直接前方入路与后外侧入路全髋关节置换治疗股骨颈骨折的疗效比较 及术后髋关节功能的影响因素分析.

Objective: To compare the efficacy of direct anterior approach and posterolateral approach total hip arthroplasty in the treatment of femoral neck fracture and analysis of the influencing factors of postoperative hip function. Methods: A total of 96 patients with femoral neck fracture who were treated with total hip arthroplasty in the Affiliated Hospital of Xuzhou Medical University from May 2019 to December 2021 were selected, and they were divided into direct anterior approach group (n=48) and posterolateral approach group (n=48) according to different surgical methods. Perioperative indicators and complications of the two groups were observed, and Harris score and visual analog scale (VAS) were compared between the two groups before and after treatment. The influencing factors of postoperative hip function were analyzed by univariate and multivariate Logistic regression. Results: The time to get out of bed, the length of incision and the length of hospital stay in the direct anterior approach group were significantly shorter than those in the posterolateral approach group, the intraoperative blood loss and postoperative drainage volume were significantly lower than those in the posterolateral approach group, and the operation time was significantly longer than that in the posterolateral approach group (P<0.05) .Harris score at 1, 3 months after surgery in the direct anterior approach group was significantly higher than in the posterolateral approach group, and VAS score was lower than that in the posterolateral approach group (P<0.05) . There was no significant difference in the incidence of postoperative complications between the two groups (P>0.05). There was no significant difference in the excellent and good rate of hip function between the two groups after 6 months of treatment (P>0.05). Multivariate Logistic regression analysis showed that body mass index ≥24 kg/m², postoperative exercise time <3 h/d and combined with osteoporosis were the risk factors for postoperative hip dysfunction in patients with femoral neck fracture undergoing total hip replacement (P<0.05). Conclusion: The direct anterior approach total hip arthroplasty has obvious advantages over total hip arthroplasty with posterolateral approach in the short term, which is manifested as less trauma to patients and less postoperative pain, which is beneficial to the recovery of patients’ hip function. Body mass index ≥24 kg/m², postoperative exercise time <3 h/d, combined with osteoporosis are the risk factors for postoperative hip dysfunction in patients with femoral neck fracture undergoing total hip replacement. [ABSTRACT FROM AUTHOR]