摘要
目的 探讨人工髋关节不稳定的影响因素，以期防止人工全髋关节置换术后髋关节脱位。方法 1995—2005年收治人工关节置换术后脱位患者19例，其中男8例，女11例；年龄54—78岁，平均62．1岁。原发病包括股骨颈骨折4例，病理性股骨颈骨折1例，先天性髋关节脱位5例，骨性关节炎4例，股骨头无菌性坏死2例，人工关节翻修术后3例。8例患者采用闭合复位石膏固定3—6周，1例在闭合复位时死亡，10例在闭合复位失败后或有明确脱位原因的患者，采用手术切开复位。结果 8例患者采用闭合复位、石膏固定3—6周后获得成功。2例患者经闭合复位后再次失败，采用手术切开复位获得成功。8例闭合复位不成功直接手术切开复位获得成功。术后随诊2年，未再出现脱位现象。术后髋关节Harris评分平均82分（72—96分）。结论 人工全髋关节脱位由多种因素造成，强调以预防为主，全面分析和研究患者的具体情况，制定相应的方案，使关节周围组织张力、关节位置和头臼间的匹配关系达到最佳，并选用合适的假体，才能彻底避免髋关节不稳定的发生。
Objective To study the factors relating to hip instability after total hip arthroplasty （THA） for prevention and treatment of hip dislocation. Methods Nineteen patients （8 males and 11 females ） with dislocation of THA were reviewed in our department from 1995 to 2005. The mean age was 62.1 years （54-78 years）. Prior disease included congenital dislocation of hip in 5 cases, osteoarthoritis of hip in 4, avascular necrosis of femoral head in 2, fracture of femoral neck in 4, pathologic fracture of femoral neck in 1 and revision of THA in 3. Eight patients were treated with close reduction and fixation with plaster cast for 3 to 6 weeks. One case died during close reduction. Ten patients were treated opera- tively after failure of close reduction. Results Eight patients got good result with close reduction and fixation of plaster cast. Ten cases were re-operated on for the failure of reduction of hip joint, and had a good result, and the 2-year follow-up didn＇ t find hip dislocation either. After THA, Harris score of hip was 82 scores （72-96 scores）. Conclusions There are many factors causing hip instability, like preoperative, intraoperative and postoperative reasons. Before operation we should notice primary disease of the patient, select appropriate prostheses and work out a preoperative plan. In operation we must insure that the position of the implants is correct. We emphasize particularly the relationship of the cup and femoral head of prosthesis. A good relationship means they match well each other. In some special situation we depend on the need of stability of the hip for the position of implants. Besides, we should keep the soft tissues of surrounding bone balanceable and tensile and avoid the impingement from implants.
出处
《中华创伤杂志》
CAS
CSCD
北大核心
2007年第4期273-276,共4页
Chinese Journal of Trauma
关键词
关节成形术
置换
髋
脱位
关节
并发症
手术后
Arthroplasty,replacement, hip
Postoperative complications
Dislocations,joint prosthesis
