人工全髋关节置换术中3种肢体长度测量方法比较

Comparison of three measurements of lower extremity length during total hip arthroplasthy

目的：分析人工全髋关节置换术中3种常用肢体长度测量方法的准确性，探讨影响其准确性的原因及对策。方法：回顾性分析2010年1月至2013年1月行人工全髋关节置换手术的患者145例，男66例，女79例；年龄48～89岁，平均66．7岁。术中采用3种不同的肢体长度测量方法，其中31例采用健侧对照法（A法），63例采用克氏针定位测量法（B法），51例采用解剖标志定位测量法（C法）。术后检查双下肢长度差，并比较这3种方法的准确性及肢体不等长的发生率。结果：145例患者术后获得随访，上述3种方法在手术时间、出血量上差异无统计学意义。A、B、C法术后双下肢长度差的平均值分别为（8．7±5．7）、（3．1±2．6）、（5．6±5．3）mm，各组间的差异均有统计学意义，准确性从高到低依次为B、C、A法。A、B、C法术后发生双下肢不等长的比例分别为32．3％、1．6％、11．8％，A法的发生比例较B、C法高，B法与C法之间差异无统计学意义。结论：上述的3种方法中克氏针定位测量法（B法）最为准确，解剖标志定位测量法（C法）其次，健侧对照法（A法）准确性最差。建议除股骨颈骨折患者外均采用克氏针定位测量法，对于股骨颈骨折患者可采用解剖标志定位测量法。

Objective：To analyze the accuracy of three measurements of lower extremity length during total hip arthro- plasty （THA）, and explore the causes that influence the accuracy. Methods：From January 2010 to January 2013,145 patients underwent THA were retrospectively analyzed. There were 66 males and 79 females, ranging in age from 48 to 89 years with an average of 66.7 years. Their lower extremities were measured by three methods during operation, among them, 31 cases with reference method of contralateral legs （A method）, 63 cases with measurement method of Kirschner wire location （B method ）, and other 51 cases with measurement method of anatomical landmark （C method）. The accuracy of the three measurements and the incidence rate of length inequality of lower extremity were analyzed. Results：All patients were followed up, there was no significant differences in the operation time and the intraoperative blood loss among three groups. The difference of lower extremity length with A, B, C method were respectively （8.7±5.7）, （3.1±2.6）, （5.6±5.3） mm after operation; there were sig- nificant difference between any two groups. The accuracy of three methods from high to low were respectively B, C ,A method. The incidence rate of length inequality of lower extremity with A, B, C method were respectively 32.3%, 1.6%, 11.8%, the inci- dence rate with A method was higher than that other two methods;and there was no significant difference between B method and C method. Conclusion：The t method of Kirschner wire location has the best accuracy in the three methods and the measurement method of anatomical landmark is the second. The measurement method of Kirschner wire location is recommended in all THA except for the patients with femoral neck fracture. And the measurement method of anatomical land- mark can be used in the patients with femoral neck fracture.