应用股骨近端解剖X线测量均衡全髋关节置换术双下肢长度的临床分析

目的：结合股骨近端解剖X线测量，均衡全髋关节置换术（THA）双下肢的长度。方法：将2011年2月至2012年12月120例接受单侧初次THA的患者作为研究对象，其中男65例，女55例。术前临床测量患者双下肢不等长数据，并拍摄双髋标准正位片，在PACS系统上测量双下肢不等长程度及手术对侧股骨头中心和大粗隆顶点连线与股骨纵轴的夹角并记录，术中使用定点测量法结合术前测量的上述交角的恢复程度作为均衡肢体长度的参考依据，通过股骨假体头部或颈部长度进行调节纠正，并结合Shuck实验、稳定实验进行评估。结果：所有患者创口均一期愈合。术后2周测量，双下肢长度相差＜0.5 cm者68例，相差0.5～1.0 cm者40例，相差＞1.0 cm者12例。其中102例患者随访至今，除4例长度差异超过1.0 cm的患者外，其余患者均无明显跛行或疼痛。患者Harris评分从术前（46.2±7.2）分，提高到（86.5±6.9）分。结论：术前对髋关节进行正位X线测量，结合术中综合定点测量法，股骨近端角度的恢复及各种辅助实验，可以使THA后双下肢均衡的问题得到很好的解决。

Clinical research of measurement of anatomical proximal femor using X ray in equalizing limb length in total hip arthroplasty

Objective：To explore the clinical meaning of measurement of anatomical proximal femor in equalizing limb length in total hip arthroplasty. MethodFrom Feburary 2011 to December 2012, 120 patients including 65 males and 55 females underwent unilateral THA. The clinical measurement and radiographic exami-nation were accomplished. The discrepancy of limb length was measured using PACS system in computer, and at the meantime, from the other hip, the angle of the anatomical axis of femur and the line linked the center of femo-ral head and the top of great trochant was measured. Based on these results, the surgical protocols were designed, the type of hip prosthesis was chosen, and the neck length of femoral prothesis, and the position of osteotomy were estimated. By the proper wearing of the acetabula, the best rotation point was found out. According to the results of radiographic and other examination, the neck length was readjusted after the insertion of the prosthesis so as to achieve intended leg length equalization. The discrepancy of the leg length was measured and evaluated after operation. ResultThe incision healed by ifrst intention in all patients. The leg length equalization was got in 108 patients （＆lt;0.5 cm, 68 cases;0.5~1.0 cm, 40 cases）, and only 12 limbs had been lengthened more than 1.0 cm. One hundred and two patients were followed up for 15.1 months on average （5~27 months）. Setting the results against those before surgery （46.2±7.2）, the mean Harris score was 86.5±6.9 points after surgery. Conclu-sion：With the measurement of the anatomical proximal femor using X ray accompanying other methods before and during operation, the problem of unequal leg length can be well solved in total hip arthroplasty.