Wang Gang, Gu Gui-shan, Li Dan, Sun Da-hui, Zhang Wei, Wang Tie-jun
Department of Bone and Joint Surgery, First Teaching Hospital, Jilin University, Changchun 130021, China.
Chin J Traumatol. 2010 Aug 1;13(4):234-9.
To compare the clinical outcome of anterolateral minimally invasive approach versus conventional posterior approach for total hip replacement against femoral neck fractures in elderly patients.
The retrospective study was carried out on 42 patients who suffered from displaced femoral neck fractures (19 cases of Garden type III, 23 cases of Garden type IV) treated by total hip replacement via anterolateral minimally invasive approach or conventional posterior approach by the same experienced surgeon. The average age of the patients was 78.1 years (range: 65-89 years). They were divided into anterolateral mini-invasive group (22 cases) and posterior group (20 cases). The mean time of follow-up was 13 months (range: 6-36 months). The anterolateral approach described by Hardinge goes through between anterior 1/3 and posterior 2/3 of the gluteus medius muscle, reaching the femoral neck from anterior capsule. The traditional posterior approach described by Moore (Southern incision) goes through the insertions of short external rotation muscles, reaching the femoral neck from posterior capsule. The related variables under observation were length of incision, operation time, postoperative limp, length of hospital stay and bed stay and dislolcation rate.
The length of the skin incision varied between 7 cm and 12 cm with the anterolateral minimally invasive technique, compared to 15-22 cm in the conventional procedure. It took less time (average 15 minutes) to complete the anterolateral minimally invasive approach (72 min+/-15 min), compared with the conventional approach (87 min+/-10 min). The average Harris hip score was 91.23+/-10.20 in anterolateral approach, 90.03+/-11.05 in the posterior approach. The average length of hospital stay for patients with the anterolateral approach was (6.4+/-2.2) days (range: 4-9 days), while that in posterior approach was (9.2+/-3.1) days (range: 6-13 days). The average length of bed stay was (3.4+/-1.1) days (range: 2-5 days) in anterolateral group and (6.2+/-2.8) days (range: 3-10 days) in posterior group. No patients in anterolateral group experienced dislocation. One (5%) hip in posterior approach had dislocation.
Anterolateral mini-invasive approach can decrease trauma, operation time, length of hospital stay and bed stay and rehabilitation time. The stability and minimal muscular damage permit the acceleration of postoperative rehabilitation, which can subsequently reduce the perioperative risk in the treatment of femoral neck fractures in the elderly undergoing total hip replacement.
比较老年股骨颈骨折患者全髋关节置换术中前外侧微创入路与传统后入路的临床疗效。
对42例移位型股骨颈骨折患者（GardenⅢ型19例，GardenⅣ型23例）进行回顾性研究，这些患者均由同一位经验丰富的外科医生采用前外侧微创入路或传统后入路行全髋关节置换术。患者平均年龄78.1岁（范围：65 - 89岁）。他们被分为前外侧微创组（22例）和后入路组（20例）。平均随访时间为13个月（范围：6 - 36个月）。Hardinge描述的前外侧入路经臀中肌前1/3与后2/3之间进入，从前侧关节囊到达股骨颈。Moore（南方切口）描述的传统后入路经短外旋肌附着点进入，从后侧关节囊到达股骨颈。观察的相关变量包括切口长度、手术时间、术后跛行、住院时间、卧床时间和脱位率。
前外侧微创技术的皮肤切口长度在7 cm至12 cm之间，而传统手术为15 - 22 cm。前外侧微创入路完成手术所需时间较少（平均15分钟）（72分钟±15分钟），而传统入路为（87分钟±10分钟）。前外侧入路的Harris髋关节平均评分为91.23±10.20，后入路为90.
