摘要
目的探讨全髋关节置换术后双下肢不等长的预防和处理。方法2004年1月-2006年12月,收治87例患者进行单侧全髋关节置换术。男36例,女51例;年龄35～78岁,平均60.2岁。股骨头缺血性坏死35例,股骨颈头下型骨折38例,股骨颈肿瘤4例,类风湿性关节炎6例,髋臼发育不良4例。70例术前双下肢不等长,肢体短缩1～6 cm。Harris评分(34.81±1.36)分。患者术前均进行双下肢长度测量和X线片模板测量,确定髋臼中心,设计截骨平面和选择股骨颈长。术中应用克氏针法测量及综合调整决定截骨平面,确定合适的假体长度。术后测定对比双下肢长度差异。结果2例于术后第5天出现浅表感染,局部引流后治愈;4例于术后4周出现脱位,2例手法复位成功,2例手术切开复位。患者获随访6～36个月,平均18.3个月。术后3个月Harris评分(91.50±1.87)分,与术前比较差异有统计学意义(P<0.05)。术前双下肢等长17例中1例延长1.5 cm;70例不等长患者中,术后66例恢复等长(均在1 cm以内),4例延长或短缩1.6～2.1 cm,总等长率94.25%。结论术前、术中双下肢长度和X线片模板测量、综合调整,以及术后矫正处理能有效预防和处理全髋关节置换术后双下肢不等长。
Objective To explore the prevention and treatment of leg length discrepancy after total hip arthroplasty （THA）. Methods There were 87 patients who were treated by THA from January 2004 to December 2006, including 36 males and 51 females, with the average age of 60.2 years （ranging from 35 years to 78 years）. Among these cases, there were 35 of avascular necrosis of the femoral head, 38 of subcapital femoral neck fracture, 4 of femoral neck tumor, 6 of rheumatoid arthritis and 4 of acetabular dysplasia. In 70 cases, the patients had leg length discrepancy, and the legs shortened from 1 cm to 6 cm. Based on the clinical measurement and radiographic examination, the surgical protocols were designed, the type of the hip prosthesis was chosen, and the neck length of the femoral prosthesis and the position of osteotomy were estimated. By the proper wearing of the acetabula, the best rotation point was found out. The cut plane of the femoral neck was adjusted according to the results of the radiographic and other examinations, The neck length was readjusted after the insertion of the prosthesis so as to achieve intended leg-length equalization, The discrepancy of the leg length was measured and evaluated after operation. Results Superficial infestation happened in 2 cases 5 days after the operation and was cured by mero-drainage. Luxation happened in 4 cases 4 weeks after the operation, in which 2 cases were cured by operation while the other 2 were cured by manual reduction. All the patients were followed up for 6 months to 36 months, with the average time of 18.3 months, The Harris scores were 34.81 ± 1.36 preoperatively and 91.50 ± 1.87 postoperatively （P 〈 0.05）. In the 17 patients with equal legs before the operation, 1 was lengthened 1.5 cm in the leg, while in the 70 patients with shortened legs before the operation, 66 returned to the same length in their legs, and 4 were lengthened or shortened from 1,6 cm to 2.1 cm, The total rate of equal leg length was 94.25%. Conclusion The preoperative meas
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2008年第6期662-664,共3页
Chinese Journal of Reparative and Reconstructive Surgery
关键词
全髋关节置换术
下肢
不等长
预防和处理
Total hip arthroplasty Leg Length discrepancy Prevention and treatment
