手术入路对双髋关节同时置换下肢长度的影响  

Effect of different approaches on leg length discrepancy for bilateral total hip arthroplasty

作　　者：唐竞[1] 周一新[1] 张纪[1] 柳剑[1] TANG Jing;ZHOU Yi-xin;ZHANG Ji;LIU Jian(Department of Adult Reconstructive Surgery, Beijing Jishuitan Hospital, Beijing 100035, China)

机构地区：[1]北京积水潭医院矫形骨科,北京100035

出　　处：《中国医刊》2018年第6期616-619,共4页Chinese Journal of Medicine

基　　金：2015年度人力资源和社会保障部留学人员科技活动项目([2015]192)择优资助

摘　　要：目的探讨前入路和后入路两种手术方法对双侧髋关节同时置换术后患者下肢长度的影响。方法回顾性分析2014年6月至2016年8月在北京积水潭医院矫形骨科行双髋关节同时置换患者的影像学资料,按照手术入路不同分为前入路组和后入路组。前入路组22例(44髋),其中男17例,女5例,年龄34~67岁,平均(50±9)岁;股骨头坏死Ⅲ期或Ⅳ期17例,髋关节发育不良4例,类风湿性关节炎1例。后入路组24例(48髋),其中男18例,女6例,年龄37~62岁,平均(48±7)岁;骨性关节炎7例,股骨头坏死Ⅲ期或Ⅳ期12例,髋关节发育不良4例,类风湿性关节炎1例。分析患者手术前后的影像学资料,测量肢体长度,比较两组患者下肢长度的差异。结果两组患者全部使用生物固定型假体。术前测量两组患者下肢长度差异无明显差别。术后前入路组下肢长度差异为0.5~6.8mm,平均(2.0±1.5)mm,后入路组下肢长度差异为0~14.8mm,平均(4.6±4.0)mm,两组比较差异有显著性(P<0.05)。后入路组患者中出现功能性不等长的比例(13%)明显高于前入路组(5%),差异有显著性(P<0.05)。结论与后入路手术相比,采用平卧位的前入路双髋关节置换术重建下肢长度更加准确。Objective To investigate the effect of direct anterior approach（DAA） and posterior lateral approach（PLA） on leg length discrepancy（LLD） after bilateral total hip arthroplasty（THA）. Method We retrospectively studied a series of cases with bilateral avascular necrosis of the femoral head（AVN） or degenerative dysplastic hip or osteoarthritis and rheumatoid arthritis that were treated by THA in the Beijing Jishuitan Hospital. These patients were divided into two groups, one for DAA group（n=22） and another for PLA group（n=24）. There were 17 males and 5 females, the average age was（50±9） years（34-67 years） in DAA group; there were 18 males and 6 females, the average age was（48±7） years（37-62 years） in PLA group. The X ray images of bilateral hips were taken after surgery within one week for all patients. The LLD was analyzed for the two group patients. Result We used biological fixed prosthesis in all the patients. The average LLD before surgery was similar in two groups. The average LLD was（2.0±1.5）mm（0.5-6.8 mm） for DAA group and（4.6±4.0）mm（0-14.8 mm） for PLA group after surgery. There was statistical difference between the two groups（P〈0.05）. The functional LLD that reported by the patients was significantly higher in PLA group than DAA group（P〈0.05）. Conclusion Although bilateral THA can restore the leg length successfully, the DAA technique with supine position has the advantage of more accurately restoration of the leg length for bilateral THA.

关 键 词：关节成形术 置换 髋 下肢长度 前入路 后入路 

分 类 号：R681.6[医药卫生—骨科学]