, 98(7): 561-567. DOI: 10.2106/JBJS.15.01022.
[7]  周宏博, 罗正亮, 陈敏, 等. 全髋关节置换术直接前入路改良切口与股外侧皮神经损伤的解剖学研究[J]. 中华解剖与临床杂志, 2021, 26(04): 387-390. DOI: 10.3760/cma.j.cn101202-20210329-00089.
[8] Ozaki Y, Baba T, Homma Y, et al. Preoperative ultrasound to identify distribution of the lateral femoral cutaneous nerve in total hip arthroplasty using the direct anterior approach[J]. Sicot j, 2018, 4: 42. DOI: 10.1051/sicotj/2018037.
[9]  Homma Y, Baba T, Sano K, et al. Lateral femoral cutaneous nerve injury with the direct anterior approach for total hip arthroplasty[J]. Int Orthop, 2016, 40(8): 1587-1593. DOI: 10.1007/s00264-015-2942-0.
[10] Barnett SL, Peters DJ, Hamilton WG, et al. Is the Anterior Approach Safe? Early Complication Rate Associated With 5090 Consecutive Primary Total Hip Arthroplasty Procedures Performed Using the Anterior Approach[J]. J Arthroplasty, 2016, 31(10): 2291-2294. DOI: 10.1016/j.arth.2015.07.008.
[11] Jewett BA, Collis DK. High complication rate with anterior total hip arthroplasties on a fracture table[J]. Clin Orthop Relat Res, 2011, 469(2): 503-507. DOI: 10.1007/s11999-010-1568-1.
[12] 郭文利, 晋陶然, 李昊, 等. 直接前入路髋关节置换前100例并发症分析[J]. 中国骨与关节杂志, 2017, 6(09): 649-654. DOI: 10.3969/j.issn.2095-252X.2017.09.003.
[13] Meneghini RM, Pagnano MW, Trousdale RT, et al. Muscle damage during MIS total hip arthroplasty: Smith-Petersen versus posterior approach[J]. Clin Orthop Relat Res, 2006, 453: 293-298. DOI: 10.1097/01.blo.0000238859.46615.34.
[14] Mihalko WM, Phillips MJ, Krackow KA. Acute sciatic and femoral neuritis following total hip arthroplasty. A case report[J]. J Bone Joint Surg Am, 2001, 83(4): 589-592. DOI: 10.2106/00004623-200104000-00017.
[15] Moslemi A, Kierszbaum E, Descamps J, et al. Does using the direct anterior approach with a standard table for total hip arthroplasty reduce leg length discrepancies? Comparative study of traction table versus standard table[J]. Orthop Traumatol Surg Res, 2021, 107(1): 102752. DOI: 10.1016/j.otsr.2020.102752.

基金

河北省自然科学基金青年项目(H2024105002);河北省医学科学研究课题计划(20221741)

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