浅谈全髋关节置换术后早期脱位（附47例全髋置换术3例脱位报告）

目的：回顾性研究２１年来行全髋关节置换术的早期脱位率与相关因素。方法：４５例４７髋行全髋关节置换术病例，年龄２６～８７岁，术前诊断３７例为股骨头缺血性坏死，占７８％；２例为先天性髋关节脱位；８例为股骨颈骨折。结果：术后早期脱位２例３髋，脱位率为６３％。１例新鲜股骨颈骨折，１例陈旧股骨颈骨折行ＴＨＡ术后第１ｄ即发生脱位。新鲜股骨颈骨折第３ｄ行翻修术，术中见股骨侧假体自前倾位变为后倾，纠正位置后治愈。陈旧股骨颈骨折经闭合复位，牵引后仍反复脱位，３月后行翻修术，术后第８ｄ又脱位，再次经闭合复位，牵引治愈。结论：术后早期脱位与术者经验，术前设计，假体部件的安装，尤其是髋臼假体及髋臼对人工股骨头的覆盖以及外展肌的力量有关。

A Preliminary Investigation of Early Dislocation Following Total Hip Joint Replacement

Objective:To study retrospectively the rate of early dislocation following total hip joint replacement (THR) and related factors during 21 years.Methods:Fortyfive patients (47 hips)aged from 26 to 87 years underwent THR.Preoperative diagnosis was avascular necrosis of femoral head in 37 cases(78%),congenital dislocation of the hip in 2 cases and fracture femorale neck in 8 cases.Results:Early dislocation following THR occurred in 2 cases,3 hips (the dislocation rate was 63%).The dislocation occurred in two patients at one day after the operation,one with fresh fracture and the another with old fracture of the femoral neck.Conclusion:Early dislocation following THR is closely related to the experience of the surgeons,the preoperative designs,the placement of the components of the prosthesis,especially the acetabulum component and its coverage of the femoral head,as well as the muscular tension of the abductors.