人工全髋关节置换双下肢不等长的预防策略  

Exploration of prevention methods of limbs length discrepancy in total hip arthroplasty

作　　者：李山珠[1] 刘玉平[1] 袁锋[1] 俞光荣[1] 

机构地区：[1]同济大学附属同济医院骨科,上海市200065

出　　处：《中国骨与关节损伤杂志》2012年第6期485-487,共3页Chinese Journal of Bone and Joint Injury

摘　　要：目的探讨人工髋关节置换术后双下肢不等长(LLD)的预防策略。方法选择92例接受初次单侧人工全髋关节置换术的患者作为研究对象,通过测量术前骨盆标准正位X线片来评定LLD的程度,利用厂家模板确定假体置入位置,预判股骨颈截骨平面及股骨距的保留长度。术中根据假体试模以及各种验证方法及软组织松解程度来保持双下肢的长度等长。结果术后患者LLD在1.2 cm以内共77例(84.7%),在0.6 cm以内的58例(64.1%)。92例术后随访16～49个月,平均31个月,均未发生感染、神经麻痹。1例术后发生髋关节脱位,经髋人字石膏固定1个月后未复发。术后髋关节功能平均评分从48分提高到90.3分,所有患者均无需拐杖助行。结论全髋关节置换术后LLD对全髋置换手术效果有很大影响,通过术前模板评估测量,术中反复检查试验,可以获得较好结果。Objective To explore the prevention methods of limbs length discrepancy in total hip arthroplasty.Methods A total of 92 primary THA patients,the limbs length discrepancy was evaluated preoperatively by measuring the posterior-anterior pelvic radiograph with templates from the prothesis corporation and the optimal implantation position of the prosthesis was predetermined and the level of the femoral neck cutting and length of the femoral calcar was decided.To maintain the equality of limbs length effectively,the prosthesis modules were applied repeatedly and the elasticity of soft tissue was examined during the operation.Results There were 84.7% of the patients that had postoperative limbs length discrepancy（LLD） less than 1.2 cm,and 64.1% had a LLD within 6 mm,the limb length discrepancy were improved much more than before.These patients were followed up form 16 months to 49 months（mean 31 months）,the mean HHS score of these patients were improved from 48 to 90.3 at the latest follow-ups,no patients required a crutch to support walking.All cases had no infection and nerve paralysis.One case was found with prothesis dislocation after total hip arthroplasty and treated with plaster bandage fixation for 1 month and cured without recurrence.Conclusion The limbs length discrepancy has significant influence on the results of total hip arthroplasty.Preoperative LLD of evaluation by template measurements and comparison two legs intraoperative with kinds of methods could achieve better results.

关 键 词：人工髋关节置换术 肢体不等长 并发症 预防策略 

分 类 号：R687.4[医药卫生—骨科学]