نویسندگان
دانشگاه علوم پزشکی تهران
چکیده
پیشزمینه: امروز در خصوص انتخاب آرتروپلاستی در درمان شکستگی با جابجایی گردن فمور در افراد مسن اتفاق نظر وجود دارد. رویکردهای شایع جراحی در پشت یا کناری (پوستریور و لاترال) میباشند. استفاده از رویکرد جلو (دایرکت انتریور) در بسیاری مراکز دنیا محبوبیت پیدا کرده است. با درنظر گرفتن امتیازهای متعدد این رویکرد مطالعهای برای بررسی نتایج آن در افراد مسنی که در مرکز ما تحت عمل همیآرتروپلاستی با رویکرد «مستقیماً جلو» قرار گرفته بودند انجام پذیرفت.
مواد و روشها: تمام موارد شکستگی گردن ران که در مرکز آموزشی درمانی امام خمینی تهران در فاصله سه سال 2010 تا 2013 تحت عمل همیآرتروپلاستی با رویکرد «مستقیماً جلو» قرار گرفته بودند از سیستم پروتکل آیندهنگر آن مرکز استخراج شدند – اطلاعات قبل، ضمن و بعد از عمل که همگی با برنامهریزی قبلی در سیستم موجود بودند جمعآوری شدند. همچنین اطلاعات پیگیریهای بیماران در درمانگاه در فواصل معین که همگی ذخیره شده بودند در آورده شدند و آنالیز شدند.
یافتهها: 45 بیمار شامل 16 مرد و 29 زن با متوسط سن 73.4 در مطالعه شرکت داده شدند. بیماران پیگیری متوسط 76 ماه داشتند. هیچ یک از عوارض معمول از قبیل مشکلات زخم و عفونت عمقی و دررفتگی در این بیماران دیده نشد. امتیاز هاریس بیماران عدد 87 (95-76) بود.
نتیجهگیری: به دلیل سن بالای اکثر افرادی که به شکستگی گردن فمور دچار میشدند، درمان همی آرتروپلاستی با رویکرد «مستقیماً جلو» امتیازهای متعددی دارد و در این گروه از بیماران قویاً توصیه میشود.
کلیدواژه‌ها
عنوان مقاله [English]
Elderly Femoral Neck Fracture: Hemiarthroplasty via Direct Anterior Approach Surgical Techniques and Literature Review
نویسندگان [English]
- SMJavad Mortazavi
- Seyyedhossein Shafiei
- M A Ghasemi
چکیده [English]
Introduction: Nowadays, there is consensus regarding arthroplasty as the preferred treatment method for displaced femoral neck fracture among the elderly population. Although posterior and lateral surgical approaches are the most commonly used approaches for hip arthroplasty, direct anterior approach (DAA) has become popular in many centres. Considering the many advantages of DAA, this study aimed to study the results of hemiarthroplasty via DAA for femoral hip fracture in the elderly people in our centre.
Methods: All the femoral neck fractures that had received hemiarthroplasty via DAA between January 2010 and January 2013 in a teaching hospital were extracted from the database. The pre, intra, and post-operative information and clinical follow-up data were all collected and analysed. The Harris Hip Score and physical exam was used for functional assessment.
Results: 45 patients (16 males and 29 females) with a mean age of 73.4 years and a mean follow-up of 76 months entered the study. There was no complication such as dislocation, wound problem or deep infection. The final mean Harris Hip Score was 87 (76-95).
Conclusion: given that the patients with femoral neck fractures are often old, hemiarthroplasty treatment via direct anterior approach (DAA), has multiple advantages and is recommended for this population.
کلیدواژه‌ها [English]
- Keywords: Femoral Neck Fracture
- Hemiarthroplasty
- Direct Anterior Approach
Hemiarthroplasty versus internal fixation for displaced
intracapsular hip fractures in the elderly. A randomised
trial of 455 paƟents. J Bone Joint Surg Br. 2002;84:1150-
5.
2. Rogmark C, Johnell O. Primary arthroplasty is
better than internal fixation of displaced femoral neck
fractures: a meta-analysis of 14 randomized studies with
2,289 paƟents. Acta Orthop. 2006;77:359-67.
3. Blomfeldt R, Tornkvist H, Ponzer S, Soderqvist
A, Tidermark J. Comparison of internal fixation with
total hip replacement for displaced femoral neck
fractures. Randomized, controlled trial performed at
four years. J Bone Joint Surg Am. 2005;87:1680-8.
4. Bhandari M, Devereaux PJ, Swiontkowski MF,
Tornetta P, 3rd, Obremskey W, Koval KJ, et al. Internal
fixation compared with arthroplasty for displaced
fractures of the femoral neck. A meta-analysis. J Bone
Joint Surg Am. 2003;85-a:1673-81.
5. Macaulay W, Pagnotto MR, Iorio R, Mont MA,
Saleh KJ. Displaced femoral neck fractures in the elderly:
hemiarthroplasty versus total hip arthroplasty. J Am
Acad Orthop Surg. 2006;14:287-93.
6. Tol MC, van den Bekerom MP, Sierevelt IN,
Hilverdink EF, Raaymakers EL, Goslings JC.
Hemiarthroplasty or total hip arthroplasty for the
treatment of a displaced intracapsular fracture in active
elderly paƟents: 12-year follow-up of randomised trial.
Bone Joint J. 2017;99-b:250-4.
7. Post ZD, Orozco F, Diaz-Ledezma C, Hozack WJ,
Ong A. Direct anterior approach for total hip
arthroplasty: indications, technique, and results. J Am
Acad Orthop Surg. 2014;22:595-603.
8. Kristensen TB, Vinje T, Havelin LI, Engesæter LB,
Gjertsen J-E. Posterior approach compared to direct
lateral approach resulted in better patient-reported
outcome after hemiarthroplasty for femoral neck
fracture. Acta Orthop. 2017;88:29-34.
9. Amlie E, Havelin LI, Furnes O, Baste V,
Nordsletten L, Hovik O, et al. Worse patient-reported
outcome after lateral approach than after anterior and
posterolateral approach in primary hip arthroplasty. A
cross-secƟonal quesƟonnaire study of 1,476 paƟents 1-3
years aŌer surgery. Acta Orthop. 2014;85:463-9.
10. Parker MJ. Lateral versus posterior approach
for insertion of hemiarthroplasties for hip fractures: A
randomised trial of 216 paƟents. Injury. 2015;46:1023-7.
11. Gharanizade K, Karimi Heris H, Abolghasemian
M, Joudi S, Hassany Shariat Panahy P, Yoosefzadeh A. A
Comparative Evaluation of Primary Total Hip
Arthroplasty via Lateral and Posterolateral Approaches.
Shafa Ortho J. 2016;3:e3901.
12. Abram SG, Murray JB. Outcomes of 807
Thompson hip hemiarthroplasty procedures and the
2015;46:1013-7.
13. Svenoy S, Westberg M, Figved W, Valland H,
Brun OC, Wangen H, et al. Posterior versus lateral
approach for hemiarthroplasty after femoral neck
fracture: Early complications in a prospective cohort of
583 paƟents. Injury. 2017;48:1565-9.
14. Bender B, Nogler M, Hozack WJ. Direct anterior
approach for total hip arthroplasty. Orthop Clin North
Am. 2009;40:321-8.
15. Zawadsky MW, Paulus MC, Murray PJ,
Johansen MA. Early outcome comparison between the
direct anterior approach and the mini-incision posterior
approach for primary total hip arthroplasty: 150
consecutive cases. J Arthroplasty. 2014;29:1256-60.
16. Berend KR, Lombardi AV, Jr., Seng BE, Adams
JB. Enhanced early outcomes with the anterior supine
intermuscular approach in primary total hip
arthroplasty. J Bone Joint Surg Am. 2009;91 Suppl 6:107-
20.
17. Banaszkiewicz PA, Kader DF. Classic Papers in
Orthopaedics. 1st ed. New York; Springer; 2014.
18. Bergin PF, Doppelt JD, Kephart CJ, Benke MT,
Graeter JH, Holmes AS, et al. Comparison of minimally
invasive direct anterior versus posterior total hip
arthroplasty based on inflammation and muscle damage
markers. J Bone Joint Surg Am. 2011;93:1392-8.
19. Pogliacomi F, Paraskevopoulos A, Costantino C,
Marenghi P, Ceccarelli F. Influence of surgical
experience in the learning curve of a new approach in
hip replacement: anterior mini-invasive vs. standard
lateral. Hip Int. 2012;22:555-61.
20. Yue C, Kang P, Pei F. Comparison of Direct
Anterior and Lateral Approaches in Total Hip
Arthroplasty: A Systematic Review and Meta-Analysis
(PRISMA). Medicine (BalƟmore). 2015;94:e2126.
21. Alecci V, Valente M, Crucil M, Minerva M,
Pellegrino CM, Sabbadini DD. Comparison of primary
total hip replacements performed with a direct anterior
approach versus the standard lateral approach:
perioperative findings. J Orthop Traumatol.
2011;12:123-9.
22. Nakata K, Nishikawa M, Yamamoto K, Hirota S,
Yoshikawa H. A clinical comparative study of the direct
anterior with mini-posterior approach: two consecutive
series. J Arthroplasty. 2009;24:698-704.
23. Martin CT, Pugely AJ, Gao Y, Clark CR. A
comparison of hospital length of stay and short-term
morbidity between the anterior and the posterior
approaches to total hip arthroplasty. J Arthroplasty.
2013;28:849-54.
24. Higgins BT, Barlow DR, Heagerty NE, Lin TJ.
Anterior vs. posterior approach for total hip
arthroplasty, a systematic review and meta-analysis. J
Arthroplasty. 2015;30:419-34.
)