Abstract：
BACKGROUND: Femoral neck fractures (FNF) are one of the most common traumatic injuries in the elderly. The conjoined tendon-preserving posterior (CPP) approach was developed as a modification of the conventional posterolateral (PL) approach in hemiarthroplasty (HA) for displaced femoral neck fractures (FNF) to reduce postoperative dislocation. We hypothesized that the CPP approach would result in fewer dislocations and similar functional and radiographic outcomes compared to the PL approach.
METHODS: This was a retrospective multicenter (TRON group) study. We evaluated the rate of complications, and functional and radiographic outcomes for patients aged >65 years who underwent HA via the PL approach or the CPP approach from 2017 to 2019 and followed up for at least 24 months. To adjust for baseline differences between the groups, a propensity score-matching algorithm was used in a 1:1 ratio.
RESULTS: We identified 135 patients who underwent HA via the PL approach and 135 patients via the CPP approach. The mean follow-up period was 32.4 ± 14.0 months. The incidence of dislocation was 6 in 135 patients (4.4%) in the PL group and 0 in 135 patients (0%) in the CPP group, and there was significant difference (p = 0.04). Operation time was equivalent between the two groups (73.1 ± 30.4 vs. 71.8 ± 30.0 min; p = 0.72). The rate of varus insertion of stems in the PL group lower than that in the CPP group (19.3% vs. 33.3%; p = 0.01). Postoperative Parker\'s mobility score was similar between the two groups at 12 months follow-up (6.17 vs. 6.27; p = 0.81).
CONCLUSIONS: The CPP approach showed a significantly lower dislocation rate, similar functional outcome and more varus stem insertions compared with the PL approach in this retrospective study.
METHODS: This was a retrospective multicenter (TRON group) study. We evaluated the rate of complications, and functional and radiographic outcomes for patients aged >65 years who underwent HA via the PL approach or the CPP approach from 2017 to 2019 and followed up for at least 24 months. To adjust for baseline differences between the groups, a propensity score-matching algorithm was used in a 1:1 ratio.
RESULTS: We identified 135 patients who underwent HA via the PL approach and 135 patients via the CPP approach. The mean follow-up period was 32.4 ± 14.0 months. The incidence of dislocation was 6 in 135 patients (4.4%) in the PL group and 0 in 135 patients (0%) in the CPP group, and there was significant difference (p = 0.04). Operation time was equivalent between the two groups (73.1 ± 30.4 vs. 71.8 ± 30.0 min; p = 0.72). The rate of varus insertion of stems in the PL group lower than that in the CPP group (19.3% vs. 33.3%; p = 0.01). Postoperative Parker\'s mobility score was similar between the two groups at 12 months follow-up (6.17 vs. 6.27; p = 0.81).
CONCLUSIONS: The CPP approach showed a significantly lower dislocation rate, similar functional outcome and more varus stem insertions compared with the PL approach in this retrospective study.
摘要：
背景：股骨颈骨折（FNF）是老年人最常见的创伤性损伤之一。联合肌腱保留后（CPP）入路是对半髋关节置换术（HA）中常规后外侧（PL）入路的改进，用于治疗移位的股骨颈骨折（FNF），以减少术后脱位。我们假设与PL方法相比，CPP方法会导致更少的位错以及类似的功能和影像学结果。
方法：这是一项回顾性多中心（TRON组）研究。我们评估了并发症的发生率，从2017年至2019年通过PL方法或CPP方法接受HA的年龄>65岁患者的功能和影像学结局，并随访至少24个月。要调整组间的基线差异，使用1:1比例的倾向评分匹配算法.
结果：我们确定了135例通过PL方法接受HA的患者和135例通过CPP方法接受HA的患者。平均随访时间为32.4±14.0个月。PL组135例患者脱位发生率为6例(4.4%),CPP组135例患者脱位发生率为0例(0%),差异有统计学意义(p=0.04)。两组手术时间相当（73.1±30.4vs.71.8±30.0分钟；p=0.72）。PL组的茎内翻插入率低于CPP组（19.3％vs.33.3%；p=0.01）。术后12个月随访时，两组患者Parker的活动度评分相似（6.17vs.6.27；p=0.81）。
结论：CPP方法显示出明显较低的脱位率，在这项回顾性研究中,与PL方法相比,功能结局相似,内翻茎插入更多.
方法：这是一项回顾性多中心（TRON组）研究。我们评估了并发症的发生率，从2017年至2019年通过PL方法或CPP方法接受HA的年龄>65岁患者的功能和影像学结局，并随访至少24个月。要调整组间的基线差异，使用1:1比例的倾向评分匹配算法.
结果：我们确定了135例通过PL方法接受HA的患者和135例通过CPP方法接受HA的患者。平均随访时间为32.4±14.0个月。PL组135例患者脱位发生率为6例(4.4%),CPP组135例患者脱位发生率为0例(0%),差异有统计学意义(p=0.04)。两组手术时间相当（73.1±30.4vs.71.8±30.0分钟；p=0.72）。PL组的茎内翻插入率低于CPP组（19.3％vs.33.3%；p=0.01）。术后12个月随访时，两组患者Parker的活动度评分相似（6.17vs.6.27；p=0.81）。
结论：CPP方法显示出明显较低的脱位率，在这项回顾性研究中,与PL方法相比,功能结局相似,内翻茎插入更多.
