全髋关节置换术后脱位的原因分析及防治对策

Causes and preventions of dislocation after total hip arthroplasty

目的探讨全髋关节置换术(THA)后脱位的原因及防治措施。方法回顾分析2000年3月至2008年12月9例THA术后脱位患者的术前病因、脱位原因、治疗经过及术后预防再次脱位采取的措施。结果术后经6个月至8年随访,其中7例未再发生脱位,1例伴有偏瘫患者反复出现脱位,另1例在6个月内再次出现脱位后经限制患髋活动,未再出现脱位。结论髋关节周围软组织失衡、患肢主动或被动活动范围过大、假体安装位置不当是脱位的常见原因;脱位后大多数患者可通过麻醉下行闭合复位治疗,少数假体位置不当且稳定实验阳性者应考虑手术翻修;术前和术后对患者进行有关THA的康复知识教育是预防脱位的重要措施。

Objective To explore the causes and preventions of dislocation after total hip arthroplasty（THA）. Methods 9 pa- tients with dislocation after THA from March 2000 to December 2008 were studied retrospectively through analysis of preoperative causes of disease,reasons of dislocation,processes of therapy and measures of prevention for dislocation. Results During the half to 8 years follow-up, 7 patients walked well without relapse,and 1 patient with hemiplegia repeatly appeared dislocation, 1 patient re- dislocated in half year walked well without relapse through limitating range of hip activity. Conclusion Unbalanced soft tissue,ex- cessive range of passive and initiative activity, uncorrected fixing prosthesis are the major causes of dislocation after THR. Majority of the dislocations can be corrected by closed reduction, but re-operation should be done in the case of severely improper prosthetic position. The educations of rehabilitation knowledges about THA are important measures of preventing dislocation.