摘要
目的分析前外侧与后外侧入路小切口髋关节置换术对创伤性股骨颈骨折患者疼痛、髋关节恢复的影响。方法我院84例行髋关节置换术治疗的创伤性股骨颈骨折患者,其中经前外侧入路小切口手术者45例(前外侧组),经后外侧入路小切口手术者39例(后外侧组)。记录两组手术相关指标、术后并发症发生情况,比较两组术前及术后1、12周疼痛程度、骨代谢指标差异,并评估两组术前及术后6、12、24周髋关节功能恢复情况。结果前外侧组切口长度、术中出血量、术后引流量及住院时间均低于后外侧组,手术时间高于后外侧组(P<0.05)。两组术后并发症发生情况比较,差异无统计学意义(P>0.05)。两组手术前后血清I型前胶原氨基前肽(PINP)、Ⅰ型前胶原羧基端肽(PICP)比较,均为术前<术后12周<术后1周,且术后1周时,前外侧组血清PINP、PICP高于后外侧组(P<0.05);两组手术前后血清β胶原降解产物(β-CTx)比较,术前>术后12周>术后1周;目测类比评分法(VAS)比较,术前>术后1周>术后12周,且术后1周时,前外侧组VAS评分及血清β-CTx低于后外侧组(P<0.05);术后12周时,两组VAS评分及血清PINP、PICP、β-CTx比较,差异无统计学意义(P>0.05)。两组手术前后髋关节Harris功能评分(HHS)比较,术前<术后6周<术后12周<术后24周,且术后6周时,前外侧组HHS评分高于后外侧组(P<0.05),术后12、24周时,两组HHS评分比较,差异无统计学意义(P>0.05)。结论2种入路小切口髋关节置换术治疗创伤性股骨颈骨折效果均较好,但前外侧入路术后早期恢复快,后外侧入路手术时间短,临床可根据实际情况选择合适的入路。
Objective To analyze the effects of mini-incision hip replacement with anterolateral approach or posterolateral approach on pain and hip joint recovery in patients with traumatic femoral neck fracture.Methods The clinical data of 84 patients with traumatic femoral neck fracture who were treated with hip replacement in our hospital were retrospectively analyzed.Among them,45 patients underwent anterolateral approach mini-incision surgery(anterolateral group),and 39 patients were treated with posterolateral approach mini-incision surgery(posterolateral group).The surgery-related indexes and occurrence of postoperative complications were recorded.The pain level estimated by visual analogue score(VAS)and bone metabolism indicators such as type I procollagen amino propeptide(PINP),type I procollagen carboxy terminal peptide(PICP)andβ-collagen degradation product(β-CTx)were compared between the two groups before surgery and after 1 week and 12 weeks of surgery.The hip joint function recovery estimated by Hip Harris Function Score(HHS)was evaluated in the two groups before and after 6,12 and 24 weeks of surgery.Results The incision length,intraoperative blood loss,postoperative drainage volume and hospital stay in the anterolateral group were lower or shorter(P<0.05),and the operative time was longer than those in the posterolateral group(P<0.05).There were no statistically significant differences in the occurrence of postoperative complications between the two groups(P>0.05).Serum PINP and PICP were preoperative<12 weeks<1 week after operation in both groups(P<0.05)and after 1 week of surgery,the serum PINP and PICP in the anterolateral group were higher than those in the posterolateral group(P<0.05).Serumβ-CTx was preoperative>12 weeks>1 week after operation in both groups(P<0.05).The VAS score was preoperative>1 week>12 weeks after surgery(P<0.05),and after 1 week of surgery,the VAS score and serumβ-CTx in the anterolateral group were lower than those in those in the posterolateral group(P<0.05).After 12 weeks of surgery,there were no significant differences in the VAS score and serum PINP,PICP andβ-CTx between the two groups(P>0.05).HHS score in the two groups was preoperative<6 weeks<12 weeks after surgery<24 weeks after surgery(P<0.05).After 6 weeks of surgery,the HHS score in the anterolateral group was higher than that in the posterolateral group(P<0.05).After 12 weeks and 24 weeks of surgery,there was no significant difference in HHS score between the two groups(P>0.05).Conclusion The two types of mini-incision hip replacement are effective in treating traumatic femoral neck fracture,but anterolateral approach has faster early postoperative recovery and posterolateral approach has shorter operative time.Either clinical approach can be selected according to the actual situation.
作者
赵发云
唐维才
苏万富
ZHAO Fa-yun;TANG Wei-cai;SU Wan-fu(Department of Orthopaedics,Hospital of Integrated Traditional Chinese and Western Medicine,Liangshan Yi Autonomous Prefecture,Xichang 615000,China)
出处
《实用医院临床杂志》
2020年第5期83-86,共4页
Practical Journal of Clinical Medicine
关键词
髋关节置换术
前外侧入路
后外侧入路
创伤性股骨颈骨折
髋关节功能
Hip replacement
Anterolateral approach
Posterolateral approach
Traumatic femoral neck fracture
Hip joint function
