季卫平 吴博 王波

[摘要] 目的 探讨SuperPATH微创入路人工全髋关节置换术（THA）下肢等长控制方法及效果。 方法 自2016年2月～2017年9月，对我院50例采用 SuperPATH微创入路THA患者，通过术前影像学评估、模板测量、计算股骨柄假体最高点与大转子顶点距离，术中C臂机拍摄两侧髋关节和股骨近段正位片，测量大转子顶点、小转子最下缘或高点与两侧坐骨结节最低点连线的垂直距离，比较左右侧位置关系，选择相应颈长、调整股骨柄打入深度及股骨头的增减型号来调整肢体长度趋于等长。 结果 所有患者均获得随访，时间6～18（8.0±0.5）个月。切口愈合瘢痕长度5.4～7.5（6.0±0.4）cm。术后6个月回院复查时Harris评分82～93（86.0±2.5）分，术后双下肢长度相等47例，不相等3例（0.3～0.7 cm）。 结论 SuperPATH微创入路THA术，术前应用模板在 X片上测量精确预算，术中通过臼深、截骨位置调整、不同型号假体组件组合、再次 X线透视精确再评估等措施控制下肢长度的方法能使患者术后双下肢获得等长。

[关键词] 微创；置换；髋；髋关节；下肢

[中图分类号] R687.4 [文献标识码] B [文章编号] 1673-9701（2018）25-0090-05

[Abstract] Objective To investigate the methods and effectiveness of SuperPATH minimal invasive approach on the lower limb isometric control of total hip arthroplasty（THA）. Methods 50 patients who were treated with SuperPATH minimal invasive approach of THA in our hospital from February 2016 to September 2017 were selected. The distance between the highest point of femoral stem prosthesis and greater trochanter tip was calculated using preoperative imaging evaluation and template measurement. The vertical dimensions between greater trochanter tip， lesser trochanter lowest edge/high point and the line of bilateral sciatic tubercle lowest points were measured using posteroanterior radiograph of bilateral hip joints and proximal femur filmed by C-arm fluoroscopy. The relationship between the locations of two sides was compared. Selection of corresponding femur body length， adjustment of femoral stem penetration depth and regulation of femoral head type specification were used to adjust the limb length to be equilong. Results Follow-up visit was paid in all the patients and the follow-up duration was 6-18（8.0±0.5） months. The length of incision was 5.4-7.5（6.0±0.4） cm. The score of Harris 6 months after operation was 82-93（86.0±2.5）. Both lower extremities of 47 patients were equilong while those of 3 patients were not（0.3-0.7 cm）. Conclusion SuperPATH minimal invasive approach of THA could make both lower extremities equilong after the operation by the accurate pre-calculation of template using X-ray before the operation， the adjustment of trochanter depth and osteotomy position， combination of different type specification of prosthesis components and accurate re-evaluation of X-ray during the operation.

[Key words] Minimal invasive； Replacement； Hip； Hip joint； Lower limbs

人工全髖关节置换术后双下肢长度达到相等或平衡是患者的要求也是术者的追求，因为双下肢不等长会直接引起患者对手术效果的担忧，如相差大引起跛行会间接影响膝踝关节、脊柱等过早出现退变性疾病，使患者对手术体验不良，同时也影响人工髋关节使用寿命，增加翻修率和投诉风险。近几年，随着骨科医生对全髋关节置换术后双下肢不等长问题的重视，出现了多种预防该并发症的方法[1]。……