全髋关节置换术后下肢不等长与临床愈后关系的随访报告

The study on the relationship between leg length discrepancy and clinical outcomes after total hip arthroplasty

目的探讨人工全髋关节置换术(THA)后肢体不等长(LLD)与聚乙烯内衬磨损的关系,及其对髋关节功能的影响。方法对42例42髋进行平均76.6个月的随访,测量聚乙烯内衬的线性磨损大小及下肢不等长程度,并对患髋进行Harris髋关节功能评分,然后进行统计学分析。结果在最近的随访中,4例患者因故排除,余38例38髋均未见临床松动和失败征象,绝对下肢不等长(9.8±7.1)mm,最近一次随访Harris评分82.1±14.6,聚乙烯内衬平均线性磨损率0.25mm/y。线性回归分析未发现LLD与磨损率有明显相关关系,LLD与Harris评分相关性分析有意义(r=-0.3482,P=0.032),但直线性相关关系并不明确。在分组差异性分析中,发现LLD≤10mm与LLD>10mm两组的Harris评分有显著性差异(P=0.0066),未发现两组磨损率有显著性差异。结论THA术后的肢体不等长对髋关节的长期功能有一定影响,同时可能会造成患者对侧髋关节的损伤,尤其是过度不等长更有可能引起坐骨神经痛、腰背痛,甚至假体不稳定。因此临床应通过术前、术后一系列测量评估尽量平衡肢体长度,以改善髋关节功能,提高患者满意度。

Objective A group of total hip arthroplasties were followed up to investigate the relationship between the leg length discrepancy with the extent of wearing and the function of the operated hip. Methods 42 hip （42 patients） were followed up. The average follow-up period was 76. 6 months. The leg length and linear polyethylene were measured, while the Harris Hip Score（HHS） was also assessed. The results were statistically analyzed, with a P value less than 0. 05 indicating significant difference. Results 4 hips were excluded for some reasons and 38 hips were left with no evidences of component loosening and clinical failure at the latest follow-up. The average absolute LLD was（9.8±7. 1 ） mm, the average Harris score was 82.1 ±14. 6 at the latest follow-up, the average linear wear rate 0. 25mm per year. There was significantly correlation between LLD and HHS（ r = -0. 3482, P= 0. 032） ,but the rectilinear relationship was not clear. In the variability analysis, the patients were divided into two groups, LLD≤ 10mm and LLD 〉 10mm. There was still significantly difference of HHS between the two group （ P = 0. 0066）. However, no correlation of linear wear rate with LLD was found in linear regression analysis, and there was no significantly difference between the wear rate of two groups either. Conclusions Leg length discrepancy after THA will influence the long-term function of hip joints, meanwhile it may result in lesion of the contralateral hip. Excessive LLD will be more likely to cause sciatica, low back pain, even instability. It is essential to balance the leg length for better outcomes and satisfaction, depending on careful preoperative templating and intraoperative judgement.