全髋关节置换术后双下肢不等长对功能和满意度影响的研究

Leg length discrepancy after total hip arthroplasty:impacts on postoperative function and patients' satisfaction

目的:研究全髋关节置换术后下肢不等长与患者功能的关系。方法:随诊80例(其中男38例,女42例;年龄56～86岁,平均72.3岁)2004年6月至2007年6月行初次单侧全髋关节置换术的患者,术后拍摄双髋正位X线片,测量出双下肢长度差;术后3个月及1年分别对患者随访,用牛津髋关节功能评分(OHS)评估患者术后功能及满意度。结果:①下肢长度。术后患肢延长者52例,平均延长(9.2±3.2)mm,其中延长1～10mm者29例,平均4.9mm;延长11～22mm者23例,平均14.6mm。缩短者13例,平均缩短(6.4±2.1)mm;等长者15例。②牛津髋关节功能评分。术后3个月OHS评分结果显示下肢延长者,延长1～10mm组与延长11～22mm组之间OHS评分差异无统计学意义(P=0.766);下肢延长者(两组)比缩短者及等长者OHS评分差;缩短者与等长者之间OHS评分差异无统计学意义(P=0.437)。术后1年OHS评分结果显示下肢延长11～22mm者比缩短者、等长者及下肢延长1～10mm者OHS评分差;缩短者、等长者及下肢延长1～10mm者之间OHS评分差异无统计学意义(P=0.657)。肢体延长11～22mm者、肢体等长者、肢体缩短者的术后3个月与术后1年OHS评分相比差异均无统计学意义;肢体延长1～10mm者的术后3个月与术后1年OHS评分差异有统计学意义(P<0.05)。结论:全髋置换术后下肢不等长,尤其是患肢延长11～22mm对术后功能有很大的影响,且不会随时间推移而减轻。因此,术前、术中应尽量采取措施避免下肢不等长的产生,术后则应积极对下肢不等长进行处理。

Objective：To explore the association between the leg length discrepancy and postoperative function after total hip arthroplasty.Methods：From June 2004 to June 2007,the Leg length in 80 consecutive patients（38 males and 42 females,ranging in age from 56 to 86 years,with an average of 72.3 years） who underwent primary unilateral total hip arthroplasty was measured radiologically.Postoperative hip function and patients＇ satisfaction was assessed using the Oxford Hip Score （OHS） at three months and one year after surgery.Results：①Leg length：52 operated legs were longer than the other side by a mean of （9.2±3.2） mm（1 to 22 mm）,in which 29 legs were longer for 1 to 10 mm（mean value 4.9 mm） and 23 legs were longer for 11 to 22 mm （mean value 14.6 mm）;13 operated legs were shorter by a mean of （6.4±2.1） mm （3 to 19 mm）;15 operated legs were of the same length as the other side.② Oxford hip scores：At three months after operation,the mean Oxford hip scores in patients with lengthened legs（two groups） were significantly higher （i.e.,worse） than in the patients with shortened legs or in patients with legs of the same length.Significant difference in Oxford Hip Score was not found between the two groups of lengthened legs （1 to 10 mm vs 11 to 22 mm）.Significant difference in Oxford Hip Score was also not found between the patients with shortened leg and the patients with legs of the same length.At one year after operation,the Oxford hip scores were significantly higher （i.e.worse） in the patients with lengthened limbs （11 to 22 mm） than in those of shortened limbs,or with limbs of equal length,or patients with lengthened legs （1 to 10 mm）.No significantly differences of the Oxford hip scores were found within the patients with shortened limbs,the patients with limbs of equal length and the patients of lengthened limbs（1 to 10 mm）.There was no significant difference between the Oxford hip scores at three months＇ follow up and that at one year＇s follow up in the lengthened group （11 to 22 mm）,shortened group or same length group.The Oxford hip score was improved significantly one year after surgery when compared with that of three months after surgery in the lengthened group （1 to 10 mm）.Conclusion：Leg length discrepancy,especially for that 11 to 20 mm longer than the healthy side,affects the functional outcome after total hip arthroplasty,and it does not relieve over time.Well planned measures should be taken to minimize leg length discrepancy.