侧卧位改良直接外侧入路与改良后外侧入路髋关节置换术治疗高龄股骨颈骨折的疗效分析

Effects analysis of modified direct lateral approach and modified posterolateral approach for hip replacement in the treatment of femoral neck fractures in elderly patients

摘要:

目的 分析侧卧位改良直接外侧入路与改良后外侧入路髋关节置换术治疗高龄股骨颈骨折的疗效。方法 选取2019年2月—2023年1月三亚中心医院收治的102例高龄股骨颈骨折患者，以随机数字表法分为研究组、对照组，各51例。对照组接受侧卧位改良后外侧入路，研究组接受侧卧位改良直接外侧入路。比较两组手术相关指标、疼痛程度、血清学指标、髋关节功能、平衡功能及并发症。结果 研究组切口长度低于对照组（P <0.05），术后下地时间、术后住院时间短于对照组（P <0.05）。两组患者手术时间、术中出血量比较，差异均无统计学意义（P >0.05）。两组患者术前、术后12 h、术后24 h、术后48 h的视觉模拟评分（VAS）比较，结果 ①不同时间点的VAS评分比较，差异有统计学意义（P <0.05）；②两组患者VAS评分比较，差异有统计学意义（P <0.05），研究组术后VAS评分低于对照组；③两组患者VAS评分变化趋势比较，差异有统计学意义（P <0.05）。两组患者术前、术后12 h、术后24 h、术后48 h的降钙素原（PCT）、C反应蛋白（CRP）、红细胞沉降率（ESR）比较，结果 ①不同时间点的PCT、CRP、ESR比较，差异均有统计学意义（P <0.05）；②两组患者PCT、CRP、ESR评分比较，差异均有统计学意义（P <0.05），研究组术后PCT、CRP、ESR评分低于对照组；③两组患者PCT、CRP、ESR变化趋势比较，差异均有统计学意义（P <0.05）。两组患者出院当日、术后1个月、术后6个月UCLA髋关节系统评分、Harris髋关节功能评分比较，结果 ①不同时间点UCLA评分、Harris评分比较，差异均有统计学意义（P <0.05）；②两组患者UCLA评分、Harris评分比较，差异均有统计学意义（P <0.05），研究组出院当日、术后1个月UCLA评分、Harris评分比对照组高；③两组患者UCLA评分、Harris评分变化趋势比较，差异均有统计学意义（P <0.05）。两组患者出院当日、术后1个月、术后6个月的平衡功能评分（BBS）比较，结果 ①不同时间点的BBS评分比较，差异有统计学意义（P <0.05）；②两组患者BBS评分比较，差异有统计学意义（P <0.05），研究组出院当日、术后1个月BBS评分比对照组高（P <0.05）；③两组患者BBS评分变化趋势比较，差异有统计学意义（P <0.05）。研究组并发症总发生率低于对照组（P <0.05）。结论 相比于侧卧位改良后外侧入路，侧卧位改良直接外侧入路髋关节置换术治疗高龄股骨颈骨折效果更佳，可改善患者平衡功能与髋关节功能，促进术后康复，减轻软组织损伤与疼痛，降低并发症发生风险。

Abstract:

Objective To analyze the efficacy of modified direct lateral approach versus modified posterolateral approach in hip arthroplasty for elderly femoral neck fractures.Methods A total of 102 elderly patients with femoral neck fractures treated at Sanya Central Hospital from February 2019 to January 2023 were divided into a study group and a control group, with 51 cases in each group, using a random number table. The control group underwent surgery via a modified posterolateral approach, while the study group underwent surgery via a modified direct lateral approach. Surgical parameters, pain levels, serum markers, hip joint function, balance function, and complications were compared between the two groups.Results The incision length in the study group was shorter than that in the control group (P < 0.05), and the postoperative weight-bearing and hospital stay were shorter in the study group than in the control group (P < 0.05). There was no significant difference in operation time and intraoperative blood loss between the two groups (P > 0.05). Visual analog scale (VAS) scores at different time points (preoperative, 12 hours postoperative, 24 hours postoperative, and 48 hours postoperative) were significantly lower in the study group compared to the control group (P < 0.05). Similarly, levels of procalcitonin (PCT), C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR) were lower in the study group compared to the control group at different time points (P < 0.05). UCLA hip joint scores, Harris hip function scores, and balance function scores (BBS) were significantly higher in the study group compared to the control group at discharge, 1 month postoperatively, and 6 months postoperatively (P < 0.05). The overall incidence of complications was lower in the study group compared to the control group (P < 0.05).Conclusion Compared to the modified posterolateral approach, the modified direct lateral approach in hip arthroplasty for elderly femoral neck fractures yields better outcomes, improves balance and hip joint function, promotes postoperative recovery, reduces soft tissue damage and pain, and lowers the risk of complications.