全髋关节置换术中恢复双下肢等长和外展偏心距的处理

Restoring the abductor offset and limb length in total hip arthroplasty

目的探讨通过术前测量,应用一种简单、可靠的术中方法恢复全髋关节置换术后双下肢等长和外展偏心距。方法 45例单侧髋关节疾病患者采用后路全髋关节置换术。通过术前测量,在术中参考股骨局部解剖标志及测量与股骨柄球头的距离以恢复全髋关节置换术中双下肢等长和外展偏心距。结果术前患侧外展偏心距为健侧外展偏心距的85%~100%,平均94%。术后患侧外展偏心距为健侧外展偏心距的85%~110%,平均95%。双下肢长度差异<5mm定义为双下肢等长。术前40例患者双下肢不等长,均为患肢缩短,距离差异为-5^-30mm,平均-8mm。术后40例双下肢长度差异<5mm,4例双下肢长度差异5~10mm,1例>10 mm,89%的患者术后双下肢等长。结论在后路全髋关节置换术中应用这种简单、可靠的方法,可以有效的恢复双下肢等长和外展偏心距,并不需要额外的操作器械、切口暴露和术中X线片。

Objective To investigate A simple intraoperative technique to restoring the abductor offset and limb length in total hip arthroplasty. Methods According to measurement of abductor offset and limb length inequality in preoperative radiographs, a simple and undemanding means of reference fixed reference points within the Femur and measure the distance between the reference points to femoral Components head centre was studied in 45 consecutive unilateral primary total hip arthroplasties. Results Preoperatively the median abductor offset on the affected side was 94% （range ： 85 to 100） of that on the opposite side. After THR, Postoperative the abductor medial offset was 95% （range： 85 to 110） on the operated side as compared to the opposite side. The LLI〈5mm difference defined as limb length equality. Preoperative, 40 cases had short limbs with the range of LLI was -5 mm to -30 mm, mean -8mm. After the THR, 40 cases were less than 5 mm discrepancy, 4 cases were 5-10 mm discrepancy, only one case was 12 mm discrepancy, the limb length equalization were got in 40 （89%） patients. Conclusion This technique is a simple, accurate and undemanding intraoperative technique of restoring the fabductor offset and correcting the limb length inequality, which can be easily used in THA surgery done by posterior approach without any additional equipment, incision and radiographs.