Hoseth John Magne, Aae Tommy Frøseth, Lian Øystein Bjerkestrand, Myklebust Tor Åge, Husby Otto Schnell
Department of Orthopaedic Surgery, Health Møre and Romsdal HF, Kristiansund Hospital, Kristiansund; Faculty of Medicine and Health Sciences, NTNU, Trondheim, Norway.
Department of Orthopaedic Surgery, Health Møre and Romsdal HF, Kristiansund Hospital, Kristiansund; Department of Neuromedicine and Movement Science, NTNU, Trondheim; The Clinical Research Unit, Health Møre and Romsdal HF, Ålesund, Norway.
Acta Orthop. 2025 Jan 13;96:73-79. doi: 10.2340/17453674.2025.42847.
The optimal approach to the hip joint in patients with displaced femoral neck fractures (dFNF) receiving a total hip arthroplasty (THA) remains controversial. We compared the direct lateral approach (DLA) with the direct anterior approach (DAA) primarily on Timed Up and Go (TUG), and secondarily on the Forgotten Joint Score (FJS), the Oxford Hip Score (OHS), EQ5D-5L, and the EQ5D-VAS.
Between 2018 and 2023, we conducted a randomized controlled trial including elderly patients with dFNFs treated with THA. The primary outcome was the difference in TUG at 6 weeks postoperatively. Key secondary outcomes were TUG at 2, 12, and at 52 weeks postoperatively, and FJS, OHS, EQ5D-5L, and EQ5D-VAS at 2, 6, 12, and at 52 weeks postoperatively.
130 patients with a mean age of 78.6 (standard deviation 1.2) were allocated to DAA (n = 64) or DLA (n = 66). There was no statistically significant difference in TUG times at 6 weeks postoperatively between the DAA and the DLA, 16.0 s (95% confidence interval [CI] 13.2-18.7) vs 17.8 s (CI 15.1-20.4), estimated mean difference -1.8 s (CI -5.7 to 2.0). However, patients who underwent DAA had a significantly higher FJS at 2, 6, and 12 weeks.
Among elderly patients with dFNF we found no difference between DAA or DLA regarding crude mobility as demonstrated with the TUG test, but patients treated with DAA showed better outcomes in the FJS in the early post-fracture period though not at 52 weeks.
对于接受全髋关节置换术（THA）的移位型股骨颈骨折（dFNF）患者，最佳的髋关节入路仍存在争议。我们主要比较了直接外侧入路（DLA）和直接前入路（DAA）在计时起立行走测试（TUG）方面的差异，其次比较了在遗忘关节评分（FJS）、牛津髋关节评分（OHS）、EQ5D - 5L和EQ5D视觉模拟量表（EQ5D - VAS）方面的差异。
在2018年至2023年期间，我们进行了一项随机对照试验，纳入接受THA治疗的老年dFNF患者。主要结局是术后6周时TUG的差异。关键次要结局是术后2周、12周和52周时的TUG，以及术后2周、6周、12周和52周时的FJS、OHS、EQ5D - 5L和EQ5D - VAS。
130例平均年龄为78.6岁（标准差1.2）的患者被分配至DAA组（n = 64）或DLA组（n = 66）。DAA组和DLA组术后6周时的TUG时间无统计学显著差异，分别为16.0秒（95%置信区间[CI] 13.2 - 18.7）和17.8秒（CI 15.1 - 20.4），估计平均差异为 - 1.8秒（CI - 5.7至2.0）。然而，接受DAA治疗的患者在术后2周、6周和12周时的FJS显著更高。
在老年dFNF患者中，通过TUG测试表明，DAA和DLA在粗略活动能力方面无差异，但接受DAA治疗的患者在骨折后早期的FJS结果更好，不过在52周时并非如此。
