Bikini切口与传统纵向切口全髋关节置换术治疗老年股骨颈骨折的效果对比研究

Comparison of Bikini and traditional longitudinal incisions for total hip arthroplasty in elderly patients with femoral neck fractures

摘要:

目的 比较Bikini切口与传统纵向切口全髋关节置换术治疗老年股骨颈骨折的效果，探讨Bikini切口全髋关节置换术的应用价值。方法 回顾性分析2021年1月—2023年12月保定市第二医院收治的103例老年股骨颈骨折患者的资料，根据皮肤切口方式分为两组，其中51例接受传统纵向切口全髋关节置换术（传统纵向切口组），52例接受Bikini切口全髋关节置换术（Bikini切口组）。比较两组手术相关指标情况、髋关节功能、下肢功能、疼痛情况、髋臼假体角度、手术切口美观度及并发症发生情况。结果 两组手术时间、术中出血量、切口长度、术后双下肢长度差比较，差异均无统计学意义（P >0.05）。两组术前、术后6个月的Harris评分、下肢功能量表（LEFS）评分比较，差异均无统计学意义（P >0.05），同组内术后6个月Harris评分和LEFS评分均高于术前（P <0.05）。两组术前、术后12 h、术后24 h、术后48 h的静息状态疼痛视觉模拟法（VAS）评分比较，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）；②两组的VAS评分比较，差异无统计学意义（P >0.05）；③两组VAS评分变化趋势比较，差异有统计学意义（P <0.05）。两组术后1 d、术后3个月的髋臼假体前倾角、外展角比较，差异均无统计学意义（P >0.05），同组内术后3个月前倾角高于术后1 d、外展角低于术后1 d（P <0.05）。Bikini切口组术后6个月的温哥华瘢痕量表（VSS）评分低于传统纵向切口组（P <0.05），同组内术后6个月VSS评分低于术后3个月（P <0.05）。两组并发症总发生率比较，差异无统计学意义（P >0.05）。结论 传统纵向切口和Bikini切口下全髋关节置换术用于老年股骨颈骨折治疗，手术相关指标相近，均可有效改善患者髋关节功能及下肢功能，患者在围手术期疼痛、髋臼假体角度及下肢DVT等并发症发生风险方面差异不明显，但Bikini切口可获取更佳美观度。

Abstract:

Objective To compare the outcomes of total hip arthroplasty performed through a Bikini incision versus a traditional longitudinal incision in elderly patients with femoral neck fractures, and to explore the application value of Bikini incision total hip arthroplasty.Methods A retrospective analysis was conducted on the data of 103 elderly patients with femoral neck fractures admitted to the Second Hospital of Baoding from January 2021 to December 2023. The patients were grouped according to the skin incision approach. Fifty-one patients underwent traditional longitudinal incision total hip arthroplasty (traditional longitudinal incision group), and 52 patients underwent Bikini incision total hip arthroplasty (Bikini incision group). Perioperative indicators, hip joint function, lower extremity function, pain condition, acetabular prosthesis angle, surgical incision aesthetics, and the occurrence of complications were compared between the two groups.Results There was no significant difference in the operation time, intraoperative blood loss, incision length, and postoperative difference in the lengths of both lower limbs in two groups (P > 0.05). There was no statistically significant difference in the Harris scores and lower extremity function scale (LEFS) scores between the two groups before and 6 months after the operation (P > 0.05). Within the same group, the Harris scores and LEFS scores 6 months after the operation were higher than those before the operation (P < 0.05). The comparison of pain visual analogue scale (VAS) scores under resting conditions before surgery, 12 hours after surgery, 24 hours after surgery, and 48 hours after surgery in the two groups showed the following results: (1) Comparisons of VAS scores at different time points showed statistically significant differences (P < 0.05); (2) Comparisons of VAS scores between the two groups showed no statistically significant differences (P > 0.05); (3) Comparisons of the change trends of VAS scores between the two groups showed statistically significant differences (P < 0.05). There was no statistically significant difference in the anterior inclination angle and abduction angle of the acetabular prosthesis between the two groups at 1 day after surgery and 3 months after surgery (P > 0.05). Within the same group, the anterior inclination angle was higher at 3 months after surgery than at 1 day after surgery, and the abduction angle was lower at 3 months after surgery than at 1 day after surgery (P < 0.05). The Vancouver Scar Scale (VSS) score of the Bikini incision group at 6 months after the operation was lower than that of the traditional longitudinal incision group (P < 0.05), and the VSS score of the same group at 6 months after the operation was lower than that at 3 months after the operation (P < 0.05). There was no statistically significant difference in the total incidence of complications between the two groups (P > 0.05).Conclusion Total hip arthroplasty through either a traditional longitudinal incision or a Bikini incision yields similar perioperative outcomes and improves hip and lower limb function in elderly patients with femoral neck fractures. The approaches do not differ significantly in perioperative pain, acetabular component angles, or the risk of complications such as lower extremity deep vein thrombosis; however, the Bikini incision provides better cosmetic outcomes.