吴博 季卫平 陈继营 柴伟

[摘要] 目的 分析在改良Hardinge入路人工全髖关节置换术中两种肢体长度测量方法在双下肢等长效果中的比较。方法 回顾性分析2015 年1 月～2017 年5月在我院行初次单侧改良Hardinge入路人工全髋关节置换术151例患者的临床病例资料，术中采用两种肢体长度测量方法，其中84例采用X线健侧对照法（A组），67例采用克氏针定位法（B组）。比较两组患者的手术时间、术中出血量、术后双下肢长度差、双下肢不等长的发生率、术后住院时间和髋关节功能Harris评分等方面的差异。 结果 151例患者均完成随访。A组的手术时间[（107.32±12.01）min vs（94.56±15.39）min]较B组长，差异具有统计学意义（P<0.05）。但A组术后双下肢长度差[（1.08±0.52）mm vs（3.79±1.54）mm]较B组小，差异具有统计学意义（P<0.05）。而两组在术中出血量、双下肢不等长的发生率、术后住院时间和髋关节功能Harris评分等方面的差异无统计学意义。 结论 上述的两种方法中X线健侧对照法（A组）较克氏针定位法（B组）在下肢长度控制方面有更为精确的优势，但其术中所用时间较B组长。

[关键词] 改良Hardinge入路；人工全髋关节置换术；下肢；长度测量

[中图分类号] R687.4 [文献标识码] B [文章编号] 1673-9701（2018）15-0041-07

The comparison of two kinds of limb length measurement in total hip arthroplasty with modified hardinge approaches

WU Bo1 JI Weiping1 CHEN Jiying2 CHAI Wei2

1.Department of Joint Surgery， Lishui City People's Hospital， Sixth Affiliated Hospital of Wenzhou Medical University， Lishui 323000， China； 2.Department of Joint Surgery， Chinese PLA General Hospital， Beijing 100853， China

[Abstract] Objective To compare the effectiveness of two kinds of limb length measurement in total hip arthroplasty（THA） with modified Hardinge approaches on equal length of lower extremities. Methods Clinical records of 151 patients who had been through one-side THA with modified Hardinge approaches for the first time in our hospital from January 2015 to May 2017 were retrospectively analyzed. Two limb length measurements were applied： 84 patients were measured using X-ray normal side control （group A） and 67 patients were measured using location method of Kirschner pin （group B）. The operation duration， blood loss during operation， length difference of lower limbs， the incidence of unequal length of lower limbs， hospitalization time and Harris scores of hip function were compared between two groups. Results All of 151 patients completed the follow-up visit. The duration of operation in group A was statistically longer than that in group B[（107.32±12.01） min vs （94.56±15.39） min）] （P<0.05）. The length difference of lower limbs in group A was significantly smaller than that in group B[（1.08±0.52） mm vs （3.79±1.54） mm）] （P<0.05）. The blood loss during operation， the incidence of unequal length of lower limbs， hospitalization time and Harris score of hip function in two groups were not statistically different. Conclusion Between two methods mentioned above， X-ray normal side control （group A） was more accurate than the location method of Kirschner pin（group B） in length control of lower limbs， but it took longer duration of operation than group B.

[Key words] Modified Hardinge Approaches； Total Hip Arthroplasty； Lower Limb； Length Measurement

人工全髋关节置换术是治疗髋关节病变的重要方法[1]，其中最常见的手术入路方式是后外侧入路[1-4]，但后外侧入路对外旋肌群会造成损伤，术后假体后方脱位发生率相对较高。我院骨科采用改良Hardinge入路手术方式，其优点在于不破坏髋关节后方的外旋肌群，改良 Hardinge 入路是切开臀中肌肌腱的后1/3、股外侧肌的前1/3，将臀中肌前中 2/3连同股外侧肌前1/3作为整体向前牵开，有利于暴露，也有利于髋关节后方的稳定[5-8]。但术后双下肢长度不等长仍然是改良Hardinge入路术式常见的远期并发症，可引起患者跛行、腰背痛、坐骨神经痛等症状，严重影响其生活质量[9-11]，后期甚至可导致假体松动。

对于全髋关节置换术后双下肢等长的控制，国内外专家总结出众多方法，主要是通过术前、术中的多种方法来进行双下肢等长的评估调控，其中术中对双下肢长度的测量评估最为重要[12]。……