Clinical Analysis Of Bipolar Femoral Head Arthroplasty Through MIS-DAA And AL Approach In The Treatment Of Femoral Neck Fracture In The Elderly

Objective: Evaluate the short-term clinical efficacy of hip hemiarthroplasty through minimally invasive direct anterior approach in the treatment of femoral neck fractures in the elderly,and to compare the clinical efficacy with anterolateral hip hemiarthroplasty.METHODS: elderly patients with femoral neck from December 2018 to December 2020 in the third Department of orthopedics,Gansu Provincial People’s hospital were retrospectively selected and divided into minimally invasive direct anterior approach group and anterolateral approach group according to the operation methods.According to Garden classification,there were1 case of type I,1 case of type II,7 cases of type III and 5 cases of type IV;body mass index(BMI)was 28.06 ± 2.96;in anterolateral approach group,there were 14 cases,including 3 males and 11 females,with an average age of 69.28 ± 5.72;according to Garden classification,there were 1 case of type I,2 cases of type II,6 cases of type III and 5 cases of type IV;BMI was 2 The difference of short-term curative effect between the two groups was compared through the statistical analysis of perioperative related indicators,surgical efficacy related indicators and surgical complications.Results: In the minimally invasive direct anterior approach group,the average length of incision was(8.26±0.24)cm,intraoperative bleeding was(257.07±20.49)ml,operative time was(72.57±2.76)min,postoperative drainage volume was(50.64±8.39)ml,initial loading time was(1.57±0.51)days,and postoperative hospitalization duration was(7.50±1.58)days.In the anterolateral approach group,the mean incision length was(11.10±0.26)cm,intraoperative bleeding was(303.57±27.36)ml,operative time was(53.50±2.82)min,postoperative drainage volume was(65.61±8.82)ml,and postoperative hospital stay was(8.46±1.05)days.In the minimally invasive direct anterior approach group,the indexes of incision length,intraoperative bleeding,postoperative drainage volume,time to the first postoperative weight bearing,and length of postoperative hospital stay were lower than those in the anterolateral approach group,with statistical significance(P <0.05).The operative time in the minimally invasive direct anterior approach group was longer than that in the anterolateral approach group,and the difference was statistically significant(P<0.05).There was no significant difference in hip VAS scores between the two groups on the 1st day after surgery(P > 0.05).The VAS scores of the minimally invasive direct anterior approach group were lower than those of the anterolateral approach group at 3 days and 1 week after surgery,with statistical significance(P <0.05).In the minimally invasive direct anterior approach group,there was 1 case of periprosthetic fracture and longitudinal cleavage of femoral trochanter,which did not affect the installation and stability of the femoral stem.There was 1 case of lower limb deep vein thrombosis,which was implanted through the inferior vena cava and discharged from the hospital.There was no periprosthetic infection,dislocation,or heterotopic ossification.No complications occurred in the anterolateral approach group.The incidence of complications in the minimally invasive direct anterior approach group and the anterolateral approach group were 14.28% and 0%,respectively,and the difference between the two groups was statistically significant(P <0.05).Conclusion: Both minimally invasive direct anterior approach and anterolateral approach are safe and feasible in the treatment of femoral neck fracture in elderly patients,and good clinical effects have been achieved.At the same time,the minimally invasive direct anterior approach is a kind of intermuscular approach,which has less surgical trauma,good perioperative efficacy and can promote rapid recovery as well as is available to clinicians and patients.