| 摘要: |
| ［摘要］ 目的 探讨髋关节周围软组织松解平衡在中重度肢体短缩患者全髋关节置换中的重要性。方法 对2009-06～2013-06在该院治疗的25例伴有中重度肢体短缩股骨头坏死或成人髋关节发育不良的患者进行全髋关节置换，其中男17例，女8例，年龄37～71(58.6±11.2)岁，2 cm<患肢短缩≤3 cm的患者16例，3 cm<患肢短缩≤4 cm 7例，患肢短缩>4 cm 2例，术前Harris评分（38.2±9.6）分、VAS疼痛评分（7.8±1.3）分。全部患者均由同一组医生采用前外侧手术入路行全髋关节置换，在保证牵引力平衡的前提下采用髋周软组织分步松解法依次对患肢进行适当松解延长，尽可能恢复肢体的长度同时保证人工假体的稳定；术后对患者进行随访，评估其肢体长度恢复情况、髋关节功能及疼痛情况，评价其手术效果。结果 所有患者均获得随访，随访时间为1～3（2.2±0.7）年。术后双侧肢体长度差距≤0.5 cm的患者15例，0.5 cm<双侧不等长≤1 cm 8例，双侧不等长>1 cm 2例；术后3个月VAS疼痛评分为（2.6±1.1）分，疼痛得到明显缓解，术后1年Harris评分为（87.2±8.6）分，关节活动度满意，外展功能得到明显改善。结论 在对伴有中重度肢体短缩患者行全髋关节置换时，采用髋周软组织分步松解法适当行髋周软组织松解能使患肢获得较好的长度恢复，术后在获得良好髋关节功能的同时髋部疼痛亦有明显缓解，对患者的康复具有重要意义。 |
| 关键词: 全髋关节置换 软组织松解 短缩 |
| DOI：10.3969/j.issn.1674-3806.2015.07.22 |
| 分类号:R 68 |
| 基金项目: |
|
| Release and balance of the soft tissue around hips in total hip arthroplasty for patients with moderate-to-severe leg-length inequality |
|
HUANG Xue-jing, WEI Yong-zhong, QIN Qi-xin
|
|
Department of Orthopedic, Chinese Medicine Hospital of Mashan County, Guangxi 530600, China
|
| Abstract: |
| ［Abstract］ Objective To evaluate the effect of release and balance of the soft tissue around hips in total hip arthroplasty for patients with moderate-to-severe leg-length inequality.Methods 25 patients with femoral head necrosis or adult dysplasia of hips with moderate-to-severe leg-length inequality were collected from June 2009 to June 2013 and included in the study. Among them, there were 8 females and 17 males, from 37 to 71 years with an average of (58.6±11.2)years old. Before surgery, the affected limbs shortening more than 2 cm and less than or equal to 3 cm were in 16 cases, and those shortening more than 3 cm and less than or equal to 4 cm were in 7 cases, and those shortening more than 4 cm were in 2 cases. The average Harris score was （38.2±9.6） and the average visual analogue scale(VAS) pain score was （7.8±1.3）. Total hip arthroplasty was performed with lateral approach by the same group of surgeons in all. The length of the affected limbs was restored as far as possible through release of soft tissue around hips step-by-step, and the techniques of balance of soft tissue were applied to extend force arm of hip abductor and improve its function. The postoperative effect was evaluated by follow-up survey.Results The average time of the follow-up was 1～3（2.2±0.7）years. After the operation, the leg-length discrepancy ≤0.5 cm was in 15 cases, and that >0.5 cm or ≤1 cm was in 8 cases, and that >1 cm was in 2 cases. The average VAS pain score reduced （2.6±1.1） scores at 3 months after the operation and the average Harris score increased to （87.2±8.6） at 1 year after the operation. All hips functioned well and all patients were released from pain and functioned well.Conclusion The technique of release and balance of soft tissues around hips step-by-step in the total hips arthroplasty can be helpful to restore the length of the affected limbs in the patients with moderate-to-severe leg-length inequality, and can be helpful to release pain and restore physiological function of affected hips. |
| Key words: Total hip arthroplasty Release soft tissues Shortening |
