[全髋关节置换术后肢体长度不等的防治]

Zheng Zhihe, Dong Junfeng, Li Xinzhi, Lu Guoqiang

Department of Orthopaedics, the Second Clinical Medical College (Renhe Hospital), China Three Gorges University, Yichang Hubei, 443000, P.R.China.

Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2008 Jun;22(6):662-4.

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 measurement, radiographic templating and intraoperative correction, together with postoperative orthopraxy, are effective in prevention and treatment of leg length discrepancy after THA.

目的

探讨全髋关节置换术（THA）后肢体长度不等的防治方法。

方法

选取2004年1月至2006年12月行THA治疗的87例患者，其中男性36例，女性51例，平均年龄60.2岁（35岁至78岁）。其中股骨头缺血性坏死35例，股骨颈头下型骨折38例，股骨颈肿瘤4例，类风湿关节炎6例，髋臼发育不良4例。70例患者存在肢体长度不等，下肢短缩1 cm至6 cm。根据临床测量及影像学检查设计手术方案，选择髋关节假体类型，预估股骨假体颈长及截骨位置。通过合适的髋臼假体安装，找出最佳旋转点。根据影像学及其他检查结果调整股骨颈截骨平面。假体植入后重新调整颈长，以达到预期的肢体长度均衡。术后测量并评估肢体长度差异。

结果

术后5天2例发生浅表感染，经局部引流治愈。术后4周4例发生脱位，其中2例经手术治愈，另2例手法复位治愈。所有患者随访6个月至36个月，平均18.3个月。术前Harris评分为34.81±1.36，术后为91.50±1.87（P<0.05）。术前双下肢等长的17例患者中，1例下肢延长1.5 cm；术前下肢短缩的70例患者中，66例双下肢恢复等长，4例下肢延长或短缩1.6 cm至2.1 cm。肢体长度相等的总有效率为94.25%。