Effect of total hip arthroplasty between SuperPATH approach and posterolateral approach on clinical efficacy, fracture healing and joint function in patients with traumatic femoral neck fracture
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摘要:
目的探讨SuperPATH入路与后外侧入路治疗对创伤性股骨颈骨折患者临床疗效、骨折愈合及关节功能的影响，以探讨治疗创伤性股骨颈骨折的较为理想的方法。 方法分析2017年6月~2019年6月我院因创伤性股骨颈骨折手术的病例并归列为两组：后外侧入路全髋关节置换术（对照组，n=42）和SuperPATH入路全髋关节置换术（观察组，n=54），术后采用髋关节功能Harris评分评价两组关节功能，同时对两组临床疗效[手术时间、术中出血量、总失血量、手术切口长度、术后住院时间、骨折愈合所需时间、疼痛情况、血红蛋白（Hb）、红细胞压积、C-反应蛋白（CRP）、红细胞沉降率（ESR）及肌酸激酶等]进行比较，组间比较行t检验。 结果两组患者在术中出血、总失血量及术后住院时间的差异无统计学意义（P > 0.05），但观察组患者手术时间较对照组长，而手术切口长度及骨折愈合所需时间均短于对照组（P < 0.05）；两组患者术前Hb、红细胞压积、CRP、ESR及肌酸激酶比较差异无统计学意义（P > 0.05）；但术后两组患者Hb、红细胞压积均较术前降低，而CRP、ESR及肌酸激酶均较术前升高，且术后两组患者Hb、红细胞压积、CRP、ESR比较差异无统计学意义（P > 0.05），但观察组肌酸激酶低于对照组（P < 0.05）；两组患者术前VAS和Harris评分比较差异无统计学意义（P > 0.05），术后3 d和14 d两组患者VAS平均均较术前降低，Harris评分均较术前升高，且术后3d观察组VAS显著低于对照组，Harris评分较对照组明显升高，差异有统计学意义（P < 0.05），而术后14 d两组VAS及Harris评分差异无统计学意义（P > 0.05）；两组均未出现并发症及假体下沉、松动。末次随访观察组活力、躯体功能、社会功能及总体健康评分均显著高于对照组患者，比较差异间具有统计学意义（P < 0.05）。 结论SuperPATH入路全髋关节置换术治疗创伤性股骨颈骨折患者较后外侧入路比较而言，更有利于减轻患者术后早期疼痛和肌肉损害，可明显改善患者早期髋关节功能和预后恢复，且具有一定的安全性，值得临床推广使用。 -
关键词:
- SuperPATH入路 /
- 后外侧入路 /
- 创伤性股骨颈骨折 /
- 全髋关节置换术 /
- 临床价值
Abstract:ObjectiveTo explore the effect of total hip arthroplasty between Super PATH approach and posterolateral approach on clinical efficacy, fracture healing and joint function in patients with traumatic femoral neck fracture. MethodsThe patients with surgey for traumatic femoral neck fracture in this hospital from June 2017 to June 2019 were analyzed and classified into two groups: total hip arthroplasty through posterolateral approach (referred to as control group) (n=42), and total hip arthroplasty through SuperPATH approach (referred to as observation group)(n=54). The Harris score of hip function was used to evaluate the joint function of patients in the two groups after surgey. The clinical effects between the two groups [operation time, intraoperative blood loss, total blood loss, length of surgical incision, postoperative hospitalization time, time required for fracture healing, pain, hemoglobin (Hb), hematocrit, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and creatine kinase] were statistically analyzed. The t test was used for comparison between groups. ResultsThere was no difference in intraoperative blood loss, total blood loss and postoperative hospitalization time between two groups. However, the operation time of the observation group was longer than that of the control group, and the length of the surgical incision and the time required for fracture healing were significantly shorter than those of the control group, and the differences were statistically significant (P < 0.05). There was no significant difference in preoperative Hb, hematocrit, CRP, ESR and creatine kinase of patients between the two groups (P > 0.05). However, after operation, Hb and hematocrit decreased in both groups, while CRP, ESR and creatine kinase increased. There was no difference of Hb, hematocrit, CRP and ESR between the two groups after operation, but the level of creatine kinase in the observation group was significantly lower than that in the control group (P < 0.05). There were no significant differences of preoperative VAS and Harris scores between the two groups (P > 0.05). 3 days and 14 days after operation, the average VAS of two groups was lower than that before surgery, and the Harris score was higher than that before surgery. The VAS of the observation group 3 days after surgery was significantly lower than that of the control group, and the Harris score was significantly higher than that of the control group (P < 0.05). There was no significant difference in the VAS and Harris scores 14 days after surgery between two groups (P > 0.05). There were no complications and the sinking and loosening of the prosthesis in both groups. In the final follow-up, the scores in vitality, physical function, social function and overall health of the observation group were significantly higher than those of the control group (P < 0.05). ConclusionCompared with the posterolateral approach, SuperPATH approach of total hip arthroplasty is more effective in the treatment of patients with traumatic femoral neck fractures, which can reduce early postoperative pain and muscle damage. It can significantly improve early hip function and recovery of prognosis. -
图 1 创伤性股骨颈骨折术前
A: 术前骨盆正位片图; B: 术前髋关节正位片; C: 术前髋关节侧位片.
Figure 1. Preoperativeof traumatic femoral neck fracture.
图 2 创伤性股骨颈骨折SuperPATH入路髋关节置换术后
A: 术后骨盆正位片; B: 术后髋关节侧位片; C: 术后髋关节正位片.
Figure 2. Postoperative of total hip arthroplasty in traumatic femoral neck fracture patient by SuperPATH approach
表 1 两组一般资料比较
Table 1. Comparison of general clinical data between the two groups
Group Gender (male/female) Age (years old) Site of injury (left/right) BMI（kg/m2） ASA rating Combined disease Ⅰ Ⅱ Ⅲ Hypertension Diabetes Chronic obstructive pulmonary disease Control (n=42) 24/17 55.86±2.46 22/20 23.60±1.02 12 24 6 12 6 2 Observation (n=54) 29/25 55.97±2.62 30.24 23.22±1.10 18 28 8 18 8 5 t/χ2 0.210 1.733 P 0.835 1.086 
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表 2 两组患者的手术情况比较
Table 2. Comparison of surgical conditions between the two groups (Mean±SD)
Group Operation time（min） Intraoperative blood loss（mL） Total blood loss（mL） Length of the incision（cm） Postoperative hospitalization time（d） Fracture healing time（d） Control (n=42) 70.36±3.46 146.78±6.98 909.58±4.82 12.86±1.68 3.72±1.12 150.14±4.62 Observation (n=54) 110.52±5.12 144.96±6.90 910.78±4.76 10.08±1.02 3.80±1.10 100.86±44.785 t 43.646 1.262 0.427 10.023 0.351 57.683 P < 0.001 0.210 0.671 < 0.001 0.727 < 0.001
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表 3 两组患者Hb、红细胞压积、CRP、ESR及肌酸激酶比较
Table 3. Comparison of Hb, hematocrit, CRP, ESR and creatine kinase between the two groups(Mean±SD)
Group Hb（g/L） Hematocrit CRP（Uu/lg/L） ESR（mm/h） Creatine kinase（U/L） Before operation After operation Before operation After operation Before operation After operation Before operation After operation Before operation After operation Control (n=42) 145.24±10.54 108.36±5.98a 0.42±0.10 0.30±0.04 a 4.34±1.28 12.68±4.64 a 20.36±2.08 37.68±4.32 a 125.25±6.78 190.68±10.34 a Observation 144.86±10.50 107.93±5.90 a 0.44±0.12 0.29±0.04 a 4.26±1.24 11.94±4.30 a 21.00±1.94 36.64±4.26 a 124.97±6.70 142.58±8.08 a t 0.176 0.352 0.870 1.215 0.309 0.808 1.554 1.179 0.202 25.594 P 0.861 0.726 0.386 0.227 0.758 0.421 0.124 0.241 0.840 < 0.001 aP < 0.05 vs术前.
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表 4 两组患者VAS评分及Harris评分比较
Table 4. Comparison of VAS and Harris scores between the two groups (min, Mean±SD)
Group VAS score Harris score Before operation On the 3th day after operation On the 14th day after operation Before operation On the 3th day after operation On the 14th day after operation Control (n=42) 5.68±1.56 2.98±0.46a 2.02±0.20ab 45.86±2.32 64.98±4.78a 74.02±5.86 ab Observation (n=54) 5.60±1.50 2.02±0.20 a 1.98±0.18ab 45.48±2.30 70.68±6.02 a 75.86±5.98ab t 0.255 13.759 1.029 0.800 5.025 1.629 P 0.780 < 0.001 0.306 0.426 < 0.001 0.107 aP < 0.05 vs术前; bP < 0.05 vs术后3 d.
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表 5 两组患者末次随访生活健康比较
Table 5. Comparison of the health of the last follow-up between the two groups of patients (Mean±SD)
Groups Energy rating score Physical pain score Social function score Overall health score Control (n=42) 80.26±3.56 81.68±3.62 78.56±2.48 78.74±2.68 Observation (n=54) 75.08±2.86 76.90±2.90 74.02±1.68 74.10±2.02 t 7.907 7.185 10.670 9.675 P < 0.001 < 0.001 < 0.001 < 0.001
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