Comparison of the direct anterior and posterolateral piriformis-sparing approach in bipolar hemiarthroplasty for the elderly patients with femoral neck fracture
ZHANG Ying-jian，LI Zhi-yong，WU Shu-wen，FANG Guang-wen，SHANG Fu-qing，LIU Wei
Chinese Journal of Clinical Anatomy ›› 2018, Vol. 36 ›› Issue (6) : 678-682.
Comparison of the direct anterior and posterolateral piriformis-sparing approach in bipolar hemiarthroplasty for the elderly patients with femoral neck fracture
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.
Elderly patients / Femoral neck fracture / Bipolar hemiarthroplasty / Direct anterior approach / Posterolateral piriformis-sparing approach
[1] Boukebous B, Boutroux P, Zahi R, et al. Comparison of dual mobility total hip arthroplasty and bipolar arthroplasty for femoral neck fractures: a retrospective case-control study of 199 hips[J]. Orthop Traumatol Surg Res，2018，104(3):369-375.
[2] Dietrich M, Kabelitz M, Dora C，et al. Perioperative fractures in cementless total hip arthroplasty using the direct anterior minimally invasive approach: reduced risk with short stems[J]. J Arthroplasty，2018，33(2):548-554.
[3] van der Sijp MPL, van Delft D, Krijnen P，et al. Surgical approaches and hemiarthroplasty outcomes for femoral neck fractures: a meta-analysis[J]. J Arthroplasty，2018，33（5）: 1617-1627.
[4] Ainsworth BE, Haskell WL, Herrmann SD,et al. 2011 Compendium of Physical Activities: a second update of codes and MET values[J]. Med Sci Sports Exerc, 2011, 43(8):1575-1581.
[5] 祝宗华，郭涛，徐文联，等.微创后外侧入路全髋关节置换的应用解剖[J].中国临床解剖学杂志，2009, 27（6）：654-657.
[6] Söderman P, Malchau H. Is the Harris hip score system useful to study the outcome of total hip replacement[J]. Clin Orthop Relat Res，2001，384:189-197. （下转第689页）
（上接第682页）
[7] 肖智青，徐洲发，朱锦忠，等. 平卧位下改良前外侧入路人工全髋关节置换术的初步探讨[J]. 中国临床解剖学杂志，2017，35（4）：456-458.
[8] Schultz K, Ewbank ML, Pandit HG. Changing practice for hip arthroplasty and its implications[J]. Br J Nurs, 2017, 14, 26(22):1238-1244.
[9] Mayr E, Nogler M, Benedetti MG ,et al. A prospective randomized assessment of earlier functional recovery in THA patients treated by minimally invasive direct anterior approach:a gait analysis study[J]. Clin Biomech (Bristol，Avon). 2009 ，24（10）: 812-818.
[10] Nakata K, Nishikawa M, Yamamoto K, et al. A clinical comparative study of the direct anterior with mini-posterior approach: two consecutive series[J]. J Arthroplasty, 2009, 24(5): 698-704.
[11] Meneghini RM , Pagnano MW , Trousdale RT，et al. Muscle damage during MIS total hip arthroplasty: Smith-Peterson versus posterior approach[J]. Clin Orthop Relat Res, 2006, 453:293-298.
[12] Alexiou KI, Roushias A, Varitimidis SE, et al. Quality of life and psychological consequences in elderly patients after a hip fracture: a review[J]. Clin Interv Aging, 2018, 13:143-150.
[13] Taunton MJ, Mason JB, Odum SM, et al. Direct anterior total Hip arthroplasty yields more rapid voluntary cessation of all walking aids: a prospective, randomized clinical trial[J]. J Arthroplasty, 2014，29（9 suppl）:169-172.
[14] Renken F, Renken S, Paech A, et al. Early functional results after Hemiarthroplasty for femoral neck fracture: a randomized comparison between a minimal invasive and a conventional approach[J]. BMC Musculoskelet Disord, 2012，13:141.
/
| 〈 |
|
〉 |
