人工髋关节置换术后早期脱位的原因分析及防治

Analysis of early hip joint dislocation after total hip arthroplasty (THA) and its significance

目的:通过临床病例研究分析,探讨人工髋关节置换术后早期脱位的发病因素及预防治疗方法,为髋关节术后脱位治疗提供依据。方法:回顾分析1999年10月～2011年10月,我组所进行的人工髋关节置换术295例患者,所有患者由同一术者完成,均采用后外侧手术入路。患者平均年龄57.2岁,其中男187髋女108髋。因股骨头坏死手术179髋,股骨颈骨折91髋,翻修术15髋,骨性关节炎7髋,病理骨折2髋。术后有13例发生关节脱位,并给予复位治疗。本文对脱位病例进行了性别、年龄、诊断、手术切口、安装角度、术后不良活动等多因素进行分析。结果:在平均住院20.5天,术后随访1-3年。有13例发生脱位,所有脱位患者均为术后不良活动导致,都属于后上方脱位,在患侧臀部可触到脱位的股骨粗隆部。脱位后分别采用床头手法复位、麻醉下手法复位和切开复位。床头手法复位13例,成功8例,失败5例。2例麻醉下复位成功,3例切开复位成功。所有复位患者无2次脱位发生。结论:随着人工髋关节技术的发展,术后不良活动逐渐成为目前脱位的重要原因。正确的康复锻炼方式,能有效地防止早期脱位的发生。不良活动的脱位复位后,不用限制肢体的正常活动锻炼。脱位患者无2次脱位发生。

Objective：To investigate the factors lead to the early hip joint dislocation after total hip arthroplasty（THA） by clinical case analysis,found the reason of dislocation and provided the effective treatment.Methods：295 cases were reviewed with post - lateral operative THA from October 1999 to October 2011,with an average age of 57.2 years.There were 187 males and 108 females.The reasons for THA were femoral head necrosis（179cases）,fracture of the femoral neck（91cases）,revision THA（15cases）,osteoarthritis （7cases）,pathologic fracture（2cases）.There were 13 cases occurred dislocation,and successfully corrected the dislocation in all cases. We analyzed the factors of sex,age,diagnosis,type of prosthesis,virus angle of the prosthesis assemble,operative incision,incorrect actions, then carried out statistical for dislocation.Results：The average time in hospital was 20.5 days.1-3 years was reviewed after THA. The 13 cases with post - dislocation after THA.We could touch the dislocation femoral head at the buttocks.These patients could be treated with restoration by hand in bed,restoration after anaesthesia and restoration by slash.13 cases restorated in bed,8 cases were successful, 5 cases were failed,2 cases were successful by anaesthesia,and 3 cases were successful by cutting.Conclusion：The incorrect actions were the main reasons for the THA in current.Correct rehabilitation exercise could effectively avoid the early dislocation.Generally, the dislocation after THA could be successful positioned by hands,the bipolar was usually treated by cutting restoration,after the dislocation was reposited for incorrect actions,could normally exercise without redislocation.