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.
Key words
Traction table /
/
/
Elderly /
/
/
Femoral neck fracture /
/
/
Direct anterior approach /
Hemiarthroplasty
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
References
[1] 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.
[2] Dolatowski FC, Frihagen F, Bartels S, et al. Screw fixation versus hemiarthroplasty for nondisplaced femoral neck fractures in elderly patients: a multicenter randomized controlled trial[J]. J Bone Joint Surg Am, 2019, 101(2): 136-144. DOI: 10.2106/JBJS.18.00316.
[3] 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(6): 678-682, 689. DOI: 10.13418/j.issn.1001-165x. 2018.06.016.
[4] 李骏然, 翟婧秀, 赵洪波, 等. 牵引床直接前侧入路人工全髋关节置换术的学习曲线分析[J]. 中国微创外科杂志, 2021, 21(11): 1024-1030. DOI:10.3969/j.issn.1009-6604.2021.11.014.
[5] Nakamura J, Hagiwara S, Orita S, et al. Direct anterior approach for total hip arthroplasty with a novel mobile traction table -a prospective cohort study[J]. BMC Musculoskelet Disord, 2017, 18(1): 49. DOI: 10.1186/s12891-017-1427-2.
[6] Matta JM, Shahrdar C, Ferguson T. Single-incision anterior approach for total hip arthroplasty on an orthopaedic table[J]. Clin Orthop Relat Res, 2005, 441: 115-124. DOI: 10.1097/01.blo. 0000194309.70518.cb.
[7] 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. DOI: 10.1016/j.arth.2008.04.012.
[8] Mahmood SS, Mukka SS, Crnalic S, et al. The influence of leg length discrepancy after total hip arthroplasty on function and quality of life: a prospective cohort study[J]. J Arthroplasty, 2015, 30(9): 1638-1642. DOI: 10.1016/j.arth.2015.04.012.
[9] Cui S, Wang D, Wang X, et al. The choice of screw internal fixation and hemiarthroplasty in the treatment of femoral neck fractures in the elderly: a meta-analysis[J]. J Orthop Surg Res, 2020, 15(1): 433. DOI: 10.1186/s13018-020-01958-2.
[10] 肖智青, 刘勇, 徐洲发, 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. DOI: 10.13418/j.issn.1001-165x.2017.04.021.
[11] 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.
[12] Sarraj M, Chen A, Ekhtiari S, et al. Traction table versus standard table total hip arthroplasty through the direct anterior approach: a systematic review[J]. Hip Int, 2020, 30(6): 662-672. DOI: 10.1177/11207000199 00987.
[13] 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(4): 387-390. DOI: 10.3760/cma.j.cn101202-20210329-00089.
[14]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.
[15]Hartford JM, Bellino MJ. The learning curve for the direct anterior approach for total hip arthroplasty: a single surgeon's first 500 cases[J]. Hip Int, 2017, 27(5): 483-488. DOI: 10.5301/hipint.5000488.
PDF(2719 KB)
