人工全髋关节置换术术前的模板测量与术后评估

目的通过全髋关节置换术术前模板测量与术后相关因素的评估,探讨全髋关节置换术术前模板测量的准确性和重要性.方法 2003年10月至2004年9月,选取因特发性股骨头无菌性坏死行单侧全髋关节置换术的19 例病人作为研究对象,其中男11 例,女8 例.年龄40～74 岁,平均58.7 岁.术前通过临床查体及骨盆X光正位片,对双下肢不等长和双侧股骨偏心距的差异程度进行测量和评估.再利用模板测量,预测髋臼及股骨假体的型号及置入位置,估计股骨颈的截骨水平以及预定出平衡双下肢长度的计划.术后对这些指标进行评估和验证.结果 19 例患者中术前有15 例存在双下肢不等长,术后这些患者的下肢不等长情况都有显著改善.此19 例患者双下肢长度差均值由术前8.4 mm减小到4.4 mm,73.7%的患者术后双下肢长度差异在5 mm之内.双侧股骨偏心距差均值由术前6.3 mm减小到3.0 mm.术前模板测量出的假体型号与实际应用的假体比较,髋臼假体符合率为52.6%,股骨柄假体符合率为63.2%.结论人工全髋关节置换术术前精确的模板测量对于重建髋关节结构和功能及恢复下肢长度具有重要的意义.

Measurement of Preoperative Templating and Postoperative Evaluation in Total Hip Arthroplasty

Objective To study the accuracy and importance of preoperative templating in total hip arthroplasty.Methods Nineteen hips from 19 patients with unilateral primary total hip replacement from October 2003 to September 2004 were studied,including 11 males and 8 females,aged from 40 to 74 years(mean 58.7 years).Evaluation of limb length and offset difference through clinical measurements and radiographic templates was done preoperatively to anticipate optimal implantation component position and determine the level of femoral neck cutting,and plan to restore equality of limbs.After surgery,all factors above were reevaluated.Results Fifteen patients with preoperative limb length difference obtained significant improved results.Of these patients,limb length difference decreased from 8.4 mm to 4.4 mm. 73.7% of patients had limb length discrepancies controlled within 5 mm.Bilateral offset difference decreased from 6.3 mm to 3.0 mm.Coincidence rate between planned and actually used components was 52.6% on the acetabular side and 63.2% on the femoral side.Conclusion Accurate and careful preoperative templating is of advantage to balance hip reconstruction by correcting leg length differences and restoring offset.