人工全髋关节置换术下肢不等长的预防和处理

目的：研究人工全髋关节置换术下肢不等长的预防和处理。方法：对1994的6月－1997年6月的8例单侧人工全髋关节置换术后不等长的分析，采用术前模板预测股骨颈截骨平面和假体植入位置，同时术中标记和测量股骨近端至髋臼上方两标志点的间距；对1997年7月－2001年6月的36例（髋），术中髋关节假体试件反复调节平衡后，再测量两点间距；运用综合平衡法平衡下肢下长度。结果：从早期8例术后下肢不等长的经验，对近年36例术前下肢明显不等长的病人采用综合平衡法，29例（80．6％），两个肢等长，7例（19．4％），尚有1．0－1．2cm的差异，结论：术前用模板预测股骨颈截骨水平，有用术中骨标志间距测量和综合平衡法，是预防和治疗全髋关节置换术后下肢不等长的有效方法。

Prevention and Traetment of Leg Length Discrepancy During Total Hip Arthroplasty

Objective:To research the prevention and treatment of leg length discrepancy during total hip arthroplasty.Methods:Eight hips of 8 patients which had leg length discrepancy post operation,they were undergone unilateral primary total hip arthoplasty between June 1994 and June 1997,and analyzed the caues.And thirty-six hips of 36 patients were performed unilateral primary total hip arthroplasty between July 1997 and June 2001.They were leg length discrepancy remarkable preoperation.Evaluation of the leg 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 and with the synthesis to maintain the equlity the legs.During the surgery,the distance between two reference points made at pelvis and femur were measured before femoral neck osteotomy was performed according to the parameters estimated preoperatively.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:Of the 29 patients(80.6%)with leg length discrepancy were equalitied in secend series including two cases with congenital dislocation of the hip.More than 1.0cm of leg length were three,and less than 1.2cm were four.Conclusion:The preoperative measurements,templating and intraoperative corrections with synthesis equality are helpful in minimizing leg length discrepancy during total hip arthroplasty and correcting preoperative leg length discrepancy.