股骨颈骨折髋关节置换术中下肢长度测量方法的比较  

Comparison of measurement methods of lower limb length in hip arthroplasty for femoral neck fracture

作　　者：张金山 郑勇强[2] 林振宇[2] 林亮[2] 许永权[2] 施纯南[2] 徐又佳[1] ZHANG Jin-shan;ZHENG Yong-qiang;LIN Zhen-yu;LIN Liang;XU Yong-quan;SHI Chun-nan;XU You-jia(不详;The Second Affiliated Hospital of Soochow University,Suzhou 215004,Jiangsu,China)

机构地区：[1]苏州大学附属第二医院,江苏苏州215004 [2]晋江市医院骨一科,福建晋江362200

出　　处：《中国骨伤》2020年第11期1012-1016,共5页China Journal of Orthopaedics and Traumatology

基　　金：福建省泉州市卫计委资助项目(编号:泉卫计函2015248);苏州市民生科技项目(编号:SS201814)。

摘　　要：目的:比较3种股骨颈骨折髋关节置换术中双下肢长度测量方法的准确性,并介绍1种股骨“肩对肩”解剖定位标记法。方法:自2017年1月至2019年1月,采用髋关节置换治疗90例股骨颈骨折的老年患者,男39例,女51例;年龄65~96(78.0±7.4)岁;全髋56例,半髋34例;骨折按Garden分型:Ⅱ型7例,Ⅲ型63例,Ⅳ型20例。术中根据不同下肢测量方法分3组:健侧对比法(A组)19例,Shuck试验法(B组)28例,“肩对肩”解剖标记定位法(C组)43例。术后通过体外和影像学测量双下肢的长度差,比较3种方法的准确性。结果:所有患者顺利完成手术。全髋关节置换术后双下肢不等长测量结果:A组(12.9±8.6)mm,B组(10.3±4.4)mm,C组(6.8±2.5)mm;半髋关节置换术后双下肢不等长测量:A组(13.2±7.2)mm,B组(8.7±3.5)mm,C组(6.3±2.8)mm;所有关节置换术后双下肢不等长测量结果:A组(12.9±8.1)mm,B组(9.6±4.0)mm,C组(6.6±2.6)mm。经析因方差分析,结果显示3组间差异有统计学意义(F=9.763,P<0.01),两两比较显示A组、B组术后双下肢不等长均高于C组(P均<0.05)。全髋、半髋关节置换两种手术方式间术后双下肢不等长的差异无统计学意义(F=0.270,P=0.605)。3种不同术中测量方法术后双下肢不等长分别是C组<B组<A组,C组的准确性最高。结论:股骨“肩对肩”的解剖定位标记法在老年人股骨颈骨折髋关节置换中,可以简单、有效、准确的减少术后双下肢不等长。Objective:To compare the accuracy of three methods for measuring the length of both lower limbs in hip arthroplasty for femoral neck fracture in the elderly,and to introduce a"shoulder to shoulder"anatomical location marking method for femur.Methods:From January 2017 to January 2019,90 elderly patients with femoral neck fracture were treated with hip replacement,including 39 males and 51 females,aged 65 to 96(78.0±7.4)years,56 cases of total hip and 34 cases of hemi hip.According to garden classification,there were 7 cases of typeⅡ,63 cases of typeⅢand 20 cases of typeⅣ.The patients were divided into three groups according to different measurement methods:contralateral contrast method(group A)of 19 cases,shuck test method(group B)of 28 cases,and"shoulder to shoulder"anatomical marker localization method(Group C)of 43 cases.The accuracy of the three methods was compared by measuring the length difference of lower limbs in vitro and imaging.Results:All patients completed the operation successfully.After total hip arthroplasty,the length of lower limbs in group A was(12.9±8.6)mm,and that in group B was(10.3±4.4)mm.After hemiarthroplasty,the length of lower limbs in group A was(13.2±7.2)mm,group B was(8.7±3.5)mm,and group C was(6.3±2.8)mm;the measurement results of unequal length of lower limbs after total hip arthroplasty were(12.9±8.1)mm in group A,(9.6±4.0)mm in group B and(6.6±2.6)mm in group C.The results of factorial analysis of variance showed that the differences among the three groups were statistically significant(F=9.763,P<0.01).The difference between two groups showed that the length of lower limbs in group A and group B was higher than that in group C(P<0.05).There was no significant difference between total hip arthroplasty and hemiarthroplasty(F=0.270,P=0.605).Three different intraoperative measurement methods for postoperative lower limb length difference were group C<group B<group A,the accuracy of group C was the highest.Conclusion:The"shoulder to shoulder"anatomic lo-calization marki

关 键 词：股骨颈骨折 关节成形术 置换 髋 下肢 

分 类 号：R687.42[医药卫生—骨科学]