全髋置换术对下肢短缩的治疗

Lengthening of Limb during Total Hip Replacement

目的 :探讨全髋关节置换术对肢体短缩的纠正。方法 :2 0 0 0年 2月～ 2 0 0 2年 12月 ,将 30例接受单侧全髋关节置换术的患者进行了研究 :男 19例 ,女 12例。术前通过临床及对骨盆前后位X线片的测量评估双下肢不等长的程度 ,然后利用模板预测髋臼及股骨假体的置入位置 ,估计股骨颈的截骨水平以维持双下肢等长。术中先标记并测量股骨近端至髋臼上方两标记之间的距离 ,而后在术前估计的位置进行股骨颈截骨。置入假体试模之后再次测量两标记之间的距离和检查髋周软组织的张力、关节活动和drop kick试验。最后通过调整股骨头假体颈部或头部长度进一步进行纠正。结果 :2 2例肢体短缩 2cm以上的病人中 ,术后双下肢等长 (双下肢相差在 1cm内 ) 2 0例 ,2例仍有短缩 ,1例短 3cm ,另 1例短 1.5cm。 8例肢体短缩在 1～ 2cm的病人术后肢体完全等长。全部病人没有髋关节的僵硬和疼痛 ,活动范围恢复 75 %以上者 2 6例 ,恢复 5 0 %～ 75 %者 4例。结论 :通过术前测量评估 ,术中定位测量 ,术中软组织充分松解 ,置入假体试模后再次测量和检查髋周软组织的张力、关节活动和drop kick试验 。

Objective:To study lengthening of limb during total hip replacement.Methods:Thirty hips undergone unilateral primary total hip replacement were included in this study.Evaluation of the limb length discrepancy through clinical measurements and radiographic templates was done preoperatively to anticipate the optimal implantation position of the components and determine the level of expected femoral neck cut to maintain the equality of the limbs.During the surgery,the distance between two reference points made at pelvis and femur were measured before femoral neck osteotomy were performed based on preoperatively estimated parameters.The distance between the two points was measured again after insertion of the trail components in order to adjust the offsets of the femoral neck and head.Results:Results of the 22 patients with shortened limb ranging 2 to 5 cm preoperatively,only 2 had limb length discrepancy between 1 and 3 cm after surgery.Of the 8 patients with shortened limb ranging 1 to 2 cm preoperatively,none limb had been lengthened more than postoperatively compared with its contralateral limb.Conclusion:The preoperative measurements,tem-plating intraoperative corrections and drop-kick test are helpful in minimizing limb length discrepancy during total hip replacements and correcting preoperative limb length discrepancy as well.