不同入路与髋关节置换术后并发症的相关性分析

目的探讨采用前外侧、外侧、后外侧3种不同手术入路实施人工髋关节置换术治疗不同髋关节疾病的术后深静脉血栓及脱位的发生率。方法回顾分析我院960例人工髋关节置换术病例,采用不同手术入路治疗不同髋关节病种术后发生深静脉血栓及脱位的情况,总结术后并发症类型与入路选择的相关性。结果股骨颈骨折组536例,术后发生下肢深静脉血栓5例,后脱位3例。5例发生下肢深静脉血栓均为前外侧入路,后脱位3例均为后外侧入路。股骨头无菌性坏死组280例,发生后脱位1例,术后深静脉血栓1例。髋臼骨折术后骨性关节炎组50例,发生后脱位1例。髋关节发育不良组22例,术后发生脱位1例。发育性髋关节脱位组38例,术后发生深静脉血栓1例。髋关节置换术后翻修组34例,发生后脱位1例。结论采用前外侧入路更适合老年股骨颈骨折患者。外侧入路更适合单纯股骨头无菌性坏死病例。后外侧入路更适合髋臼骨折术后骨性关节炎、髋关节发育不良、发育性髋关节脱位、晚期强直性脊柱炎及髋关节置换术后翻修病例。个体化的入路选择可以减少术后深静脉血栓与脱位的发生率。

Correlation between various operative approaches and complications after artificial hip joint replacement

Objective To investigate the incidences of venous thrombosis and dislocation after artificial hip joint replacement （AHJR） via anterolateral, lateral and posterolateral approaches. Methods A total of 960 cases of AHJR in our hospital were re- viewed, and the correlation between complications after AHJR and applied approaches was analyzed. Results In the 536 cases of femoral neck fracture, deep vein thrombosis in lower extremity happened in 5 ones, in which anterolateral approach was used, and posterior dislocation happened in 3 cases, in which posterolateral approach was used. In the 280 cases of aseptic necrosis of femoral head, one encountered posterior dislocation, and another one encountered post-operative deep venous thrombosis. In the 50 cases of acetabular fracture after osteoarthritis, one suffered from posterior dislocation. In the 22 cases of hip dysplasia, one suffered from dislocation. In the 38 cases of dislocation of hip joint development, one suffered from postoperative deep venous thrombosis. In the 34 cases of revision after total hip replacement, one suffered from dislocation. Conclusion Anterolateral approach is more suitable for old patients with femoral neck fracture. The lateral approach is more suitable for simple cases of aseptic necrosis of the femoral head. The posterolateral approach is more suitable for aeetabular fracture after osteoarthritis, hip dysplasia, congenital hip dislocation, late stage ankylosing spondylitis and revision after hip replacement. Customized approach can reduce postoperative deep vein thrombosis and the incidence of dislocation.