Morgan Steven, Jarvis Stephanie, Conti Alexander, Staudinger Kelsey, Reynolds Cassandra, Greenseid Samantha, Bar-Or David
Department of Orthopedic Trauma, Swedish Medical Center, Englewood, CO, USA.
Department of Statistical, Injury Outcomes Network (ION) Research, Englewood, CO, USA.
Geriatr Orthop Surg Rehabil. 2024 Aug 18;15:21514593241278390. doi: 10.1177/21514593241278390. eCollection 2024.
The surgical approach of hemiarthroplasty for displaced femoral neck fractures remains debated. The study objective was to compare in-hospital outcomes for geriatric displaced femoral neck fractures treated with hemiarthroplasty based on surgical approach (direct lateral vs. posterior approach).
This retrospective cohort study included geriatric patients (≥60 y/o) admitted 7/1/2016-3/31/2020 treated with hemiarthroplasty. Outcomes included: operative time (incision to closure), length of stay (HLOS), and blood loss volume (mL). The Harding direct lateral approach was compared to the posterior approach; < .05.
There were 164 patients (59% direct lateral, 41% posterior). Patients treated with the direct lateral approach had an advanced directive ( = .03), dementia, ( = .03), or were functionally dependent ( = .03) more often than patients treated with the posterior approach. Time to surgery was comparable between groups ( = .52). The direct lateral approach was associated with a shorter operative time (2.3 vs. 2.8 h, = .03), a longer HLOS (5.0 vs. 4.0 days, < .01), and a lower median volume of blood loss (50 vs. 100 mL, = .01), than the posterior approach, respectively. In a stratified analysis, for those who functionally dependent, dementia or an advanced directive, the direct lateral approach led to a longer HLOS ( = .03) and shorter operative time ( = .04) than the posterior approach. Whereas among those functionally dependent, dementia or an advanced directive, the direct lateral approach led to less blood loss ( = .02) than the posterior approach.
While those treated with the direct lateral approach lost significantly less blood, they had a significantly longer HLOS than those treated with the posterior approach. Comorbidities significantly modified outcomes, which may suggest their presence could assist with treatment decisions.
This study found neither approach, the direct lateral nor posterior, to be superior. Surgical approach could remain physician preference.
对于移位型股骨颈骨折，半髋关节置换术的手术入路仍存在争议。本研究的目的是比较基于手术入路（直接外侧入路与后入路）的老年移位型股骨颈骨折患者接受半髋关节置换术后的院内结局。
这项回顾性队列研究纳入了2016年7月1日至2020年3月31日期间接受半髋关节置换术的老年患者（≥60岁）。结局指标包括：手术时间（切开至缝合）、住院时间（HLOS）和失血量（毫升）。将哈丁直接外侧入路与后入路进行比较；P<0.05。
共有164例患者（59%为直接外侧入路，41%为后入路）。与接受后入路的患者相比，接受直接外侧入路的患者更常具有预先指示（P=0.03）、痴呆（P=0.03）或功能依赖（P=0.03）。两组之间的手术时间相当（P=0.52）。与后入路相比，直接外侧入路的手术时间较短（2.3小时对2.8小时，P=0.03），住院时间较长（5.0天对4.0天，P<0.01），失血量中位数较低（50毫升对100毫升，P=0.01）。在分层分析中，对于那些功能依赖、患有痴呆或有预先指示的患者，直接外侧入路导致的住院时间比后入路更长（P=0.03），手术时间更短（P=0.04）。而在那些没有功能依赖、没有痴呆或没有预先指示的患者中，直接外侧入路导致的失血量比后入路更少（P=0.02）。
虽然接受直接外侧入路的患者失血量显著较少，但他们的住院时间比接受后入路的患者显著更长。合并症显著改变了结局，这可能表明合并症的存在有助于治疗决策。
本研究发现直接外侧入路和后入路均无优势。手术入路可能仍取决于医生的偏好。
