全髋关节置换术后脱位的治疗

Treatments of dislocation after total hip joint replacement

目的:探讨全髋关节置换术后假体脱位的治疗方法。方法:自1997年7月～2004年10月共收治假体脱位23例,对该23例病人做CT及X线片检查,了解假体是否松动及假体位置,分析脱位原因。无假体松动者,麻醉下手法复位、做稳定试验。手法复位成功且稳定者,胫骨结节牵引4～6周。手法复位失败或不稳定者原入路切开,根据术前及术中情况调整offset值及部分假体组件,对已稳定者行关节囊修补,胫骨结节牵引4～6周,对仍不稳定及松动者采用翻修手术。结果:23例脱位患者,1例假体松动,其余22例中10例手法复位治疗成功。12例手法复位后不稳定或失败患者中,7例行切开复位关节囊修补,2例采用加长股骨头增加offset值,2例改用防脱位髋臼内衬,1例采用加长股骨头并调整异常髋臼内衬位置。1例假体松动及2例切开复位后仍不稳定者采用全髋关节翻修。结论:全髋关节置换术后假体脱位的治疗应根据脱位原因和术中稳定情况选择不同的治疗方法。

Objective To explore the treatments of dislocation after total hip joint replacement. Methods From July 1997 to October 2004,there were 23 cases dislocation after total hip joint replacement. CT and serial X-rays were undertaken to observe the position of prostheses. The strength of their hip abductor was also tested. To the patients without loosening, closed reduction was attempted at first. Stability test was used to value the stability of hip. If closed reduction failed,we adjusted the offset or（and） parts of the components, then repairing the capsular. If instability still, revision was adopted. Results There were 23 cases of dislocation, 10 cases were treated successfully by closed reduction,7 by open reduction combined with capsular repairing. The offset were adjusted with a larger one in 2 cases. 2 cases used elevated rim liners, 1 case treated by using larger offset and adjusting abnormal liner. Revision was used in 1 case with loosening and 2 cases still instability. Conclusion The treatments of dislocation after total hip joint replacement should be used different ways according to the causes of dislocation and the stability of hip.