The Effect Of Modified Hardinge Approach On The Quality Of Life Of Patients Undergoing Artificial Femoral Head Replacement

BackgroundWith the advent of aging of the age structure,the incidence of femoral neck fractures in the elderly is increasing significantly.Artificial femoral head replacement has the advantages of less trauma,short operation time,less intraoperative blood loss,and faster postoperative recovery.As an effective treatment for femoral neck fractures in the elderly,the choice of surgical approach is important.The mainstream approach for artificial femoral head replacement is the posterolateral approach.In recent years,the modified Hardinge approach has been aroused more and more attention,and the pros and cons of the two have been controversial.With the introduction of the concept of "quality of life" into the medical community,what we concern has gradually shifted from biomedicine to the biomedical-psychological-social.SF-36 is a quality of life measurement scale widely used in general human health measurement,clinical efficacy evaluation,planning and decision making.As for the application of the SF-36 scale to the evaluation of the quality of life of patients undergoing artificial femoral head replacement with the modified Hardinge approach,no report has been found.ObjectiveThis project aims to investigate the clinical efficacy and advantages of artificial femoral head replacement using the modified Hardinge approach comparied with posterolateral approach,the most commonly used approach of hip.With the SF-36 scale,which is used to evaluate the various dimensions of patients after surgery,we aim to explore another femoral head replacement approach with less surgical trauma,less bleeding,low risk,less complications,faster postoperative recovery,and can improve the quality of life of patients after surgery,which will benefit elderly patients with femoral neck fractures.MethodsThis study is a prospective clinical randomized controlled trial and selected 58 cases of elderly patients with femoral neck fractures treated with artificial femoral head replacement from January 2019 to November 2020 in the Second Department of Orthopedics,Shantou Hospital of Traditional Chinese Medicine,randomly divided into 2 groups.29 patients in the observation group were treated with modified Hardinge approach,and 29 patients in the control group were treated with traditional posterolateral approach.The operation condition,postoperative recovery,hip function and postoperative quality of life of the two groups were observed and compared.In this study,the SF-36 scale was used to assess the postoperative quality of life of patients;the hip function was assessed by the Harris score.The SF-36 score and Harris score of the affected hip were recorded before operation,1 month after operation,and 3 months after operation.Results1.Comparison of baseline data:(1)There were 3 and 4 patients in the observation group and the control group quit respectively,and there was no significant difference in completion between the two groups(P>0.05).(2)There was no significant difference between the two groups in baseline comparison of age,gender,Body Mass Index(BMI),presence or absence of comorbidity,fracture Garden type,preoperative hip function,preoperative quality of life.(P>0.05).2.Comparison of effect indicators:(1)The length of surgical incision,intraoperative blood loss,postoperative drainage,ambulation time,time to full body-weight loading,and length of stay in the observation group were signifi cantly less than those in the control group(P<0.05).There was no significant difference between the two groups in the operation time(P>0.05).(2)The Harris score and SF-36 score of the observation group were higher than those of the control group in the first month after operation.Among the SF-36 scale,"Physical Function,Role Physical,Bodily Pain,General Health,Social Functioning,Role-Emotional,Mental Health"of the observation group was better than the control group(P<0.05),and there was no significant difference between the two groups in the "Vitality"(P>0.05).(3)There was no significant difference in Harris scores between the two groups at 3 months after surgery(P>0.05),while SF-36 scores in the observation group was significantly higher than that in the control group(P<0.05).Among them,"Physical Function,General Health,Social Functioning,Role-Emotional" 4 dimensions of the observation group is better than the control group(P<0.05),while in the comparison of other 4 dimensions:"Role Physical,Bodily Pain,Vitality,and Mental Health",there is no significant difference between the two groups(P>0.05).(4)There was no significant difference in the incidence of postoperative complications between the two groups(P>0.05).ConclusionThe modified Hardinge approach for artificial femoral head replacement for elderly femoral neck fractures,compared with the traditional posterolateral approach,not only brings less trauma,less bleeding,and faster postoperative recovery,but also can improve the early postoperative hip function and the patient’s quality of life.Benefiting patients in biology,mentality and sociability,it is worthy of further clinical application.