全髋置换术对下肢短缩的治疗

目的：探讨全髋关节置换术对肢体短缩的纠正。方法：2000年2月～2002年12月,将30例接受单侧全髋关节置换术的患进行了研究：男19例,女12例。术前通过临床及对骨盆前后位X线片的测量评估双下肢不等长的程度,然后利用模板预测髋臼及股骨假体的置入位置，估计股骨颈的截骨水平以维持双下肢等长。术中先标记并测量股骨近端至髋臼上方两标记之间的距离，而后在术前估计的位置进行股骨颈截骨。置入假体试模之后再次测量两标记之间的距离和检查髋周软组织的张力、关节活动和drop-kick试验。最后通过调整股骨头假体颈部或头部长度进一步进行纠正。结果：22例肢体短缩2cm以上的病人中。术后双下肢等长(双下肢相差在1cm内)20例，2例仍有短缩，1例短3cm，另1例短1．5cm。8例肢体短缩在1～2cm的病人术后肢体完全等长。全部病人没有髋关节的僵硬和疼痛，活动范围恢复75％以上26例，恢复50％～75％4例。结论：通过术前测量评估，术中定位测量。术中软组织充分松解，置入假体试模后再次测量和检查髋周软组织的张力、关节活动和drop-kick试验,可以有效地治疗下肢的短缩。

Lengthening of Limb during Total Hip Replacement

Objective:To study lengthening of limb during total hip replacement.Methods:Thirty hips undergone unilateral primary total hip replacement were included in this study.Evaluation of the limb length discrepancy through clinical measurements and radiographic templates was done preoperatively to anticipate the optimal implantation position of the components and determine the level of expected femoral neck cut to maintain the equality of the limbs.During the surgery,the distance between two reference points made at pelvis and femur were measured before femoral neck osteotomy were performed based on preoperatively estimated parameters.The distance between the two points was measured again after insertion of the trail components in order to adjust the offsets of the femoral neck and head.Results:Results of the 22 patients with shortened limb ranging 2 to 5 cm preoperatively,only 2 had limb length discrepancy between 1 and 3 cm after surgery.Of the 8 patients with shortened limb ranging 1 to 2 cm preoperatively,none limb had been lengthened more than postoperatively compared with its contralateral limb.Conclusion:The preoperative measurements,tem-plating intraoperative corrections and drop-kick test are helpful in minimizing limb length discrepancy during total hip replacements and correcting preoperative limb length discrepancy as well.