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前路髋关节置换术治疗移位型股骨颈骨折脱位后髋关节脱位发生率更低。

Fewer Hip Dislocations With Anterior Total Hip Arthroplasty for Displaced Femoral Neck Fracture.

出版信息

Orthopedics. 2021 Mar-Apr;44(2):e248-e252. doi: 10.3928/01477447-20210104-02. Epub 2021 Jan 8.

Abstract

The primary goal of this study was to compare dislocation rates with an anterior approach vs a posterior approach for patients who underwent total hip arthroplasty (THA) for displaced femoral neck fracture. A retrospective review was conducted of patients who underwent THA for acute femoral neck fracture at the authors' level I trauma center. All patients had at least 1 year of follow-up. Modified Harris Hip Score (mHHS) and EuroQol 5D-5L score were obtained to assess hip function and overall quality of life at a minimum of 12 months postoperatively. The study population included 76 patients (posterior, 22; anterior, 54), with mean follow-up of 39 months (range, 12-125 months). Significantly more postoperative complications occurred in the posterior group compared with the anterior group (7 vs 4, respectively; =.006). In addition, significantly more hip dislocations occurred in the posterior group compared with the anterior group (3 vs 1, respectively; =.037). The study did not show a difference in mHHS (anterior, 82; posterior, 77; =.411). The findings suggest that an anterior-based approach to THA may result in fewer complications than a posterior-based approach for patients who have displaced femoral neck fracture. Patients should be counseled on the higher perioperative risk after surgery compared with patients undergoing elective THA. Patients undergoing THA with an anterior approach for femoral neck fracture can expect to achieve good hip functional outcome and good quality of life 12 months after surgery. [. 2021;44(2):e248-e252.].

摘要

本研究的主要目的是比较经前路与后路治疗移位型股骨颈骨折行全髋关节置换术(THA)的脱位率。对作者所在的一级创伤中心行 THA 治疗急性股骨颈骨折的患者进行回顾性研究。所有患者均随访至少 1 年。采用改良 Harris 髋关节评分(mHHS)和欧洲五维健康量表(EQ-5D-5L)评分评估术后至少 12 个月的髋关节功能和总体生活质量。研究人群包括 76 例患者(后路 22 例,前路 54 例),平均随访 39 个月(12-125 个月)。后路组术后并发症明显多于前路组(分别为 7 例和 4 例,P =.006)。此外,后路组髋关节脱位的发生率明显高于前路组(分别为 3 例和 1 例,P =.037)。两组 mHHS 无差异(前路组 82 分,后路组 77 分,P =.411)。研究结果表明,对于移位型股骨颈骨折患者,前路入路 THA 可能比后路入路 THA 并发症更少。应告知患者与择期 THA 相比,术后围手术期风险更高。前路入路治疗股骨颈骨折行 THA 的患者可期望在术后 12 个月获得良好的髋关节功能和生活质量。[2021;44(2):e248-e252.]。

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