| BackgroundArtificial femoral head replacement is an effective method for the treatment of unstable intertrochanteric fractures in the elderly.As a major complication of artificial femoral head replacement,Limb Length Discrepancy(LLD)can cause claudication,back pain,aseptic loosening of prostheses,and become one of the main reasons that affect the function of patients’ hip joints and cause legal proceedings.In recent years,more and more clinicians have paid attention to the difference in length of both lower limbs after surgery.Although there are many methods to balance the difference in length of both lower limbs during surgery,there are still many disputes about the efficacy of various methods.Objective :To compare the effectiveness of the relative position of the greater trochanter tip and the center of rotation of the femoral head combined with the measurement of femoral neck to acetabular top in reducing the difference in the length of both lower limbs during artificial femoral head replacement,and to obtain a convenient and highly reproducible method.Methods:The clinical data of 79 patients undergoing artificial femoral head replacement for unstable intertrochanteric fractures in Huaihe Hospital Of Henan University from February 2019 to February 2022 were retrospectively analyzed.38 cases were treated with the relative position method between the greater trochanteric tip and the center of rotation of the femoral head(Group A),and 41 cases were treated with the relative position method between the greater trochanteric tip and the center of rotation of the femoral head(Group B),combined with the measurement of femoral neck to acetabular top.The differences in the length of both lower limbs after surgery,as well as the Visual Analog Scale(VAS),Harris hip score,Forgotten Joint Score(FJS),and postoperative complications at the first,sixth,and twelfth months after surgery were analyzed.According to the difference in the length of both lower limbs,all patients with LLD>10mm were divided into difference groups,and patients with LLD ≤ 10 mm were divided into equal length groups.Harris scores and FJS scores at the first,sixth,and twelfth months after surgery were compared between the two groups.Results:1.The LLD of patients in Group A was 8.71 ± 2.94 mm,while that of patients in Group B was 6.24 ±2.51 mm.The LLD of patients in Group B was significantly lower than that in Group A(P<0.05).There were10(26.3%)patients with LLD>10mm in Group A,and 3(7.3%)patients with LLD>10mm in Group B.There were significantly more patients with LLD>10mm in Group A than in Group B,with a statistically significant difference(P<0.05).The postoperative LLD distribution of patients in Group B was better than that in Group A,with a statistically significant difference(P<0.05).2.The operation time in Group A was 70.29 ± 10.22 minutes,while that in Group B was 68.17 ± 9.27 minutes.Group B was slightly longer than Group A,but the difference was not statistically significant(P>0.05).3.Comparison of hip VAS scores between the two groups at preoperative,1-month,6-month,and 12-month follow-up showed that the results of Group B were superior to those of Group A at 1-month after surgery,with a statistically significant difference(P<0.05).However,there was no statistically significant difference between Group A and Group B at preoperative,6-month,and 12-month after surgery(P>0.05).4.Comparison of Harris scores between the two groups at 1,6,and 12 months after surgery showed that the results of Group B were better than those of Group A,but the difference was not statistically significant(P>0.05).5.Comparison of hip joint FJS scores between the two groups at 1,6,and 12 months after surgery showed that the results of Group B were better than those of Group A,with a statistically significant difference(P<0.05).6.Group A had a total of 4 cases(10.53%)of complications,including 1 case(2.63%)of dislocation,2cases of claudication(5.26%),and 1 case(2.63%)of lower extremity deep vein thrombosis;There were 2cases(4.88%)of postoperative complications in group B,including 1 case(2.44%)of dislocation.There was1 case(2.44%)of claudication.There was no statistically significant difference between the two groups(P>0.05).7.According to the difference in length of both lower limbs,LLD>10mm were divided into the difference group(13 people),LLD ≤10mm were divided into the equal length group(66 people),and the hip Harris score and hip FJS score in January,June and December after surgery were better than the difference group,and the difference was statistically significant(P<0.05).The difference in complication rate was statistically significant between the group(23.07%)> the isometric group(4.55%).Conclusions:The method of relative position of the greater trochanter tip combined with the measurement of femoral neck to acetabular top can effectively control the length of both lower limbs.This method is simple and fast,and can achieve better results without significantly increasing the surgical time.When the difference in the length of both lower limbs exceeds 10 mm,it will have a significant impact on the hip joint function and daily life of patients. |
PDF Full Text Request