数字化模板测量对全髋关节置换后下肢不等长的影响

Digital templating alleviates leg length discrepancy after total hip arthroplasty

背景:置换前模板测量是全髋关节置换非常重要的置换前计划步骤。准确的模板测量可以帮助骨科医生选择最合适的假体型号,指导置换中下肢长度的控制,使患者获得满意的下肢长度和偏心距,从而减少置换后并发症的发生。目的:观察置换前进行数字化模板测量对全髋关节置换后下肢不等长的影响。方法:回顾性分析2004年10月至2012年5月在东南大学附属中大医院骨科行人工全髋关节置换的334例患者,根据是否进行数字化模板测量分为对照组(n=124)和测量组(n=210),分别在置换前未进行数字化模板测量和进行由NEUSOFT PACS/RIS3.0影像系统对骨盆正位进行的数字化模板测量,比较2组患者置换后下肢不等长的发生情况。结果与结论:测量组全髋关节置换患者下肢不等长绝对值小于对照组(Z=-3.638,P<0.01),表明测量组比对照组下肢不等长程度更小,更加趋向于下肢等长。以下肢不等长绝对值>10mm作为下肢不等长的诊断标准,测量组全髋关节置换患者比对照组下肢不等长发生率明显降低(χ2=7.17,P=0.007<0.05)。说明数字化模板测量能够减少全髋关节置换后下肢不等长的发生。

BACKGROUND： Digital templating before replacement is a very important step in pre-operatlve planning of total hip arthroplasty. Accurate preoperative templating can help orthopedists to select the most appropriate prosthesis and control the lower limb length during replacement. Consequently, patients can get satisfactory lower limb length and offset. The incidence of complications after operation will be decreased, OBJECTIVE： To investigate the influence of pre-operative digital templating on leg length discrepancy aftertotal hip arthroplasty. METHODS： We performed a retrospective analysis in 334 patients who received total hip arthroplasty from October 2004 to May 2012 in the Department of Orthopedics, Zhongda Hospital Southeast University. Patients were divided into two groups according to the willingness of digital templating： control group （n=124） and measurement group （n=210）. The patients in the control group did not receive digital templating. Patients in the measurement group received digital templating on the anteroposterior pelvic with the NEUSOFT PACS/RIS3.0 imaging system. The incidence of leg length discrepancy after replacement was compared between two groups RESULTS AND CONCLUSION： The absolute value of leg length discrepancy of the patients in the measurement group was less than that in the control group （Z=-3.638, P 〈 0.01 ）, indicating that the severity of leg length discrepancy in the measurement group was lower than that in the control group, more inclining to lower limb equal length. The absolute value of leg length discrepancy 〉 10 mm was considered as the diagnostic standard. The incidence rate of leg length discrepancy of the patients in the measurement group was lower than that in the control group （X^2=7.17, P=0.O07 〈 0.05）. The results indicate that digital templating can reduce the incidence of leg length discrepancy after total hip arthroplasty.