改良Hardinge入路人工全髋关节置换术中两种肢体长度测量方法比较
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摘要
目的分析在改良Hardinge入路人工全髋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。
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 January2015 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.
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 January2015 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.
引文
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[22]Aminiaghdam S,Blickhan R,Muller R,et al.Posture alteration as a measure to accommodate uneven ground in able-bodied gait[J].PLo S One,2017,12(12):e0190135.
[23]Aminiaghdam SRC,Muller RBR.Increasing trunk flexion transforms human leg function into that of birds despite different leg morphology[J].J Exp Biol,2017,220(Pt3):478-486.
[24]Aminiaghdam S,Blickhan R,Muller R,et al..Posture alteration as a measure to accommodate uneven ground in able-bodied gait[J].PLo S One,2017,12(12):e0190135.
[25]Muller R EM,Blickhan R.Leg adjustments during running across visible and camouflaged incidental changes in ground level[J].J Exp Biol,2012,215(Pt17):3072-3079.
[26]Flecher XOM,Argenson JN.Lower limb length and offset in total hip arthroplasty[J].Orthop Traumatol Surg Res,2016,102:S9-20.
[27]Esposito CI,Gladnick BP,Lee YY,et al.Cup posi tion alone does not predict risk of dislocation after hip arthroplasty[J].The Journal of Arthroplasty,2015,30(1):109-113.
[28]Rosenlund S,Broeng L,Holsgaard-Larsen A,et al.Patient-reported outcome after total hip arthroplasty:Comparison between lateral and posterior approach[J].Acta Orthopaedica,2017,88(3):239-247.
[29]Barbier O,Ollat D,Versier G.Interest of an intraoperative limb-length and offset measurement device in total hip arthroplasty[J].Orthop Traumatol Surg Res,2012,98(4):398-404.
[30]Lazennec JY,Folinais D,Florequin C,et al.Does Patients'Perception of Leg Length After Total Hip Arthroplasty Correlate With Anatomical Leg Length[J].J Arthroplasty,2017,17(3):1092-1096
[31]季卫平,王波,李浩,等.改良Hardinge入路全髋置换在双下肢等长控制中的应用[J].临床骨科杂志,2014,(6):664-667.
[32]Kruse C,Rosenlund S,Broeng L,et al.Radiographic cup position following posterior and lateral approach to total hip arthroplasty.An explorative randomized controlled trial[J].PLo S One,2018,13(1):e0191401.
[33]Strm NJ,Reikeras O.Templating in uncemented THA.On accuracy and postoperative leg length discrepancy[J].J Orthop,2018,15(1):146-150.
[2]Rodriguez JA,Deshmukh AJ,Rathod PA,et al.Does the direct anterior approach in THA offer faster rehabilitation and comparable safety to the posterior approach[J].Clin Orthop Relat Res,2014,472(2):455-463.
[3]Lavernia CJ,Iacobelli DA,Brooks L,et al.The Cost-Utility of Total Hip Arthroplasty:Earlier Intervention,Improved Economics[J].J Arthroplasty,2015,30(6):945-949.
[4]Barrett WP,Turner SE,Leopold JP.Prospective randomized study of direct anterior vs postero-lateral approach for total hip arthroplasty[J].J Arthroplasty,2013,28(9):1634-1638.
[5]Goyal P,Lau A,Mc Calden R,Teeter MG,et al.Accuracy of the modified Hardinge approach in acetabular positioning[J].Can J Surg,2016,59(4):247-253.
[6]Takeda Y,Fukunishi S,Nishio S,et al.Surgical Treatment of Synovial Osteochondromatosis of the Hip Using a Modified-Hardinge Approach with a Z-Shaped Capsular Incision[J].Orthop Rev(Pavia),2015,7(4):5705.
[7]Mazoochian F,Schmidutz F,Fottner A,et al.[Modified mini-Hardinge access for hip prosthesis implantation in the supine position][J].Oper Orthop Traumatol,2014,26(2):171-183.
[8]Bernasek TL,Thatimatla NK,Levering M,et al.Effect of immediate full weight bearing on abductor repair and clinical function after THA through a modified Hardinge approach[J].Orthopedics,2013,36(3):e266-270.
[9]Iversen MD,Chudasama N,Losina E,et al.Influence of self-reported limb length discrepancy on function and satisfaction 6 years after total hip replacement[J].J Geriatr Phys Ther,2011,34(3):148-152.
[10]García-Juárez JD,Bravo-BernabéPA,García-Hernández A,et al.[Incidence and effect of leg length discrepancy after total hip arthroplasty][J].Acta Ortop Mex,2013,27(1):43-46.
[11]Chu YM,Zhou YX,Kou YH,et al.[Comparative study of total hip arthroplasty with subtrochanteric osteotomy for treating Hartofilakidis types C1 and C2 developmental dysplasia of the hip][J].Beijing Da Xue Xue Bao Yi Xue Ban,2015,47(2):232-236.
[12]Feng W,Liu JG,Qi X,et al.[Clinical and radiographic evaluation for total hip arthroplasty in treatment of bony ankylosis of hips][J].Zhongguo Gu Shang,2012,25(11):899-902.
[13]Vissers MM,Bussmann JB,Verhaar JA,et al.Recovery of physical functioning after total hip arthroplasty:systematic review and meta-analysis of the literature[J].Phys Ther,2011,91(5):615-629.
[14]Flecher X,Ollivier M,Argenson JN.Lower limb length and offset in total hip arthroplasty[J].Orthop Traumatol Surg Res,2016,102(1 Suppl):S9-20.
[15]Rosenlund S,Broeng L,Overgaard S,et al.The efficacy of modified direct lateral versus posterior approach on gait function and hip muscle strength after primary total hip arthroplasty at 12months follow-up.An explorative randomised controlled trial[J].Clin Biomech(Bristol,Avon),2016,39:91-99.
[16]Ng CY,Ballantyne JA,Brenkel IJ.Quality of life and functional outcome after primary total hip replacement.A five-year follow-up[J].J Bone Joint Surg Br,2007,89(7):868-873.
[17]Sariali E,Klouche S,Mouttet A,et al.The effect of femoral offset modification on gait after total hip arthroplasty[J].Acta orthopaedica,2014,85(2):123-127.
[18]吕厚山.人工关节外科学[M].北京:科学出版社,1998:173-177.
[19]Winiarski S,Aleksandrowicz K,Jarzab S,et al.Assessment of gait after bilateral hip replacement.Case study[J].Ortop Traumatol Rehabil,2014,16(2):197-208.
[20]Wilson DA,Astephen WJL,Richardson G,et al.Changes in the functional flexion axis of the knee before and after total knee arthroplasty using a navigation system[J].J Arthroplasty,2014,29(7):1388-1393.
[21]Mahmood SS,Mukka SS,Crnalic S,et al.Association between changes in global femoral offset after total hip arthroplasty and function,quality of life,and abductor muscle strength[J].Acta Orthopaedica,2016,87(1):36-41.
[22]Aminiaghdam S,Blickhan R,Muller R,et al.Posture alteration as a measure to accommodate uneven ground in able-bodied gait[J].PLo S One,2017,12(12):e0190135.
[23]Aminiaghdam SRC,Muller RBR.Increasing trunk flexion transforms human leg function into that of birds despite different leg morphology[J].J Exp Biol,2017,220(Pt3):478-486.
[24]Aminiaghdam S,Blickhan R,Muller R,et al..Posture alteration as a measure to accommodate uneven ground in able-bodied gait[J].PLo S One,2017,12(12):e0190135.
[25]Muller R EM,Blickhan R.Leg adjustments during running across visible and camouflaged incidental changes in ground level[J].J Exp Biol,2012,215(Pt17):3072-3079.
[26]Flecher XOM,Argenson JN.Lower limb length and offset in total hip arthroplasty[J].Orthop Traumatol Surg Res,2016,102:S9-20.
[27]Esposito CI,Gladnick BP,Lee YY,et al.Cup posi tion alone does not predict risk of dislocation after hip arthroplasty[J].The Journal of Arthroplasty,2015,30(1):109-113.
[28]Rosenlund S,Broeng L,Holsgaard-Larsen A,et al.Patient-reported outcome after total hip arthroplasty:Comparison between lateral and posterior approach[J].Acta Orthopaedica,2017,88(3):239-247.
[29]Barbier O,Ollat D,Versier G.Interest of an intraoperative limb-length and offset measurement device in total hip arthroplasty[J].Orthop Traumatol Surg Res,2012,98(4):398-404.
[30]Lazennec JY,Folinais D,Florequin C,et al.Does Patients'Perception of Leg Length After Total Hip Arthroplasty Correlate With Anatomical Leg Length[J].J Arthroplasty,2017,17(3):1092-1096
[31]季卫平,王波,李浩,等.改良Hardinge入路全髋置换在双下肢等长控制中的应用[J].临床骨科杂志,2014,(6):664-667.
[32]Kruse C,Rosenlund S,Broeng L,et al.Radiographic cup position following posterior and lateral approach to total hip arthroplasty.An explorative randomized controlled trial[J].PLo S One,2018,13(1):e0191401.
[33]Strm NJ,Reikeras O.Templating in uncemented THA.On accuracy and postoperative leg length discrepancy[J].J Orthop,2018,15(1):146-150.