The early clinical efficacy of minimally invasive direct anterior approach (DAA) and traditional posterolateral approach for total hip arthroplasty in the treatment of femoral neck fractures
微创直接前侧入路（direct anterior approach, DAA）与传统后外侧入路行全髋关节置换术治疗股骨颈骨折的早期临床疗效情况

摘要

目的 分析微创直接前侧入路（DAA）与传统后外侧入路（PLA）行全髋关节置换术（THA）治疗股骨颈骨折的早期临床疗效。方法 抽选61例病例，均为某院收治的行THA股骨颈骨折患者，纳入时间2021年5月到2025年6月，组间分组经随机数字表法，分为DAA组（n=31）和PLA组（n=30）。评估组间患者的手术时间、术中出血量、术后疼痛视觉模拟评分（VAS）、下地行走时间、住院天数、术后早期髋关节功能Harris评分（HHS）以及并发症概率。结果 DAA组较PLA组在术后早期（第1、3天）VAS评分更低，下地行走时间及住院天数均短于PLA组（P<0.05）。术后6周及3个月时，DAA组比PLA组的HHS评分更高（P<0.05）。组间手术时间、术中出血量及总体并发症概率相似（P>0.05），但PLA组出现1例术后早期脱位，DAA组无脱位发生。结论 与传统后外侧入路相比，实施微创DAA入路行THA治疗股骨颈骨折，可缓解患者术后早期疼痛，加速功能康复，缩短住院时长，凸显更优的早期临床疗效，且具有良好的关节稳定性，是一种有效且安全的术式选择。

Abstract

Objective To analyze the early clinical efficacy of total hip arthroplasty (THA) using the minimally invasive direct anterior approach (DAA) and the traditional posterolateral approach (PLA) in the treatment of femoral neck fractures.
Methods Sixty-one cases were selected, all of whom were patients with femoral neck fractures who underwent THA in a certain hospital. The inclusion period was from May 2021 to June 2025. The groups were divided into the DAA group (n=31) and the PLA group (n=30) by the random number table method. The operation time, intraoperative blood loss, Visual Analogue Scale (VAS) for postoperative pain, time to walk out of bed, length of hospital stay, Harris score (HHS) for early postoperative hip function, and the probability of complications of patients between the groups were evaluated.
Results The VAS scores of the DAA group were lower than those of the PLA group in the early postoperative period (days 1 and 3), and the walking time and hospital stay were both shorter than those of the PLA group (P<0.05). At 6 weeks and 3 months after the operation, the HHS score of the DAA group was higher than that of the PLA group (P<0.05). The operation time, intraoperative blood loss and overall complication probability were similar between the groups (P>0.05), but one case of early postoperative dislocation occurred in the PLA group, while no dislocation occurred in the DAA group.
Conclusion   Compared with the traditional posterolateral approach, the minimally invasive DAA approach for THA in the treatment of femoral neck fractures can relieve the early postoperative pain of patients, accelerate functional recovery, shorten the length of hospital stay, highlight better early clinical efficacy, and has good joint stability. It is an effective and safe surgical option.