直接前方入路髋关节置换治疗老年股骨转子间骨折

Direct Anterior Approach Hip Arthroplasty for Intertrochanteric Fractures in the Elderly

摘要: 目的：探讨直接前方入路髋关节置换治疗老年股骨转子间骨折的疗效。方法：采用直接前方入路髋关节置换治疗10例老年股骨转子间骨折患者。记录手术的持续时间、切口的长度、出血量、术后引流量及并发症的发生情况，病例均采用Harris髋关节功能评分标准进行疗效评估。结果：患者的随访时间为2至9个月。切口长度在10至15厘米之间，手术时间介于1.5至3.5 h，术中出血量则为200至800毫升，引流量130至500毫升。无围手术期死亡，术后首次负重时间为6至20天。术后无术区浅深部感染、股外侧皮神经损伤、关节畸形、假体松动以及关节脱位等并发症的发生情况。在最后一次随访中，髋关节Harris评分介于75至94分之间，其中优良评估为7例，中等评估为3例，优良率7/10。结论：直接前方入路髋关节置换治疗老年股骨转子间骨折，该方法具有创伤小、并发症发生率低的优点，并且能够迅速促进髋关节功能的恢复。

Abstract: Objective: This paper aims to evaluate the efficacy of direct anterior approach hip arthroplasty in treating intertrochanteric fractures in elderly patients. Methods: Ten elderly patients with intertrochanteric fractures were treated with direct anterior approach hip arthroplasty. The duration of surgery, incision length, blood loss, postoperative drainage volume, and incidence of complications were recorded. All cases were assessed for efficacy using the Harris Hip Function Score. Results: The follow-up period for patients ranged from 2 to 9 months. The incision length was between 10 and 15 cm, with operative duration ranging from 1.5 to 3.5 hours. Intraoperative blood loss ranged from 200 to 800 mL, and drainage volume ranged from 130 to 500 mL. No perioperative mortality was observed, and the first postoperative weight-bearing time was 6 to 20 days. No complications such as superficial or deep wound infections, lateral femoral cutaneous nerve injury, joint deformity, prosthesis loosening, or joint dislocation occurred postoperatively. In the final follow-up, the Harris score of the hip joint ranged from 75 to 94 points, with 7 cases rated as excellent and 3 as moderate, yielding an excellent rate of 7/10. Conclusion: The direct anterior approach for hip arthroplasty in the treatment of intertrochanteric fractures in elderly patients offers the advantages of minimal trauma, low complication rate, and rapid promotion of hip joint function recovery.