目的:探讨直接前方微创髋关节手术(Direct Anterior Minimally Invasive Surgery, DAMIS)在80岁以上高龄股骨颈患者中的应用,并探讨其对患者术后早期快速功能康复的意义.方法:2015年2月~2016年10月,采用前瞻性对照研究选取80岁以上高龄无手术禁忌症的单侧股骨颈骨折(平均年龄83.5岁)且符合纳入标准的40例患者,采用随机抽签方法分为DAMIS手术组(20例),传统手术组(20例).比较两组患者围手术期各项数据.结果:两组患者手术切口均获得一期愈合.两组在切口长度、失血量、住院时间上差异有统计学意义(P<0.05),在自主行走力能力,下肢本体感觉上DAMIS手术组要明显优于传统手术组.术后并发症两组组间比较无统计学意义,均经对症治疗后缓解.结论:与传统后外侧髋关节手术相比,采用DAMIS手术对高龄患者进行人工半髋关节置换手术具有手术创伤小,操作简便,患者术后活动早,住院时间短等优点.在此基础上通过快速康复流程能够提高患者的满意度.%Objective:To evaluate the Direct anterior minimally invasive surgery (DAMIS) in hip fracture patients over 80 years old.And make a discussion in enhanced postoperative rehabilitation.Methods:45 cases over 80 years old with hip fracture (mean 83.5 Ys) treated in department of orthopaedics from Feb.2015 to Oct.2016.Exclusion criteria were: walking disable caused by internal diseases and bad rehabilitation compliance by disturbance of consciousness.After the above criteria, 40 cases were randomly divided into two groups.20 cases (group 2) who had undergone DAMIS hip hemiarthroplasty were compared with 20 cases (group B) who had undergone standard posterolateral incision.Perioperative data was calculated for statistical analysis(P<0.05),with significant difference.Results:Two groups were matched in physiological conditions.And all of cases incision were primary healing.Statistical differences were found in incision length, blood loss and length of hospital stay.Compared with group B, group A had advantage in independent walking and proprioceptive sensibility.Postoperative cognitive dysfunction was the most common complication (6 cases), followed by urinary infection (4 cases), digestive disorders (4 cases), arrhythmia and ectrolyte disturbance (3 cases), DVT and superficial tissue infection (2 cases).No mortality was found in latest follow-up.The satisfaction rate was 90% in group A and 85% in group B.Conclusion:Compared with traditional surgery, DAMIS has obvious advantages in reducing iatrogenic trauma and hospitalization time.Therefore, it could benefit the rapid rehabilitation in eldly and improve the satisfaction, which was worthy of clinical application.
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