【摘要】 目的研究直接前方入路（DAA）与后外侧入路（PLA）全髋关节置换（THA）治疗老年股骨颈骨折（FNF）的临床效果分析。方法前瞻性研究2015年7月—2018年6月佳木斯大学附属第一医院骨科收治的老年FNF患者96例,男性52例,女性44例;年龄62～86岁,平均73.3岁。依据随机数字表法分为DAA组（n=48）与PLA组（n=48）。观察并比较两组切口长度、术中出血量、手术时间及术后住院时间等围术期指标;髋臼前倾角、外展角等影像学指标;术后1、6、12个月髋关节Harris评分及外展肌力矩;术前、术后7d血清皮质醇（Cor）、去甲肾上腺素（NE）等应激因子水平; VAS评分及血清前列腺素E2（PGE2）、缓激肽（BK）、5-羟色胺（5-HT）等疼痛因子水平以及术后并发症。结果 DAA组切口长度、术中出血量、术后住院时间、髋臼前倾角、髋臼外展角均少于PLA组[（10.48±1.16） cm vs.（13.39±1.42） cm,（229.96±24.57）m L vs.（352.76±36.85） m L,（11.89±1.34） d vs.（17.64±1.86） d,（21.54±2.25）°vs.（23.51±2.47）°,（37.98±3.93）°vs.（41.06±4.32）°],手术时间长于PLA组[（112.85±13.07） min vs.（90.38±9.22） min],P <0.05。术后1个月,DAA组髋关节Harris评分及外展肌力矩均高于PLA组[（82.39±8.41）分vs.（77.68±7.90）分,（0.23±0.04） Nm/kg vs.（0.16±0.02） Nm/kg,P<0.05];术后6个月,两组髋关节Harris评分及外展肌力矩差异均无统计学意义[（91.98±9.33）分vs.（90.79±9.28）分,（0.42±0.06） Nm/kg vs.（0.41±0.06） Nm/kg,P>0.05]。术后12个月,两组髋关节Harris评分及外展肌力矩差异均无统计学意义[（93.64±9.47）分vs.（93.70±9.49）分,（0.53±0.07） Nm/kg vs.（0.52±0.06） Nm/kg,P>0.05]。术后7d,DAA组VAS评分及血清Cor、NE、PGE₂、BK、5-HT水平均低于PLA组[（149.88±16.69） nmol/L vs.（163.59±18.38） nmol/L,（236.49±25.48） pmol/L vs.（252.77±27.19） pmol/L,（132.44±14.96） pg/m L vs.（144.77±15.94） pg/m L,（5.41±0.56）μg/L vs.（5.84±0.60）μg/L,（136.78±15.42） ng/L vs.（148.55±16.45） ng/L,（4.83±0.52）分vs.（5.21±0.54）分,P<0.05]。DAA组术后并发症发病率低于PLA组（2.08%vs.16.67%,P<0.05）。结论较PLA THA相比,DAA THA治疗老年FNF创伤小,可有效缓解机体应激,抑制疼痛因子生成,髋关节功能恢复良好,术后并发症发生率低。更多还原

【Abstract】 Objective To study the clinical effect of total hip arthroplasty（THA） by direct anterior approach（DAA） and posterolateral approach（PLA） in the treatment of femoral neck fractures（FNF） in the elderly.Methods Totally 96 cases of elderly patients with FNF admitted to our hospital from Jul.2015 to Jun.2018 were included in this study and divided into DAA group（n = 48） and PLA group（n = 48） using random number table method.There were 52 males and 44 females with an average age of 73.3（62-86） years.DAA was given to patients in DAA group,and PLA was given to patients in PLA group.Perioperative indicators including incision length,intraoperative blood loss,operation time and postoperative hospital stay,imaging indicators including acetabular anterior inclination and abduction angle in both groups were observed and compared.At 1,6 and 12 months after surgery,Harris score and abductor moment of hip joint in both groups were observed and compared;the levels of serum stress factors including Cortisol（Cor） and Norepinephrine（NE） were detected before and 7 days after surgery;VAS scores and the levels of serum pain factors such as Prostaglandin E₂（PGE₂）,Bradykinin（BK）,5-HT and postoperative complications in both groups were observed and compared.Results Incision length,intraoperative blood loss and pstoperative hospital stay,acetabular anterior inclination and abduction angle in DAA group were less than those in PLA group[（10.48± 1.16） cm vs.（13.39± 1.42） cm,（229.96± 24.57） m L vs.（352.76 ± 36.85） m L,（11.89 ±1.34） days vs.（17.64±1.86） days,（21.54 ± 2.25） ° vs.（23.51 ± 2.47） °,（37.98 ± 3.93） ° vs.（41.06 ± 4.32） °],and the operation time in DAA group were longer than those in PLA group[（112.85±13.07） min vs.（90.38±9.22）min,P<0.05].At 1 month after surgery,Harris score and abductor moment of hip joint in DAA group were higher than those in PLA group[（82.39±8.41） points vs.（77.68±7.90） points;（0.23±0.04） Nm/kg vs.（0.16±0.02）Nm/kg,P<0.05].At 6 months after surgery,there was no difference in Harris score and abductor moment of hip joint between the two groups[（91.98±9.33） points vs.（90.79±9.28） points;（0.42±0.06） Nm/kg vs.（0.41±0.06） Nm/kg,P>0.05].Also,at 12 months after surgery,there was no difference in Harris score and abductor moment of hip joint between the two groups[（93.64±9.47） points vs.（93.70± 9.49） points;（0.53± 0.07） Nm/kg vs.（0.52±0.06） Nm/kg,P>0.05].At 7 days after surgery,VAS score,the levels of serum Cor,NE,PGE2,BK,5-HT in DAA group were lower than those in PLA group[（149.88 ± 16.69） nmol/L vs.（163.59 ± 18.38） nmol/L;（236.49±25.48） pmol/L vs.（252.77±27.19） pmol/L;（132.44±14.96） pg/m L vs.（144.77±15.94） pg/m L;（5.41±0.56） μg/L vs.（5.84±0.60） μg/L;（136.78±15.42） ng/L vs.（148.55±16.45） ng/L;（4.83±0.52）points vs.（5.21±0.54） points,P < 0.05].The incidence of postoperative complications in DAA group was lower than that in PLA group（2.08%vs.16.67%,P<0.05）.Conclusion THA via DAA for treatment of FNF in the elderly is mini-invasive,can effectively relieve the body stress,inhibit the generation of pain factors,and have good hip function recovery and low incidence of postoperative complications.更多还原