摘要
目的探讨人工全髋关节置换术治疗僵直髋伴中重度双下肢不等长的平衡策略及效果分析。方法回顾性分析2014年1月至2017年1月于新疆医科大学第一附属医院关节外科行单侧人工髋关节置换的30例双下肢中重度不等长患者的临床资料。男性18例，女12例，年龄（43.5±9.7）岁（范围：30～68岁）。患者均有不同程度骨盆倾斜及脊柱侧弯。术中充分松解挛缩软组织、彻底清除关节周围骨赘、重建旋转中心，不进行股骨短缩截骨。统计患者手术前后髋关节功能评分、双下肢影像、功能、感知肢体长度差异（LLD）等指标及术后患者满意度，数据分析采用配对样本t检验。结果随访时间（17.6±7.6）个月（范围：12～30个月），患者术前Harris髋关节评分为（37.6±5.7）分，术后1年提高至（84.3±5.2）分，两者差异有统计学意义（t＝-57.54，P＝0.000）。术前双下肢影像、功能、感知LLD与术后测量值相比[（3.19±0.82）cm比（0.70±0.71）cm、（4.36±1.72）cm比（0.46±0.53）cm、（7.74±2.01）cm比（0.98±0.79）cm]差异均有统计学意义（t＝26.47、t＝15.05、t＝26.9，P值均〈0.01）。30例患者中，术后感知双下肢等长（LLD≤10 mm）27例，术后无坐骨神经损伤，患者满意率90.0%（27/30）。结论术前充分测量评估、采用个体化手术方式和术中软组织松解对恢复下肢长度平衡有重要作用。全髋关节置换术可以改善僵直髋伴有中重度双下肢不等长患者的双下肢差异，患者满意度较高。
To observe the outcomes of total hip arthroplasty in patients with stiff hip and moderate or severe leg length discrepancy and to explore the strategy for balance recovery.MethodsA retrospective review was conducted on the clinical data of 30 patients who had stiff hip and moderate or severe leg length discrepancy treated with unilateral primary total hip arthroplasty at Department of Joint Surgery, First Affiliated Hospital of Xinjiang Medical University from January 2014 to January 2017.There were 18 male and 12 female patients aging of （43.5±9.7）years （range, 30-68 years）. All patients had different degrees of pelvic tilt and scoliosis. In operation, contractured soft tissues were released, periarticular osteophytes were removed thoroughly and the center of ratation was restablished without femoral shortening osteotomy.Patient satisfaction, Harris hip score, perceived leg length discrepancy （LLD）, true LLD and functional LLD were collected.Data were analyzed by paired-samples t-test.ResultsThe mean follow-up duration was （17.6±7.6）months （range, 12-30 months）. The Harris hip score was improved from 37.6±5.7 preoperatively to 84.3±5.2 at last follow-up （t=-57.54, P=0.000）. The preoperative and last follow-up data of true LLD（（3.19±0.82）cm vs.（0.70±0.71）cm）, functional LLD（（4.36±1.72）cm vs.（0.46±0.53）cm） and perceived LLD（（7.74±2.01）cm vs.（0.98±0.79）cm） was significantly difference（t=26.47, t=15.05, t=26.9, P〈0.01）. Twenty-seven patients were restored to normal level （LLD≤10 mm ） and there was no sciatic nerve injury observed after surgery. 90.0% （27/30） patients were satisfied by the outcome.ConclusionsTotal hip arthroplasty have satisfactory effect in correcting leg-length discrepancy of stiff hip patients. Preoperative assessment, individualized surgical methods and soft tissue releasing are important for balance recovery of affected limbs.
作者
胥伯勇
郭文涛
穆文博
纪保超
阿斯哈尔江·买买提依明
曹力
Xu Boyong;Guo Wentao;Mu Wenbo;Ji Baochao;Asihaerjiang Mamtimin;Cao Li(Department of Joint Surgery,First Affiliated Hospital of Xinjiang Medical University,Urumqi 830054,China)
出处
《中华外科杂志》
CAS
CSCD
北大核心
2018年第11期854-859,共6页
Chinese Journal of Surgery
关键词
关节成形术
置换
髋
髋关节
下肢长度差异
Arthroplasty
replacement
hip
Hip joint
Leg length discrepancy
