| 李立群,罗鹏,肖耀广,等.直接前侧入路和后外侧入路人工股骨头置换术治疗阿尔茨海默病病人股骨颈骨折的临床疗效.骨科,2019,10(6): 504-508. |
| 直接前侧入路和后外侧入路人工股骨头置换术治疗阿尔茨海默病病人股骨颈骨折的临床疗效 |
| Clinical efficacy of direct anterior approach vs. posterolateral approach of artificial femoral head replacement for the treatment of femoral neck fracture in Alzheimer's patients |
| 投稿时间：2019-03-14 |
| DOI：10.3969/j.issn.1674-8573.2019.06.004 |
| 中文关键词: 直接前侧入路 后外侧入路 股骨颈骨折 人工股骨头置换 阿尔茨海默病 |
| 英文关键词: Direct anterior approach Posterolateral approach Femoral neck fracture Artificial femoral head replacement Alzheimer's disease |
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| 中文摘要: |
| 目的 探讨直接前侧入路（direct anterior approach, DAA）与后外侧入路（posterolateral approach, PA）人工股骨头置换术治疗阿尔茨海默病病人股骨颈骨折的短期临床疗效。方法 回顾性分析2013年6月至2017年5月我院收治的65例阿尔茨海默病股骨颈骨折病人，根据治疗方式的不同分为两组，其中33例采用DAA行人工股骨头置换术（DAA组），32例采用PA行人工股骨头置换术（PA组）。记录并比较两组病人手术时间、切口长度、髋关节脱位及相关并发症发生情况。采用髋关节Harris评分及Charnley评分评价病人术后髋关节功能。结果 两组病人手术切口长度比较，差异无统计学意义（P＞0.05）；DAA组手术时间长于PA组，术中失血量少于PA组，差异均有统计学意义（P＜0.05）。术后所有病人均获得随访，术后1周，DAA组Harris评分及Charnley髋关节功能评分均高于PA组，差异均有统计学意义（P＜0.05）。术后3个月及末次随访时，两组间Harris评分及Charnley髋关节功能评分的差异无统计学意义（P＞0.05）。DAA组术后无脱位发生，PA组术后有3例发生髋关节脱位（3/32，9.4%）。DAA组3例病人出现股骨大粗隆撕脱骨折，1例出现股骨距裂隙样骨折（4/33，12.1%）；PA组1例病人出现股骨大粗隆撕脱骨折，2例出现股骨距裂隙样骨折（3/32，9.4%），两组术中并发症比较，差异无统计学意义（P＞0.05）。结论 DAA人工股骨头置换术治疗阿尔茨海默病病人股骨颈骨折可取得良好疗效，该入路创伤更小，具有恢复快、脱位率低的优点。 |
| 英文摘要: |
| Objective To discuss the short-term clinical efficacy of direct anterior approach (DAA) and posterolateral approach (PA) of artificial femoral head replacement in the treatment of femoral neck fracture in Alzheimer's patients. Methods Sixty-five Alzheimer's patients with femoral neck fracture from June 2013 to May 2017 were retrospectively analyzed. The patients were divided into two groups according to the different treatments. Thirty-three cases were treated with DAA (DAA group) and 32 cases were treated with PA of artificial femoral head replacement (PA group). The operation time, incision length, incision healing, dislocation of hip joint and related complications were recorded and compared between the two groups. Harris score and Charnley score were used to evaluate the postoperative hip function. Results There was no significant difference in the length of incision between the two groups (P＞0.05); the operation time was significantly longer, and the blood loss was significantly less in DPP group than in PA group (both P＜0.05). All patients were followed up after operation. At first week after operation, Harris score and Charnley hip function score in DAA group were significantly higher than in PA group (P＜0.05). There was no significant difference in Harris score and Charnley hip function score between the two groups at 3rd month and the last follow-up (P＞0.05). There was no dislocation in DAA group, but in PA group there were 3 cases (3/32, 9.4%). Three patients in DAA group had avulsion fracture of femoral trochanter, and one patient had fracture of femoral calcar (4/33, 12.1%); one patient in PA group had avulsion fracture of femoral trochanter, and two patients had fracture of femoral calcar (3/32, 9.4%). There was no significant difference between the two groups (P＞0.05). Conclusion DAA of artificial femoral head replacement can achieve good results in the treatment of femoral neck fracture in Alzheimer's patients. This approach has the advantages of less trauma, fast recovery and low dislocation rate. |
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