老年人脑血管意外偏瘫侧股骨颈骨折人工关节置换术后脱位的原因分析及防治对策

Cause analysis and prevention strategy of dislocation following artificial joint replacement in previous stroke aged patients with femoral neck fracture of the hemiplegic extremity

目的探讨老年人脑血管意外后偏瘫侧股骨颈骨折人工关节置换术后脱位的原因、治疗方法及预防措施。方法脑血管意外后偏瘫侧股骨颈骨折人工关节置换术后脱位8例患者,6例麻醉下手法复位,1例手法复位失败后行手术切开复位加后侧结构加固修复术,1例反复脱位后行翻修术。结果 8例患者治疗后随访1年半至5年,所有患者均无再发脱位。结论脑血管意外后患者偏瘫侧人工髋关节置换术后脱位是由于术前、术中、术后因素综合影响术后髋关节假体的稳定性,而假体位置安装不良及术后周围软组织失衡是术后髋关节脱位的主要原因。围手术期充分的手术准备及积极的预防可减少术后脱位的发生率。

Objective To study reason, treatment method, and prevention of dislocation following artificial joint replacement in previous stroke aged patients with femoral neck fracture of the hemiplegic extremity. Methods Of 8 previous stroke aged patients with femoral neck fracture of the hemiplegic extremity, 6 were successfully relocated by manual reduction, 1 was performed with open reduction plus rear side structural reinforcement after the failure of manual reduction, and the other with overhaul operation after repeated dislocation. Results All 8 patients were followed up for 1.5 to 5 years, no dislocation was observed. Conclusion Dislocation following artificial joint replacement in previous stroke aged patients with femoral neck fracture of the hemiplegic extremity was due to preoperative, operative, and postoperative factors affecting the stability of hip prosthesis. Poor hip prosthesis installation and postoperative surrounding soft tissue imbalance are the main culprits. Well preoperative preparation and active prephylaxis can reduce the dislocation after operation.