术中测量股骨假体肩部与大转子顶点垂直高度预防全髋关节置换术后下肢不等长

Intraoperative measurement of vertical dimension between prosthesis shoulder and acro-greater trochanter for prevention of leg length discrepancy after total hip arthroplasty

目的探讨全髋关节置换术中股骨假体肩部与大转子顶点垂直高度(顶肩距)与术后下肢等长的关系。方法单侧初次生物型全髋关节置换术患者41例进行前瞻性研究。术前临床检查及X线仔细测量评估,术中采用腿与腿比较、Shuck试验、稳定试验等判断肢体长度。同时测量股骨假体肩部与大转子顶点垂直距离来均衡双下肢长度。结果符合纳入标准的患者41例,术后X线测量双下肢不等长(双下肢长度差异大于10mm)的发生率为21.95%(9/41),术后患肢相对于健肢的长度与术中测量股骨假体肩部至大转子顶点垂直高度成负相关。结论术中采用多种方法综合评估肢体长度可有效降低术后肢体不等长的发生率,通过术中测量顶肩距来指导选择合适型号和颈长的假体可作为控制术后下肢等长的有效方法之一。

Objective To study the prevention of leg length discrepancy after total hip arthroplasty by intraoperative measurement ot vertical dimension between prosthesis shoulder and acro-greater trochanter. Methods 41 cases undergoing the unilateral primary total hip arthroplasty were prospective studied. The extent of limb length discrepancy was preoperatively evaluated by clinical and radiographic measurements, and the suitable size and place for the prosthetic implantation were predicted. The vertical dimension between prosthesis shoulder and acro-greater trochanter was de- tected and used to achieve limb length equality during operation. Results The rate of leg length discrepancy was21.95%（9/41） by radiographic measurements, Compared with the unaffected extremity, the postoperative length of affected limb was negatively correlated with the vertical dimension between prosthesis shoulder and acro-greater trochanter. Conclusion Intraoperative measurement of vertical dimension between prosthesis shoulder and acro-greater trochanter is effective to prevent leg length discrepancy during total hip arthroplasty.