全髋关节置换术后下肢不等长对功能和步态的影响

Influnce of leg length discrepancy on hip function and gait in patients of total hip arthroplasty

目的探讨全髋关节置换术后下肢不等长与患者功能和步态的关系。方法 2008年6月至2009年6月行初次单侧全髋关节置换术的患者62例(其中男28例,女34例),平均年龄67岁。术后拍摄骨盆正位X线片,测量出双下肢长度差。术后6个月对患者随访,用Harris髋关节功能评分(HHS)评估患者术后功能及步态分析。结果 (1)下肢长度:下肢等长者16例。下肢长度术后患肢延长46例,其中延长l～10mm者28例(下肢延长A组),平均5.3mm;延长11～20mm者18例(下肢延长B组),平均15.7mm。(2)髋关节HHS评分:下肢延长A和B组之间HHS评分的差异无统计学意义(t=1.5,P>0.05),下肢延长B组HHS评分低于等长组(t=2.6,P<0.05);(3)步态分析:在步长、单腿支撑时间以及Footoff方面,下肢延长B组与等长组之间存在统计学差异(t=2.6,t=3.2,t=2.8;P<0.05),下肢延长A组和等长组之间无统计学差异(t=1.6,t=1.2,t=1.5;P>0.05)。结论全髋关节置换术后肢体延长时,髋关节步态参数明显改变。当患肢延长超过10mm后,对髋关节功能和步态有一定影响。

Objective To evaluate the influence of limb discrepancy on hip function and gait following total hip arthroplasty （THA）. Methods 62 patients （mean age 67 years） adopted THA during June 2008-June 2009 were assessed by Harris hip scores （ HHS ） and gait analysis. The anteroposterior radiographs of the pelvis were used to assess limb discrepancy following THA. Results （ 1 ） Leg length. There were 16 cases of equal length legs. 46 operated legs were longer than the other side, among which 28 legs were longer for one to 10 mm （ mean value 5.3 ram, group A） and 18 legs were longer for 11 to 20 mm （mean value 15.7 ram, group B）. （2） Harris hip scores. Three months after operation, significant difference in HSS was not found between the two groups of lengthened legs. The mean HSS in group B was significantly higher than that of the equal legs group. （3） There were significant differences in gait parameters between group B and equal legs group. Conclusions When leg length inequality was （11 - 20） mm, it does impair the hip kinematics and kinetics during walking. A limb lengthening after THA should be corrected.