全髋关节翻修术后双下肢不等长病因分析——非组配型股骨柄10年随访

Etiology analysis of leg length discrepancy after hip revision—10-year follow-up of monobloc femoral stem

目的探讨非组配型股骨柄用于全髋翻修的长期疗效,分析髋关节翻修术后残留的不等长的影响因素。方法分析随访武汉市第四医院2009年1月至2014年12月进行髋关节翻修,同一术者使用带棘非组配型股骨假体的病例。共62例,男16例,女46例。复查双侧髋关节正侧位片,并进行Harris评分。评估术前和术后双侧肢体长度差异(LLD)的情况。我们将全髋关节置换术后LLD分为髋臼侧,股骨侧,关节间隙3个部分,并分别记录。两组间比较采用两独立样本t检验,术前术后数值的比较使用配对样本t检验。3组之间数值的比较使用方差分析。结果患者年龄(68.5±8.76)岁,随访(117.1±21.1)个月。术前Harris评分40.7±38.6,术后Harris评分平均为(84.2±27.6)分。术前患肢短缩(1.89±0.94)cm,术后患肢短缩(0.56±0.46)cm,LLD术后明显缩小(P<0.01)。根据术前患者肢体长度差异来源,将患者分为髋臼侧组(A组,10例,16.1%),股骨侧组(F组,38例,61.3%)和混合组(C组,14例,22.6%)。3组之间术前肢体长度差异无统计学意义,F组(0.45±0.42)cm术后肢体长度差异明显低于A组(0.67±0.43)cm和C组(0.79±0.50)cm(P<0.05)。结论髋关节翻修术前患者存在的LLD可以分为髋臼侧组,股骨侧组和混合组3种不同类型,髋臼假体重建位置对翻修术后LLD影响更大。

Objective To summarize the long-term efficacy of monobloc femoral stems in total hip revision and analyze the influencing factors of leg length discrepancy(LLD)after hip revision.Methods From January 2009 to December 2014,the patients who underwent hip revision in Wuhan Fourth Hospital and received monobloc femoral stems with spines were retrospectively analyzed.A total of 62 cases were reported,including 16 males and 46 females.Bilateral hip radiographs were reviewed and Harris scores were evaluated.Bilateral LLD was assessed before and after surgeries.LLD after total hip replacement was divided into acetabular side,femoral side and joint space,and recorded respectively.Independent sample t test was used for comparison between the two groups,and paired sample t test was used for comparison of preoperative and postoperative values.Comparison of values between the three groups was performed using ANOVA.Results The age of the patients was(68.5±8.76)years,and the mean follow-up period was(117.08±21.11)months.Preoperative and postoperative Harris score was 40.7±38.6 and 84.2±27.6,respectively.The mean shortening of the affected limb before and after surgery was(1.89±0.94)cm and(0.56±0.46)cm respectively(P<0.01).According to the source of preoperative LLD,patients were divided into acetabular group(group A,10 cases,16.1%),femoral group(group F,38 cases,61.3%)and combined group(group C,14 cases,22.6%).There was no significant difference in preoperative LLD among the three groups.The postoperative LLD in group F[(0.45±0.42)cm]was significantly lower than that in group A[(0.67±0.43)cm]and group C[(0.79±0.50)cm,P<0.05].Conclusion This study suggests the LLD from the femoral side can also be regained after the use of monobloc femoral stems.LLD in patients before hip revisions can be divided into acetabular side group,femoral side group and combined group.The location of acetabular cup has a greater influence on LLD after revision.