| ?Objective? Objective to investigate the causes and protection methods of the lateral femoral cutaneous nerve in DAA total hip arthroplasty,and to evaluate the early effect of DAA in the treatment of femoral neck fractures in the elderly.?Methods?5 adult cadavers(10 hips)were used for anatomic research.The branches and the distance between the lateral femoral cutaneous nerve and the surrounding anatomical marks were observed and recorded.Retrospective analysis of the clinical data of 60 cases of senile femoral neck fracture treated by artificial total hip arthroplasty from February 2016 to June 2017 in Putian First Hospital joint surgery.Aaccording to different approaches,the patients were divided into 2 groups: DAA group(30 hips)and PSA group(30 hips).The operative time,incision length,intraoperative blood loss,ambulation time,ambulatory time,length of hospital stay,positioning of the artificial hip(Cup anteversion and inclination),Harris hip score postoperative 1 week,1month,3 months and 6 months,Visual analog scale(VAS)postoperative 1 day,3 days,5 days,7 days and 14 days and postoperative complications were compared between the two groups.All data were analyzed by SPSS19.0 software.?Results?The average distance between LFCN trunk and ASIS is 22 mm(range 5-53 mm).The mean angle between the LFCN and inguinal ligament is 62o(range 38o-80o).On the surface of tensor fasica,the average distance between the lateral branch of the LFCN and ASIS is 72 mm(range 54-91 mm).All two groups of patients were followed up for at least 6 months.There was no significant difference in age,sex,BMI,location and underlying diseases between the two groups(p>0.05),The operation time: DAA group(92±16)min and PSA(80±12)min,which showed statistically significant differences(p<0.05).The length of incision: DAA group(9.7±1.2)cm and PSA group(10.5±2.3)cm,which indicated statistically significant differences(p<0.05).The blood loss : DAA group(578±164)ml and PSA group(686±195)ml,which showed statistically significant differences(p<0.05).The ambulation time : DAA group(1.9±0.6)d and PSA group(3.1±0.8)d,which showed statistically significant differences(p<0.05).The use of an assistive ambulatory device : DAA group(23.8±9.2)d and PSA group(35.1±12.4)d,which showed statistically significant differences(p<0.05).The hospital stay time: DAA group(9.2±1.6)d and PSA group(12.1±3.8)d,which showed statistically significant differences(p<0.05).The positoning of the artificial hip(angles of acetabular abduction and anteversion): DAA group(16.5±4.2 / 37.4±6.8)o,PSA group(18.2±4.7 / 38.1±5.2)o,No statistical significant differences were found(p>0.05),VAS postoperative 1 day,3 days,5 days,7 days and 14 days,the DAA group is significantly lower than the PSA group(p<0.05),The avedage hip Harris scores for 1 month and 3 months' follow up were signifcantly higher in DAA group compared with those in PSA group(p<0.05),while the difference had not significance after 3 months postoperatively(p>0.05).Complications: in group DAA,there was 1 case(3.3%)greater trochanteric fracture and two cases FLCN injury(6.6%),While one case of postoperative hip dislocation(3.3%)and one case wound infection(3.3%)in PSA group,No deep vein thrombosis,nervus motorius injury,prosthetic loosening or other complication was observed in the two groups.?Conclusions?1,The LFCN injury is a common complication in the progress of DAA,the main cause of the injury is the unfamiliarity of the approach and the improper operation.It can be avoid or reduced by improving the operation skills and standardizing the operation.2,Direct anterior approach total hip replacement has slight effect on soft tissue damage and the stable of the posterior hip joint and abductor muscle function,It can achieve rapid recovery of patients,obviously shorten the time of hospitalization and bed rest,and has a positive effect on the prognosis of the elderly patients with femoral neck fracture,the early curative effect is superior to the posterolateral approach. |
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