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朱永良, 陈东阳. 微创直接前方入路全髋关节置换术治疗老年股骨颈骨折的效果及对患者早期骨代谢的影响[J]. 实用临床医药杂志, 2023, 27(6): 55-59. DOI: 10.7619/jcmp.20223697
引用本文: 朱永良, 陈东阳. 微创直接前方入路全髋关节置换术治疗老年股骨颈骨折的效果及对患者早期骨代谢的影响[J]. 实用临床医药杂志, 2023, 27(6): 55-59. DOI: 10.7619/jcmp.20223697
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ZHU Yongliang, CHEN Dongyang. Effects of minimally invasive total hip arthroplasty through direct anterior approach in treatment of elderly femoral neck fractures and its influence on early bone metabolism[J]. Journal of Clinical Medicine in Practice, 2023, 27(6): 55-59. DOI: 10.7619/jcmp.20223697
Citation: ZHU Yongliang, CHEN Dongyang. Effects of minimally invasive total hip arthroplasty through direct anterior approach in treatment of elderly femoral neck fractures and its influence on early bone metabolism[J]. Journal of Clinical Medicine in Practice, 2023, 27(6): 55-59. DOI: 10.7619/jcmp.20223697
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微创直接前方入路全髋关节置换术治疗老年股骨颈骨折的效果及对患者早期骨代谢的影响

Effects of minimally invasive total hip arthroplasty through direct anterior approach in treatment of elderly femoral neck fractures and its influence on early bone metabolism

    摘要
  • 摘要:
    目的 探讨微创直接前方入路(DAA)全髋关节置换术(THA)治疗老年股骨颈骨折的效果及对患者术后早期平衡功能及骨代谢的影响。
    方法 前瞻性选取84例老年股骨颈骨折患者, 随机分为观察组与对照组, 每组42例。对照组采用后外侧入路(PLA)行THA, 观察组采用微创DAA行THA术。比较2组围术期指标、术后早期髋关节功能和平衡功能、骨代谢指标骨钙素(OC)、Ⅰ型胶原C末端肽(CTX)、25-羟基维生素D25(OH)D、Ⅰ型前胶原氨基端原肽(PINP)和骨特异性碱性磷酸酶(BALP)及并发症。
    结果 2组手术时间比较, 差异无统计学意义(P>0.05)。观察组术中出血量和住院时间少于或短于对照组, 差异有统计学意义(P < 0.05)。与术前比较, 2组术后3个月Harris、Berg、Tinetti评分及OC、25(OH)D和BALP水平升高, CTX和PINP水平降低, 差异有统计学意义(P < 0.05)。与对照组相比, 观察组Harris、Berg、Tinetti评分及OC、25(OH)D和BALP水平增高, CTX和PINP水平降低, 差异有统计学意义(P < 0.05)。观察组术后并发症发生率为2.38%, 低于对照组的19.05%, 差异有统计学意义(P < 0.05)。
    结论 微创DAA行THA治疗股骨颈骨折切口小、创伤小、术后并发症发生率低, 可促进患者早期髋关节功能和平衡功能恢复, 并改善其骨代谢。

     

    Abstract:
    Objective  To investigate the effect of minimally invasive total hip arthroplasty (THA) through direct anterior approach (DAA) in treatment of elderly femoral neck fractures and its effect on early postoperative balance function and bone metabolism.
    Methods  A total of 84 elderly patients with femoral neck fracture were prospectively selected and randomly divided into observation group and control group, with 42 cases in each group. The control group was given THA by the posterolateral approach (PLA), and the observation group was given THA by the minimally invasive DAA approach for THA. The perioperative indexes, early postoperative hip function and balance function, bone metabolism indexes osteocalcin (OC), type Ⅰ collagen C-terminal peptide (CTX), 25 hydroxyvitamin D25 (OH) D, type Ⅰ procollagen N-terminal peptide (PINP) and bone-specific alkaline phosphatase (BALP) and complications were compared between the two groups.
    Results  There was no significant difference in the operation time between the two groups(P>0.05). The intraoperative blood loss and hospitalization time in the observation group were significantly less than or shorter than those in the control group (P < 0.05). Compared with before surgery, the Harris score, Berg score, Tinetti score, OC, 25(OH)D and BALP levels were significantly increased, while CTX and PINP levels were significantly decreased in two groups at 3 months after surgery (P < 0.05). Compared with the control group, the Harris score, Berg score, Tinetti score, OC, 25(OH)D and BALP levels in the observation group were significantly increased, while the CTX and PINP levels were significantly decreased (P < 0.05). The incidence of postoperative complications in the observation group was 2.38%, which was significantly lower than 19.05% in the control group (P < 0.05).
    Conclusion THA with minimally invasive DAA for the treatment of femoral neck fracture has small incision, little trauma and low incidence of postoperative complications, which can promote early recovery of hip function and balance function, and improve bone metabolism.

     

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