术前精确测量及术中透视调整在预防全髋关节置换术双下肢不等长中的应用

目的探讨术前精确测量及术中透视调整预防全髋关节置换术(THR)后双下肢不等长(LLD)方法和实用性。方法将100例计划行THR的患者随机分为A、B两组(各50例),A组仅用术前精确模板测量髋臼和股骨假体的大小以减少术后LLD;B组除术前精确模板测量外术中加用C型臂X线机透视,以评估置入髋臼假体的准确性并作适当的调整。结果 100例均获2~10个月随访。A组中有10例术后下肢不等长(延长或短缩)超过6 mm;B组没有出现术后下肢不等长超过6 mm,术中C型臂X线机透视图像调整的距离平均为4 mm(0~12 mm)。结论通过术前数字影像精确测量及术中根据C型臂X线机透视影像调整置入髋臼假体可有效控制全髋关节置换术后下肢不等长。     

股骨近端形态对全髋关节置换术后下肢不等长的影响

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...     

股骨近端形态和髋关节置换术后下肢不等长的关系

目的为评估股骨近端形态与髋关节置换术后下肢不等长是否相关，本文研究了股骨髓腔闪烁指数(CFI)对髋关节置换术后下肢不等长(LLD)情况的影响。 方法选取2012年至2019年间进行单侧无骨水泥首次全髋关节置换术患者作为研究对象，纳入标准：单侧手术；无神经功能症状；使用生物型假体；初次手术；术侧无存在髋关节病变。排除标准：患侧或对侧存在髋臼发育不良及髋关节间隙破坏；患侧或对侧存在股骨近端畸形；术前下肢不等长大于2 cm；骨折的患者；患侧旋转中心距对侧距离大于3 mm，最后纳入研究235例患者。回顾性分析这些患者的年龄、性别、身体质量指数(BMI)、术前疾病和影像学资料和术后下肢不等长情况；根据患者髓腔形态将患者分为3组，并对比这3组患者下肢不等长性。计量数据满足方差齐性的多组资料间比较采用方差分析，两两比较采用事后检验LSD-t检验；计数资料组间比较采用卡方检验，单项有序分类变量资料采用Kruskal-wallis H检验，两两比较采用Nemenyi法比较。 结果总共纳入患者235例，所有患者CFI的平均值为(4.3±1.2)；根据股骨髓腔形态进行分组后各组对比结果性别、身体质量指数、术前诊断、假体股骨头颈长类型、髋臼旋转中心与泪滴连线距离、股骨头中心至假体远端的垂直距离，差异均无统计学意义(P>0.05)。香槟型髓腔的患者年龄较其他两组小，差异具有统计学意义(P<0.05)；香槟型髓腔的患者LLD差异较其他两组明显大(P<0.05)；烟囱型髓腔的患者股骨柄假体打入深度较香槟型组更深(P<0.05)；烟囱型髓腔的股骨头中心至小转子上缘的垂直距离较香槟型短，差异有统计学意义(P<0.05)；详细比较3组患者的LLD情况，3组间比较差异有统计学意义(P<0.05)，进一步两两比较，香槟型的LLD大于烟囱型(P<0.05)，余两两比较差异均无统计学意义(P>0.05)。 结论香槟型髓腔(CFI高)的患者术后患侧肢体过长的可能性较大，烟囱型髓腔(CFI低)患者术后患侧肢体短缩的可能性较大。     

全髋关节置换术后下肢不等长对患者下肢功能及生活质量影响的前瞻性研究

目的探讨全髋关节置换术(THA)后下肢不等长(LLD)对患者下肢功能和生活质量的影响。方法笔者自2008-10—2012-12收集248例原发性髋关节骨性关节炎(OA)且初次接受单侧THA的患者为研究对象,通过测量术后双髋正位X线片评估患者骨性LLD后分为Ⅰ、Ⅱ、Ⅲ、Ⅳ4组。通过问卷调查患者的WOMAC评分和EQ-5D评分,运用方差分析,评价患者髋关节功能与LLD之间的相关性及LLD对患者术后生活质量的影响。结果 215例获得随访,4组术前WOMAC评分值、EQ-5D值比较,差异无统计学意义(P0.05)。4组中所有患者术后的WOMAC评分值、EQ-5D值均较术前明显改善,差异有统计学意义(P0.01);术后4组WOMAC评分、EQ-5D值进行组间方差分析发现,差异有统计学意义(P0.05)。Ⅰ、Ⅱ、Ⅲ组进行组间方差分析发现其差异无统计学意义(P0.05);Ⅰ、Ⅱ、Ⅲ组分别与第IV组进行对比发现其差异均有统计学意义(P0.05)。结论在术后12~18个月,20 mm以上的LLD会明显降低患者下肢功能和生活质量。     

全髋关节置换术后下肢不等长与临床愈后关系的随访报告

目的探讨人工全髋关节置换术（THA）后肢体不等长（LLD）与聚乙烯内衬磨损的关系，及其对髋关节功能的影响。方法对42例42髋进行平均76．6个月的随访，测量聚乙烯内衬的线性磨损大小及下肢不等长程度，并对患髋进行Harris髋关节功能评分，然后进行统计学分析。结果在最近的随访中，4例患者因故排除，余38例38髋均未见临床松动和失败征象，绝对下肢不等长（9．8&#177;7．1）mm，最近一次随访Harris评分82．1&#177;14．6，聚乙烯内衬平均线性磨损率0．25mm／y。线性回归分析未发现LLD与磨损率有明显相关关系，LLD与Harris评分相关性分析有意义（r=-0．3482，P=0．032），但直线性相关关系并不明确。在分组差异性分析中，发现LLD≤10mm与LLD〉10mm两组的Harris评分有显著性差异（P=0．0066），未发现两组磨损率有显著性差异。结论THA术后的肢体不等长对髋关节的长期功能有一定影响，同时可能会造成患者对侧髋关节的损伤，尤其是过度不等长更有可能引起坐骨神经痛、腰背痛，甚至假体不稳定。因此临床应通过术前、术后一系列测量评估尽量平衡肢体长度，以改善髋关节功能，提高患者满意度。     

四种平衡方法在减少全髋关节置换术后下肢不等长作用中的效果比较

目的观察全髋关节置换术(total hip arthroplasty,THA)四种下肢平衡方法在减少下肢不等长(leg length discrepancy,LLD)的临床效果。方法单侧THA手术病人120例,随机分为A、B、C、D组4组,每组各30例,A组术中采用Shuck试验法进行下肢平衡,B组采用双侧髌骨平齐法,C组采用克氏针测量法,D组采用缝线测量法。术后测量病人双髋关节正位片和髂前上棘与内踝尖距离计算LLD,比较4组病人LLD的差异。结果 120例病人中有42例术后发生LLD(≥5 mm),其中7例LLD≥10 mm。当LLD5 mm时,四种下肢平衡方法之间比较差异无统计学意义(P0.05);当LLD介于5～10 mm和≥10 mm时,缝线测量法和克氏针测量法减少LLD的效果最佳。结论克氏针测量法和缝线测量法可有效减少THA术后LLD,优于Shuck试验法和双侧髌骨平齐法。     

全髋关节置换术后双下肢长度不等长对髋关节功能的影响

目的研究人工全髋关节置换术后双下肢长度不等长对髋关节功能的影响。方法选取2013年5月到2015年5月我院行人工髋关节置换术患者150例,然后行骨盆平片检查,测量双下肢长度,根据双下肢长度差值(limbs length discrepancy,LLD)将患者分为对照组41例(LLD≤5 mm)、Ⅰ组80例(5 mmLLD≤10 mm),Ⅱ组20例(10 mmLLD≤20 mm),Ⅲ组9例(LLD20 mm),应用Harris评分标准评价各组髋关节功能,并比较各组满意度。结果对照组和组Harris评分显著高于Ⅱ组和Ⅲ组(P0.05),对照组和Ⅰ组Harris评分比较差异无统计学意义(P0.05),Ⅰ组和Ⅱ组Harris评分显著高于Ⅲ组,比较差异具有统计学意义(P0.05);对照组满意率显著高于Ⅰ组、Ⅱ组和Ⅲ组,Ⅰ组满意率显著高于Ⅱ组和Ⅲ组,Ⅱ组满意率显著高于Ⅲ组,比较差异具有统计学意义(P0.05)。结论人工全髋关节置换术后双下肢长度不等超过10 mm对髋关节功能具有一定影响。     

人工髋关节置换治疗老年骨质疏松性股骨颈骨折

目的 探讨人工股骨头置换术与全髋关节置换术治疗老年骨质疏松性股骨颈骨折的疗效.方法 将我科109例老年有移位的股骨颈骨折患者分为两组,人工股骨头置换术 (BFHR) 组44例和全髋关节置换术 (THR) 组65例,并对两组进行疗效比较.结果 BFHR组平均手术时间、平均输血量、平均住院费用及术后早期并发症的发生率均明显低于THR组,通过统计学分析差异有统计学意义.BFHR组手术安全性更高.且两组平均住院时间、术后 Harris功能评分统计学差异无统计学意义.结论 人工股骨头置换治疗老年骨质疏松性股骨颈骨折早期效果满意,优于全髋关节置换术.     

全髋关节置换术后下肢不等长对功能和步态的影响

目的探讨全髋关节置换术后下肢不等长与患者功能和步态的关系。方法2008年6月至2009年6月行初次单侧全髋关节置换术的患者62例（其中男28例,女34例）,平均年龄67岁。术后拍摄骨盆正位x线片,测量出双下肢长度差。术后6个月对患者随访,用Harris髋关节功能评分（HHS）评估患者术后功能及步态分析。结果（1）下肢长度：下肢等长者16例。下肢长度术后患肢延长46例,其中延长1-10mm者28例（下肢延长A组）,平均5．3mm;延长11～20mm者18例（下肢延长B组）,平均15．7mm。（2）髋关节HHS评分：下肢延长A和B组之间HHS评分的差异无统计学意义（t=1．5,P〉0．05）,下肢延长B组HHS评分低于等长组（t=2．6,P〈0．05）;（3）步态分析：在步长、单腿支撑时间以及Footoff方面,下肢延长B组与等长组之间存在统计学差异（t=2．6,t=3．2,t=2．8;P〈0．05）,下肢延长A组和等长组之间无统计学差异（t=1．6,t=1．2,t=1．5;P〉0．05）。结论全髋关节置换术后肢体延长时,髋关节步态参数明显改变。当患肢延长超过10mm后,对髋关节功能和步态有一定影响。     

全髋关节置换术后双下肢不等长对功能和满意度影响的研究

目的：研究全髋关节置换术后下肢不等长与患者功能的关系。方法：随诊80例（其中男38例,女42例;年龄56～86岁,平均72.3岁）2004年6月至2007年6月行初次单侧全髋关节置换术的患者,术后拍摄双髋正位X线片,测量出双下肢长度差;术后3个月及1年分别对患者随访,用牛津髋关节功能评分（OHS）评估患者术后功能及满意度。结果：①下肢长度。术后患肢延长者52例,平均延长（9.2±3.2）mm,其中延长1～10mm者29例,平均4.9mm;延长11～22mm者23例,平均14.6mm。缩短者13例,平均缩短（6.4±2.1）mm;等长者15例。②牛津髋关节功能评分。术后3个月OHS评分结果显示下肢延长者,延长1～10mm组与延长11～22mm组之间OHS评分差异无统计学意义（P=0.766）;下肢延长者（两组）比缩短者及等长者OHS评分差;缩短者与等长者之间OHS评分差异无统计学意义（P=0.437）。术后1年OHS评分结果显示下肢延长11～22mm者比缩短者、等长者及下肢延长1～10mm者OHS评分差;缩短者、等长者及下肢延长1～10mm者之间OHS评分差异无统计学意义（P=0.657）。肢体延长11～22mm者、肢体等长者、肢体缩短者的术后3个月与术后1年OHS评分相比差异均无统计学意义;肢体延长1～10mm者的术后3个月与术后1年OHS评分差异有统计学意义（P〈0.05）。结论：全髋置换术后下肢不等长,尤其是患肢延长11～22mm对术后功能有很大的影响,且不会随时间推移而减轻。因此,术前、术中应尽量采取措施避免下肢不等长的产生,术后则应积极对下肢不等长进行处理。     

Prevalence and functional impact of patient-perceived leg length discrepancy after hip replacement

The aim of this postal survey was to determine the prevalence and impact of patient-perceived leg length discrepancy (LLD) at 5-8 years after primary total hip replacement (THR). A postal audit survey was undertaken of all consecutive patients who had a primary unilateral THR at one elective orthopaedic centre between April 1993 and April 1996. The questionnaire included the Oxford hip score (OHS) and questions about LLD. Questionnaires were received from 1,114 patients. In total, 329 THR patients (30%) reported an LLD, although radiographic analysis revealed that only 36% of these patients had anatomical LLD. Patients with a perceived LLD had a significantly poorer OHS (p < 0.001) and reported more limping than those patients without a perceived LLD. This study found that a third of patients perceived an LLD after THR and that perceived LLD was associated with a significantly poorer midterm functional outcome.     

Modified Girdlestone arthroplasty and hip arthrodesis using the Ilizarov external fixator as a salvage method in the management of severely infected total hip replacement

Background:

Resection arthroplasty or hip arthrodesis after total hip replacement (THR) can be used to salvage the limb in case with deep infection and severe bone loss. The Ilizarov fixator provides stability, axial correction, weight-bearing and good fusion rates.

Materials and Methods:

We retrospectively assessed the outcomes of 37 patients with severe periprosthetic infection after THR treated between 1999 and 2011. The treatment included implant removal, debridement and a modified Girdestone arthroplasty (29 cases) or hip arthrodesis (seven cases) using the Ilizarov fixator. The Ilizarov fixation continued from 45 to 50 days in the modified arthroplasty group and 90 days in the arthrodesis group. One case was treated using the conventional resection arthroplasty bilaterally.

Results:

Eighteen months after treatment, infection control was seen in 97.3% cases. Six hips were fused as one patient died in this group. Limb length discrepancy (LLD) averaged 5.5 cm. The Harris hip score ranged from 35 to 92 points. Hip joint motion ranged from 10° to 30° in the modified arthroplasty group. All subjects could walk independently or using support aids. No subluxation or LLD progression was observed.

Conclusion:

The modified Girdlestone arthroplasty and hip arthrodesis using the Ilizarov apparatus results in sufficient ability for ambulation and good infection control in cases of failed THR associated with severe infection.     

The safety and efficacy of bilateral simultaneous total hip replacement: an analysis of 2063 cases

Comparison of the safety and efficacy of bilateral simultaneous total hip replacement (THR) and that of staged bilateral THR and unilateral THR was conducted using DerSimonian-Laird heterogeneity meta-analysis. A review of the English-language literature identified 23 citations eligible for inclusion. A total of 2063 bilateral simultaneous THR patients were identified. Meta-analysis of homogeneous data revealed no statistically significant differences in the rates of thromboembolic events (p = 0.268 and p = 0.365) and dislocation (p = 0.877) when comparing staged or unilateral with bilateral simultaneous THR procedures. A systematic analysis of heterogeneous data demonstrated that the mean length of hospital stay was shorter after bilateral simultaneous THR. Higher blood transfusion requirements were expected following bilateral simultaneous THR than staged or unilateral THR, and surgical time was not different between groups. This procedure was also found to be economically and functionally efficacious when performed by experienced surgeons in specialist centres.     

Total Hip Replacement in Ankylosing Spondylitis

Eighteen total hip replacements were performed in 10 patients with ankylosing spondylitis. The mean observation time was 3.8 years. Seven hips had been operated on before total hip replacement (THR): 6 were ankylotic before THR. The results as regards pain relief and increased walking distance were good. All hips improved in mobility after THR and this improvement was maintained during the observation time. Six of the 10 patients went back to full-time work. The differences between patients with ankylosing spondylitis and rheumatoid arthritis, as regards indications for and rehabilitation after THR, are discussed.     

Total hip replacement in ankylosing spondylitis

Eighteen total hip replacements were performed in 10 patients with ankylosing spondylitis. The mean observation time was 3.8 years. Seven hips had been operated on before total hip replacement (THR); 6 Were ankylotic before THR. The results as regards pain relief and increased walking distance were good. All hips improved in mobility after THR and this improvement was maintained during the observation time. Six of the 10 patients went back to full-time work. The differences between patients with ankylosing spondylitis and rheumatoid arthritis, as regards indications for and rehabilitation after THR, are discussed.     

The risk of peri-prosthetic fracture after primary and revision total hip and knee replacement

Peri-prosthetic fracture after joint replacement in the lower limb is associated with significant morbidity. The primary aim of this study was to investigate the incidence of peri-prosthetic fracture after total hip replacement (THR) and total knee replacement (TKR) over a ten-year period using a population-based linked dataset. Between 1 April 1997 and 31 March 2008, 52,136 primary THRs, 8726 revision THRs, 44,511 primary TKRs, and 3222 revision TKRs were performed. Five years post-operatively, the rate of fracture was 0.9% after primary THR, 4.2% after revision THR, 0.6% after primary TKR and 1.7% after revision TKR. Comparison of survival analysis for all primary and revision arthroplasties showed peri-prosthetic fractures were more likely in females, patients aged > 70 and after revision arthroplasty. Female patients aged > 70 should be warned of a significantly increased risk of peri-prosthetic fracture after hip or knee replacement. The use of adjuvant medical treatment to reduce the effect of peri-prosthetic osteoporosis may be a direction of research for these patients.     

Enhanced recovery after surgery (ERAS) in hip and knee replacement surgery: description of a multidisciplinary program to improve management of the patients undergoing major orthopedic surgery

Enhanced recovery after surgery (ERAS) protocols aim to develop peri-operative multidisciplinary programs to shorten length of hospital stay (LOS) and reduce complications, readmissions and costs for patients undergoing major surgery. The aim of this study is to evaluate the effects of an ERAS pathway for total hip (THR) and knee (TKR) replacement surgery in terms of length of stay, incidence of complications and patient satisfaction. Patients scheduled for hip and knee replacement were included in the study. The main aspects of this program were preoperative education/physical therapy, rational choice of the anesthetic technique, optimization of multimodal analgesia, reduction of incidence of urinary retention and catheterization, active management of risk for blood loss and deep vein thrombosis, and early mobilization of the patients. All patients had 6 months predicted and planned follow-up appointments. Primary outcomes of the study were the mean LOS, readmission and complication rates. Secondary Outcomes were percentage of Knee Injury & Osteoarthritis Outcome Score (KOOS) and Hip disability and Osteoarthritis Outcome Score (HOOS) increase and patient’s satisfaction. We consecutively enrolled 207 patients who underwent total joint arthroplasty, 78 hip and 129 knee joint replacements. The mean length of stay (LOS) for patients of the two groups was 4.3 days for ASA 3-4 patients subjected to TKR and THR, in ASA 1-2 patients 3.6 days for TKR and 3.9 days for THR respectively. Postoperative satisfaction level was higher than 7 (very satisfied) in 94.4% of the cases. All patients were discharged home: 61.8% continued physical therapy in complete autonomy, 23.7% supported by a home-physiotherapist and only 14.5% needed the attendance to a physiotherapy center on a daily basis. The overall incidence of major complications was 3.4%. The implementation of an ERAS program for hip and knee replacement surgery allows early patient’s discharge and a quick return to independency in the daily activities. IV.     

Resurfacing arthroplasty for hip dysplasia: a prospective randomised study

In this prospective study a total of 80 consecutive Chinese patients with Crowe type I or II developmental dysplasia of the hip were randomly assigned for hip resurfacing arthroplasty (HRA) or total hip replacement (THR). Three patients assigned to HRA were converted to THR, and three HRA patients and two THR patients were lost to follow-up. This left a total of 34 patients (37 hips) who underwent HRA and 38 (39 hips) who underwent THR. The mean follow-up was 59.4 months (52 to 70) in the HRA group and 60.6 months (50 to 72) in the THR group. There was no failure of the prosthesis in either group. Flexion of the hip was significantly better after HRA, but there was no difference in the mean post-operative Harris hip scores between the groups. The mean size of the acetabular component in the HRA group was significantly larger than in the THR group (49.5 mm vs 46.1 mm, p = 0.001). There was no difference in the mean abduction angle of the acetabular component between the two groups. Although the patients in this series had risk factors for failure after HRA, such as low body weight, small femoral heads and dysplasia, the clinical results of resurfacing in those with Crowe type I or II hip dysplasia were satisfactory. Patients in the HRA group had a better range of movement, although neck-cup impingement was observed. However, more acetabular bone was sacrificed in HRA patients, and it is unclear whether this will have an adverse effect in the long term.