人工全髋关节置换术后早期脱位八例报告并文献复习

Eight cases report of early dislocation after artificial total hip replacement and literature review

目的探讨人工全髋关节置换(total hip arthroplasty,THA)术后早期脱位的易发因素及防治。方法对2010年2月至2014年1月,在我院进行THA的216例患者进行回顾性分析,其中8例术后发生早期脱位。计算机检索Pubmed数据库、中文科技期刊数据库、中国生物医学文献数据库、万方全文数据库近10年(2005年至2015年)公开发表的文献,同时手工检索已发表的骨科论文并查阅文章所附参考文献,对所纳入文献进行分析探讨。结果纳入9篇文献,共报道2052例(2093髋),其中早期脱位105例,结合本院经治的216例(216髋),8例早期脱位者,共计2268例(2309髋)早期脱位113例,被纳入本研究。其中前外侧入路267例(11.8%),后外侧入路1836例(81.0%),165例未知(7.2%);113例早期脱位者中前脱位9例(8.0%),后脱位75例(66.3%),假体下沉1例(0.9%),28例文献中未予描述(24.8%);术后脱位采用Dorr分类:I类脱位8例(7.1%),II类脱位49例(43.4%),III类脱位15例(13.3%),IV类脱位6例(5.3%),另35例文献中未予描述(31.0%);早期脱位患者均予以积极治疗,经随访88例未再发生脱位,放弃治疗及死亡各1例,另23例患者随访资料不全。结论 THA术后早期脱位与手术入路、假体选择与安放、软组织条件及宣教等多因素相关,软组织失衡已逐渐成为假体脱位主要因素;术中有效修复髋关节周围软组织,后外侧入路时重建关节囊和外旋肌群,可获得良好张力及稳定性,减少脱位发生率。

Objective To investigate the prone factors of dislocation after total hip arthroplasty（ THA） and preventive measures. Methods A retrospective analysis of 216 patients in our department between February 2010 to January 2014 was conducted, with a total of 8 cases of postoperative hip joint dislocation. Related articles published in the past 10 years（ 2005- 2015） in Pubmed, Chinese Science Technology Journal Database, Chinese Biomedical Literature Database and Wanfang Database were searched. Published orthopedic papers and attached reference found by manual searching were consulted. Results Nine articles with 2052 cases（ 2093 hips） were included, among which there were 105 cases of early dislocation. Combining with 216 cases（ 216 hips） with 8 cases of early dislocation admitted in our hospital, there were 2268 cases（ 2309 hips） with 113 cases of early dislocation. There were 267 cases of anterolateral approach（ 11.8%）, 1836 cases of posterolateral approach（ 81.0%）, and 165 cases of unknown approach（ 7.2%）. In 113 cases of early dislocation, 9 cases were of anterior dislocation（ 8.0%）, 75 cases of posterior dislocation（ 66.3%）, 1 case of subsided prosthesis（ 0.9%）, and 28 cases without any descriptions in the literature（ 24.8%）. Dorr classification： 8 cases（ 7.1%） of I type dislocation, 49 cases（ 43.4%） type II, 15 cases（ 13.3%） type III, 6 cases（ 5.3%） type IV, and 35 cases（ 31.0%） without any descriptions in the literature. All patients of early dislocation were conducted with active treatment. In follow-up： no dislocations occurred in 88 cases, 1 case gave up treatment, 1 case died, and 23 patients without complete follow-up. Conclusions THA early postoperative dislocation is related with the surgical approach, prosthesis selection and setting, soft tissue condition, advertisement and other factors. Soft tissue imbalance has gradually become the main factor leading to prosthesis dislocation. Intraoperative effective repairing of soft tissues around the hip joint and reconstruction of the joint capsule and extorsion muscle group in the posterolateral approach are of great significance to obtain good tension and stability and further reduce the incidence of dislocation.