OffsetRuler结合可调颈假体柄在全髋关节置换术中的应用

目的 探讨Offset Ruler结合可调颈假体柄在全髋关节置换术（THA）中的应用价值.方法 2009年4月至2010年3月所有THA的患者中,共有67例患者（67髋）采用了Offset Ruler结合Wright公司的Profemur Z可调颈假体柄.其中DDH 31例（Crowe Ⅰ型 9例,Ⅱ型18例,Ⅲ型4例）,股骨头坏死11例,髋关节骨关节炎6例,股骨颈骨折19例;男31例（31髋）,女36例（36髋）,年龄平均64.3岁（42～81岁）.术前测量患者双下肢长度,并通过X线（标准骨盆平片）测量股骨偏心距（femoral offset,FO）及双下肢长度,计算术中需调整的患侧FO及长度.术中利用Offset Ruler,确定最后的假体型号.手术由同一组医生完成,评估由未参加手术的同一位医生完成.结果 67例患者均获得随访,随访时间为12～26个月,平均随访20.3个月.所有患者术中测试人工关节稳定性好,无脱位倾向,无撞击;术后均未出现神经损伤、感染、假体脱位等并发症.术前患肢较健侧平均短缩1.8 cm（0～3.3 cm）,术后患者双下肢平均长度差0.2 cm（0～1.3 cm）.所有患者行走均无跛行感,均感满意.结论 Offset Ruler操作方便,在THA术中使用Offset Ruler,结合可调颈假体柄,可以有效恢复股骨偏心距,减少或消除术后双下肢不等长的发生,增加患者满意度.

Value of offset ruler and neck adjustable prosthesis in total hip arthroplasty

Objective To evaluate the application of the offset ruler combined with the neck adjustable prosthesis in total hip arthroplasty （THA）. Methods 67 patients （67 hips） were enrolled from April 2009 to March 2010, and the offset ruler and Profemur Z neck adjustable prosthesis of the Wright company were used in the operations. There were 31 cases of DDH （nine of Crowe type Ⅰ, 18 of type Ⅱ, four of type Ⅲ）, 11 cases of osteonecrosis of the femoral head（ONFH）, six cases of hip osteoarthritis, and 19 cases of the femoral neck fracture. There were 31 males （31 hips） and 36 females （36 hips）, and the mean age was 64.3 years old （42-81 years）. The bilateral limb length and the femoral offsets （FO） were measured physically and by the X ray （standard pelvis plain film） respectively so as to calculate the needed FO and the length during the operation. The final prosthesis type was determined by the offset ruler. All the operations were performed by the same doctor team and the evaluation was carried out by a doctor who was not involved in the operations. Results All the patients were followed up for 12-26 months with an average time of 20.3 months. All the artificial joints were stable during the operation and showed no nerve injury, infection, or the prosthesis dislocation after the operation. Compared with the healthy limb, the operated limb was 1.8 cm shorter in average （0-3.3 cm） preoperatively, and 0.2 cm shorter in average （0-1.3 cm） postoperatively. All the patients were satisfied without limp. Conclusion The offset ruler is easy to operate, and it can be combined with the neck adjustable prosthesis during the operation to obtain the femoral offset so as to reduce or eliminate the discrepancy of the lower limbs and satisfy the patients.