UR2CA, Pasteur 2 Hospital, iULS-University Institute for Locomotion and Sports, 30, voie Romaine, 06000 Nice, France; Unité de recherche clinique Côte-d'Azur (UR2CA), université Côte-d'Azur (UCA), CHU de Nice, 28, avenue de Valombrose, 06107 Nice, France.
Department of Orthopaedic and Trauma Surgery, HIA Laveran, 34, boulevard Laveran, 13013 Marseille, France.
Orthop Traumatol Surg Res. 2024 Sep;110(5):103911. doi: 10.1016/j.otsr.2024.103911. Epub 2024 May 25.
Femoral neck fractures constitute a public health problem due to significant associated morbidity and mortality amongst the ageing population. Perioperative blood loss can increase this morbidity. Blood loss, as well as the influence that the surgical approach exerts on it, remains poorly evaluated. We therefore conducted a retrospective comparative study in order to: (1) compare total blood loss depending on whether the patients were operated on using an anterior or posterior approach, (2) compare the transfusion rates, operating times and hospital stays between these two groups and, (3) analyze dislocation rates.
Total blood loss is greater from an anterior approach following a hip hemiarthroplasty for femoral neck fracture, compared to the posterior approach.
This retrospective single-center comparative study included 137 patients operated on by hip hemiarthroplasty between December 2020 and June 2021, and seven patients were excluded. One hundred and thirty patients were analyzed: 69 (53.1%) had been operated on via the anterior Hueter approach (AA) and 61 (46.9%) via the posterior Moore approach (PA). The analysis of total blood loss was based on the OSTHEO formula to collect perioperative "hidden" blood loss. The risk of early dislocation (less than 6 months) was also analyzed.
Total blood loss was similar between the two groups, AA: 1626±506mL versus PA: 1746±692mL (p=0.27). The transfusion rates were also similar between the two groups, AA: 23.2% versus PA: 31.1% (p=0.31) as well as the duration of hospitalization, AA: 8.5±3.2 versus PA: 8.2±3.3 days (p=0.54). The operating time was shorter in the PA group (Δ=10.3±14.1minutes [p<0.001]) with a greater risk of early dislocation when the patient was operated on by PA with AA: 9.8% versus PA: 1.4% (p=0.03).
This study does not demonstrate any influence of the approach (anterior or posterior) on total blood loss. Transfusion rates and length of hospitalization were similar between the groups with a slightly shorter operating time but a greater risk of early dislocations after posterior hemiarthroplasty in a population at high anesthesia-related risk.
III, comparative study of continuous series.
由于老年人群体中与股骨颈骨折相关的发病率和死亡率较高，因此股骨颈骨折构成了一个公共卫生问题。围手术期失血会增加这种发病率。失血以及手术入路对其的影响评估仍不充分。因此，我们进行了一项回顾性比较研究，目的是：（1）比较患者接受前路或后路手术时的总失血量；（2）比较两组之间的输血率、手术时间和住院时间；（3）分析脱位率。
与后路相比，前路髋关节半髋关节置换术治疗股骨颈骨折时总失血量更大。
这是一项回顾性单中心比较研究，纳入了 2020 年 12 月至 2021 年 6 月期间接受髋关节半髋关节置换术的 137 例患者，其中 7 例被排除。对 130 例患者进行了分析：69 例（53.1%）采用前路 Hueter 入路（AA）进行手术，61 例（46.9%）采用后路 Moore 入路（PA）进行手术。总失血量分析基于 OSTHEO 公式，以收集围手术期的“隐性”失血。还分析了早期（<6 个月）脱位的风险。
两组之间的总失血量相似，AA：1626±506mL 与 PA：1746±692mL（p=0.27）。两组之间的输血率也相似，AA：23.2%与 PA：31.1%（p=0.31）以及住院时间，AA：8.5±3.2 与 PA：8.2±3.3 天（p=0.54）。PA 组的手术时间更短（差值=10.3±14.1 分钟[p<0.001]），且当患者接受 PA 手术时，早期脱位的风险更高，AA：9.8%与 PA：1.4%（p=0.03）。
本研究未显示手术入路（前路或后路）对总失血量有任何影响。两组之间的输血率和住院时间相似，后路手术的手术时间略短，但在高麻醉相关风险人群中，后路半髋关节置换术后早期脱位的风险更高。
III，连续系列比较研究。
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