股骨近端形态对全髋关节置换术后下肢不等长的影响  

Impact of proximal femoral shape on leg length discrepancy after total hip arthroplasty

作　　者：马济民 陆汉力 陈心星 杨昕[1] 王强[1] MA Ji-min;LU Han-li;CHEN Xin-xing;YANG Xin;WANG Qiang(Department of Orthopaedics,Yijishan Hospital,Wannan Medical College,Wuhu 241000,Anhui,China)

机构地区：[1]皖南医学院弋矶山医院关节骨科皖南医学院弋矶山医院创伤骨科,安徽芜湖241000

出　　处：《中国骨伤》2021年第7期641-645,共5页China Journal of Orthopaedics and Traumatology

摘　　要：目的:探讨不同股骨近端形态对全髋关节置换术(total hip arthroplasty,THA)后重建下肢不等长(leg length discrepancy,LLD)的影响。方法:选取2013年6月至2019年6月接受单侧生物型全髋关节置换术的131例髋关节骨关节炎或股骨头坏死的患者,回顾性分析年龄、性别、侧别和骨盆正位DR平片。其中男69例,女62例;左髋57例,右髋74例;年龄25~89岁,平均62岁。诊断原发性髋关节骨性关节炎48例,股骨头缺血性坏死继发髋关节骨性关节炎83例。采用股骨皮质指数(femoral cortical index,FCI)作为股骨近端形态分型的参考标准,通过术前术后骨盆正位X线片测量双侧下肢长度差。根据FCI进行分组:>0.6为Dorr A组,0.5~0.6为Dorr B组,<0.5为Dorr C组,明确股骨近端形态与全髋关节置换术后双下肢不等长的关系。结果:术后FCI为0.56±0.08,LLD中位数为5.10 mm(IQR-1.00~8.80 mm)。按FCI水平分为3组,各组间性别、年龄、侧别、诊断、术中骨折率的分布差异均无统计学意义。FCI>0.6时,术后LLD为6.30 mm(IQR 1.00~10.95 mm);FCI在0.5~0.6时,术后LLD为5.85 mm(IQR-0.55~8.90 mm);FCI<0.5时,术后LLD为1.95 mm(IQR-2.50~6.68 mm)。不同股骨近端形态下的LLD比较,差异存在统计学意义(P<0.05)。结论:高FCI增加患侧术后下肢延长的风险,低FCI使患侧术后下肢延长的风险较小。外科医生可以通过术前评估患者股骨近端形状,提前告知全髋关节置换患者术后双下肢腿长的可能变化风险。Objective:To investigate the effect of different proximal femoral shapes on leg length discrepancy(LLD)after total hip arthroplasty(THA).Methods:Total 131 patients with osteoarthritis or osteonecrosis received unilateral biological total hip arthroplasty from June 2013 to June 2019.All patients’age,sex,side and pelvis anteroposterior digital radiography were retraspectively analyzed.There were 69 males and 62 females,57 cases of left hip and 74 cases of right hip.The age ranges from 25 to 89 with an average age of 62 years.There were 48 cases of osteoarthritis and 83 cases of osteonecrosis.In this study,femoral cortical index(FCI)was used as the classification of proximal femoral shape,and bilateral lower limb length differences were measured by preoperative and postoperative pelvis anteroposterior digital radiography.Grouping according to FCI:>0.6 was Dorr A group,0.5 to 0.6 was Dorr B group,<0.5 was the Dorr C group,and the relationship between proximal femur morphology and the leg length discrepancy after total hip arthroplasty was determined.Results:The postoperative average FCI was(0.56±0.08)mm and the median LLD was 5.10 mm(IQR-1.00 to 8.80 mm).Three groups were divided according to the level of FCI,and there were no statistically significant differences in gender,age,side,diagnosis and intraoperative fracture rate distribution among three groups.FCI>0.6,the postoperative LLD was 6.30 mm(IQR 1.00 to 10.95 mm).When FCI was 0.5 to 0.6,the postoperative LLD was 5.85 mm(IQR-0.55 to 8.90 mm).FCI<0.5,the postoperative LLD was 1.95 mm(IQR-2.50 to 6.68 mm).LLD comparison of different proximal femoral shape was statistically significant(P<0.05).Conclusion:High FCI increases the risk of lower extremity prolongation after surgery on the affected side,while low FCI reduces the risk of lower extremity prolongation after surgery on the affected side.The surgeon can assess the shape of the proximal femur of the patient preoperatively and inform the patient in advance of possible changes in leg length of both lower extr

关 键 词：关节成形术 置换 髋 股骨皮质指数 下肢不等长 股骨近端 

分 类 号：R687.4[医药卫生—骨科学]