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中华老年骨科与康复电子杂志[ISSN:1674-3911/CN:11-9292/R]

卷:

期数:

2024年05期

页码:

287-293

栏目:

髋部骨折

出版日期:

2024-10-05

文章信息/Info

Title:

Comparison of clinical efficacy between hemiarthroplasty via direct anterior approach and posterolateral approach for femoral neck fracture associated with senile dementia

作者:

茹江英1; 廖启宇1; 温国洪1; 潘思华2; 刘栋2; 张皓琛2; 牛云飞2

511518 清远，广州医科大学附属清远医院（清远市人民医院）关节外科1；200433 上海，海军军医大学附属长海医院创伤骨科２

Author(s):

Ru Jiangying1;  Liao Qiyu1;  Wen Guohong1;  Fan Sihua2;  Liu Dong2;  Zhang Haochen2;  Niu Yunfei2.

1Department of Orthopedics, Affiliated Qingyuan Hospital, Guangzhou Medical University, Qingyuan people’s Hospital, Qingyuan 511518, China;2Department of Orthopedics, Changhai Hospital of the Navy Military Medical University, Shanghai 200433, China

关键词:

股骨颈骨折;  老年痴呆;  关节成形术

Keywords:

Femoral neck fractures;  Senile dementia;  Hemiarthroplasty

DOI:

10.3877/cma.j.issn.2096-0263.2024.05.005

文献标志码:

A

摘要:

目的　比较直接前方入路（DAA）和后外侧入路（PLA）半髋关节置换治疗老年痴呆股骨颈骨折的疗效。方法　回顾性分析2021年2月至2022年2月收治的57例老年痴呆股骨颈骨折患者的临床资料，骨折Garden分型为Ⅲ和Ⅳ型，年龄≥70岁，符合中国精神障碍分类与诊断标准第3版（CCMD-3）诊断标准；按手术入路分为两组，采用直接前方入路半髋关节置换术的病例为DAA组（n=27），采用后外侧入路半髋关节置换术的病例为PLA组（n=30）。比较两组患者的手术时间、术中出血量、下床时间、住院时间和并发症发生率；通过髋部骨折功能恢复量表（FRS）、欧洲五维度健康量表（EQ-5D）、简易智力状态检查量表（MMSE）和精神错乱评估方法（CAM），于术后1、3月评估患者的髋关节功能、生活质量和精神状态，并分别进行比较。采用t检验或校正t检验或卡方检验分析比较两组的数据。结果　所有患者均获得随访，随访时间平均为（13.85±1.64）个月（8～20个月）。与PLA组相比，DAA组的手术时间显著延长[（78.32±10.63 min）vs（55.12±11.36 min），P＜0.05]，且术中出血量显著增加[（285.67±78.52 ml）vs（175.12±62.35 ml），P＜0.05]；但其术后下床时间和住院时间均显著缩短[（21.52±10.67 h）vs（62.89±28.34 h），（7.82±2.51 d）vs（12.78±3.32 d），P均＜0.05]；于术后1，3个月随访时，DAA组的FRS评分[（56.45±8.90）vs（41.34±5.62），（66.94±5.87）vs（50.67±6.36）]和EQ-5D评分[（0.72±0.18）vs（0.43±0.15），（0.74±0.25）vs（0.45±0.16）]均显著高于PLA组（P均＜0.05），但在术后6个月随访时，两组的FRS评分和EQ-5D评分差异无统计学意义[（72.56±9.82）vs（69.90±8.31），（0.77±0.34）vs（0.71±0.26），P均＞0.05]；术后1，3和6个月随访时，两组的MMSE评分和CAM评分差异均无统计学意义（P均＞0.05）；PLA组的总并发症的发生率（16.67%）显著高于DAA组（7.40%）（P＜0.05）。结论 采用DAA入路髋关节置换治疗老年痴呆股骨颈骨折患者，手术微创、术后康复快、利于早期下床活动、住院时间短、并发症少，且早期髋关节功能改善较好，与后外侧入路相比优势明显。

Abstract:

Objective To compare the clinical efficacy between hemiarthroplasty via direct anterior approach（DAA）and posterolateral approach（PLA） for femoral neck fracture associated with senile dementia. Methods A retrospective study was conducted to analyze the data of 57 elderly patients with femoral neck fracture associated with senile dementia from February 2021 to February 2022, and the fractures were classified as Garden type Ⅲ and Ⅳ, aged ≥70 years, met the diagnostic criteria for senile dementia and were divided into two groups according to surgical approach. All patients were treated with hemiarthroplasty. Direct anterior approach (DAA) was performed in 27 patients (DAA group) and posterolateral approach (PLA) was performed in 30 patients (PLA group).The surgical time,intraoperative blood loss, time to get out of bed, length of hospital stay, and the complication rate of the two groups were compared. At the follow-up of 1, 3 and 6 months after operation, the functional recovery scale (FRS), Euro Qol -5 dimesions (EQ-5D), mini-mental stateexamination (MMSE) and confusion assessmentmethods (CAM) of the two groups respectively were recorded to evaluate hip joint function, life quality and mental state of the two groups of patients. The SPSS 19.0 statistical software was used to analyze the data of the two groups by t test or corrected t test and Chi-square test. Results All 57 patients were followed up for 8-20 months (average 13.85±1.64 months). Compared with that in PLA group, the surgical time and intraoperative blood loss in DAA group were both increased significantly [(78.32±10.63 min) vs (55.12±11.36 min), (285.67±78.52 ml) vs(175.12±62.35 ml), all P<0.05]. Yet, the time to get out of bed and length of hospital stay were both decreased significantly in DAA group [(21.52±10.67 h) vs (62.89±28.34 h), (7.82±2.51 d) vs (12.78±3.32 d), all P<0.05]. At the follow-up of 1and 3 months after operation, the FRS score[(56.45±8.90) vs (41.34±5.62), (66.94±5.87) vs (50.67±6.36)] and EQ-5D score[(0.72±0.18) vs (0.43±0.15), (0.74±0.25) vs (0.45±0.16)] in DAA group were both higher than that in PLA group (all P<0.05), while the FRS score and EQ-5D score were both similar between the two groups of patients at the follow-up of 6 months after operation [(72.56±9.82) vs (69.90±8.31), (0.77±0.34) vs (0.71±0.26), all P>0.05]. At the follow-up of 1,3 and 6 months after operation, there was no significant difference , in terms of MMSE and CAM, between the two groups of patients (all P>0.05). In addition, the rate of all complication (16.67%) in PLA group was higher obviously than that (7.40%) in DAA group (P<0.05）. Conclusion Hemiarthroplasty via DAA for femoral neck fracture in elderly patients with senile dementia is superior to that via PLA, because of less invasion, faster recovery,earlier time to get out of bed , shorter hospital stay, less complications and better hip function in the early period.

备注/Memo

备注/Memo:

基金项目：国家自然科学基金（81772343）

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更新日期/Last Update: 2024-10-12