中国骨与关节损伤杂志

目的 比较直接前入路与后外侧入路人工股骨头置换术治疗高龄（年龄>80岁）股骨颈骨折的早期临床疗效。方法纳入自2023-01—2024-01采用初次人工股骨头置换术治疗的118例股骨颈骨折，随机分为直接前入路组和后外侧入路组，各59例，然后通过倾向得分匹配共获得50对股骨颈骨折患者。比较两组手术时间、术中出血量、术后至下床时间、住院时间、并发症发生率，以及术后髋关节功能Harris评分、生活质量SF-36评分。结果 100例术后均获得至少6个月随访，直接前入路组术后出现2例下肢深静脉血栓形成，1例股外侧皮神经麻痹。后外侧入路组术后出现3例切口感染，2例下肢深静脉血栓形成，2例髋关节脱位，3例假体松动。直接前入路组与后外侧入路组手术时间、术后至下床时间、术后并发症发生率差异无统计学意义（P>0.05）。直接前入路组术中出血量较后外侧入路组少，住院时间比后外侧入路组短，差异有统计学意义（P<0.05）。直接前入路组术后1个月、3个月髋关节功能Harris评分、生活质量SF-36评分均高于后外侧入路组，差异有统计学意义（P<0.05），而两组术后6个月Harris评分、SF-36评分差异无统计学意义（P>0.05）。结论 直接前入路人工股骨头置换术是治疗高龄股骨颈骨折安全、有效的手术方法，与常规后外侧入路手术相比，直接前入路手术在不延长手术时间的前提下减少了术中出血量、缩短了住院时间，获得更优的早期功能结局和生活质量，同时并发症发生率更低。

ObjectiveTo compare the early clinical outcomes of direct anterior approach versus posterolateral approach in hemiarthroplasty for the treatment of femoral neck fractures in elderly patients(age>80 years).MethodsA total of 118 patients with femoral neck fractures who underwent primary hemiarthroplasty between January 2023 and January 2024 were included and randomly assigned to either the direct anterior approach group or the posterolateral approach group, with 59 patients in each group. Subsequently, 50 matched pairs of patients were obtained through propensity score matching. The operative time,intraoperative blood loss, time to ambulation postoperatively, length of hospital stay and complication rates, as well as postoperative Harris Hip Score and SF-36 quality of life score were compared between the two groups.ResultsAll 100 patients were followed up for at least 6 months postoperatively. In the direct anterior approach group, there were 2 cases of deep vein thrombosis and 1 case of lateral femoral cutaneous nerve palsy. In the posterolateral approach group, there were 3 cases of surgical site infection, 2 cases of deep vein thrombosis, 2 cases of hip dislocation, and 3 cases of prosthesis loosening. No statistically significant differences were found between the direct anterior approach and posterolateral approach groups in terms of operative time,time to ambulation postoperatively and incidence of postoperative complications(P>0.05). The direct anterior approach group demonstrated significantly less intraoperative blood loss and a shorter hospital stay compared to the posterolateral approach group(P<0.05). Furthermore, the direct anterior approach group showed significantly higher Harris Hip Score and SF-36 scores at 1 month and 3 months postoperatively compared to the posterolateral approach group(P<0.05). However, no significant differences in Harris Hip Score and SF-36 scores were observed between the two groups at the 6-month follow-up(P>0.05).ConclusionHemiarthroplasty via the direct anterior approach is a safe and effective method for treating femoral neck fractures in the elderly. Compared to the conventional posterolateral approach, the direct anterior approach reduces intraoperative blood loss,shortens the hospital stay, and yields superior early functional outcomes and quality of life, with a lower complication rate and without the operative time prolonged.