Patel Niketa, Golwala Paresh
Department of Physiotherapy, College of Physiotherapy, Sumandeep Vidyapeeth Deemed to be University, Pipariya, Vadodara, IND.
Department of Orthopaedics, Sumandeep Vidyapeeth Deemed to be University, Pipariya, Vadodara, IND.
Cureus. 2024 Apr 27;16(4):e59120. doi: 10.7759/cureus.59120. eCollection 2024 Apr.
Introduction Proximal femoral fractures are common fractures of the hip that are considered a major healthcare concern globally; these include subtrochanteric, intertrochanteric, and the neck of the femur fractures. Internal fixation surgery and joint replacement surgery are the two most common intervention techniques used to treat these fractures. Consequently, weakness in the hip abductor muscle post-surgery may lead to implant loosening, necessitating revision of the surgery. In light of this, this study aimed to compare hip abductor strength recovery outcomes between joint replacement surgery and internal fixation surgery. Methodology A comparative study was performed over six months at the Department of Orthopaedics and Physiotherapy. Based on the inclusion and exclusion criteria and anticipating potential dropouts, a total of 56 patients were included in the study, and their hip abductor strength was measured using a sphygmomanometer. The patients were classified into two groups: Group A or Group B as per the type of hip surgery. Group A included 29 patients who underwent joint replacement surgeries involving either cemented or uncemented total hip arthroplasty (THA) or hip hemiarthroplasty (HHA). Group B comprised 27 patients who were operated on using either proximal femoral nail (PFN) or dynamic hip screw (DHS). Results The cohort consisted of 36 males and 20 females, with a mean age of 51.71 years. The overall mean value of hip abductor muscle strength at postoperative day (POD) three in the internal fixation group was 65.06 ±5.98, which progressed to 107.51 ±24.76 after six months; in the joint replacement surgery group, it was 70.03 ±12.46 at POD three, which progressed to 113.11 ±21.27 after six months. The age-wise distribution demonstrated that the patients in the age group of 18-50 years demonstrated progressive results: from 65.33 ±4.9 at POD three to 105.95 ±22.71 after six months in the internal fixation group; from 66.82 ±7.72 at POD three to 109.59 ±22.54 after six months in the joint replacement group. Moreover, patients aged above 50 years showed progression from 64.80 ±6.98 at POD three to 103.33 ±27.30 after six months in the internal fixation group, and from 69.58 ±14.75 at POD three to 108.22 ±20.62 after six months in the joint replacement group. Conclusions Our findings revealed that joint replacement surgery resulted in greater improvements in the hip abductor muscle strength compared to internal fixation surgery in the immediate postoperative period and during follow-ups. Additionally, younger patients exhibited better strength-related outcomes in comparison to the elderly population regardless of the type of surgery.
引言 股骨近端骨折是常见的髋部骨折，被视为全球主要的医疗关注点；这些骨折包括股骨转子下骨折、股骨转子间骨折和股骨颈骨折。内固定手术和关节置换手术是治疗这些骨折最常用的两种干预技术。因此，术后髋外展肌无力可能导致植入物松动，需要进行手术翻修。有鉴于此，本研究旨在比较关节置换手术和内固定手术之间髋外展肌力量恢复的结果。
方法 在骨科和理疗科进行了为期六个月的比较研究。根据纳入和排除标准，并预计可能出现的失访情况，共有56名患者纳入研究，使用血压计测量他们的髋外展肌力量。根据髋部手术类型将患者分为两组：A组或B组。A组包括29名接受关节置换手术的患者，手术方式包括骨水泥型或非骨水泥型全髋关节置换术（THA）或髋关节半关节置换术（HHA）。B组由27名使用股骨近端髓内钉（PFN）或动力髋螺钉（DHS）进行手术的患者组成。
结果 该队列包括36名男性和20名女性，平均年龄为51.71岁。内固定组术后第3天（POD）髋外展肌力量的总体平均值为65.06±5.98，六个月后进展至107.51±24.76；关节置换手术组在POD 3时为70.03±12.46，六个月后进展至113.11±21.27。按年龄分布显示，18 - 50岁年龄组的患者表现出逐渐改善的结果：内固定组在POD 3时为65.33±4.9，六个月后为105.95±22.71；关节置换组在POD 3时为66.82±7.72，六个月后为109.59±22.54。此外，50岁以上的患者在内固定组中从POD 3时的64.80±6.98进展至六个月后的103.33±27.30，在关节置换组中从POD 3时的69.58±14.75进展至六个月后的108.22±20.62。
结论 我们的研究结果表明，与内固定手术相比，关节置换手术在术后即刻和随访期间能使髋外展肌力量有更大改善。此外，无论手术类型如何，年轻患者与老年人群相比表现出更好的力量相关结果。
