经皮辅助关节囊入路治疗老年股骨颈骨折的早期疗效

doi:10.3877/cma.j.issn.1674-134X.2019.03.004

目的

探讨经皮辅助关节囊(SuperPATH)微创入路初次人工股骨头置换术治疗老年股骨颈骨折的可行性及早期疗效。

方法

回顾性分析2015年10月年2016年11月期间，在仪征市人民医院骨科严格按照纳入和排除标准收集的老年股骨颈骨折，采用SuperPATH微创入路初次人工股骨头置换，共纳入患者21例，其中男5例，女16例；左髋6例，右髋15例；平均年龄为(74±9)岁。观察切口长度、手术时间、术中出血量及并发症等情况。采用髋关节Harris评分标准评定术前、术后3 d及术后3个月患髋功能。计量资料用W检验观察数据是否成正态分布；髋关节Harris评分采用重复测量的方差分析比较，组间两两比较采用t检验。

结果

21例患者均获3～6个月随访。手术切口平均长度(7.0±1.5)cm，住院平均时间(9.6±1.8)d，手术平均时间(64±13)min，术中平均出血量(138.7±30.5)ml，下床负重活动平均时间(2.4±0.8)d。患者随访期限内均未发生皮肤坏死、感染、骨折、深静脉血栓(DVT)、关节脱位及下肢不等长等严重并发症。术后3 d患侧髋关节Harris评分平均为(67.3±6.3)分，与术前(12.1±4.3)分比较差异有统计学意义(t＝23.132，P<0.05)；术后3个月患侧髋关节Harris评分平均为(84.7±4.5)分，与术后3 d比较差异有统计学意义(t＝9.075，P<0.05)。

结论

SuperPATH微创入路初次人工股骨头置换术治疗老年股骨颈骨折早期疗效有明显优势，具有创伤小、切口小、出血少、术后疼痛轻、可早期下床、患者满意度高，能降低术后关节脱位等并发症，符合微创外科和快速康复外科的发展理念。

关键词: 关节成形术，置换，髋, 外科手术，微创性, 股骨颈骨折

Objective

To explore the feasibility and early efficacy of supercapsular percutaneously-assisted total hip (SuperPATH) minimally invasive approach for the treatment of femoral neck fractures in the elderly with primary artificial femoral head replacement.

Methods

From October 2015 to November 2016, the Orthopedics Department of Yizheng People’s Hospital strictly followed the inclusion and exclusion criteria for the elderly femoral neck fractures. The SuperPATH minimally invasive approach was used for the first artificial femoral head replacement, and 21 patients were included. They were five males and 16 females, six cases in left hip and 15 cases in right hip. The mean age was (74±9) years. The length of incision, operation time, intraoperative blood loss and complication were observed. The hip function was evaluated by hip joint Harris scores before the operation, three days and three months after operation. The measurement data were observed by W test to see whether the data was normally distributed. The hip joint Harris score was analyzed by repeated measures analysis of variance, and the t test was used to compare the two groups.

Results

Twenty-one patients were followed up for three to six months.The average length of the incision was (7.0±1.5) cm, the mean time of hospitalization was (9.6±1.8) d, the average operation time was (61±13) min, the average intraoperative blood loss was (138.7±30.5) ml. The average activity time was (2.4±0.8) d. No serious complications such as skin necrosis, infection, fracture, DVT, joint dislocation and unequal length of the lower limb occurred during the follow-up period.The mean Harris score of the affected hips three days after operation(67. 3±6.3) points was significantly higher than the preoperative one(12.1±4.3) points (t=23.132, P<0.05). The mean Harris score of the affected hips six mouths after operation (84.7±4.5) points was significantly higher than that three days after operation (67.3±6.3) points (t=9.075, P <0.05).

Conclusion

SuperPATH minimally invasive approach has remarkable advantages in the primary treatment of femoral neck fractures of the elderly, which is small trauma, small incision, less bleeding, less pain, early ambulation, good patient satisfaction, and less complications such as joint dislocation after operation, and it conforms to the development concept of minimally invasive surgery and rapid rehabilitation surgery.

Key words: Arthroplasty, replacement, hip, Minimally invasive surgical procedures, Femoral neck fractures

表1 21例患者术前术后髋关节Harris评分比较[n＝21，分，(±s)]

时间	疼痛评分	行走评分	功能评分	关节活动度评分	总分
术前	8.9±3.5	1.2±0.6	2.6±1.3	1.6±0.7	12.1±4.3
术后3 d	37.1±5.1^a	13.4±1.5^a	12.3±1.3^a	3.7±0.8^a	67.3±6.3^a
术后3个月	41.3±1.8 ^a，b	30.1±1.7^a，b	15.8±1.1^a，b	4.5±0.3^a，b	84.7±4.5^a，b
F值	329.735	2863.003	837.054	397.657	563.674
P值	<0.01	<0.01	<0.01	<0.01	<0.01

表1 21例患者术前术后髋关节Harris评分比较[n＝21，分，(±s)]

时间	疼痛评分	行走评分	功能评分	关节活动度评分	总分
术前	8.9±3.5	1.2±0.6	2.6±1.3	1.6±0.7	12.1±4.3
术后3 d	37.1±5.1^a	13.4±1.5^a	12.3±1.3^a	3.7±0.8^a	67.3±6.3^a
术后3个月	41.3±1.8 ^a，b	30.1±1.7^a，b	15.8±1.1^a，b	4.5±0.3^a，b	84.7±4.5^a，b
F值	329.735	2863.003	837.054	397.657	563.674
P值	<0.01	<0.01	<0.01	<0.01	<0.01

图1 左侧股骨颈骨折行SuperPATH(经皮辅助关节囊)微创入路初次人工股骨头置换术前、术中、术后随访资料。图A　为术前左髋关节正位X线片，示左侧股骨颈头下型骨折(Garden Ⅲ型)；图B　为术前左髋关节CT三维成像，示左股骨颈头下型骨折；图C　为术前左髋关节冠状位CT，示左侧股骨头下型骨折，髋臼壁完整，未见骨缺损；图D　为术后复查骨盆X线平片，示假体在位，位置良好；图E　为术中转子间窝开口扩髓；图F　为术中安装股骨柄假体；图G　为术后切口长度；图H　为术后第2天下地行走；图I　为术后6个月复查骨盆X线片，示左侧人工股骨头置换术后，假体位置良好，未见松动、下沉

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Early efficacy of percutaneous assisted joint capsule approach for femoral neck fracture in elderly patients

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Early efficacy of percutaneous assisted joint capsule approach for femoral neck fracture in elderly patients