全髋关节置换术均衡双下肢长度的探讨

The investigate for the balance of limb length discrepancy during total hip replacement

目的探讨全髋关节置换术均衡双下肢长度的临床意义和手术设计。方法回顾分析2000-2004年获得随访的单侧全髋关节置换手术病例48例,采用骨水泥型假体12髋,混合型假体36髋,术前双下肢等长30例(含股骨颈骨折患者),10例患肢长度短缩1.0-2.0cm,6例短缩2.0-4.0cm,2例短缩4.0-6.0cm。通过术前肢体长度测量及X片测量制定手术方案,选择假体、预估颈长和截骨平面;术中正确磨削髋臼,寻找最佳旋转中心,结合透视及特殊试验修正截骨平面,调节假体颈长,达到均衡双下肢长度的目的。结果全部病例采用Harris评分,优30例,良12例,中4例,差2例。术前等长30例巾术后出现5例手术侧延长1.0-2.0cm,1例延长2.5cm。术前不等长的18例中,术后恢复等长10例,6例手术侧延长1.0-2.0cm,2例术前重度短缩的先天性髋关节发育不良病人术后仍然短缩2.0-3.0cm。术后肢体等长35例Harris评分平均92.3分,术后肢体不等长13例Harris评分平均88.6分。结论全髋关节置换术的手术设计。手术技巧以及假体设计等诸多因素影响下肢长度,术后肢体不等长降低了患者的满意度。应重视术前测量及术中综合评价方法的运用,重视软组织平衡技术和肢长调节,掌握全髋置换术中均衡下肢长度的手术技术,进一步改善手术效果。

Objective To invest the clinical significance and operation design about limb length discrepancy during total hip replacement. Methods 48 patients undergone unilateral primary total hip replacement between 2000 to 2004 （were followed up） .which 12 hip prosthesis were bone cementle, 36 hip were mixture. Of the 30 patients with equal limb length included the femoral neck fracture, 10 patients with shortened limb ranging 1 to 2cm, 6 patients with shortened limb ranging 2 to 4 cm, 2 patients with shortened limb 4 to 6cm. Make the operation scheme through the clinical measurements and radiographic templates preoperatively to choose the hip prosthesis type, anticipate the neck length of the femoral prosthesis and position ofosteotomy. Wear the acetabula correctly to find the best rotation point during the operation. Combined with x-ray perspective and special experiments to adjust the level of femoral neck cut, the neck length were re-adjusted after insertion of the prosthesis, to achieve the intension of limb-length equalization. Results According to Harris score system, excellent in 30, good in 12, fair in 4 and poor in 2. Oftbe 30 patients with equal limb preoperatively, 5 had been lengthed I to 2 cm and 1 had lengthed 2.5cm postoperatively compared with its healthy limb. Of the 18 patients with shortened limb preoperatively, 10 were recovered equal, 6 had been lengthed ranging 1 to 2cm, 2 serious shortened patients with congenital dysplasia of hip joint were still shortened 2 to 3cm after the surgical. The Harris hip score averaged 92.3 points for the equal limb patients and 88.6 points for the shortened limb patients. Conclusion Many factors such as operation plan, prosthesis design and the handling technique during the operation affected the limb length. Limb length discrepancy depressed the satisfaction of the patients.It is important to pay more attention to the clinical measurements preoperatively, application of the comprehensive appraisal methods during the operation and methods of soft tissue balance. Grasp the skill of limb-length equal during total hip arthroplasty to improve the result further more.