经梨状肌和臀小肌间隙入路行全髋关节置换对老年髋部骨折的治疗效果及病人生存质量的影响

目的探究经梨状肌和臀小肌的间隙入路行全髋关节置换对老年髋部骨折的治疗效果及病人生存质量的影响。方法选取96例老年髋部骨折病人(108髋)为本研究对象，其中50例病人(55髋)行后外侧入路全髋关节置换术为A组，46例病人(53髋)行经梨状肌和臀小肌间隙入路全髋关节置换术为B组，记录对比2组病人围手术期情况(手术时间、切口最大长度、术中出血量、术后下地时间)、并发症情况、术前术后髋关节HHS评分、VAS疼痛评分和下肢功能变化情况、术后6个月病人影像学指标情况(外展角、前倾角、偏心距)和生存质量情况(以SF-36量表表示)。结果A组病人手术时间、切口长度短于B组，术后首次下地时间长于B组(P < 0.05~P < 0.01)；A组病人术后1、3、7 d的HISS评分低于B组，VAS评分高于B组(P < 0.05~P < 0.01)，2组病人术前、术后14、30、90、180 d的HISS和VAS评分差异无统计学意义(P>0.05)；B组病人术后30、90 d“起立-行走”计时测试显著优于A组，术后30 d单腿站立测试时间长于A组，术后90 d的6 min步行测试距离优于A组(P < 0.05)，其他时间点2组病人下肢功能情况差异无统计学意义(P>0.05)；A组前倾角小于B组，偏心距大于B组(P < 0.05)；B组病人SF-36评分量表肢体功能、社会功能、心理健康和总健康程度得分均优于A组(P < 0.05)。结论相比于传统后外侧入路行全髋关节置，经梨状肌与臀小肌间隙入路对老年髋部骨折病人的损伤更小、恢复更快，近期疗效指标显著优于传统术式，符合快速康复理念，但手术时长显著增加，病人术后前倾角偏大，偏心距偏小。

Effect of the total hip arthroplasty through the gap between the piriformis and gluteal muscles approaches on the outcome and quality of life of elderly patients with hip fractures

ObjectiveTo explore the effects of total hip arthroplasty through the gap between the piriformis and gluteal muscles approaches on the outcome and quality of life of elderly patients with hip fractures.MethodsA total of 96 elderly patients(108 hips) with hip fractures were divided into the group A(50 cases, 55 hips) treated with posterolateral approach total hip arthroplasty and group B(46 cases, 53 hips) treated through the gap between the piriformis and gluteal muscles approaches.The perioperative condition(including the operation time, maximum length of the incision, intraoperative blood loss, postoperative down time), postoperative complications, preoperative hip HHS score, VAS pain score and lower limb function change situation, imaging indexes after six months of operation(including outreach angle, inclination angle and eccentricity) and quality of life(SF-36 scale) in two groups were recorded.ResultsThe operation time and incision length in group A were shorter than those in group B, and the first landing time after operation in group A wasd longer than that in group B(P < 0.05 to P < 0.01).After 1, 3, and 7 days of operation, the HISS score in group A were lower than those in group B, and the VAS score in group A was higher than that in group B(P < 0.05 to P < 0.01).The differences of the scores of HISS and VAS after 14, 30, 90 and 180 days of operation between two groups were not statistically significant(P>0.05).The "stand up and walk" timing test after 30 and 90 days of operation in groups B were significantly better than those in group A, the one-leg standing test time after 30 days of opertaion in group B was longer than that in group A, the 6 min walk test distance at postoperative 90 days in groups B was significantly better than that in group A(P < 0.05).There was no statistical significance in the lower limb function between two groups at other time points(P>0.05).The rake angle in group A was smaller than that in group B, and the eccentricity in group A was larger than that in group B(P < 0.05).The scores of limb function, social function, mental health and total health of SF-36 scale in group B were better than those in grop A(P < 0.05).ConclusionsCompared with the traditional posterolateral approach for total hip arthroplasty, the transpiriformis and gluteal muscle approach has less damage and faster recovery for elderly patients with hip fractures, and the short-term efficacy indicators of which are significantly better than that of traditional surgical methods.The total hip arthroplasty through the gap between the piriformis and gluteal muscles approaches is in line with the concept of rapid recovery, but the duration of surgery significantly increases, the patient′s postoperative anterior inclination is larger, and the eccentricity is smaller.Clinical follow-up is still needed to explore the long-term efficacy.