Hu Wei, Xu Wen-Bo, Li Hao, Jiang Wen-Hua, Shao Yin-Chu, Shan Ji-Chun, Yang Di, Wan De-En, Shuang Feng
Department of Orthopaedics, The 908th Hospital of the Joint Logistic Support Force of the Chinese People's Liberation Army, Nanchang, China.
Front Surg. 2023 Mar 14;10:1087338. doi: 10.3389/fsurg.2023.1087338. eCollection 2023.
Hemiarthroplasty is a surgical choice for super-aged patients with a high surgical risk and a sedentary lifestyle. The direct superior approach (DSA), a minimally invasive modification of the posterior approach, is rarely studied in hemiarthroplasty. The aim of the present study was to compare the clinical outcomes in elderly patients with displaced femoral neck fractures undergoing hemiarthroplasty DSA with the conventional posterolateral approach (PLA). A total of 48 elderly patients with displaced femoral neck fractures who underwent hemiarthroplasty between February 2020 and March 2021 were retrospectively included in the study. Of them, 24 patients (mean age 84.54 ± 2.11 years) were treated with hemiarthroplasty DSA (DSA group), while the other 24 patients (mean age 84.92 ± 2.15 years) were treated with hemiarthroplasty PLA (PLA group). Clinical outcomes, perioperative data, and complications were recorded. There were no obvious differences in the baseline characteristics between the DSA and PLA groups, including age, gender, body mass index, Garden type, American Society of Anesthesiologists score, and hematocrit. Perioperative data showed that the length of the incision in the DSA group was smaller than that in the PLA group ( < 0.001). However, the duration of the operation and blood loss in the DSA group were longer and higher than those in the PLA group, respectively ( < 0.001). In addition, the DSA group had a shorter hospitalization time than the PLA group ( < 0.001). The visual analog scale score and Harris score 1 month postoperatively in the DSA group were better than those in the PLA group ( < 0.001). Moreover, there were no significant differences between the two groups in Harris score (for assessment dysfunction) 6 months postoperatively ( > 0.05). DSA is less invasive and has better clinical outcomes, which can allow an early return to daily living activities in elderly patients with displaced femoral neck fractures undergoing hemiarthroplasty.
半髋关节置换术是手术风险高且生活方式久坐的超高龄患者的一种手术选择。直接上方入路（DSA）是后入路的一种微创改良术式，在半髋关节置换术中很少被研究。本研究的目的是比较采用DSA行半髋关节置换术的老年移位型股骨颈骨折患者与采用传统后外侧入路（PLA）的患者的临床结局。本研究回顾性纳入了2020年2月至2021年3月期间接受半髋关节置换术的48例老年移位型股骨颈骨折患者。其中，24例患者（平均年龄84.54±2.11岁）接受了DSA半髋关节置换术（DSA组），而另外24例患者（平均年龄84.92±2.15岁）接受了PLA半髋关节置换术（PLA组）。记录临床结局、围手术期数据和并发症。DSA组和PLA组的基线特征，包括年龄、性别、体重指数、Garden分型、美国麻醉医师协会评分和血细胞比容，均无明显差异。围手术期数据显示，DSA组的切口长度小于PLA组（<0.001）。然而，DSA组的手术时间和失血量分别比PLA组长和多（<0.001）。此外，DSA组的住院时间比PLA组短（<0.001）。DSA组术后1个月的视觉模拟评分和Harris评分优于PLA组（<0.001）。此外，两组术后6个月的Harris评分（用于评估功能障碍）无显著差异（>0.05）。DSA的侵入性较小，临床结局较好，可使接受半髋关节置换术的老年移位型股骨颈骨折患者早日恢复日常生活活动。
