中国组织工程研究 ›› 2023, Vol. 27 ›› Issue (27): 4312-4317.doi: 10.12307/2023.638

• 人工假体 artificial prosthesis • 上一篇    下一篇

牵引床辅助直接前侧入路全髋关节置换治疗老年股骨颈骨折

李骏然1,2,翟婧秀2,赵洪波3,王  磊2,王宏润2,梁俊生1,李力更1,2   

  1. 唐山市第二医院,1老年骨科,2创伤外科研究所,3关节科,河北省唐山市   063000
  • 收稿日期:2022-07-04 接受日期:2022-08-19 出版日期:2023-09-28 发布日期:2022-11-07
  • 通讯作者: 梁俊生,主任医师,唐山市第二医院老年骨科,河北省唐山市 063000
  • 作者简介:李骏然,男,1990年生,河北省唐山市人,汉族,硕士,主治医师,主要从事骨与关节疾病相关研究。
  • 基金资助:
    河北省医学科学研究课题计划(20221741),项目负责人:李骏然

Assistance of traction table for total hip arthroplasty through the direct anterior approach for treating femoral neck fracture in the elderly

Li Junran1, 2, Zhai Jingxiu2, Zhao Hongbo3, Wang Lei2, Wang Hongrun2, Liang Junsheng1, Li Ligeng1, 2   

  1. 1Department of Geriatric Orthopedics, 2Institute of Trauma Surgery, 3Department of Joint Surgery, Second Hospital of Tangshan, Tangshan 063000, Hebei Province, China
  • Received:2022-07-04 Accepted:2022-08-19 Online:2023-09-28 Published:2022-11-07
  • Contact: Liang Junsheng, Chief physician, Department of Geriatric Orthopedics, Second Hospital of Tangshan, Tangshan 063000, Hebei Province, China
  • About author:Li Junran, Master, Attending physician, Department of Geriatric Orthopedics, and Institute of Trauma Surgery, Second Hospital of Tangshan, Tangshan 063000, Hebei Province, China
  • Supported by:
    the Science and Medicine Program of Hebei Province, No. 20221741 (to LJR)

摘要:


文题释义:

直接前侧入路:基于Heuter间隙(即阔筋膜张肌、缝匠肌和臀中肌、股直肌)从前方显露髋关节,后经Smith-Peterson入路(缝匠肌、股直肌与阔筋膜张肌)改良,使其安全性更高。该方法利用自然解剖肌间隙入路,术中避免损伤切断任何肌肉肌腱,因此较大程度保持了髋关节原有的解剖形态,为真正意义的微创手术入路。
牵引床:牵引床在创伤骨科手术中十分常见,常用于下肢骨折手术,施加纵向牵引力将骨折断端分离,便于骨折复位。JUDET等学者首次发明辅助直接前侧入路全髋关节置换术的特制牵引床,使用牵引床有利于该手术的顺利完成。

背景:直接前侧入路是近年来新兴的微创全髋关节置换手术入路,具备软组织损伤小、出血少、疼痛轻、康复快等优势,但手术操作难度相对较大,术中是否需要使用牵引床仍存在争议。
目的:分析牵引床辅助下直接前侧入路全髋关节置换治疗老年股骨颈骨折的临床疗效。
方法:回顾性分析2019年1月至2020年3月唐山市第二医院收治的126例老年股骨颈骨折患者的临床资料,其中接受牵引床辅助直接前侧入路全髋关节置换67例,为牵引床手术组;接受无牵引床直接前侧入路全髋关节置换59例,为传统手术组。记录两组患者术前准备时间、手术时间、麻醉时间、术中出血量及术后假体影像学指标;采用Harris评分评估术后髋关节功能,观察并发症的发生情况。
结果与结论:①所有患者术后均获得12个月以上随访;②与传统手术组相比,牵引床手术组术前准备时间较长、手术时间较短、术中出血量较少、股骨假体中心性固定率更优,差异有显著性意义(P < 0.05);③两组麻醉时间、髋臼杯位于安全区比率、双下肢长度差值小于10 mm比率、术后1周、1,6,12个月Harris髋关节功能评分以及并发症比较,差异无显著性意义(P > 0.05);④结果说明,相对于传统直接前侧入路全髋关节置换治疗老年股骨颈骨折,牵引床辅助直接前侧入路全髋关节置换可有效降低手术时间和术中出血量,提高股骨假体置入的精准度,但其术前准备时间较长。

https://orcid.org/0000-0003-2339-704X (李骏然) 

中国组织工程研究杂志出版内容重点:人工关节;骨植入物;脊柱;骨折;内固定;数字化骨科;组织工程

关键词: 牵引床, 直接前侧入路, 股骨颈骨折, 全髋关节置换, 老年,

Abstract: BACKGROUND: Total hip arthroplasty through the direct anterior approach has a significant minimally invasive effect and has the advantages of less soft tissue damage, less bleeding, less pain, and fast recovery. However, it is difficult to operate. Whether the traction table should be required or not during surgery is still controversial.  
OBJECTIVE: To analyze the clinical efficacy of assisting by the traction table in direct anterior approach-total hip arthroplasty for femoral neck fracture in the elderly.
METHODS: A retrospective study was conducted to assess the clinical data of 126 elderly patients with femoral neck fractures from January 2019 to March 2020 in Second Hospital of Tangshan. 67 patients were operated by the assistance of traction table and included as the traction table group. 59 patients were operated in non-traction table and set as the conventional operation group. The preoperative preparation time, the operation time, the anesthesia time, intraoperative blood loss, and postoperative radiological evaluation of prosthesis were recorded between the two groups. Hip joint function after operation was assessed by Harris score. Complications in the two groups were documented.  
RESULTS AND CONCLUSION: (1) All patients were followed up over 12 months after operation. (2) The traction table group showed significant longer preoperative preparation time, shorter operation time, less intraoperative blood loss and better central fixation ratio of femoral prosthesis than those in the conventional operation group (P < 0.05). (3) No significant difference was found between the traction table group and the conventional operation group for the anesthesia time, the ratio of the acetabular cup located in the safe zone, the ratio of limb length discrepancy shortened than 10 mm, Harris scores and complications in 1 week, 1, 6 and 12 months after the operation (P > 0.05). (4) The results conclude that compared with performing traditional total hip arthroplasty through the direct anterior approach without the use of a traction table on the treatment of geriatric patients suffering from femoral neck fracture, assistance of traction table in direct anterior approach-total hip arthroplasty can significantly shorten operation time, reduce the intraoperative blood loss and improve accuracy of femoral prosthesis. However, using a traction table can also prolong the preoperative preparation time.

Key words: traction table, direct anterior approach, femoral neck fracture, total hip arthroplasty, elderly, hip

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