Pala E, Trono M, Bitonti A, Lucidi G
Department of Orthopaedics and Traumatology, Ospedale Infermi, Viale Settembrini 2, 47900, Rimini, Italy.
Eur J Orthop Surg Traumatol. 2016 May;26(4):423-7. doi: 10.1007/s00590-016-1767-x. Epub 2016 Mar 30.
The minimally invasive direct anterior approach (MDAA) has been reported to be useful in total hip arthroplasty. The benefits of this approach may be useful for the treatment of femoral neck fractures. Aim of this study is to compare MDAA and postero-lateral approach (PLA) in patients treated with hip hemiarthroplasty for femoral neck fractures.
Between 2013 and 2014, 109 patients underwent bipolar hip hemiarthroplasty for femoral neck fracture: 88 female and 21 male with a mean age of 88 years old. PLA was performed in 54 cases and MDAA in 55 cases.
The mean surgery time was significantly lower in MDAA group (P = 0.001). The hemoglobin loss was significantly lower in MDAA group (P = 0.02). The mean postoperative pain was significantly lower in the MDAA group (P = 0.001). The mean hospitalization period was 2 days lower in the MDAA group but with no significant difference between the two groups (P = 0.09). Hip dislocation was higher in PLA cases (7.4 %) than in MDAA cases (1.8 %). Periprosthetic fracture occurred only in one case of PLA. Great trochanter fracture occurred in 1 MDAA cases, while no cases were observed in the PLA group.
Minimally invasive direct anterior approach for hip hemiarthroplasty in elderly people with femoral neck fracture provided significant benefit in the early postoperative period when compared to the postero-lateral approach in terms of surgery time, hemoglobin loss, postoperative pain, time of recovery and dislocation rate.
Therapeutic study, level IV (case series).
据报道，微创直接前路入路（MDAA）在全髋关节置换术中有用。这种入路的益处可能对股骨颈骨折的治疗有用。本研究的目的是比较MDAA和后外侧入路（PLA）在接受股骨颈骨折半髋关节置换术的患者中的效果。
2013年至2014年期间，109例患者因股骨颈骨折接受双极半髋关节置换术：88例女性和21例男性，平均年龄88岁。54例行PLA，55例行MDAA。
MDAA组的平均手术时间显著更短（P = 0.001）。MDAA组的血红蛋白损失显著更低（P = 0.02）。MDAA组的平均术后疼痛显著更低（P = 0.001）。MDAA组的平均住院时间短2天，但两组之间无显著差异（P = 0.09）。PLA病例的髋关节脱位发生率（7.4%）高于MDAA病例（1.8%）。假体周围骨折仅发生在1例PLA病例中。1例MDAA病例发生大转子骨折，而PLA组未观察到此类病例。
与后外侧入路相比，股骨颈骨折老年患者采用微创直接前路入路进行半髋关节置换术在手术时间、血红蛋白损失、术后疼痛、恢复时间和脱位率方面在术后早期提供了显著益处。
治疗性研究，IV级（病例系列）。
