Zhang Jin-Shan, Zheng Yong-Qiang, Liu Xiao-Feng, Xu Yong-Quan, Fang Yang-Zhen, Lin Zhen-Yu, Lin Liang, Xu You-Jia
Department of Orthopedics, The Second Affiliated Hospital of Soochow University, Jiangsu, China.
Department of Orthopedics, Jinjiang Municipal Hospital, Fujian, China.
Front Surg. 2022 Nov 1;9:1030657. doi: 10.3389/fsurg.2022.1030657. eCollection 2022.
To determine whether the two lower extremities are of equal length after hip arthroplasty for femoral neck fractures, we developed a novel method of manual positioning based on anatomical mark (shoulder-to-shoulder) in hip arthroplasty.
Patients with femoral neck fractures requiring hip arthroplasty from July 2020 to March 2022 in the orthopedic department of Jinjiang Municipal Hospital, Fujian Province, China were recruited. Hip arthroplasty was performed using the proposed "shoulder-to-shoulder" method of manual positioning based on anatomical mark in 52 patients with femoral neck fractures who met the inclusion criteria. "Shoulder-to-shoulder" was achieved by alignment of the marked femoral "shoulder" and the "shoulder" of prosthesis stem. There were 16 male and 36 female patients, with 27 undergoing total hip arthroplasty (THA) and 25 undergoing hip hemiarthroplasty (HA). The fractures were categorized according to the Garden classification: type II, type III, and type IV in 5, 11, and 36 patients, respectively. The vertical distance from the apex of the medial margin of the femoral trochanter to the tear drop line on both sides which was regarded as the length of both limbs were compared postoperative imaging, and the apex-shoulder distance on the ipsilateral side measured postoperative imaging was compared with those measured intraoperatively.
All patients completed the surgery successfully. The measurement results for the lower extremities after THA were as follows: contralateral group, 43.87 ± 5.59 mm; ipsilateral group, 44.64 ± 5.43 mm. The measurement results for the lower extremities after HA were as follows: contralateral group, 45.18 ± 7.82 mm; ipsilateral group, 45.16 ± 6.43 mm. The measurement results for the lower extremities after all arthroplasties were as follows: contralateral group, 44.50 ± 6.72 mm; ipsilateral group, 44.89 ± 5.90 mm. The results for the apex-shoulder distance were as follows: postoperative imaging, 19.44 ± 3.54 mm; intraoperative apex-shoulder distance, 27.28 ± 2.84 mm. Statistical analysis results indicated no statistically significant difference in the postoperative bilateral lower extremity length after hip arthroplasty ( = 0.75), while a statistically significant difference was found between the intraoperative and postoperative imaging measurements of the apex-shoulder distance ( < 0.01).
The novel method of manual positioning based on anatomical mark (shoulder-to-shoulder) for femoral neck fractures in hip arthroplasty is simple and accurate, making it effective for preventing postoperative bilateral leg length discrepancy.
为确定股骨颈骨折行髋关节置换术后双下肢长度是否相等，我们开发了一种基于解剖标志（肩对肩）的髋关节置换术中手动定位新方法。
招募2020年7月至2022年3月在中国福建省晋江市医院骨科因股骨颈骨折需行髋关节置换术的患者。对52例符合纳入标准的股骨颈骨折患者采用基于解剖标志的“肩对肩”手动定位方法进行髋关节置换术。“肩对肩”通过标记的股骨“肩”与假体柄的“肩”对齐来实现。男性患者16例，女性患者36例，其中27例行全髋关节置换术（THA），25例行髋关节半关节置换术（HA）。骨折根据Garden分型进行分类：Ⅱ型、Ⅲ型和Ⅳ型分别有5例、11例和36例患者。术后影像学检查比较双侧股骨大转子内侧缘顶点至泪滴线的垂直距离（视为双下肢长度），并将术后影像学测量的同侧顶点-肩峰距离与术中测量值进行比较。
所有患者手术均成功完成。THA术后双下肢测量结果如下：对侧组，43.87±5.59 mm；同侧组，44.64±5.43 mm。HA术后双下肢测量结果如下：对侧组，45.18±7.82 mm；同侧组，45.16±6.43 mm。所有关节置换术后双下肢测量结果如下：对侧组，44.50±6.72 mm；同侧组，44.89±5.90 mm。顶点-肩峰距离结果如下：术后影像学检查，19.44±3.54 mm；术中顶点-肩峰距离，27.28±2.84 mm。统计分析结果表明，髋关节置换术后双侧下肢长度差异无统计学意义（=0.75），而顶点-肩峰距离的术中与术后影像学测量结果之间存在统计学显著差异（<0.01）。
髋关节置换术中基于解剖标志（肩对肩）的股骨颈骨折手动定位新方法简单准确，可有效预防术后双侧腿长不等。
