人工髋关节置换术中下肢不等长的处理

Treatment of limb length discrepancy in the artificial hip replacement

目的探讨人工髋关节置换术下肢不等长的重要性及处理。方法选择32例接受单侧人工髋关节置换术的患者作为研究对象，男20例，女12例，年龄32～100岁，平均68岁；通过术前临床检查及骨盆标准正位片测定双下肢不等长的程度，利用模板预测假体置入位置，估计股骨颈截骨平面及股骨距的保留长度。术中根据假体试模反复验证及软组织松解程度有效保持双下肢的长度。结果术前双下肢等长的17例患者中，术后仅2例患肢延长超过1．0cm，术前患肢短缩1．5～6．5cm的15例患者中，可有效的保持术后双下肢基本等长的12例，术前仅3例短缩超过5．0cm的患者术后短缩2．0～2．5cm，32例患者术后随访6～35个月，平均14．1个月，1倒股神经麻痹6个月后完全恢复，术后双下肢等长27例（84．4％），除3例外均无跛行。结论全髋关节置换术下肢不等长的重要性不容忽视，通过术前测量评估，术中反复测量验证，获得满意效果。

Objective To explore the importance and management of limb length discrepancy in the treatment of artificial hip ar throplasty. Methods 32 patients were chosen to undergo unilateral artificial hip arthroplasty,including 20 males and 12 females. The mean age of patients was 68 years ranging from 32 to 100 years; Evaluation of the limb length discrepancy through clinical measurements and radiographic Templates was done preoperatively to predetermine optimal implantation position of the components and to decide the level of the femur neck cut and length of the femur quadrature. The components temp late was tried repeatedly and the looseness of soft tissue was examined during the operation. All these could maintain equal limb length effectively. Results Of the 17 patients with equal limb length preoperatively,only 2 limb had been lengthened more than 1.0 cm postoperatively. Of the 15 patients with shortened limb from 1.5-6.5 cm preoperatively,only 3 had limb length discrepancy more than 5.0 cm after surgery, of 12 could keep equal limb length. The followed up periods ranged from 6 to 35 months（mean 14.1 months） in 32 patients. One case of femoral nerve palsy six months after full recovered,and 27 cases（84.4 %） were equal limb length after surgery, with three exceptions. Conclusion The importance of limb length discrepancy during treatment of artificial hip arthroplasty must not be neglected. The preoperative measurements and intraoperative leg-length measurement are helpful in achiving satisfactory results.