初次人工髋关节置换术后复发性脱位的治疗方法研究

Different treatments for recurrent dislocation after primary total hip arthroplasty

背景:人工髋关节置换术目前广泛运用于临床治疗老年患者股骨颈骨折或终末期髋关节疾病,而术后人工关节脱位仍是其最常见的并发症之一。目的目的:回顾性研究不同方法治疗初次人工髋关节置换术后复发性脱位的疗效。方法方法:回顾分析我院2007年1月至2014年6月行人工髋关节置换术的704例患者的临床资料,术后早期脱位25例,14例转为复发性脱位,分析脱位的原因,采取不同治疗。7例采用假体翻修术称为翻修组;5例老年患者,不能耐受翻修手术,采用髋臼聚乙烯内衬加盖治疗,称为髋臼加盖组;2例未在我院治疗。结果结果:704例患者,术后随访3～8年,平均(5.5±1.7)年,初次脱位25例,发生率3.6%;复发性脱位14例,发生率2.0%,12例再次手术的患者获得随访。术后随访Harris评分均达到优良;末次随访Harris评分均优于术前(P<0.05)。12例患者术后均无再脱位,无感染及松动,无假体周围骨折等并发症。髋臼加盖组1例患者出现固定加盖衬垫的螺钉断裂。髋臼加盖组手术时间、术中出血量、术后引流量、隐性失血量均优于翻修组(P<0.05)。结论结论:髋臼聚乙烯衬垫加盖,可用于治疗高龄、活动量少、不存在明显假体位置错误、难以耐受翻修手术患者的复发性人工髋关节脱位,且疗效明显。

Background:Total hip arthroplasty (THA)is now widely used in the treatment of elderly patients with femoral neck fracture and terminal stage of some hip joint diseases.Dislocation is still one of the most common postoperative complications of hip joint arthroplasty.Objective:To investigate the effect of different treatments for recurrent dislocation after primary THA retrospectively.Methods:Between January 2007and June 2014,704patients received THA in our hospital.25cases of them occurred prima_gr'dislocation in the early stage,and 14patients had recurrent dislocation,among which 7patients received re- vision operation,5elderly patients with more underlying disease,expected poor operation tolerance,low functional requirement and without obvious prosthesis malposition received acetabulum augmentation operation,and another 2patients did not receive operation in our hospital.Results:The follow-up for 704patients lasted for 3-8years,with an average time of (5.5±1.7)years after surgery.Dislocation occurred in 25patients,the occurrence rate was 3.6%.Recurrent dislocation occurred in 14patients,and the occurrence rate was 2.0%.12patients receiving re-operation had been all followed up.Their postoperative Harris score achieved good leveh Harris score of the last follow-up visit was better than that of preoperation (P<0.05).No dislocation and complications like infection,loosing,pulmonary embolism and periprosthetic fracture were found.In the ace- tabulum augmentation group,1case happened to screw breakage in the fixed polyethylene liner.The operation time,blood loss,postoperative drainage and hidden blood loss were better in acetabulum augmentation group than in the revision group (P< 0.05).Conclusions:Aeetabular polyethylene augmentation is a good treatment for recurrent dislocation of THA,especially in those without obvious malposition and can not tolerate the revision surgery.