初次人工髋关节置换术稳定性评估

Evaluate of Stability for the Primary Hip Arthroplasty

目的探讨影响人工髋关节置换术后稳定性影响因素。方法本组108例,均采用后外侧入路,THA者采用相同的摆动角128°及28mm股骨头,根据术中稳定性试验及软组织张力测试结果分为稳定组与不稳定组,58例术后再作骨盆平片及CT,分别用Kalteis法、Andrew法及Takashi法测定两组假体的外展角及联合前倾角。所有病例均作American Society of Anesthesiologists(ASA)评分。结果本组108例,随访时间6～24个月,平均14个月,出现后脱位7例,其中全髋脱位5例,半髋脱位2例。全髋脱位的5例中,4例出现在术后1周内;2例因假体外展角大于60°引起,作了翻修手术;另3例经手法复位、卧床2周后痊愈。7例脱位中2例伴有神经肌肉功能不全,68例THA中,2例因张力过松出现术后即刻半脱位,硬膜外麻醉消失后自然恢复;7例后脱位中,2例ASA评分≥3分,占脱位病例的28.5%。结论人工髋关节置换术后,假体安放位置、软组织张力及患者的ASA评分均影响术后的稳定性。

Objective To investigate the influencing factors of the stability after hip arthroplasty. Methods 108 cases were divided into stable group and unstable group according to the trials of stability and soft-tissue tension and evaluated through a posterolateral approach In all patients, American Socie- ty of Anesthesiologists （ASA） score were recorded. Results 108 cases were followed up for an average period of 14 months （ranged from 6 to 24 months）. Posterior dislocation occurred in 7 hips, in which THA represented 5 hips and herniarthroplasty represented 2 hips. In 5 dislocation cases, 2 hips were revisioned,The other 3 hips were reduced by closed method and restrained to bed two weeks. Two of seven dislocations were complicated with muscular and neurologic diseases. Two hips were occurred immediate postoperative subluxation because of soft-tissue laxity over 10 mm in THA and components reduced after anesthetic recovery. In 7 patients of posterior dislocations, ASA score of 2 hips were 3, which represented 28. 5%. Conclusion The positions of prosthesis, soft-tissue tension and ASA score of the patients, all influence the stability of hip arthroplasty.