Comparison Of Early Clinical Effects Between Minimally Invasive Direct Anterior Approach And Posterolateralapproach For Total Hip Arthroplasty In The Treatment Offemoral Neck Fractures

Femoral neck fracture is a common disease in orthopedics.It often occurs in the elderly.If it is not treated in time,it will lead to disability or death.Total hip replacement(THR)is a common surgical method for the treatment of femoral neck fracture in the elderly.The development trend is how to increase the stability of early artificial joints,how to reduce the trauma of patients,and achieve the purpose of rapid rehabilitation.Recently,the minimal an intensive approach(DAA)is the most likely to avoid surrounding because of the use of natural anatomical gaps.The damage of the tissue has attracted more and more attention from everyone.At the same time,the reconstruction of the external rotation group in the posterior lateral approach has significantly reduced the posterior dislocation of the joint compared with the traditional posterolateral approach.Artificial total hip arthroplasty was used to assess whether DAA is more advantageous than posterior lateral approach.ObjectiveTo compare the minimally invasive direct anterion approach(DAA)and posterior lateral approach for total hip arthroplasty in the treatment of femoral neck fractures,and to compare the early postoperative functional rehabilitation and explore the value of DAA.MethodsA total of 80 patients with femoral neck fractures in the Department of Orthopaedics,Changzhou Second People's Hospital from 2016.09----2017.12 were compared.Among them,35 patients underwent minimally invasive direct anterior approach and 45 underwent posterior approach.At the same time,the external rotation muscle group was reconstructed.All cases were unilateral total hip arthroplasty.Excluding patients with severe medical diseases,pathological fractures,severe obesity,all artificial total hip arthroplasty were performed by the same surgeon.Patients were collected for age,gender,body mass index(BMI),length of incision,operative time,postoperative drainage,postoperative complications,first postoperative time,postoperative pain visual analogue scale(VAS),one month after surgery,6 The Harris hip function score for the month,the abduction angle of the acetabular cup and the neck stem angle of the femoral stem were compared one week after surgery.ResultsThe length of the incision in the DAA group was shorter than that in the posterior lateral group(P<0.01).The painful VAS score was lower in the DAA group within 72 hours after surgery(P<0.01),and the wound drainage was less(P<0.01).The first time after the operation was earlier(P<0.01);the operation time was longer than the posterior lateral group.The abduction angle of the acetabular cup and the neck stem angle of the femoral stem were not statistically significant in the two groups(P>0.05).The Harris hip function score in the DAA group was better than the posterior group in the first month(P<0.01).There were no significant differences in the groups after six months(P>0.05).Early complications:1 case of femoral greater trochanter fracture in the DAA group,recovered after 2 months,1 case of posterior dislocation in the posterolateral group,and no dislocation after reduction.ConclusionDAA total hip replacement for the treatment of femoral neck fractures has a short surgical incision,mild postoperative pain symptoms,early first time after surgery,early hip function,and early clinical efficacy.