髋部骨折半髋关节置换术中前路与侧路入路的前瞻性比较：一项研究方案
Prospective comparison of the anterior and lateral approach in hemiarthroplasty for hip fractures: a study protocol.
作者信息
van der Sijp Max P L, Schipper Inger B, Keizer Stefan B, Krijnen Pieta, Niggebrugge Arthur H P
机构信息
Department of Surgery, Haaglanden Medical Centre, P.O. Box 432, 2501, CK, The Hague, the Netherlands.
Department of Surgery, Leiden University Medical Centre, P.O. Box 9600, 2300 RC, Leiden, the Netherlands.
出版信息
BMC Musculoskelet Disord. 2017 Aug 23;18(1):361. doi: 10.1186/s12891-017-1724-9.
BACKGROUND
The Direct Anterior Approach (DAA) is an alternative approach to the currently most used Lateral Approach (LA) for hip replacement in femoral neck fracture patients. Compared to the LA, the DAA minimizes soft tissue damage. Sparing muscle tissue may facilitate early and improved postoperative mobility. It may also be associated with fewer complications, increased quality of life and lower 1-year mortality. The aim of this study is to compare postoperative complications, hip function and patient mobility after hemiarthroplasty via the anterior or lateral approach following a displaced femoral neck fracture.
METHODS
138 elderly patients with displaced femoral neck fractures will be operated using either the direct anterior approach or the lateral approach for a hemiarthroplasty in a single centre, prospective, comparative cohort study. The choice of surgical approach will depend on the expertise of the trauma surgeon on call. The primary outcome of this study will be the functionality of the hip after surgery measured using the Harris Hip Score during routine outpatient check-ups. Secondary outcomes include surgical and non-surgical complication rates, admission time, postoperative pain, rehabilitation time, performance in activities of daily living, health-related quality of life measured, cognitive function and balance.
DISCUSSION
Many approaches are known for hip replacement arthroplasty in trauma patients with little consensus on the preferred method. Identifying the best approach facilitating an adequate and fast recovery could optimize patient independence and quality of life and minimize rehabilitation costs, morbidity and mortality rates. The study design will reflect daily clinical practice and aims to present an accurate depiction of clinical outcomes.
TRIAL REGISTRATION
This trial entered the Dutch Trial Registry with registration number (NTR)6238 on the 24th of April 2017. http://www.trialregister.nl/trialreg/index.asp . Protocol version 2.0 16-03-2017.
背景
对于股骨颈骨折患者的髋关节置换手术，直接前路手术（DAA）是目前最常用的外侧入路手术（LA）的一种替代方法。与外侧入路相比，直接前路手术可将软组织损伤降至最低。保留肌肉组织可能有助于术后早期活动并改善活动能力。它还可能与较少的并发症、更高的生活质量和更低的1年死亡率相关。本研究的目的是比较移位型股骨颈骨折后采用前路或外侧入路进行半髋关节置换术后的并发症、髋关节功能和患者活动能力。
方法
在一项单中心、前瞻性、对比队列研究中，138例移位型股骨颈骨折的老年患者将接受直接前路手术或外侧入路手术进行半髋关节置换。手术入路的选择将取决于当班创伤外科医生的专业技能。本研究的主要结局将是在常规门诊检查时使用Harris髋关节评分来衡量术后髋关节的功能。次要结局包括手术和非手术并发症发生率、住院时间、术后疼痛、康复时间、日常生活活动表现、测量的健康相关生活质量、认知功能和平衡能力。
讨论
对于创伤患者的髋关节置换术，有许多手术入路，但对于首选方法几乎没有共识。确定有助于充分且快速康复的最佳入路可以优化患者的独立性和生活质量，并将康复成本、发病率和死亡率降至最低。该研究设计将反映日常临床实践，旨在准确描述临床结局。
试验注册
本试验于2017年4月24日进入荷兰试验注册中心，注册号为（NTR）6238。http://www.trialregister.nl/trialreg/index.asp 。方案版本2.0 2017年3月16日。
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