课题背景：2006-10-14/16召开的武汉首届国际骨科高峰论坛暨第九届中南六省骨科学术会议上,国内外知名骨科专家做了大量关于髋关节置换的报告,重点探讨了髋关节置换的前景和适应证选择,并且在手术方法和材料上有较多争论，但术后肢体不等长现象的讨论较少。

应用要点：作者通过复习国内外相关文献,结合自己10余年临床经验, 证明运用精确的术前测量及术中测量和综合调整策略，有利于更精确的选择适宜的人工假体，使全髋关节置换能有效控制双下肢等长，方法简单且实用,并在临床实践中反复应用疗效较好。

偏倚或不足：本方法尚还缺乏与其他肢体等长控制方法的对比。

摘要
目的：双下肢不等长是全髋关节置换后最受关注的并发症，可影响患者满意度和缩短假体使用寿命。因此，诸多专业人员十分关注全髋关节置换术中如何选择和应用相关控制双下肢等长的方法和策略。
方法：选择2004-01/2006-12三峡大学仁和医院进行单侧髋关节置换87例患者。男36例，女51例；年龄35~78岁，平均60.2岁。股骨头缺血性坏死25例，股骨颈头下型骨折48例，股骨颈肿瘤4例，类风湿性关节炎6例，髋臼发育不良4例，其中术前双下肢不等长共70例。所有患者术前均进行双下肢长度测量和X射线片模板测量，从而确定髋臼中心，设计截骨平面和选择股骨颈长。同时术中使用克氏针法测量及综合调整决定截骨平面，确定合适的假体长度。
结果：术后随访6~36个月，术前双下肢等长(双下肢长度差小于1.0 cm)17例患者中，仅1例延长1.5 cm；术前肢体短缩1.0 ~6.0 cm的70例患者中，术后恢复等长66例，均在1.0 cm以内，其余4例延长或短缩1.6~2.1 cm。
结论：术前测量及术中测量和综合调整策略，有利于选择合适假体，有效控制置换后的双下肢等长。
关键词：全髋关节置换；假体选择；下肢长度；等长；人工假体

谢德平，董军峰，郑之和，李新志，卢国强，周治国.全髋关节置换双下肢等长的控制策略[J].中国组织工程研究与临床康复，2008，12(9):1655-1658 [www.zglckf.com/zglckf/ejournal/upfiles/08-9/9k-1655(ps).pdf]

Strategies for managing equality of leg length following total hip replacement

Abstract
AIM: Inequality of lower limbs is a frequent complication following total hip replacement. It affects patients' satisfaction and prosthesis usage time. This study investigated clinical significance and surgical strategy about the equality of leg lengths after total hip replacement.
METHODS: Eighty-seven patients undergoing unilateral primary total hip replacement in Renhe Hospital of Three Gorges University from January 2004 to December 2006 were selected, including 36 males and 51 females with average age of 60.2 years (range, 35 to 78 years). Of the subjects, there were 25 cases with avascular necrosis of the femoral head, 48 with subcapital femoral neck fracture, 4 with femoral neck tumor, 6 with rheumatoid arthritis, and 4 with acetabular dysplasia. Moreover, 70 cases had inequality of lower limbs before operation. Based on the clinical measurement and radiographic examination, the acetabular center and the length of femoral neck prosthesis were confirmed. Meanwhile, the position of osteotomy was adjusted according to the Kirschner wire measurement and other examinations to readjust the neck length.
RESULTS: All patients were followed up for 6-36 months. Of the 17 patients with equal legs before operation (length discrepancy < 1.0 cm), 1 was lengthened by 1.5 cm in the leg. Of the 70 patients with shortened legs (1.0 cm-6.0 cm) before operation, 66 returned to equal length in their legs, and 4 were lengthened or shortened 1.6-2.1 cm in their legs.
CONCLUSION: Preoperative and perioperative measurements, and comprehensive adjusting strategy are helpful to select proper prosthesis and control leg length equality after total hip replacement.

Xie DP, Dong JF, Zheng ZH, Li XZ, Lu GQ, Zhou ZG.Strategies for managing equality of leg length following total hip replacement. Zhongguo Zuzhi Gongcheng Yanjiu yu Linchuang Kangfu 2008;12(9):1655-1658(China)
[www.zglckf.com/zglckf/ejournal/upfiles/08-9/9k-1655(ps).pdf]