Mitchell Ronald J, Kay Andrew B, Smith Kevin M, Murphy Stephen B, Le Daniel T
Department of Orthopaedic Surgery, Houston Methodist Hospital, Houston, TX, USA.
New England Baptist Hospital, Center for Computer Assisted & Reconstructive Surgery, Boston, MA, USA.
Arthroplast Today. 2019 Mar 16;5(2):193-196. doi: 10.1016/j.artd.2019.02.003. eCollection 2019 Jun.
Total hip arthroplasty (THA) is the preferred treatment for displaced femoral neck fractures in select patients, although dislocation remains a concern. In some studies, the supercapsular percutaneously assisted (SuperPATH) approach has demonstrated early mobilization, short hospital stay, and low dislocation rates in primary THA, but there are little data on its use for fractures. This study describes the perioperative outcomes and early dislocation rate of SuperPATH THA for displaced femoral neck fragility fractures.
A retrospective review was performed of previous ambulatory patients with a displaced femoral neck fragility fracture treated with THA using the SuperPATH approach. Demographic data, time to ambulation, length of stay, and in-hospital complications during the hospital stay and follow-up period were recorded. Phone interviews were conducted to check for dislocations 1 year after surgery.
Thirty-seven consecutive patients were included with an average age of 75.0 years. Hospital stay averaged 5.5 days, and patients were discharged on average postoperative day 3.6. About 83.8% of patients were ambulatory by postoperative day 1, and 94.6% ambulatory before discharge. Twenty-seven percent of patients were discharged home, 46% to inpatient rehabilitation, 24% to skilled nursing facility, and 1 patient to hospice. At follow-up, there was no symptomatic heterotopic ossification and no infections. Thirty-two patients were available for telephone interviews at 1 year, with no dislocations reported.
In this small cohort, the SuperPATH approach for THA appears to be safe and effective for use in femoral neck fragility fractures, resulting in early ambulation and a low dislocation rate.
全髋关节置换术(THA)是特定患者移位型股骨颈骨折的首选治疗方法,尽管脱位仍是一个问题。在一些研究中,经皮辅助的关节囊上入路(SuperPATH)在初次全髋关节置换术中已显示出早期活动、住院时间短和脱位率低的特点,但关于其用于骨折治疗的数据很少。本研究描述了SuperPATH全髋关节置换术治疗移位型股骨颈脆性骨折的围手术期结果和早期脱位率。
对既往采用SuperPATH入路行全髋关节置换术治疗移位型股骨颈脆性骨折的门诊患者进行回顾性研究。记录患者的人口统计学数据、下地行走时间、住院时间以及住院期间和随访期间的院内并发症。术后1年通过电话访谈检查是否发生脱位。
纳入连续37例患者,平均年龄75.0岁。平均住院时间为5.5天,患者平均在术后3.6天出院。约83.8%的患者在术后第1天即可下地行走,94.6%的患者在出院前能够行走。27%的患者出院回家,46%的患者转至住院康复机构,24%的患者转至专业护理机构,1例患者转至临终关怀机构。随访时,未发现有症状的异位骨化和感染。32例患者在术后1年接受了电话访谈,均未报告脱位情况。
在这个小队列研究中,SuperPATH全髋关节置换术用于股骨颈脆性骨折似乎是安全有效的,可实现早期行走且脱位率低。