两种入路全髋关节置换术治疗股骨颈骨折术后早期足底压力对比研究

A comparative study of early postoperative plantar pressure after total hip arthroplasty via two different surgical approaches for femoral neck fracture

摘要:

目的 探讨直接前方入路（DAA）与后外侧入路（PLA）全髋关节置换术（THA）治疗股骨颈骨折患者术后早期步长、足底压力及髋关节活动能力的差异，为临床术式选择提供客观依据。方法 采用前瞻性随机对照研究设计，选取2023年10月—2024年12月于湖南中医药大学附属益阳中心医院行单侧THA的63例股骨颈骨折患者为研究对象，采用随机数字表法分为DAA组（30例）和PLA组（33例）。分别于术后1周、1个月、3个月，采用FootWork足底压力分析系统对两组患者的步长及双侧足底压力差进行定量检测；同时采用站立-行走计时测试（TUGT）与2 min步行测试（2MWT）评估功能性髋关节活动能力。结果 两组患者性别、年龄、体质量指数等基线资料比较，差异均无统计学意义（P >0.05）。两组术后1周、1个月、3个月患者步长、双侧足底压力差、TUGT、2MWT比较结果：①不同时间点患者步长、双侧足底压力差、TUGT、2MWT比较，差异均有统计学意义（P <0.05）；②两组患者步长、双侧足底压力差、早期TUGT、2MWT比较，差异均有统计学意义（P <0.05），均随术后时间推移呈步长增加、双侧足底压力差减小、TUGT用时缩短、2MWT距离延长的恢复趋势，DAA组相对恢复效果更优（P <0.05）；③两组患者步长、双侧足底压力差、TUGT、2MWT变化趋势比较，差异均有统计学意义（P <0.05）。结论 DAA在THA术后早期能更有效地改善患者步态对称性、足底压力分布及髋关节功能，促进早期康复，其效果优于PLA。

Abstract:

Objective To explore the differences in step length, plantar pressure, and hip joint mobility in the early postoperative period between patients with femoral neck fractures treated by total hip arthroplasty (THA) via the direct anterior approach (DAA) and posterolateral approach (PLA), and to provide objective evidence for clinical surgical approach selection.Methods A prospective randomized controlled study design was adopted. A total of 63 patients with femoral neck fractures who underwent unilateral THA at Yiyang Central Hospital Affiliated to Hunan University of Chinese Medicine from October 2023 to December 2024 were selected as study subjects. Using a random number table method, they were divided into a DAA group (n = 30) and a PLA group (n = 33). At 1 week, 1 month, and 3 months postoperatively, the FootWork plantar pressure analysis system was used to quantitatively measure the step length and the bilateral plantar pressure difference. Meanwhile, the Timed Up and Go Test (TUGT) and the 2-Minute Walk Test (2MWT) were used to evaluate functional hip joint mobility.Results There were no statistically significant differences in baseline data such as gender, age, and body mass index between the two groups (P > 0.05). The comparison of step length, bilateral plantar pressure difference, TUGT, and 2MWT at 1 week, 1 month, and 3 months postoperatively between the two groups, using repeated-measures analysis of variance, showed that: (1) there were statistically significant differences in step length, bilateral plantar pressure difference, TUGT, and 2MWT at different time points (P < 0.05); (2) there were statistically significant differences in step length, bilateral plantar pressure difference, TUGT, and 2MWT between the two groups (P < 0.05), showing a recovery trend of increased step length, decreased bilateral plantar pressure difference, shortened TUGT time, and extended 2MWT distance over time, with the DAA group showing relatively better recovery (P < 0.05); (3) there were statistically significant differences in the change trends of step length, bilateral plantar pressure difference, TUGT, and 2MWT between the two groups (P < 0.05).Conclusion DAA can more effectively improve gait symmetry, plantar pressure distribution, and hip joint function in the early stage after THA, promoting early rehabilitation, and its effect is superior to that of PLA.