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目的 探讨采用侧卧位直接前侧入路(DAA)行全髋关节置换手术治疗老年股骨颈骨折患者的早期疗效及安全性.方法 选取2015年10月至2017年4月解放军沈阳军区总医院骨科行初次单侧人工全髋关节置换手术的高龄股骨颈骨折患者60例.根据入路方式的不同,随机分为DAA组和PLA组,每组30例.记录比较两组患者的手术时间、术中出血量、术后引流量、下床行走时间、住院时间、术后并发症的发生情况,以及术后1周,1、3、6个月采用Harris髋关节功能评分和视觉模拟评分法评定髋关节功能及患髋的疼痛情况.结果 对所有患者3~9个月,平均6.8个月.两组患者的手术时间比较,差异无统计学意义(P>0.05);两组的术中出血量、术后引流量、下床行走时间、住院时间比较,差异均有统计学意义(P<0.05).术后l周、1个月DAA组的HHS评分及VAS评分均高于PLA组,差异有统计学意义(P<0.05),术后3、6个月两组的HHS评分及VAS评分比较,差异无统计学意义(P>0.05).PLA组术后发生后脱位1例,DAA组未发生脱位,无其他早期术后并发症发生.结论 对高龄股骨颈骨折患者行全髋关节置换手术时,侧卧位DAA与传统PLA均安全有效,但前者创伤更小,早期可更有效地缓解疼痛,提高术后活动能力,防脱位能力强,有利于患者术后康复.

Objective To investigate the evaluation of lateral decubitus position direct anterior approach(DAA) for primary total hip arthroplasty(THA) in the treatment of elderly femoral neck fracture.Methods A retrospective study was performed on 60 patients with elderly femoral neck fracture that underwent primary unilateral THA that were admitted from October 2015 to April 2017.According to different approaches,patients were divided into the DAA group and the PLA group,with 30 cases in each group.The operation time,intraoperative blood loss,postoperative drainage,postoperative bed time,hospitalization time,postoperative complications,Harris hip score and VAS score of postoperative 1 week,1 month,3 months and 6 months were evaluated to access the hip function and hip pain.Results All patients received follow-up for 3-9 months,with an average of 6.8 months.The operation time between the two groups had no statistically significant difference(P>0.05);the intraoperative blood loss,postoperative drainage,postoperative activity time,hospitality stay had statistically significant difference(P<0.05).HHS and VAS scores of DAA group after 1 week and 1 month of operation were higher than those of PLA group(P<0.05),HHS and VAS scores between the two groups had no statistically significant difference in postoperative 3 and 6 months(P>0.05).There were 1 case of postoperative dislocation in PLA group and no dislocation in DAA group,no other early postoperative complications occurred.Conclusion Compared with PLA,DAA in THA had the advantages of less bleeding,less pain,stronger anti dislocation ability and faster postoperative recovery.The method is feasible and the effect is better.