Abstract Introduction In elderly patients, an established treatment for femoral neck fractures is hip hemiarthroplasty (HHA) using the anterolateral approach (ALA). Early postoperative mobilization is crucial to reduce perioperative complications. The direct anterior approach (DAA) has been reported to facilitate early recovery of ambulation and is increasingly popular in elective hip surgery but rarely used in femoral neck fractures. The aim was to compare the outcome of the DAA and the ALA in patients treated for femoral neck fracture.Materials and methods All HHAs with complete data sets were reviewed from a tertiary public healthcare institution (2013–2020). Propensity score matching was applied to compensate for possible confounders; outcome parameters were perioperative blood loss, postoperative mobility and pain. Secondary outcomes were duration of surgery, length of stay (LOS), complications, reoperation and mortality rates.Results There were 237 patients (mean age 85.8?years) available for analysis. The DAA group mobilized earlier during hospitalization (outside patient room: 50.6 vs 38.6, p?=?0.01; walking on crutches/walker: 48.1 vs 36.1, p?
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机译：摘要 引言 在老年患者中，股骨颈骨折的既定治疗方法是采用前外侧入路（ALA）的髋关节半关节置换术（HHA）。术后早期活动对于减少围手术期并发症至关重要。据报道，直接前入路 （DAA） 有助于早期恢复行走，在择期髋关节手术中越来越受欢迎，但很少用于股骨颈骨折。目的是比较 DAA 和 ALA 在接受股骨颈骨折治疗的患者中的结局。材料和方法 所有具有完整数据集的 HHA 均来自一家三级公立医疗机构（2013-2020 年）。应用倾向评分匹配来补偿可能的混杂因素;结局参数为围手术期失血量、术后活动度和疼痛。次要结局是手术持续时间、住院时间（LOS）、并发症、再次手术和死亡率。结果 237例患者（平均年龄85.8岁）可供分析。DAA组在住院期间活动较早（病房外：50.6 vs 38.6%，p？=？0.01;拄拐杖/助行器行走：48.1 vs 36.1%，p？0.01），手术时间较短（DAA vs ALA：72.5 vs 89.5？min，p？0.001），并发症有减少的趋势（32.9% vs 44.9%，p？=？0.076）。失血量（286 vs 287？ml）、LOS（10.4 vs 9.5？天）、疼痛（停止阿片类药物：术后 2.9 vs 3.3？天）、翻修（2.5 vs 3.2%）或死亡率（30 天：7.6 vs 5。7%）在患者组间无差异。结论 DAA治疗HHA可提高院内活动能力，缩短手术时间，减少并发症。在围手术期失血和疼痛方面没有发现任何优势。
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