全髋关节置换术下肢长度均衡方法的临床研究

Clinic Research on Accurate Limb Length Equalization in Total Hip Replacement

目的探讨全髋关节置换术中下肢长度均衡的方法及可行性。方法42例(44髋)接受全髋置换术的病人,男24例,女18例;患者平均年龄61.5岁(48～72岁)。左髋24例,右髋20例。术前Harris评分平均53.5分(46～62分)。术前拍摄双髋关节前后位X线片,健侧下肢内旋15°,用模板测量髋臼的旋转中心和股骨偏心距,标记出需切除骨距位置。对单侧置换的患者,术中依健侧股骨偏心距重建患侧偏心距;对双侧同时置换的,采用双侧偏心距一致的方法。术中假体试模安装完毕后,测量股骨头中心与股骨大粗隆顶点高度是否一致。麻醉下牵拉患肢测试关节间隙为4～5 mm,比较双侧膝关节是否在同一水平等,据此选取人工股骨头的颈长,以避免下肢的不等长。结果经上述方法完成的全髋置换术,36例(83%)下肢长度一致,使下肢不等长的发生率大大降低。平均随访时间3～15个月,术后Harris评分平均89.6分(82～93分)。结论通过术前测量和术中综合应用上述方法,使全髋关节置换术后下肢长度均衡的问题得以很好地解决。

Objective To explore the effective method of the accurate limb length equalization in patients undergoing primary total hip arthroplasty. Methods Forty- four （male 24, female 18） patients were treated with total hip arthroplasty. Before operation, the high - quality X - ray pictures of pelvis were got with the uninjured side legs rotated internally in 15°and the X - ray tube part of lm from the body. The rotation centers of the acetabulum and the offsets of the femur were measured on templates. Then the presumptive cutting lines were marked. The femoral offset for the unilateral THR was restored according to the offset of healthy hip. The same size offset for the bilateral THR was designed. During operation, after the trial of prosthesis was inserted, whether the height of the center of the femur prosthesis and the top of the great trochanter was the same was tested. The joint space should be 4-- 5 mm under traction of the leg. The length of both knees level was used as a landmark. The femoral prosthesis with different neck length was adjusted in order to avoid the leg - length inequality. Results Corrected with managements above- mentioned, the limb length equalization were got in 36 （83 % ） patients. The rate of leg- length inequality was cut down significantly. The average time of follow- up was 10 months （3 15 months）. The Harris score was 89. 6 points （82--93 points）. Conclusion By measuring before operation and restoring the right femur offset and correcting with combination managements above - mentioned during the procedures, the problem of leg- length inequality is solved during the total hip replacement.