侧卧位直接前方入路全髋关节置换在老年下肢肌力弱侧股骨颈骨折患者中的应用

doi:10.3969/j.issn.1003-9198.2026.04.015

摘要/Abstract

摘要： 目的探究侧卧位直接前方入路全髋关节置换(direct anterior approach total hip arthroplasty,DAA-THA)治疗老年下肢肌力弱侧股骨颈骨折的临床疗效。方法收集2020年1月至2025年9月南京医科大学第二附属医院收治的65例下肢肌力弱侧股骨颈骨折患者为研究对象,其中35例行DAA-THA(观察组),30例行后外侧入路全髋关节置换(posterolateral approach total hip arthroplasty,PLA-THA)(对照组)。比较2组手术时间、术中出血量、切口长度、并发症发生率以及术后Harris髋关节功能评分。结果所有患者均顺利完成手术, 与对照组比较,观察组手术时间长,切口长度短,出血量少,差异有统计学意义(P<0.05);随访12周,观察组患者术后出现1例髋关节后脱位,对照组出现切口感染1例,髋关节后脱位4例,2组并发症发生率差异无统计学意义(P＞0.05);观察组患者术后1、4、12周Harris评分均高于对照组,差异有统计学意义(P<0.05)。结论应用DAA-THA治疗老年患者下肢肌力弱侧股骨颈骨折早期疗效较好,能减少患者术后假体脱位的可能性,尽早恢复活动能力,提高生活质量,且具有较高的安全性。

关键词: 股骨颈骨折, 全髋关节置换, 直接前方入路, 后外侧入路, 下肢肌力弱

Abstract: Objective To investigate the clinical efficacy of total hip arthroplasty (THA) via the direct anterior approach(DAA) in elderly patients with femoral neck fractures and ipsilateral lower limb muscle weakness. Methods A total of 65 patients with weak lower limb muscle strength and femoral neck fractures admitted to the Second Affiliated Hospital of Nanjing Medical University from January 2020 to September 2025 were enrolled as study subjects. Among them, 35 patients underwent DAA-THA(observation group), and 30 patients underwent posterolateral approach total hip arthroplasty (PLA-THA, control group). Operative time, intraoperative blood loss, incision length, complication rates, and postoperative Harris Hip Score between the two groups were compared. Results All patients successfully completed the surgery and were followed up for 12 weeks. The observation group had a longer operative time, shorter incision length, and less blood loss compared to the control group, with statistically significant differences (P<0.05). In the observation group, there was only one case of hip joint posterior dislocation. In contrast, the control group had one case of surgical site infection and four cases of hip joint posterior dislocation, with no statistically significant difference (P＞0.05). The Harris Hip Scores of the observation group were higher than those of the control group 1 week, 4 weeks, and 12 weeks after operation, with statistically significant differences (P<0.05). Conclusions The DAA-THA in elderly patients with femoral neck fractures on the lower limb muscle side demonstrates favorable early outcomes, including reduced risk of prosthetic dislocation, accelerated recovery of pre-injury mobility, improved quality of life, and with high safety.

Key words: femoral neck fracture, total hip arthroplasty, direct anterior approach, posterolateral approach, lower limb muscle weakness

中图分类号:

R 683.42

邢晨阳, 闵美鹏, 徐培力, 计钟凯, 姚承, 王笑天, 范磊. 侧卧位直接前方入路全髋关节置换在老年下肢肌力弱侧股骨颈骨折患者中的应用[J]. 实用老年医学, 2026, 40(4): 406-410.

XING Chenyang, MIN Meipeng, XU Peili, JI Zhongkai, YAO Cheng, WANG Xiaotian, FAN Lei. Application of direct anterior approach total hip arthroplasty in elderly patients with weak lower limb muscle strength and femoral neck fractures[J]. Practical Geriatrics, 2026, 40(4): 406-410.

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