人工髋关节置换术后脱位及内衬分离的原因和防治

Dislocation of Total Hip Prostheses and Dissociation of Polyethylene Acetabular Line:Risk Factors and Treatment

目的探讨人工髋关节置换术后脱位及内衬分离的原因和防治。方法行人工全髋关节置换术40例,2例术后发生脱位,1例内衬脱落。对其临床表现、诊断、治疗和结果进行了临床分析。结果2例股骨头脱位手法复位,1例行内衬翻新手术,术后随访Harris评分84.3分。结论术中假体位置不当、髋部软组织松弛为术后脱位及内衬分离的主要原因;另外,手术入路、假体选择、髋臼缘骨赘和骨水泥均可导致术后脱位。术后肌肉和关节囊重新恢复张力之前,使用牵引或外展架是正确选择。反复脱位和内衬分离须翻新手术。

Objective To investigate the reason and prevention of dislocation of total hip prostheses and dissociation of polyethylene acetabular line. Methods From February 1999 to July 2005, in 40 hips of 36 patients operated on by THA, 3 had postoperative dislocation. The dislocation of clinical situation, diagnosis, treatment and outcome were investigated. Results One was revised while the other two underwent closed reduction. The average Harris score was improved to 84.3 postoperatively from 36.7 before operation in the latest follow - up. Conclusion Risk factors include malposition of prosthesis, unbalanced bilateral soft - tissues, especially the loosening of abductor. The surgical approach, selection of prosthesis, previous surgery and osteophytes and bone cement may also induce the postoperative dislocation. The traction or an abduction brace should be used before the tension of muscle and articular capsule are recovered. If dislocation is a recurring problem and dissociation of acetabular line occurs, revision of the prosthesis is often the only solution.