探讨侧卧位直接前方入路(DAA)髋关节置换治疗偏瘫患者偏瘫肢体GardenⅢ型、Ⅳ型股骨颈骨折术后的稳定性及其临床效果。

选自蚌埠医学院第一附属医院2018年2月至2022年1月收治的股骨颈骨折(GardenⅢ型、Ⅳ型)合并偏瘫患者43名，根据髋关节置换手术入路分为DAA组22例(男13例，女9例)和后外侧入路组21例(男11例，女10例)，随访时间为12~26个月，记录并采用t检验、卡方检验对比DAA组与后外侧入路组基线资料差异、术中出血量、手术时间、住院时间、术后第一次下地活动时间、术后并发症、活动能力恢复情况、视觉模拟疼痛评分(VAS)、生活质量评分(改良Barthel评定量表)、Harris髋关节功能评分、偏瘫肢体功能恢复情况(Brunnstrom偏瘫功能分期)，评定侧卧DAA入路髋关节置换治疗偏瘫患者股骨颈骨折的安全性及稳定性。

两组患者均顺利完成手术。DAA组患者术后第一次下地活动时间较后外侧入路组短、术中出血量较后外侧入路组少、住院时间较后外侧入路组短(t＝7.756、6.925、3.479，均为P<0.05)。两组疼痛(VAS评分)较术前明显减轻、髋关节功能(Harris评分)较术前改善、生活质量较术前提升，DAA组改善情况较后外侧入路组显著(t＝11.200、－8.429、－11.034、均为P<0.05)；两组术后下肢Brunnstrom偏瘫功能分期较术前得到明显改善，DAA组改善较后外侧入路组更明显(Z＝6.747，P＝0.009)。DAA组16例(72.7%)恢复至术前，后外侧入路组9例(42.9%)恢复至术前(χ²＝3.939，P＝0.047)；两组患者早期并发症差异无统计学意义(χ²＝0.009，P >0.05)。

合并偏瘫的Garden Ⅲ、Ⅳ型股骨颈骨折行侧卧DAA入路髋关节置换是一种积极的安全有效的手术方式，具有较好的临床效果。

To evaluate the stability and clinical effect of lateral decubitus direct anterior approach (DAA) hip replacement in patients with hemiplegia after treatment of Garden type Ⅲ and Ⅳ femoral neck fracture.

A total of 43 patients with femoral neck fracture (Garden type III and IV) combined with hemiplegia admitted to the First Affiliated Hospital of Bengbu Medical College from February 2018 to January 2022 were selected, and divided into 22 patients (13 males and nine females) in DAA group and 21 patients (11 males and 10 females) in posterolateral approach group according to hip replacement surgical approach. The follow-up period was 12 to 26 months. T test, chi square test and rank sum test were used to compare baseline data variance, intraoperative blood loss, operation time, hospital stay, first postoperative movement time, postoperative complications, mobility recovery, visual analoguepain scale (VAS), quality of life score (modified Barthel rating scale) and Harris hip between DAA group and posterolateral approach group Joint function scores and functional recovery of hemiplegic limbs (Brunnstrom stage of hemiplegic function) were used to evaluate the safety and stability of hip replacement with lateral DAA approach in the treatment of femoral neck fractures in hemiplegic patients.

All the patients accpeted completed surgery successfully. DAA group had shorter time for first postoperative exercise, less intraoperative blood loss and shorter length of hospital stay than the posterolateral approach group (t=7.756、6.925、3.479, all P<0.05). Pain (VAS score) was significantly relieved, hip function (Harris score) was improved and quality of life was improved in both groups. The improvement in DAA group was more remarkable than that the posterolateral approach group (t=11.200、-8.429、-11.034、P<0.05, all P<0.05). The stage of Brunnstrom hemiplegia function of lower limbs was significantly improved in both groups after surgery, and the improvement in DAA group was more obvious than the posterolateral approach group (Z=6.747, P=0.009). In the DAA group, 16 cases (72.7%) recovered to the status before surgery, and in the posterolateral approach group, nine cases (42.9%) recovered to the status before surgery (χ²=3.939, P=0.047). There was no significant difference in early complications between the two groups (χ²=0.009, P>0.05).

Lateral DAA approach for hip replacement of Garden Ⅲ and Ⅳ femoral neck fractures with hemiplegia is a safe and effective surgical method with good clinical results.