Jia Xiaolin, Zhou Mingquan, Hu Wei, Gan Qiang
Department of Orthopedics, Chongqing People's Hospital, Chongqing, 400013, P.R.China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2016 Nov 8;30(11):1331-1337. doi: 10.7507/1002-1892.20160273.
To compare the early clinical and radiographic outcomes of hemiarthroplasty by a minimal invasive Supercap approach and by a conventional approach for elderly displaced femoral neck fractures.
Between January and June 2015, 70 geriatric patients with displaced femoral neck fracture underwent cementless bipolar hemiarthroplasty by minimally invasive Supercap approach (group A, =35) or by posterolateral approach (group B, =35). One patient was excluded from the study in group B because of too wide femur cavity. There was no significant difference in gender, age, body mass index, fracture cause, time from fracture to operation, fracture side, fracture classification, and preoperative visual analogue scale (VAS), and hemoglobin-level between the 2 groups (>0.05). The operation time, intraoperative blood loss, incision length, and complications were recorded. The early clinical evaluations included timed up and go test (TUG), hemoglobin-level, VAS score, and satisfaction. The anteroposterior and lateral X-ray films were taken to measure the stem alignment, difference in leg length, and difference in femoral offset.
All the patients were followed up 6-11 months (mean, 7.32 months). No patients died during follow-up. There was no significant difference in operation time and intraoperative blood loss between the 2 groups (>0.05). The incision length of group A was significantly smaller than that of group B (<0.05). One patient had delayed union of incision in group A (2.86%); 2 patients had deep vein thrombosis in group B (5.88%); and there was no significant difference in the complication rate (=0.764, =0.512). The postoperative hemoglobin level showed no significant difference between the 2 groups (>0.05). Group A had lower VAS score and higher subjective satisfaction than group B, showing significant difference at 1, 5, and 14 days after operation (<0.05). The TUG of group A was significantly shorter than that of group B at 5, 14, and 30 days (<0.05). There was no significant difference in femoral offset or leg length on the X-ray films (=1.273, =0.851; =0.409, =0.327). The good rate of stem alignment was 82.86% (29/35) in group A, and was 85.30% (29/34) in group B, showing no significant difference (=0.584, =0.497).
Both minimal invasive Supercap approach and conventional posterolateral approach are effective and safe for elderly displaced femoral neck fractures in hemiarthroplasty. Supercap approach has the advantages of less trauma, pain relief, and improvement of mobility and rapid rehabilitation.
比较采用微创Supercap入路与传统入路行半髋关节置换术治疗老年移位型股骨颈骨折的早期临床及影像学结果。
2015年1月至6月，70例老年移位型股骨颈骨折患者分别采用微创Supercap入路（A组，n = 35）或后外侧入路（B组，n = 35）行非骨水泥型双极半髋关节置换术。B组有1例患者因股骨髓腔过宽被排除在研究之外。两组患者在性别、年龄、体重指数、骨折原因、骨折至手术时间、骨折侧、骨折分型及术前视觉模拟评分（VAS）、血红蛋白水平方面差异无统计学意义（P>0.05）。记录手术时间、术中出血量、切口长度及并发症情况。早期临床评估包括计时起立行走测试（TUG）、血红蛋白水平、VAS评分及满意度。拍摄正位和侧位X线片测量假体柄对线、双下肢长度差及股骨偏心距差。
所有患者均获随访6～11个月（平均7.32个月）。随访期间无患者死亡。两组患者手术时间和术中出血量差异无统计学意义（P>0.05）。A组切口长度明显小于B组（P<0.05）。A组有1例患者切口延迟愈合（2.86%）；B组有2例患者发生深静脉血栓（5.88%）；两组并发症发生率差异无统计学意义（P = 0.764，P = 0.512）。两组术后血红蛋白水平差异无统计学意义（P>0.05）。A组术后VAS评分低于B组，主观满意度高于B组，术后1、5和14天差异有统计学意义（P<0.05）。术后5、14和30天A组的TUG明显短于B组（P<0.05）。X线片显示两组股骨偏心距及双下肢长度差异无统计学意义（P = 1.273，P = 0.851；P = 0.409，P = 0.327）。A组假体柄对线良好率为82.86%（29/35），B组为85.30%（29/34），差异无统计学意义（P = 0.584，P = 0.497）。
微创Supercap入路和传统后外侧入路行半髋关节置换术治疗老年移位型股骨颈骨折均有效且安全。Supercap入路具有创伤小、缓解疼痛、改善活动度及康复快等优点。
