SuperPATH微创人工全髋关节置换术下肢等长的控制策略

摘要

目的 探讨SuperPATH微创人工全髋关节置换术(THA)下肢等长控制方法及效果.方法 对30例患者采用SuperPATH技术行微创THA,术前通过直接测量及影像学测量评估患者双下肢长度,模板测量预估假体型号及假体安放位置,预先测量预估股骨柄假体最高点与大转子顶点距离,术中试模复位后,在基本保证双下肢间隙与身体纵轴平行的情况下,通过C臂机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,比较坐骨结节与小转子最下缘的位置关系,相应选择颈长、调整股骨柄打入深度及股骨头的增减型号,以调整肢体长度趋于等长.结果 切口长度5.6~6.5 cm.患者均获得随访,时间6~12(7 ± 0.6)个月.术后6个月Harris评分84~92(86 ± 2.4)分,术后双下肢等长28例,不等长2例(分别相差0.3、0.5 cm).结论 SuperPATH技术通过术前模板测量精确计算、术中精细的X线再评估等综合措施调整肢体长度,能使THA患者有良好的下肢等长控制.%Objective To investigate the method and effect of lower limb length control in SuperPATH minimally in-vasive total hip arthroplasty(THA). Methods The 30 cases underwent SuperPATH minimally invasive total hip ar-throplasty,the length of both lower extremities was assessed by direct measurements and radiographic measurements evaluation before surgery. Template measurements were used to predict prosthesis type and prosthesis placement. The distance between the highest point of the femoral stem prosthesis and the apex of the large rotor was measured. After resetting hip joint in operation,the lower extremities were made parallel to the vertical axis of the body. Bilateral hip and proximal femoral radiographs were taken by a C-arm,and then measured the vertical distance between the top of the large rotor and the lowest edge of the small rotor and the lowest point of the two sides of the tuberosity. The loca-tion of the lowest edge of the lesser trochanter was compared with that of the sciatic tuberosties,the neck length, the depth of the femoral prosthesis,and the model number of femoral head were adjusted to the length of the limb. Re-sults The incision length was 5.6 ~6.5 cm. All patients were followed up for 6 ~12 (7 ± 0.6) months. At 6 months after the operation,the Harris score was 84~92 (86 ± 2.4). There were 28 cases with equal length of lower limbs and 2 cases of unequal length (0.3 cm,0.5 cm, respectively). Conclusions Via the comprehensive meas-ures of preoperative measurement of the template and intraoperative accurate calculation with X-ray,SuperPATH min-imally invasive technique can control the lower limb length of the the patients undergone THA well.