[EARLY EFFECTIVENESS COMPARISON OF HEMIARTHROPLASTY BY MINIMAL INVASIVE Supercap APPROACH AND BY CONVENTIONAL APPROACH FOR ELDERLY FEMORAL NECK FRACTURE].

To compare the early clinical and radiographic outcomes of hemiarthroplasty by a minimal invasive Supercap approach and by a conventional approach for elderly displaced femoral neck fractures.Between January and June 2015, 70 geriatric patients with displaced femoral neck fracture underwent cementless bipolar hemiarthroplasty by minimally invasive Supercap approach (group A, n=35) or by posterolateral approach (group B, n=35). One patient was excluded from the study in group B because of too wide femur cavity. There was no significant difference in gender, age, body mass index, fracture cause, time from fracture to operation, fracture side, fracture classification, and preoperative visual analogue scale (VAS), and hemoglobin-level between the 2 groups (P>0.05). The operation time, intraoperative blood loss, incision length, and complications were recorded. The early clinical evaluations included timed up and go test (TUG), hemoglobin-level, VAS score, and satisfaction. The anteroposterior and lateral X-ray films were taken to measure the stem alignment, difference in leg length, and difference in femoral offset.All the patients were followed up 6-11 months (mean, 7.32 months). No patients died during follow-up. There was no significant difference in operation time and intraoperative blood loss between the 2 groups (P>0.05). The incision length of group A was significantly smaller than that of group B (P<0.05). One patient had delayed union of incision in group A (2.86%); 2 patients had deep vein thrombosis in group B (5.88%); and there was no significant difference in the complication rate (χ2=0.764, P=0.512). The postoperative hemoglobin level showed no significant difference between the 2 groups (P>0.05). Group A had lower VAS score and higher subjective satisfaction than group B, showing significant difference at 1, 5, and 14 days after operation (P<0.05). The TUG of group A was significantly shorter than that of group B at 5, 14, and 30 days (P<0.05). There was no significant difference in femoral offset or leg length on the X-ray films (t=1.273, P=0.851; t=0.409, P=0.327). The good rate of stem alignment was 82.86% (29/35) in group A, and was 85.30% (29/34) in group B, showing no significant difference (χ2=0.584, P=0.497).Both minimal invasive Supercap approach and conventional posterolateral approach are effective and safe for elderly displaced femoral neck fractures in hemiarthroplasty. Supercap approach has the advantages of less trauma, pain relief, and improvement of mobility and rapid rehabilitation.比较微创Supercap入路与传统后外侧入路行半髋关节置换治疗高龄股骨颈骨折的早期疗效差异。.将2015年1月-6月收治并符合选择标准的70例老年移位股骨颈骨折患者随机分为微创Supercap组（A组，n=35）及传统后外侧入路组（B组，n=35），均行生物型双动头半髋关节置换。B组1例患者因髓腔过大，术中改用骨水泥型假体排除研究。两组患者性别、年龄、体质量指数、致伤原因、骨折至手术时间、骨折侧别及类型以及术前疼痛视觉模拟评分（VAS）、血红蛋白比较，差异均无统计学意义（P＞0.05），具有可比性。记录两组手术时间、术中失血量、切口长度，以及术中、术后并发症发生情况。术后60 d内评价早期疗效，包括起立行走测试（timed up and go test，TUG）、血红蛋白水平、VAS评分、患者满意度调查，摄正侧位X线片观测假体柄位置、双下肢长度差及双侧偏心距差距。.患者均获随访，随访时间6～11个月，平均7.32个月；随访期间均无患者死亡。A、B组手术时间及术中出血量比较，差异均无统计学意义（P＞0.05）；但A组切口显著短于B组（P＜0.05）。术后A组1 例（2.86%）切口延迟愈合，B组2例（5.88%）发生下肢深静脉血栓形成；两组并发症发生率比较，差异无统计学意义（χ2=0.764，P=0.512）。术后各时间点两组间血红蛋白水平比较，差异均无统计学意义（P＞0.05）。术后各时间点A组VAS评分均低于B组，患者主观满意度高于B组，其中1、5、14 d时比较差异有统计学意义（P＜0.05）。术后各时间点A组TUG均短于B组，除术后60 d外，其余各时间点两组间比较差异均有统计学意义（P＜0.05）。X线片示，A、B组双侧偏心距差距、双下肢长度差比较差异均无统计学意义（t=1.273，P=0.851；t=0.409，P=0.327）；A、B组假体柄力线良好率分别为82.86%（29/35）、85.30%（29/34），比较差异无统计学意义（χ2=0.584，P=0.497）。.高龄移位股骨颈骨折患者行半髋关节置换时，微创Supercap入路与传统后外侧入路均安全有效，但前者创伤更小，早期可更有效缓解疼痛、提高术后活动能力，有利于患者术后康复。.