人工全髋关节置换术后脱位原因分析及诊治策略

The investigation of cause and treating strategy of dislocation after total hip replacement.

目的探讨人工全髋关节置换术(THR)术后脱位的原因及诊治策略。方法对我院1996年10月～2010年3月进行THR的434髋,28例脱位原因进行分析,总结诊治策略。结果脱位发生于术后至36个月。采用麻醉状态闭合复位成功17例,切开复位9例,行内收肌松解6例。结论 THR术后脱位是多因素作用的结果,假体位置不当,内收肌紧张未进行松解,术后不恰当搬运和体位,增加术后早期脱位的风险。外展肌乏力,是习惯性脱位的重要原因。麻醉下闭合复位可获得良好效果;对于闭合复位失败的患者应进行切开复位、固定或翻修。术前对脱位风险因素的评估,以及术中术后避免髋关节不稳定的技术处理是预防脱位的主要措施。

Objective To investigate cause and treating strategy of dislocation after total hip replacement（THR）.MethodsAmong 434 hips of THR,28 cases with dislocation were investigated to find causes of dislocation and preventing methods.ResultsDislocations happened in 36 months after operation.Successful reductions were accomplished by closed reductions in 17 cases,opening reductions in 9 cases and adductor muscle brisement in 6 cases under anesthesia.Conclusion The postoperative dislocation after THR are related with the improper position of prostheses,addutor muscle tension,the improper postoperative transport and position.The adductor muscle acratia is an important factor of habitual dislocation.Good curative effects could be acquired by closed reductions under anesthesia.The cases with unsuccessful closed reductions should be treated with opening reduction,fixation and revision.The evaluation of risk factors of dislocation and the technique to avoid joint instability are able to effectively preventing dislocation.