改良Hardinge入路半髋关节置换术治疗老年股骨颈骨折的短期临床疗效

Short-Term Clinical Efficacy of Modified Hardinge Approach Hemiarthroplasty in the Treatment of Femoral Neck Fractures in the Elderly

摘要: 目的：探究改良hardinge入路行髋关节置换术治疗老年股骨颈骨折的短期疗效及安全性能，为临床治疗方案的选定提供实证参考。方法：回顾性分析2023年7月至2025年9月于本院接受改良hardinge入路髋关节置换术的17例老年股骨颈骨折患者临床资料。所有患者术前完成全面检查以评估手术耐受度，术中采用改良hardinge入路实施人工髋关节置换，术后常规开展抗感染、抗凝治疗及康复指导。观察患者手术时长、切口长度、术中出血量、术后24 h引流量、首次下床负重时间、伤后至手术间隔及术后住院天数等围术期指标；采用Harris髋关节功能评分评估术后1个月、3个月的关节功能恢复状况，并记录术后并发症发生情况。结果：17例患者均顺利完成手术，无术中严重并发症。手术时长50~100 min，切口长度8~12 cm，术中出血量50~200 ml，术后24 h引流量20~230 ml，首次下床负重时间2~5 d，伤后至手术间隔2~9 d，术后住院天数7~17 d。术后1个月Harris评分为81~89分，术后3个月升至93~97分，后者较前者显著提高。术后随访3~12个月，未出现深静脉血栓、假体脱位、感染等严重并发症。结论：改良hardinge入路髋关节置换术治疗老年股骨颈骨折具有手术耗时短、术中出血少、术后恢复快等优势，短期疗效确切且安全性高，值得临床推广。

Abstract: Objective: To investigate the short-term efficacy and safety of modified hardinge approach hip arthroplasty in the treatment of elderly patients with femoral neck fractures, providing evidence-based reference for clinical treatment selection. Methods: A retrospective analysis was conducted on the clinical data of 17 elderly patients with femoral neck fractures who underwent modified hardinge approach hip arthroplasty in our hospital from July 2023 to September 2025. All patients underwent comprehensive preoperative evaluations to assess surgical tolerance. The modified hardinge approach was employed for total hip arthroplasty (THA) during the procedure, followed by standard postoperative care including anti-infection therapy, anticoagulation, and rehabilitation guidance. Perioperative parameters were monitored, including operative duration, incision length, intraoperative blood loss, drainage volume within 24 hours postoperatively, first ambulation time, interval from injury to surgery, and postoperative hospitalization duration. Harris Hip Function Score was used to evaluate postoperative joint function recovery at 1 and 3 months, with postoperative complications recorded. Results: All 17 patients underwent successful surgery without intraoperative severe complications. The operative duration ranged from 50 to 100 minutes, with incision lengths of 8~12 cm and intraoperative blood loss of 50~200 mL. Postoperative drainage volume at 24 hours ranged from 20 to 230 mL. The first ambulation time was 2~5 days, the interval from injury to surgery was 2~9 days, and the postoperative hospitalization duration was 7~17 days. The Harris score was 81~89 at 1 month postoperatively and increased to 93~97 at 3 months, with the latter showing a significant improvement. During the 3~12 months follow-up, no severe complications such as deep vein thrombosis, prosthesis dislocation, or infection were observed. Conclusion: The modified hardinge approach for hip arthroplasty in elderly patients with femoral neck fractures demonstrates advantages including shorter operative time, reduced intraoperative bleeding, and faster postoperative recovery. With confirmed short-term efficacy and high safety, this technique is worthy of clinical promotion.