先天性短股骨颈人工全髋关节置换时避免下肢延长的临床研究

目的探讨对先天性短股骨颈患者行人工全髋关节置换时避免下肢延长的方法。方法回顾分析2005年4月-2010年12月接受单侧人工全髋关节置换的38例先天性短股骨颈患者临床资料。男26例,女12例;年龄45～78岁,平均62.3岁。股骨头缺血性坏死11例,骨关节炎17例,股骨颈骨折10例。术前29例双下肢不等长,临床测量肢体短缩10～24 mm,平均14.5 mm;X线片测量肢体短缩11～25 mm,平均14.7 mm。术前Harris评分为(44.0±3.6)分。结果术后1 d临床及X线片测量示3例患者下肢延长,其余35例双下肢差异均<10 mm,视为等长;总等长率为92.1%(35/38)。术后患者切口均Ⅰ期愈合,无感染、下肢深静脉血栓形成等并发症发生。1例下肢延长16 mm患者步态异常,经增加足跟垫矫正后仍有轻度跛行;其余2例不等长患者有轻度跛行。其余患者行走正常,髋部疼痛明显缓解。术后36例获随访,随访时间12～68个月,平均43.8个月。术后6个月髋关节Harris评分为(86.7±2.3)分,与术前比较差异有统计学意义(t=3.260,P=0.031)。X线片复查示假体无松动与下沉。结论对先天性短股骨颈患者行人工全髋关节置换术时应注意下肢长度测量和截骨平面确定,并使用带领假体,可有效避免下肢延长。

A method to avoid lengthening lower limbs after total hip arthroplasty in patients with congenital short femoral neck

Objective To investigate the method to avoid lengthening lower limbs after total hip arthroplasty in patients with congenital short femoral neck.Methods The clinical data were analyzed retrospectively from 38 patients undergoing unilateral total hip arthroplasty between April 2005 and December 2010.There were 26 males and 12 females,aged 45-78 years(mean,62.3 years).Among these cases,there were 11 cases of avascular necrosis of the femoral head,17 cases of hip osteoarthritis,and 10 cases of femoral neck fracture.Before operation,29 cases had leg length discrepancy;and the shortened length of the legs was 10-24 mm with an average of 14.5 mm by clinical measurement,and was 11-25 mm with an average of 14.7 mm by X-ray film measurement.The Harris score before operation was 44.0 ± 3.6.Results At 1 day after operation,3 cases had legs lengthening by clinical and X-ray film measurement;limb length difference less than 10 mm was regarded as equal limb length in the other 35 patients(92.1%).All incisions healed by first intention,and no complication of infection or lower limb deep venous thrombosis occurred.In 3 patients who had legs lengthening,1 patient had abnormal gait and slight limping after increasing heel pad because the lower limb was lengthened by 16 mm,and 2 patients had slight limping.The other patients could walk normally and achieved pain relief of hip.Thirty-six patients were followed up 12-68 months(mean,43.8 months).The Harris score was 86.7 ± 2.3 after 6 months,showing significant difference(t=3.260,P=0.031) when compared with that before operation.The X-ray films showed no prosthetic loosening or subsidence.Conclusion For patients with congenital short femoral neck during total hip arthroplasty,the surgeons should pay attention to osteotomy plane determination,limb length measurement,and use of the prosthesis with collar to avoid the lengthening lower limbs.