Tsukada Sachiyuki, Wakui Motohiro
Department of Orthopaedic Surgery, Niigata Central Hospital, 1-18 Shinko-chou, Chuo-ku, Niigata 950-8556, Japan.
J Orthop Sci. 2010 Nov;15(6):753-7. doi: 10.1007/s00776-010-1541-6. Epub 2010 Nov 30.
Minimally invasive surgery (MIS) can lead to early recovery, but its postoperative effect is short after total hip arthroplasty for osteoarthritis. Because bipolar hemiarthroplasty (BHA) for femoral neck fractures is preferred for elderly patients, early functional recovery may prevent the rapid progression of disuse atrophy, and an MIS surgical approach may improve subsequent hip joint function.
MIS-BHA was performed using the direct anterior approach, without muscle or tendon detachment. A total of 83 patients who underwent BHA from April 2007 to February 2009 were assigned to MIS-BHA or conventional BHA. Selection of patients for MIS-BHA was not randomized. Hip joint function was evaluated with the Hospital for Special Surgery (HSS) system at 1 month and 1 year after surgery.
There were no significant differences in age, sex, height, weight, body mass index, time from admission to surgery, or preinjury HSS scores between two groups. HSS scores were higher with MIS-BHA (24.2 vs. 20.2; P = 0.01) at 1 month but were similar 1 year after surgery (29.9 vs. 27.2; P = 0.10).
The effectiveness of MIS-BHA for femoral neck fracture is limited to the early postoperative period. Therefore, MIS-BHA does not appear to be appropriate for treatment of femoral neck fractures.
微创手术（MIS）可促使早期康复，但在骨关节炎全髋关节置换术后其术后效果维持时间较短。由于股骨颈骨折的双极半髋关节置换术（BHA）更适合老年患者，早期功能恢复可防止废用性萎缩的快速进展，且MIS手术入路可能改善后续髋关节功能。
采用直接前路进行MIS-BHA，不进行肌肉或肌腱分离。2007年4月至2009年2月期间接受BHA手术的83例患者被分为MIS-BHA组或传统BHA组。MIS-BHA组患者的选择并非随机进行。术后1个月和1年时采用特殊外科医院（HSS）系统评估髋关节功能。
两组患者在年龄、性别、身高、体重、体重指数、入院至手术时间或伤前HSS评分方面无显著差异。术后1个月时，MIS-BHA组的HSS评分更高（24.2对20.2；P = 0.01），但术后1年时两组相似（29.9对27.2；P = 0.10）。
MIS-BHA治疗股骨颈骨折的有效性仅限于术后早期。因此，MIS-BHA似乎不适用于股骨颈骨折的治疗。
