平卧位直接前方入路微创半髋关节置换治疗老年股骨颈骨折的早期临床疗效

Early Clinical Efficacy of Minimally Invasive Hemiarthroplasty via Direct Anterior Approach in the Supine Position for Elderly Patients with Femoral Neck Fracture

摘要: 目的：探讨直接前方入路(DAA)微创半髋关节置换术对老年股骨颈骨折患者的早期临床应用效果。方法：回顾性分析2024年9月至2025年6月收治的19例老年股骨颈骨折患者临床资料，均采用平卧位DAA微创半髋关节置换术治疗。其中女性12例、男性7例，年龄72~85岁。记录手术切口长度、手术时长、术中出血量等手术相关指标，随访观察患者首次下床负重时间、并发症发生情况，并采用视觉模拟评分(VAS)及髋关节Harris评分评估术后疼痛与功能恢复状况。结果：所有患者手术切口均为10 cm，手术耗时1.25~2.4 h，术中出血量100~200 ml；术后影像学检查显示假体位置及匹配度均良好，首次下床负重时间3~9 d，随访6~12个月。末次随访时，VAS评分0~2分，髋关节Harris评分78~96分，优良率达84.2% (16/19)；仅出现1例下肢深静脉血栓、1例切口近端愈合不良，经对症处理后好转，未发生神经损伤、股骨穿孔、假体脱位等严重并发症。结论：平卧位DAA微创半髋关节置换术治疗老年股骨颈骨折，具有软组织损伤轻、术中出血少、并发症发生率低、术后恢复快等优势，可促进患者早期功能锻炼，是一种安全可靠的微创治疗方案。

Abstract: Objective: To investigate the early clinical application effects of direct anterior approach (DAA) minimally invasive total hip arthroplasty in elderly patients with femoral neck fractures. Methods: A retrospective analysis was conducted on the clinical data of 19 elderly patients with femoral neck fractures admitted from September 2024 to June 2025, all of whom underwent supine DAA minimally invasive total hip arthroplasty. Among them, there were 12 female cases and 7 male cases, aged 72~85 years. Surgical-related indicators such as incision length, operative duration, and intraoperative blood loss were recorded. Follow-up observations included the first ambulation time and complication occurrence. Postoperative pain and functional recovery were assessed using visual analog scale (VAS) and Harris hip score. Results: All patients had a 10cm surgical incision, with a duration of 1.25 to 2.4 hours and intraoperative blood loss ranging from 100 to 200 ml. Postoperative imaging revealed satisfactory prosthetic positioning and fit. The first ambulation with weight-bearing was achieved within 3 to 9 days, and follow-up lasted 6 to 12 months. At the final follow-up, the VAS score ranged from 0 to 2, and the Harris score for the hip joint ranged from 78 to 96, with an excellent or good rate of 84.2% (16/19). Only one case of deep vein thrombosis in the lower extremity and one case of poor wound healing proximal to the incision occurred, both of which improved after symptomatic treatment. No serious complications such as nerve injury, femoral perforation, or prosthesis dislocation occurred. Conclusion: The supine DAA minimally invasive hemiarthroplasty for femoral neck fractures in elderly patients offers advantages such as minimal soft tissue damage, reduced intraoperative bleeding, low complication rate, and rapid postoperative recovery. It promotes early functional exercise and is a safe and reliable minimally invasive treatment option.