摘要
目的 探讨后外侧入路与直接前入路的全髋关节置换术治疗老年股骨颈骨折的疗效分析.方法 选取2019年2月至2023年12月商丘市第一人民医院收治的42例股骨颈骨折患者作为研究对象,根据手术治疗方法分为后外侧入路组和直接前入路组,每组21例,后外侧入路组患者行后外侧入路全髋关节置换术,直接前入路组患者行直接前入路全髋关节置换术.观察两组手术方式患者围手术期指标变化;评估两组患者的疼痛程度和髋关节功能;采用试剂盒检测患者血清氧化应激指标谷胱甘肽过氧化物酶,超氧化物歧化酶和丙二醛变化;采用酶联免疫吸附试验分析两组患者血清炎性因子白细胞介素-1β、白细胞介素-10和肿瘤坏死因子水平.组间比较采用t检验.结果 直接前入路组患者手术切口、手术出血量、住院时间和安全负重时间[(8.16±0.79)cm、(201.14±19.78)ml、(5.10±1.14)d、(32.43±2.68)d]低于后外侧入路组[(8.16±0.79)cm、(201.14±19.78)ml、(6.57±1.25)d、(40.52±3.64)d],差异有统计学意义(t=8.265、3.845、4.009、8.210,P＜0.05).直接前入路组患者手术时间[(90.33±5.65)min]高于后外侧入路组[(82.80±5.28)min],差异有统计学意义(t=4.459,P＜0.05).直接前入路组患者视觉模拟疼痛评分[(3.00±0.89)分]低于后外侧入路组[(4.71±1.06)分],差异有统计学意义(t=5.678,P＜0.05).直接前入路组患者髋关节(Harris)评分[(87.19±4.07)分]高于后外侧入路组[(77.23±5.23)分],差异有统计学意义(t=6.879,P＜0.05).直接前入路组患者超氧化物歧化酶活性和谷胱甘肽过氧化物酶活性[(100.33±8.99)、(576.95±58.77)U/ml]高于后外侧入路组[(77.10±8.95)、(435.19±56.54)U/ml],差异有统计学意义(t=8.395、7.798,P＜0.05).直接前入路组患者丙二醛水平[(5.69±0.48)mmol/L]低于后外侧入路组[(7.42±0.57)mmol/L],差异有统计学意义(t=10.630,P＜0.05).直接前入路组患者血清白细胞介素-1β和肿瘤坏死因子-α[(52.29±7.40)、(82.90±8.89)ng/ml]低于后外侧入路组[(73.71±6.97)、(100.33±7.16)ng/ml],差异有统计学意义(t=9.565、6.999,P＜0.05).结论 直接前入路全髋关节置换术治疗老年股骨颈骨折疗效显著,手术创伤小,患者术后氧化应激和炎症水平较低,有助于减轻患者疼痛,促进关节功能恢复.
Abstract
Objective To analyze the effect of posterior lateral approach and direct anterolateral approach total hip arthroplasty in treating geriatric femoral neck fractures.Methods A total of 42 patients with femoral neck fractures admitted to the first people's hospital of shangqiu city from February 2019 to December 2023 were selected as the research subjects and divided into the posterior lateral approach group and the direct anterolateral approach group,with 21 patients in each group.The patients in the posterior lateral approach group underwent posterior lateral approach total hip arthroplasty,while the patients in the direct anterolateral approach group underwent direct anterolateral approach total hip arthroplasty.The chan-ges in perioperative indicators(operation time,incision size,blood loss,hospital stay,drainage volume)were observed in the two groups of patients;the degree of pain and hip function were evaluated by visual analog scale(VAS)and Harris hip score;the oxidative stress indicators glutathione peroxidase,superoxide dismutase,and malondialdehyde in the blood were detected by kit;the inflammatory factors interleukin-1 β,interleukin-10,and tumor necrosis factor in the blood were analyzed by enzyme-linked immunosorbent assay.Quantitative data between groups were compared by t-test.Results The surgical incision,blood loss,hospital stay and safe weight-bearing time of patients in the direct anterior approach group[(8.16±0.79)cm,(201.14±19.78)ml,(5.10±1.14)d,(32.43±2.68)d]were significantly lower than those in the posterolateral approach group[(8.16±0.79)cm,(201.14±19.78)ml,(6.57±1.25)d,(40.52±3.64)d,t=8.265.3.845,4.009,8.210,P＜0.05].The operation time in the direct anterior approach group[(90.33±5.65)min]was significantly higher than that in the posterolateral approach group[(82.80±5.28)min,t=4.459,P＜0.05].The visual analogue pain score in the direct anterior approach group[(3.00±0.89)points]was significantly lower than that in the posterolateral approach group[(4.71±1.06)points,t=5.678,P＜0.05].The Harris score in the direct anterior approach group[(87.19±4.07)points]was significantly higher than that in the posterolateral approach group[(77.23±5.23)points,t=6.879,P＜0.05].The activities of superoxide dismutase and glutathione peroxidase in the direct anterior approach group[(100.33±8.99),(576.95±58.77)U/ml]were signifi-cantly higher than those in the posterolateral approach group[(77.10±8.95),(435.19±56.54)U/ml,t=8.395,7.798,P＜0.05].The level of malondialdehyde in the direct anterior approach group[(5.69±0.48)mmol/L]was significantly lower than that in the posterolateral approach group[(7.42±0.57)mmol/L,t=10.630,P＜0.05].The serum levels of interleukin-1 β and tumor necrosis factor A in the direct anterior approach group[(52.29±7.40),(82.90±8.89)ng/ml]were significantly lower than those in the posterolateral approach group[(73.71±6.97),(100.33±7.16)ng/ml],and the difference was statistically significant(t=9.565,6.999,P＜0.05).Conclusion Direct anterior approach total hip arthroplasty for the treatment of femoral neck fractures in elderly patients demonstrates significant efficacy,with minimal surgical trauma and lower postoperative oxidative stress and inflammation levels.This ap-proach helps alleviate patient pain and facilitates joint function recovery.
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